bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea
Authors: Lüthje Lars , Renner Bernd , Kessels Roger , Vollmann Dirk , Raupach Tobias , Gerritse Bart , Tasci Selcuk , Schwab Jörg O. , Zabel Markus , Zenker Dieter , Schott Peter , Hasenfuss Gerd , Unterberg‐Buchwald Christina , Andreas Stefan
Published: February 2009

Aims

The combined therapeutic impact of atrial overdrive pacing (AOP) and cardiac resynchronization therapy (CRT) on central sleep apnoea (CSA) in chronic heart failure (CHF) so far has not been investigated. We aimed to evaluate the effect of CRT alone and CRT + AOP on CSA in CHF patients and to compare the influence of CRT on CHF between CSA positive and CSA negative patients.

Methods and results

Thirty patients with CRT indication underwent full night polysomnography, echocardiography, exercise testing, and neurohumoral evaluation before and 3 months after CRT implantation. In CSA positive patients (60%), two additional sleep studies were conducted after 3 months of CRT, with CRT alone or CRT + AOP, in random order. Cardiac resynchronization therapy resulted in significant improvements of NYHA class, left ventricular ejection fraction, N‐terminal pro‐brain natriuretic peptide, VO2max, and quality of life irrespective of the presence of CSA. Cardiac resynchronization therapy also reduced the central apnoea–hypopnoea index (AHI) (33.6 ± 14.3 vs. 23.8 ± 16.9 h−1; P < 0.01) and central apnoea index (17.3 ± 14.1 vs. 10.9 ± 13.9 h−1; P < 0.01) without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a small but significant additional decrease of the central AHI (23.8 ± 16.9 vs. 21.5 ± 16.9 h−1; P < 0.01).

Conclusion

In this study, CRT significantly improved CSA without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a significant but minor additional improvement of CSA. Positive effects of CRT were irrespective of the presence of CSA.
Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure)
Authors: Mortara Andrea , Pinna Gian Domenico , Johnson Paul , Maestri Roberto , Capomolla Soccorso , La Rovere Maria Teresa , Ponikowski Piotr , Tavazzi Luigi , Sleight Peter ,   on behalf of the HHH Investigators
Published: February 2009

Aims

The Home or Hospital in Heart failure (HHH) study was a European Community‐funded, multinational, randomized controlled clinical trial, conducted in the UK, Poland, and Italy, to assess the feasibility of a new system of home telemonitoring (HT). The HT system was used to monitor clinical and physiological parameters, and its effectiveness (compared with usual care) in reducing cardiac events in heart failure (HF) patients was evaluated. Measurements were patient‐managed.

Methods and results

From 2002 to 2004, 461 HF patients (age 60 ± 11 years, New York Heart Association class 2.4 ± 0.6, left ventricular ejection fraction 29 ± 7%) were enrolled at 11 centres and randomized (1:2) to either usual outpatient care or HT administered as three randomized strategies: (i) monthly telephone contact; (ii) strategy 1 plus weekly transmission of vital signs; and (iii) strategy 2 plus monthly 24 h recording of cardiorespiratory activity. Patients completed 81% of vital signs transmissions, as well as 92% of cardiorespiratory recordings. Over a 12‐month follow‐up, there was no significant effect of HT in reducing bed‐days occupancy for HF or cardiac death plus HF hospitalization. Post hoc analysis revealed a heterogeneous effect of HT in the three countries with a trend towards a reduction of events in Italy.

Conclusion

Home or Hospital in Heart failure indicates that self‐managed HT of clinical and physiological parameters is feasible in HF patients, with surprisingly high compliance. Whether HT contributes to a reduction of cardiac events requires further investigation.
Trends in the Management of Pediatric Chronic Sinusitis: Survey of the American Society of Pediatric Otolaryngology
Authors: Sobol Steven E. , Samadi Daniel S. , Kazahaya Ken , Tom Lawrence W. C.
Published: February 2009

Background: The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS.

Methods: A multiple choice survey of the members of the American Society of Pediatric Otolaryngology (ASPO) was performed to assess for various factors related to the management of CS in children.

Results: A total of 175 ASPO members responded to the survey. The majority of respondents initially treat patients medically with oral antibiotics (95%), topical steroids (90%), and nasal saline sprays (68%). Fifty‐five percent performed adenoidectomy as part of the treatment of CS, with 81% performing the operation before endoscopic sinus surgery (ESS). Compared with 3 years before the survey, 47% of respondents performed approximately the same number of ESS cases, whereas 35% reported doing fewer cases annually. Seventy‐two percent of practitioners do not routinely perform a second‐look surgery.

Conclusions: The majority of pediatric otolaryngologists use oral antibiotics, nasal steroids, and saline lavage, and will perform adenoidectomy when managing patients with CS. More than a third of pediatric otolaryngologists are using more stringent criteria for surgery and performing less extensive surgery than 3 years before the survey. Surgical outcomes for CS do not appear to have changed over the past 3 years.
Neutrophil‐Derived Metalloproteinase‐9 Predicts Healing Quality after Sinus Surgery
Authors: Watelet J B. , Demetter P , Claeys C , Van Cauwenberge P , Cuvelier C , Bachert C
Published: February 2009

Background: In a recent study, we have shown that gelatinase‐B (metalloproteinase [MMP]‐9) in nasal secretions can have both monitoring and predictive value on the healing outcome after functional endoscopic sinus surgery (FESS) to treat chronic rhinosinusitis (CRS) and nasal polyposis (NP). In this work, we aimed to explore the source of MMP‐9 and the influence of inflammation on MMP‐9 expression and release in nasal tissue and secretions during airway remodelling after surgery.

Methods: Biopsies from 23 patients operated by FESS for CRS or NP were collected 1, 3, and 6 months after sinus surgery. MMP‐9 expression in the paranasal mucosa was correlated with healing quality, with MMP‐9 concentrations in nasal fluid, and with histomorphologic findings (edema, fibrosis, αsmooth muscle actin, CD‐68, myeloperoxidase, EG2, and transforming growth factor [TGF]‐β1 stainings).

Results: MMP‐9 concentrations in nasal fluid were paralleled by MMP‐9 expression inside the extracellular matrix (ECM) after sinus surgery. MMP‐9 expression in ECM was significantly correlated with healing quality (r = 0.378, P = .0181), and poor healers presented significantly more edema (P < .05). The amounts of MMP‐9 in nasal fluid were significantly and independently predicted by the number of neutrophils (P = .0224) and macrophages (P = .0497) in the tissue. In contrast, MMP‐9 expression was not related to fibrosis, number of myofibroblasts, or TGF‐β1 expression in ECM.

Conclusions: MMP‐9 expression is increased in the ECM during wound healing and parallels concentrations of MMP‐9 in nasal fluids. Inflammatory cells represent the major source of increased MMP‐9 expression, which is linked to poor healing quality.
Postoperative Tonsillectomy Bleed: Coblation Versus Noncoblation
Authors: Divi Venu , Benninger Michael
Published: February 2009

Objective: To examine the incidence of postoperative bleeding after coblation and noncoblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with this new surgical technique.

Study Design: A retrospective review of records from January 1999 to April 2003 to determine type of tonsillectomy performed and the presence of postoperative bleeding. A chi‐square analysis was used to determine a statistical difference between the postoperative bleed rate of coblation and noncoblation procedures. The examined time period was divided into 3‐month intervals, and the coblation postoperative bleeds were tallied for each interval. The Cochraine‐Armitage test of linear trend was used to assess change in the postoperative bleeds.

Results: One thousand seven hundred sixty‐two tonsillectomies were performed. The postoperative bleed rate for noncoblation tonsillectomy was 6.1% (74/1,216). The bleeding rate for coblation tonsillotomy was 5.9% (18/303) and 5.4% (13/239) for coblation tonsillectomy. There was no statistical difference (P = .93) between bleed rates for coblation versus noncoblation techniques. There was no difference in the need for operative intervention to control postoperative bleeding: 16.2% (12/74) for noncoblation technique and 25.85 (8/31) for coblation procedures (P = .25). The postoperative coblation bleed rates for the 3‐month periods did not reveal an increasing or decreasing trend in the postoperative bleed rate (P = .49).

Conclusion: Coblation is a safe procedure for performing tonsil surgery with no significant difference in postoperative bleeding from previous techniques and no increased need for operative intervention to control postoperative bleeding. A learning curve could not be identified when using postoperative bleeding as an outcome measure for coblation tonsillectomy.
Combined Microtia and Aural Atresia: Issues in Cochlear Implantation
Authors: Lin Karen , Marrinan Michelle S. , Shapiro William H. , Kenna Margaret A. , Cohen Noel L.
Published: February 2009

Objectives: This article presents the first report of cochlear implantation in a patient with congenital aural atresia, microtia, dysplastic cochlea and internal auditory canals, and bilateral profound sensorineural hearing loss (HL). This rare combination requires special management considerations. Preoperative issues include thorough evaluation of computed tomography and magnetic resonance imaging to determine favorable anatomy, cochlear implantation candidacy, and surgical planning. Intraoperative concerns include incision placement, surgical approach to the middle ear, and abnormal facial nerve anatomy. Postoperative use of a special headset combining a microphone and transmitter coil is required.

Study Design: Case report and literature review.

Methods: The patient's chart was reviewed for diagnostic studies, operative strategy, and postoperative auditory stimulation and testing. A literature review was performed.

Results: A 2‐year‐old male presented with bilateral aural atresia, microtia, and profound sensorineural HL. Imaging studies revealed multiple abnormalities of the cochlea, vestibule, and internal auditory canal, all of which were more favorable on the right side. An incision was designed to accommodate future microtia repair. The cochlear implant was placed without difficulty by way of a facial recess approach to the middle ear. Postoperative results include the detection of Ling sounds and voices in the environment as well as the ability to locate sounds.

Conclusions: This is the first report of cochlear implantation in a patient with bilateral aural atresia, microtia, and profound sensorineural HL in conjunction with multiple inner ear abnormalities. Close collaboration among the otologist, neuroradiologist, and plastic surgeon is essential to coordinate surgical management and optimize cosmetic and functional outcomes in this unique population.
Development and Maturation of the Pediatric Human Vocal Fold Lamina Propria
Authors: Hartnick Christopher J. , Rehbar Reza , Prasad Vinay
Published: February 2009

Objective: To identify characteristic patterns of maturation of the human vocal fold lamina propria as it develops into a mature structure.

Methods: Histologic evaluation of sectioned true vocal folds from 34 archived larynges ages 0 to 18 years using hematoxylin‐eosin, trichrome, Alcian blue pH 2.5, Weigert reticular, and Miller's elastin stain.

Location: Pathology department at a tertiary care children's hospital.

Results: At birth and shortly thereafter, there exists a relative hypercellular monolayer of cells throughout the lamina propria. By 2 months of age, there are the first signs of differentiation into a bilaminar structure of distinct cellular population densities. Between 11 months and 5 years, two distinct patterns are seen: 1) this bilaminar structure and 2) a lamina propria where there exists a third more hypocellular region immediately adjacent to the vocalis muscle (this region is similar to the superficial hypocellular region found just deep to the surface epithelium). By 7 years of age, all of the specimens exhibit this transition between the middle and the deeper layers according to differential density of cell populations. A lamina propria structure defined by differential fiber composition (elastin and collagen fibers) is not present until 13 years of age and then is present throughout adolescence.

Conclusions: Using the classic adult model of fiber composition and density to differentiate the layered structure of the lamina propria of the human vocal fold may not adequately allow for a thorough description of the process of maturation and development. Rather, distinct regions of cell density are seen as early as 2 months postpartum, and the model of cellular distribution may serve better to describe the lamina propria as it develops. Cell‐signaling processes that shape the formation of the lamina propria appear to produce layered populations of differential cell density that in turn will later produce differential fiber compositions. Early development therefore can be followed by evaluating the maturation of these differing cell populations. Future studies are needed to quantify these cell distribution patterns, to study the cell signaling processes that trigger this maturation, and to correlate these findings with mechanical modeling.
Circumferential Tracheal Reconstruction for the Functional Treatment of Airway Compromise
Authors: Olias João , Millán Gerardo , da Costa Duro
Published: February 2009

Objectives/Hypothesis:The objective was to describe a surgical technique for replacement of long tracheal defects with a totally autologous free prefabricated cutaneous chondromucosal forearm tubular flap, applied to humans.

Study Design:Surgical reconstruction of the trachea.

Methods:A three‐stage surgery was performed in a 25‐year‐old patient who presented with a long tracheal defect not resolved by previous resection with primary anastomosis and laser surgery.

Results:The staged surgery has been well tolerated by the patient, and no problems at all were reported. The postoperative computed tomography scan and the bronchofibroscopy examination of the “neo‐trachea” at 2 and 6 months revealed normal caliber, good healing of the suture lines, absence of crusts or granulation tissue, and a well‐vascularized internal mucosal lining.

Conclusion:The modified flap reconstruction technique has the potential to be considered reliable for the definitive circumferential reconstruction of extensive laryngotracheal defects not amenable to being cured by conventional techniques.
Cricopharyngeal Muscle Electromyography in Laryngopharyngeal Reflux
Authors: Celik Münevver , Alkan Zeynep , Ercan Ibrahim , Ertasoglu Hülya , Alkm Canan , Erdem Levent , Turgut Suat , Ertekin Cumhur
Published: February 2009

Objectives/Hypothesis: The objective was to determine whether laryngopharyngeal reflux was associated with an electrophysiological abnormality of the main part of the upper esophageal sphincter, namely, the cricopharyngeal muscle, which could be related to laryngopharyngeal reflux symptoms.

Study Design: A prospective study of 20 patients with symptoms of laryngopharyngeal reflux.

Methods: The diagnosis was based on clinical, laryngoscopic, and ambulatory 24‐hour pH monitoring findings. Double‐probe pH monitoring was performed with placement of the distal and proximal probes 5 cm above the proximal border of the lower esophageal sphincter and 15 cm proximal to the distal probe, in or just beneath the upper esophageal sphincter. Electromyographic recordings were obtained simultaneously on submental and cricopharyngeal muscles during water swallowing. The peak of the submental electromyographic amplitude and its duration was measured using bipolar surface electrodes placed under the chin. The electromyographic features of the cricopharyngeal muscle were investigated by means of concentric needle electrodes inserted percutaneously both in 20 normal subjects and in 20 patients with laryngopharyngeal reflux.

Results: All electrophysiological parameters were normal in all of the patients. The durations of foreburst revealed significant correlation with the number of reflux episodes and acid exposure time (P = .026 and P = .044, respectively).

Conclusion: The duration of the foreburst correlating with acid exposure time and number of reflux episodes suggested that foreburst duration was extended because of the irritation caused by the acid reflux.
Hush Puppy: A New Mouse Mutant With Pinna, Ossicle, and Inner Ear Defects
Authors: Pau Henry , Fuchs Helmut , de Angelis Martin Hrabé , Steel Karen P.
Published: February 2009

Objectives/Hypothesis: Deafness can be associated with abnormalities of the pinna, ossicles, and cochlea. The authors studied a newly generated mouse mutant with pinna defects and asked whether these defects are associated with peripheral auditory or facial skeletal abnormalities, or both. Furthermore, the authors investigated where the mutation responsible for these defects was located in the mouse genome.

Methods: The hearing of hush puppy mutants was assessed by Preyer reflex and electrophysiological measurement. The morphological features of their middle and inner ears were investigated by microdissection, paint‐filling of the labyrinth, and scanning electron microscopy. Skeletal staining of skulls was performed to assess the craniofacial dimensions. Genome scanning was performed using microsatellite markers to localize the mutation to a chromosomal region.

Results: Some hush puppy mutants showed early onset of hearing impairment. They had small, bat‐like pinnae and normal malleus but abnormal incus and stapes. Some mutants had asymmetrical defects and showed reduced penetrance of the ear abnormalities. Paint‐filling of newborns' inner ears revealed no morphological abnormality, although half of the mice studied were expected to carry the mutation. Reduced numbers of outer hair cells were demonstrated in mutants' cochlea on scanning electron microscopy. Skeletal staining showed that the mutants have significantly shorter snouts and mandibles. Genome scan revealed that the mutation lies on chromosome 8 between markers D8Mit58 and D8Mit289.

Conclusion: The study results indicate developmental problems of the first and second branchial arches and otocyst as a result of a single gene mutation. Similar defects are found in humans, and hush puppy provides a mouse model for investigation of such defects.
Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty
Authors: Spiegel Jeffrey H. , Raval Tejas H.
Published: February 2009

Objectives: To determine whether patients with obstructive sleep apnea who undergo uvulopalatopharyngoplasty (UPPP) have a significant incidence of postoperative complications that would justify overnight postoperative observation in the hospital.

Study Design: Part 1: review of published medical literature to determine incidence of postoperative complications. Part 2: retrospective review of 117 patients undergoing UPPP with or without additional procedures.

Methods: A literature search for existing studies describing the postoperative complications after UPPP for obstructive sleep apnea was conducted. After this, the records of 117 patients who had undergone UPPP at a university‐based medical center during a 5‐year span were reviewed.

Results: Respiratory events occur in 2% to 11% of cases. These include airway obstruction (e.g., laryngospasm), postobstructive pulmonary edema (POPE), and desaturation. Airway obstruction occurred in the immediate postoperative setting. POPE was rare and usually occurred within minutes after the conclusion of the surgical procedure. Desaturation could occur at any time, but the severity was usually equivalent to that found on preoperative sleep study. Hemorrhage occurred in 2% to 14% of cases and had a biphasic incidence, occurring either immediately postoperatively or several days after surgery. Depending on definition, hypertension was observed in between 2% and 70% of patients postoperatively. This was most commonly diagnosed and treated in the immediate postoperative setting. In most reports, arrhythmia and angina occurred in less than 1% of cases.

Conclusions: The majority of complications after UPPP with or without additional procedures occur within 1 to 2 hours after surgery. Postoperative oxygen desaturation is usually no worse than that that was observed on preoperative polysomnography findings. A 2 to 3 hour observation period may be suitable for patients after UPPP; if a patient experiences no complications and is maintaining adequate oxygenation and analgesia, same‐day discharge from recovery room may be considered.
Telescopic‐Assisted Radiofrequency Adenoidectomy: A Prospective Randomized Controlled Trial
Authors: Shehata Emad M. , Ragab Sameh M. , Behiry Abu Bakr S. , Erfan Fat‐he A. , Gamea Ahmed M.
Published: February 2009

Objectives/Hypothesis: The objective was to conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of transoral telescopic‐assisted radiofrequency adenoidectomy in young children.

Study Design: Prospective randomized controlled trial.

Methods: One hundred twenty patients who were 36 months of age or less and planned to undergo adenoidectomy or adenoidectomy with insertion of tympanostomy tubes were included in the study. Children were prospectively and randomly assigned into two equal treatment groups: the telescopic‐assisted adenoidectomy using radiofrequency curette and the conventional adenoid‐curette adenoidectomy. The main parameters included visual analogue scale score for nasal breathing, amount of blood loss, operating time, completeness of adenoid resection, smoothness of postoperative recovery, and complications.

Results: Both groups had a significant improvement in the visual analogue scale score after surgery with no evidence for a significant difference between the conventional adenoid‐curette and radiofrequency groups. The amount of blood lost during radiofrequency adenoidectomy was minimal, with a mean difference of 31 mL and a median difference of 26 mL. There was a tendency for shorter operative time in the radiofrequency group, but this did not reach a statistical significance. No evidence for a significant difference was noticed in the smoothness of postoperative recovery or complication rate.

Conclusion: Telescopic‐assisted radiofrequency‐curette adenoidectomy allows removal of huge adenoids completely in a precise, easy, and cost‐effective procedure, with minimal blood loss and short operating time. The use of transoral telescopes provides a clear visualization that helps complete removal of the adenoids, reduction of unnecessary trauma, and effective control of bleeding.
Infectious Complications in Pediatric Cochlear Implants
Authors: Hopfenspirger Michael T. , Levine Samuel C. , Rimell Frank L.
Published: February 2009

Objectives: Infectious complications may cause significant delay in cochlear implant device initiation and programming and be a source of additional morbidity. We reviewed our experience with infectious complications in the pediatric age group to determine specific sources that may not be seen in adults.

Study Design: A retrospective analysis from a single implant center.

Methods: Cases of pediatric cochlear implants were reviewed for data on infectious complications. Complications were identified as “major” or “minor,” “early” or “delayed.” Information was gathered regarding any comorbid, chronic health condition. Data related to the causative organism(s) were collected.

Results: Two hundred sixty‐eight cases of pediatric implants were reviewed. Twenty‐two cases were identified (an infection rate of 8.2%), all classified as “major.” The majority, 12, were classified as “delayed” complications. Twenty‐one cases required explantation with 14 successfully reimplanted. Five cases (in 4 patients) or 23% were associated with a specific chronic pediatric condition including two children with tracheostomies. Among implanted children who had chronic health conditions, 42% developed implant‐related infections. Among otherwise healthy implanted children, only 6.6% developed implant‐related infections. Resistant bacterial infections were not identified.

Conclusions: Health conditions in the pediatric age group were associated with 23% of our complications, a risk factor not previously identified in the literature. These children, demonstrating seven times the infection rate of healthy children, should be carefully observed postoperatively. Overall, cochlear implantation in children continues to be associated with a low risk of infectious complications.
Thyroid Cancer in Pregnancy
Authors: Fanarjian Nicole , Athavale Sanjay M. , Herrero Nicholas , Fiorica James , Padhya Tapan A.
Published: February 2009

We report a case of papillary thyroid cancer in pregnancy and discuss the various diagnostic and therapeutic challenges inherent to this condition. Several case series are reviewed. In addition, we examine the effect of pregnancy on the development and progression of thyroid malignancy.
Hyaluronan‐Based Scaffolds to Tissue‐Engineer Cartilage Implants for Laryngotracheal Reconstruction
Authors: Weidenbecher Mark , Henderson James H. , Tucker Harvey M. , Baskin Jonathan Z. , Awadallah Amad , Dennis James E.
Published: February 2009

Objectives: Donor site morbidity, including pneumothorax, can be a considerable problem when harvesting cartilage grafts for laryngotracheal reconstruction (LTR). Tissue‐engineered cartilage may offer a solution to this problem. This study investigated the feasibility of using Hyalograft C combined with autologous chondrocytes to tissue engineer cartilage grafts for LTR in rabbits.

Study Design: Animal study.

Methods: Eighteen New Zealand white rabbits underwent LTR: 12 rabbits received autologous tissue‐engineered cartilage grafts and 6 animals, serving as a positive control group, native auricular cartilage. To determine any differences in response to the site of implantation and any potential immune response to the scaffold, a second piece of engineered neocartilage and a non–cell‐loaded scaffold were inserted paralaryngeally into a subset of the rabbits. The rabbits were sacrificed 3, 6, 8, 10, and 12 weeks after the LTR and their larynx examined.

Results: None of the 18 rabbits showed signs of respiratory distress. A smooth, noninflammatory scar was visible intraluminally. Histologically, the native auricular cartilage implants showed excellent integration without any signs of inflammation or cartilage degradation. In contrast, all tissue‐engineered grafts and empty scaffolds revealed marked signs of an unspecific foreign body reaction, leading to a complete degradation of the neocartilage, whether implanted para‐ or intralaryngeally.

Conclusion: In contrast to the success with which Hyalograft C has been applied in articular defect repair, our results indicate that, in rabbits, Hyalograft C initiates a foreign body reaction if implanted intra‐ or paralaryngeally, leading to cartilage degradation and possible graft failure. These findings suggest limitations on the environment in which Hyalograft C can be applied.
Chronic Rhinosinusitis With Nasal Polyps is Associated With Decreased Expression of Mucosal Interleukin 22 Receptor
Authors: Ramanathan Murugappan , Spannhake Ernst W. , Lane Andrew P.
Published: February 2009

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disorder of the sinonasal mucosa that is frequently associated with microbial colonization. Innate defense mechanisms at the mucosal surface are critical in protecting the host from airborne environmental pathogens. Recent studies of skin and gastrointestinal tract inflammatory diseases have shown that stimulation of the interleukin‐22 receptor (IL‐22R1) nonspecifically increases innate immune responses. The potential role of IL‐22R1 in the pathogenesis of CRSwNP has never been explored.

Study Design: Prospective.

Methods: Nine controls and 19 subjects with CRS were prospectively enrolled prior to undergoing endoscopic sinus surgery. Nasal epithelial cells were cultured from surgically obtained ethmoid mucosa and IL‐22R1 protein expression was examined via flow cytometry. RNA was extracted from whole mucosal samples and real‐time polymerase chain reaction (PCR) was employed to determine expression of IL22 and IL‐22R1. Subjects were followed for at least 6 months postoperative to assess for recurrence or persistence of polyps.

Results: Flow cytometry demonstrated the expression of IL‐22R1 protein on the surface of cultured nasal epithelial cells. IL‐22R1 mRNA was expressed in 100% of the controls and CRSsNP. However, IL‐22R1 was only expressed in 55% of patients with recalcitrant CRSwNP. Additionally, levels of IL22R1 were significantly lower in recalcitrant CRSwNP compared to controls and CRSsNP. IL22 levels did not reach statistical significance.

Conclusions: In this study, we demonstrate IL‐22R1 mRNA and protein expression on nasal epithelial cells. Failure of medical and surgical therapy in CRSwNP is associated with significantly decreased expression of IL‐22R1. Further research is needed to determine the potential of IL‐22R1 as a therapeutic target in CRSwNP.
Tracheal Ceramic Rings for Tracheomalacia: A Review After 17 Years
Authors: Göbel Gyula , Karaiskaki Niki , Gerlinger Imre , Mann Wolf J.
Published: February 2009

Background: Despite different support techniques, the surgical management of tracheomalacia is still a challenging problem. Satisfactory results after internal stenting are above 80%, whereas, when performing external stenting using biocompatible ceramic rings, results are reported at over 90%.

Objective: The purpose of this study was to examine the efficiency of surgical treatment in patients with segmentary tracheomalacia using external ceramic ring grafts.

Methods: In this retrospective study, we collected data from 12 patients who underwent surgery during the last 17 years for symptomatic segmentary tracheomalacia by use of biocompatible aluminum‐oxide ceramic rings. All except one patient had undergone previous tracheostomy, six had a history of long‐term intubation, two had previous trauma, and two patients had previous cancer treatment including radiotherapy. One of the patients still had an existing tracheostoma, which was closed when a ceramic ring was implanted. Tracheal wall collapse with pseudoglottis formation or flattened anterior‐posterior tracheal diameter was documented with fiberoscopy at rest, and both pre‐ and postoperative airway resistance measurements were performed in all 12 patients using a spirometer. After malacic segments were found to be expandable using rigid tracheoscopy while the patient was under general anesthesia, preparation of the trachea was performed using a midline vertical incision in the neck. Subsequently, the malacic trachea was expanded by placing and suturing proper‐sized ceramic ring(s) around it.

Results: In all patients, surgical expansion of the malacic segment using ceramic rings was successfully carried out without major complications while inspiratory stridor was resolved. Airway resistance decreased significantly from an average of 0.62 to 0.385 kPascal.

Conclusion: Although the results of applying internal tracheal stents are encouraging, complications such as stent migration, granulation tissue and fistula formation, and mucociliary transport arrest are possible. Biocompatible ceramic rings do not cause foreign body reactions, remain stabile, and, with a proper suturing technique, provide a suitable long‐term solution.
Induction of Regional Collateral Sprouting Following Muscle Denervation
Authors: Koob Jason W. , Moradzadeh Arash , Tong Alice , Hayashi Ayato , Myckatyn Terence M. , Tung Thomas H. , Mackinnon Susan E.
Published: February 2009

Objectives/Hypothesis: Anecdotal clinical findings suggest that denervated muscle may regain modest functional recovery via spontaneous collateral sprouts from intact adjacent nerve fibers. The current study evaluates the conditions needed for the denervated masseter muscle to induce axonal sprouting from the facial nerve. We hypothesize that epineurial injury is required to induce collateral sprouting toward a neighboring denervated muscle.

Study Design: Twelve thy1‐yellow fluorescent protein‐16 (thy1‐YFP‐16) transgenic mice whose axons express yellow fluorescent protein were allocated into six groups, with four degrees of facial nerve injury (intact, crush, transection, removed segment) with or without masseter denervation.

Methods: Animals underwent serial in vivo imaging analyses under the fluorescent microscope weekly for 5 or 7 weeks and were subsequently perfused for analysis. Masseter muscle acetylcholine receptors (AChRs) were stained with Alexa Fluor 594 conjugated α‐bungarotoxin, and whole mounts were imaged with confocal microscopy.

Results: In groups with intact or crushed facial nerves, no evidence of collateral sprouting was demonstrated. Mice with transected facial nerve branches or removed segments demonstrated sprouting from the proximal stump into the denervated masseter. Staining of the AChRs confirmed that new neuromuscular junctions were established between the facial nerve and the denervated masseter.

Conclusions: This study suggests that epineurial injury is required to stimulate axonal sprouting into adjacent denervated muscle. Nerves with compromised epineurium may be useful in promoting neo‐neurotization after muscle denervation.
Contralateral Ear in Chronic Otitis Media: A Histologic Study
Authors: Rosito Letícia Petersen Schmidt , da Costa Sady S. , Schachern Patricia A. , Dornelles Cristina , Cureoglu Sebahatin , Paparella Michael M.
Published: February 2009

Objective: The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media.

Study Design: Transversal.

Material and Methods: The temporal bones were examined under light microscopy and then described. Chronic otitis media was defined by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less affected ear. To compare the qualitative variables, the χ2 test was used. Spearman's nonparametric test was used for correlations. P values less than or equal to .05 were considered significant.

Results: We studied 85 pairs of temporal bones. Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of contralateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%), and tympanic membrane retractions (35%). There was a direct and moderately strong correlation between the extent of granulation tissue in the more damaged ear and the contralateral ear (r
s = 0.345, P = .004). A strong correlation was observed between the extent of cholesteatoma in the more damaged ear and in the contralateral ear (r
s = 0.617, P < .001).

Conclusion: We observed a high prevalence of changes in the contralateral ear. There was a direct correlation between the extent of both granulation tissue and cholesteatoma between the two ears, demonstrating that the more extensive the manifestation of these pathologies in the more damaged ear, the greater they will be in the contralateral ear.
Gene Expression Changes of Inflammatory Mediators in Posterior Laryngitis Due to Laryngopharyngeal Reflux and Evolution With PPI Treatment: A Preliminary Study
Authors: Thibeault Susan L. , Smith Marshall E. , Peterson Kathryn , Ylitalo‐Moller Riitta
Published: February 2009

Hypothesis: Standard of care in laryngopharyngeal reflux (LPR) is acid suppression therapy. Its treatment efficacy and mechanism of action are not well documented. No objective study investigating the molecular patterns of inflammation in LPR or in response to proton pump inhibitor (PPI) treatment has been accomplished. We hypothesized that gene expression levels of mediators of inflammation—interleukin 6 (IL6), interleukin 8 (IL8), interleukin 1a (IL1a), interleukin 1b (IL1b), transforming growth factor beta 1 (TGFβ1), vascular endothelial growth factor (VEGF), fibroblast growth factor‐2 (FGF2), and tumor necrosis factor alpha (TNFα)—in posterior larynx tissue would be increased in those with diagnosed LPR and would be then reduced with PPI treatment.

Study Design: Prospective uncontrolled trial.

Methods: Biopsies from the posterior larynx were taken from 25 participants with LPR before and after a 10‐week period with rabeprazole (40 mg). RNA isolation and real‐time PCR was used to measure gene expression levels.

Results: No significant differences were measured for any of the cytokines, either for the entire participant group (n = 25) or for the subset of participants who did not have a previous history of PPI usage (n = 15). In those participants who had a history of PPI usage (n = 10), a significant increase in gene expression levels post medication was measured for TGFβ1 (P = .0396), VEGF (P = .0216), IL8 (P = .0297), after adjusting for compliance, subjective improvement, and reflux severity.

Conclusions: Our findings are provocative and speak to the unresolved understanding of the pathophysiology of LPR, its diagnosis, and its differences from gastroesophageal reflux disease.
Comparison Between Mitomycin C and Chitosan for Prevention of Anterior Glottic Steno After CO2 Laser Cordectomy in Dogs
Authors: Fang Rui , Sun Jingwu , Wan Guanglun , Sun Dongdong
Published: February 2009

Objective: To compare the effectiveness of an immediate application of topical mitomycin C (MMC) with chitosan for prevention of anterior glottic stenosis (AGS) after microsurgical resecting of both vocal fold with CO2 laser, including the anterior commissure, in a canine model.

Design: Prospective randomized experimental study.

Method: Twenty‐four canine larynges were injured by a microresecting procedure of both vocal folds with a CO2 laser. The dogs were randomly divided into three groups for treatment, respectively with MMC, chitosan, or isotonic sodium chloride solution (control) for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected, the ultrastructures of the fibroblasts were examined with a transmission electronic microscope, and expression of basic fibroblast growth factor (bFGF) and transforming growth factor beta1 (TGF‐β1) were evaluated by enzyme‐linked immunosorbent assay (ELISA). Three weeks after surgery, the remaining dogs' glottic web were lysed and repeatedly treated with MMC, chitosan, or isotonic sodium chloride solution. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically 6 weeks after the initial surgery.

Results: Results included 1) transmission electronic microscope examination of the ultrastructures of the fibroblasts indicated that both MMC and chitosan inhibited the proliferation of fibroblast; 2) the expression of bFGF and TGF‐β1 increased both in the MMC group and the chitosan group, and the expression of bFGF in the chi‐tosan group was higher than in the MMC group (P = .010), while the expression of TGF‐β1 was lower (P = .000);3) the extent of AGS formation was decreased both in the MMC group and the chitosan group, while it was less in the chitosan group than in the MMC group (P = .047); 4) the grade of collagen content between the MMC group and the chitosan group was not significantly different (P = .5).

Conclusion: Chitosan is more effective in preventing AGS after CO2 laser cordectomy than MMC.
When to Cut? Using an Objective Structured Clinical Examination to Evaluate Surgical Decision‐Making
Authors: Franzese Christine
Published: February 2009

Objectives: To create an objective structured clinical examination (OSCE) tailored to surgical residents that uses surgical case scenarios appropriate for the experience level of the resident to evaluate whether residents understand the indications for a specific surgery, identify when indications are met, and make the appropriate decision to proceed with an operation.

Methods: The surgical OSCE consisted of two case scenarios: a junior case created for postgraduate year (PGY) 2 to 3 level residents and a senior case created for PGY 4 to 5 level residents. Four senior residents and four junior residents in the otolaryngology department participated. Residents were instructed to proceed as if they had all the capabilities of the otolaryngology clinic. Recordings were made of each encounter and were reviewed by two separate faculty member with expertise in each case. Faculty evaluated whether surgical indications were elicited by history, whether certain physical examination or radiographic findings were recognized, whether residents made the correct diagnosis, and whether residents not only made the decision to proceed with surgery but also indicated the correct surgery.

Results: Seniors (100%) were better at obtaining needed surgical information and indications than juniors (25%). Seniors were more willing to make the decision to proceed with surgery (100%), whereas no juniors actually scheduled surgery. The reasons for this ranged from failure to elicit surgical indications to lack of surety in proceeding with surgery. All seniors recommended the appropriate surgery, but only 75% correctly identified the need for emergent intervention. Results of evaluations were reviewed with each resident individually.

Conclusions: The surgical OSCE was successful in evaluating resident surgical decision‐making. Juniors were not as capable as seniors in eliciting surgical indications and in “making the jump” to proceed with surgery. These results were used by our faculty to work with juniors on surgical history‐taking and decision‐making. These results were also useful in identifying seniors who could recognize an emergency situation.
The Old‐Fashioned Politzer Maneuver: A Video Clip Demonstration
Authors: Casale Manuele , Rinaldi Vittorio , Setola Roberto , Salvinelli Fabrizio
Published: February 2009

Politzer maneuver causes retrograde inflation of the middle ear by forcing air through the eustachian tube, and it has been proposed by many authors as the main nonsurgical treatment of middle ear effusion. To our knowledge, this is the first case in the literature in which air entering into a middle ear with effusion through a Politzer maneuver has been captured on video (www.laryngoscope.com).
Actinomycosis of the Temporal Bone With Labyrinthine and Facial Nerve Involvement
Authors: Mehta Deepak , Statham Melissa , Choo Daniel
Published: February 2009

Objectives: To demonstrate the clinical, radiologic, and pathologic findings of actinomycosis of the temporal bone.

Study Design: Case report and literature review.

Methods: Analysis of a case through medical records and literature review.

Results: Actinomycosis is a rare cause of subacute‐chronic suppurative infection of the temporal bone. We present an 11‐year‐old male with a history of ciliary dyskinesia presenting with a 6‐week history of right‐sided otorrhea, otalgia, and a 1‐week history of progressive facial weakness. Final histopathology revealed a diagnosis of actinomycosis. A review of the literature showed 25 cases of temporal bone actinomycosis. This is the first reported case of actinomycosis causing facial nerve palsy and labyrinthine invasion. Effective treatment includes aggressive surgical debridement followed by long‐term administration of appropriate antibiotic.

Conclusions: Actinomycosis can be a cause for bone erosive lesions of the temporal bone and can result in significant morbidities. Prompt tissue diagnosis with suspicion for nonmalignant causes of bone erosive disease can help in implementing appropriate treatment.
Modulation of MyoD‐ and Ki‐67‐Positive Satellite Cells in the Short‐Term Denervated Rat Thyroarytenoid Muscle
Authors: Kumai Yoshihiko , Ito Takaaki , Miyamaru Satoru , Yumoto Eiji
Published: February 2009

Objectives: To evaluate the effects of short‐term denervation on the kinetics of satellite cells (SCs) and myocytes in the rat thyroarytenoid (TA) muscle using immunohistochemistry for a myogenic regulatory factor, MyoD, and a cell proliferation marker, Ki‐67.

Study Design: Quantitative immunohistochemical assessment of MyoD and Ki‐67 expression in SCs and myocytes after denervation.

Methods: The left recurrent laryngeal nerve (RLN) was transected in 15 adult Wistar rats, which were sacrificed 1, 3, or 7 days after the treatment (n = 5, each group). Fluorescein immunostaining was used to visualize the localization of MyoD+ and Ki‐67+ SCs in combination with M‐cadherin immunostaining for detection of SCs. We examined the temporal changes of the ratios of MyoD+ and Ki‐67+ SCs for all of the counted muscle fibers and M‐cadherin+ cells in both the denervated and the contralateral control TA muscle.

Results: On the denervated side, the TA muscle contained 3.8 ± 0.4% MyoD+ SCs and 1.3 ± 0.4% Ki‐67+ SCs. Of the SCs, 22.6 ± 2.2% were MyoD+, and 14.5 ± 4.4% were Ki‐67+, whereas SCs on the control side did not express these markers.

Conclusions: In the rat TA muscle, denervation induces SC activation, and some SCs enter the cell cycle, whereas others are involved in the differentiation process. The number of activated SCs is relatively small compared with all M‐cadherin+ SCs. Therefore, SCs might be good targets for a therapy to prevent TA muscle atrophy after RLN paralysis.
Crile's Neck Dissection
Authors: Silver Carl E. , Rinaldo Alessandra , Ferlito Alfio
Published: February 2009

George Crile, after a long experience with treatment of head and neck cancer and study of a large number of cases, appreciated that these tumors almost always drained through the lymphatic pathways of the neck, rarely metastasized distantly, and were thus theoretically curable by resection of the primary tumor and its lymphatic draining shed. After evaluation of his early failures, he found that a block resection of all of the lymph node‐bearing tissue of the neck in addition to resection of the primary tumor was the most effective means of obtaining a cure, particularly in patients with clinical evidence of spread of disease to the neck. Such radical surgery, at the time, was fraught with difficulty because of the lack of blood transfusion, antibiotics, and endotracheal anesthesia, but Crile devised several strategies for combating these obstacles. Crile performed 36 such block resections with a determinate 3‐year survival of 75% compared with 19% 3‐year survival in patients who had not undergone block resection. The surgical precepts developed by Crile laid the foundation for the effective modern surgical treatment of head and neck cancer.