bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Prolonged Length of Stay After Major Elective Head and Neck Surgery
Authors: BuSaba Nicolas Y. , Schaumberg Debra A.
Published: February 2009

Objective/Hypothesis: Longer length of stay (LOS) after elective surgery is associated with an increased use of health care resources and higher costs. The objectives of this study were to determine the perioperative factors that predict a prolonged LOS after elective major head and neck operations and to test the hypothesis that factors related to process of care (intra‐ and postoperative) independently predict prolonged LOS after adjustment for preoperative patient characteristics.

Study Design: Prospective hospital‐based cohort study.

Methods: The National VA Surgical Quality Improvement Program data were accessed for seven head and neck operations: radical neck dissection (RND) (n = 398), modified RND (n = 891), total laryngectomy (n = 431), total laryngectomy with RND (n = 747), hemiglossectomy with unilateral RND (n = 201), composite resection (n = 105), and composite resection with RND (n = 312). Prolonged LOS was defined as exceeding the 75th percentile for the LOS distribution of each operation. Multivariable logistic regression analysis was performed to identify factors that predicted prolonged LOS.

Results: Sixty‐eight variables were analyzed among 3,050 patients who qualified for inclusion. Preoperative patient characteristics that predicted prolonged LOS were older age, poorer functional status, consumption of more than two drinks of alcohol per day, history of chronic obstructive pulmonary disease, and diabetes mellitus. Intraoperative processes that predicted prolonged LOS were a longer operative time and transfusion of erythrocytes. The postoperative variables that predicted a prolonged LOS were a return to the operating room within 30 days of the index operation and the occurrence of two or more operative complications.

Conclusion: Several intraoperative processes and postoperative adverse events contributed additional predictive information for prolonged LOS, after consideration of preoperative patient characteristics.
Reliability of the Welling Scale (WS1) for Rating Temporal Bone Dissection Performance
Authors: Butler Nancy N. , Wiet Gregory J.
Published: February 2009

Objective: To determine the inter‐ and intrarater reliability of using a new scale (Welling scale) for resident evaluation of temporal bone dissection performance.

Study Design: Prospective, double‐blinded, randomized trial.

Methods: Twelve residents in otolaryngology (postgraduate year [PGY] 2–5) drilled 26 temporal bones (21 cadaveric, 5 plastic) with the objective to perform a complete mastoidectomy with facial recess approach. These bones were then rated using the Welling scale by six independent raters on two separate occasions (4–6 wk apart). Raters were blinded to PGY year. The Kappa statistic was calculated for inter‐ and intrarater reliability.

Results: Intrarater agreement was high for all raters, ranging from κ = 0.65 to 0.72 (all P < .001), whereas the interrater agreement scores were more moderate (range, κ = 0.49–0.64; all P < .01).

Conclusion: The Welling scale can be used reliably to assess temporal bone dissection performance where performance is measured by assessment of end product (mastoidectomy with facial recess approach).
Laryngopharyngeal Abnormalities in Hospitalized Patients With Dysphagia
Authors: Postma Gregory N. , McGuirt W Frederick , Butler Susan G. , Rees Catherine J. , Crandall Heather L. , Tansavatdi Kristina
Published: February 2009

Objectives: To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES).

Study Design: Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video‐recorded by a speech‐language pathologist (SLP).

Methods: Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings.

Results: Sixty‐one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy‐six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty‐five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated.

Conclusions: Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow‐up of mucosal and neuromuscular findings that do not respond to medical management.
Eosinophilic Bacterial Chronic Rhinosinusitis
Authors: Ferguson Berrylin J. , Seethala Raja , Wood William A.
Published: February 2009

Background: A subset of Chronic Rhinosinusitis (CRS) patients are those with eosinophilic CRS (ECRS). These patients remain the most refractory to medical and surgical intervention, and are thought to reflect an inflammatory process arising from a variety of causes. Recently the role of fungus in ECRS, defined as the presence of fungi in the eosinophilic mucin of CRS, has been proposed as causal in many cases. Other proposed causes of ECRS include bacterial superantigen induction of inflammation and aspirin sensitivity.

Design: Retrospective review.

Methods: Histopathology from patients with previously diagnosed ECRS was prospectively re‐reviewed for bacterial and fungal presence and correlated with patients' demographic data. The study population was comprised of 55 specimens with ECRS from 34 patients, over a 3‐year period from a single investigator at the University of Pittsburgh Medical Center.

Results: Histologic presence of bacteria was shown in 34 of 55 (62%) of all ECRS specimens. Specimens with fungal colonization were more often associated with bacterial presence than without bacteria (17 of 22 [77%] vs. 5 of 22 [23%], P < .02).

Conclusion: Bacteria were present in almost two‐thirds of all specimens, and most cases of fungal presence were accompanied by bacterial presence, potentially providing support for bacteria as a source of superantigen. Other possible reasons for the high rate of bacterial and fungal colonization of ECRS include increased pathogen exposure, or failure to eliminate pathogens.
Management of Supraglottic Squeeze in Adductor Spasmodic Dysphonia: A New Technique
Authors: Young Nwanmegha , Blitzer Andrew
Published: February 2009

Objectives: Spasmodic dysphonia is a disabling disorder of the voice characterized primarily by involuntary disruptions of phonation. Botulinum toxin injections of the thyroarytenoid muscles have been the treatment of choice for adductor spasmodic dysphonia (ADSD). We describe a new technique to address the problem of compensatory or supraglottic hyperadduction in some of these patients.

Study Design: Case series.

Methods: Four patients with ADSD with sphincteric supraglottic contraction were seen for evaluation of botulinum toxin injection. On fiberoptic exam, it was noted that they had type I hyperadduction of the true vocal cords with a significant type III, and/or type IV hyperadduction of the supraglottis. After standard management of the thyroarytenoid muscles, the strained/strangled voice continued. On fiberoptic exam it was noted that the vocal folds were weakened, but the supraglottic hyperfunction persisted. The patients were treated by speech therapists to unload their supraglottis without success. All patients then had their oblique portion of the lateral cricoarytenoid muscles injected with botulinum toxin A through a thyrohyoid approach. This was done in the office under electromyographic control.

Results: On follow‐up, all patients demonstrated improvement in the quality of their voices (as compared to thyroarytenoid injections alone).

Conclusions: We describe a new technique for injection of the supraglottic portion of the lateral cricoarytenoid muscles. We demonstrate this can be done safely and successfully in an office setting with electromyography control.
Minimally Invasive Endoscope‐Assisted Parotidectomy: A New Approach
Authors: Chen Mu‐Kuan , Chang Cheng‐Chuan
Published: February 2009

Objective: To evaluate the benefits of a new approach, endoscopic parotidectomy through a postauricular skin incision by using an ultrasonically activated scalpel.

Study Design: An investigation of the outcome of endoscopic parotidectomy at a tertiary referral medical center.

Methods: Fourteen operations for selected patients presenting with benign parotid tail disease were performed via minimally invasive endoscopic resection by a single surgeon (MK Chen).

Results: All 14 operations were successfully performed endoscopically, and no conversions to conventional open resection were necessary. The procedures lasted 60 to 160 minutes. Two patients had transient grade II facial paresis. The scars were almost invisible due to their concealed location behind the ear.

Conclusions: Minimally invasive endoscope‐assisted parotidectomy is a feasible method for treatment of benign lesions located in the parotid tail. The main advantage of this procedure is that the small operative scar is concealed in the postauricular area resulting in improved cosmetic results.
Lingual Thyroid Carcinoma With Nodal Metastasis
Authors: Kennedy Thomas L. , Riefkohl Waldemar L.
Published: February 2009

Objectives: To discuss treatment options and surgical management of lingual thyroid carcinoma with cervical metastasis.

Study Design: Lingual thyroid is relatively uncommon, and carcinoma of the lingual thyroid is extremely rare, with only 40 cases reported. We report a new case of a young female who presented with a cervical neck mass found to represent metastatic papillary thyroid carcinoma. Further workup revealed the patient's only thyroid tissue was located at the tongue base and was the site of the primary tumor. Management of lingual thyroid carcinoma and review of the literature is discussed.

Methods: A case report and review of the literature of lingual thyroid carcinoma.

Results: A young female presented with a left neck mass diagnosed as metastatic papillary thyroid carcinoma. Review of the computed tomography scan of the neck revealed a tongue base mass, absence of an othotopic thyroid gland and bilateral cervical lymphandenopathy. Bilateral selective neck dissections with removal of the tongue base lesion confirmed the diagnosis of lingual thyroid carcinoma with multiple left cervical nodal metastases.

Conclusions: A case of lingual papillary thyroid carcinoma with cervical metastasis is reported. Treatment is best managed with surgical excision of all thyroid tissue followed by radioactive iodine ablation. Surgical approaches to the tongue base need to be considered based on the size of the lingual primary tumor and the need to address lymph node metastases gland. This is the first reported case in the literature of lingual papillary thyroid carcinoma presenting with cervical nodal metastasis in a female with absence of an orthotopic thyroid gland. This is also the first report to show that papillary and not follicular cell carcinoma is the predominating histopathology in lingual thyroid carcinoma.
Etiology of Late Free Flap Failures Occurring After Hospital Discharge
Authors: Wax Mark K. , Rosenthal Eben
Published: February 2009

Objectives: Vascular compromise of free flaps most commonly occurs in the immediate postoperative period in association with failure of the microvascular anastomosis. Rarely do flaps fail in the late postoperative period. It is not well understood why free flaps can fail after 7 postoperative days. We undertook a case review series to assess possible causes of late free flap failure.

Study Design: Retrospective review at two tertiary referral centers: Oregon Health Sciences University and University of Alabama at Birmingham.

Methods: A review of 1,530 flaps performed in 1,592 patients between 1998 and 2006 were evaluated to identify late flap failure. Late flap failure was defined as failure occurring after postoperative day 7 or on follow‐up visits after hospital discharge. A prospective database with the following variables was examined: age, medical comorbidities, postreconstructive complications (fistula or infection), hematoma, seroma, previous surgery, radiation therapy, intraoperative findings at the time of debridement, nutrition, and, possibly, etiologies.

Results: A total of 13 patients with late graft failure were identified in this study population of 1,530 (less than 1%) flaps; 6 radial forearm fasciocutaneous flaps, 2 rectus abdominis myocutaneous flaps, 4 fibular flaps, and 1 latissimus dorsi myocutaneous flap underwent late failure. The time to necrosis was a median of 21 (range, 7–90) days. Etiology was believed to possibly be pressure on the pedicle in the postoperative period in four patients (no sign of local wound issues at the pedicle), infection (abscess formation) in three patients, and regrowth of residual tumor in six patients. Loss occurring within 1 month was more common in radial forearm flaps and was presented in the context of a normal appearing wound at the anastomotic site, as opposed to loss occurring after 1 month, which happened more commonly in fibula flaps secondary to recurrence.

Conclusion: Although late free flap failure is rare, local factors such as infection and possibly pressure on the pedicle can be contributing factors. Patients presenting with late flap failure should be evaluated for residual tumor growth.
Gold Laser Versus Curettage Adenoidectomy: Incidence of Complications and Otorrhea After Concurrent Pressure‐Equalization Tube Placement
Authors: Worley N Knight , Abdalkhani Arman , Hagmann Michael A. , Belafsky Peter C. , Amedee Ronald G.
Published: February 2009

Objectives: To measure the incidence of postoperative complications and otorrhea in patients undergoing Gold laser or curettage adenoidectomy with pressure‐equalization (PE) tube placement.

Study Design: A prospective study of 100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting.

Methods: Pediatric patients with chronic otitis media with effusion and adenoid hypertrophy after failure of medical management were included in the study. Adenoid size and middle ear status were recorded at surgery. The total adenoidectomy procedure time was recorded. All patients were evaluated at 1 week, 1 month, and 4 months postoperatively. The incidence of nasal complications and otorrhea was recorded.

Results: There was no statistical difference in age, race, sex, adenoid size, or middle ear status between groups. The laser group had a shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024). There was no difference in nasal complications between groups.

Conclusions: The Gold laser adenoidectomy technique can be safely performed with PE tube placement and may offer advantages over the traditional curettage adenoidectomy technique.
Cochlear Implant Outcomes and Quality of Life in Adults with Prelingual Deafness
Authors: Klop W Martin C. , Briaire Jeroen J. , Stiggelbout Anne M. , Frijns Johan H. M.
Published: February 2009

Objectives: To evaluate sound and speech perception and quality of life in prelingually deafened adults implanted with state of the art devices. To investigate which patient factors influence postoperative performance.

Study Design: Prospective intervention study.

Methods: Eight prelingually deafened subjects (with onset of severe hearing impairment before the age of 4 years and functioning in an oral‐aural setting) participated in this study. Subjects were implanted at a mean age of 36 (range, 21–55) years with a CII or 90 K cochlear implant (Advanced Bionics Corp.). All subjects completed standard speech perception tests as well as quality of life measures (Health Utility Index Mark‐II, Nijmegen Cochlear Implant Questionnaire, visual analogue scale for subject's hearing and health) at different points in time. Postoperative scores were compared with each other and with the baseline preoperative scores. The relationship between nine patient variables and the postoperative consonant‐vowel‐consonant (CVC) phoneme score was also investigated.

Results: Significant improvement was measured for CVC word and phoneme scores and several quality of life measures. Postoperative speech perception correlated with a new and promising factor named quality of a patient's own speech production (QoSP).

Conclusion: With state of the art implants, speech perception and quality of life do improve in prelingually deafened adults. More importantly, the prognostic value of QoSP should be investigated further.
Conservative Therapy of Esophageal Perforation With Neck Abscess in a Child
Authors: Miller Matthew C. , Schmidt Richard J. , Keller Marc S. , Murphy Stephen G. , Reilly James S.
Published: February 2009

Conservative management of complicated esophageal perforations has gained favor in recent years. However, there are limited data concerning the applicability of this approach in the pediatric population. We describe the care and outcome of a 14‐year‐old girl who sustained an esophageal perforation after accidental ingestion of a shard of glass. The patient was treated using ultrasound‐guided drainage catheter placement with simultaneous esophagoscopy and postoperative antibiotics. She was discharged within 1 week of presentation and enjoyed an uncomplicated recovery. We believe that selected cases of pediatric esophageal perforation may be safely and effectively treated using a conservative approach.
Branchial Sinus of the Piriform Fossa: Reappraisal of Third and Fourth Branchial Anomalies
Authors: James Adrian , Stewart Craig , Warrick Paul , Tzifa Constance , Forte Vito
Published: February 2009

Objective: The objective of this study was to review clinical and embryologic aspects of third and fourth branchial anomalies.

Study Design: Retrospective study.

Methods: We reviewed the institutional and departmental databases at our institution to identify all cases of third and fourth branchial anomalies encountered from 1992 to 2006. All patient records were examined with respect to demographics, clinical history, and radiologic and pathologic reports.

Results: We identified 17 cases of third and fourth branchial anomalies, the largest series of its kind reported to date. The lesions were predominantly left sided, all presenting with neck infection. Fistula formation was iatrogenic, secondary to incision and drainage. Preoperative direct laryngoscopy always revealed a pit within the apex of the piriform fossa. Surgical excision involved ipsilateral thyroidectomy as the lesion passed through the thyroid gland. No lesions following the classical course of a either a third or fourth branchial anomaly were identified.

Conclusions: The clinical presentation of branchial sinuses arising from the piriform fossa is more in keeping with derivation from the thymopharyngeal duct (of the third pouch) than the hypothetical course of third and fourth branchial fistulae.
Chronic Ear Surgery in Patients With Syndromes and Multiple Congenital Malformations
Authors: O'Malley Matthew R. , Kaylie David M. , Van Himbergen Daniel J. , Bennett Marc L. , Jackson C Gary
Published: February 2009

Objectives/Hypothesis: The propensity for the development of chronic ear disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of chronic ear disease in patients with congenital syndromes or multiple major malformations associated with high rates of ear disease.

Study Design: Retrospective chart review.

Methods: Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of chronic ear disease who underwent ear surgery for chronic ear disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported.

Results: Forty‐three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 ears. Seventy‐nine percent of patients had undergone an ear procedure prior to presentation. Disease eradication was achieved in 64% of ears with a single procedure, and 89% of ears were controlled with two surgeries or less. Thirty‐two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air‐bone gap, resulting in hearing improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered.

Conclusions: Syndromic patients and those with a major congenital malformation may present with significant chronic ear disease. Appropriate surgical management can yield successful eradication of disease with low complication rates.
Classification and Management of Tracheoesophageal and Tracheopharyngeal Fistulas After Laryngectomy
Authors: Gehrking Eckard , Raap Michael , Sommer Konrad D.
Published: February 2009

Objectives: Tracheoesophageal fistulas (TEF) and tracheopharyngeal fistulas (TPF) are intentionally created for prosthetic or surgical voice restoration after laryngectomy or can develop after radiotherapy or surgical interventions. If the fistula does not shrink or close spontaneously or does not respond to conservative measures, surgical closure of the fistula is indicated.

Study Design: Retrospective study of 177 patients.

Methods: Data of 168 laryngectomy patients who needed a voice prosthesis (VP) replacement were obtained. Our experiences with nine severe TEF/TPF were analyzed, and a classification of these fistulas depending on the anatomic and clinical appearance was developed.

Results: TEF/TPF can be divided into five types: high TEF with leakage through the VP (type Ia), high TEF with leakage around the VP (type Ib), enlarged high TEF (type II), deep TEF (type III), TPF (type IV), and TPF associated with pharynx stenosis (type V). Persisting TEF/TPF after unsuccessful attempts at surgical closure in four patients and the surgical solutions and procedures in these rare cases are discussed in detail.

Conclusions: Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, and in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multilayer sutures of the esophagus and trachea. Persisting TEF/TPF after unsuccessful surgical attempts at revision surgery remain challenging. Our experiences show that tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation, a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube‐shaped fasciocutaneous radial forearm flap must be considered.
Injection Versus Medialization Laryngoplasty for the Treatment of Unilateral Vocal Fold Paralysis
Authors: Morgan Justin E. , Zraick Richard I. , Griffin Allison W. , Bowen Travis L. , Johnson Felicia L.
Published: February 2009

Objective/Hypothesis: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the treatment of unilateral vocal fold paralysis.

Study Design: A retrospective study of patients with unilateral vocal fold paralysis who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and March 8, 2005.

Methods: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and posttreatment voice parameters of videostrobolaryngoscopy, perceptual analysis, and patients' subjective voice assessment.

Results: Nineteen patients were evaluated. The average time from intervention to posttreatment evaluation was 3 (range, 1–9) months. Improvements were demonstrated in all three voice parameters in both the injection and the medialization groups. No significant differences were found in the degree of improvement between the two groups. Videostrobolaryngoscopy and the perceptual analysis, both rated by the authors, correlated well with each other, but they both correlated poorly with the patients' subjective voice analysis.

Conclusions: Injection and medialization laryngoplasty were comparable in their improvement of subjective and objective voice outcomes. Both treatment modalities should be included in the otolaryngologist's armamentarium for managing unilateral vocal fold paralysis.
Injection of Embryonic Stem Cells Into Scarred Rabbit Vocal Folds Enhances Healing and Improves Viscoelasticity: Short‐Term Results
Authors: Cedervall Jessica , Ährlund‐Richter Lars , Svensson Bengt , Forsgren Kristina , Maurer Franz H. J. , Vidovska Daniela , Hertegård Stellan
Published: February 2009

Objectives: Scarring caused by trauma, postcancer treatment, or inflammation in the vocal folds is associated with stiffness of the lamina propria and results in severe voice problems. Currently there is no effective treatment. Human embryonic stem cells (hESC) have been recognized as providing a potential resource for cell transplantations, but in the undifferentiated state, they are generally not considered for therapeutic use due to risk of inadvertent development. This study assesses the functional potential of hESC to prevent or diminish scarring and improve viscoelasticity following grafting into scarred rabbit vocal folds.

Study Design: hESC were injected into 22 scarred vocal folds of New Zealand rabbits. After 1 month, the vocal folds were dissected and analyzed for persistence of hESC by fluorescence in situ hybridization using a human specific probe, and for differentiation by evaluation in hematoxylin‐eosin‐stained tissues. Parallel‐plate rheometry was used to evaluate the functional effects, i.e., viscoelastic properties, after treatment with hESC.

Results: The results revealed significantly improved viscoelasticity in the hESC‐treated vs. non‐treated vocal folds. An average of 5.1% engraftment of human cells was found 1 month after hESC injection. In the hESC‐injected folds, development compatible with cartilage, muscle and epithelia in close proximity or inter‐mixed with the appropriate native rabbit tissue was detected in combination with less scarring and improved viscoelasticity.

Conclusions: The histology and location of the surviving hESC‐derived cells strongly indicate that the functional improvement was caused by the injected cells, which were regenerating scarred tissue. The findings point toward a strong impact from the host microenvironment, resulting in a regional specific in vivo hESC differentiation and regeneration of three types of tissue in scarred vocal folds of adult rabbits.
Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size
Authors: Moretz William H. , Watts Tammara L. , Virgin Frank W. , Chin Edward , Gourin Christine G. , Terris David J.
Published: February 2009

Objectives: To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism.

Methods: Retrospective evaluation of consecutive patients undergoing minimally invasive parathyroidectomy with iPTH measurement. Data collected include preoperative serum calcium, ionized calcium, and serum parathyroid hormone (PTH) levels, iPTH levels at baseline, 5 minutes, and 10 minutes, and parathyroid adenoma weight. Adenoma volume was calculated using an equation for the volume of a spheroid object.

Results: Thirty patients underwent minimally invasive parathyroidectomy with iPTH measurement for a single parathyroid adenoma between March 2004 and January 2006. There were 8 men and 22 women, with a mean age of 59.3 (range 26–92) years. A significant correlation between preoperative serum calcium and ionized calcium levels and parathyroid adenoma weight was identified (P = .0008 and P = .03, respectively). A significant correlation was also shown between baseline iPTH measurements and parathyroid adenoma volume (P = .03). There was no correlation between baseline iPTH levels and parathyroid adenoma weight. There was a significant correlation between parathyroid adenoma weight and percentage decrease of iPTH levels at 10 minutes compared to baseline (P = .04).

Conclusion: Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10‐minute postparathyroidectomy interval.
Comparison of Animal Models for Head and Neck Cancer Cachexia
Authors: Cannon Trinitia , Couch Marion , Yin Xiaoying , Guttridge Denis , Lai Victor , Shores Carol
Published: February 2009

Objectives/Hypothesis: Despite its negative impact on cancer patients, there are few animal models of cancer cachexia. Our hypothesis was that different human cell lines would variably induce cachexia.

Study Design: Prospective animal study.

Methods: We established two xenograft models in athymic mice and compared these with a cachexigenic cell line, the murine adenocarcinoma 16 (MAC16) cell line. Eight‐week‐old female, athymic mice were injected with human head and neck cell lines (JHU022, JHU012) and the MAC16 cell line. Body weight, food intake, body composition, leg weights, serum cytokines, and lipid mobilizing factor (LMF) were compared.

Results: Mean food intake for all groups was equivalent. Mean percent change in body weight after 18 days was 18%, 19%, 12%, and 3% for control, JHU012, JHU022, and MAC16 experimental groups, respectively. Both JHU022‐ and MAC16‐injected mice showed wasting even when tumor burden was low. In contrast, mice injected with JHU012 developed larger tumors yet lacked evidence of cachexia. These mice demonstrated loss of lean body mass but not fat mass. Serum cytokine levels for interleukin (IL)‐1α and IL‐1β were elevated in JHU022‐bearing mice, whereas IL‐1α, IL‐6, interferon (IFN)‐γ, and tumor necrosis factor alpha (TNF)‐α were elevated in MAC16‐bearing mice. LMF was present in both the JHU022 and JHU012 cell lines.

Conclusions: The JHU022 cell line caused more severe cachexia than the JHU012 cells, suggesting these cell lines may be used to further study cancer cachexia. IL‐1α and IL‐1β in the JHU022 model may be mediators of cachexia, whereas TNF‐α, IFN‐γ, and IL‐6 may be mediators in MAC16‐induced cachexia.
Cervical Discitis and Epidural Abscess After Tonsillectomy
Authors: Curry Joseph M. , Cognetti David M. , Harrop James , Boon Maurits S. , Spiegel Joseph R.
Published: February 2009

Approximately 6 weeks after an uncomplicated tonsillectomy for chronic tonsillitis, a 37‐year‐old woman presented to our emergency department with complaints of odynophagia and cervical pain persistent since surgery. Computed tomographic and magnetic resonance imaging revealed cervical spinal osteomyelitis with epidural abscess at C2 to 3. The patient underwent treatment with intravenous antibiotics, operative debridement, and cervical spinal stabilization. She recovered with no neurologic deficit.

Conclusions: Significant infectious complications of tonsillectomy are uncommon, and cervical spinal osteomyelitis and epidural abscess are exceptionally rare occurrences. In the presence of prolonged pain and dysphagia, imaging can be considered to evaluate for such sequelae.
Human Nasal Turbinates as a Viable Source of Respiratory Epithelial Cells Using Co‐Culture System Versus Dispase Dissociation Technique
Authors: Noruddin Nur Adelina Ahmad , Saim Aminuddin B. , Chua Kien Hui , Idrus Ruszymah
Published: February 2009

Objective: To compare a co‐culture system with a conventional dispase‐dissociation method for obtaining functional human respiratory epithelial cells from the nasal turbinates for tissue engineering application.

Methods: Human respiratory epithelial cells were serially passaged using a co‐culture system and a conventional dispase‐dissociation technique. The growth kinetics and gene expression levels of the cultured respiratory epithelial cells were compared. Four genes were investigated, namely cytokeratin‐18, a marker for ciliated and secretory epithelial cells; cytokeratin‐14, a marker for basal epithelial cells; MKI67, a proliferation marker; and MUC5B, a marker for mucin secretion. Immunocytochemical analysis was performed using monoclonal antibodies against the high molecular‐weight cytokeratin 34βE12, cytokeratin 18, and MUC5A to investigate the protein expression from cultured respiratory epithelial cells.

Results: Respiratory epithelial cells cultured using both methods maintained polygonal morphology throughout the passages. At passage 1, co‐cultured respiratory epithelial showed a 2.6‐times higher growth rate compared to conventional dispase dissociation technique, and 7.8 times higher at passage 2. Better basal gene expression was observed by co‐cultured respiratory epithelial cells compared to dispase dissociated cells. Immunocytochemical analyses were positive for the respiratory epithelial cells cultured using both techniques.

Conclusion: Co‐culture system produced superior quality of cultured human respiratory epithelial cells from the nasal turbinates as compared to dispase dissociation technique.
Treatment of Ménière's Disease by Low‐Dosage Intratympanic Gentamicin Application: Effect on Otolith Function
Authors: Helling Kai , Schönfeld Uwe , Clarke Andrew H.
Published: February 2009

Objectives: The intratympanic application of a low dosage of gentamicin is increasingly favored as treatment for Ménière's disease. While posttreatment observations have confirmed a long‐term success of the therapy of vertigo attacks, clear differences in the posttreatment recovery interval can be observed. In addition to differences in central‐vestibular compensation, the degree of peripheral vestibular damage, i.e., to the saccule, utricle, and semicircular canal ampullae, varies among patients. This study provides comprehensive pre‐ and posttreatment results from unilateral functional tests of the individual vestibular receptors and of the cochlea in patients with Ménière's disease.

Study Design: Prospective clinical study.

Methods: Nineteen patients with unilateral Ménière's disease were treated by intratympanic application of gentamicin by injection of 0.3 mL (12 mg) through the tympanic membrane under local anesthesia. Tests were performed immediately previous to treatment and subsequently in the periods 4 to 8 weeks and 12 to 16 weeks after treatment. Unilateral saccular function was tested by means of acoustic‐click, vestibular‐evoked myogenic potentials (VEMP), and unilateral utricular function by subjective visual vertical (SVV) during unilateral centrifugation. Bithermal caloric testing was performed to assess unilateral semicircular canal function.

Results: Prior to gentamicin treatment, the caloric response from the diseased ear was normal in 3 patients, below normal in 14 patients, and in 2 cases almost completely absent. VEMP responses could be recorded bilaterally in 13 patients; while in 6, no VEMPs could be measured from the diseased ear. Utricular function measured by SVV estimation was found to be normal in 11 patients and marginally abnormal in 2 patients. In six cases, the SVV was clearly underestimated during centrifugation of the diseased side. The posttreatment findings demonstrate that VEMPs were absent in all treated patients, and the caloric response was abnormally low in all but one case. In contrast, only 12 of 19 patients produced abnormal SVV responses.

Conclusion: The results demonstrate that incremental, intratympanic application of gentamicin effectively eliminates semicircular canal and saccular function. In contrast, utricular function appears to be maintained in 30 to 40% of cases.
Scala Tympani Cochleostomy I: Results of a Survey
Authors: Adunka Oliver F. , Buchman Craig A.
Published: February 2009

Objective: To assess current surgical techniques for scala tympani cochlear implantation among North American surgeons.

Material: A survey was distributed to all cochlear implant surgeons participating in the 2006 William House Cochlear Implant Study Group in Toronto, Canada. Participants were asked to anonymously identify their routine surgical practices. Images of trans‐facial recess approaches to the round window and cochlear promontory were used in a multiple‐choice fashion to assess the surgeon's typical exposure and cochleostomy location. Returned questionnaires were electronically processed and evaluated.

Results: Fifty‐five (75%) of 73 returned surveys had adequate data validity and availability. Landmark identification and preferred cochleostomy locations varied greatly. About 20% of surgeons selected cochleostomy locations superior to the round window membrane. Cochleostomy size and location appeared to be influenced by surgical experience and whether or not the round window overhang was drilled off.

Conclusion: This survey clearly documents marked variations in surgical techniques for scala tympani cochlear implantation. Future studies should more clearly define the surgical anatomy of this region for appropriate placement of a scala tympani cochleostomy. These findings may ultimately have an impact on hearing and neural preservation cochlear implant surgeries.
Bacteriologic Comparison of Tonsil Core in Recurrent Tonsillitis and Tonsillar Hypertrophy
Authors: Jeong Jin Hyeok , Lee Dong Wook , Ryu Ri A. , Lee Young Sup , Lee Seung Hwan , Kang Jung Oak , Tae Kyung
Published: February 2009

Objectives: Although many bacteriology studies on tonsillar diseases have been completed, all have been confined to children and were characterized by a paucity of cases. The purpose of this study was to analyze the underlying bacterial pathogens in tonsillar disease.

Methods: A retrospective study was performed on 824 patients who underwent elective tonsillectomy with or without adenoidectomy. We analyzed the differences between the bacterial pathogens in recurrent tonsillitis and tonsillar hypertrophy with regard to age, season, and antibiotic sensitivity.

Results: Among 824 cases, 966 bacterial strains from the tonsil core were isolated. In recurrent tonsillitis, Staphylococcus aureus was the most common pathogen (30.3%), followed by Haemophilus influenzae (15.5%) and group A β‐hemolytic Streptococcus (Streptococcus pyogenes, 14.4%). In patients over 14 years of age, quite differently from other age groups, Klebsiella pneumoniae was isolated at a significantly higher percentage. In tonsillar hypertrophy, H. influenzae was isolated most commonly (31.4%) regardless of age, followed by S. pyogenes (24.2%), S. aureus (22.9%), and Streptococcus pneumoniae (12.6%). Furthermore, mixed infection was common because of its high resistance to penicillin. In both groups, S. pneumoniae was more common in younger patients, whereas K. pneumoniae was relatively common in adults. We found no differences in the detection rate by season; however, H. influenzae was frequently isolated in the tonsillar hypertrophy group regardless of seasonal variations. We also found no difference in the antibiotic sensitivity between the two groups; however, strains resistant to penicillin were relatively prevalent and showed a high sensitivity to third‐generation cephalosporin.

Conclusions: We observed some differences in the types of bacteria in the tonsillar core between the recurrent tonsillitis and tonsillar hypertrophy groups. Our study indicates that essential bacteria have been changing and, thus, we need to change our choice of antibiotics.
Imaging of the Pediatric Airway Using Optical Coherence Tomography
Authors: Ridgway James Matthew , Ahuja Gurpreet , Guo Shuguang , Su Jianping , Mahmood Usama , Chen Zhongping , Wong Brian
Published: February 2009

Objectives: Optical coherence tomography (OCT) is an imaging modality that uses a broadband light source to produce high‐resolution cross‐sectional images in living tissue (8–20 μm). A prospective study of normal, benign, and pathologic tissues in the pediatric airway was conducted to assess the utility of OCT technology in characterizing the microanatomy of the pediatric upper aerodigestive tract in vivo.

Study Design: Prospective clinical trial.

Materials and Methods: Fifteen patients from 1 to 17 years of age underwent surgical endoscopy and OCT for various airway disorders. OCT imaging was performed at a frame rate of 1 Hz using a 1.3‐μm broadband light source to produce images 1.6 × 6 mm in vertical and horizontal dimensions. The epithelium, lamina propria, and unique tissue microstructures were visualized and then measured using digital micrometry. Direct comparison of OCT images with endoscopic photography was performed.

Results: Systematic imaging of the oral cavity, oropharynx, hypopharynx, and larynx was performed in all 15 patients. Normal microstructures identified included papillae, ducts, glands, and vessels, whereas pathologic conditions included distinct zones of mature scar, granulation tissue, edema, ulceration, and papillomatosis. Endoscopic photographs were well correlated with OCT images.

Conclusions: OCT is capable of obtaining high‐resolution microanatomy images of pediatric airway in vivo tissue. OCT clearly identifies the epithelium and lamina propria while providing detailed structural information on normal and diseased tissues. OCT is a promising emerging imaging modality for use in current pediatric patient populations.
Nasal Valve Suspension Revisited
Authors: Nuara Michael J. , Mobley Steven Ross
Published: February 2009

Objectives: Nasal valve suspension (NVS) is a simple technique to correct nasal valve obstruction or collapse by providing a lateral vector of pull on the nasal sidewall. The purpose of this research was to review our experience with NVS in a cohort of patients with nasal valve collapse, including a subset of patients with facial paralysis. The objectives were to determine patient satisfaction and complication rates after NVS.

Study Design: A retrospective review of patients 18 years and older who had NVS from 2003 to 2006 with a follow‐up of at least 1 month was performed.

Methods: Data were collected on diagnosis, surgical outcomes, complications, and treatments required. Complications included adverse outcomes, infections, and the need for repeat surgery or treatments.

Results: In 17 charts reviewed, 9 patients (53%) had nasal valve collapse as a result of facial paralysis, and 8 (47%) had previous nasal surgery. Follow‐up ranged from 1 to 30 months, with a mean of 16.5. Moderate to complete resolution of obstruction was reported by 82% of patients, or for 88% of procedures. Sustained relief was observed in two of eight patients who had previous nasal surgery and six of nine who had no previous nasal surgery (P = .1). Infection occurred in four (24%) patients and five (21%) total suspensions and ranged from 1.5 to 7 months. Six (35%) patients experienced a loss of suspension at 6 to 22 months.

Conclusions: NVS is a technically straightforward, relatively reversible procedure particularly useful in the patient with facial paralysis. The efficacy is excellent in the short term yet appears to diminish with time.
Symptom Outcomes in Endoscopic Sinus Surgery: A Systematic Review of Measurement Methods
Authors: Chester Alexander C. , Sindwani Raj
Published: February 2009

Objective: To determine the type and prevalence of measurement methods used to analyze symptom outcomes after endoscopic sinus surgery (ESS).

Data Sources: Data were derived from PubMed, MEDLINE, EMBASE, Web of Science, Cochrane databases, Google Scholar, and manual searches.

Study Selection: All English‐language studies consisting of more than 10 adult patients from January 1980 to December 2006 reporting ESS symptom outcome results were reviewed. Studies of radical surgery and studies involving patients with significant comorbidities were excluded.

Results: The ESS symptom outcome results of 29,333 patients were reported in 204 studies. Symptom outcome was determined by survey instruments in 47 (23.0%) studies and individual symptom scoring in 63 (31%) studies. Of 18 validated instruments used, almost two thirds of studies that reported results by survey measures used the following three instruments: Chronic Sinusitis Survey (12 studies), Sinonasal Outcome Test‐20 (11 studies), and Medical Outcomes study 36‐Item Short‐Form Health Survey (10 studies). The percentages of studies that reported specific results of the 1997 American Academy of Otolaryngology–Head Neck Surgery Rhinosinusitis Task Force (RSTF) chronic rhinosinusitis symptom criteria varied as follows: facial pain/pressure, 35%; facial congestion/fullness, 10%; nasal obstruction/blockage, 42%; nasal discharge/purulence/discolored postnasal discharge, 47%; hyposmia/anosmia, 35%; fever, 2%; halitosis, 4%; fatigue, 11%; dental pain, 3%; cough, 10%; and ear pain/pressure/fullness, 6%.

Conclusions: ESS symptom outcome is assessed inconsistently by numerous measures. Individual report‐ ing of all RSTF chronic rhinosinusitis symptom criteria, as recommended by the RSTF and by subsequent consensus conferences, is rarely noted. Many RSTF symptom criteria are seldom studied.
Evaluation of a Particle Repositioning Maneuver Web‐Based Teaching Module
Authors: Beyea Jason Atkins , Wong Eric , Bromwich Matthew , Weston W Wayne , Fung Kevin
Published: February 2009

Objectives/Hypothesis: To compare the pass rate of residents performing the Particle Repositioning Maneuver (PRM) after one of three interventions: 1) small group PRM instruction (SG); 2) standard classroom instruction (CI); and 3) Web‐based learning module (WM). We hypothesize that our Web‐based learning module is more effective than CI and as effective as SG.

Study Design: Prospective randomized control trial.

Methods: The study population includes all family medicine residents at the University of Western Ontario. On day 0, all subjects were tested. Residents were then randomized to one of three intervention groups: 1) SG, 2) CI, or 3) WM. On day 7, the residents were again tested. Observers were blinded to the intervention type. Testing (day 0 and day 7) was performed using the DizzyFIX (Clearwater Clinical Ltd., London, Ontario, Canada), a pass/fail test, and evaluation by a trained observer (correct or incorrect).

Results: There were no statistically significant differences in pass rates between the three groups before the interventions (DizzyFIX: P = .2096, observer: P = .3710). After the interventions, DizzyFIX testing pass rates were 50.0% SG, 60.0% CI and 100.0% WM (P = .3564). Observer testing pass rates were 85.7% SG, 28.6% CI, and 83.3% WM (P = .0431).

Conclusions: This study demonstrated that our Web‐based learning module for the PRM is comparable to small‐group clinical instruction, and superior to standard classroom instruction for teaching the PRM when evaluated by a trained observer.