bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumomediastinum and Pneumothorax From Blunt Cervical Trauma in Children
Authors: Schoem Scott R. , Choi Sukgi S. , Zalzal George H.
Published: November 2003

Minor blunt cervical injuries in children are relatively common occurrences leading to serious sequelae in only rare circumstances, yet sufficient impact of even a seemingly minor event may lead to a significant posterior tracheal wall laceration, resulting in pneumomediastinum with or without pneumothorax. Three cases demonstrate how the mechanism of injury does not always match either the severity of initial presentation or the consequent necessary level of emergent management. Pneumomediastinum without pneumothorax often can be treated conservatively; however, the onset of massive pneumomediastinum and pneumothorax may necessitate both tracheotomy and tube thoracostomy as initial treatment.
Variation of Nasal Respiratory Pattern With Age During Growth and Development
Authors: Laine‐Alava Maija T. , Minkkinen Ulla K.
Published: November 2003

The purpose of this study was to determine changes in nasal respiratory pattern with growth and development, particularly to determine the age where upper airway growth ceases. The results on 361 healthy subjects, aged 7 to 24 years, based on aerodynamic measurements during rest breathing, showed clear differences between inspiratory and expiratory phases. Nasal airflow rate and cross‐sectional area increased and oral‐nasal pressure and nasal resistance decreased with age up to the age of 16, levelling by the age of 20 years. The body size and gender had effect only on nasal airflow rate. This study suggests that the measurements of the nasal respiratory pattern, determining impaired nasal airway, should be done during inspiration and using age‐related assesment from a healthy population until the age of 16 years. From then on, guidelines for adults are applicable.
Pentoxifylline in the Treatment of Radiation‐Related Soft Tissue Injury: Preliminary Observations
Authors: Futran Neal D. , Trotti Andrea , Gwede Clement
Published: November 2003

Soft tissue or mucosal injuries following radiotherapy of head and neck cancer include ulceration (necrosis), fibrosis, pain, and atrophy. Current management includes analgesics, wound debridement, antibiotics, and physical therapy depending on the type of injury. Pentoxifylline is a methylxanthine derivative that produces dose‐related hemorrheologic effects, lower blood viscosity, improved erythrocyte flexibility, and increased tissue oxygen levels. Twenty‐six patients with late radiation complications (occurring more than two months after x‐ray therapy) were given treatment with oral pentoxifylline: 15 for soft tissue necrosis (STN), six for fibrosis, and five for mucosal pain. Nine of 12 patients with STN completely healed. In all three failures osteoradionecrosis developed. Mucosal pain resolved in all five patients. Fibrosis improved in 67% of those patients. Pentoxifylline appears to accelerate healing of STN and reverse some late radiation injuries. This is the first series to our knowledge that documents activity of this agent in moderate radiotherapy complications such as fibrosis, pain, or mucosal fragility.
Pitfalls in the Diagnosis of Hemifacial Spasm
Authors: Zappia John J. , Wiet Richard J. , Chouhan Ajay , Zhao Jin‐Cheng
Published: November 2003

Hemifacial spasm (HFS), a condition characterized by involuntary unilateral facial spasms, is a disabling disorder resulting in functional compromise, patient frustration, cosmetic deformity, and social embarrassment. Compression of the seventh nerve at the root entry zone via vascular loop is presently the most widely accepted causative theory. Although less common, there are other entities that can result in HFS. Basic evaluation, including a thorough history, physical examination, and magnetic resonance imaging (MRI) scan, is important to confirm the diagnosis and rule out other causes. The relation of vascular loop syndrome to HFS is well enough established that radiologic documentation of a vascular loop is probably not necessary in every case. Here we present 12 cases of HFS, 6 without VLS. The etiology and evaluation of HFS are reviewed.
Recent Trends in Utilization of Procedures in Otolaryngology‐Head and Neck Surgery
Authors: Manoukian Paul D. , Wyatt J. Robert , Leopold Donald A. , Bass Eric B.
Published: November 2003

The development of minimally invasive techniques and increasing performance of surgery in outpatient settings have had a major influence on otolaryngology‐head and neck surgery (OLHNS), but little is known about the extent to which these forces have affected the overall distribution and total rate of performance of OLHNS procedures. The aims of this study were to determine whether there has been a change in the total number of people undergoing OLHNS procedures between 1989 and 1992 in Maryland and to identify those procedures for which there has been a significant change in utilization. Data were obtained on 171,579 patients undergoing OLHNS procedures between 1989 and 1992 in Maryland's nonfederal, acute care hospitals, hospital‐based outpatient centers, and freestanding multispecialty surgical centers. Age‐adjusted annual surgical rates were calculated by direct standardization using 1990 Maryland census data, and changes in rates over time were examined using linear regression. From 1989 to 1992, there was no significant change in the total age‐adjusted annual rate of performance of the most commonly performed OLHNS procedures (P > 0.05), yet there was a significant increase(P < 0.05) in the rates of ethmoidectomy from 37/100,000 to 73/100,000, intranasal antrotomy from 25/100,000 to 44/100,000, and septoplasty from 70/100,000 to 89/100,000, and a significant decrease (P > 0.05) in the rate of rhinoplasty from 44/100,000 to 36/100,000. The data show an annual average decrease in inpatient surgery of 5.2% (P=0.006), and a corresponding increase in outpatient surgery of 5.1% (P = 0.005). Maryland surgery rates for commonly performed procedures in OLHNS remained stable overall, except for an increase in sinus surgery and septoplasty rates and a decrease in rhinoplasty rates.
Osseointegrated Oral Implants in Head and Neck Cancer Patients
Authors: Kwakman Joke M. , Freihofer Hans‐Peter M. , van Waas Marinus A.J.
Published: November 2003

After cancer treatment in the head and neck area, mastication and speech are often affected. Some of the problems encountered can be solved by adequate dental rehabilitation. However, dental rehabilitation is often compromised for various reasons. The change in anatomy due to surgery often results in lack of denture‐bearing mucosa. The effects of radiotherapy on the salivary glands and the mucosa result in dry oral tissue and diminished retention of removable dentures. Osseointegrated oral implants can help to solve these problems. Although implant treatment for patients with cancer of the head and neck is covered by the Dutch national health insurance, and there is therefore no financial obstacle, implants have not, so far, been widely used with these patients. In order to establish the possible reasons for this, an analysis was performed. Retrospective data on 95 consecutive patients were collected from records. The indication for the use of oral osseointegrated implants was reviewed. Analysis of the data showed that 45% did not need specific prosthetic rehabilitation. An indication for the use of osseointegrated implants was found in 25% of the patients. For various reasons, only 3% actually received implants. In striving to completely rehabilitate a cancer patient, the possible use of osseointegrated oral implants should be evaluated before the initial oncological treatment begins. The insertion of implants during the initial surgical procedure should be considered more often, with a view to reducing the number of surgical procedures.
Sudden Sensorineural Hearing Loss After General Anesthesia for Nonotologic Surgery
Authors: Evan Karin E. , Tavill Michael A. , Goldberg Andrew N. , Silverstein Herbert
Published: November 2003

Sudden sensorineural hearing loss (SNHL) is a well‐recognized phenomenon that is attributed to a variety of etiologies. Sudden SNHL after cardiopulmonary bypass surgery has been well reported and is thought to be due to microemboli. However, a review of the English literature revealed only 15 cases of SNHL after general anesthesia for nonotologic surgery. Several etiologies for this loss have been suggested, but no proven pathogenesis is yet available. This report adds to the literature three additional cases of sudden SNHL after general anesthesia for nonotologic surgery. The literature is reviewed and proposed mechanisms of injury are discussed.
Genetic Susceptibility to Head and Neck Cancer: Interaction Between Nutrition and Mutagen Sensitivity
Authors: Schantz Stimson P. , Zhang Zuo‐Feng , Spitz Margaret S. , Sun Ming , Hsu Tao C.
Published: November 2003

The development of head and neck cancer may depend not only on exposure to environmental carcinogens but also on a genetically based susceptibility to carcinogen‐induced damage. This thesis presents a case‐control study that demonstrates the significance of mutagen sensitivity, a measure of an individual's intrinsic DNA repair capacity against free radical damage, as a risk factor for the disease. As part of the case‐control analysis, 167 previously untreated patients and 177 age‐ and sex‐matched healthy controls were assessed for various lifestyle factors including tobacco and alcohol habits, occupational exposures, and diet. Mutagen sensitivity expressed by each individual was determined by quantifying bleomycin‐induced chromosomal breaks within peripheral blood lymphocytes in vitro. Consistent with our initial observations and those of others, mutagen hypersensitivity was strongly associated with increased risk of head and neck cancer (odds ratio, 4.95; 95% confidence interval, 2.67 to 9.17) after adjusting for age, sex, and race. Low intake of vitamins C and E was also associated with an increased risk of disease and was interactive with mutagen sensitivity in risk estimates. Individuals with both a low intake of various antioxidants and increased chromosomal sensitivity to oxidant‐induced DNA damage were at greatest risk. This study supports the concept that the risk of head and neck cancer is determined by a balance of factors that either enhance or protect against free radical oxygen damage, including innate capacities for DNA repair.
Factors Affecting Smoking Cessation in Patients With Head and Neck Cancer
Authors: Ark Wesley Vander , DiNardo Laurence J. , Oliver David S.
Published: November 2003

The role of tobacco in the etiology of upper aerodigestive tract carcinomas is well established. Smoking decreases the effectiveness of cancer therapy and increases the risk of all treatment modalities. Smoking adversely affects the general health of the cancer survivor and places the patient at risk of developing additional primary tumors. The smoking habits of head and neck cancer patients were evaluated using a questionnaire administered at two tertiary head and neck cancer centers. Demographic factors, level of exposure, tumor stage and location, treatment modalities, concomitant alcohol use, and cessation methods were examined. Results demonstrate a high rate of smoking cessation at the time of cancer diagnosis. Significant demographic factors were not identified. Physical barriers to continued smoking because of cancer treatment as well as counseling at the time of tumor diagnosis were the most effective deterrents to continued tobacco use. Heavy alcohol use was a negative predictor of smoking cessation. Pharmacologic aids alone were found to be of no value. This study demonstrates the difficulties with smoking cessation in head and neck cancer patients, and emphasizes the importance of intervention by the otolaryngologist‐head and neck surgeon.
Adenovirus and Respiratory Syncytial Virus in Chronic Sinusitis Using Polymerase Chain Reaction
Authors: Ramadan Hassan H. , Farr R. Wesley , Wetmore Stephen J.
Published: November 2003

The aim of this study is to investigate the role of adenovirus and respiratory syncytial virus (RSV) in chronic sinusitis using the polymerase chain reaction (PCR) to assay for the viruses. PCR has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses. Adenovirus and RSV are among the most common viruses to cause upper respiratory tract infections. Sinus mucosa biopsies from 20 patients undergoing endoscopic sinus surgery were sterilely collected. Four specimens (20%) tested positive for RSV by PCR and none tested positive for adenovirus. Only one specimen tested positive for RSV and one for adenovirus by viral culture and immunofluorescence. Bacterial cultures tested positive in 40% of the 20 specimens. PCR can be used to detect RSV in patients with chronic sinusitis and PCR is more sensitive than viral culture and immunofluorescence techniques on sinus polyps and mucosa.
Anterior Petrosectomy Approach to Infraclinoidal Basilar Artery Aneurysms: The Emerging Role of the Neuro‐otologist in Multidisciplinary Management of Basilar Artery Aneurysms
Authors: Friedman Rick A. , Pensak Myles L. , Tauber Michael , Tew John M. , van Loveren Harry R.
Published: November 2003

Aneurysms of the basilar artery are uncommon. Historically, because of the central location of these basilar lesions, surgical access has been difficult. Moreover, while this disease and its surgical management inherently carry a high risk of patient morbidity, the presence of neighboring vital neural and vascular structures introduces additional intraoperative challenges. Since 1986 we have employed a transpetrous approach for access to selective aneurysms involving the basilar artery. Removal of the petrous apex has provided an expanded deep window through which infraclinoidal basilar artery aneurysms can be controlled. Reported herein are our results utilizing an anterior petrosectomy approach to the management of infraclinoidal artery aneurysms.
Implantation of the Lateral Cochlear Wall for Auditory Nerve Stimulation
Authors: Yueh Bevan , Manis Paul , Niparko John K.
Published: November 2003

Although cochlear implants now regularly achieve gratifying results, traditional intrascalar implants have certain limitations. Extraluminal implants may offset some of these problems by accessing neurons subserving a wider tonotopic range, avoiding intracochlear insertion trauma, and offering alternatives when cochlear obliteration is present. We have investigated the utility of a lateral cochlear wall implant in a normal‐hearing cat model with implants at the middle and basal turns, and found successful activation of the auditory nerve at thresholds of 28.1 and 40.6 μA, respectively. No adventitial stimulation of the facial nerve was noted within the dynamic range. Maximum responsiveness was observed with implants of the middle turn of the cochlea, an area that is not reliably approached with current intrascalar implants. These observations support and extend prior observations of the feasibility of extraluminal stimulation of the auditory nerve.
Sensorineural Hearing Loss in themdx Mouse: A Model of Duchenne Muscular Dystrophy
Authors: Raynor Eileen M. , Mulroy Michael J.
Published: November 2003

Sensorineural hearing loss has been identified in several types of muscular dystrophy, but few studies have investigated any relationship between Duchenne muscular dystrophy and hearing. An animal model of Duchenne muscular dystrophy, themdx mouse, exhibits the same genetic defect as humans. We performed brainstem auditory evoked responses on mdx and control mice in order to assess sensorineural hearing loss. The amplitude and latency of wave I for each animal were measured at increasing sound pressure levels. A significant increase in threshold and a decrease in wave I amplitude were found in the mdx mice. These results indicate that significant sensorineural hearing loss is associated with muscular dystrophy in the mdx mouse. Possible cellular mechanisms contributing to the hearing deficit are presented.
Argon Laser Irradiation to the Semicircular Canal
Authors: Sugio Yuichiro , Nomura Yasuya , Oki Seido
Published: November 2003

In order to elucidate the effects of argon laser irradiation on the lateral semicircular canal of the guinea pig, the vestibular labyrinth was histologically studied after irradiation, using the conventional celloidin method. Irrigation of the external meatus with ice water was used to evaluate the function of the semicircular canal by recording caloricnystagmus. When irradiation was performed, a laser probe was approximated to the lateral canal, 0.5 to 1 mm away from the surface of the canal. Each time, power applied was 1.0 W on the dial of the laser machine. The duration of irradiation was 0.5 s. The lateral canal was irradiated one to 15 times. Twenty‐five to 87 days after irradiation, the temporal bones were fixed in Heidenhein‐Susa solution, removed, and subjected to celloidin processing. The irradiated bony wall of the lateral canal demonstrated charring. Lucent areas were observed around and under the charred area. The semicircular duct showed shrinkage with disappearance of the trabecular mesh. New bone formation was observed along the endosteum of the irradiated area. The lateral canal was completely occluded by ossification with or without fibrosis when sufficient energy was applied. The anterior and posterior canals were normal. Caloric tests using 5 mL of ice water for 5 s failed to elicit nystagmus on the irradiated side.
Platelet Aggregation in Head and Neck Tumors in China
Authors: Huang Guang‐Wu , Nong Hui‐Tu , Yu Qi‐Song , Kinjoh Kiyohiko , Nakamura Mariko , Kosugi Tadayoshi
Published: November 2003

We measured the maximum aggregation rate (MAR) of platelets in 770 patients with malignant head and neck tumors, 55 patients with benign tumors of the head and neck, and 164 healthy people as a control group. The results were as follows:1. the mean MAR value of patients with malignant tumors was significantly higher than the control group mean value; 2. prior to treatment, the mean MAR value increased with advancing tumor stage;3. both MAR values of relapsed or metastasized patients and of nonsurvivors in stage III and IV increased significantly compared with survivors or patients recovering from malignant tumors. The results of the present study suggest that MAR values of patients with malignant tumors of the head and neck may serve as indicators in evaluating therapeutic procedures and prognosis.
Molecular Temporal Bone Pathology: I. Historical Foundation
Authors: Wackym Phillip A.
Published: November 2003

The application of molecular biology techniques to temporal bone research is resulting in rapid changes in our understanding of the fundamental mechanisms of auditory, facial nerve, and vestibular function. The use of the polymerase chain reaction, cDNA libraries, and in situ hybridization histochemistry, the determination of genetic defects, and the manipulation of transgenic animals are the molecular biology tools that are available to approach these research problems. Knowledge of the molecular pathology that results in the otologic and neuro‐otologic dysfunction many of our patients experience is currently in its infancy. A review of the historical foundation of temporal bone pathology and the evolution of the application of cell and molecular biology methods to archival celloidin‐embedded human temporal bone material is presented.
Congenital Cholesteatomas in the Tympanic Membrane
Authors: Weber Peter C. , Adkins Warren Y.
Published: November 2003

The etiology of congenital middle ear (ME) cholesteatomas is unclear. One etiologic possibility of ME cholesteatoma may be progression of a congenital tympanic membrane (TM) cholesteatoma. We recently have encountered three cases of congenital tympanic membrane cholesteatoma. Each child, ages 1, 3, and 14 years, presented with cholesteatoma of the tympanic membrane extending into the middle ear. These children have not had previous otologic surgery including myringotomy, nor had they had repeated middle ear infections, perforation, or trauma. Neither the 3‐year‐old nor 14‐year‐old child complained of hearing loss. Audiograms demonstrated only a mild conductive loss. Each child underwent excision with tympanoplasty. Although the middle ear component of the cholesteatoma was always more extensive than the pearl seen, the point of attachment was the TM and not the middle ear. This demonstrates one possible source for congenital cholesteatomas.
Interleukin‐8 Concentration Predicts the Neutrophil Count in Middle Ear Effusion
Authors: Nassif Paul S. , Simpson Steven Q. , Izzo Angelo A. , Nicklaus Pamela J.
Published: November 2003

Interleukin‐8 (IL‐8), a potent neutrophilic chemoattractant and inflammatory cytokine, is present in middle ear effusions (MEEs) of children with otitis media and is thought to be responsible for the accumulation of neutrophils in MEEs. We hypothesized that IL‐8 concentration predicts the total number and proportion of neutrophils in MEEs. IL‐8 concentration and total and differential cell counts were measured in MEEs of children undergoing tympanostomy tube placement for otitis media. IL‐8 was present in 80 (98%) of 82 effusions. The mean ± SEM value for IL‐8 was 7342 ± 847 pg/mL. The mean ± SEM count and percentage of neutrophils were 1.34 × 106 ± 3.44 × 105 and 70.6 ± 3.1%, respectively. IL‐8 concentrations correlated positively with the total number(r = +0.30; P = 0.02) and percentage of neutrophils(r= +0.32; P = 0.01) in the effusion. Additionally, purulent effusions had greater IL‐8 concentrations (P = 0.003) and greater neutrophil count (P = 0.03) than mucoid or serous effusions. We conclude that IL‐8 is consistently present in MEEs of children and IL‐8 concentration predicts the total number and proportion of neutrophils. Furthermore, IL‐8 concentration and the total number of neutrophils correlate positively with the type of effusion. These results support the hypothesis that IL‐8 recruits neutrophils to the middle ear in MEEs.
An Optimal Choice: Home Intravenous Hydration After Tonsillectomy
Authors: Blakeslee Don B. , Jafek Bruce W. , Birney Janice L.
Published: November 2003

Most tonsillectomies are performed as outpatient procedures in an ambulatory care facility. The postoperative period can be protracted, which can cause dehydration and readmission to the hospital. Timely intervention with home intravenous (IV) hydration can help prevent this complication. A prospective clinical trial was designed to evaluate the benefit of home IV therapy after tonsillectomy. One hundred consecutive patients underwent tonsillectomy. Fifty returned home without home IV hydration and another 50 returned home with home IV hydration. Clinical data were collected by the homecare nurse during the postoperative period. Comparison between these two groups showed that the patients with home IV hydration had less morbidity. Daily assessment of the patient by telephone is the best screening method to determine the need for IV hydration for the posttonsil‐lectomy patient.
Rethinking the Use of Auditory Brainstem Response in Acoustic Neuroma Screening
Authors: Zappia John J. , O'Connor Cathleen A. , Wiet Richard J. , Dinces Elizabeth A.
Published: November 2003

The ability of magnetic resonance imaging (MRI) to detect very small acoustic tumors has triggered many to rethink the use of auditory brainstem response (ABR) in the screening of acoustic tumors. To assess ABR accuracy, we conducted a retrospective study of 388 surgically treated patients. Of these patients, 111 had complete databases including both preoperative MRIs and ABRs. The ABR was abnormal by wave V interaural latency difference in 106 (95%) of the cases. Although our overall sensitivity was 95%, sensitivity varied according to tumor size. ABR was abnormal or absent for all tumors (100%) larger than 2 cm in diameter, for 98% of tumors 1.1 to 2 cm in diameter, and for only 89% of tumors less than or equal to 1 cm in diameter. Ramifications of this in the decision‐making process are presented. Criteria for cut‐off values are also discussed.
Ethical Issues Raised by Managed Care
Authors: Gonsoulin Thomas P.
Published: November 2003

Health care costs have risen steadily for many years as a result of an inflationary reimbursement system, technologic advances, an aging population, and increasing patient expectations. The growth of managed care organizations (MCOs) has accelerated rapidly in recent years as an attempt to control costs. Because MCOs are involved with medicine, a moral enterprise, they enter the ethical arena. In this report several of the ethical issues raised by the attempted union of potentially conflicting systems are explored. The discussion focuses on four sets of relationships: physician‐patient, physician‐physician, patient‐MCO and medicine‐MCO as systems. Some remedies for dealing with the conflicts raised are offered.
Wound Complications Associated With Brachytherapy for Primary or Salvage Treatment of Head and Neck Cancer
Authors: Righi Paul D. , Weisberger Edward C. , Krakovits Paul R. , Timmerman Robert D. , Wynne Michael K. , Shidnia Homayoon
Published: November 2003

Brachytherapy can be employed in the primary or salvage treatment of head and neck cancer. The advantage of brachytherapy is the stereotactic limitation of radiation exposure to noninvolved tissues. Wound complications associated with brachytherapy have been discussed only sporadically in the literature. This retrospective study examines 28 patients, 20 for initial treatment and eight for salvage, with varying site and stage head and neck cancer treated with brachytherapy in addition to external beam radiation therapy and/or surgery. The overall complication rate was 50% (14/28), with infection and minor flap breakdown being the most common problems. Tumor site in the primary treatment group was the only significant factor in wound complications. In the salvage group complications were minor and primarily related to flap coverage of brachytherapy catheters.
Trends and Perspectives in Minimally Invasive Surgery in Otorhinolaryngology‐Head and Neck Surgery
Authors: Plinkert Peter , Löwenheim Hubert
Published: November 2003

The roots of minimally invasive surgery (MIS) in otolaryngology‐head and neck surgery (ORL‐HNS) can be traced to the 1950s. Today, endonasal sinus surgery and endolaryngeal surgery already fulfill the principles of MIS. To widen its spectrum of indications, however, MIS must be able to offer three advantages that conventional macrosurgery and microsurgery already have: free maneuverability for the instrument, sensory feedback, and three‐dimensional imaging. Every anatomical region (e.g., paranasal sinuses, upper aerodigestive tract, cerebellopontine angle) requires specific surgical instrumentation. Here, the authors present recently developed steerable instruments that allow two additional degrees of freedom not attainable with conventional instruments. These instruments may permit access to problem zones(e.g., laterally extending frontal and ethmoidal sinus recesses) in the near future. For better control of the instrument and the operative procedure, tactile feedback can be achieved with appropriate microsensor systems. Three‐dimensional vision can be realized by three‐dimensional video‐endoscopes and sequential image processing.
Frey's Syndrome After Parotidectomy: A Retrospective and Prospective Analysis
Authors: Linder Thomas E. , Huber Alex , Schmid Stephan
Published: November 2003

Gustatory sweating is a well‐known sequela after parotid surgery. In a retrospective and prospective study of patients undergoing parotid surgery, the onset, time course, extent, and treatment modalities of Frey's syndrome were analyzed. Twenty‐two percent of the patients evaluated by questionnaires and 43% of the patients followed prospectively within 1 year were found to be symptomatic. Although the Minor starch‐iodine test was positive in 38% of patients at 3 months, none of these patients experienced symptoms. Up to 12 months after surgery the rate of patients who tested positive increased to 96% and the total area of sweating expanded to a mean value of 18 cm2. Whereas most of the patients are not markedly disturbed, few patients (5% to 10%) suffer from severe gustatory sweating. These patients present a therapeutic challenge.
Effects of Aspergillus fumigatus and Alternaria alternata on Human Ciliated Epithelium in Vitro
Authors: Cody D. Thane , McCaffrey Thomas V. , Roberts Glen , Kern Eugene B.
Published: November 2003

Fungi represent the etiologic agent in a large number of patients with chronic sinusitis. Despite this, no study has examined the effects of fungi on ciliated epithelium. This study evaluates the effects of cultures and filtrates of
Aspergillus fumigatus
and
Alternaria alternata
on ciliary beat frequency (CBF) in vitro. CBF was recorded after exposure to either a control or experimental solution. A statistical comparison of control and experimental values was performed to determine significance at
P
< 0.05. A statistically significant inhibition of CBF in cultures and filtrates of
A fumigatus
and
A alternata
was demonstrated. We conclude that a soluble metabolite produced by clinical isolates of both
A fumigatus
and
A alternata
causes inhibition of CBF and may represent one virulence factor involved in the development of fungal sinusitis.
Expression of Adhesion Molecules in Nonallergic Chronic Sinusitis
Authors: Shimomura Akira , Ikeda Katsuhisa , Suzuki Hideaki , Nakabayashi Seiichiro , Oshima Takeshi , Furukawa Masayuki , Takasaka Tomonori , Ando Noriaki , Ohtani Haruo , Nagura Hiroshi
Published: November 2003

Endothelial and epithelial adhesion molecules are important in the recruitment of leukocytes to inflammatory sites. To determine the relationship between recruited leukocytes and adhesion molecules in the paranasal sinus mucosa of nonallergic chronic sinusitis, we surgically obtained mucosa from 16 patients and identified the expression of intercellular adhesion molecules(ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1), E‐selectin, and P‐selectin by immunohistochemistry. Neutrophils were significantly dominant in the nasal discharge as compared with eosinophils. The degree of neutrophil infiltration in the paranasal sinus mucosa was prominent in both intraepithelial and subepithelial areas as compared with the lamina propria. In each tissue site, the degree of infiltration of neutrophils was similar to that of eosinophils. These findings suggest that the tissue neutrophils actively and rapidly migrated into the lumen. All the adhesion molecules except VCAM‐1 were expressed in the vascular endothelial cells. On the other hand, the surface epithelial cells showed the expression of only ICAM‐1. The expression of ICAM‐1 on the endothelial cells correlated with the degree of neutrophil infiltration in the mucosa. The eosinophil infiltration was not dependent on any adhesion molecules examined here. It was concluded that ICAM‐1 expression in the mucosa may be involved in neutrophil recruitment and may contribute to the establishment of the inflammatory cell distribution in the paranasal sinus of nonallergic chronic sinusitis.
Incus and Stapes Footplate Simulator
Authors: Mathews Shawn B. , Hetzler Douglas G. , Hilsinger Raymond L.
Published: November 2003

Prosthesis placement in stapes surgery is difficult to master. Although temporal bone dissection is an important adjunct to operative experience and anatomic knowledge when training residents to perform this procedure, the high cost and scarcity of temporal bones available for teaching purposes limit their convenience as teaching tools. Therefore, to augment training of residents, the authors developed an inexpensive, easily constructed middle ear simulator made from a disposable drinking cup, toothpicks, and a tongue depressor. The device is used with a microscope and ear instruments to manipulate, place, and crimp stapes prostheses. Improved surgical skills can lead to better surgical results, and this middle ear simulator can help to improve otologic surgical skills by giving residents the opportunity to practice techniques necessary to master stapes surgery.
Tumors of the Nasal Columella Treated by Mohs Micrographic Surgery
Authors: Oriba Howard A. , Snow Stephen N.
Published: November 2003

Primary nasal columellar tumors are rare but can exhibit aggressive clinical behavior, often leading to devastating outcomes if these tumors are not completely removed. Eleven patients with nonmelanoma nasal columellar lesions were evaluated. All lesions were excised by obtaining tumor‐free margins with Mohs micrographic surgery. Seven of eight cases with basal cell carcinoma have been tumor free for more than 5 years, the eighth case remains tumor free at 4 years. The primary squamous cell carcinoma lesions treated in this study have fared well; one patient has been tumor free for the past 4.3 years. No local recurrence or distant metastasis has occurred to date for all cases. We conclude that intervention with Mohs micrographic surgery for the treatment of early nasal columellar tumors may lead to improved outcomes.
Analysis of the Mechanical Behavior of the Nijdam Voice Prosthesis
Authors: Verkerke Gijsbertus J. , de Vries Martin P. , Schutte Harm K. , van den Hoogen Frank J.A. , Rakhorst Gerhard
Published: November 2003

The valveless Nijdam prosthesis is a new voice prosthesis for laryngectomized patients using tracheoesophageal speech. An “umbrella‐like hat” covers the esophageal side of the tracheoesophageal fistula and is deformed during speech by air pressure. To decrease pressure loss during speech, a good understanding of the mechanical behavior is essential. In the present study, the Finite Element Method (FEM), used in engineering to analyze the mechanical behavior of complex structures, was applied to analyze eight possible improvements of the Nijdam prosthesis. This study found that, during speech, deformation of hat and soft tissue occur. Distinct differences in the hat's deformation of the eight models also were found. It is concluded that complex structures like the Nijdam prosthesis can be analyzed by FEM. An optimal model was found to decrease pressure loss while stresses in the device remain safe.
The Physiologic Reservoir of Epstein‐Barr Virus Does Not Map to Upper Aerodigestive Tissues
Authors: Liavaag Per Gunnar , Cheung Roy K. , Kerrebijn Jeroen D.F. , Freeman Jeremy L. , Irish Jonathan C. , Dosch Hans‐Michael
Published: November 2003

The human Epstein‐Barr herpesvirus (EBV) has distinct oncogenic potential, but with over 90% of the adult world population infected, malignancy is a rare outcome of carrier status. However, EBV's association with over half of Hodgkin's and non‐Hodgkin's lymphomas as well as several solid tumors, notably nasopharyngeal carcinoma, makes EBV‐linked malignancies one of the largest single cancer entities. EBV is a B‐lymphotropic virus, well controlled by surveillant T cells in immunocompetent hosts. To determine the presence and site of principal virus reservoirs is a likely prerequisite for understanding the etiology of EBV‐associated tumors. Its near 100% association with nasopharyngeal carcinoma led to postulates that the upper aerodigestive tract tissue may be common sites of persistent latent or low‐grade replicating infection. Using a protocol designed to avoid viral crosscontamination, the authors employed polymerase chain reaction to detect genomic EBV DNA sequences in 231 biopsies from different mucosal sites in the upper aerodigestive tract, as well as from salivary gland tissue and neck nodes in individuals not suspected to have EBV‐related malignancy. Only two samples, one from oral cavity mucosa and one from parotid gland tissue, were positive for EBV. The observation that oropharyngeal tissue is not the principal EBV reservoir has mechanistic implications for the development of EBV‐positive tumors in that locale.
Nitric Oxide Synthase in the Innervation of the Human Nasal Mucosa: Correlation With Neuropeptides and Tyrosine Hydroxylase
Authors: Tasman Abel‐Jan , Bogatzki Beate , Heppt Werner , Hauser‐Kronberger Cornelia , Fischer Axel
Published: November 2003

Nitric oxide (NO) is a powerful mediator in the central and peripheral nervous system. In the present study the authors have examined the human nasal mucosa innervation for the presence of the neuronal isoform of the NO‐generating enzyme, NO‐synthase (NOS), and its correlation with other neuronal mediators and markers by means of double‐labeling immunohistochemistry. NOS‐immunoreactive nerve fibers were observed to be numerously present around glands and venous sinusoids and, less frequently, around small arteries and veins. Few fibers were seen in the lamina propria. NOS appeared to be frequently colocalized in nerve fibers with vasoactive intestinal peptide and, occasionally, with substance P and tyrosine hydroxylase, a marker for catecholamine biosynthesis. These findings suggest that neurally released NO is an important regulatory mediator of glandular secretion and blood flow in the nasal mucosa.
A Surgical Technique to Prevent Tracheostomal Stenosis After Laryngectomy
Authors: Vlantis Alex C. , Marres Henri A.M. , van den Hoogen Frank J.A.
Published: November 2003

Tracheostomal stenosis after total laryngectomy is a frequently occurring nuisance to both the patient and the surgeon. Although many causes may contribute to the development of tracheostomal stenosis, operative technique seems to play a major role. The authors describe and explain their method of stomal construction. Over a 10‐year period they have used the described method on 260 patients undergoing a total laryngectomy, with an incidence of tracheostomal stenosis of 6%.
Intelligibility and Perceptual Ratings After Treatment for Laryngeal Cancer: Laryngectomy Versus Radiotherapy
Authors: Finizia Caterina , Lindström Jörgen , Dotevall Hans
Published: November 2003

In Sweden the most common treatment for T3‐T4 laryngeal carcinoma is radical radiotherapy (with surgery for salvage), because the voice is thus preserved. A Swedish study showed that surgery yielded a significantly better 5‐year survival and locoregional control at 3 years in T4 laryngeal carcinoma than radical radiotherapy. With these results in mind, we wanted to compare the different modes of treatment (surgery with a tracheoesophageal [TE] fistula and radical radiotherapy) with respect to the patients' speech proficiency. Twenty‐eight subjects (with 14 patients in each treatment group) were judged by inexperienced and experienced listeners according to intelligibility by transcription and three perceptual ratings. From the perceptual ratings of speech intelligibility, voice quality, and speech acceptability we conclude that there is a significant difference, the irradiated speakers being rated higher than the tracheoesophageal speakers. It is also clear that most of the TE and irradiated laryngeal speaking patients are comparable to normal laryngeal speakers in intelligibility by transcription. Experienced and inexperienced listeners are able to rate TE and irradiated laryngeal speech reliably and similarly according to intelligibility by transcription. The inexperienced listeners rated the TE speakers significantly higher than did the experienced listeners.
Interleukin‐12 Gene Therapy Prevents Establishment of SCC VII Squamous Cell Carcinomas, Inhibits Tumor Growth, and Elicits Long‐term Antitumor Immunity in Syngeneic C3H Mice
Authors: Myers Jeffrey N. , Mank‐Seymour Amy , Zitvogel Laurence , Storkus Walter , Clarke Martha , Johnson Candace S. , Tahara Hideaki , Lotze Michael T.
Published: November 2003

Interleukin‐12 (IL‐12) is an immunostimulatory agent with very promising antitumor activity. Using a retroviral expression vector, the authors have successfully transduced the genes encoding the two subunits of murine IL‐12 to the squamous cell carcinoma cell line, SCC VII. Once IL‐12 gene transcription and protein production were successfully verified, IL‐12 expression was found to inhibit the establishment of SCC VII tumors in syngeneic C3H/HeJ mice inoculated with 1 × 106 SCC VII/IL‐12 viable tumor cells. Mice immunized in this manner and rechallenged with parent SCC VII were capable of rejecting tumor up to 40% of the time. Treatment of established SCC VII tumors with irradiated IL‐12‐producing tumors cells led to significant tumor regression in a high percentage of animals.
Hearing Screening in Jamaica
Authors: Lyn Charles , Jadusingh Winston A. , Ashman Hugh , Chen Donald , Abramson Allan , Soutar Iris
Published: November 2003

Hearing screening is well established in most developed countries, and the data extensively published. However, little information has been presented by the developing, nonwhite populations. A screening study was carried out on 2202 Jamaican children aged 5 to 7 years. This involved tympanometry and puretone audiometry (frequencies of 0.5, 1, and 2 kHz.) Failure was considered to have occurred if a type B or C curve was obtained or if the threshold of hearing was greater than 20 dB. These children were further evaluated by a full ear, nose, and throat examination, inclusive of pneumatic otoscopy, and audiologic testing. The prevalence of hearing impairment was 4.9%. Otitis media with effusion (OME) was present in 1.9%. The prevalence of OME in Jamaica is low when compared with that of the same age‐group in the developed countries.
Acute Sinusitis in the Rabbit Model: Histologic Analysis
Authors: Marks Steven C.
Published: November 2003

Objectives:Characterize the histology of the rhinogenic model of sinusitis and compare this with existing models of sinusitis.

Study Design:Prospective controlled trial in animals.

Methods:New Zealand white rabbits were implanted with a synthetic sponge, which was then impregnated withStreptococcus pneumoniaebacteria. After a specified time the animals were sacrificed, and whole‐mount sectioning of both the infected and noninfected sinuses was performed. The sinuses were carefully examined for evidence of inflammatory changes.

Results:This model produced a sinus infection that is characterized by luminal exudates of neutrophils and eosinophils, mucosal infiltration with lymphocytes and plasma cells, and epithelial degeneration. In addition, discrete lymphoid follicles were identified in both the implanted and nonimplanted sides that in the implanted sides appear to hypertrophy and liberate leukocytes into the sinus lumen. Other areas were observed where luminal exudates seem to act on and degrade mucosa that has little or no underlying inflammation. In severely infected sinuses submucosal vacuole formation with overlying granulation tissue was observed.

Conclusions:The rhinogenic model of sinusitis demonstrates features typical of other known models of sinusitis. In addition, there appear to be unique features of this model, specifically the identification of discrete lymphoid aggregates, which suggest that this model has the potential to be valuable for the study of the immune response of the sinuses.
Indications for Sinus Surgery: How Appropriate Are the Guidelines?
Authors: Piccirillo Jay F. , Thawley Stanley E. , Haiduk Andrea , Kramper Maggie , Wallace Mark , Hartman James M.
Published: November 2003

Sinusitis is the most commonly reported chronic disorder in America. More than 75,000 sinus surgical procedures were performed in 1993. Evaluating the appropriateness of procedures is a major focus of health care reform. The American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) collaborated with Value Health Sciences, Inc. (VHS) to develop guidelines for the use of sinus surgery. The clinical utility of these guidelines is presented. Patients undergoing sinus surgery at Barnes Hospital in St. Louis, Missouri, between November 1994 and July 1995 were eligible. Relevant patient information was used to prospectively rate surgery on the nine‐point VHS appropriateness scale (1 to 3, inappropriate; 4 to 6, equivocal; 7 to 9, appropriate). Of 55 patients, 37 (67%) had chronic sinusitis, 10 (18%) recurrent sinusitis, five (9%) chronic sinusitis with nasal polyps, and three (6%) sinusitis with moderate to severe asthma; 27 (49%) had previous sinus surgery. Appropriateness ratings ranged from 1 to 9, with nine (16%) procedures rated as inappropriate, 22 (40%) uncertain, and 24 (44%) appropriate. There were no significant differences in the ratings of appropriateness between the group of patients who had undergone previous sinus surgery and the group of patients who had not. Overall, the guidelines were easily applied and clinically pertinent.
Anthrapyrazoles and Interstitial Laser Phototherapy for Experimental Treatment of Squamous Cell Carcinoma
Authors: Graeber Ines P. , Paiva Marcos B. , Eshraghi Adrien A. , Suh Michael J. , Castro Dan J. , Saxton Romaine E.
Published: November 2003

Interstitial laser therapy (ILT) is an effective palliative treatment for advanced head and neck cancer, but recurrence often is seen at the margin. The objective of the current study was to test combined drug and laser therapy as an experimental approach for improved treatment of human squamous cell carcinoma (SCCA). Human SCCA tumor transplants were grown in nude mice and injected with the photosensitive anthrapyrazole CI‐941 before ILT. Intralesional drug injections alone at levels ranging from 60 to 1200 μg/gm of tumor induced a growth delay at the higher doses, but recurrence was seen in all 35 tumors tested. SCCA tumor transplants injected with 240 μg/gm CI‐941 followed after 4 hours by ILT with the KTP532 laser led to a complete response rate of 72% (21/29) compared with 45% (13/29) for ILT alone. Laser chemotherapy was a significant improvement compared with ILT when partial and complete responses were combined (P< 0.03). The results provide preclinical evidence that laser chemotherapy may become a useful minimally invasive treatment for advanced squamous cell carcinoma of the head and neck.
Structural Stability of the Rotary Door Myocutaneous Flap
Authors: Papay Frank A. , Eliachar Isaac , Stein Jeannine M. , Sebek Bruce A. , Ramirez Hector M. , Tucker Harvey M.
Published: November 2003

This canine study examines the structural stability of extensive laryngotracheal reconstruction with the sternohyoid myocutaneous rotary door flap (RDF) and modifications of the RDF with subdermal collagen and collagen hydroxyapatite matrix. The postre‐construction stability of the RDF and these modifications were tested and compared by measuring immediate postmortem airway stability during application of negative intraluminal pressures. Comparisons between controls and experimental specimens demonstrated that the RDF provides structural stability to secure airway patency under physiologic pressures. Biocompatible matrix adds further structural support in maintenance of the reconstructed lumen. This study validates that the RDF provides adequate rigid support for extensive laryngotracheal reconstruction without the requirement of skeletal support.
Correlation Between Ciliary Beat Frequency and the Structure of Ciliated Epithelia in Pathologic Human Nasal Mucosa
Authors: Joki Susanna , Toskala Elina , Saano Veijo , Nuutinen Juhani
Published: November 2003

The structure and function of ciliated epithelium were studied in 44 human nasal mucosa samples using a photoelectric method and scanning electron microscopy (SEM). The ciliary beat frequency (CBF) of cases with recurrent or chronic sinusitis was 9.1 ± 5.4 Hz. In eight of the samples (18.2%) no ciliary activity was detected. The amount of ciliated cells, the orientation of cilia, epithelial metaplasia, and secretion were found to be explanatory factors accounting for the decreased ciliary activity. Ciliary disorientation and a lack of ciliated cells in SEM correlated with low ciliary activity. In cases where sinusitis secretion was not seen, the CBF was slower than in cases with mucus or mucopurulent secretion. Sinusitis with disoriented cilia, a loss of ciliated cells, and a lack of mucosal secretion is associated with a decreased CBF. This may lead to impaired mucociliary clearance and increase the risk of recurrent and chronic sinusitis.