bluuebunny/crossref_metadata_2025 huggingface dataset:
The Significance of Immunohistochemically Demonstrated Nodal Micrometastases in Patients With Squamous Cell Carcinoma of the Head and Neck
Authors: Rhee Dukhee , Wenig Bruce M. , Smith Richard V.
Published: November 2003

Objectives/Hypothesis Patients with primary squamous cell carcinoma of the head and neck have a relatively high risk of occult lymph node metastases. Pathological demonstration of these metastases may be difficult, and the detection of such occult metastases may identify patients who are at an increased risk for early recurrence or reduced survival. Immunohistochemistry may be applied in the identification of occult metastases that may be missed on routine (H&E) histological examination. The aim of the study is to determine the prevalence and prognostic significance of immunohistochemically identified micrometastases in squamous cell carcinoma of the head and neck.

Study Design A retrospective analysis of neck dissection specimens having no evidence of metastatic disease.

Methods Lymph nodes from neck dissections performed on 10 patients with squamous cell carcinoma of the head and neck without conventional histological evidence of nodal metastases were subsequently stained for cytokeratins by the monoclonal antibody cocktail AE1/AE3 to detect micrometastases.

Results Occult micrometastases were found in the lymph nodes 5 of 10 patients examined. There was no association between the site of primary tumor, or T tage, and the presence of occult metastases. Three of five patients found to have occult metastases developed recurrence in the neck, whereas only one of five patients with no evidence of micrometastases had regional recurrence. There was no significant discrepancy in the patient survival rate.

Conclusions Metastatic tumor cells are frequently present in lymph nodes, even in patients without histological evidence of nodal metastases by conventional methods. The presence of micrometastases may identify patients at increased risk for recurrence and may indicate poorer prognosis. The true clinical significance of these occult metastases will be determined by a long‐term follow‐up.
Strategies for Prevention of Toxicity Caused by Platinum‐Based Chemotherapy: Review and Summary of the Annual Meeting of the Blood–Brain Barrier Disruption Program, Gleneden Beach, Oregon, March 10, 2001
Authors: Blakley Brian W. , Cohen James I. , Doolittle Nancy D. , Muldoon Leslie L. , Campbell K. C. , Dickey D. Thomas , Neuwelt Edward A.
Published: November 2003

Objectives To summarize the findings relevant to otolaryngology from the annual meeting of the Blood–Brain Barrier Disruption Consortium in Gleneden Beach, Oregon, March 10, 2001.

Study Design Summaries are provided by the speakers, as well as related data from the published literature. Findings in otology and oncology regarding ototoxicity that were discussed at the meeting are included.

Results Data considered included physiological research, animal studies, and clinical trials that relate to platinum‐based chemotherapy and prevention of toxicity.

Conclusions The dose‐limiting side effects of platinum‐based chemotherapy are preventable, but questions about the effect of the protective agents on oncological efficacy remain. Strategies for prevention of chemotherapy‐induced toxicity include temporal or anatomical separation of cisplatin or carboplatin from sodium thiosulfate, D‐methionine, or N‐acetyl‐cysteine. Clinical application of these methods has begun. The mechanisms presumably involve free radicals or drug conjugation, or both. Understanding the role of free radicals in medicine is likely to become important in the future.
Syndrome of Inappropriate Antidiuretic Hormone or Arginine Vasopressin Secretion in Patients Following Neck Dissection
Authors: Zacay Galia , Bedrin Lev , Horowitz Zeev , Peleg Michael , Yahalom Ran , Kronenberg Jona , Taicher Shlomo , Talmi Yoav P.
Published: November 2003

Objectives/Hypothesis The syndrome of inappropriate antidiuretic hormone or arginine vasopressin secretion (SIADH) is a disorder in which release of antidiuretic hormone is independent of plasma osmolarity, resulting in fluid retention and development of dilutional hyponatremia. The incidence of SIADH following neck dissection was found to be 18% to 30% in two separate reports. The incidence of SIADH in a cohort of patients who underwent neck dissection was prospectively studied.

Methods Eighty‐six patients were included in the study, along with a control group of 19 patients who underwent other neck procedures. Patient gender, age, physical condition (American Society of Anesthesiologists score), type of neck dissection, prior treatment, and smoking history were noted. Blood and urine osmolarity and sodium levels were sampled before surgery and during the first 24 hours after the surgery. These were recorded daily in cases with SIADH until the syndrome resolved.

Results The incidence of SIADH was only 1.15% in patients before surgery. The syndrome developed in seven patients following neck dissection (8.14%) and in none of the patients in the control group. SIADH resolved within 72 hours at the latest. No association was found with patient gender, age, physical condition, or type or laterality of neck dissection. A statistically significant connection between the syndrome and history of smoking was noted (P <.05), and it was more commonly seen in patients with node‐positive necks (P = .1231).

Conclusions SIADH following neck dissection may be less common than formerly reported. Previous studies have presented contradicting data concerning the influence of tumor recurrence or prior radiation therapy on its incidence. Our results indicate no such association. A statistically significant connection between smoking and the syndrome was found. No clinical symptoms developed in the patients with SIADH, but it seems prudent to suggest limiting fluid intake in the first postoperative 24 hours for patients following neck dissection.
Integrins in Head and Neck Squamous Cell Carcinoma Invasion
Authors: Dyce Orville H. , Ziober Amy F. , Weber Randal S. , Miyazaki Kaoru , Khariwala Samir S. , Feldman Michael , Ziober Barry L.
Published: November 2003

Objective To relate the invasive properties of different squamous cell cancer cell lines to the function and expression of the integrins.

Study Design A series of in vitro and in vivo experiments were designed to assess and compare integrin expression and function in two different head and neck squamous cell carcinoma cell lines.

Methods Invasive properties of two squamous cell carcinoma cell lines (UM‐SCC‐1 and JHU‐022‐SCC) were assessed using an in vitro artificial matrix assay as well as an in vivo system with orthotopically implanted tumor cells in mice. Whole cell and surface expression levels of integrin subunits (alpha2, alpha3, alpha5, alpha6, beta1, and beta4) were determined for each cell line using Western blot analysis and flow cytometry. We compared the ability of JHU‐022‐SCC and UM‐SCC‐1 cells to bind the extracellular matrix elements collagen IV, fibronectin, laminin 5, and laminin10 using an in vitro adhesion assay. Contributions of the different integrins to the adhesive properties were determined by selective antibody blocking of different subunits.

Results The UM‐SCC‐1 cell line is 50% more invasive in vitro and displays a greater propensity for perineural and lymphatic invasion in vivo. The UM‐SCC‐1 cells exhibited greater adherence to fibronectin than JHU‐022‐SCC cells. Alpha6 and beta4 expression is approximately twofold greater in the JHU‐022‐SCC cells. Alpha2, alpha3, and beta1 expression appears to be upregulated in UM‐SCC‐1 cells.

Conclusion The UM‐SCC‐1 carcinoma cells are more invasive than JHU‐022‐SCC cells and may be related to differential expression of the integrins alpha6beta4, alpha3beta1, and alpha2beta1.
Inhibition of the c‐Jun N‐Terminal Kinase Signaling Pathway Influences Neurite Outgrowth of Spiral Ganglion Neurons In Vitro
Authors: Bodmer Daniel , Gloddek Bertrand , Ryan Allen F. , Huverstuhl Jochen , Brors Dominik
Published: November 2003

Objectives Inhibitors of the c‐Jun N‐terminal kinase (JNK) signaling pathway have been demonstrated to protect hair cells of the auditory system and different types of neurons from various insults, and their use for future therapeutic applications has been proposed. In the study, we evaluated the effects of inhibition of the JNK pathway on process outgrowth from spiral ganglion neurons.

Methods Spiral ganglion explants from rats (postnatal days 3–5) that were cultured on laminin were treated with neurotrophin‐3 and/or the JNK signaling pathway inhibitor CEP‐11004. Both neurite length and number of the explants were evaluated and statistically analyzed by analysis of variance.

Results Inhibition of the JNK signaling pathway reduced process outgrowth from spiral ganglion explants. The reduction, both in length and number of neurites, was reversed by the application of neurotrophin‐3.

Conclusions The results indicate that an intact JNK signaling pathway is important for process outgrowth of spiral ganglion neurons. However, neurotrophin‐3 stimulates process extension by a JNK independent pathway. Our results demonstrate that inhibition of the JNK pathway can have adverse effects on the extension of spiral ganglion neurons, but that the negative effects can be ameliorated by appropriate treatment.
Impact of Unilateral Sinus Surgery With Resection of the Turbinates by Means of Midfacial Degloving on Nasal Air Conditioning
Authors: Lindemann Jörg , Leiacker Richard , Sikora Thomas , Rettinger Gerhard , Keck Tilman
Published: November 2003

Objective/Hypothesis One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air.

Study Design Retrospective study.

Methods Humidity and temperature were measured in the nasopharynx during normal respiration by means of a miniaturized thermocouple device and a humidity sensor for continuous detection. Eight patients after prior unilateral sinus surgery by means of midfacial degloving for a one‐sided inverted papilloma were enrolled into the study. The humidity and temperature data of the surgically treated side were compared to the values of the healthy side that was not surgically treated. Active anterior rhinomanometry and acoustic rhinometry were performed.

Results At the end of inspiration, absolute humidity and temperature values in the nasopharynx were statistically significantly lower on the surgically treated side compared with the side that was not surgically treated.

Conclusions Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity. Reduced absolute humidity and temperature may contribute to crusting, bleeding, and nasal dryness as frequent complaints of patients after aggressive sinus surgery with resection of the turbinates.
Determining the Site of Airway Obstruction in Obstructive Sleep Apnea With Airway Pressure Measurements During Sleep
Authors: Demin Han , Jingying Ye , Qingwen Wang Jun Yang , Yuhua Lin , Jiangyong Wang
Published: November 2003

Objective To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG).

Method Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid‐state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern.

Result 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue–pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue–pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05).

Conclusion UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.
Cross‐Linked Hyaluronan Used as Augmentation Substance for Treatment of Glottal Insufficiency: Safety Aspects and Vocal Fold Function
Authors: Hertegård Stellan , Hallén Lars , Laurent Claude , Lindström Elisabeth , Olofsson Katarina , Testad Per , Dahlqvist Åke
Published: November 2003

Objective To examine safety aspects and vocal fold function after vocal fold augmentation with a cross‐linked hyaluronan derivative (hylan B gel) as compared with bovine collagen.

Study Design A prospective, randomized trial.

Methods Eighty‐three patients with glottal insufficiency were treated with injection augmentation with hylan B gel and bovine collagen and were examined at 1, 6, and 12 months after treatment. Seventy patients with unilateral vocal fold paresis (n = 35) or atrophy (n = 35) were randomly assigned to receive either hylan B gel (n = 47) or collagen (n = 23) injections into one vocal fold. Thirteen patients with glottal insufficiency caused by scar defects or paresis resulting from malignant disease were included in a nonrandomized group and were treated only with hylan B gel. Evaluations were made from patients' subjective ratings (visual analogue scales), digitized videostroboscopic measurements, phonetograms, maximum phonation time, and phonation quotients.

Results Twelve months after injections, the patients' self‐ratings were significantly improved for both the hylan B gel and the collagen groups. In addition, the videostroboscopic measurements showed significantly improved glottal closure for both groups. However, for the hylan B gel group, vibration amplitude and glottal area variations were preserved, and this group showed significantly less resorption at the injected vocal fold edge. Furthermore, maximum phonation time had increased significantly for the hylan B gel patients (collagen, nonsignificant). No serious adverse events were observed; three patients injected with hylan B gel had temporary inflammation at the injection site, which resolved without sequelae.

Conclusions The results showed that both hylan B gel and collagen can be safely used for injection treatment of glottal insufficiency. Both treatments resulted in significantly improved voice as rated by the patients. However, the patients treated with hylan B gel showed better vocal fold status and longer maximum phonation time at 12 months after treatment as compared with patients treated with collagen.
Auditory Late Cortical Response and Speech Recognition in Digisonic Cochlear Implant Users
Authors: Maurer Jan , Collet L. , Pelster H. , Truy E. , Gallégo S.
Published: November 2003

Objective The purpose of the study was to test for differences in late electrically evoked auditory potentials between subjects exhibiting “good” versus “poor” speech recognition performances with their cochlear implants.

Methods Late auditory evoked responses were measured in 30 subjects equipped with the Digisonic (MXM, Antibes, France) cochlear implant, 15 of whom had “good” speech recognition scores (i.e., more than 89% correct phoneme identification without lip reading). The 15 other subjects had poorer speech recognition scores (i.e., less than 85%).

Results Differences in N1P2 amplitude, as well as P1, N1, and P2 latencies, and N1‐P1 and N1‐P2 latency intervals were tested. Wave P2 latency was found to be significantly different between the two groups (P = .016), being shorter in “good” than in “poor” performers. The strength of the statistical relationship between electrophysiological and speech recognition variables (r2 = 17%) was substantially smaller than that observed using electrically evoked auditory brainstem response (EABR) for the same implanted device (r2 = 49% for the EABR wave III–V latency interval).

Conclusions Some characteristics of late electrically evoked auditory potentials differ significantly among cochlear implant users depending on their speech recognition performance. However, the relationship between electrophysiological and speech recognition variables is more pronounced when early (brainstem) rather than late (cortical) evoked responses are considered.
Regular Tracheostomy Tube Changes to Prevent Formation of Granulation Tissue
Authors: Yaremchuk Kathleen
Published: November 2003

Objectives/Hypothesis Tracheostomy is a commonly performed operative procedure that has been described since 2000 b.c. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long‐term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support.

Study Design The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques.

Methods A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention.

Results The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P = .02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes.

Conclusions A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications.
Laryngotracheal Injury After Percutaneous Dilational Tracheostomy in Cadaver Specimens
Authors: Hotchkiss Karin S. , McCaffrey Judith Czaja
Published: November 2003

Objective To evaluate the stoma and surrounding insertion site for common laryngotracheal injury patterns after percutaneous dilational tracheostomy that may contribute to clinically significant tracheal stenosis.

Study Design Preliminary prospective cadaver study.

Methods A preliminary prospective cadaver study was performed in which percutaneous dilational tracheostomy (Ciaglia Blue Rhino kit) was placed in six fixed cadaveric specimens. Laryngotracheal segments were harvested. Two independent evaluators graded cadaver features and characteristic injuries in laryngotracheal specimens the tracheal site of stoma placement was identified. Cadaver features evaluated included gender, obesity, and ease of landmark identification. Mucosal and cartilage injuries were evaluated on a scale of 0 to 4, with 4 representing severe comminuted injuries beyond the intended stoma site.

Results Accurate prediction of tracheal placement was achieved in only three (50%) of the specimens. In the remaining cadavers, one stoma site was placed higher than intended (16%) and two sites were lower than intended (33%). Mucosal injury was most severe at the anterior internal surface of the trachea with all specimens sustaining tears beyond one tracheal ring (mean mucosal injury score, 3.5). Cartilaginous injury was severe in five of six specimens (83%) that sustained multiple comminuted injuries to two or more adjacent rings (mean cartilage injury score, 3.34). Cricoid comminutions and a posterior membranous tracheal wall injury were each found in one specimen.

Conclusions Laryngotracheal injuries found after percutaneous dilational tracheostomy in the study indicated that severe damage to mucosa and cartilage surrounding the intended stoma site occurs at the time of placement. These injuries may contribute to clinically significant tracheal stenosis preventing decannulation in patients undergoing percutaneous dilational tracheostomy. Two case studies that support this hypothesis are also presented.
The Safety of Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in an Outpatient Otolaryngology Setting
Authors: Cohen Manderly A. , Setzen Michael , Perlman Philip W. , Ditkoff Michael , Mattucci Kenneth F. , Guss Joel
Published: November 2003

Objective To study the safety of flexible endoscopic evaluation of swallowing with sensory testing in a private otolaryngology office setting.

Study Design Five parameters were prospectively evaluated. These included airway compromise, epistaxis, change in heart rate, level of discomfort, and patient's willingness to repeat the examination in the future.

Methods All persons undergoing flexible endoscopic evaluation of swallowing with sensory testing between July 1, 1999, and June 30, 2001, were prospectively evaluated. A flexible fiberoptic endoscope with a specially designed air port channel was passed transnasally (without topical anesthesia or nasal constriction) into the more patent nostril. Nasopharyngeal and laryngeal anatomy were first evaluated. Laryngopharyngeal sensory and motor function were then assessed, followed by a comprehensive swallowing evaluation. Five test parameters were examined during each study. Descriptive statistics were calculated.

Results Three hundred forty‐nine consecutive examinations in 305 adult patients with dysphagia were performed during the study period. Mild epistaxis occurred in four patients (1.1%). There were no episodes of airway obstruction or laryngospasm. There was no statistically significant difference between the average pretest and post‐test heart rates; no patients became symptomatically bradycardic or tachycardic. The discomfort ratings were as follows: 44 patients (12.6%) rated the overall discomfort of the test as none, 169 (48.4%) thought it was mild, 110 (31.5%) described moderate discomfort, and 26 (7.5%) said it was severe. Three hundred forty‐two (98%) of the patients would repeat the test in the future; seven patients (2%) said that they would not.

Conclusions Flexible endoscopic evaluation of swallowing with sensory testing is a safe, well‐tolerated procedure to objectively evaluate patients with dysphagia when performed by an experienced speech‐language pathologist with an otolaryngologist in attendance in an outpatient office setting.
Electrocochleography and Intranasal Allergen Challenge as Investigational Tools in Patients With Inhalant Allergy and Ménière's Disease
Authors: Eaton Debbie A. , Roland Peter S. , Mabry Richard L. , Shoup Angela G.
Published: November 2003

Objectives To expand on a prior study investigating the relation between inhalant allergy and Ménière's disease using electrocochleography and to present data from five patients heretofore unmentioned in previous reports.

Study Design Prospective study of five patients identified with Ménière's disease and inhalant allergy in the practices of two faculty otolaryngologists.

Methods Patients were tested twice using electrocochleography: once as a baseline and again 20 minutes following intranasal challenge with the allergen to which they were most sensitive.

Results Three patients had no prior history of immunotherapy, and all were found to have a >15% increase in summating potential (SP)/action potential (AP) ratio after antigen challenge. However, only one of these patients developed audiovestibular symptoms. Two patients had a history of immunotherapy. One of these patients was tested using three different antigens to which she was highly sensitive on skin testing, one of which provoked audiovestibular symptoms on environmental exposure. Postchallenge electrocochleography, however, demonstrated normal SP/AP ratios with only one antigen causing a >15% increase. The other patient had elevated SP/AP ratios both before and after challenge and developed no audiovestibular symptoms despite a >15% increase.

Conclusions Previous work using this investigational tool has identified that all patients with a normal electrocochleography were asymptomatic from an audiovestibular standpoint at the time of postchallenge testing. An elevated SP/AP was not reliably correlated with audiovestibular symptoms in this group of patients. Further investigation in this area will examine the utility of using the variability of the SP and AP to predict audiovestibular symptoms.
Facial Fractures and Concomitant Injuries in Trauma Patients
Authors: Alvi Aijaz , Doherty Taylor , Lewen Gregory
Published: November 2003

Objectives/Hypothesis Maxillofacial fractures often occur with serious concomitant injury in trauma patients, and knowledge of the type and severity of associated injuries can assist in rapid assessment and treatment. The objective was to identify the most commonly occurring injuries associated with facial fractures in severely injured trauma patients.

Study Design Review of medical records.

Methods A retrospective review was made of 151 patients with facial fractures presenting to a level‐one trauma center over a 4‐year span. All patients had an injury severity score of 12 or greater. Chart data recorded included demographics, etiology, presentation, facial fracture site, concomitant injury, imaging studies, hospital stay and course, interventions, and outcome.

Results The most common cause or origin of facial fracture was assault (41%), followed by motor vehicle accident (26.5%). Orbital fracture was the most common overall facial fracture (24.2%), with nasal fractures being the most common isolated fracture (23.2%). Cerebral hematoma occurred in 43.7% of patients, with subdural hematoma being the most frequent. Pulmonary injury was the second most commonly associated injury (31.1%) with lung contusion being the most frequent. Seventy‐two patients (42%) required intubation, and 22 (14.8%) required tracheostomy during their hospital stay. The hospital complication rate was 50.3% and included primarily pulmonary complications, septicemia, renal failure, and severe anemia. Thirteen patients died during their hospital stay; 11 of them died of neurologic injuries, 1 of pulmonary failure, and 1 of overwhelming sepsis.

Conclusions Cerebral and pulmonary injuries are often associated with maxillofacial fractures in severely injured trauma patients. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of patients with facial fractures.
Paranasal Sinus Development: A Radiographic Study
Authors: Shah Rahul K. , Dhingra Jagdish K. , Carter Barbara L. , Rebeiz Elie E.
Published: November 2003

Objective To demonstrate the development of the paranasal sinuses in a pediatric population by computed tomography scans.

Study Design Radiology records at a tertiary care institution were reviewed for the computed tomography scans of the face, orbit, or paranasal sinuses in patients aged 0 to 12 years.

Methods Computed tomography scans were reviewed by a head and neck radiologist and otolaryngologist for the development of the frontal, maxillary, ethmoid, and sphenoid sinuses. The size of the pneumatized paranasal sinuses was measured in two planes and graded on a scale of 0 to 3. Ossification of the maxillary crest and vomer, obliteration of the foramen cecum, and development of agger nasi cells, Haller cells, and the superior turbinate were studied. Patients with syndromes, nasal stenosis, choanal atresia, or cystic fibrosis were excluded from the study.

Results In all, 91 computed tomography scans in 66 patients were studied. Serial development could be followed in 16 patients who underwent repeat scans. Patients were divided into six age cohorts based on their age at the time of the scan: 0 to 3 months (10%), 3 to 12 months (13%), 1 to 3 years (13%), 3 to 5 years (20%), 5 to 8 years (29%), and 8 to 12 years (16%). Ethmoid sinuses were the first to fully develop, followed sequentially by maxillary, sphenoid, and frontal sinuses. Each sinus has a rapid rate of development during specified age cohorts.

Conclusion The results will aid the physician when correlating the clinical and radiographic findings of pediatric patients aged 0 to 12 years who are being evaluated for sinus disease and potential surgical intervention.
Laryngopharyngeal Dysfunction From the Implant Vagal Nerve Stimulator
Authors: Zalvan Craig , Sulica Lucian , Wolf Steven , Cohen Jeffrey , Gonzalez‐Yanes Omar , Blitzer Andrew
Published: November 2003

Objectives/Hypothesis The objective of the study was to examine the side‐effect profile of the vagal nerve stimulator. Vagal nerve stimulators have been used to treat intractable seizures in all age groups. They provide relief to the patient with a seizure disorder by decreasing the overall number and severity of seizure activities. Although significant complications are rare, many patients have some complaint, usually of their voice.

Study Design A retrospective evaluation of four patients with intractable epilepsy.

Methods Evaluation of charts and medical records and endoscopic examination of the larynx.

Results In this small series, all four patients had implantation‐related paresis. Three of the four appear to have side effects from device activation.

Conclusions Patients in whom a vagal nerve stimulator is placed can have adverse side effects. These can be related to the surgical manipulation of the vagus nerve, resulting in a temporary paresis of the vocal folds. A second set of side effects is related to the actual electrical stimulation of the device, and these side effects can directly affect the laryngeal musculature.
Choanal Atresia: A Twenty‐Year Review of Medical Comorbidities and Surgical Outcomes
Authors: Samadi Daniel S. , Shah Udayan K. , Handler Steven D.
Published: November 2003

ObjectiveTo review medical comorbid conditions and surgical outcomes for children treated for choanal atresia (CA).

Study DesignRetrospective review (1979–1998).

MethodsParticipants included 78 children, aged newborn to 18 years, in the setting of an academic pediatric hospital. Main outcome measures were type and number of procedures and airway patency.

ResultsSeventy‐eight children (48 female and 30 male patients) were treated and followed for CA, with an average follow‐up of 35 months. Thirty‐five children (45%) had unilateral CA, and 43 children (55%) had bilateral CA. There was no statistically significant sex difference between unilateral and bilateral CA. Concomitant medical problems were common, mostly otitis media with effusion (32%), upper and lower airway diseases (32% and 23%, respectively), cardiac anomalies (19%), and gastrointestinal tract disorders (18%). Statistically significant correlations were found for bilateral CA and cardiac disorders (P= .04), CHARGE syndrome (P= .002), obstructive sleep apnea (P= .003), hematological problems (P= .001), and prematurity or failure to thrive (P= .006). Surgery was effective in establishing a patent airway in all cases. Average ages at first surgery were 25.2 months for unilateral and 2.4 months for bilateral CA. Unilateral CA required, on average, 2.7 total procedures, including dilation and removal of stents, compared with bilateral CA, which required 4.9 procedures. Nearly all children underwent correction by means of the transnasal approach.

ConclusionsTo the knowledge of the authors, the present report encompasses the largest series of children treated for CA. The high incidence of comorbid conditions mandates thorough medical evaluation, particularly for otological, airway, cardiac, and gastrointestinal tract diseases.
Value of Acoustic Rhinometry for Measuring Nasal Valve Area
Authors: Çakmak Özcan , Coşkun Mehmet , Çelik Hüseyin , Büyüklü Fuat , Özlüoğlu Levent Naci
Published: November 2003

Objective To assess the validity of acoustic rhinometry for measuring nasal valve area in human subjects.

Study Design A comprehensive study that compared acoustic rhinometry data with computed tomography findings from scans obtained perpendicular to the acoustic axis and perpendicular to the floor of the nose.

Methods Fifty nasal passages of 25 healthy adults with no nasal disease were examined by acoustic rhinometry and computed tomography. In each case, the area of the nasal valve as measured by acoustic rhinometry was compared with the area calculations from computed tomography sections taken in two different coronal planes, one perpendicular to the acoustic axis and one perpendicular to the floor of the nose. Computed tomography slices perpendicular to the floor of the nose were obtained at two different locations, a specific distance from the tip of the nose and a specific distance from the anterior nasal spine.

Results There was a significant correlation between the nasal valve areas determined by acoustic rhinometry and computed tomography when imaging was obtained perpendicular to the acoustic axis. In contrast, when scanning was obtained perpendicular to the straight axis of the floor of the nose, the correlations between the acoustic rhinometry and computed tomography data were weak.

Conclusions When any type of imaging is used for comparison with nasal valve areas determined by acoustic rhinometry, the cross‐sections should be perpendicular to the acoustic pathway. The results of the study show that acoustic rhinometry is a valuable method for measuring nasal valve area.
The Chemotactic Behavior of Eosinophils in Patients With Chronic Rhinosinusitis
Authors: Wei Julie L. , Kita Hirohito , Sherris David A. , Kern Eugene B. , Weaver Amy , Ponikau Jens U.
Published: November 2003

Objective To characterize peripheral eosinophil migration in patients with chronic rhinosinusitis in the presence of nasal mucin and nasal tissue extracts.

Study Design Prospective, controlled, ex‐vivo.

Methods Peripheral blood eosinophils, nasal mucin, and nasal tissue were harvested at the time of sinus surgery in 10 patients, as well as obtained in 10 healthy control subjects. Extracts were prepared from nasal mucin and nasal tissue. A modified Boyden chamber was used to study eosinophil migration from both patients and healthy control subjects in the presence of both extracts.

Results Patients with chronic rhinosinusitis and all healthy control subjects demonstrated a concentration‐dependent increased migration of eosinophils in the presence of both nasal mucin and nasal tissue extracts. The percentage of migration was consistently higher for eosinophils from patients with chronic rhinosinusitis compared with control subjects. The difference attained statistical significance in the presence of 50% tissue extract (median percentage of migration, 23.3% vs. 7.8% [P = .033]).

Conclusions Nasal mucin and nasal tissue in chronic rhinosinusitis contains chemoattractants, which can induce active eosinophil migration. The eosinophil migration from patients with chronic rhinosinusitis was consistently higher compared with eosinophils from healthy control subjects. Because the eosinophils were obtained from the peripheral blood, this finding suggests activation of eosinophils in the systemic circulation in chronic rhinosinusitis.
Gentamicin Tympanoclysis: Effects on the Labyrinthine Sensory Cells
Authors: Pender Daniel J.
Published: November 2003

Objectives The objective of the study was to determine whether a selective vestibular hair cell toxicity with sparing of the cochlear hair cells could be achieved by infusing different concentrations of gentamicin into the middle ears of adult cats.

Study Design Prospective experimental animal study treating only the left ear of each cat, the right ear serving as individual control.

Methods Gentamicin solution at concentrations of either 30 or 3 mg/mL was infused daily into the left middle ear of adult cats until overt ataxia occurred. After 1 month or 6 months, each cat was killed and its temporal bones prepared for optical microscopy.

Results Animals treated with 30 mg/mL gentamicin until ataxic required a median of five daily doses. These animals had clear‐cut cochlear basal turn hair cell losses accompanying toxic lesions in the utricle and cristae. In contrast, animals treated with 3 mg/mL gentamicin until ataxic required an average of 19 daily doses. These animals had lesions restricted to the utricle and cristae with sparing of the cochlea hair cells. Animals that failed to develop ataxia manifested neither lesions of the cochlear nor vestibular hair cells.

Conclusion Gentamicin tympanoclysis in the cat animal model, using a dilute solution and continued once daily until clinical ataxia occurs, is capable of producing selective vestibular hair cell toxicity while sparing cochlea hair cells.
Laryngopharyngeal Reflux Identified Using a New Catheter Design: Defining Normal Values and Excluding Artifacts
Authors: Maldonado Anastasia , Diederich Linda , Castell Donald O. , Gideon R. M. , Katz Philip O.
Published: November 2003

Objective To define normal values for laryngopharyngeal reflux using an improved catheter design with adjustable electrode placement for pH monitoring.

Study Design Cohort study of normal volunteers.

Methods The setting was an institutional‐based gastroenterology practice. Subjects included 20 healthy volunteers with no history of laryngeal, pharyngeal, or reflux symptoms. These included 10 men and 10 women (mean age, 33 y; age range, 26–49 y). Ambulatory 24‐hour triple‐electrode monitoring of pH in distal esophagus, proximal esophagus, and pharynx using new bifurcated probe was performed. The distal electrode was placed 5 cm above the lower esophageal sphincter, with the proximal two electrodes straddling the upper sphincter. The main outcome measure was the number of true pharyngeal reflux episodes.

Results Sixteen of 20 subjects had no episodes, and 2 subjects had only one episode of pharyngeal reflux. The two subjects exceeding this value (8 and 15 episodes, respectively) had abnormal distal and proximal esophageal reflux. Artifacts for pharyngeal reflux due to acidic meals or “pseudoreflux” were excluded. Subject tolerance of this new probe was excellent.

Conclusion The triple‐electrode bifurcated adjustable pH probe provides a well‐tolerated technique to identify true hypopharyngeal acid reflux episodes. When artifacts produced by meals and pseudoreflux are excluded, 90% of normal subjects show no episodes or a single episode over a 24‐hour period.
A Matched Survival Analysis for Squamous Cell Carcinoma of the Head and Neck in the Elderly
Authors: Bhattacharyya Neil
Published: November 2003

Objective To determine whether elderly patients manifest poorer survivals for head and neck squamous cell carcinoma.

Methods Cases of squamous cell carcinoma of the glottic larynx, oral tongue, and tonsil were extracted from the Surveillance, Epidemiology and End Results database for 1988 to 1998. For each primary site, patients were segregated into two age groups: 50 to 69 years of age and 70 years of age and older. For each case in the latter, elderly group, a reference group case was randomly matched for gender, year of diagnosis, cancer stage, extent of surgery, and radiation therapy. Overall survival and disease‐specific survival were compared between the two groups with stage stratification with the Kaplan‐Meier method.

Results Cases of glottic carcinoma (1882), tongue carcinoma (426), and tonsillar carcinoma (200) in elderly patients were matched to the reference group. Overall mean survival differences were significant for glottic carcinoma (73.9 vs. 96.7 mo, elderly and younger groups, respectively) (P <.001) and tongue carcinoma (59.5 vs. 73.1 mo) (P = .002) but not for tonsillar carcinoma (46.0 vs. 54.4 mo) (P = .220). Disease‐specific survival differences were significant but small in magnitude for glottic carcinoma (105.9 vs. 114.1 mo, respectively (P <.001) and tongue carcinoma (81.6 vs. 93.6 mo) (P = .009) but not for tonsillar carcinoma (71.5 vs. 70.7 mo) (P = .422). However, after stage stratification, elderly patients often did not exhibit statistically or practically significant poorer overall or disease‐specific survivals.

Conclusions Elderly patients do not necessarily exhibit clinically significant poorer survivals for head and neck squamous cell carcinoma. Age alone should not be used to determine treatment options for elderly patients with squamous cell carcinoma.
Total Glossectomy Without Laryngectomy as First‐Line or Salvage Therapy
Authors: Barry Béatrix , Baujat Bertrand , Albert Sébastien , Nallet Emmanuel , Depondt Joël , Guedon Charles , Gehanno Pierre
Published: November 2003

Objectives/Hypothesis Advanced carcinoma of the tongue can require total glossectomy. Although radiation therapy is of limited efficacy in T3 and T4 tumors involving the base of the tongue, many surgeons are reluctant to suggest highly mutilating surgery.

Study Design Retrospective cohort study.

Methods We compared early postoperative complications, hospital stay duration, function, and oncological outcomes in patients who underwent total glossectomy without laryngectomy as first‐line or salvage therapy.

Results Postoperative course and functional outcomes were similar in the two groups. Overall survival was 32% at 3 years and 21% at 5 years. The risk factors for shorter survival were positive margins of resection (P = .002) and tumor spread into the mandible (P = .04). Salvage surgery was not associated with significantly lower survival (P = .09 [NS]).

Conclusions Postoperative morbidity and functional outcomes are similar after first‐line and salvage total glossectomy without laryngectomy. Local tumor control is the main factor influencing survival.
The Anatomical Basis for Mandibulotomy: Midline Versus Paramidline
Authors: Pan Whei‐Lin , Hao Sheng‐Po , Lin Yaoh‐Shiang , Chang Kai‐Ping , Su Jen‐Liang
Published: November 2003

ObjectiveTo provide an anatomical basis for mandibulotomy.

Study DesignProspective.

MethodsThe angles between the long axis of the two mandibular central incisors and between the lateral incisor and canine and the corresponding root length were measured in panoramic films of 50 Taiwanese patients who had oral or oropharyngeal carcinomas.

ResultsThe angle and horizontal distance between the mandibular lateral incisor and canine were significantly wider than between the two central incisors. The root length of the canine measured 16 mm on average.

ConclusionsParamidline mandibulotomy, which cuts through a wider space between the lateral incisor and canine, preserves dentition and the genioglossus and geniohyoid muscles. It appears to be a more preferable approach than midline mandibulotomy.
Potential Biomarkers for Head and Neck Squamous Cell Carcinoma
Authors: Brown Jimmy J. , Xu Helen , Nishitani Junko , Mohammed Hezla , Osborne Ryan , Teklehaimanot Senait , Gill Gus , Liu Xuan
Published: November 2003

Objective The purpose of the study was twofold: 1) to search for potential biomarkers that were overexpressed in cell lines that could represent both a clinical premalignant (immortalized) and a malignant state, and 2) to attempt to correlate metallothionein gene expression with clinical outcome in laryngeal carcinoma.

Study Design A series of in vitro experiments were used to unearth differentially expressed genes among normal, immortalized and tumorigenic cell lines. Secondarily, a retrospective analysis was undertaken.

Methods Differential display analysis was conducted to identify differentially expressed genes between human papillomavirus–infected immortalized HOK16B and benzo[a]pyrene–derived tumorigenic cell line, HOK16B‐BaP‐T. The cell‐specific expressions were examined by Northern blot analysis and compared with other known immortalized and cancer cell lines. Immunohistochemical staining was also conducted to localize metallothionein (MT I/II) protein expression among the different cell lines studied. A retrospective analysis of laryngeal specimens from archival tissues of 29 cancer patients who underwent primary surgical resection was also undertaken after immunohistochemical staining.

Results Twenty‐one differentially expressed complementary cDNA clones, both novel and known, were identified using the differential display analysis. Northern blot analysis confirmed that clone 6 hybridized to a 1.6‐kb RNA in HOK16B‐Bap‐T cell line. Clone 4 showed decreased expression in immortalized and cancer cell compared with NHOK. MT I/II transcript was observed in HOK16B, which was further elevated in HOK16B‐Bap‐T. Retrospective analysis showed that high immunoreactivity to MT I/II in surgically resected laryngeal cancer specimen correlated with increased frequency of recurrence within 2 years of surgery.

Conclusion These findings suggest that clone 4 may potentially function as a tumor suppressor gene, which may be significant in tumor progression and invasion. Clone 6 may participate in viral‐mediated oncogenic transformation of normal cells. Clone 6 may also have potential as a tumor maker differentiating normal from malignant tissue, as in the determination of surgical resection margins. MT I/II gene product may serve as a prognostic biomarker for laryngeal squamous cell carcinoma. The differentially expressed genes and gene products may serve as sensitive biomarkers for improved early detection, diagnosis, and prognosis of head and neck squamous cell carcinoma.
Subglottic Laryngeal Paraganglioma
Authors: Maisel Robert , Schmidt Derek , Pambuccian Stefan
Published: November 2003

Objectives To review the clinical and pathological picture of laryngeal paragangliomas and compare laryngeal paragangliomas with the three other types of laryngeal neuroendocrine neoplasms.

Study Design The study presents a case review of a patient with a subglottic laryngeal paraganglioma treated at our institution, with a literature review of the laryngeal neuroendocrine neoplasms. Included is a review of all four neuroendocrine neoplasms, taking a close look at a comparison between laryngeal paragangliomas and atypical carcinoids tumors. All cases of subglottic laryngeal paragangliomas reported in the literature were also compiled and tabulated.

Methods The patient's record was reviewed for age, symptomatology, workup, and surgical procedures performed.

Results The patient was disease free 36 months after undergoing a tracheostomy for airway control, followed by a cricoid split for complete excision of the tumor.

Conclusions It is important to differentiate among the four laryngeal neuroendocrine neoplasms, especially between atypical carcinoids and paragangliomas. Each tumor requires different treatments, with the former requiring a more aggressive approach. Paragangliomas must be completely excised to prevent their recurrence, and this approach should be considered a curative treatment. In addition, the immunohistochemical battery is of paramount importance in obtaining the correct pathological diagnosis.