bluuebunny/crossref_metadata_2025 huggingface dataset:
Squamous cell carcinoma arising in inverted papilloma
Authors: Lesperance Marci M. , Esclamado Ramon M.
Published: October 2006

A retrospective review of all cases of inverted papilloma at the University of Michigan from 1975 to 1992 revealed 51 cases of inverted papilloma. Of these, 14 (27%) had an associated squamous cell carcinoma (SCC). Eight (16%) were metachronous and 6 (11%) were synchronous. At a mean follow‐up of 53 months, the disease‐free survival of patients with carcinoma limited to the nasal cavity and paranasal sinuses was 57% (4/7) compared to 14% (1/7) of those patients presenting with disease extending beyond the nasal cavity and paranasal sinuses. The data also support the lateral rhinotomy approach with medial maxillectomy and ethmoidectomy as a minimum procedure followed by postoperative radiation therapy. The mean interval between the diagnosis of inverted papilloma and development of SCC was 63 months (range, 6 months to 13 years). Therefore, long‐term follow‐up with clinical examination and computed tomography (CT) scan is indicated for all patients with inverted papilloma.
Hearing preservation in acoustic tumor surgery: Results and prognostic factors
Authors: Dornhoffer J. L. , Helms J. , Hoehmann D. H.
Published: October 2006

A retrospective study was conducted to assess the hearing results in patients who underwent acoustic neuroma removal via the middle fossa approach. A statistical correlation of results with preoperative clinical and audiological data determined if any prognostic indicators could be associated with successful hearing preservation. Of 93 patients included in the study, useful hearing was preserved in 54 (58%), and hearing was preserved near preoperative levels in 42 (45%). The potential for hearing preservation appeared to be inversely related to the size of the acoustic tumor, with hearing preserved in 39 (60%) of 65 patients with tumors less than or equal to 0.5 cm extension into the cerebellopontine angle. Preoperative hearing levels and electronystagmography seemed to have no prognostic value. However, auditory brainstem response showed that a wave V latency of less than 6.8 msec was associated with an increased chance of hearing preservation, and the presence of vertigo as a preoperative complaint appeared to be a good prognostic indicator of successful hearing preservation.
Distortion product emission features and the prediction of pure tone thresholds
Authors: Kimberley Barry P.
Published: October 2006

Distortion product emission (DPE) growth functions, demographic data, and pure tone thresholds (PTTs) were recorded in 229 normal‐hearing and hearing‐impaired ears. Half of the data set (115 ears) was used by a discriminant analysis routine to classify DPE and demographic features into either a normal PTT group or an impaired PTT group (PTT greater than 30 dB SPL [sound pressure level]) at six frequencies in the audiometric range. The six discriminant functions developed from this classification process were then used to predict PTT group membership in the remaining 114‐ear data set. Frequency‐specific prediction accuracy was approximately 85% overall.

Of the 45 DPE and demographic variables evaluated, the DPE amplitude associated with an f2 (a primary tone of frequency) of moderate level (50 dB SPL) and a frequency corresponding to PTT was generally most predictive. DPE features associated with frequencies immediately adjacent to the PTT frequency also appear to be useful. DPE level was found to be weakly correlated with subject age; perhaps for this reason, age was frequently included in discriminant functions. This study describes the DPE measures that can most reliably categorize PTTs as normal or impaired in large populations with varied cochlear hearing status.
Management of chronic sinusitis in cystic fibrosis
Authors: Davidson Terence M. , Murphy Claire , Mitchell Mark , Smith Cecilia , Light Michael
Published: October 2006

Chronic rhinosinusitis is extremely common in patients with cystic fibrosis. It causes numerous problems in these patients and can put them at risk for life‐threatening illness. Potential problems include nasal obstruction, congestion, sinus pain and pressure, infection (usually with Pseudomonas organisms), hyposmia or anosmia, and the seeding of bacteria into the lower respiratory tract. Cystic fibrosis patients with chronically infected sinuses are at increased risk for pneumonia following lung transplantation. A prophylactic protocol has been developed for the management of chronic sinusitis in patients with cystic fibrosis. These patients are fully evaluated at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. Based on the results of the evaluation, they are treated with endoscopic sinus surgery, partial middle turbinectomy, septoplasty, and a large middle meatal maxillary antrostomy. Surgery is followed by a rigorous regimen of pulsatile hypotonic saline nasal irrigation to wash away tenacious cystic secretions. Tobramycin (Nebcin®) is given once daily in the nasal irrigant to inhibit the growth of Pseudomonas organisms. At the USCD Nasal Dysfunction Clinic, this prepulmonary transplantation protocol is now used in all cystic fibrosis patients with chronic sinusitis.
Cerebrospinal fluid fistula: The identification and management in pediatric temporal bone fractures
Authors: Mcguirt William F. , Stool Sylvan E.
Published: October 2006

Cerebrospinal fluid (CSF) fistula represents a potentially lethal complication and requires a high index of suspicion to make the diagnosis. A 12‐year retrospective study of pediatric basilar skull fractures identified 147 patients with temporal bone fractures, of which 37 patients exhibited evidence of CSF fistula. The diagnosis is made from a combination of clinical, radiographic, and chemical evaluation. The evolution of diagnostic techniques are reviewed, and the more recent and sensitive tests, such as beta‐2 transferrin, are emphasized. Treatment of CSF fistula is nonsurgical in most cases. Surgical exploration and mastoid obliteration were required in two patients, and the indications for surgical treatment are explored. The use of antibiotic prophylaxis is controversial and not routinely indicated.
The use of tissue expanders in the correction of ectropion in an animal model
Authors: Day Terry A. , Aarstad Robert F. , Hoasjoe Denis K. , Stucker Fred J.
Published: October 2006

The use of tissue expanders in eyelid reconstruction has seen limited application. To determine the efficacy of tissue expanders in the correction of cicatricial ectropion, an animal model was developed. Lower‐eyelid blepharoplasty with overcorrection was performed on 18 New Zealand white rabbits. After 1 month, if significant ectropion was present, tissue expanders (1.8‐cm3 Cylindrical/Microdome [CUI Corporation, Carpinteria, Calif.]) were inserted on one side, the other eye being the control. These were inflated in the following weeks to a total volume of 2 cm3. The tissue expanders were then removed, and the animals were followed for 1 month. Although the early results were encouraging, the ectropion progressed toward its preoperative severity. It appears that lower‐eyelid ectropion remains a therapeutic problem that is only partially corrected with tissue expansion alone.
Nasal mucociliary clearance after radiation therapy
Authors: Stringer Scott P. , Stiles Warren , Slattery William H. , Krumerman Jon , Parsons James T. , Mendenhall William M. , Cassisi Nicholas J.
Published: October 2006

Irradiation has been demonstrated to cause decreased mucociliary clearance in animal models. We sought to verify this effect clinically by using the saccharin transport test to evaluate nasal mucociliary clearance in 9 patients previously treated with radiation therapy to the nasal cavity. The patients also completed a questionnaire examining the prevalence of nasal symptoms before and after radiation therapy. Patients who received radiation therapy had no clearance of saccharin from the nasal cavity at a minimum of 20 minutes. The controls had a median clearance time of 5 minutes. The patients noted a higher prevalence of nasal congestion, drainage, and facial pain after radiation therapy. This study demonstrates that radiation therapy to the nasal cavity causes a decrease in nasal mucociliary clearance. This alteration should be considered when selecting therapy for malignancies in the nasal area.
Techniques for outcomes research in chronic sinusitis
Authors: Gliklich Richard E. , Metson Ralph
Published: October 2006

Accurate assessment of patient outcome after sinus surgery requires the collection of valid and reliable data. Symptom‐based surveys were administered in a prospective manner to 104 patients with chronic sinusitis, Test‐retest reliability for the Chronic Sinusitis Survey based on duration of symptoms (0.86, P<.0001) was superior to that for a similar survey based on severity of symptoms (0.57, P<.0001). Results of the Chronic Sinusitis Survey also correlated significantly with subscales of a general health assessment in the extent to which chronic sinusitis limits physical activity (0.40, P<.01), interferes with work or other activities (0.36, P<.01), and affects patient perception of bodily pain (0.46, P<.001). The Chronic Sinusitis Survey is an efficient and reliable method to follow health status and health‐related quality of life outcomes in patients with chronic sinusitis.
Radiotherapy in the treatment of verrucous carcinoma of the head and neck
Authors: Tharp Morgan E. , Shidnia Homayoon
Published: October 2006

Because of reports of anaplastic transformation following irradiation, this study examines the incidence of anaplastic transformation and local control of these lesions. This review of seven patients who had verrucous carcinoma of the head and neck that was treated with irradiation shows local control in 71% of cases. There were no cases of anaplastic transformation. This report adds to the literature two cases of “de‐differentiation” to less differentiated squamous carcinomas; one such case occurred after surgery alone. The literature is reviewed. Overall, anaplastic transformation is reported in 7% of patients who had irradiation. De‐differentiation occurs after surgery as well. The rate of local control with irradiation is less than 50%; with surgery it is 85%. It is concluded that surgery should be used if the procedure has acceptable morbidity. Otherwise, irradiation can be used. Failures can be salvaged surgically. “Anaplastic transformation” should not affect treatment approach.
Determination of nonendemic nasopharyngeal carcinoma by in situ hybridization for epstein‐barr virus EBER1 RNA: Sensitivity and specificity in cervical node metastases
Authors: Dictor Michael , Sivén Maria , Tennvall Jan , Rambech Eva
Published: October 2006

After time‐consuming and costly investigations, patients with neck metastases from an occult primary often receive unnecessarily large radiation volumes to treat a possible origin in the nasopharynx. In this study a colorimetric antisense Epstein‐Barr early ribonucleoprotein 1 (EBER1) oligonucleotide probe specific for Epstein‐Barr virus RNA was hybridized in situ to metastatic tissue obtained from 18 nasopharyngeal, 54 oral and pharyngeal, and 12 occult carcinomas derived from an unselected population. All 16 nonkeratinizing nasopharyngeal carcinomas (NPCs) were positive for EBER1. Both cases of keratinizing NPC and all 54 other metastases were negative. A single positive case of occult carcinoma indicated its origin from NPC. In retrospect, 7 patients with occult carcinoma had received unnecessary treatment with irradiation to the nasopharynx. Nasopharyngeal carcinoma appears to be a less common origin of occult carcinoma than previously considered. In the proper clinicopathologic context EBER1 in situ hybridization (EBER1‐ISH) allows exclusion of NPC with a high degree of accuracy. Thus unnecessarily large radiation volumes and their adverse sequelae may be reduced in the treatment of occult carcinoma. Conversely, a positive result of ISH allows exclusion of further extensive diagnostic procedures.
Reduction rhinoplasty and nasal patency: Change in the cross‐sectional area of the nose evaluated by acoustic rhinometry
Authors: Grymer Luisa F.
Published: October 2006

The feeling of nasal patency is related to the dimensions of the nasal cavity. After aesthetic reduction rhinoplasty, the cross‐sectional areas of the nose may decrease critically. In this study, acoustic rhinometry, a new method based on acoustic reflections, was used to evaluate the internal dimensions of the nasal cavity in 37 patients before reduction rhinoplasty and again 6 months after surgery. The internal dimensions of the nasal cavity—especially the anterior dimensions—were reduced after rhinoplasty. Compared with the preoperative values, the minimum cross‐sectional area (at the nasal valve) decreased by 22% (totally) to 25% (unilaterally) (P = .000), and the cross‐sectional areas at the piriform aperture decreased by 11% to 13% (P = .02).
Lymphoma of the head and neck and acquired immunodeficiency syndrome: Clinical Investigation and Immunohistological Study: Introduction
Authors: Finn Douglas G.
Published: October 2006

The epidemic of acquired immunodeficiency syndrome (AIDS) has made an enormous impact in the practice of medicine within the past decade. of the many associated problems, the increasing frequency of human immunodeficiency virus (HIV)–related malignancies, particularly lymphoma, has been both a fascinating area of study and a most difficult clinical condition to manage.

This study investigates lymphoma of the head and neck with clinical studies, as well as immunohistochemical assessments from individual patients. Lymphomas of the head and neck, as they present to the otolaryngologist, can present difficult and challenging diagnostic and therapeutic dilemmas. It is well‐known that a significant number of acquired immunodeficiency patients present initially with symptoms related to the otolaryngology field; it was also found that a certain number of lymphomas in the head and neck in HIV+ patients are the initial presentation. In addition, the associated disorders, such as related infections and synchronous additional neoplasms, are described. Also presented are recommendations for diagnosis and work‐up of these conditions, based on the experience. In addition, the study of lymphoma as a neoplasm from the molecular biology viewpoint and its course in the immunodeficient state have been important areas of study in an effort to dissect the progression to oncogenesis. The rapidly expanding literature base in this area is discussed.
Relationship of environmental tobacco smoke to otitis media in young children
Authors: Kitchens George G.
Published: October 2006

Otitis media (OM) continues to be a major health problem of children in the United States. The role of environmental tobacco smoke (ETS) as a predisposing factor has not been completely discerned. This study and discussion is an investigation and review of the influence of passive cigarette smoking on OM in children, and its effect on the practice of otolaryngology within the pediatric population. A prospective study of 175 children with recurrent OM and requiring tympanostomy tubes (case group) was compared to an age‐matched group of 175 children (controls) to determine the role passive cigarette smoking has on the incidence of this disease. The results revealed that the case group more commonly had exposure to ETS (P=.04). Prospective follow‐up of the case group revealed no significant difference in the clinical course of the children who were exposed to ETS and those who were not.
Pressure measurements in the normal and occluded rabbit maxillary sinus
Authors: Scharf Keith E. , Lawson William , Shapiro Jack M. , Gannon Patrick J.
Published: October 2006

Occlusion of the maxillary ostium is considered to be a key factor in the pathogenesis of maxillary sinusitis. In this study, the authors determined the effect of ostial occlusion on pressure in the rabbit maxillary sinus which, like most humans, has only one ostium. We compared pressures in the normal and occluded maxillary sinus and the nasal cavity during spontaneous breathing in anesthetized adult animals. Serial pressure measurements were obtained from sinuses with patent ostia in nasal‐breathing rabbits and with occluded ostia in both nasal‐breathing and tracheotomized animals.

Sinuses with patent ostia showed pressure curves synchronous with the respiratory cycle. Inspiratory and expiratory pressures in the nasal cavity and the sinus were isobaric. Sinuses with occluded ostia initially developed a positive pressure followed by a negative pressure that reached a subatmospheric plateau of‐28.2 ± 7.3 mm H2O (mean ± standard deviation [SD]) within 20 to 50 minutes.

This is the first quantitative study of sinus pressures using the rabbit as an animal model. The findings may contribute to a better understanding of the role of ostial occlusion in the pathogenesis of maxillary sinusitis in humans.
Management of advanced cervical metastasis using intraoperative radiotherapy
Authors: Freeman Stephen B. , Hamaker Ronald C. , Huntley Tod C. , Borrowdale Richard , Rate William R. , Garrett Peter G. , Pugh Newell
Published: October 2006

Seventy‐five patients who had advanced cervical metastasis with possible invasion of the deep muscles or carotid artery were approached with aggressive resection and intraoperative radiotherapy (IORT). All metastatic nodes were greater than 3 cm, 65% were fixed on clinical examination, and 35% involved the carotid artery. Forty‐six (61%) of the patients had previously received irradiation. Fifteen of the patients required extended neck dissections with carotid resections and grafting. After the resection an average single dose of 2000 cGy of electron beam IORT was delivered.

At 2 years, the local control rate within the IORT port was 68% and the absolute survival rate was 45%. Local control rates for close and microscopic margins (76% and 73%, respectively) were significantly better than the control rate for gross residual disease (25%, P<.05).

The combination of extended neck dissection, including carotid artery resection if necessary, and IORT appears to offer improved control.
Treatment of vocal fold granuloma using botulinum toxin type A
Authors: Nasri Sina , Sercarz Joel A. , Mcalpin Tina , Berke Gerald S.
Published: October 2006

Contact granuloma of the vocal folds has been associated with abnormal use of the voice, and acid reflux may exacerbate the inflammatory process. Treatments have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management.

Localized injections of botulinum toxin type A (BOTOX®) have been effective in patients with disorders of muscular control in the head and neck. In this study, granulomas resolved in six patients who underwent injection of the affected vocal folds. Botulinum toxin type A is probably successful because it prevents forceful closure of the arytenoids during phonation and coughing. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates.
Contribution from crossed and uncrossed brainstem structures to the brainstem auditory evoked potentials: A study in humans
Authors: Møller Aage R. , Jho Hae Dong , Yokota Masashi , Jannetta Peter J.
Published: October 2006

The neural generators of the brainstem auditory evoked potentials (BAEPs) in humans are not completely known. Attempts to identify the anatomical location of the neural generators of the human BAEP based on the results of studies in animals commonly used in auditory experimentation have been difficult because of the considerable anatomical differences between the ascending auditory pathways in humans and animals.

The authors of this study compared recordings obtained from different locations on the lateral side of the brainstem in six patients undergoing micro vascular decompression surgery for a cranial nerve disorder affecting the fifth cranial nerve (i.e., trigeminal neuralgia). Ipsilateral click stimulation evoked prominent responses from the caudal aspect of the pons up to the junction between the pons and the midbrain, but all components of the responses with latencies shorter than 8 msec had smaller amplitudes when recorded at more rostral locations. Components with latencies in the range of peak V elicited by contralateral click stimulation had their largest amplitudes when recorded from the lateral brainstem at the level of the fourth cranial nerve (thus, close to the inferior colliculus). Earlier components of the contralateral responses (latencies in the range of the latency of peak III) had their largest amplitudes when recorded from the caudal lateral brainstem.

The results of this study indicate that the part of the uncrossed auditory pathway that is located rostral to the cochlear nucleus contributes little to the farfield potentials (i.e., BAEP), and it is doubtful whether the contralateral response that can be recorded at the level of the cochlear nucleus contributes noticeably to the BAEP.
Perioperative ketorolac tromethamine and postoperative hemorrhage in cases of tonsillectomy and adenoidectomy
Authors: Gallagher Judith E. , Blauth Jeannette , Fornadley John A.
Published: October 2006

The charts of 258 patients undergoing tonsillectomy with or without adenoidectomy between June 1991 and June 1993 were reviewed. One hundred sixty‐nine of these patients received ketorolac tromethamine during the perioperative period as a nonnar‐cotic alternative for postoperative pain management. The incidence of postoperative hemorrhage among patients who received ketorolac tromethamine was 10.1%, compared to 2.2% in those patients who received narcotic analgesia only. The average time to adequate oral intake and discharge was evaluated. Ketorolac appeared to moderately decrease the time to adequate oral intake. The use of ketorolac did not significantly alter the time to discharge.

The increased incidence of postoperative hemorrhage in patients receiving ketorolac should be considered before this medication is used in the perioperative period. The risk/benefit ratio of ketorolac use as a postoperative analgesic may be better demonstrated in a prospective study.
Basic fibroblast growth factor in human saliva: Detection and physiological implications
Authors: Van Setten G.‐B.
Published: October 2006

After the detection of epidermal growth factor and transforming growth factor alpha in various body fluids and human saliva the current study aimed to investigate the presence of basic fibroblast growth factor (bFGF) in human saliva. Basic FGF is stimulating the proliferation of cells of mesodermal and neuroectodermal origin and is highly angioge‐netic. After ELISA technique was established, saliva was collected from eight healthy individuals. Run in duplicate, 14 (87.5%) of the 16 samples investigated contained measurable amounts of bFGF. In the samples containing bFGF the concentration varied between 0.1 pg/mL and 8.4 pg/mL (mean concentration, 3.8 pg/mL; SD, 3.5). There was no correlation between age and sex and bFGF concentrations. It is therefore concluded that bFGF is present in human saliva and may even constitute a constant component. The physiological importance of this finding is discussed.
Antigen Diffusion from the perilymphatic space of the cochlea
Authors: Yeo Sanmg W. , Gottschlich Stefan , Harrris Jeffrey P. , Keithley Elizabeth M.
Published: October 2006

The diffusion pattern of horseradish peroxidase (HEP) injected into the scala tympani of the cochlear basal turn of guinea pigs was studied to test whether antigen presented in this manner can gain access to the endolymphatic sac. By two hours, HEP reaction product was found throughout the cochlea, with the greatest amounts in the spiral ligament, spiral lim‐bus, basilar membrane, and organ of Corti. In several cochleas, very weak labeling was seen in the stria vascularis. HEP reaction product was maximal in the basal turn. By two hours, HEP reaction product was also observed in the endolymphatic sac lumen, epithelial cells, subepithelial tissue, and perisaccular connective tissue. It was more common in the proximal portion. At this time, macrophages within the lumen already appeared to have phagocytosed the HEP. By 72 hours after injection, the inner ear was cleared of HEP.

The results of this study support the hypothesis that antigen in the scala tympani gains access to the endolymphatic sac lumen, where it may be presented by macrophages to the systemic immune system. Antigen most likely does not gain access to the endolymphatic space in the cochlea, but it gets to the endolymphatic sac through the perilymph and the Derisaccular tissue.
Expression of immunoregulatory cytokines duruing actue and chronic middle ear immune response
Authors: Bikhazi Paul , Ryan Allen F.
Published: October 2006

In both patients and experimental animals, immunoglobulin G (IgG) has been found to dominate acute otitis media with effusion (OME), whereas IgA tends to be present in chronic but not in acute OME. To determine whether local immunoregulation could account for this difference, the expression of cytokines associated with the production of different antibody isotypes was investigated in experimental acute and chronic OME. Mice were systemically immunized and then challenged transtympanically, once to produce an acute OME or once per week for 6 weeks to produce chronic OME. Hybridization with molecular probes for cytokine genes showed that cells producing interleukin‐2 (IL‐2) and BL‐4, but not IL‐5, were present during acute OME. In chronic OME, IL‐2‐positive (IL‐2+) and IL‐4+ cells were less prevalent, but IL‐5+ cells were numerous. These finding support a model by which locally produced IL‐2 and IL‐4 augment IgG production in acute OME, whereas, IL‐5 contributes to increased IgA production in chronic OME.
Relation of recurrent laryngeal nerve compound action potential to laryngeal biomechanics
Authors: Nasri Sina , Damrose Edward J. , Ye Ming , Rreiman Jody , Berke Gerald S. , Dulguerov Pavel
Published: October 2006

This study was designed to investigate the compound action potential (CAP) of the recurrent laryngeal nerve (RLN) and to correlate this electrophysiologic signal to laryngeal biomechanics and phonatory function. Four adult mongrel canines were anesthetized. The RLN was isolated and stimulated, and recording electrodes were applied. The electromyographic (EMG) electrode was placed in the thyroarytenoid (TA) muscle. The RLN CAP and the EMG of the TA muscle were recorded and compared to the stimulation intensity, subglottic pressure (Psub), and each other. The CAP peak‐to‐peak and EMG peak‐to‐peak amplitudes demonstrated a sigmoidal relation to stimulus intensity and a linear relation to Psub and to each other. On the basis of these findings, the RLN CAP appears to be a reliable physiologic measure of laryngeal function.
Brief report: Prognostic importance of cellular DNA content in T1‐2 N0 laryngeal squamous cell carcinomas treated with radiotherapy
Authors: Toffoli Giuseppe , Cernigoi Claudia , Boiocchi Mauro , Franceschi Silvia , Franchin Giovanni , Barzan Luigi , Carbone Antonino , Sulfaro Sandro
Published: October 2006

One hundred fifty‐two unselected, consecutive patients with T1‐2N0 laryngeal squamous cell carcinoma received radical radiation therapy at the Division of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy. Thirty‐one (20.4%) of the patients showed disease recurrence or persistence (R/P) after radiotherapy. Flow‐cytometric DNA ploidy measurements were performed in 72 cases; 20 had tumor R/P and 52 did not. Tumor R/P occurred more frequently (in 17 [85%] of 20 cases) in patients with diploid tumors. The hazard ratio of recurrence in diploid tumors as compared with aneuploid tumors, after inclusion of all the other significant prognostic factors in a Cox proportional hazards model, was 8.9 (P<.01). Therefore DNA ploidy seems to be an important marker of tumor R/P in patients with T1‐2N0 laryngeal carcinoma after radiotherapy.
Twenty‐five years of experience with stapedectomy
Authors: Glasscock Michael E. , Storper Ian S. , Haynes David S. , Bohrer Pamela S.
Published: October 2006

The purpose of this report is to review the outcomes of patients undergoing stapes surgery by the senior author during the past 25 years, and to compare these results with those obtained in other series.

A retrospective analysis of 902 patients who underwent stapes surgery by the senior author from 1970 to 1994 was performed. Twenty‐two patients underwent stapedotomy; the remainder underwent stapedectomy. Pure‐tone averages for air and bone conduction, air‐bone gap closure, technique, complications, and patient satisfaction were compared with results obtained in other stapedectomy and stapedotomy series.
Histoplasmosis: The otolaryngologist's perspective
Authors: Gerber Mark E. , Rosdeutscher John D. , Seiden Allen M. , Tami Thomas A.
Published: October 2006

Within the upper aerodigestive tract, histoplasmosis often mimics carcinoma, making prompt and accurate diagnosis imperative. More severe and potentially lethal infections with Histoplasma capsulaturn are now being seen as the numbers of patients at the extremes of age, as well as those with compromised immune systems, increase. We reviewed the cases of 115 hospitalized patients with disseminated histoplasmosis. Of these, 9 patients were identified with tolaryngologic manifestations: 4 were infected with human immunodeficiency virus (HIV), 1 was diabetic, and 3 were renal transplant patients. Sites of involvement included the larynx (in 2 cases) and the oral cavity and oral pharynx (in 7 cases). Eight of the 9 patients had a positive biopsy result; the other, a positive culture. Treatment with amphotericin B was generally effective, while the use of newer azole antifungal agents were less effective. As the number of immunocompromised patients continues to increase in modern clinical practice, histoplasmosis will undoubtedly be encountered more frequently in the head and neck area.
Correlation between preoperative computed tomography and operative findings in functional endoscopic sinus surgery
Authors: Jiannetto Daniel F. , Pratt Michael F.
Published: October 2006

This study investigated the correlation between diagnostic parameters and surgical findings in patients undergoing functional endoscopic sinus surgery (FESS) for chronic sinusitis. The parameters that were reviewed included the radiologist's report on the computed tomographic (CT) scan, the surgeon's reading of the CT scan, the operative findings, and the histopathology report.

A retrospective analysis was conducted of 84 patients with chronic maxillary and ethmoid disease who were treated by the senior author (m.f.p.) over a 5‐year period. The average concurrent agreement between the radiologist's CT report and the surgeon's CT interpretation was 92.26% for unilateral ethmoid disease, 83.73% for unilateral maxillary disease, 79.50% for bilateral ethmoid disease, and 64.28% for bilateral maxillary disease. The operative findings compared more closely with the surgeon's CT interpretation. The results of this study underscore the importance of clinical correlation in the surgical management of chronic sinus disease.
Characterization of lymphocyte subpopulations in warthin's tumor
Authors: Chin Kenley W. , Billings Kathleen R. , Ishiyama Akira , Wang Marilene B. , Wackym Phillip A.
Published: October 2006

Cell suspensions from six Warthin's tumors (WTs) were characterized with fluorescence‐labeled cell cytometry. WT lymphocyte subsets were identified with monoclonal antibodies directed against lymphocyte‐associated cell antigens including T lymphocyte subsets, B lymphocytes, and natural killer (NK) cells. Results showed that T cell proportions were 58% and B cell proportions were 39%. The T cell helper:cytotoxic‐suppressor ratio was 5.7:1 and the B to T cell ratio was 0.8:1. NK cells represented 1.3% of cells. When compared to peripheral blood lymphocytes (PBLs) in the same patients, statistically significant differences were noted between PBLs and WT lymphocytes in the percentage of B lymphocytes (P<.01), T cytotoxic‐suppressor lymphocytes (P<.02), NK cells (P<.01), and in the ratios of B to T lymphocytes (P<.01) and T helper to T cytotoxic‐suppressor lymphocytes (P<.03). Comparing these data to retrospective data on lymphocyte distribution in normal and reactive lymph nodes, the epithelial component does not appear to exert a local effect on the lymphoid component of WT.
Laser‐assisted uvulopalatoplasty for snoring and obstructive sleep apnea: Results in 170 patients
Authors: Walker Regina Paloyan , Gopalsami Chellam , Totten Mary C. , Grigg‐Damberger Madeleine M.
Published: October 2006

Laser‐assisted uvulopalatoplasty (LAUP) is a procedure for the treatment of snoring and, possibly, sleep apnea. Between July 1993 and December 1994, the authors prospectively evaluated 541 consecutive patients referred to their teaching hospital for possible LAUP to treat loud, disruptive snoring. Of these patients, 274 (51%) had one or more LAUP treatments. As of January 1995, LAUP treatment courses were completed in 170 patients. In this paper, the authors report preliminary results on the use of LAUP in these patients.

Among the 170 patients, 105 (62%) had a diagnosis of snoring and 65 (38%) obstructive sleep apnea syndrome (OSAS) based on preoperative polysomnography. LAUP treatment in the snoring only patients resulted in complete or nearly complete elimination of snoring in 63 patients (60%), partial improvement of snoring in 30 patients (29%), and no improvement in 11 patients (10%). Of the 65 OSAS patients treated with LAUP, postoperative polysomnograms were obtained in 33 patients (51%). Surgical success was achieved in 16 (48%) of the 33 patients. However, 7 patients (21%) had repeat polysomnograms that were worse than their preoperative polysomnograms, and 5 patients (15%) had no significant change. The results of this study suggest that LAUP may be a viable surgical option for patients with snoring and mild sleep apnea.
The fate of the skin graft in laryngoplasty
Authors: Gordon Neil A. , Sasaki Clarence T. , Parkash Vinita , Eisen Richard N. , Narayan Deepak
Published: October 2006

In laryngoplasty procedures, laryngotracheal soft tissue defects are often repaired using skin grafts. While stenting is necessary to approximate and immobilize the graft, prolonged stenting causes increased bacterial counts, granulation tissue formation, tissue ischemia, and graft failure. Optimal time for stent removal has not been experimentally defined.

Using the ferret animal model, 24 laryngoplasty procedures were performed. The subjects were stented by group for 0, 3, 7, 14, or 28 days. Analysis consisted of quantitative bacteriology, dye perfusion, and quantitative histologic assessment of graft viability. Tissue culture results revealed that by 3 days after the procedure all groups had 105 CFU of bacteria per gram of tissue. Graft viability in successful procedures was maximal in the 7‐day group and statistically significant from the 3‐day to the 28‐day groups.

In conclusion, while stenting is necessary for graft adherence, prolonged exposure to local tissue sepsis leads to progressive graft destruction.
Combined transpetrosal‐subtemporal craniotomy for clival tumors with extension into the posterior fossa
Authors: Blevins Nikolas H. , Jackler Robert K , Kaplan Michael J. , Gutin Philip H.
Published: October 2006

Tumors of the clivus, such as chordoma and chondrosarcoma, are generally amenable to an anterior surgical approach. However, approaches that traverse the pharynx or paranasal sinuses do not adequately expose tumor posterolateral to the horizontal course of the intrapetrous carotid artery. In addition, when tumor extends into the posterior fossa, supplemental exposure of neurovascular structures is necessary. A combination petrosectomy and subtemporal craniotomy can provide simultaneous access to the entire clivus as well as the lateral aspect of the midbrain, pons, and upper medulla. The extent of petrosectomy performed depends on a number of factors including status of hearing, facial nerve function, and degree of brainstem compression. In our experience with three patients (two chordomas and one chondrosarcoma), using either the retrolabyrinthine‐subtemporal or transcochlear‐subtemporal approach, excellent resection was achieved with acceptable morbidity considering the extensive nature of the disease.
Early temporalis muscle transposition for the management of facial paralysis
Authors: Cheney Mack L. , Mckenna Michael J. , Megerian Cliff A. , Ojemann Robert G.
Published: October 2006

Temporalis muscle transposition is a reliable surgical technique for the reanimation of patients with long‐standing facial paralysis. It is often employed when facial nerve reinnervation via crossover or cable grafting is not possible. Temporalis muscle transposition can also be used for the immediate treatment of complete facial paralysis due to insults leaving the facial nerve anatomically intact but requiring a prolonged recovery time (more than 1 year). Because temporalis muscle transposition does not interfere with neuronal regeneration, it may be employed early in the management of complete facial paralysis when recovery is predicted to be extended and incomplete.

The authors report their experience with early temporalis muscle transposition in the management of facial paralysis in 56 patients with an anatomically intact facial nerve. More than 90% of these patients achieved improved symmetry at rest as well as purposeful movement at the corner of the mouth. In the last 30 patients, the temporoparietal fascial flap was simultaneously harvested and successfully used to obliterate the donor site defect. In conjunction with the immediate implantation of a gold weight in the ipsilateral upper eyelid, this approach to the early management of facial paralysis helps reduce the period of facial disability from years to weeks in a select group of patients.
Transmastoid labyrinthectomy in older patients
Authors: Schwaber Mitchell K. , Reiber Mark E. , Pensak Myles L.
Published: October 2006

Transmastoid labyrinthectomy is an effective procedure for the control of episodic vertigo due to unilateral peripheral vestibular dysfunction. However, its application in older patients has been limited, primarily because of concerns that older patients may not compensate well postoperatively. Poor vestibular compensation results in constant disequilibrium, motion intolerance, and visual symptomatology. The purpose of this report is to review our results with transmastoid labyrinthectomy in patients over the age of 65. Complete records were available for 22 patients operated on between July 1984 and June 1994. Patient's records were reviewed for age, preoperative duration of symptoms, coexistent medical conditions, vertigo control, and postoperative disequilibrium. Advanced age need not be a contraindication to transmastoid labyrinthectomy.

Laryngoscope, 105:1152‐1154, 1995
Safety of thyroidectomy in residency: A review of 186 consecutive cases
Authors: Shindo Maisie L. , Sinha Uttam K. , Rice Dale H.
Published: October 2006

A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty‐six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology—Head and Neck Surgery at the University of Southern California were reviewed. Sixty‐nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.

Laryngoscope, 105:1173‐1175, 1995
Microcystic adnexal carcinoma: Management options based on long‐term follow‐up
Authors: Bier‐Laning Carol M. , Horn David B. , Gapany Markus , Duvall Arndt J. , Manivel J. Carlos
Published: October 2006

Microcystic adnexal carcinoma (MAC), a recently described neoplasm that frequently affects the head and neck, presents a confusing problem for the clinician due to its unusual behavior. The individual cells have a bland microscopic appearance, and there is a predilection for neural invasion. Four cases of MAC are reported. All four cases demonstrate the difficulty with pathologic diagnosis. Follow‐up of as long as 33 years begins to delineate the protracted nature of MAC. In addition, this paper includes the first report of a case of lymph node metastasis. Although resection may result in a significant defect, negative margins may not be achieved. Despite this, the defect can heal, as demonstrated by the cases described. In addition, MAC may recur many years later, irrespective of the status of the margins at the time of surgery. Given these unusual characteristics and the slowly progressive nature of MAC, strong consideration must be given to less radical surgical procedures, with close follow‐up for grossly recurrent disease.
Neck flexion and extension in children with down syndrome: A somatosensory study
Authors: Abramson Peter J. , Todd N. Wendell , Holt Philip J. , Allen A. Thomas , Hayden Gail B.
Published: October 2006

The cervical spine in Down syndrome patients is often lax, at least at radiographic imaging, and the risk of spinal cord embarrassment is increased. This study was performed to obtain information that would help identify patients at risk for this problem and reduce the risk of endotracheal intubation and other surgical procedures in patients with Down syndrome.

Somatosensory evoked potential studies were performed in 15 consecutive children who were undergoing elective otolaryngic surgery. None had neurologic symptoms or the physical examination finding of cervical spinal cord embarrassment, and their cervical spines were considered normal by plain radiographs obtained in the neutral, flexed, and extended positions. No significant change in latency (P=.16) or amplitude (P=.19) was found when the anesthetized children had their necks placed in either full flexion or full extension. With more than 90% certainty, the authors believe that children with Down syndrome who have “normal” plain cervical spine radiographs are exposed to no extra risks from neck flexion or extension during surgery.
Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy
Authors: Laccourreye Ollivier , Crevier‐Buchman Lise , Jouffre Véronique , Laccourreye Henri , Brasnu Daniel , Weinstein Gregory
Published: October 2006

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape‐recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise‐to‐harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.
Expressions of c‐jun and p53 proteins in human middle ear cholesteatoma: Relationship to keratinocyte proliferation, differentiation, and programmed cell death
Authors: Shinoda Hideo , Huang Cheng‐Chun
Published: October 2006

The c‐jun protein functions as a transcription factor for many genes, and the p53 protein functions as a negative regulator of cellular proliferation, which is related to the apoptosis pathway that induces DNA damage. It has recently been shown that c‐jun promotes keratinocyte proliferation and p53 induces apoptosis of various cells.

In this study, the presence of c‐jun and p53 in cholesteatoma was demonstrated by immunoblotting assays using polyclonal rabbit anti‐c‐jun antibody and monoconal anti‐p53 protein antibody, respectively. The cholesteatoma tissue incubated with anti‐c‐jun antibody showed the staining of keratinocytes on the basal and spinous layers of epithelium. The c‐jun protein was localized in the basal layer of normal skin, and the p53 protein was present in the nucleus of keratinocytes in the granular layer of cholesteatoma epithelium. The keratinocytes of normal external ear canal skins and normal human skins were slightly stained in the granular layer of the epidermis. The present findings suggest that c‐jun and p53 proteins have a role in keratinocyte differentiation, proliferation, and apoptosis in the cholesteatoma.
Clinical relevance of protein‐tyrosine (De‐)phosphorylation in head and neck cancer
Authors: Verschuur Hendrik P. , Wynne Herman J. , Slootweg Pieter J. , Van Langen Jeroen , Staal Gerard E. J. , Rijksen Gert , Hordijk Gert Jan
Published: October 2006

Previous studies have shown that protein tyrosine (de)phosphorylation plays an important role in head and neck cancer. Protein‐tyrosine kinases (PTK) and protein‐tyrosine phosphatases (PTPase) activities in the cytosol of tumor tissue were significantly increased compared to normal tissue of cancer patients as well as controls. Additionally, the enzyme activities in normal tissue of tumor patients were significantly higher than enzyme activities in normal tissue of the control group. In this paper, we have correlated the cytosolic and membranous PTK and PTPase activity of tumor and nontumor tissue with several clinical and histological parameters known to influence the clinical outcome. Furthermore, we have analyzed the value of the enzyme activities as an independent predictor of clinical behavior and occurrence of second primary tumors. We confirmed our earlier observations that cytosolic and membranous PTK activities and cytosolic PTPase activities in tumor tissues are increased compared to activities in nontumor tissues and controls. Moreover, we also confirmed the findings of increased enzyme activities in nontumor tissues compared to findings in control tissues. This finding in histologically proven healthy mucosa is highly interesting because it indicates that these biochemical changes are obviously not (yet) translated into morphological changes. Significant differences were found in membranous PTK activity when the patients were grouped by sex, tumor localization, lymph node metastasis, and previous radiotherapy. During the follow‐up period, no relation could be found between enzyme activities in tumor and/or nontumor tissues and disease‐free interval or occurrence of second primary tumors.