bluuebunny/crossref_metadata_2025 huggingface dataset:
Round Window Application of D‐Methionine Provides Complete Cisplatin Otoprotection
Authors: Korver Kurtis D. , Rybak Leonard P. , Whitworth Craig , Campbell Kathleen M.
Published: February 2003

OBJECTIVE

Cisplatin is a widely used, very effective chemotherapeutic agent that can cause severe ototoxicity. In this study, D‐methionine was tested as an otoprotectant via round window membrane (RWM) application in the chinchilla.

METHODS

A minute amount of cisplatin alone, or D‐methionine followed by cisplatin, was applied topically directly to the intact RWM of anesthetized adult chinchillas. Auditory brainstem responses were measured before and 1 week after topical round window application. Animals were killed, and the cochleas were examined.

RESULTS

The ears pretreated with D‐methionine were completely protected from hearing loss and hair cell loss in the organ of Corti compared with controls. The ears receiving cisplatin without D‐methionine protection sustained nearly complete hearing loss with threshold shifts of >60 dB, with extensive outer hair cell loss throughout the organ of Corti but particularly in the basal turn.

CONCLUSION

These results demonstrate that topical D‐methionine provides excellent otoprotection against cisplatin‐induced ototoxicity both electrophysiologically and structurally.
Nasal Endoscopy and the Definition and Diagnosis of Chronic Rhinosinusitis
Authors: Stankiewicz James A. , Chow James M.
Published: February 2003

OBJECTIVES

Although endoscopy has been shown by a few authors to be a valuable tool for the diagnosis of chronic rhinosinusitis, its true role in the evaluation of the patient with chronic rhinosinusitis has not been elucidated. The current definition of chronic rhinosinusitis is a symptom‐based definition, and objective testing such as endoscopy or computed tomography (CT) is not included. However, the current treatment paradigm for chronic rhinosinusitis is dependent on the definition for diagnosis. Patients are treated with 4 weeks of antibiotics and decongestant/antihistamines/steroids based on the definition. This study aims to evaluate in a prospective fashion the place of endoscopy in the diagnosis of chronic rhinosinusitis.

STUDY DESIGN

A group of 78 patients meeting the definition of chronic rhinosinusitis were subjected to same‐day endoscopy and CT scanning.

RESULTS

Seventeen (22%) of 78 patients had positive endoscopic and CT results. There were 20 (26%) of 78 patients with negative endoscopic and positive CT results. Six (8%) patients had positive endoscopic and negative CT results, and 35 (45%) had negative endoscopic and negative CT results. Overall, 37 (47%) patients had positive CT results, and 41 (53%) patients had negative CT results. Endoscopy showing the presence of purulence, nasal polyps, or watery congested mucosa correlated well with CT results. Negative endoscopy correlated with CT results in 65% of patients.

CONCLUSION

The use of endoscopy to corroborate the diagnosis in nonpolypoid or nonpurulent rhinosinusitis in previously unoperated patients is questioned. Patients who meet the subjective definition of chronic rhinosinusitis should have a high degree of sensitivity and specificity with endoscopy or CT. The fact this is not the case questions the accuracy of the definition and the treatment paradigm.

SIGNIFICANCE

According to this study, positive endoscopic results correlated well with CT, and negative endoscopic results correlated in 71% of patients with negative CT results.
Ventilation Tube Removal: Does Treatment Affect Perforation Closure?
Authors: Schwartz Kara M. , Orvidas Laura J. , Weaver Amy L , Thieling Sarah E.
Published: February 2003

OBJECTIVE

The study goal was to determine whether treatment of the tympanic membrane at the time of ventilation tube (VT) removal affects closure of the perforation.

STUDY DESIGN

We conducted a retrospective chart review and telephone follow‐up of children who underwent VT removal from 1995 through 1998.

RESULTS

Among 109 patients (162 ears; 58% male), the mean age at VT removal was 6.7 years. Most VTs (59%) were T‐tubes, and most (91%) were removed because of prolonged retention (mean 2.3 years). After VT removal, 111 ears (69%) received treatment, most commonly (44%) with 25% trichloroacetic acid (TCA). At the latest follow‐up, 151 of the ears (93%) had healed without additional treatment. Treatment failure occurred more frequently in ears not initially treated with TCA (TCA 3% failure, other treatment 13%, no treatment 8%) and in ears with VTs removed because of otorrhea.

CONCLUSIONS

Most perforations healed. TCA may promote closure, but a large randomized clinical trial is needed to eliminate physician bias.
Induction Chemotherapy Followed by Concomitant Chemoradiation‐Induced Regression of Advanced Cervical Lymphadenopathy in Head and Neck Cancer as a Predictor of Outcome
Authors: Ampil Federico L. , Mills Glenn M. , Caldito Gloria , Burton Gary V. , Nathan Cherie Ann O. , Aarstad Robert F. , Lian Timothy F. , Stucker Fred J. , Hardin John C.
Published: February 2003

OBJECTIVE

We sought to determine whether induction chemotherapy followed by concomitant chemoradiation (ICCR)‐induced advanced neck disease regression could predict outcome, especially the need for complete neck dissection in patients with N2‐3 stage IV head and neck cancer (HNC).

METHODS

A retrospective study of 339 patients evaluated for treatment of stage IV HNC during the years 1988 to 1997 revealed 36 individuals with N2‐3 cervical lymphadenopathy who were treated with ICCR. Responses to treatment, patterns of failure, and survival rates were analyzed.

RESULTS

Primary and regional tumor regressions were complete in 21 patients (58%), partial in 9 (25%), and absent in 6 (17%); the corresponding local failure rates were 5%, 44%, and 33% (P < 0.02). The regional failure rates were 24%, 89%, and 83%, respectively (P < 0.001); distant failure rates were 10%, 0%, and 0% (P > 0.99). The estimated 2‐year survival rates for complete and partial/nonresponders were 57% and 20%, respectively (P < 0.02).

CONCLUSION

Patients with advanced regional metastases of HNC who respond completely to ICCR have an excellent chance for survival. However, such ICCR‐induced complete regression of regional tumor cannot reliably predict ultimate neck disease control.
Long‐Term Outcome of Facial Growth after Functional Endoscopic Sinus Surgery
Authors: Bothwell Marcella R. , Piccirillo Jay F. , Lusk Rodney P. , Ridenour Brock D.
Published: February 2003

OBJECTIVE

We sought to determine whether functional endoscopic sinus (FES) surgery performed in children with chronic rhinosinusitis alters facial growth.

STUDY DESIGN AND SETTING

This was a retrospective age‐matched cohort outcome study performed at a tertiary care hospital.

RESULTS

Sixty‐seven children participated. There were 46 boys and 21 girls, and the mean age was 3.1 years at presentation and 13.2 years at follow‐up. There were 46 children who underwent FES surgery and 21 children who did not undergo FES surgery. Quantitative anthropomorphic analysis was performed using 12 standard facial measurements. A facial plastic expert performed qualitative facial analysis. Both quantitative and qualitative analyses showed no statistical significance in facial growth between children who underwent FES surgery and those who did not undergo FES surgery.

CONCLUSIONS

In this study, there was no evidence that FES surgery affected facial growth.

SIGNIFICANCE

These results will aid physicians when discussing with parents the risks of FES surgery.
Percutaneous Laryngeal Collagen Augmentation for Treatment of Parkinsonian Hypophonia
Authors: Kim Soo H. , Kearney James J. , Atkins Joseph P.
Published: February 2003

OBJECTIVE

Our goal was to determine whether percutaneous laryngeal collagen augmentation improves hypophonia in parkinsonian patients.

STUDY DESIGN AND SETTING

A retrospective review of 18 patients was performed. Patients and/or caretakers were called on the telephone and asked about their response to the procedure, if any. Videostroboscopic examinations for all patients were reviewed.

RESULTS

Of 18 patients, 11 (61%) reported improvement in their hypophonia for a period of at least 2 months. Five of 7 patients without improvement were relatively aphonic both before and after the procedure. Five of 7 patients without improvement had severe dysphagia, which in 3 necessitated gastrostomy tube placement. Four of 7 patients without improvement were not ambulatory at the time of the procedure.

CONCLUSIONS

Percutaneous laryngeal collagen augmentation is an effective treatment for parkinsonian hypophonia in a majority of patients. Patients with advanced neurologic disease with aphonia, difficulty with speech initiation, dysphagia, or ambulatory difficulty are less likely to respond to this procedure and should be so informed.
Laser Office Ventilation of Ears with Insertion of Tubes
Authors: Siegel Gordon J. , Chandra Rakesh K.
Published: February 2003

OBJECTIVE

Myringotomy with insertion of pressure equalization tubes has proven to be extremely effective in treating persistent serous otitis media (SOM). This study compares the advantages and disadvantages of this procedure when performed in the operating room or with a laser in an office setting.

PATIENTS AND METHODS

Patients selected either traditional myringotomy and tube (M&T; n = 29) done in an operating room under general anesthesia or Laser Office Ventilation of Ears with Insertion of Tubes (LOVE IT; n = 35) done in an office setting with only topical anesthesia. The reasons for selecting either M&T or LOVE IT and satisfaction with the procedure chosen were evaluated by survey, the results of which were compared statistically. Chart review was performed to determine the time and cost of the procedures, time interval from diagnosis to treatment, tube longevity, and complications.

RESULTS

Overall satisfaction was similar with both procedures. Patients and families were more likely to choose LOVE IT based on the anesthetic technique involved (P < 0.001, χ2). M&T required less time to perform, whereas the cost of LOVE IT was less. Tube longevity and complication rates were similar between the two procedures, and all complications were minor.

CONCLUSIONS

LOVE IT is a potential alternative to traditional M&T in the treatment of SOM. LOVE IT is most likely to be selected by patients/parents who wish to avoid a general anesthetic and provides a level of satisfaction similar to that of traditional M&T.
Rhino‐Orbital and Rhino‐Orbito‐Cerebral Mucormycosis
Authors: Talmi Yoav P. , Goldschmied‐Reouven Anna , Bakon Mati , Barshack Iris , Wolf Michael , Horowitz Zeev , Berkowicz Miriam , Keller Nathan , Kronenberg Jona
Published: February 2003

BACKGROUND

Rhino‐orbito‐cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols.

METHODS

All had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases.

RESULTS

Sixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end‐stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%.

CONCLUSIONS

ROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival‐dependent classification of ROCM are offered.
The Effect of Upper Airway Surgery on Voice
Authors: Behrman Alison , Shikowitz Mark J. , Dailey Seth
Published: February 2003

OBJECTIVE

Our goal was to assess patient perception and acoustic characteristics of voice before and after upper airway surgery.

STUDY DESIGN AND SETTING

We conducted a prospective assessment of 44 surgical patients preoperatively and postoperatively at a tertiary care, academic hospital. Operations included septoplasty and turbinectomy (n = 28) and septoplasty, turbinectomy, uvulopalatopharyngoplasty, and tonsillectomy (n = 16). Patient opinion measures included Voice Handicap Index score, perception of vocal resonance, and change in voice. Acoustic measures included assessment of the relative amplitude of selected formants (resonances) of the vocal tract.

RESULTS

Mean Voice Handicap Index scores were unchanged after surgery. Nine patients (20%) perceived their voice to be improved after surgery. None perceived the voice to be worse. Postoperative changes in relative formant amplitudes were statistically significant. These changes caused the acoustic features to become more representative of normative data than the preoperative values.

CONCLUSION

Upper airway oeprations can affect acoustics and perception of voice.

SIGNIFICANCE

Patients are unlikely to perceive a change in voice as a result of upper airway surgeries, but in those cases where a difference is perceived, it is likely to be a positive change.
Management of Pediatric Ranula
Authors: Pandit Rajiv T. , Park Albert H.
Published: February 2003

OBJECTIVE

Many surgical techniques to manage ranulas have been described in the literature. These techniques include excision of the cyst with or without excision of the ipsilateral sublingual gland, marsupialization, cryosurgery, and CO2 laser excision. Few studies have described the approach toward management in pediatric patients.

METHODS

Six patients were treated for intraoral ranulas. Two patients had spontaneous resolution of their lesions. Four patients required dissection of the submandibular duct and lingual nerve to completely excise an oral cavity ranula and an ipsilateral sublingual gland.

RESULTS

There were no recurrent lesions. One patient developed a lingual nerve injury but no numbness. The 2 patients with spontaneous resolution did not develop a subsequent lesion.

CONCLUSION

Optimal management of pediatric oral cavity ranulas may include observation for 5 months for spontaneous resolution. If the lesion does not resolve or recurs repeatedly, surgical treatment is recommended. Submandibular duct dissection with relocation appears to enhance exposure to the floor of mouth. The pseudocyst and entire sublingual gland should be removed. Identification of the lingual nerve is necessary to accomplish this goal.
The Case for an Outpatient “Approach” for All Pediatric Tonsillectomies and/or Adenoidectomies: A 4‐Year Review of 1419 Cases at a Community Hospital
Authors: Postma Duncan S. , Folsom Fain
Published: February 2003

OBJECTIVE

We sought to document the safety and efficacy of approaching all pediatric tonsillectomies and/or adenoidectomies (T/A) as outpatient procedures.

STUDY DESIGN AND SETTING

We conducted a 4‐year retrospective study of 1419 pediatric patients undergoing T/A at an outpatient center with procedures performed by a single group of surgeons.

RESULTS

None of the 593 patients undergoing an adenoidectomy and only 5 (0.6%) of those having a tonsillectomy had significant bleeding postoperatively. There were no readmissions for airway problems. Children younger than age 3 were most likely to have complications and to be held for overnight observations.

CONCLUSIONS

Most children can be safely discharged after T/A. The higher incidence of perioperative complications in children who are younger than 3 years of age paralleled their higher rate of overnight observation.

SIGNIFICANCE

Children less than 3 years of age require more careful observation, especially after tonsillectomy and more likely will need to be observed overnight than older children.
Auditory Brainstem Implantation: The University of Verona Experience
Authors: Colletti Vittorio , Fiorino Francesco , Carner Marco , Sacchetto Luca , Miorelli Veronica , Orsi Alessandro
Published: February 2003

OBJECTIVE

We sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in the application of auditory brainstem implants (ABIs) in adults with monolateral and bilateral vestibular schwannoma (VS) and in children with cochlear nerve aplasia.

STUDY DESIGN

We conducted a retrospective case review.

SETTING

The study was conducted at the ENT Department of the University of Verona, Italy.

PATIENTS

Six adult patients (5 men and 1 woman) with neurofibromatosis type 2 (NF2) were operated on for VS removal with ABI. An additional patient had a unilateral VS in the only hearing ear. Tumor size ranged from 12 to 40 mm. In addition, 2 children received ABIs for bilateral cochlear nerve aplasia.

INTERVENTION

An RS‐TM approach was used in all VS patients, and an RS approach was used in the subjects with cochlear nerve aplasia. After tumor excision, landmarks (VII, VIII and IX cranial nerves, choroid plexus) for the foramen of Luschka were carefully identified. The choroid plexus was then partially removed and the tela choroidea divided and bent back; the floor of the lateral recess of the fourth ventricle and the convolution of the dorsal cochlear nucleus became visible. In the 2 subjects with no cochlear nerve, the choroid plexus and VII and IX cranial nerves were used as landmarks. The electrode array was then inserted into the lateral recess and the correct position was monitored with the aid of electrically evoked auditory brainstem responses (EABR) and neural response telemetry (NRT).

RESULTS

Correct implantation was possible in all patients. Auditory sensations were induced in all patients with various numbers of electrodes. Different pitch sensations could be identified with different electrode stimulation.

CONCLUSIONS

We believe that the RS approach is the route of choice for patients who are candidates for ABI due to the easy and clear access to the cochlear nucleus area. This route avoids some of the drawbacks of the translabyrinthine approach, such as mastoidectomy, labyrinthectomy, sealing of the cavity and posterior fossa with abdominal fat, and contamination from the middle ear. For this reason, it is the route of choice in children with cochlear nerve aplasia or severe cochlear malformation and in adults with complete ossification of the cochlea or cochlear nerve disruption due to cranial trauma.
Pediatric External Auditory Canal Foreign Bodies: A Review of 698 Cases
Authors: Schulze Stacey L. , Kerschner Joseph , Beste David
Published: February 2003

OBJECTIVE

The study goal was to determine the relationships between patient management factors and patient outcomes in pediatric patients with external auditory canal foreign bodies.

STUDY DESIGN AND SETTING

Retrospective analysis was conducted of 698 consecutive cases of pediatric external auditory canal foreign bodies (n = 605 patients) who presented to a tertiary care pediatric referral center during a 6‐year period.

RESULTS

Emergency physicians frequently removed foreign bodies under direct visualization while otolaryngologists primarily used otomicroscopy. Both of these methods had high success rates overall (77% and 86%), but attempts under direct visualization had lower success rates with removing spherical objects, objects touching the tympanic membrane, and objects in the canal for more than 24 hours. Failed removal attempts resulted in higher complication rates.

CONCLUSION

Certain foreign body and patient characteristics are associated with poor outcomes with removal attempts made under direct visualization. These cases should be referred directly to otolaryngologists for otomicroscopic removal.
Density of Middle Turbinate Subepithelial Mucous Glands in Patients with Chronic Rhinosinusitis
Authors: Malekzadeh Sonya , Hamburger Marc D. , Whelan Philip J. , Biedlingmaier John F. , Baraniuk James N.
Published: February 2003

OBJECTIVE

Histologic changes have not been systematically assessed in chronic rhinosinusitis. Quantitative histochemical studies evaluated the extent of sinus disease and gland density in the middle turbinates.

STUDY DESIGN AND SETTING

Sinus computed tomography scans of 34 patients with chronic rhinosinusitis were retrospectively graded 0 to IV according to the May classification. Middle turbinates from patients with chronic rhinosinusitis (n = 46) and normal patients (n = 7) were harvested during endoscopic sinus surgery. The areas of Alcian blue‐stained glands were assessed in paraffin sections using a computer‐assisted microscopy video system.

RESULTS

Alcian blue‐stained glands occupied 7.94% of normal mucosa. The staining in all grade III rhinosinusitis subjects was increased to 12.94% (P < 0.01). In contrast, grade IV pansinusitis was associated with nasal polyposis (6 of 6) with decreased gland area (3.04%,P < 0.01). When polyp patients were excluded from grade III rhinosinusitis, the Alcian blue‐staining area was 17.68% (P < 0.01).

CONCLUSIONS

Distinct polypoid and glandular histopathologic patterns are present in chronic rhinosinusitis.
Patient Outcome after Surgical Management of an Accessory Nerve Injury
Authors: Novak Christine B. , Mackinnon Susan E.
Published: February 2003

OBJECTIVE

This study assessed patient outcome following surgical reconstruction of the accessory nerve after an iatrogenic injury.

STUDY DESIGN

A retrospective chart review of 8 patients was performed.

RESULTS

There were 3 men and 5 women in the study, and the mean time between injury and nerve graft/repair surgery was 5 months. Four injuries were sustained during a lymph node biopsy. Electromyography revealed a complete accessory nerve injury in all cases. In 6 cases, a nerve graft was required (mean length, 3.6 cm), and in 2 cases, a direct nerve repair was possible. The trapezius muscle was successfully reinnervated in all cases. In total, full shoulder abduction was achieved in 6 cases; in the remaining 2 cases, the patients achieved shoulder abduction to 90°.

CONCLUSION

Functional deficit after accessory nerve injury is significant. Nerve graft/repair reconstruction reliably yields a satisfactory result, providing good scapular rotation and thus good shoulder function.
Fetal Central Auditory System Metabolic Response to Cochlear Implant Stimulation
Authors: Antonelli Patrick J. , Gerhardt Kenneth J. , Abrams Robert M. , Huang Xinyan
Published: February 2003

OBJECTIVES

The purpose of this study was to examine the effects of profound auditory deprivation and its treatment by cochlear implantation and stimulation on the metabolic activity of the central auditory system in fetal sheep.

METHODS: Six ovine fetuses at 85% to 90% gestation were bilaterally deafened by kanamycin perfusion and unilaterally implanted with cochlear electrode arrays. Half of the implanted animals were stimulated with an extrauterine sound processor, and half were not. Four animals served as hearing controls. One week postoperatively, central nervous system metabolic activity was evaluated in ambient laboratory noise by quantitative autoradiography using 14C‐deoxyglucose.

RESULTS

Kanamycin perfusion deafened all treated animals as verified by auditory brainstem response and scanning electron microscopy. Glucose utilization in the inferior colliculus was markedly lower in deafened and unstimulated animals relative to hearing controls. Glucose utilization in implanted‐stimulated animals was similar to normal controls.

CONCLUSIONS

Changes in central auditory system metabolic activity associated with congenital deafness may be minimized by prompt auditory habilitation.
Unaided Speech in Tube‐Free Tracheostomy: The Supplementary Sling Procedure
Authors: Eliachar Isaac , Akst Lee M. , Eliashar Ron
Published: February 2003

OBJECTIVE

In some patients after tube‐free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients.

STUDY DESIGN AND SETTING

From September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed.

RESULTS

Fifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow‐up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow‐up already show early improvement.

CONCLUSION

The supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube‐free tracheostomata.

SIGNIFICANCE

As more patients undergo tube‐free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post‐laryngeal transplant patients.
Evaluation of the Internal Auditory Canal with Virtual Endoscopy
Authors: Vrabec Jeffrey T. , Briggs Russell D. , Rodriguez Sarah C. , Johnson Raleigh F.
Published: February 2003

OBJECTIVE

Three‐dimensional imaging can improve the understanding and comprehension of complex anatomy. Recent advances in software development allow the construction of a virtual endoscopic view of anatomic structures. This report applies virtual endoscopic capabilities to imaging of the internal auditory canal.

STUDY DESIGN, SETTING, AND PATIENTS

We conducted a retrospective case review at a tertiary referral center of patients with abnormal internal auditory canal anatomy on computed tomography.

INTERVENTIONS

Computed tomography images were obtained using conventional clinical algorithms involving multiple, 1‐mm‐thick slices through the temporal bone. Three‐dimensional reconstructions were made using General Electric Advantage Windows Navigator software. The virtual endoscopic image‐processing algorithm used selected image intensity threshold levels to visualize internal auditory canal anatomy from an endoscopic perspective.

RESULTS

Eleven cases of abnormalities of the internal auditory canal were retrospectively identified. Clinical applications using the virtual endoscopic images are presented. The virtual endoscopic images supported prior clinical decision making in 6 of the 11 cases evaluated.

CONCLUSION

This technique shows promise for the diagnosis, surgical planning, and teaching of temporal bone anatomy. Usefulness is dependent on acquisition parameters and clinical indications for examination.
Hepatocyte Growth Factor/Scatter Factor Stimulates Mitogenesis and Migration of a Head and Neck Squamous Cell Carcinoma Cell Line
Authors: Fleigel Jeffery , Sedwick Jack , Kornberg Lori J.
Published: February 2003

OBJECTIVE

We sought to assess the effect of extracellular matrix and hepatocyte growth factor/scatter factor (HGF/SF) on the growth and motility of cultured squamous cell carcinoma of the head and neck (SCCHN) cells.

METHODS

Cultured cells were incubated in the presence of HGF/SF. The effect of HFG/SF on cell growth, motility, and phosphorylation of the signaling proteins FAK and Erk was determined.

RESULTS

HGF/SF is both mitogenic and motogenic to the human SCCHN cell line FaDu. Incubation of FaDu cells in the presence of HGF/SF led to a rapid increase in phosphorylation of both FAK and the growth‐promoting kinase Erk. HGF/SF‐induced phosphorylation of FAK and Erk was observed in both detached and attached SCCHN cells. However, phosphorylation was much greater in attached cells.

CONCLUSIONS AND SIGNIFICANCE

The mitogenic and motogenic activities of HGF/SF may contribute to the pathogenesis of SCCHN in vivo.
Sinus Tympani Endoscopic Anatomy
Authors: Baki Fatthi Abdel , Dine Mohammed Badr El , Saiid Ibrahim El , Bakry Moustafa
Published: February 2003

OBJECTIVE

The sinus tympani has been the focus of clinical interest because of its tendency to be invaded by cholesteatoma, its visual obscurity, and the lack of a straightforward surgical approach by which it can be addressed. This study was undertaken to describe the microscopic as well as the endoscopic anatomy of the sinus tympani.

STUDY DESIGN AND SETTING

Thirty temporal bones harvested from cadavers were dissected using an operating microscope and telescopes with different angles and 2.7‐ and 4‐mm diameters, fitted with a videocamera. Images were transmitted to a computer screen. Precise measurements were made after scaling the distances with the digital image processing.

RESULTS

Marked variation in size and shape was the rule. It was found that the sinus tympani is bounded laterally by a constant ledge of bone anterior to the facial nerve. It was deep, extending posterior to the facial nerve in 6 specimens. The telescopes (30° to 70°) enabled the surgeon to see this region clearly because the orifice plane was more or less perpendicular to the axis of the external auditory canal.

CONCLUSION

The study emphasizes the importance of removal of this lateral lip of bone to expose the orifice of the sinus tympani. This should be complemented with the use of a 30° endoscope (1.7 mm in canal‐up and 4.0 mm in canal‐down technique) for better visualization and cleaning of this hidden area.
Community‐Based Treatment of Acute Uncomplicated Bacterial Rhinosinusitis with Gatifloxacin
Authors: Sher Lawrence D. , Poole Michael D. , Von Seggern Kristen , Wikler Matthew A. , Nicholson Susan C. , Pankey George A.
Published: February 2003

OBJECTIVE

We sought to evaluate gatifloxacin in adults with acute uncomplicated bacterial rhinosinusitis.

STUDY DESIGN

TeqCES was an open‐label, multicenter, noncomparative study of the safety and efficacy of gatifloxacin. More than 11,000 adult patients with acute uncomplicated rhinosinusitis received gatifloxacin 400 mg once daily for 10 days.

RESULTS

Moraxella catarrhalis (91% β‐lactamase producers), Haemophilus influenzae (28% β‐lactamase producers), Streptococcus pneumoniae (18% intermediately resistant and 14% fully resistant to penicillin), and Staphylococcus aureus were the predominant pathogens isolated from purulent nasal discharge. More than 99% of rhinosinusitis pathogens isolated from the nasopharynx of patients meeting the clinical criteria for rhinosinusitis were susceptible to gatifloxacin. Among 10,353 patients whose clinical response could be determined, 91.6% were cured. Clinical cure rates exceeded 90% for the major pathogens. Gatifloxacin was well tolerated; drug‐related adverse events that occurred in 1% or more of patients were nausea (4.4%), dizziness (1.8%), diarrhea (1.4%), and headache (1.0%).

CONCLUSION

Gatifloxacin is effective for patients with acute bacterial rhinosinusitis in the community.!
Long‐Term Results of Endoscopic Stapling Diverticulotomy for Pharyngeal Pouches
Authors: Raut Vivek V. , Primrose William J.
Published: February 2003

OBJECTIVE

The aim of the present study was to evaluate the long‐term success of endoscopic stapling as a primary procedure for the treatment of pharyngeal pouches.

METHODS

This study is a retrospective case review of 25 patients with pharyngeal pouches treated by endoscopic stapling (23 stapled, 2 abandoned) over a 4‐year period (1994 to 1998) at a University teaching hospital in the United Kingdom. Outcomemeasures used were relief of symptoms over a long‐term follow‐up of 2 to 5 years.

RESULTS

Of the 25 patients analyzed, 12 patients (48%) have remained asymptomatic after their initial stapling. Eight patients (32%) were relieved of their symptoms after revision stapling. The overall long‐term success rate for endoscopic stapling was 80% (20 of 25 patients)

CONCLUSION

Reduced morbidity and few complications in the elderly make endoscopic stapling a favored primary technique of treating pharyngeal pouches. Open surgery is recommended only in healthy patients with very large pouches.
Laser Therapy for Refractory Myringitis in Children
Authors: Fechner Frank P. , Cunningham Michael J. , Eavey Roland D.
Published: February 2003

OBJECTIVE

We present the application and initial results of a CO2 laser technique for the treatment of medically refractory chronic granular myringitis (CGM).

STUDY DESIGN AND SETTING

Retrospective case series of 15 treated ears in 13 consecutive patients between the ages of 6 and 14 years (median age, 9.0 years) cared for in a tertiary care specialty hospital.

RESULTS

Eleven of 15 treated ears had total resolution of CGM and associated symptoms; median follow‐up time was 10 months. Three ears were improved, and 1 ear remained unchanged. Three of 5 preoperative tympanic membrane perforations healed after laser treatment; 1 patient developed a postoperative, dry perforation. Hearing was not impaired in any patient tested.

CONCLUSION

Preliminary results suggest that CGM, when refractory to medical treatment, can often be treated effectively by a single laser treatment.
Predicting Calcium Status Post Thyroidectomy with Early Calcium Levels
Authors: Husein Murad , Hier Michael P. , Al‐Abdulhadi Khaled , Black Martin
Published: February 2003

OBJECTIVE

The study goals were to predict postoperative normocalcemia and hypocalcemia after total thyroidectomy using calcium levels and to assess the value of a standardized protocol in managing the total thyroidectomy patient.

STUDY DESIGN

We conducted a prospective study encompassing 68 patients undergoing a total thyroidectomy using a standardized protocol. Blood to measure postoperative calcium levels was drawn at 6, 12, and 20 hours and then twice daily thereafter. Calcium slope was calculated from the 6‐ and 12‐hour serum corrected calcium levels.

RESULTS

Logistic regression analysis allowed the comparison of the 6‐ and 12‐hour calcium slope versus proportion of normocalcemic patients postoperatively. A slope of +0.02 had a 97% chance of remaining normocalcemic (p = 0.0007).

CONCLUSION

Successful prediction of calcium status post total thyroidectomy can be achieved using the slope of the 6‐ and 12‐hour calcium levels. The risk of developing severe hypocalcemia can also be predicted with these slope values. Implementation of the protocol resulted in a significant reduction in the duration of hospital stay for patients who remain normocalcemic.
Cost‐Effective Diagnosis of Acoustic Neuromas: A Philosophical, Macroeconomic, and Technological Decision
Authors: Murphy Mark R. , Selesnick Samuel H.
Published: February 2003

OBJECTIVE

Our goals were to define the most sensitive techniques of acoustic neuroma diagnosis, to examine their relative costs, and to propose diagnostic modality selection given the rarity of acoustic neuroma incidence and given the other costs that society faces in more commonly encountered diseases.

METHODS

We conducted a MEDLINE search of the English language from 1966 to 2001 using the following keywords: acoustic neuroma, acoustic tumor, vestibular schwannoma, diagnosis, cost effectiveness, MRI, auditory brainstem response, brainstem audiometric evoked response, incidence, and prevalence.

RESULTS

Although magnetic resonance imaging with gadolinium remains the most sensitive diagnostic modality in the discovery of acoustic neuromas, its cost may be prohibitive for some societies.

CONCLUSION

Which modality to use in acoustic neuroma diagnosis is just as much a philosophical and macroeconomic question as a technological one.

CLINICAL SIGNIFICANCE

The cost of a timely diagnosis of acoustic neuromas must be weighed against using resources for other, more pressing, health concerns.
Thyroidectomy using the Harmonic Scalpel: Analysis of 105 Consecutive Cases
Authors: Shemen Larry
Published: February 2003

OBJECTIVE

The purpose of this report was to evaluate the technical benefits, if any, of thyroidectomy using the harmonic scalpel versus conventional thyroidectomy.

STUDY DESIGN

One hundred five consecutive patients underwent thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent thyroidectomy 1 year earlier using conventional techniques.

RESULTS

The incision length for those undergoing thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional thyroidectomy group. The operating time for a hemithyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional thyroidectomy group.

CONCLUSION

The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few.

SIGNIFICANCE

The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field.
A Comparison of Tonsillectomy with the Harmonic Scalpel versus Electrocautery
Authors: Morgenstein Stuart A. , Jacobs H. Kurt , Brusca Peter A. , Consiglio Angelo R. , Donzelli Joseph , Jakubiec James A. , Donat Terry L.
Published: February 2003

OBJECTIVE

We sought to test whether the use of the harmonic scalpel would cause less pain and more rapid recovery in tonsillectomy patients versus the use of electrocautery.

DESIGN AND SETTING

In a private practice community hospital, we conducted a prospective nonrandomized comparison of 156 pediatric tonsillectomy cases. Local anesthetic infiltrations and steroids were used at the discretion of the surgeon. Outcome variables consisted primarily of immediate‐and mid‐term pain, pain medications required, time to eating, morbidities and charges.

RESULTS

There were no differences between the groups on an intention‐to‐treat basis except for costs, which were higher in the harmonic scalpel group. When rescue use of electrocautery was required to control bleeding in the in the harmonic scalpel patients, more pain and longer times to taking food were noted.

CONCLUSIONS

Used with discretion the harmonic scalpel is equivalent to electrocautery for tonsillectomy.

SIGNIFICANCE

The harmonic scalpel does not provide a major benefit over more conventional methods of tonsillectomy.
Comparison of Methods for Determining Cricopharyngeal Intrabolus Pressure in Normal Patients as Possible Indicator for Cricopharyngeal Myotomy
Authors: Bammer Tanja , Salassa John R. , Klingler Paul J.
Published: February 2003

OBJECTIVE

We sought to compare methods for determining intrabolus cricopharyngeal pressure as a possible indicator for cricopharyngeal myotomy.

STUDY DESIGN

We determined multiple intrabolus pressures in the cricopharyngeal region of 20 normal volunteers, of whom 12 were 20 to 35 years old and 8 were older than 75 years. Data were collected using a commercially available manofluorography system and a 6‐sensor unidirectional solid‐state 2‐ x 4‐mm catheter. Each subject underwent 5 5‐mL and 5 10‐mL liquid barium swallows. Data were analyzed, and young subjects were compared with old subjects.

RESULTS

The mean mid‐bolus pressures in young subjects were 5.2 ± 4.9 mm Hg and 7.2 ± 6.5 mm Hg for the 5‐mL and 10‐mL swallows, respectively, and in older subjects, 10.8 ± 8.8 mm Hg and 12.3 ± 7.4 mm Hg. The mean gradient pressures across the 3‐cm cricopharyngeal region in young subjects were 2.02 ± 5.0 mm Hg, and −0.91 ± 4.8 mm Hg for the 5‐mL and 10‐mL swallows, respectively, and for older subjects, 4.38 ± 3.1 mm Hg and 2.82 ± 3.4 mm Hg.

CONCLUSIONS

Cricopharyngeal intrabolus pressures were lower in young than in older subjects. The mid‐bolus pressure and the gradient pressure across the cricopharyngeal region appeared to be the most consistent methods for evaluating intrabolus pressures.

SIGNIFICANCE

Intrabolus pressure anomalies in the cricopharyngeal region have been proposed as an indicator for selecting patients who would benefit from cricopharyngeal myotomy. The methods of determining intrabolus pressures vary, with resulting variations in recommendations.
Histopathologic Changes in the Vestibule after Cochlear Implantation
Authors: Tien Hui‐Chi , Linthicum Fred H.
Published: February 2003

OBJECTIVE

The study goal was to determine the histopathologic changes of the vestibular end organs after cochlear implantation and to relate them to clinical performance.

STUDY DESIGN

To differentiate the effect of implantation from the disease process that originally destroyed the hearing, 11 pairs of temporal bones from unilateral implantees were studied with light microscopy to compare the vestibular damage in the implanted ears with that in the nonimplanted ears.

RESULTS

Significant histopathologic damage of the vestibular end organs was noted in 6 patients (54.5%). The major histopathologic findings were fibrosis in the vestibule, saccule membrane distortion, new bone formation, and reactive neuromas. The scala vestibuli involvement, as a result of damage to the osseous spiral lamina or basilar membrane in cochlear basal turn, was highly correlated with vestibular damage (75%).

CONCLUSIONS

Although the clinical incidence of balance disturbance after cochlear implantation is low, damage of the vestibular end organs may occur and be asymptomatic. Keeping the electrode array in the scala tympani will minimize vestibular damage.
Bilateral Occurrence of Congenital Middle Ear Cholesteatoma
Authors: El‐Bitar Mohamed A. , Choi Sukgi S.
Published: February 2003

Congenital cholesteatoma of the middle ear is a relatively rare entity that is becoming more frequently encountered in the pediatric age group. A high index of suspicion is needed to recognize this entity at an early stage. More challenging is the bilateral occurrence of the lesion that, although still rare, should always be remembered when examining children with congenital cholesteatoma, not only on the initial visit but also on subsequent follow–up. We report the eleventh case of bilateral congenital middle ear cholesteatoma and stress the importance of long–term follow–up in these cases.
Hypocalcemia Complicating Total Thyroidectomy in Patients with Coexisting Celiac Sprue
Authors: Agrama Mark T. , Pribitkin Edmund A. , O'Hara Brian J. , Rosen David , Miller Jeffrey L. , Keane William M.
Published: February 2003

Patients with either an autoimmune thyroid disease or thyroid nodules exhibit an increased incidence of celiac sprue.1 Total thyroidectomy in the setting of celiac sprue poses an increased risk of postoperative hypocalcemia because of a characteristic malabsorption of calcium and magnesium.2 Hypocalcemia secondary to celiac sprue is independent of the well‐described risk of hypoparathyroidism after total thyroidectomy.3

Celiac sprue is a chronic condition in which there is a characteristic mucosal lesion of the small intestine that impairs nutrient absorption by the involved bowel.4,5 Intestinal absorption and associated symptoms normalize with the adoption of a gluten‐free diet. Nonetheless, chronic calcium and magnesium malabsorption coupled with an associated vitamin D insensitivity may exacerbate postoperative hypocalcemia after total thyroidectomy despite dietary precautions and normal parathyroid function.2,6

We present an illustrative case of total thyroidectomy for papillary thyroid carcinoma in a patient with Hashimoto's thyroiditis and celiac sprue. Total thyroidectomy in this setting must be undertaken with heightened attention to the risk of postoperative hypocalcemia because of chronic malabsorption of calcium and magnesium.
Concurrent Respiratory and Cutaneous Papillomatosis with Human Papillomavirus Type 11
Authors: Brown Laura , Wiatrak Brian
Published: February 2003

Recurrent respiratory papillomatosis (RRP) is a chronic upper respiratory condition caused by diffuse epithelial infection with the human papillomavirus (HPV). Symptoms include hoarseness and airway obstruction. In severe cases, patients may present in airway distress. HPV stimulates hyperproliferation of mucosal epithelium resulting in benign nonkeratinizing squamous papillomas. RRP most commonly involves the larynx but may affect the trachea, esophageal inlet, nose, mouth, and pharynx. RRP is associated with HPV types 6 and 11, the same HPV subtypes that cause vaginal condylomata. Cutaneous warts are also caused by HPV, but of various different subtypes, typically 2 and 4. We present the first reported case of laryngeal and cutaneous papillomas that were both caused by HPV‐11.
Squamous Cell Carcinoma Arising in a Lymphangioma of the Tongue
Authors: Berry Julie A. , Wolf Jeffrey S. , Gray William C.
Published: February 2003

Lymphangioma of the tongue is a rare, benign malformation of the lymphatic channels. The clinical course is characterized by multiple recurrences after local excision. A review of the literature revealed no prior association of a head and neck lymphangioma with squamous cell carcinoma (SCC). We present the case of a 64‐year‐old woman with a history of a tongue base lymphangioma who developed a base of tongue SCC. Further confounding the pathophysiologic scenario was a history of nasopharyngeal irradiation for adenoid hypertrophy.
Tele‐3‐Dimensional Computer‐Assisted Functional Endoscopic Sinus Surgery: New Dimension in the Surgery of the Nose and Paranasal Sinuses
Authors: Klapan Ivica , Šimičić Ljubimko , Rišavi Ranko , Bešenski Nada , Pasarić Karlo , Gortan Damir , Janjanin Saša , Pavić Dag
Published: February 2003

One of the main objectives of our 3‐dimensional (3D) computer‐assisted functional endoscopic sinus surgery was to design a computer‐assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high‐speed, wide‐bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele‐flythrough or tele‐virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele‐3D computer‐assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.
Incidence of Complications for Subtotal Ionized Field Ablation of the Tonsils
Authors: Lee Kelvin C. , Altenau Mark M. , Barnes David R. , Bernstein Joseph M. , Bikhazi Nadim B. , Brettscheider Frank A. , Caplan Charles H. , Ditkowsky William A. , Ingber Craig F. , Klausner Lee M. , Moghaddassi Maseih M.
Published: February 2003

OBJECTIVE

Ionized field ablation, or coblation‐assisted subtotal tonsillectomy, has been described as a new alternative technique for the management of tonsillar disease. This study was designed to review the incidence of complications in patients undergoing this procedure.

STUDY DESIGN

A 10‐surgeon retrospective chart review of the intraoperative and postoperative complications of patients undergoing ionized field ablation subtotal removal of tonsils was performed. Postoperative pain, dietary restrictions, and activity level were not reviewed.

RESULTS

Of the 528 patients who underwent ionized field ablation of their tonsils, the incidence of intraoperative and postoperative complications compared favorably with those reported in retrospective studies in the literature for traditional subcapsular tonsillectomy. Significant postoperative bleeding occurred in less than 1%, and only 1 patient required surgical control of bleeding in the operating room. No patients required transfusions of any blood products.

CONCLUSIONS

Ionized field ablation subtotal tonsillectomy may offer an alternative to traditional subcapsular tonsillar surgery with a decreased incidence of postoperative complications. Further study is necessary to establish the complication rate of this technique.