bluuebunny/crossref_metadata_2025 huggingface dataset:
The Validity and Reliability of the Reflux Finding Score (RFS)
Authors: Belafsky Peter C. , Postma Gregory N. , Koufman James A.
Published: November 2003

Background The evaluation of medical and surgical outcomes relies on methods of accurately quantifying treatment results. Currently, there is no validated instrument whose purpose is to document the physical findings and severity of laryngopharyngeal reflux (LPR).

Objective To evaluate the validity and reliability of the reflux finding score (RFS).

Methods Forty patients with LPR confirmed by double‐probe pH monitoring were evaluated pretreatment and 2, 4, and 6 months after treatment. The RFS was documented for each patient at each visit. For test–retest intraobserver reliability assessment, a blinded laryngologist determined the RFS on two separate occasions. To evaluate interobserver reliability, the RFS was determined by two different blinded laryngologists.

Results The mean age of the cohort was 50 years (± 12 standard deviation [SD]). Seventy‐three percent were women. The RFS at entry was 11.5 (± 5.2 SD). This score improved to 9.3 (± 4.7 SD) at 2 months, 7.3 (± 5.5 SD) at 4 months, and 6.1 (± 5.2 SD) at 6 months of treatment (P <.001 with trend). The mean RFS for laryngologist no. 1 was 10.8 (± 4.1 SD) at the initial screening and 10.8 (± 4.0 SD) at the repeat evaluation (r = 0.95, P <.001). The mean RFS for laryngologist no. 2 was 11.1 (± 3.8 SD) at the initial screening and 10.9 (± 3.7 SD) at the repeat evaluation (r = 0.95, P <.001). The correlation coefficient for interobserver variability was 0.90 (P <.001).

Conclusions The RFS accurately documents treatment efficacy in patients with LPR. It demonstrates excellent inter‐ and intraobserver reproducibility.
Immediate Percutaneous Medialization for Acute Vocal Fold Immobility With Aspiration
Authors: Anderson Timothy D. , Mirza Natasha
Published: November 2003

Objectives To determine the efficacy of immediate bedside or office percutaneous, trans‐thyroidal injections of a bioabsorbable gelatin material (Gelfoam, Upjohn Co., Kalamazoo, MI) to decrease the risk of aspiration resulting from acute vocal fold immobility.

Study Design Retrospective review of patients presenting with acute vocal fold immobility and aspiration or high aspiration risk at an urban, tertiary care university hospital.

Methods All patients were evaluated by videostroboscopy, functional endoscopic evaluation of swallowing (FEES), and objective voice measures. Patients with acute vocal fold immobility and evidence of aspiration on history or FEES were given the option of medialization by Gelfoam injection. Injections were performed percutaneously in the office or at the bedside under laryngoscopic guidance. FEES was repeated after injection to verify improvement in aspiration.

Results Eleven patients underwent Gelfoam injection for treatment of aspiration and vocal fold immobility. All were significantly improved on post‐injection FEES study. All patients were returned to an oral diet, avoiding the need for long‐term enteral access.

Conclusion Percutaneous Gelfoam injections is a rapid, temporary solution to the common problem of aspiration resulting from acute vocal fold immobility.
Microbiology of Chronic Frontal Sinusitis
Authors: Schlosser Rodney J. , London Scott D. , Gwaltney Jack M. , Gross Charles W.
Published: November 2003

Objectives To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis.

Study Design Retrospective, nonrandomized study.

Methods Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis.

Results Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase‐negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase‐negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery.

Conclusions This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase‐negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.
Anterior and Posterior Medialization (APM) Thyroplasty
Authors: Hong Ki Hwan , Kim Joong Ho , Kim Hyun Ki
Published: November 2003

Objective In unilateral vocal fold paralysis with dysphonia, most of the paralyzed vocal folds may be medialized effectively by medialization laryngoplasty. However, if the posterior glottal gap is wide, these procedures may sometimes have a limit to medialize the posterior glottis and cannot be effective for acceptable voice quality. The objective of this study is to introduce a new surgical technique for medializing the membranous and cartilaginous portions of the paralyzed vocal fold: anterior and posterior medialization (APM) thyroplasty.

Method Six patients underwent APM thyroplasty. They completed preoperative and postoperative evaluation with acoustic analysis and video laryngoscopy.

Results All patients satisfied their voice subjectively after surgery. The paralyzed vocal folds, membranous and cartilaginous parts, were medialized well, and the paralyzed arytenoid showed less anterior tipping postoperatively. On voice analysis all patients showed prolonged phonation times and decreased perturbations after surgery.

Conclusion The advantages of this procedure are to medialize the membranous and cartilaginous portions of the paralyzed vocal fold directly and to correct vertical mismatch between two vocal folds. This procedure might be especially indicated in the lateralized position of the paralyzed vocal fold but not in the higher paralyzed vocal fold compared with the normal vocal fold.
Evaluation of Inlay Butterfly Cartilage Tympanoplasty: A Randomized Clinical Trial
Authors: Mauri Marcelo , Neto José Faibes Lubianca , Fuchs Sandra Costa
Published: November 2003

Objectives/Hypothesis In 1998 Eavey described a new inlay technique for tympanoplasty in the pediatric age group using a cartilage graft through a transcanal approach. This technique was found to be effective and comfortable (no external canal incisions or ear packing). This study evaluated the efficacy of modified‐inlay cartilage tympanoplasty compared with the conventional underlay tympanoplasty.

Study Design Randomized clinical trial.

Methods Patients were enrolled from December 1998 to March 2000. Seventy tympanoplasties were done in adults with medium‐sized tympanic membrane (TM) perforations: 34 inlay tympanoplasties and 36 underlay tympanoplasties (control group). The main outcome measures were the “take rate” on the 30th postoperative day and the audiometric result at the second postoperative month. Secondary outcome measures include subjective postoperative hearing, postoperative pain, duration of surgery, and cost of the procedures.

Results The “take rate” did not differ between groups on the 30th postoperative day (88.2% in the inlay tympanoplasty group vs 86.1% in the underlay tympanoplasty group;P = .8). After a mean follow‐up of 7.5 ± 3.8 months (range, 3–16 mo), the “take rate” was 85.3% in the inlay tympanoplasty group and 83.3% in the underlay tympanoplasty group (P = .8). In the inlay tympanoplasty group there was closure of the air–bone gap (ABG) to within 10 dB in 64.7% and to within 20 dB in 94.1%. The corresponding numbers to underlay tympanoplasty were 75% and 97.2%. In only 2 cases (5.9%) in the inlay tympanoplasty group and in 1 case (2.8%) in the underlay tympanoplasty group the ABG was greater than 20 dB. No audiometric difference was observed between groups (P = .6). Most patients in the inlay tympanoplasty group reported immediate improvement in their hearing (P <.0001). Pain was reported by 10 patients in the inlay tympanoplasty group and by 30 patients in the underlay tympanoplasty group on the first postoperative day (P <.0001). The duration of the surgery (mean ± standard deviation) was 33.6 ± 7.8 minutes for the inlay tympanoplasty group and 62.9 ± 12.7 minutes for the underlay tympanoplasty group (P <.0001). The estimated charge for inlay tympanoplasty at our institution was 65% less expensive than underlay tympanoplasty.

Conclusion The “take rate” and audiometric results following inlay cartilage tympanoplasty or underlay tympanoplasty were similar. Inlay butterfly cartilage tympanoplasty did not require general anesthesia, was less expensive, and more comfortable to the patient.
Recurrence and Its Avoidance in Juvenile Angiofibroma
Authors: Howard David J. , Lloyd Glyn , Lund Valerie
Published: November 2003

Objective Angiofibroma is a highly vascular lesion for which a wide range of surgical approaches has been recommended. Irrespective of the approach, a significant and often rapid recurrence rate is reported in all major series.

Aim To consider the impact of lessons learned from imaging on the recurrence rate of angiofibroma.

Material and Methods From a cohort of 90 male patients with histologically proven angiofibroma, 40 individuals were studied. The recurrence rate in 20 cases treated before March 1998 was compared with that in 19 cases treated thereafter. In the latter group, an additional exploration of the basisphenoid had been undertaken.

Results The two cohorts were comparable in age range (7–27 y and 11–24 years, respectively), and all had been treated by midfacial degloving. In the first group, 8 recurrences occurred which were multiple in 1 patient. In the next 19 patients, the area of the pterygoid canal was meticulously explored and the basisphenoid drilled to remove all residual tumor. No recurrences have occurred in this group during a follow‐up of between 6 months to 3 years.

Conclusion Meticulous removal of angiofibroma infiltrating the pterygoid canal and basisphenoid is paramount to avoid “recurrence.”
Otological Manifestations of Churg‐Strauss Syndrome
Authors: Ishiyama Akira , Canalis Rinaldo F.
Published: November 2003

Objectives/Hypothesis To describe the clinical features, pathogenesis, and management of the otological complications in Churg‐Strauss syndrome (CSS).

Study Design Retrospective review of five patients with documented CSS who had otological manifestations in the later stages of CSS.

Methods The history, treatment, and outcome were evaluated using office and hospital chart data in these five cases.

Results In all cases, otological manifestations occurred during an advanced stage of CSS and was characterized by the presence of dense aural discharge, granulomatous eosinophilic infiltration into mastoid and middle ear, and subacute severe to profound hearing loss. In all cases, the recurrent aural discharge and granulomatous infiltrate was unresponsive to conventional treatment including repeated myringotomies and aggressive antibiotics. Systemic steroid administration resulted in a rapid, complete cessation of aural discharge and reversal or stabilization of hearing loss. Otological manifestations have been stable over a range of follow‐up from 1 to 20 years on a maintenance regimen of steroids.

Conclusions Temporal bone involvement in CSS is rare. Surgical intervention of the temporal bone is relegated to complications that may include infectious mastoiditis and intracranial involvement. Recognition of the association between CSS and otological disease is important because it is highly responsive to systemic steroids, and early steroid treatment may prevent progression to irreversible hearing loss, infectious otomastoiditis, or intracranial complications.
CO2 Laser Treatment in 244 Patients With Respiratory Papillomas
Authors: Dedo Herbert H. , Yu Kenneth C. Y.
Published: November 2003

Objective Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO2 laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin.

Methods Two hundred forty‐four patients with recurrent RP were treated by the senior author with CO2 laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated.

Results Careful laser excisions of RPs every 2 months achieved “remission” of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, “clearance” of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and “cure” (no clinical recurrence for 5 y after last removal) in 17%. Juvenile‐onset RP tends to follow a more aggressive course than adult‐onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment.

Conclusion Frequent and meticulously performed CO2 laser excisions can achieve significant voice and airway improvement, and some clinical “cures.” However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.
The Use of Palatal Island Flaps as an Adjunct to Microvascular Free Tissue Transfer for Reconstruction of Complex Oromandibular Defects
Authors: Ducic Yadranko , Herford Alan S.
Published: November 2003

Objective To determine the efficacy of using palatal island flaps in combination with free tissue transfer for reconstruction of large, complex oral cavity defects.

Study Design Prospective evaluation of patients with large, combined defects of the oral cavity reconstructed with palatal flaps in conjunction with microvascular free tissue transfer.

Methods Elevation of a palatal flap was performed after completion of tumor resection. The flap was rotated and secured into place. A free flap was then harvested and inset to reconstruct the remaining oromandibular defect. Free flaps included the rectus abdominis (6), fibula (16), and radial forearm (6).

Results Large complex oral cavity defects were repaired with a palatal island flap in conjunction with microvascular free tissue transfer in 28 consecutive patients. There were no complications associated with this flap.

Conclusion Maximal functional rehabilitation of large, complex oral defects requires independent reconstruction of the various regions of the oral cavity rather than single flap reconstruction. When used as an adjunct to free tissue transfer, the palatal island flap offers a reliable method for reconstructing large combination defects.
Verification of Improved Patient Outcomes With a Partially Implantable Hearing Aid, The SOUNDTEC Direct Hearing System
Authors: Roland Peter S. , Shoup Angela G. , Shea M. Coyle , Richey Hyla S. , Jones D. Betty
Published: November 2003

Introduction Partially implantable hearing devices have been developed to address some of the user‐perceived shortcomings of standard amplification systems. Partially implantable devices are purported to provide improved sound quality as a result of decreased occlusion, decreased feedback, and enhanced clarity resulting from increased high‐frequency gain. Such improvements may result in greater user satisfaction. To justify selection of a partially implantable device and undergoing a minor surgical procedure, verification techniques must be used to document user improvement or increased satisfaction over conventional amplification.

Objective To evaluate patient satisfaction with the SOUNDTEC direct hearing system.

Study Design Within‐subjects repeated measures design.

Methods Objective and subjective evaluation pre‐ and post‐implantation with the SOUNDTEC device. Verification techniques included tonal functional gain measures with traditional amplification and the SOUNDTEC device, word recognition in quiet (NU‐6) and in noise (SPIN), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hough Ear Institute Profile (HEIP).

Results Although there was no significant difference between optimal traditional amplification and the SOUNDTEC device for speech perception measures, the SOUNDTEC device yielded statistically significant increased high‐frequency functional gain. Subjective reports indicated that the SOUNDTEC device provides a cleaner, more natural sound without feedback than traditional amplification.

Conclusions Partially implantable hearing aids may address some of the limitations of traditional amplification systems.
Optimal Concentration of Epinephrine for Vasoconstriction in Ear Surgery
Authors: Gessler Eric M. , Hart A. Kristina E. , Dunlevy Timothy M. , Greinwald John H.
Published: November 2003

Objective To determine the optimal concentration of epinephrine required for vasoconstriction in ear surgery by evaluating changes in laser doppler blood flow.

Study Design Prospective, randomized, double‐blinded.

Methods Forty subjects undergoing surgical procedures under general anesthesia were injected in a standard posterior external auditory canal block with 1 mL of 1% lidocaine containing varying concentrations of epinephrine (nil, 1:50,000, 1:100,000, or 1:200,000) determined by randomization. Ear canal blood flow measurements were then made at 1‐minute intervals for a 10‐minute period using a laser doppler flow meter and compared with baseline blood flow.

Results The control solution of 1% lidocaine had a significantly higher blood flow than the epinephrine‐containing solutions with an actual 200% increase in blood flow for the first 5 minutes before returning to baseline. All epinephrine‐containing solutions had an approximately 50% decrease in blood flow from baseline over the 10‐minute period as compared with the control which was statistically significant (P <.0001). There was no significant difference between the blood flow reduction of 1:50,000, 1:100,000, and 1:200,000 epinephrine‐containing solutions (P = .8875).

Conclusions One percent lidocaine control exhibited the expected initial vasodilatory effect for approximately 5 minutes. In this experimental model, using a lower concentration of 1:200,000 epinephrine would supply equivalent vasoconstriction in the ear compared with higher concentrations, thus reducing the possible systemic toxicity and related morbidity.
5196 Mandible Fractures Among 4381 Active Duty Army Soldiers, 1980 to 1998
Authors: Boole Jason R. , Holtel Michael , Amoroso Paul , Yore Michelle
Published: November 2003

Objective We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries.

Methods Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD‐9 CM coding system.

Results We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non‐mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%).

Conclusions The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.
Do Steroids Reduce Morbidity of Tonsillectomy? Meta‐Analysis of Randomized Trials
Authors: Steward David L. , Welge Jeffrey A. , Myer Charles M.
Published: November 2003

Objectives/Hypothesis The study aims to reconcile conflicting published reports regarding the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post‐tonsillectomy morbidity.

Study Design Systematic overview (meta‐analysis).

Methods To critically evaluate the existing evidence, we performed a formal meta‐analysis of eight double‐blinded, randomized, placebo‐controlled studies of dexamethasone in pediatric patients undergoing tonsillectomy or adenotonsillectomy. Reduction in postoperative emesis and pain, as well as early return to soft or solid diet, were studied as distinct end points.

Results Children being given a single intraoperative dose of dexamethasone (dosing, 0.15–1.0 mg/kg; maximum dose, 8–25 mg) were two times less likely to vomit in the first 24 hours than children being given placebo (relative risk [RR] = 0.55; 95% confidence interval [CI], 0.41–0.74;P <.0001). Routine use in four children would be expected to result in one less patient having post‐tonsillectomy emesis (risk difference [RD] = −0.24; 95% CI, −0.38 to −0.10;P = .0006). In addition, children being given dexamethasone were more likely to advance to a soft or solid diet on post‐tonsillectomy day 1 (RR = 1.69; 95% CI, 1.02–2.79;P = .04) than those being given placebo. Because of missing data and varied outcome measures, pain could not be meaningfully analyzed as a distinct end point.

Conclusion Given the frequency of tonsillectomy, relative safety and low cost of dexamethasone, and the reduction in postoperative morbidity, we recommend routine use of a single intravenous dose during pediatric tonsillectomy.
Angioedema Associated With Angiotensin II Receptor Antagonists: Challenging Our Knowledge of Angioedema and Its Etiology
Authors: Chiu Alexander G. , Krowiak Edward J. , Deeb Ziad E.
Published: November 2003

Introduction Use of angiotensin converting enzyme inhibitors has long been associated with angioedema. Increased levels of bradykinin caused by the inhibition of angiotensin converting enzyme have been thought to be responsible for this side effect. Angiotensin II receptor antagonists (AT2 blockers), such as losartan potassium (Cozaar; Merck & Co., West Point, PA), are a new class of antihypertensives developed in part to eliminate cough and angioedema associated with ACE inhibitors. These agents act by selectively binding to angiotensin II receptor sites, thereby eliminating the hypertensive effects of angiotensin without affecting local and systemic bradykinin levels. We present three cases of AT2 receptor antagonist‐induced angioedema, and examine its significance in the treatment of angioedema and its proposed etiology.

Methods A retrospective chart review and review of the literature.

Results Three patients taking the AT2 blocker losartan presented with mucosal swelling in the head and neck clinically consistent with angioedema. All three patients had prior episodes of angioedema while on losartan. Two patients presented with involvement of the anterior tongue and face that resolved within 12 hours of discontinuation of the losartan and a course of intravenous steroids. The third patient experienced recurring episodes of angioedema that eventually required a tracheotomy for airway compromise. After discontinuing the losartan and receiving a course of intravenous steroids, the angioedema resolved in 5 days. The patient was decannulated 10 days after onset of symptoms.

Conclusion Angioedema is a potentially life‐threatening condition commonly associated with ACE inhibitor use. AT2 blockers bind to angiotensin II receptor sites and have no demonstrable effect on local or systemic bradykinin levels. We present three cases that demonstrate AT2 blocker‐induced angioedema. They were all complicated by the fact that the inciting agent, losartan, was not discontinued after the initial episode and resulted in recurrent episodes of angioedema, one of which required surgical airway intervention. The incidence of AT2 blocker‐induced angioedema brings into question prior theories on the etiology of angioedema and bradykinin's role in its pathogenesis.
Nontuberculous Mycobacterial Adenitis of the Head and Neck in Children: Experience From a Tertiary Care Pediatric Center
Authors: Rahal Akram , Abela Anthony , Arcand Pierre H. , Quintal Marie‐Claude , Lebel Marc H. , Tapiero Bruce F.
Published: November 2003

Objective To describe our experience with the diagnosis, surgical treatment, and outcome of nontuberculous mycobacterial (NTM) adenitis of the head and neck in children, and to present a preliminary report about the use of NTM skin tests in our institution.

Study Design Retrospective study.

Methods The medical records of all children diagnosed with cervicofacial NTM adenitis were retrospectively reviewed for the period from January 1, 1995, through December 31, 2000. We also examined the use of intradermal skin tests for the diagnosis of NTM infection.

Results Fifty patients were diagnosed with NTM cervicofacial adenitis. Pertinent demographic information, clinical presentation, investigation, and type of diagnostic procedures were documented. Surgical procedures, complications, and relapses were also noted. One unusual case of retropharyngeal adenitis is illustrated. All patients were treated with complete excision of their lesion at the first operation. No major complications were noted. Only one patient relapsed and required a second operation. Forty‐one children were skin‐tested with NTM antigens. Of these, 30 patients were dual‐tested with Purified Protein Derivative (PPD) also. No adverse reactions were noted with the use of skin tests. Sensitivity of NTM antigens alone is 87%. Sensitivity of dual testing is 78%. No patient had a PPD‐dominant reaction.

Conclusion Surgical excision is the treatment of choice of NTM adenitis because of the high cure rate with a single procedure, the excellent cosmetic result, and the low complication rate. NTM skin tests are safe and could be useful in early diagnosis of the infection but further investigation is needed.
Aminoglycoside Ototoxicity: A Human Temporal Bone Study
Authors: Hinojosa Raul , Nelson Erik G. , Lerner Stephen A. , Redleaf Miriam I. , Schramm David R.
Published: November 2003

Objective Hearing loss after aminoglycoside administration has been thought to result primarily from hair cell injury. The purpose of the study was to determine the potential for direct injury of spiral ganglion cells and hair cells in cases of documented human aminoglycoside ototoxicity.

Study Design Retrospective case review.

Methods The clinical course of two individuals with aminoglycoside ototoxicity are documented, including the details of administration of tobramycin and other ototoxic medication and serial audiograms. The temporal bones were processed, and the cochlear elements quantified.

Results Histopathological study of the temporal bones from the individuals in the study demonstrated reduction of both ganglion cell and hair cell populations. Spiral ganglion cell loss was not necessarily subadjacent to areas of hair cell loss in cases of aminoglycoside ototoxicity. Instead, spiral ganglion cell reduction may be present in segments of the cochlea with normal‐appearing hair cells.

Conclusions The study suggests that aminoglycoside antibiotics can injure spiral ganglion cells directly, as well as hair cells. Thus, the characteristic hearing loss of ototoxicity can result from degeneration of either cochlear element.
Physical Therapy Outcomes for Persons With Bilateral Vestibular Loss
Authors: Brown Kathryn E. , Whitney Susan L. , Wrisley Diane M. , Furman Joseph M.
Published: November 2003

Objective The purpose of the study was to assess the efficacy of physical therapy for patients with bilateral vestibular loss.

Study Design Retrospective case series.

Methods Twenty‐four patients with a diagnosis of bilateral vestibular loss were identified by a retrospective chart review. Thirteen of the 24 patients met the inclusion criteria of having a moderate or greater loss of vestibular function bilaterally as rated by an otoneurologist based on the patient's vestibular function tests. These patients were treated with a custom‐designed physical therapy program for a mean of 4.6 visits over an average period of 3.8 months. Patients completed the Dizziness Handicap Inventory and the Activities‐specific Balance Confidence Scale at initial evaluation and discharge. Patients were asked to perform the balance and gait tasks of the Dynamic Gait Index, Sensory Organization Test of computerized dynamic posturography, and the Timed “Up and Go” test at their first and last physical therapy sessions. The number of falls in the previous 4 weeks and the use of an assistive device at initial evaluation and discharge were reported. Composite score, an overall score of clinical outcome, was calculated to determine clinically significant changes in physical performance and subjective information.

Results On a population basis, statistically significant improvement was observed after physical therapy for each of the outcome measures including the composite score (P <.05). Clinically significant changes were demonstrated by 33% to 55% of the patients on the various outcome measures. No change was noted in the patients' risk of falling, their number of falls, and the use of assistive devices.

Conclusion Many patients with bilateral vestibular loss benefit from an individualized vestibular physical therapy exercise program based on improved physical function and reduced self‐perceived levels of handicap.
Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) Expression in Squamous Cell Carcinomas of the Head and Neck
Authors: Neuchrist Csilla , Erovic Boban M. , Handisurya Alessandra , Steiner Georg E. , Rockwell Patricia , Gedlicka Claudia , Burian Martin
Published: November 2003

Objectives Vascular endothelial growth factor receptor 2 (VEGFR2; Flk‐1 [fetal liver kinase]/KDR [kinase insert domain containing receptor]) has been identified as a high affinity receptor for vascular endothelial growth factor (VEGF) on vascular endothelium. Head and neck squamous cell carcinomas (HNSCC) have already been shown to produce substantial amounts of VEGF. VEGFR2 is supposed to play a major role in tumor‐neoangiogenesis.

Methods We investigated 24 tumor specimens and 4 HNSCC cultured tumor cell lines for the incidence and distribution of VEGFR2 by immunohistochemistry using monoclonal antibodies (mAbs) and RT‐PCR.

Results Analysis of frozen sections by immunohistochemistry showed that in 90% of tumor specimens VEGFR2‐positive cells were found which were associated with vascular endothelium. VEGFR2 was also expressed on tumor cells and vessels, which was confirmed by double immunolabeling of tumor cells with an a‐cytokeratin mAb. Furthermore, 2 (JPPA, SCC9) of 4 HNSCC cultured tumor cell lines revealed positive VEGFR2 immunoreactivity. Synthesis of VEGFR2 mRNA on all 4 HNSCC cultured tumor cell lines (JPPA, SCC9, SCC25, and LFFR) and in 6 tumor specimens was confirmed by RT‐PCR. In conclusion, our results showed that VEGFR2 is expressed in HNSCCs on tumor cells. VEGFR2 expression is associated with the beginning of vasculogenesis represented by accumulation of VEGFR2‐positive cells budding into new vessels (“hot spots”). The focal expression pattern of VEGFR2 on tumor cells suggests an autocrine loop for VEGF in tumor cell growth.
P53 and Ki‐67 as Outcome Predictors for Advanced Squamous Cell Cancers of the Head and Neck Treated With Chemoradiotherapy
Authors: Lavertu Pierre , Adelstein David J. , Myles Jonathan , Secic Michelle
Published: November 2003

Hypothesis P53 and Ki‐67 status will predict response to treatment, organ preservation, and survival in patients with advanced squamous cell cancers of the head and neck treated with chemoradiotherapy (CRT).

Study Design Retrospective analysis of p53 and Ki‐67 status from the CRT arm of a randomized, controlled trial (n = 50) and from patients receiving the same treatment but not enrolled in the trial (n = 55).

Methods P53 and Ki‐67 status were established from archived tissue samples using immunohistochemical (IHC) staining. Tumors were positive for p53 (p53+) when more than 2% of cells stained for p53 and were positive for Ki‐67 (Ki‐67+) when any cell stained for Ki‐67. End points were tumor response, tumor recurrence, survival status, and organ preservation at last follow‐up, and time to events. Predictive models were calculated for each outcome.

Results Neither marker predicted tumor response to treatment. P53+ status was associated with tumor recurrence (P = .003) and locoregional recurrence (P = .003). Adjusting for time to event, p53+ status was significantly related to a lower recurrence‐free survival (P = .004), lower disease‐specific survival (P = .04), lower overall survival with primary site preservation (P = .03), and lower disease‐specific survival with primary site preservation (P = .003). Multivariate analysis revealed that p53+ status was significantly related to a lower recurrence‐free survival (P = .01, risk ratio [RR] = 3.65) and lower disease‐specific survival with organ preservation (P = .02, RR = 3.41). Ki‐67+ status was not related to any variables. However, multivariate analysis revealed that Ki‐67+ was significantly related to a lower overall survival (P = .05, RR = 2.03). The combination of both markers negative (p53‐/Ki‐67‐) was associated with a lower incidence of tumor recurrence (P = .02), lower locoregional recurrence (P = .01), and fewer second primary lesions (P = .04). Adjusting for time to event, p53‐/Ki‐67‐ status was significantly related to a higher recurrence‐free survival (P = .02), higher disease‐specific survival with primary site preservation (P = .02), and higher overall survival with primary site preservation (P = .02). Multivariate analysis revealed that p53‐/Ki‐67‐ status was significantly related to a higher overall survival with site preservation (P = .01, RR = 2.78).

Conclusions P53 and Ki‐67 status appear to be related to the various survival end points considered in this study. However, this relation does not seem to be sufficient to warrant treatment modifications. Closer follow‐up may be justified in both p53+ and Ki67+ patients to detect recurrence or a second primary at an earlier stage, possibly improving survival.
Remote Delivery of rAAV‐GFP to the Rat Brainstem Through the Recurrent Laryngeal Nerve
Authors: Rubin Adam D. , Hogikyan Norman D. , Sullivan Kelli , Boulis Nicholas , Feldman Eva L.
Published: November 2003

Objective To demonstrate that a recombinant adeno‐associated viral vector (rAAV) carrying the gene for green fluorescent protein (GFP) could be delivered to the rat brainstem by remote injection into the recurrent laryngeal nerve.

Study Design/Methods rAAV‐GFP is a serotype 2 adeno‐associated vector containing the cDNA of GFP and woodchuck hepatitis virus posttranscriptional regulatory element (WPRE) under the control of the CAG promoter (obtained from Matthew During, PhD, Thomas Jefferson Medical College). Five microliters or 10 μL of 1.4 × 109 particles/μL of rAAV‐GFP were injected into the right recurrent laryngeal nerve of adult Sprague‐Dawley rats. Rats were killed and perfused at 3 (n = 3) and 11 weeks (n = 3). Brainstems were removed and cryosectioned. Fluorescent in‐situ hybridization (FISH) was performed on cryosections from animals killed at 3 weeks using a cDNA probe for woodchuck polyribosomal enzyme within the rAAV vector. In a third group (n = 2), Fluoro‐Gold (Fluorochrome, Inc., Denver, CO) was injected into the right thyroarytenoid muscle for comparison of neuronal uptake distribution. These rats were killed and perfused at 3 weeks.

Results The presence of GFP was noted in neurons throughout the medulla of all rat brainstems after unilateral rAAV‐GFP injection at both 3 and 11 weeks. In contrast to the Fluoro‐Gold, GFP was noted bilaterally and outside of the nucleus ambiguus. FISH confirmed the presence of virus within neurons expressing GFP at 3 weeks.

Conclusions Remote delivery of rAAV‐GFP to the rat brainstem is possible through injection into the recurrent laryngeal nerve. This has important therapeutic implications for the future treatment of recurrent laryngeal nerve injury and neurodegenerative diseases.
Long‐Term Follow‐up Results of Electrogustometry and Subjective Taste Disorder After Middle Ear Surgery
Authors: Saito Takehisa , Manabe Yasuhiro , Shibamori Yoshiyuki , Yamagishi Takahiro , Igawa Hideki , Tokuriki Masaharu , Fukuoka Yoko , Noda Ichiro , Ohtsubo Toshio , Saito Hitoshi
Published: November 2003

Objectives The present study compares the long‐term follow‐up results of electrogustometry with patient reports of taste dysfunction after middle ear surgery.

Study Design Retrospective review of 371 patients who underwent middle ear surgery.

Methods Patients were divided into the following groups depending on the degree of manipulation or surgical damage to the chorda tympani nerves: the no‐touch group (group 1 [n = 109]); the touch group (group 2 [n = 149]); and the severed nerve group (group 3 [n = 113]). Electrogustometry was periodically performed over the course of several years.

Results The incidences of postoperative subjective taste disorder in groups 1, 2, and 3 were 2.8%, 25.5%, and 38.9%, respectively. Although the subjective taste disorder usually recovered within 1 to 2 years after surgery in all groups, it persisted for more than 2 years in 2.7% of the touch group and 5.3% of the severed nerve group. Concerning postoperative electrogustometric results, in the no‐touch group, 8.3% of patients showed threshold elevation on electrogustometry, but the elevated thresholds completely recovered in all cases. In the touch group, 45% of patients exhibited elevated electrogustometric thresholds on their first postoperative test, including 32.9% who subsequently had complete electrogustometric recovery, 10.1% who subsequently had incomplete recovery, and 2% who failed to recover during the follow‐up period. In the severed nerve group, none of the patients was responsive to the electrical stimulus on the first postoperative test, including 8.8% of patients who subsequently exhibited complete electrogustometric recovery, 32.7% who later had incomplete electrogustometric recovery, and 58.4% who never recovered any electrogustometric responsiveness. Nerve repair in the severed nerve group produced better recovery, as measured electrically.

Conclusions The incidence of postoperative subjective taste disorder was low, although inconsistent with the high incidence of threshold elevation on electrogustometry, especially in the severed nerve group. Preservation or repair of the chorda tympani nerve is recommended in order to maintain or recover gustatory function.
Determination of Ototoxicity of Common Otic Drops Using Isolated Cochlear Outer Hair Cells
Authors: Jinn Tae Hoon , Kim Paul D. , Russell Paul T. , Church Christopher A. , John Earnest O. , Jung Timothy T. K.
Published: November 2003

Objectives Otic drops are commonly used not only for otitis externa, but also for otorrhea in the presence of tympanostomy tubes or tympanic membrane perforations. Many studies have demonstrated the ototoxicity of common otic preparations such as Cortisporin® otic drops (Monarch Pharmaceuticals, Bristol, TN). The purpose of this study was to assess the relative ototoxicity of common otic preparations by direct exposure to isolated cochlear outer hair cells (OHCs).

Methods OHCs from adult chinchilla cochlea were exposed to standard bathing solution (control), acetic acid, Acetasol HC® (Alpharma USPD Inc., Baltimore, MD), Gentacidin® (CIBA Vision Ophthalmics, Atlanta, GA), and Tobradex® (Alcon, Fort Worth, TX). The cells were observed using an inverted microscope, and the images were recorded in digital still‐frame and video, and analyzed on the Image Pro‐Plus 3.0 program (Media Cybernetics, Silver Spring, MD).

Results and Conclusions As measured by time to cell death and change in morphology of OHCs, acetic acid with or without hydrocortisone was most toxic to OHCs. Cortisporin was more cytotoxic than gentamicin and Tobradex.
Enhancement of Delta Aminolevulinic Acid–Photodynamic Therapy In Vivo by Decreasing Tumor pH With Glucose and Amiloride
Authors: Piot Benoît , Rousset Nathalie , Lenz Peter , Eléouet Sabine , Carré Jérome , Vonarx Véronique , Bourré Ludovic , Patrice Thierry
Published: November 2003

Objectives/Hypothesis Delta aminolevulinic acid (ALA)–induced protoporphyrin IX (PpIX) is a fluorescent sensitizer that permits detection and treatment of squamous cell carcinoma of the oral cavity. An exogenously induced decrease in tissue pH was evaluated for its effect in enhancing cellular uptake of ALA and facilitating its transformation into PpIX.

Study Design Mice grafted with HT29 colonic cancers had been given glucose and amiloride to modify the pH of tissues. Influence of pH changes has been evaluated on ALA‐induced PPIX fluorescence by optic fiber spectrofluorimetry as well as on tumor growth.

Methods Results: The pH in HT 29 tumor decreased from 7.1 to 6.67 (P <.05) after intraperitoneal injection of glucose and amiloride. The PpIX fluorescence ratios in tumor or muscle before, between, and 2 hours after glucose and amiloride injection were not higher than control ratios. Aminolevulinic acid–photodynamic therapy was more efficient on HT 29 tumor–bearing mice when the pH value was decreased with glucose and amiloride, showing a difference in the tumor growth index ratio from the 1st to 14th day of 22% between amiloride‐glucose aminolevulinic acid–photodynamic therapy and aminolevulinic acid–photodynamic therapy alone (P <.05).

Conclusions Glucose and amiloride did not change PpIX fluorescence in HT 29 tumor after intraperitoneal injection of aminolevulinic acid but enhanced aminolevulinic acid–photodynamic therapy efficacy. This was probably a result of mechanisms other than an increase in aminolevulinic acid cellular penetration and PpIX production, such as susceptibility to free radical toxicity or alteration of cellular repair enzymes under acidotic conditions. If a decrease of pH induces a more efficient photodynamic therapy as suggested by our results, an easier way to obtain this decrease than glucose and amiloride would be necessary for clinical applications.
Effect of Nasal Surgery on Sleep‐Related Breathing Disorders
Authors: Verse Thomas , Maurer Joachim T. , Pirsig Wolfgang
Published: November 2003

Objective/Hypothesis Single cases of patients who have experienced obstructive sleep apnea (OSA) and who recovered completely after nasal surgery have been described in various studies. The purpose of this study was to evaluate the efficacy of only nasal surgery 1) in a group of patients with obstructive sleep apnea and 2) in simple snorers.

Study Design A prospective, controlled study with 26 adult patients who underwent nasal surgery as single treatment of their sleep‐related breathing disorders. The cases were evaluated based on the severity level of their preoperative Apnea Hypopnea Index (AHI).

Material and Methods Between August 1996 and July 2000, 26 patients who snored and had impaired nasal breathing underwent attended polysomnography in the sleep laboratory as single treatment nasal surgery was performed. Postoperative polysomnographic findings and complications were reviewed.

Results Nineteen of 26 patients (73.1%) were diagnosed as having OSA. Seven patients were simple snorers with an AHI below 10. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative AHI and a postoperative AHI of less than 20, was 15.8% in the apneics. For the whole group, the AHI decreased postoperatively from 31.6 to 28.9. However, daytime sleepiness improved significantly and arousals decreased significantly in both apneics and simple snorers after nasal surgery.

Conclusions We conclude that nasal surgery has a limited efficacy in the treatment of adult patients with sleep apnea. Nevertheless, nasal surgery significantly improves sleep quality and daytime sleepiness independent of the severity of obstructive sleep‐related breathing disorders.