bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Septal Squamous Cell Carcinoma: A Chart Review and Meta‐analysis
Authors: DiLeo Michael D. , Miller Robert H. , Rice Janet C. , Butcher R. Brent
Published: November 2003

Squamous cell carcinoma of the nasal septum occurs infrequently and is often misdiagnosed because its symptoms are similar to everyday rhinologic complaints. The published series have been too small to determine the best form of treatment for this cancer. The authors of this study retrospectively reviewed nasal septal squamous cell carcinomas treated at three university‐affiliated hospitals over a 30‐year period. Sixteen primary tumors were identified and reviewed for presentation, staging, treatment, recurrence patterns, and risk factors. The authors then combined their findings with those of suitable literature series and performed a meta‐analysis to evaluate predictors of survival.

There were too few patients in each stage and treatment group to significantly determine the optimal treatment for nasal septal squamous cell carcinoma. However, based on the present study and the literature series, the authors suggest that small lesions may be confidently treated with either radiation or surgery and that combined therapy may be reserved for more advanced tumors.

Laryngoscope, 106:1218‐1222, 1996
Absorption of Topical Cocaine in Rhinologic Procedures
Authors: Greinwald John H. , Holtel Michael R.
Published: November 2003

Although topical intranasal cocaine remains a common anesthetic in nasal surgery, controversy surrounds its dosage and mucosal absorption. A prospective study of 12 patients undergoing nasal surgery was performed to evaluate the absorption of cocaine solution from standard cotton pledgets. Of a 160‐mg cocaine solution applied, a mean amount of 102 mg or 63.8% was recovered by gas chromatography/mass spectrometry analysis. Similar analysis of nasopharyngeal packs revealed less than 1.5% cocaine loss in the nasopharynx. Serum levels of cocaine were rarely detectable and did not correlate with either the amount of nasal absorption or time of mucosal contact. These results indicate that less than 37% of cocaine is absorbed from cotton pledgets during nasal surgery. The cocaine dose of 160 mg, used by many otolaryngologists, did not result in significant plasma levels.

Laryngoscope, 106:1223‐1225, 1996
Laryngeal Tuberculosis in HIV‐Infected Patients: A Difficult Diagnosis
Authors: Singh Bhuvanesh , Balwally Atul N. , Nash Michael , Har‐El Gady , Lucente Frank E.
Published: November 2003

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non‐HIV‐infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma‐like appearance of the laryngeal TB lesions in HIV‐infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection.

Laryngoscope, 106:1238‐1240, 1996
Tracheobronchography in Children
Authors: Deutsch Ellen S. , Smergel Eleanor , Crisci Kristin , Panitch Howard
Published: November 2003

Tracheobronchography (TBG) can provide anatomic information supplementing endoscopy in evaluating complex congenital and acquired tracheal abnormalities. With the use of modern non‐ionic contrast agents and flexible fiberoptic bronchoscopes, TBG can be performed safely and comfortably in children. As some tracheal lesions have a significant risk of mortality, obtaining maximum definition of the abnormality is imperative prior to attempting surgical management.

Twenty‐two patients underwent TBG at St. Christopher's Hospital for Children(Philadelphia) from July 1990 through June 1995. With the use of iohexol as a contrast agent, flexible bronchoscopes and adequate sedation and analgesia, without the need for intubation or general anesthesia, there were no significant complications or discomfort during or after the procedure.

Techniques and illustrative radiographs are presented. TBG provides a useful adjunct to endoscopy.

Laryngoscope, 106:1248‐1254, 1996
Indirect Larynx and Pharynx Surgery: A Replacement for Direct Laryngoscopy
Authors: Bastian Robert W. , Delsupehe Kathelijne G.
Published: November 2003

During a 2‐year period, 192 indirect surgeries on the laryngopharynx were performed in an outpatient videoendoscopy laboratory under topical anesthesia with or without intravenous sedation. These procedures included cancer staging and biopsy; vocal fold injections of Teflon, Gelfoam, botulinum toxin, or steroids; glottic web lysis; and granuloma removal. The techniques used to perform these procedures are elucidated. Careful chart review of these patients shows that indirect surgery was performed successfully in 96% of cases. Intravenous conscious sedation was utilized in 39% of patients. No significant complications were encountered. By avoiding the need for an operating room, hospitalization, or general anesthesia, this technique was clearly as safe or safer, more convenient for surgeon and patient, and more cost‐effective than the same procedure would have been via the traditional direct laryngoscopy. As the authors have already done in their practices, the indirect method should therefore be reinstated as the preferred approach to the clinical circumstances described here.

Laryngoscope, 106:1280‐1286, 1996
Unique Case Presentations of Acute Epiglottic Swelling and a Protocol for Acute Airway Compromise
Authors: Parsons David S. , Smith Russell B. , Mair Eric A. , Dlabal Luke J.
Published: November 2003

Acute epiglottitis is a well‐described life‐threatening disease. Since the generalized use of the Haemophilus influenzae type B (HIB) vaccine, presentations of this disorder have decreased dramatically in children. Presentations of this and other acute epiglottic swelling can vary remarkably and may easily be misdiagnosed by physicians who have little or no experience with the acutely obstructed airway. Early suspicion and a proper evaluation is mandatory to prevent a life‐threatening crisis. Six patients are presented with unusual presentations of acute epiglottic swelling from differing etiologies; these include the following: case 1, recurrent epiglottitis; case 2, chronic epiglottitis; case 3, traumatic epiglottitis; case 4, caustic ingestion; and cases 5 and 6, simultaneous infection of family members. Because the incidence of acute epiglottitis is decreasing, it has become rare at most institutions. To help primary care and emergency room physicians, a formal written protocol should be available at medical facilities that might be faced with patients presenting with acute airway obstruction. An “acute airway obstruction protocol” used successfully for the last decade is offered. Use of such a written document might be lifesaving for patients with impending upper airway obstruction. The otolaryngologist is a key member of the recommended multidisciplinary team.

Laryngoscope, 106:1287‐1291, 1996
Sudden Bilateral Sensorineural Hearing Loss
Authors: Fetterman Bruce L. , Luxford William M. , Saunders James E.
Published: November 2003

Most cases of sudden sensorineural hearing loss (SHL) remain idiopathic, and the majority are unilateral. From 1989 to 1993, 823 patients with sudden SHL were evaluated. Of these, 14 (1.7%) had sudden bilateral SHL. We reviewed the charts of these 14 patients to compare sudden bilateral SHL with sudden unilateral SHL. Usually, bilateral SHL was asymmetric. Most bilateral cases received combined steroid and vasodilator treatment, while unilateral cases were more likely to receive only one of these treatments. By audiological criteria, 67% of bilateral SHL cases improved, while the improvement rate in unilateral SHL was 52%; however, this difference was not statistically significant. In bilateral SHL patients showing improvement, both ears responded. Bilateral SHL patients were older at the onset of hearing loss, had a higher incidence of vascular disease, and were more likely to have positive antinuclear antibody titer. Recognition of similarities and differences between sudden unilateral and bilateral SHL can help in counseling patients.
Submillimeter Magnetic Resonance Imaging of the Temporal Bone in Meniere's Disease
Authors: Welling D. Bradley , Clarkson Mark W. , Miles Beth A. , Schmalbrock Petra , Williams Philip M. , Chakeres Donald W. , Oehler Mary C.
Published: November 2003

The pathoetiology of Meniere's disease remains elusive. Histopathologic and imaging studies have implicated congenital or developmental abnormality of the endolymphatic duct as a likely predisposing factor to the development of endolymphatic hydrops and clinical Meniere's disease. Recently, improved high‐resolution magnetic resonance imaging (MRI) protocols have allowed better demonstration of the soft tissues of the endolymphatic duct and sac.

This study is a prospective evaluation of the ability of submillimeter MRI to detect the endolymphatic duct in Meniere's disease patients and control subjects. In addition, the development of the temporal bone in the region of the endolymphatic sac and duct is evaluated by measurements of the distance from the posterior semicircular canal to the subarachnoid space and the distance from the vestibule to the subarachnoid space.

Visualization of the endolymphatic duct was found to be significantly less frequent in the Meniere's disease patients (29%) than in the control subjects(91%). Temporal bone measurements in the region of the endolymphatic duct showed patients with Meniere's disease to have smaller dimensions than control subjects.
Closure of the Fibula Free Flap Donor Site With the Sure‐Closure™ Skin‐Stretching Device
Authors: Futran Neal D.
Published: November 2003

Fibula osseocutaneous free tissue transfer represents state‐of‐the‐art reconstruction of the oromandibular complex following oncologic resection. The width of the fibula skin paddle is usually limited by the ability to achieve primary wound closure. In some cases the donor site requires skin grafting and subsequent surgical procedures to achieve effective closure, or placement of a tissue expander. The recent development of an indexed tissue advancement system(Sure Closure™) makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in a single procedure. The system secures and brings together wound edges by applying graduated pressure with a metered force approximator. A series of 12 fibula osseocutaneous free flap defects is presented, which have been successfully closed using this simple, convenient, and safe device.
Contraction Patterns of Intrinsic Laryngeal Muscles Induced by Orderly Recruitment in the Canine
Authors: Broniatowski Michael , Vito Kenneth J. , Shah Bharat , Shields Robert W. , Secic Michelle , Dessoffy Ray , Strome Marshall
Published: November 2003

The specific performance of intrinsic laryngeal muscles has been difficult to evaluate, especially in living subjects. To reproduce natural contractions, we artificially induced orderly recruitment of their innervating axons according to the size principle. In 5 dogs, both recurrent laryngeal nerves(RLNs) were stimulated with 50 through 10 Hz, 300 to 1000 μA currents while 600 Hz, 1000 to 0 μA decreasing blocking currents were administered. Surface electromyography electrodes placed on the thyroarytenoid, posterior cricoarytenoid, and lateral cricoarytenoid muscles were used to determine the amplitudes (in mA) of compound muscle action potentials. There was a highly statistically significant difference (P<.004) between the thyroarytenoideus which had the fastest rate of recruitment (8.38%), and posterior cricoarytenoideus, which had the slowest (4.81%). There was an intermediate recruitment rate (6.72%) of the lateral cricoarytenoideus, a divergence attributed to a more equal distribution in fast and slow types of myofibers and a smaller sample. We submit that RLN axons can be recruited in an orderly manner according to their sizes and that the rates are unique to the muscle classes they innervate. The parameters defining these contraction patterns may offer key information for laryngeal pacing.
Experimental Study on Reinnervation of Vocal Cord Adductors With the Ansa Cervicalis
Authors: Zheng Hongliang , Li Zhaoji , Zhou Shuimiao , Cuan Yi , Wen Wu , Lan Jingshang
Published: November 2003

The purpose of this study was to reestablish the adduction of the paralyzed vocal cord through reinnervation of the adductor muscles for unilateral vocal cord paralysis. In nine dogs, the adductor branch of the recurrent laryngeal nerve was anastomosed to the main branch of the ansa cervicalis. Six months later, various techniques of observation showed that seven of nine cases had excellent to good adduction during whining. Adduction was caused by reinnervation of the adductor muscles from the ansa cervicalis as demonstrated by laryngeal spontaneous and evoked electromyography, contraction tension, and various histologic findings. Therefore, the new technique could be a good treatment of unilateral vocal cord paralysis.
Endoscopic Sinus Surgery in the Treatment of Cystic Fibrosis With Nasal Polyposis
Authors: Rowe‐Jones Julian M. , Mackay Ian S.
Published: November 2003

We have performed endoscopic sinus surgery on 46 patients with chronic, polypoid rhinosinusitis since 1989. Follow‐up ranged from 1 month to 6 years(mean, 28.2 months). Overall, our patients had a 50% chance either of their symptoms returning to preoperative severity or of undergoing a second endoscopic sinus procedure, by 18 to 24 months of postoperative follow‐up. Patients with predominantly infective symptoms of mucopurulent rhinorrhea and pain had a significantly better outcome than those with predominantly nasal blockage. The chance of the former group of patients suffering symptom deterioration back to the preoperative state or undergoing a second endoscopic sinus operation was 37% of that of the latter group. The extent of disease on computed tomography scan had no relation to outcome.
Effect of Cortisporin Otic Suspension on Cochlear Function and Efferent Activity in the Guinea Pig
Authors: Perry Brian P. , Smith David W.
Published: November 2003

To predict cochlear receptor cell insult from therapeutic aminoglycoside antibiotics, we sought to determine whether the presence of subtoxic concentrations of Cortisporin otic suspension in the cochlea can be detected by measuring changes in efferent suppression of compound action potentials recorded from the round window. Olivocochlear efferent suppression in an earlier study was reversibly inhibited by injections of gentamicin in guinea pigs. Using that same technique, we found that 2.0 μL of Cortisporin otic suspension (neomycin, polymyxin B, hydrocortisone) placed on the round window of guinea pigs in varying concentrations causes a rapid, permanent alteration in thresholds. Solutions of Cortisporin otic suspension diluted to a concentration of 1:20 yield a reversible loss of efferent suppression without measurable changes in compound action potential. These data suggest that the presence of Cortisporin otic suspension can be detected functionally in the cochlea at very low concentrations prior to the development of a threshold shift.
Extended Use of Topical Nasal Decongestants
Authors: Yoo John K. , Seikaly Hadi , Calhoun Karen H.
Published: November 2003

Use of sympathomimetic topical nasal decongestants to treat nasal obstruction is usually restricted to 3 to 5 days to avoid potential rebound swelling (rhinitis medicamentosa). In this study, 10 healthy volunteers used oxymetazoline (long‐acting topical nasal decongestant) nightly for 4 weeks. Subjects who used antihistamines, oral or topical decongestants, or systemic steroids or who had active sinusitis were excluded from the study. Weekly history, physical examination, and anterior rhinomanometry revealed no adverse effects. Eight (80%) subjects developed nightly nasal obstruction a few hours before the evening dose; the obstruction resolved within 48 hours if no more decongestant was used. All subjects remained responsive to oxymetazoline 4 weeks and 8 weeks after the study began. This finding suggests that long‐acting decongestants may be safely used for longer than the recommended 3 to 5 days without adverse effects if used once nightly.
The Effects of 13‐cis Retinoic Acid on Squamous Cell Carcinoma Proliferation and Adhesion to Extracellular Matrix Proteins
Authors: Speyer Matthew T. , Jackson Jon A. , Burkey Brian B.
Published: November 2003

To understand the role of retinoids in chemoprevention, the authors examined the effects of 13‐cis retinoic acid (cRA) on squamous cell carcinoma proliferation and adhesion to extracellular matrix proteins. The antiproliferative effects of cRA were first seen on day 11 (66% inhibition) and progressed through day 19 (96% inhibition).

Using an adhesion assay, the authors then investigated the effects of cRA and transforming growth factor‐beta1 (TGF‐β1) on cellular adhesion to purified type IV collagen, fibronectin, and laminin matrices. Cells treated for 4 days with TGF‐β1 increased adhesion by 15% to 29%, and cells treated with cRA increased adhesion by 19% to 39%. However, the use of cRA alone resulted in a decrease in adhesion when tumor cells were treated for 7 days (20% to 32%) and 15 days (25% to 40%).

The authors also discuss how cRA acts as a differentiating agent on squamous cell carcinoma.
Use of the KTP‐532 Laser in Acoustic Neuroma Surgery
Authors: Nissen Alan J. , Sikand Ashley , Welsh Joseph E. , Curto Frank S.
Published: November 2003

The potassium titanyl phosphate (KTP‐532) laser has been applied to otologic surgery with a proven record of both safety and efficacy. The aim of this study was to demonstrate the use, safety, and advantages of laser dissection in the surgical treatment of acoustic neuromas. The authors' experience with 111 patients in whom laser surgery was used in acoustic neuroma is presented, with emphasis on surgical technique employed and facial nerve functional outcome. The method of laser dissection did not result in deleterious neurologic sequelae or laser‐specific complications. In addition, laser dissection afforded certain advantages to traditional techniques, especially in larger tumors. The facial nerve functional outcome as assessed by the House‐Brackmann grading system revealed that 90.2% of small tumors, 72.2% of medium tumors, and 75.0% of large tumors achieved satisfactory (grades I and II) functional results. These results compare favorably with the literature describing nonlaser dissection techniques. The observations and results reported in this article demonstrate the safety of the KTP‐532 laser in the posterior cranial fossa, and specific advantages that this technology may offer to the surgical armamentarium of the neuro‐otologist are outlined.
Myringotomized Mice Develop Myringosclerosis in the Pars Flaccida and Not in the Pars Tensa
Authors: Mattsson Cecilia , Carlsson Lena , Marklund Stefan L. , Hellström Sten
Published: November 2003

The development of myringosclerosis has been correlated with increased production of oxygen‐derived free radicals. For the present study, we used a null mutant mouse lacking extracellular superoxide dismutase to test the hypothesis that increased production of free radicals can cause the development of myringosclerosis. Null mutant mice and wild‐type, control mice were myringotomized and kept in ambient air for 3 weeks. Both groups developed myringosclerosis in the pars flaccida, but not in the pars tensa. The sclerotic lesions were visible in both the light and the electron microscope but not in the otomicroscope. In particular, the localization of the sclerotic deposits was found beneath both the inner and outer epidermal epithelium. No difference concerning the extent or number of sclerotic lesions between the null mutant and the wildtype mice could be distinguished.
Demonstration of Autoantibodies to the Endolymphatic Sac in Meniere's Disease
Authors: Alleman Anthony M. , Dornhoffer John L. , Arenberg I. Kaufman , Walker Patrick D.
Published: November 2003

Recent evidence suggests that immune mechanisms may underlie some cases of Meniere's disease. This study was conducted to determine whether an autoimmune mechanism is involved. Sera from 30 patients with Meniere's disease were reacted with human endolymphatic sacs and examined by indirect immunohistochemistry and fluorescence microscopy. Three of the samples (10%) showed positive staining, indicating immunoglobulin G (IgG) binding against the sac. No positive staining occurred when sera from healthy individuals or phosphate‐buffered saline was used as a control. Clinical data showed an association between immunoreactivity and extent of disease (worse hearing over a shorter disease course and bilateral involvement). This study suggests that, in some cases of Meniere's disease, autoantibodies directed against human endolymphatic sac are present in the sera, supporting the theory that a specific autoimmune reaction takes place in a minority of patients with Meniere's disease.
Comparison of Anti‐Heat Shock Protein 70 (Anti‐hsp70) and Anti‐68‐kDa Inner Ear Protein in the Sera of Patients with Meniere's Disease
Authors: Shin See‐Ok , Billings Peter B. , Keithley Elizabeth M. , Harris Jeffrey P.
Published: November 2003

The 68‐kDa antigen detected in the sera of patients with autoimmune inner ear disease is known to represent the highly inducible heat shock protein 70 (hsp70). To evaluate the existence of anti‐hsp70 in the sera of patients with Meniere's disease and to develop a more reliable method to detect this antibody, the sera of patients and controls were examined.

Bovine kidney (MDBK) cells were cultured and some of them were heat shocked. Proteins in the cells were separated using sodium dodecyl sulfate polyacrylamide gel electrophoresis. Sera were reacted simultaneously with the blots of non‐heat‐shocked cells and heat‐shocked cells. The serum was considered positive if the band in the 70‐kDa location was denser in the lane with heat‐shocked cells relative to non‐heat‐shocked cells. Presence of the antibody against the 68‐kDa protein was compared with the result of immunoblotting with MDBK cells.

In immunoblotting with MDBK cells, 33.3% of patients with Meniere's disease had anti‐hsp70, while in the control group, only 5% had this antibody. Of the 60 cases, 13 were positive against both hsp70 and the 68‐kDa protein, whereas 7 were positive only against hsp70 and 6 only against the 68‐kDa protein. These differences appeared to result from the greater sensitivity of the differential anti‐hsp assay and from difficulties in interpreting the results in blots with bovine inner ear extracts because of faint, broad, or overlapping multiple bands.

Quite a number of patients with Meniere's disease have anti‐hsp70, and it may be indicative of an immune etiology of the disease. The Western blot using heat‐shocked and non‐heat‐shocked cells could be a reliable method to detect this antibody.
Clinical Classification as a Guide to Treatment of Sinusitis in Children
Authors: Weinberg Ellen A. , Brodsky Linda , Brody Alan , Pizzuto Michael , Stiner Holly
Published: November 2003

Evaluation of all 153 children undergoing CT scan of the paranasal sinuses for recalcitrant sinusitis symptoms between January 1988 and July 1992 was performed. Clinical categorization into groups of patients presenting with chronic sinusitis (CS) and recurrent acute sinusitis (RAS) was based upon pattern of disease and presentation. Clinical symptoms and signs, radiological examination, treatment, and outcome were compared between these distinct clinical groups. Eighty‐two (55%) children were categorized as RAS and 68 (45%) as CS. Children with CS presented more frequently with a persistent cough, purulent nasal discharge, immune deficiency, and more severe mucosal disease on CT than children with RAS. Medical therapy successfully controlled the symptoms of sinusitis in 79 (96%) with RAS versus 27 (40%) with CS. Surgery was performed in 44 children: 3 (3.6%) with RAS versus 41 (60%) with CS, p<0.01. At a mean follow‐up of 2.0 years, >80% of all the children were either asymptomatic or improved regardless of treatment modality. These data support the use of clinical classification as a guide to medical versus surgical therapy in children with sinusitis.
One‐Stage Reconstruction of Partial Laryngopharyngeal Defects
Authors: Schuller David E. , Mountain Rodney E. , Nicholson Roy E. , Bier‐Laning Carol M. , Powers Bret , Repasky Michael
Published: November 2003

Advanced‐stage lesions of the hypopharynx or tongue base often involve the larynx. The difficulty of reconstructing large partial laryngopharyngeal defects can result in total laryngectomy being performed to avoid the assumed problems with aspiration. This article describes the first reported experience using the pectoralis musculocutaneous flap for primary one‐stage reconstruction of laryngopharyngeal defects following resection of advanced‐stage lesions, to reconstruct both the laryngeal and the pharyngeal components of the defect. In this group of 21 patients, there were 16 with hypopharyngeal and 5 with tongue base cancers. Two had received prior treatment, and all received some form of postoperative radiotherapy and/or chemotherapy. Six patients experienced complications, including two fistulae, three wound infections, two myocardial infarctions, and one colon perforation. There were no instances of stenosis of the reconstructed segment. The length of hospitalization ranged from 9 to 60 days, the average being 17 days. Forty‐seven percent (21) of the patients were not tolerating an oral diet at the time of discharge. However, 15 patients (71%) ultimately were eating by mouth, with 13 (62%) achieving an oral intake of liquids and solids. This analysis supports the hypothesis that the pectoralis major musculocutaneous flap is an effective one‐stage primary reconstruction technique for laryngopharyngeal defects in patients either who have received prior therapy or who will receive postoperative therapy.
Combined Transconjunctival/Intranasal Endoscopic Approach to the Optic Canal in Traumatic Optic Neuropathy
Authors: Kuppersmith Ronald B. , Alford Eugene L. , Patrinely James R. , Lee Andrew G. , Parke Robert B. , Holds John B.
Published: November 2003

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.
Effect of Sinus Surgery on Pulmonary Function in Patients With Cystic Fibrosis
Authors: Madonna Dino , Isaacson Glenn , Rosenfeld Richard M. , Panitch Howard
Published: November 2003

The impact of sinus surgery on the pulmonary status of cystic fibrosis patients is unknown. This retrospective study reviewed the charts of the cystic fibrosis patients presenting to our institution's cystic fibrosis center with nasal obstruction, recurrent sinusitis, and nasal polyposis. This group subsequently underwent endoscopic ethmoidectomy and antrostomy. Fourteen of the 15 patients, ages 5‐24 years, received preoperative and postoperative pulmonary function testing obtained by spirometry. The data were compiled and analyzed statistically. Our results suggested no significant improvement in the pulmonary function of cystic fibrosis patients after sinus surgery.
Natural Course of Serum‐Specific Immunoglobulin E and Immunoglobulin G4 for a Span of Eight Years in Untreated Patients With Perennial Allergic Rhinitis
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Ohno Yoshiharu , Okamoto Hideki , Kakinoki Yasushi , Masamoto Tateo , Tanaka Ayaki , Hayashi Motoyo
Published: November 2003

During the past two decades, considerable attention has been devoted to the clinical role of serum‐specific IgE and IgG4 following immunotherapy. To definitely discuss the clinical role of serum‐specific IgG4, we should know the natural course of serum‐specific IgG4 in the untreated patient with allergic rhinitis. To our knowledge, however, no such kind of study can be found in the literature. Our present study focused on the long‐term follow‐up of serum‐specific IgE and IgG4 in patients who were not treated with immunotherapy for perennial allergic rhinitis. They were scheduled to take no medication for their perennial nasal symptoms for 8 years. Serum‐specific IgE and IgG4 in untreated patients with perennial allergic rhinitis never significantly change during the observation period. These data will be of great value for studies in serologic changes following active treatment for atopic diseases. Additionally, our study suggests that a reduction in serum‐specific IgE and an increase in serum‐specific IgG4 following immunotherapy are not the result of an immunotherapy‐independent and age‐related phenomenon but the result of active immunologic modulation by immunotherapy.
Detection of Epstein‐Barr Virus in Nasopharyngeal Carcinoma by In Situ Hybridization and Polymerase Chain Reaction
Authors: Murono Shigeyuki , Yoshizaki Tomokazu , Tanaka Saichiro , Takeshita Hajime , Park Chang‐Soo , Furukawa Mitsuru
Published: November 2003

The association of Epstein‐Barr virus (EBV) with nasopharyngeal carcinoma (NPC) has been shown by various methods. The purpose of this study is to identify the most useful method to detect EBV in NPC. Both polymerase chain reaction (PCR) for EBV‐DNA and in situ hybridization for EBV‐encoded small RNAs(EBERs) were examined in formalin‐fixed, paraffin‐embedded NPC specimens. In situ hybridization was performed in 56 cases, and PCR for EBV‐DNA was performed in 42 cases. EBV‐DNA was detected in 0 of 3 keratinizing squamous cell carcinomas(KSCC), 22 of 24 nonkeratinizing carcinomas (NKC), all 13 undifferentiated carcinomas (UNPC), and 0 of 2 adenocarcinomas (AC). EBERs were detected in 0 of 5 KSCC, 30 of 32 NKC, 16 of 17 UNPC, and 0 of 2 AC. Among them, EBERs was detected in 35 of 42 cases in which PCR was also performed, 0 of 3 KSCC, 22 of 24 NKC, all 13 UNPC, and 0 of 2 AC, respectively. Both results were consistent in 40 of 42 cases. We conclude that both PCR and in situ hybridization are useful to detect EBV in NPC. In situ hybridization has a particular advantage because it can demonstrate the localization of EBV in neoplastic cells. In addition, close association of NKC and UNPC but not KSCC and AC with EBV is suggested.
In Situ Lifetime, Causes for Replacement, and Complications of the ProvoxTMVoice Prosthesis
Authors: Laccourreye Ollivier , Ménard Madeleine , Crevier‐Buchman Lise , Couloigner Vincent , Brasnu Daniel
Published: November 2003

One hundred ProvoxTMvoice prostheses consecutively inserted in 37 patients and replaced only when phonation was impaired or complications noted were analyzed for in situ lifetime, causes for replacement, and complications. The mean in situ lifetime was 311 days. Actuarial analysis(Kaplan‐Meier method) of the in situ lifetime revealed that 65.9%, 23.7%, and 16.4% of the voice prosthesis were still in situ by the 6th, 12th, and 18th postinsertion month. Cause for replacement was salivary leakage through the prosthesis valve, salivary leakage around the prosthesis, deterioration of the prosthesis, and excessive crusting resulting in increased airflow resistance in 33%, 27%, 24%, and 16% of cases, respectively. Complications included granulation tissue formation, cervical cellulitis, necrosis of the tracheoesophageal puncture, tracheostomal stenosis, and swallowing impairment in six, two, one, three, and one patient, respectively.
Analysis of Voice Changes After Thyroplasty Using Linear Predictive Coding
Authors: Plant Randall L. , Hillel Allen D. , Waugh Patricia F.
Published: November 2003

Objective measurement of vocal quality is difficult in patients with severe voice disorders. Improved success has been reported using a modeling technique known as linear predictive coding. This technique uses an inverse filter to estimate a glottic excitation signal. The pitch amplitude is defined as the height of the first peak of the autocorrelation of the glottic excitation signal. In this study linear predictive coding was used to analyze voice disorders in patients with vocal fold immobility. Voice recordings were made in 16 patients undergoing vocal fold medialization and 10 patients who had no surgical procedure between measurements. The voice quality was rated by three speech pathologists. Five acoustic parameters were calculated from the samples. The best agreement with the listeners' perceptual analysis was achieved using the pitch amplitude. Both pitch amplitude and the perceptual ratings of voice quality improved in patients undergoing vocal fold medialization. Therefore the linear model of speech production and inverse filtering are useful in measuring vocal quality in patients with vocal fold immobility.
Utility of Preoperative Radionuclide Scanning for Primary Hyperparathyroidism
Authors: Sinha Christopher K. , Hamaker Ronda , Hamaker Ronald C. , Freeman Stephen B. , Borrowdale Richard W. , Huntley Tod C.
Published: November 2003

This study retrospectively reviews 60 cases of primary hyperparathyroidism, 21 of whom underwent technetium 99 sestamibi scanning and 10 of whom underwent thallium 201/technetium 99 pertechnetate scanning preoperatively. The sestamibi and thallium scans demonstrated an 89.5% and a 62.5% sensitivity rate for adenoma, respectively. Neither scan demonstrated hyperplastic glands well. Although the scans localized adenomatous glands to the correct side well, the ability to localize them more discretely was 68.4% and 62.5%, respectively. In cases of solitary adenoma the effect of an accurate preoperative scan on operative time for bilateral exploration was not significant, whereas the experience of the attending surgeon was significant. Also, the cost of the scans at our institution was greater than the cost of the time saved in performing even unilateral neck exploration. Thus preoperative radionuclide scanning is not cost‐effective for the initial exploration of patients with primary hyperparathyroidism and is insufficiently sensitive to make routine unilateral neck exploration for adenoma consistently effective.
Positional Vertigo and Ageotropic Bidirectional Nystagmus
Authors: Casani Augusto , Giovanni Vannucci , Bruno Fattori , Luigi Ghilardi Pier
Published: November 2003

A strong paroxysmal positional horizontal nystagmus accompanied by symptoms similar to those of paroxysmal positional vertigo (PPV) can be observed in a small fraction of patients who have positional vertigo. This nystagmus may be a lateral canal variant of PPV. We evaluated nine patients who had episodes of prolonged, intense positional vertigo provoked by lateral movements of the head while in the supine position. The nystagmus appeared as horizontal and was directed toward the uppermost ear (ageotropic) when the head was rotated to either side (bidirectional). The duration of nystagmus lasted more than 1 minute in all the cases, although it presented a progressive decrease in the velocity of the slow component. The clinical and electronystagmographic features of this syndrome lead us to propose a different form of horizontal canal PPV associated with a paroxysmal positional ageotropic and bidirectional nystagmus, probably caused by a “heavy cupula” as a result of deposits of extraneous bodies (otolithic?) or by a cupula denser than the endolymph.
Mutation of p53 in Squamous Cell Cancer of the Head and Neck: Relationship to Tumor Cell Proliferation
Authors: Wood Nancy B. , Kotelnikov Valery , Caldarelli David D. , Hutchinson James , Panje William R. , Hegde Poornima , Leurgans Sue , LaFollette Suzanne , Taylor Samuel G. , Preisler Harvey D. , Coon John S.
Published: November 2003

Rapid proliferation of squamous cell carcinomas of the head and neck (SCCHN) during therapy may contribute to treatment failure. We have investigated the presence of p53 abnormalities in patients with SCCHN as a correlate of proliferation rate and other pathologic and clinical variables. p53 Mutation, as determined by polymerase chain reaction and single‐strand conformation polymorphism analysis of microdissected frozen sections of tumor biopsies, was significantly associated with a high labeling index, as determined by in vivo infusion of IUdR and BrdU (P = 0.017). p53 Protein expression was detected by immunohistochemistry with two different antibodies, followed by quantitative image analysis. Many cases exhibited strong p53 protein expression in the absence of mutations within the conserved region of the gene, and expression was not related to proliferation. The presence of p53 mutations was related to tumor differentiation in this group of patients.
Suprastomal Granulation Tissue and Pediatric Tracheotomy Decannulation
Authors: Merritt Robert M. , Bent John P. , Smith Richard J. H.
Published: November 2003

Although numerous decannulation techniques have been reported, often involving costly sleep studies, repetitive laser procedures, and tracheotomy tube “downsizing,” no established standard of care exists. We advocate the following simple, minimally invasive decannulation protocol. After excluding concomitant airway lesions, suprastomal granulation is removed transtomally by an endoscopically guided rongeur. A tracheotomy tube is then fashioned with a fenestration centered in the tracheal lumen. Decannulation occurs if the patient maintains adequate ventilation over a 12‐ to 24‐hour observation period with the fenestrated tracheotomy capped. Over 18 months we prospectively followed 10 consecutive children presenting as potential decannulation candidates. Using the aforementioned technique, nine of 10 patients were successfully decannulated (average follow‐up, 11.5 months). The postoperative capped fenestrated tracheotomy trial provides a realistic assessment of preparedness for decannulation. We recommend this protocol as a rapid, efficient, and cost‐effective means of achieving decannulation.
Efficacy of Tympanomastoid Surgery for Control of Infection in Active Chronic Otitis Media
Authors: Merchant Saumil N. , Wang Pa‐chun , Jang Chul‐Ho , Glynn Robert J. , Rauch Steven D. , McKenna Michael J. , Nadol Joseph B.
Published: November 2003

The efficacy of surgery in controlling infection in 272 tympanomastoidectomy procedures for chronic otitis media (COM) was assessed by means of a four‐point rating scale that incorporated both symptoms and signs, such as the presence or absence of otorrhea and granulation tissue. Of the 272 procedures, 170 were performed for COM with cholesteatoma and 102 were for active COM with granulation tissue but no cholesteatoma. Forty‐seven percent were primary procedures, and 53% were revisions. Minimum follow‐up was 12 months for all cases, with a mean of 30 months. Adequate control of infection occurred in 248 (91%) of the 272 cases. Of the 24 cases (9%) that developed persistent infection, 10 were controlled with a combination of oral and topical antibiotics and/or delayed skin grafting in the office. Thus overall satisfactory control of infection was achieved in 258 of 272 cases (95%). The outcome was influenced by the diagnostic category of COM: COM with cholesteatoma did significantly better than COM with granulation tissue (P= 0.02). The outcome was not influenced by the following variables: primary versus revision surgery, canal wall‐up versus canal wall‐down surgery, and extent of disease. The results suggest that active COM with granulation tissue may be more difficult to control than COM with cholesteatoma.
Stapedectomy in Patients With Small Air‐Bone Gaps
Authors: Lippy William H. , Burkey John M. , Schuring Arnold G. , Rizer Franklin M.
Published: November 2003

Controversy exists concerning stapedectomy for patients with small air‐bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air‐bone gap. One hundred fifty‐four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure‐tone average (PTA) improved 16.7 dB and overclosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overclosing even small air‐bone gaps due to otosclerosis.
Soluble Intercellular Adhesion Molecule‐1 Level in Sera Is Elevated in Perennial Allergic Rhinitis
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Tanaka Ayaki , Kakinoki Yasushi , Ohno Yoshiharu , Masamoto Tateo , Sakamoto Hirokazu , Kato Akifumi , Washio Yushi , Hayashi Motoyo
Published: November 2003

Soluble intercellular adhesion molecule‐1 (sICAM‐1) in sera was measured in some allergic disorders, but serum sICAM‐1 levels in perennial allergic rhinitis remain to be determined. Our study was aimed at elucidating whether the serum sICAM‐1 levels in patients with perennial allergic rhinitis are different from those in nonatopic healthy volunteers and whether immunotherapy can modulate sICAM‐1 levels. Serum sICAM‐1 was determined in 20 nonallergic volunteers and 137 patients with perennial allergic rhinitis by a sandwich enzyme‐linked immunosorbent assay. Our study demonstrated that the level of sICAM‐1 in untreated patients is significantly elevated, as compared with nonatopic subjects. Immunotherapy could decrease sICAM‐1 in perennial allergic rhinitis, but this suppressive effect became apparent only after many years of immunotherapy. In patients on immunotherapy, a close correlation was observed between sICAM‐1 and nasal symptom scores. To take these lines of evidence together, a decrease in sICAM‐1 might be related to the working mechanism of immunotherapy, and serum sICAM‐1 could be used to monitor the effect of immunotherapy.
Nasal and Sinus Polyposis in Children
Authors: Triglia Jean‐Michel , Nicollas Richard
Published: November 2003

Nasal and sinus polyposis in the pediatric population is uncommon and its etiology is unclear. In this 11‐year retrospective study, the authors describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 46 children. Patients were divided into three groups according to whether nasal and sinus polyposis was isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 27). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 22% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, especially chronic nasal obstruction, rhinorrhea, and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e., a few micropolyps localized on the roof of the ethmoid cavity) was observed in 24% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 12%. However, recurrences were higher in patients with cystic fibrosis, because minor recurrence with no clinical manifestation was observed in 32% of these cases and major recurrence in 16%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow‐up of 3.7 years, results in this series are encouraging.
Resource Utilization and Patient Morbidity in Head and Neck Reconstruction
Authors: Brown Matthew R. , McCulloch Timothy M. , Funk Gerry F. , Graham Scott M. , Hoffman Henry T.
Published: November 2003

Many papers have addressed the technical aspects of free tissue transfer in head and neck cancer patients. However, there has not been a critical assessment of the impact of free tissue transfer on resource utilization and patient morbidity compared with pedicle flap reconstructions. Two cohorts of patients derived from 245 consecutive reconstructions were tightly matched by age, site, stage, and histology, yielding 44 patient pairs differing in method of reconstruction. Patients undergoing free flap reconstruction spent more time in the operating room than those reconstructed with pedicled flaps (993 min vs. 777 min, P < 0.0001). The group with free flap reconstruction spent fewer days in the surgical intensive care unit and hospital (2 days vs. 2.5 days; 18.5 days vs. 22.6 days). This difference is attributed to the paucity of postoperative complications in the group with free flap reconstruction (fistula formation 4.5% vs. 21%, P < 0.04). These data indicate that the continued use of sophisticated reconstructive techniques in head and neck cancer patients is economically sound as assessed by patient morbidity and resource utilization.
Necrotizing Fasciitis of the Face
Authors: Shindo Maisie L. , Nalbone Vincent P. , Dougherty William R.
Published: November 2003

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Its occurrence in the head and neck region is uncommon, the majority of reported cases being limited to involvement of the neck, usually from infections of dental or pharyngeal origin. Involvement of the face from NF is rare; only 35 such cases have been reported in the literature since 1960. It is not only associated with a high mortality but can also result in severe disfigurement of the face, posing challenging reconstructive problems. Successful management of facial NF requires early diagnosis, prompt institution of broad spectrum antibiotics, aggressive surgical debridement to control the infection, and reconstruction of the resultant soft tissue defects. This report describes four additional cases of facial necrotizing fasciitis. One of the four patients died as a result of sepsis and multi‐organ system failure. Two of the three surviving patients had significant facial disfigurement. A comprehensive review of the facial NF cases reported in the literature is also provided. Based on our experience with facial NF and the results of all previous case reports, the clinical manifestations, pathogenesis, and management of this disease are discussed.