bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory Findings in Patients with Maternally Inherited Diabetes and Deafness Harboring a Point Mutation in the Mitochondrial Transfer RNALeu (UUR) Gene
Authors: Yamasoba Tatsuya , Oka Yoshitomo , Tsukuda Katsunori , Nakamura Masaichi , Kaga Kimitaka
Published: November 2003

Five patients with sensorineural hearing loss, who harbored a point mutation in the mitochondrial transfer RNA (tRNA) gene tRNALeu (UUR), from five unrelated family pedigrees were examined. In these families diabetes and deafness were maternally inherited. Bilateral hearing was more severely impaired at higher frequencies. Audiometric test results revealed that hearing loss involved the cochlea. Hearing gradually deteriorated; the progression rate ranged from 1.5 to 7.9 dB per year. Proportion of mutant mitochondrial DNAs (mtDNAs) in the leukocytes was not related to the rate or degree of hearing loss, although hearing loss appeared at a younger age in patients with higher heteroplasmy. We speculate that after the proportion of damaged mtDNAs, mostly as a result of mutation, exceeds the expression threshold for deficiencies in mitochondrial protein synthesis and oxygen consumption, a drop in adenosine triphosphate level could lead to an imbalance of ion concentration, resulting in cell death in the cochlea.
Endoscopic Sinus Surgery in the Developmentally Delayed Child
Authors: Ramadan Hassan H. , Rosen David
Published: November 2003

Functional endoscopic sinus surgery (FESS) has gained widespread support as the treatment of choice for chronic sinusitis in children. Seven developmentally delayed children were evaluated for chronic sinusitis with symptoms of cough, chronic rhinorrhea, and head banging because of pain. All seven were nonresponsive to repeated courses of oral and sometimes intravenous antibiotics; computed tomography scans on all revealed sinus disease. FESS was performed on all of them. Three children had marked respiratory difficulty at the end of the procedure, with two requiring reintubation. Two children were not able to take oral feedings postoperatively. Because of the complicated postoperative course, a second‐look procedure was performed in only two children. We believe that FESS for developmentally delayed children should be tailored accordingly and that a second‐look procedure should not be a routine.
Effects of Middle Ear Oxygen and Carbon Dioxide Tensions on Eustachian Tube Ventilatory Function
Authors: Shupak Avi , Tabari Reza , Swarts J. Douglas , Bluestone Charles D. , Doyle William J.
Published: November 2003

The objective of this study was to determine the effect of middle ear (ME) gas composition on eustachian tube ventilatory function (ETVF). ETVF was evaluated by using forced‐response and inflation‐deflation tests in four alert cynomolgus monkeys during test sessions with different gas compositions. The ME was flushed with one of the four gas mixtures: 1. air; 2. 12% oxygen, 88% nitrogen; 3. 100% oxygen; and 4. 5% carbon dioxide, 21% oxygen, and 74% nitrogen before and during testing. The results documented lower opening, steady‐state, and closing pressures, lower passive and active resistance, and greater dilatory efficiency following ME flushes with the hypercarbic and hypoxic gas mixtures when compared to the others. Also, for applied ME overpressure, the maximum pressure change during a swallow, the average pressure drop for all swallows, and the percentage of the applied pressure equalized were greater under hypoxic and hypercarbic conditions. These results show that ME gas composition affects ETVF and support feedback modulation of ME pressure regulation.
Laryngotracheal Reconstruction Using Microplates in a Porcine Model With Subglottic Stenosis
Authors: Mitskavich Mary T. , Rimell Frank L. , Shapiro Andrew M. , Christopher Post J. , Kapadia Silloo B.
Published: November 2003

Current techniques of laryngotracheal reconstruction require a choice between prolonged stenting (conventional technique) or short‐term stenting with maintenance of sedation and paralysis until the airway has stabilized(single‐stage laryngotracheal reconstruction). An alternative method is proposed using microplates to provide immediate airway stabilization without stenting. This study was designed to evaluate the long‐term effects of microplate repair of stenosis of the subglottis and trachea on the growing larynx. Subglottic stenosis was produced in piglets using a transoral endoscopic technique. Eight animals underwent repair of the stenosis using an anterior cricoid split with microplate distraction and stabilization of the cricoid cartilage and first tracheal ring. The distraction was maintained and airway growth continued for the duration of this study. However, with growth of the larynx the plates migrated away from their original position. In 50% of the animals followed up for 90 days the plates migrated into the airway lumen. This study suggests that rigid distraction of the stenotic airway with microplates is a viable alternative to more traditional methods of repair. However, plate removal at some interval after surgery is required in the growing larynx in order to prevent migration of the plate into the airway.
Pneumatized Superior Turbinate as a Cause of Referred Migraine Headache
Authors: Clerico Dean M.
Published: November 2003

Three patients with typical (common) migraine unresponsive to conventional therapy were evaluated with complete otolaryngologic examination, diagnostic nasal endoscopy, and coronal sinus computed tomography (CT). Enlargement of the superior turbinate due to pneumatization, with accompanying mucosal contact, was found in each case. Application of topical or injected anesthetic to the superior turbinate lessened or relieved headache, and subsequent endoscopic sinonasal surgery succeeded in providing significant headache relief (follow‐up of 6 to 14 months). This is the first report of superior turbinate variations/abnormalities causing migraine, or indeed any type of headache. A discussion of the mechanism of referred pain from mucosal contact is offered after a discussion of each case.

Laryngoscope, 106:874‐879, 1996
Regulation of Transforming Growth Factor‐β1‐Mediated Apoptosis in Head and Neck Squamous Cell Carcinoma
Authors: Duffey Dianne C. , Calcaterra Thomas C. , Lichtenstein Alan K.
Published: November 2003

The apoptotic cell death in Cal‐27 cells induced by exposure to transforming growth factor‐β1 was inhibited by the endonuclease inhibitor aurintricarboxylic acid (ATA) in a concentration‐dependent fashion. In vitro studies of cytotoxicity, DNA fragmentation, and protein synthesis by Cal‐27 cell lines were performed. Inhibition of cytotoxicity as well as endonucleolytic DNA cleavage was detected. ATA did not inhibit cytotoxicity either via transforming growth factor cell‐surface‐receptor alteration or by inhibition of macromolecular synthesis. ATA‐sensitive events occurred late during treatment. These data suggest that endonucleolytic DNA cleavage is a mandatory event leading to cell death in this system.

Laryngoscope, 106:889‐894, 1996
The Importance of Mandibular Position in Microvascular Mandibular Reconstruction
Authors: Li, Kasey K. , Cheney Mack L. , Teknos Theodoros N.
Published: November 2003

The challenge of mandibular reconstruction rests in the difficulty of re‐creating the intricate three‐dimensional relationship of the oral cavity, thereby ensuring occlusal relationships, oral competence, and facial contour. Recent advances in microvascular surgery have made reliable transfer of autologous tissue possible, but successful reconstruction depends on accurate insetting of the bone flap.

The authors reviewed their five years of experience with mandibular reconstruction and found six patients with a poor reconstructive result secondary to improper insetting of the bone flap. Anteromedially rotated and free‐floating proximal mandibular segments appeared to be the most significant contributor to incorrect placement of the bone flap. Based on their findings, the authors devised a simple technique for stabilizing proximal mandibular segments.

Laryngoscope, 106:903‐907, 1996
Residual Mesenchyme in Temporal Bones of Children
Authors: Kasemsuwan Lalida , Schachern Patricia , Paparella Michael M. , Le Chap T.
Published: November 2003

The role of mesenchyme in the temporal bone is still poorly understood. A microscopic study of residual mesenchyme was undertaken in temporal bones of children from birth to 5 years of age. Residual mesenchyme was found to be located in the mastoid antrum and epitympanum more often than in the mesotympanum. The amount of mesenchymal tissue remaining in the temporal bones decreased with increasing age. Persistence of mesenchyme in the temporal bone was related to congenital morphologic ear anomalies and syndromes. There was also an association evident with pulmonary disease, but not with congenital heart defects. Persistent mesenchyme was also found to be significantly associated with chronic middle ear inflammation, and in cases of unilateral otitis media the ear with otitis media had more residual mesenchyme than the non‐otitis media ear.
Parathyroid Visualization With Cibacron Blue/BB5‐G1
Authors: King Raymund C. , Mills Stanley L. , Medina Jesus E.
Published: November 2003

BB5‐G1 is a murine monoclonal antibody with proven affinity for human parathyroid tissue. The authors conjugated BB5‐G1 to cibacron blue, a watersoluble dye, in an attempt to enhance intraoperative parathyroid visualization. Athymic nude mice possessing intramuscularly implanted human parathyroid tissue were infused with the conjugate, then surgically explored. Intraoperative findings were video‐captured, then analyzed by three independent observers and by computer, generating subjective and objective data quantifying parathyroid visualization. Parathyroid tissue implants were stained and were easily visualized. The implants in the test mice displayed higher computer‐generated color intensity ratings (mean, 10.25 units) compared to control mice (mean, 6.10 units) (p<0.5). Histologic sections confirmed the presence of dye and antibody within parathyroid tissue. This represents the first study to use such a conjugate to selectively enhance parathyroid visualization.
Laser‐Assisted Uvulopalatoplasty With Nd:YAG Laser for Sleep Disorders
Authors: Hanada Takehiro , Furuta Shigeru , Tateyama Toshiro , Uchizono Akihiro , Seki Daihachiro , Ohyama Masaru
Published: November 2003

We evaluated the apnea index (AI), the oxygen saturation above 95% (SA95), the lowest oxygen saturation (LSAT), and snoring before and after laser‐assisted uvulopalatoplasty (LAUP) in 106 patients with obstructive sleep apnea syndrome (n=59) or snoring (n=47). Type 1 LAUP was performed in 42 patients and type 2 LAUP in 64 patients. A 50% or greater reduction in AI was observed in 15 patients (35.7%) who underwent type 1 LAUP and 37 patients(57.8%) who underwent type 2 LAUP. Snoring was diminished in 18 (51.4%) of 35 patients who underwent type 1 LAUP and 30 (55.6%) of 54 patients who underwent type 2 LAUP. SA95 and LSAT showed no difference. No serious complications such as significant bleeding, postoperative episodes of asphyxia, nasopharyngeal stenosis, or nasal regurgitation were observed. LAUP was an effective outpatient treatment.
Detection of Epstein‐Barr Virus in Salivary Gland Specimens from Sjögren's Syndrome Patients
Authors: Merne Marina E.T. , Syrjänen Stina M.
Published: November 2003

The cause of Sjögren's syndrome remains unclear, but several environmental and genetic factors have been implicated. The Epstein‐Barr virus(EBV), among others (e.g., cytomegalovirus, human herpesvirus 6, and retroviruses), has been widely studied in connection with Sjögren's syndrome without conclusive results. To determine the role of EBV infection in patients with Sjögren's syndrome, the presence of EBV deoxyribonucleic acid (DNA) in major and minor salivary gland biopsy specimens was investigated by means of sulfur 35 in situ hybridization and polymerase chain reaction. Additionally, the presence of latent virus proteins EBV latent membrane protein and Epstein‐Barr nuclear antigen 2 was analyzed by immunohistochemical methods. Viral DNA, detected by in situ hybridization, was found in 19% of patients with a diagnosis of Sjögren's syndrome and in 3% of controls. All tissues studied were found to be negative for EBV DNA by polymerase chain reaction. EBV latent membrane protein‐positive staining was seen in 17% of patients and 22% of control subjects, while Epstein‐Barr‐positive staining was found in 25% of patients and 39% of controls. The low frequency of EBV DNA detected in the biopsy specimens does not indicate that the virus itself is the cause of Sjögren's syndrome. However, the possibility that the virus acts as a cofactor cannot be ruled out.
Restoration of Function in the Paralyzed Rabbit Orbicularis Oculi Muscle by Direct Functional Electrical Stimulation
Authors: Otto Randal A.
Published: November 2003

Restoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model.

Using a pacing device developed by the author, functional restoration of a normal‐appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation.

The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.
Time Course of Recovery After Epley Maneuvers for Benign Paroxysmal Positional Vertigo
Authors: Smouha Eric E.
Published: November 2003

The canalith repositioning maneuver (CRP) of Epley is an effective treatment for benign paroxysmal positional vertigo (BPPV). While CRP has been advocated by some as a “single treatment” for BPPV, others have had less uniform results for this self‐limited disorder. In order to better define the role of CRP in relieving vertigo, we studied the time course of recovery in 27 consecutive cases of BPPV. We recorded nystagmus after each head maneuver and at each evaluation until complete resolution took place, using absence of nystagmus as a strict criterion for cure. We found that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a CRP session. We believe that in certain cases, the effect of CRP may be due to adaptive conditioning, rather than particle redistribution.
Prognostic Features in Tall Cell Papillary Carcinoma and Insular Thyroid Carcinoma
Authors: van den Brekel Michiel W. M. , Hekkenberg Robert J. , Asa Sylvia L. , Tomlinson George , Rosen Irving B. , Freeman Jeremy L.
Published: November 2003

Tall cell papillary carcinoma (TCPC) and insular carcinoma (IC) are variants of thyroid carcinoma that are considered to be more aggressive than well differentiated papillary or follicular carcinoma. To determine the clinical significance of these diagnoses, we evaluated 65 patients with these tumors. There were 30 TCPCs, 27 ICs, and 8 ICs or TCPCs with focal anaplastic carcinoma (FAC). Forty‐two patients (27 TCPCs, 14 ICs, and 1 FAC) are alive and free of disease. Nine patients with IC are alive with distant metastases. Ten patients (2 TCPCs, 2 ICs, and 7 FACs) died of disease. Univariate analysis of disease‐free interval determined that, as for all thyroid carcinomas, patient age, tumor size, extrathyroidal extension, and lymph node metastases were significant for prognosis. ICs did significantly worse than TCPCs. Focal anaplastic dedifferentiation predicted a worse prognosis. Multivariate analysis for disease‐free interval showed age, number of lymph node metastases, and tumor type to be significant. Analysis of the same factors for prediction of mortality showed that TCPC and IC were not significantly different. These data suggest that TCPC is less aggressive than IC, which often results in disseminated disease. Focal AC predicts poor survival.
Quantitative Evaluation of the Effects of Thyroarytenoid Muscle Activity upon Pliability of Vocal Fold Mucosa in an In Vivo Canine Model
Authors: Yumoto Eiji , Kadota Yoshimi
Published: November 2003

Stiffness of the vocal fold is a significant factor in determining mucosal wave propagation and in the control of the fundamental frequency of phonation. We measured pliability of the vocal fold mucosa in an in vivo canine model as an index of stiffness while the histological layer‐by‐layer structure of the vocal fold was not disrupted.

The point 1 mm below the free edge showed a maximal pliability that gradually diminished toward the tracheal side and reached a minimum. When the thyroarytenoid (TA) muscle contracted, pliability of the mucosa was significantly increased (P < 0.001). Mucosal pliability of the excised larynx was significantly increased compared with that in vivo (P < 0.001). The point of minimal pliability in the absence of TA muscle contraction did not shift after excision of the larynx, while TA muscle contraction caused a downward shift of the point of minimal pliability. Mucosal pliability can thus be used to quantitatively assess the effects of TA muscle contraction on stiffness of the vocal fold mucosa.
Mucociliary Clearance and Buffered Hypertonic Saline Solution
Authors: Talbot Andrew R. , Herr Timothy M. , Parsons David S.
Published: November 2003

Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose‐buffered normal saline or buffered hypertonic saline‐and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.
Electrocautery Versus Carbon Dioxide Laser for Uvulopalatoplasty in the Treatment of Snoring
Authors: Gnuechtel Michael M. , Keyser Jeffrey S. , Greinwald John H. , Postma Gregory N.
Published: November 2003

Laser‐assisted uvulopalatoplasty is a popular method for reducing snoring. Drawbacks are the large initial expense of the laser unit and related equipment and required safety precautions. The equipment required for electrocautery for cautery‐assisted uvulopalatoplasty is significantly less expensive to obtain and operate compared with the carbon dioxide laser. Ninety‐eight patients were randomly assigned to one of two treatment groups to undergo uvulopalatoplasty: one performed with the carbon dioxide laser and the other with electrocautery. We compared postoperative pain, time off work, efficacy, and the number of treatments required to achieve a satisfactory result. We found no statistically significant difference in any of these parameters between the two treatment groups (P > 0.05). Our data show that the use of the carbon dioxide laser offers no advantage over electrocautery in performing uvulopalatoplasty to treat snoring.
Experience With Segmental Reconstruction of the Radiated Mandible With Alloplastic Prostheses
Authors: Greene David , Sussman Stephen , Singer Mark I.
Published: November 2003

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high‐risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time‐efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.
Medial Antebrachial Cutaneous Nerve: A New Donor Graft for Repair of Facial Nerve Defects at the Skull Base
Authors: Haller Jeffrey R. , Shelton Clough
Published: November 2003

When grafting a facial nerve defect after resection of a skull base cancer, the use of the greater auricular nerve is generally contraindicated because of concern of malignant involvement. In the past, the sural nerve was used as a donor graft for reconstruction of the facial nerve. We have found a sensory branch of the median nerve of the upper arm, the medial antebrachial cutaneous(MAC) nerve, to be a suitable option for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction of the distal facial nerve in the parotid bed. The length is adequate to graft from the brainstem to the distal facial branches. Loss of sensation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facial nerve defects. No complications have been encountered, and the functional return appears to be similar to other grafts. In our practice the MAC nerve is a valuable option for facial nerve repair at the skull base.
Calcium Channel Blockade Reduces Noise‐Induced Vascular Permeability in Cochlear Stria Vascularis
Authors: Goldwyn Benzion G. , Quirk Wayne S.
Published: November 2003

Exposure to noise results in multiple perturbations of cochlear microcirculation, including increases in vascular permeability. There is evidence that these events are mediated, in part, by calcium channels. The current study examined the effects of calcium channel blockade on the diameter and permeability of cochlear vessels during noise exposure. Subjects were exposed to either noise alone or noise after verapamil pretreatment. Vessels of the cochlear stria vascularis were imaged using intravital microscopy. Animals exposed to noise showed decreases in diameter and increased permeability above baseline levels. Animals pretreated with the calcium channel blocker verapamil and exposed to noise demonstrated increases in vessel diameter and no changes in permeability. These data indicate that calcium channel blockade reduces noise‐induced microvascular permeability. Treatment strategies designed to protect from increases in vascular permeability due to noise exposure may reduce temporary threshold shifts.
Planned Early Neck Dissection Before Radiation for Persistent Neck Nodes After Induction Chemotherapy
Authors: Thomas Giovana R. , Greenberg Jason , Wu Kuo‐Tsung , Moe Kris , Esclamado Ramon , Bradford Carol , Carroll William , Eisbruch Avraham , Urba Susan , Wolf Gregory T.
Published: November 2003

Optimal management of advanced neck metastases as part of an organ preservation treatment approach for head and neck squamous carcinoma (HNSC) is unclear. Since 1989, our management paradigm for patients on organ preservation was modified to incorporate planned early neck dissection before radiation therapy for patients who did not achieve a complete response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissection is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty‐eight consecutive patients with advanced HNSC who were entered in organ preservation trials using induction chemotherapy and radiation with surgical salvage were studied. Median follow‐up was 26 months. Of the 58 patients, 71% were stage IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, complications, and survival. Overall, the rate of CR of neck nodes was 49%. Fifty‐one percent had less than a complete response of neck nodes after IC and required planned early neck dissection. There were no significant differences in patterns of recurrence, complications, interval time to start of radiation, recurrence, or survival rates between the CR and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We believe that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanced head and neck carcinoma.
Outcome‐Based Assessment of Endolymphatic Sac Surgery for Meniere's Disease
Authors: Smith Darrell R. , Pyle G. Mark
Published: November 2003

This study reports the preliminary results of an outcomes approach to analysis of the effectiveness of endolymphatic sac decompression (ELSD). Using the medical outcomes survey's 36‐item, shortform health survey (SF‐36), we assessed the quality of life in 33 patients with disabling Meniere's disease undergoing ELSD for medically intractable vertigo. Results indicate that patients with 1995 American Academy of Otolaryngology‐Head and Neck Surgery(AAO/HNS) class A or B outcomes showed no significant difference from population norms on the SF‐36, whereas patients with AAO/HNS classes C to E outcomes scored significantly below norms. Six patients who were given the SF‐36 preoperatively scored consistently below population norms. Postoperatively, they showed a statistically significant improvement and were statistically equal to norms. These findings suggest that the SF‐36 is a good measure of the quality of life impairment in patients with disabling Meniere's disease. In addition, SF‐36 scores correlated well with the 1995 AAO/HNS classification.
Fallopian Bridge Technique in Surgery for Chronic Ear Disease
Authors: Pensak Myles L. , Friedman Rick A.
Published: November 2003

Disease that lies in the posterior mesotympanum, including inflammatory polyps, cholesterol granuloma, and cholesteatoma, is often difficult to extirpate. The literature reflects a divided and often controversial opinion regarding the removal of the bony posterior canal wall to reach this disease. Recently, endoscopic visualization has been advocated to enhance exposure. Employing a fallopian bridge technique wherein the bone medial to the facial nerve is opened into the posterior mesotympanum the authors have used this approach in selective circumstances to optimize the eradication of disease. Three hundred patients undergoing tympanomastoidectomy were included in this analysis. The fallopian bridge technique was attempted in 58 cases and was successfully employed in 42 patients. Indications as well as limitations for this procedure are discussed.
Optimizing Suicide Gene Therapy for Head and Neck Cancer
Authors: Sewell Duane A. , Li Daqing , Duan Ling , Schwartz Mary R. , O'Malley Bert W.
Published: November 2003

An effective “suicide gene” therapy strategy in experimental studies has been the use of the herpes simplex virus thymidine kinase gene(HSV‐tk) to sensitize tumors to the cytotoxic effects of ganciclovir administration. Previous studies using this model have focused on utilizing maximal viral titers and high levels of ganciclovir that are not compatible with human dosing. Because of the high ganciclovir doses and the maximal viral titers, this strategy has limited application to actual clinical scenarios. In the following studies the authors investigate tumor regression in an oral squamous cell carcinoma animal model as a function of variable adenoviral titers and more physiologic ganciclovir dosing. Using adenoviral titers ranging from 1 × 108 to 2 × 109 plaque forming units(pfu) to treat oral tumors, they found no statistical difference in tumor regression among the different viral doses, despite differences in mitotic activity. Each treatment group, however, demonstrated a significant effect on tumor regression when compared with controls. Furthermore, the authors were able to reduce the level of ganciclovir administration to 10 mg/kg twice daily from established levels of 100 to 150 mg/kg twice daily while maintaining significant tumor responses to the HSV‐tk therapy. Mean survival of animals treated with this lower ganciclovir dose was significantly higher than in controls and was equal to established means based on previous studies using higher ganciclovir doses. The optimization of this suicide gene therapy strategy is imperative in order to minimize theoretical and known viral and ganciclovir toxicities while establishing a foundation upon which to design appropriate and effective clinical trials.
Clinical Diagnoses Associated With Histologic Findings of Fibrotic Tissue and New Bone in the Inner Ear
Authors: Keithley Elizabeth M. , Chen Mien‐Chi , Linthicum Fred
Published: November 2003

Fibrotic tissue or new bone occurs following inner ear inflammation, fracture, or surgery. The prevalence is unknown and was investigated using the National Temporal Bone, Hearing and Balance Pathology Resource Registry database. A search yielded 264 temporal bones with diagnoses of otosclerosis, tumor, Meniere's disease, meningitis, labyrinthitis, chronic otitis media, autoimmune disease, temporal bone fracture, or sensorineural hearing loss. All autoimmune cases contained some new bone, whereas only 20% to 30% of the labyrinthitis/meningitis cases were reported to contain new bone. Otosclerosis, Meniere's disease, and otitis media had relatively few cases containing new bone. Although new bone may derive from surgical trauma, it is also likely to be a result of the disease process. It seems that all these disease processes may contain a common feature that acts as a stimulus to induce fibrosis or bone growth in the inner ear.
Review of Percutaneous Tracheostomy
Authors: Powell David M. , Price Phillip D. , Forrest L. Arick
Published: November 2003

The purpose of this study is to assess the safety and efficacy of the four known methods of percutaneous tracheostomy. Perioperative, postoperative, and late complication rates were generated for each method after a complete literature review identified 1684 percutaneous tracheostomy patients reported in 40 series. Two methods, the Toye and the guide wire dilator forceps (GWDF) methods, have been the subject of few investigations. Two other methods have been extensively studied. A high perioperative complication rate was calculated for the Rapitrac™ method, whereas percutaneous dilational tracheostomy (PDT) has complication rates similar to those reported for standard operative tracheostomy. A retrospective review of 22 patients who underwent PDT at a local community hospital confirmed a “learning curve” for this technique that had been previously suggested. Review of the literature suggests that PDT can be safe and cost‐effective for selected patients, but a learning curve for this technique exists that dictates caution, experience, and preparation on the part of any surgeon who wishes to add percutaneous tracheostomy to his or her repertoire.
Laryngotracheal Reconstruction With Tracheal Patch Allografts
Authors: Delaere Pierre R. , Liu Ziying , Hermans Robert
Published: November 2003

The capacity of tracheal allotransplants in providing optimal tissues for laryngotracheal repair was studied in an animal model. Segments of cervical trachea could be revascularized completely when wrapped in a receptor fascia flap in immunosuppressed rabbits. In phase I the revascularized tracheas were incised longitudinally and transformed into four different patches after a 14‐day revascularization period. The blood supply toward the four patch designs was examined with angiography. The patch designs that showed a vascularization over at least 75% of their mucosal surface area were used in phase II to reconstruct extended anterior laryngotracheal defects. The morphologic characteristics of the tracheal patches when used inside laryngotracheal defects were studied using radiographic, angiographic, and histologic techniques. The revascularized allograft patches that were fully supported by tracheal cartilage were most suitable to repair anterior laryngotracheal defects in this animal study. This model allowed us to define the tissue characteristics necessary for obtaining a combination of primary healing and optimal luminal support in the repair of laryngotracheal defects.
Local Failure After Supracricoid Partial Laryngectomy: Symptoms, Management, and Outcome
Authors: Laccourreye Ollivier , Laccourreye Laurent , Muscatello Luca , Périé Sophie , Weinstein Gregory , Brasnu Daniel
Published: November 2003

The medical files of 15 patients with local recurrence after supracricoid partial laryngectomy consecutively managed at Laënnec Hospital were reviewed. The clinical symptoms and the laryngeal computed tomography appearance of local recurrence, as well as the salvage treatment performed, are presented. The main presenting symptom was dyspnea. None of the local recurrences was considered to be unresectable. One patient refused any form of salvage treatment. Radiation therapy and salvage total laryngectomy were the options retained for local salvage. A minimum 5‐year follow‐up was always achieved. In patients who underwent salvage total laryngectomy, perioperative or postoperative death and postoperative pharyngocutaneous fistula were not encountered. The 5‐year survival was 33.3%. The local control rate was 66.6%. The percentage of patients who experienced nodal recurrence was 26.6%, and the distant metastasis estimate was 53.3%. The cause of death was distant metastasis in eight patients, local recurrence in two, and intercurrent disease in one. Peristomal recurrence was not encountered. Overall, 80% local control and 6.6% laryngeal preservation rates were achieved.
Is Aspiration Necessary Before Tympanostomy Tube Insertion?
Authors: Egeli Erol , Kiriş Muzaffer
Published: November 2003

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause‐and‐effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty‐one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow‐up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.
Histology and Histomorphometry of Ethmoid Bone in Chronic Rhinosinusitis
Authors: Kennedy David W. , Senior Brent A. , Gannon Frank H. , Montone Kathleen T. , Hwang Peter , Lanza Donald C.
Published: November 2003

Mucosal changes have been well described in chronic sinusitis, yet little is known about the underlying bone, despite clinical and experimental evidence suggesting that bone may be involved in chronic sinusitis. Techniques of undecalcified bone analysis were used for detailed histologic examination of ethmoid bone in chronic sinusitis compared with controls. Bone synthesis, resorption, and inflammatory cell presence were specifically assessed. Additionally, histomorphometry techniques were used to determine ethmoid bone physiology in individuals undergoing surgery for chronic sinusitis. Overall, individuals undergoing surgery for chronic sinusitis were found to have evidence of marked acceleration in bone physiology with histologic changes including new bone formation, fibrosis, and presence of inflammatory cells. These findings are compared with osteomyelitis in long bone and the jaw. The suggestion that underlying bone may serve as a catalyst for chronic sinusitis is supported and implications for therapy are discussed.
Identification of Obstructive Sleep Apnea in Patients Who Snore
Authors: Tami Thomas A. , Duncan Heather J. , Pfleger Michael
Published: November 2003

As the field of sleep medicine has evolved, the clinical implications of obstructive sleep apnea (OSA) in snoring patients have become well accepted. Recent advances in surgical therapy for snoring allow otolaryngologists to offer simple outpatient treatment to patients with this problem. However, because the incidence of OSA in snorers seeking medical attention is unknown, the appropriate pretreatment evaluation of these patients is a subject of continued debate. Ninety‐four snoring patients were recruited for a study to determine the incidence of OSA in this highly selected population. Subjects answered an extensive sleep questionnaire to determine factors that might suggest a diagnosis of OSA. Level III ambulatory sleep studies were performed on each participant. The incidence of OSA in this group was 72% (42% severe and 30% mild to moderate). Twenty of the subjects with OSA also underwent formal level I sleep studies, and the diagnosis of OSA was confirmed in each instance. Although there was a relationship between body mass index and OSA and certain questions correlated with OSA, the sensitivity and specificity of these data alone or in combination were too low to recommend their use in lieu of a formal sleep study. Given the remarkably high incidence of OSA in this group, which may reflect that seen by otolaryngologists who treat snoring, a sleep study should be performed to diagnose OSA and institute therapy for this condition. Level III ambulatory monitoring devices may be the most cos‐teffective alternative for evaluating this high‐risk population.
Childhood Imbalance and Chronic Otitis Media With Effusion: Effect of Tympanostomy Tube Insertion on Standardized Tests of Balance and Locomotion
Authors: Hart Mary C. , Nichols Deborah S. , Butler E. M. , Barin Kamran
Published: November 2003

The goal of this study was to investigate the role of chronic otitis media with effusion as a cause of childhood imbalance. Nineteen 4‐ to 6‐year‐old children with chronic otitis media with effusion and 14 matched control children underwent a series of laboratory tests, including two standardized tests of balance and locomotion: the Peabody Developmental Motor Scales (PDMS) and the Bruininks‐Oseretsky Test of Motor Proficiency (BOTMP). The children in the chronic otitis media with effusion group underwent tympanostomy tube insertion. Both groups underwent the same battery of tests within 6 to 8 weeks of initial testing. Analysis of variance for the PDMS and BOTMP demonstrated significantly lower performance in the balance subscales for the otitis group before (P < .01). Both otitis and control groups improved when retested. The improvement was greater and approaching significance in the otitis group on the PDMS and BOTMP (P = .056 and .097, respectively). It is concluded that chronic otitis media with effusion significantly affects balance and coordination skills in 4‐ to 6‐year‐old children. These skills improve after tympanostomy tube insertion at a rate greater than that of the control group.
Observations on Control of N2 and N3 Neck Disease in Squamous Cell Carcinoma of the Head and Neck by Intra‐arterial Chemoradiation
Authors: Weisman Robert A. , Christen Randolph D. , Jones Vicky E. , Kerber Charles W. , Seagren Stephen L. , Orloff Lisa A. , Glassmeyer Sherrie L. , Howell Stephen B. , Robbins K. Thomas
Published: November 2003

Patients with head and neck squamous cell cancer with N2 and N3 neck disease have a poor prognosis and are at risk to fail regionally despite combined surgery and radiation. Twenty‐two patients with N2 and N3 neck disease (and T3‐4 primaries) were treated with intra‐arterial, high‐dose cisplatin (CDDP), 150 mg/m2 per week for 4 weeks, and concurrent radiation. All patients were followed for at least 2 years or until death from any cause. Twenty patients had a complete response at the primary site. Two of the 20 with a complete response later had a neck recurrence and died. Five patients with palpable nodes after treatment underwent fine‐needle aspiration (FNA), one of which was positive and two suggestive of cancer. Six neck dissections were performed in this group, only two of which had positive nodes. This chemoradiation protocol may offer reasonable control of N2 and N3 neck disease in advanced head and neck squamous cell cancer. Neck dissection appeared to be necessary in only those patients with nodes 8 weeks after treatment in whom FNA was positive or suggestive of cancer. Because of the relatively small size of this series, additional accrual and monitoring of such patients is planned.
Bone Cement Reconstruction of the Ossicular Chain: A Preliminary Report
Authors: Feghali Joseph G. , Barrs David M. , Beatty Charles W. , Chen Douglas A. , Green J. Douglas , Krueger Wesley W. O. , Shelton Clough , Slattery William H. , Thedinger Bradley S. , Wilson David F. , McElveen John T.
Published: November 2003

Objective: To determine the feasibility and efficacy of using a bone cement, Oto‐Cem, to reconstruct the ossicular chain.

Study Design: Prospective clinical trial on nine consecutively chosen adult patients with ossicular chain defects.

Patients and Setting: Nine patients with ossicular chain defects involving the long process of the incus were treated at the Carolina Ear and Hearing Clinic. The ossicular chain was reconstructed using bone cement by itself or in conjunction with a stapes prosthesis.

Main Outcome Measures: Preoperative audiograms were compared with audiograms 3, 6, and 12 months after reconstruction.

Results: There was a mean pure‐tone average (PTA) improvement of 15 dB in patients undergoing incus to stapes suprastructure reconstruction with the bone cement. The incus to mobile footplate reconstruction (using a stapes prosthesis attached to the newly reconstructed incus) resulted in a 34‐dB PTA postoperative improvement. Two of the three patients with incus to oval window repairs experienced a 10‐dB improvement in PTA. One of the three patients experienced a loss in speech discrimination and a 2‐dB loss in PTA.

Conclusions: Despite the limited number of patients, this preliminary study demonstrates the effectiveness of Oto‐Cem in reconstructing a foreshortened incus. There was a substantial hearing improvement in all but one patient in the incus to stapes or the incus to footplate categories.
Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer
Authors: Pauloski Barbara Roa , Logemann Jerilyn A. , Colangelo Laura A. , Rademaker Alfred W. , McConnel Fred M. S. , Heiser Mary Anne , Cardinale Salvatore , Shedd Donald , Stein David , Beery Quinter , Myers Eugene , Lewin Jan , Haxer Marc , Esclamado Ramon
Published: November 2003

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6‐ to 7‐minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.
Radiologic percutaneous gastrostomy: Results in 56 patients with head and neck cancer
Authors: Righi Paul D. , Reddy Deepkaran K. , Weisberger Edward C. , Johnson Matthew S. , Trerotola Scott O. , Radpour Shokri , Johnson Paul E. , Stevens Christopher E.
Published: November 2003

Objective: The establishment of a direct enteral feeding route is critical in the overall treatment of many patients with head and neck cancer. Use of radiologic percutaneous gastrostomy (RPG), the newest technique for gaining enteral access, has not been studied in such patients extensively. This study evaluated the indications, technique, success rate, and complications associated with RPG in patients with head and neck cancer. Study Design: Retrospective. Methods: A comprehensive chart review was undertaken of 56 patients with head and neck cancer treated at a tertiary care institution who had undergone successful or attempted RPG at some point during their treatment course. Results: Most study patients had advanced oropharyngeal squamous cell carcinoma. The most frequent indications for RPG were dysphagia/aspiration following tumor resection (n = 26) and dysphagia following completion of single‐ or combined‐modality therapy (n = 22). The success rate of attempted RPGs was 98.2%. The overall complication rate for RPG was 12.7% (10.9% minor and 1.8% major). Conclusions: RPG is a valuable tool for establishing enteral nutrition in patients with head and neck cancer. Advantages of RPG include high success rate despite obstructing lesions, low complication rate, time efficiency and scheduling ease compared with intraoperative percutaneous gastrostomy (PEG) by a second team, no reported tumor seeding of the tube site, and the fact that postoperative RPG allows for more accurate selection of patients who require a gastrostomy tube.