bluuebunny/crossref_metadata_2025 huggingface dataset:
Xenon‐Enhanced Computed Tomography Quantifies Normal Maxillary Sinus Ventilation
Authors: Leopold Donald , Zinreich S. James , Simon Brett A. , Cullen Michelle M. , Marcucci Catherine
Published: November 2005

OBJECTIVE

The purpose of this study was to determine the applicability, safety, and normal parameters of a xenon‐enhanced CT technique to quantify maxillary sinus ventilation.

PATIENTS AND METHODS

Nine healthy subjects inhaled a xenon‐oxygen‐air mixture through their noses while repeated CT scans were performed through the same section of their sinuses. Images were obtained every 1 to 3 minutes and analyzed to measure the density of the gas in the maxillary sinus as a function of time.

RESULTS

Individual nasal cavity time constants ranged from 0.5 to 18 minutes. Studies performed after decongestion showed poorer sinus ventilation.

CONCLUSIONS

The xenon‐CT washin/washout technique is safe, effective, and gives representative data.
Effects of iNtracochlear Factors on Spiral Ganglion Cells and Auditory Brain Stem Response after Long‐Term Electrical Stimulation in Deafened Kittens
Authors: Myers Eugene N. , Araki Susumu , Kawano Atsushi , Lee Seldon H. , Shepherd Robert K. , Funasaka Sotaro , Clark Graeme M.
Published: November 2005

Using an animal model, we have studied the response of the auditory brain stem to cochlear implantation and the effect of intracochlear factors on this response. Neonatally, pharmacologically deafened cats (100 to more than 180 days old) were implanted with a 4‐electrode array in both cochleas. Then, the left cochlea of each cat was electrically stimulated for total periods of up to 1000 hours. After a terminal 14C‐2‐deoxyglucose (2DG) experiment, the fraction of the right inferior colliculus with a significant accumulation of 2DG label was calculated. Using 3‐dimensional computer‐aided reconstruction, we examined the cochleas of these animals for spiral ganglion cell (SGC) survival and intracochlear factors such as electrode positions, degeneration of the organ of Corti, and the degree of fibrosis of the scala tympani. The distribution of each parameter was calculated along the organ of Corti from the basal end. There was a positive correlation between SGC survival and the level of fibrosis in the scala tympani, and a negative correlation between SGC survival and the degree of organ of Corti degeneration. Finally, there was a negative correlation between the 2DG‐labeled inferior colliculus volume fraction and the degree of fibrosis, particularly in the 1‐mm region nearest the pair of electrodes, and presumably in the basal turn.
Laser‐Assisted Outpatient Septoplasty: Results in 703 Patients
Authors: Kamami Yves‐Victor , Pandraud Luc , Bougara A.
Published: November 2005

Laser‐assisted outpatient septoplasty is a new technique devised to minimize and simplify surgery under local anesthesia. It takes 5 minutes and has a specific clinical application in chronic nasal obstruction because of moderate anterior septal deviation in adults. It is less invasive than traditional septoplasty and has less morbidity, lower medical costs, and faster return to full activity. Seven hundred three patients underwent this operation from August 1995 to June 1998, with a patient evaluation performed before and after surgery. The evaluation was first performed by means of a direct interview, with a clinical examination and acoustic rhinometry, and then by means of a telephone interview, with strictly standardized questioning. Our results show a surgical success rate of 90.8% on the nasal obstruction but also an improvement on nasal discharge, sneezing, recurrent headaches, and chronic rhinosinusitis.
Posturographic performance in patients with the potential for secondary gain
Authors: Gianoli Gerard , Mcwilliams Sean , Soileau James , Belafsky Peter
Published: November 2005

OBJECTIVES

To determine the incidence of nonorganic sway patterns on computerized dynamic posturography (CDP) among patients with potential secondary gain compared with patients without any obvious secondary gain.

METHODS

A retrospective chart review of 100 patients who underwent clinical evaluation, audiometry, electronystagmography, and CDP was undertaken. Group 1 consisted of 50 patients who were randomly selected from a group who had pending lawsuits, worker's compensation claims, or disability claims. Group 2 consisted of 50 randomly selected patients who had no pending legal status, worker's compensation claims, or disability claims. Previously published criteria for nonorganic sway patterns were then applied to each group. Statistical analysis was performed.

RESULTS

The average age of group 1 patients was 43.8 years compared with 63.2 years for group 2 patients (P < 0.0001). Among group 1 patients 50% had normal audiovestibular evaluations compared with only 4% of group 2 patients (P < 0.0001). Nonorganic sway patterns were found in 76% of group 1 patients, but only in 8% of group 2 patients (P < 0.0001).

CONCLUSION

Patients who have the potential for secondary gain are generally younger and have a much higher prevalence of normal audiovestibular evaluations and a much higher prevalence of nonorganic sway patterns on CDP. A high degree of clinical suspicion should be maintained when evaluating the dizzy patient who has a pending lawsuit, worker's compensation claim, or disability claim. (Otolaryngol Head Neck Surg 2000;122:11‐8.)
Systematic management of chyle fistula: The Southwestern experience and review of the literature
Authors: Nussenbaum Brian , Liu James H. , Sinard Robert J.
Published: November 2005

Postoperative cervical chyle fistula after neck dissection is a complication with potentially serious morbidity. Once it is recognized, treatment decisions to optimize patient care can be difficult. Different management strategies have been advocated on the basis of institutional and personal experience. In this study we comprehensively review the published protocols and retrospectively review our experience in the management of 15 patients with chyle fistula. All patients in this study were given a trial of nonoperative management with nutritional modification, pressure dressings, and closed drainage. Medical management ultimately failed in 3 patients (20%). Two patients had prolonged courses of medical management with associated complications. An analysis of our data supports early operative intervention if the peak 24hour drainage is greater than 1000 mL without a prompt response to medical management. Persistent low‐output drainage after 10 days is associated with a prolonged management course and treatment‐related complications. Optimal treatment of these patients is unclear. (Otolaryngol Head Neck Surg 2000;122:31‐8.)
Communication after laryngectomy: An assessment of quality of life
Authors: Carr Michele M. , Schmidbauer Judy A. , Majaess Lillian , Smith Rachael L.
Published: November 2005

The purpose of this study was to examine quality of life in laryngectomees using different methods of communication. A survey was mailed to all the living laryngectomees in Nova Scotia. Patients were asked to rate their ability to communicate in a number of common situations, to rate their difficulty with several communication problems, and to complete the EORTC QLQ‐C30 quality‐of‐life assessment tool. Sixty‐two patients responded (return rate of 84%); 57% were using electrolaryngeal speech, 19% esophageal speech, and 8.5% tracheoesophageal speech. These groups were comparable with respect to age, sex, first language, education level, and years since laryngectomy. There were very few differences between these groups in ability to communicate in social situations and no difference in overall quality of life as measured by these scales. The most commonly cited problem was difficulty being heard in a noisy environment. Despite the fact that tracheoesophageal speech is objectively most intelligible, there does not seem to be a measurable improvement in quality of life or ability to communicate in everyday situations over electrolaryngeal or esophageal speakers. (Otolaryngol Head Neck Surg 2000;122:39‐43.)
Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck
Authors: Randall David A. , Johnstone Peter A. S. , Foss Robert D. , Martin Peter J.
Published: November 2005

OBJECTIVES

The purpose of this study was to discuss the experience of one tumor registry with performing tonsillectomy in the diagnostic approach to unknown head and neck primary tumors. It also describes the importance of including tonsillectomy in this evaluation algorithm.

STUDY DESIGN

A retrospective chart review was done of 68 patients with either tonsillar or unknown primary squamous cell carcinoma culled from 829 patients seen from 1956 to 1996 at the head and neck tumor registry at the Naval Medical Center San Diego.

METHODS

Records from the head and neck tumor registry, radiation oncology service, and pathology department were reviewed with attention to presenting symptom, initial examination, diagnostic studies performed, and type and result of biopsies performed.

RESULTS

Thirty‐four patients sought treatment for a neck lymph node metastasis of squamous cell carcinoma without an identifiable primary tumor site. Six of these (18%) had the primary site diagnosed by performing tonsillectomy ipsilateral to the presenting neck mass. Six of 14 T1 tonsillar carcinomas in this series had the primary site identified by tonsillectomy.

CONCLUSIONS

Despite a diligent search, a primary tumor site may not be found in the head and neck cancer patient. The tonsil may harbor an occult squamous cell carcinoma. The patient benefits from identification of the initial tumor site because postoperative irradiation ports may be reduced and because surveillance for recurrence may be improved. For these reasons, tonsillectomy should be performed ipsilateral to the presenting cervical metastasis if no other primary tumor site is identified. (Otolaryngol Head Neck Surg 2000;122:52‐5.)
Changing trends in neonatal subglottic stenosis
Authors: Choi Sukgi S. , Zalzal George H.
Published: November 2005

OBJECTIVES

To determine whether there are any changes in the incidence and management of neonatal subglottic stenosis (SGS).

METHODS

A retrospective chart review of 416 infants who were admitted to the neonatal intensive care unit of the Children's National Medical Center between July 1, 1995, and June 30, 1996, was carried out. The incidence of airway obstruction requiring anterior cricoid split or placement of tracheotomy tube was determined and compared with the incidence studied 10 years ago at the same institution.

RESULTS

One of 416 neonates required surgical intervention for airway obstruction caused by SGS, for an overall neonatal SGS incidence of 0.24%. When only the neonates who were intubated for 48 hours or longer were considered, the incidence of SGS was 0.49% (1/204). In neonates who were intubated for 48 hours or longer and survived, the incidence of SGS was 0.63% (1/160). This is in comparison with the incidences of 0.65% (3/462), 1.5% (3/195), and 1.9% (3/159), respectively, seen in a study done at the Children's National Medical Center 10 years ago. Five infants in this current study required placement of a tracheotomy tube for reasons other than SGS. Two infants needed tracheotomy tube placement for micrognathia, and 3 others for central hypotonia, an omphalocele that required multiple surgical procedures, and choanal atresia with a serious heart anomaly, which was a manifestation of CHARGE association. None of these 5 infants had evidence of SGS at rigid endoscopy preceding the tracheotomy tube placement.

CONCLUSION

The incidence and management of neonatal SGS remain unchanged during this study period when compared with those of 10 years ago. (Otolaryngol Head Neck Surg 2000;122:61‐3.)
ImmunoCAP and HY•TEC enzyme immunoassays in the detection of allergen‐specific IgE compared with serial skin end‐point titration by receiver operating characteristic analysis
Authors: Corey Jacquelynne P. , Mamikoglu Bulent , Akbar Imran , Houser Steven M. , Gungor Anil
Published: November 2005

OBJECTIVES

In this study, we compared 2 different immunoassays, HY•TEC enzyme immunoassay (Hycor Biomedical Inc, Garden Grove, CA) and Pharmacia Upjohn ImmunoCAP (Pharmacia and Upjohn, Kalamazoo, MI) using skin end‐point titration as a gold standard by receiver operating characteristic analysis.

MATERIALS

One hundred patients were enrolled in this study and were tested with the above 3 modalities. The results were analyzed by receiver operating characteristic analysis, in which the curves give a decision criterion for any diagnostic test relative to its sensitivity and specificity against an accepted gold standard test. Only inhalant allergens (Dermatophagoides pteronyssinus, Dermatophagoides farina, cat dander, giant ragweed, English plantain weed, timothy grass, Alternaria tenuis, Aspergillus fumigatus, meadow fescue, oak tree, white ash tree, and lamb's‐quarter weed) were studied.

RESULTS

The results obtained with both ImmunoCAP and HY•TEC showed a good correlation with skin end‐point titration for D pteronyssinus, D farina, cat dander, giant ragweed, timothy grass, A tenuis, and meadow fescue, with sensitivities ranging from 71% to 88%. However, the sensitivity of both tests to English plantain weed, lamb's‐quarter weed, oak tree, and white ash tree was lower (66% down to 39%). Additionally, HY•TEC results were not satisfactory for detecting specific IgE to A fumigatus (30% sensitivity). The overall sensitivity for each test was 65.67% for the HY•TEC and 71.25% for the Immuno‐CAP.

CONCLUSION

The 2 in vitro testing systems are comparable for most of the allergens, except for A fumigatus, English plantain, lamb's‐quarter, and white ash tree; ImmunoCAP and HY•TEC would benefit from improved technology for detecting these specific IgE antibodies. The HY•TEC assay did not give acceptable results for A fumigatus. The overall assay characteristics were good to excellent for each system tested. (Otolaryngol Head Neck Surg 2000;122:64‐70.)
Effect of improved nasal breathing on obstructive sleep apnea
Authors: Friedman Michael , Tanyeri Hasan , Lim Jessica W. , Landsberg Roy , Vaidyanathan Krishna , Caldarelli David
Published: November 2005

OBJECTIVES

The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures.

METHODS

A prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out.

RESULTS

Subjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the remaining 33 (66%) patients did not notice any significant change in their snoring. Daytime energy levels increased in 39 (78%) patients and remained unchanged or worsened in 11 (22%). In review of the polysomno‐graphic data, the group overall did not have significant changes in respiratory disturbance index (RDI) or lowest oxygen saturation levels (LSaO2). Continuous positive airway pressure (CPAP) levels required to correct OSA decreased after nasal surgery (P < 0.01). Patients with mild OSA showed significant worsening in RDI (P < 0.05), whereas LSaO2 levels were improved in the group with moderate OSA (P < 0.05). In patients with severe OSA neither the RDI levels nor the LSaO2 changed, but CPAP levels required to alleviate the obstruction after surgery were reduced (P < 0.01).

CONCLUSIONS

Most patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction. However, nasal surgery alone does not consistently improve OSA when measured objectively. Depending on the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA. (Otolaryngol Head Neck Surg 2000;122:71‐4.)
Tongue‐base suspension with a soft tissue‐to‐bone anchor for obstructive sleep apnea: Preliminary clinical results of a new minimally invasive technique
Authors: Derowe Ari , Gunther Eck , Fibbi Antonio , Lehtimaki Kimmo , Vahatalo Kimmo , Maurer Joachim , Ophir Dov
Published: November 2005

The Repose system is a new minimally invasive technique for tongue‐base suspension in the treatment of sleep‐disordered breathing caused by tongue‐base collapse. It involves the insertion of a titanium miniscrew with attached suture into the anterior intraoral mandible and passing the suture through the tongue base. The procedure was performed in 16 patients with sleep‐disordered breathing. Fourteen patients reported an improvement in daytime sleepiness, and their bed partners reported an improvement in snoring. The mean respiratory distress index before surgery was 35. Two months after surgery, the mean respiratory distress index was 17, an improvement of 51.4% (P = 0.001, 2‐tailed t test). These preliminary results show the initial efficacy and safety of this new surgical procedure. (Otolaryngol Head Neck Surg 2000;122:100‐3.)
Structure of the principal olfactory tract
Authors: Gil‐Carcedo Luis Maria , Vallejo Luis Angel , Gil‐Carcedo Elisa
Published: November 2005

Although the purpose and importance of the sense of smell in human beings has not been totally clarified, it is one of the principal information channels in macrosmatic animals. It was the first long‐distance information system to have appeared in phylogenetic evolution. The objective of this article is to deepen the knowledge of the pathways that join the olfactory epithelium with the cortical olfaction areas, to better understand olfactory dysfunction in human beings. Differential staining and marking techniques were applied to histologic sections obtained from 155 animals of different species, to study the different connections existing among olfactory tract components. Our study of the connections between the olfactory mucosa and the principal olfactory bulb deserves special mention. The distribution of second neuron connections of the olfactory tract with the central nervous system is quite complex and diffuse. This indicates an interrelation between the sense of smell and a multitude of functions. These connections seem to be of different quantitative importance according to species, but qualitatively they exist in both human beings and other macrosmatic animals. (Otolaryngol Head Neck Surg 2000;122:129‐38.)
Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip
Authors: ÖNerci Metin , Yilmaz Taner , Gedikoğlu GÖKhan
Published: November 2005

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3.79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis. (Otolaryngol Head Neck Surg 2000;122:139‐42.)
Standardized format for depicting hearing preservation results in the management of acoustic neuroma
Authors: Rappaport Jamie M. , Nadol Joseph B. , McKenna Michael J. , Ojemann Robert G. , Thornton Aaron R. , Cortese Richard A.
Published: November 2005

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology‐Head and Neck Surgery recently published guidelines for reporting hearing preservation in the treatment of acoustic neuromas. These suggestions included pretreatment and posttreatment pure‐tone hearing thresholds, word recognition scores, and hearing classification. We present a standardized reporting format that addresses the Committee's recommendations and displays individual patient audiologic data as a simple, concise plot of posttreatment hearing results. To illustrate the use of the recommended format, preoperative and postoperative hearing data from our institution are reported. Such reporting criteria will facilitate comparative reviews of studies of hearing preservation after surgical or radiotherapeutic management of acoustic neuromas, while providing specific data for individual patient outcome analysis.
Thermal myringotomy for eustachian tube dysfunction in hyperbaric oxygen therapy
Authors: Potocki Stanley E. , Hoffman Douglas S.
Published: November 2005

Otolaryngologists are frequently asked to manage eustachian tube dysfunction (ETD) in patients undergoing hyperbaric oxygen therapy (HBO). HBO patients with intractable ETD currently are treated by tympanostomy tube placement; typically, these tubes are indwelling far longer than is required by the duration of HBO. Also, tubes in this population are associated with higher complication rates of persistent perforation and otorrhea. We investigated the use of thermal myringotomy as an alternative to tympanostomy tube placement in this clinical setting. Potentially, thermal myringotomy avoids the risks and complications associated with indwelling tympanostomy tubes and would be a temporally more appropriate treatment during short‐and intermediate‐term HBO. In this study 13 patients undergoing HBO who would have required tympanostomy tube placement instead underwent bilateral thermal myringotomies. At the fifth postoperative week, 96% of myringotomies were patent; this duration is adequate for most HBO courses. No patient required a second myringotomy for premature closure. The persistent perforation rate was 15% (at the end of 6 months), which compares favorably with the rate observed with tympanostomy tubes in this unique population of poor wound healers. Only 1 patient had otorrhea; this resolved with dry ear precautions. This study demonstrates thermal myringotomy to be an effective technique for middle ear ventilation in patients undergoing HBO in whom ETD develops.
Impact of resistant pneumococcus on rates of acute mastoiditis
Authors: Antonelli Patrick J. , Dhanani Nadeem , Giannoni Carla M. , Kubilis Paul S.
Published: November 2005

OBJECTIVE

To determine whether the rate of acute mastoiditis is rising, specifically as a result of antibiotic‐resistant strains of Streptococcus pneumoniae.

METHODS

A retrospective chart review of all patients with a discharge diagnosis of acute mastoiditis between July 1, 1987, and June 30, 1997, was performed at our academic, tertiary‐care medical center. There were no interventions, and the main outcome measures included the number of cases of acute or coalescent mastoiditis, stratified by pathogen, per year.

RESULTS

The rate of acute mastoiditis as a proportion of yearly otorhinolaryngology admissions increased linearly over time (P = 0.024). Pneumococcal‐related rates of acute mastoiditis, expressed as a proportion of yearly hospital and otorhinolaryngology admissions, increased linearly over time (P = 0.002, P = 0.002). All but 1 case of pneumococcal mastoiditis during the past 3 years were caused by penicillin‐resistant strains.

CONCLUSIONS

The emergence of antibiotic‐resistant S pneumoniae may be responsible for an increasing rate of acute mastoiditis.
Clinical and histologic evaluation of an indwelling, inflatable, long‐term laryngeal stent in the canine model
Authors: Milo Anton G. C. , Eliachar Isaac , Lane Charles J. , Myles Jonathan L. , Munoz‐Ramirez Hector
Published: November 2005

OBJECTIVE

The goal was assessment of a revolutionary approach to laryngeal stenting. A radically designed, atraumatic, inflatable, low‐pressure, high‐volume, endoscopically inserted laryngeal stent for effective intralaryngeal support or long‐term prevention of aspiration was prospectively evaluated in a canine model to reveal any significant short‐and long‐term anatomic and functional changes in the larynx.

METHODS

A self‐sustaining, tube‐free, long‐term flap tracheostomy was performed in 14 dogs, followed by endoscopic laryngeal stent insertion. The stents were inflated, and their intraluminal pressures were monitored daily. The stenting period ranged between 3 and 46 days (mean 27.4 days). The animals were then euthanized, and total laryngectomy was performed. The larynges underwent gross and microscopic examinations, and a grading scale of reactive changes caused by the stent placement was created on the basis of the findings.

RESULTS

Dye studies for aspiration were negative in all animals. Gross findings consisted of varying degrees of small ulceration, localized polypoid lesions, and granulomas. Grossly, 9 dogs exhibited small superficial ulceration of the true vocal cords and posterior commissure. Six dogs developed minor polyps or polypoid changes and/or granulomas, respectively. No gross changes were seen in 2 of the dogs. Histopathologically, 10 dogs demonstrated grade I or II histopathologic changes. Only 4 of the dogs exhibited inflammation extending into the underlying cartilages, grade III. One dog did not complete the observation period.

CONCLUSION

This new stent demonstrated safety and biocompatibility with minimal local tissue reaction to its extended long‐term placement. Good tolerance to the stent was documented, with minimal side effects similar to those that would be observed in human subjects after endotracheal intubation. When followed up in human patients, such minimal lesions have not resulted in significant long‐lasting functional impairments. These initial results would indicate that this stent is well tolerated for long‐term application and qualify as the preferred device for both management of aspiration and postoperative endolaryngeal bolstering support.
Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap
Authors: Browne J. Dale , Burke Alan J. C.
Published: November 2005

Maxillary defects lead to functional and cosmetic deficiencies, especially with tumor invasion of the orbit and cribriform plate. Additionally problematic is the near‐total palatal resection in patients with poor dentition (ie, not useful for anchoring obturators) and the desire for return of deglutition and useful speech. A series of 12 patients is presented in whom a rectus abdominis free flap was used for reconstruction of the palate, maxilla, and/or orbit. Nine of 12 free flaps were used to reconstruct defects involving the maxilla and orbit; all were successful in restoring hard palate continuity and function without the use of an obturator. The remaining 3 patients underwent successful repair of defects involving the orbit and medial maxilla without complication. Four of those 9 patients with palatal reconstruction augmented their dental rehabilitation with either their existing upper denture plate or the use of a cosmetic appliance anchored to their remaining dentition. Objectively, the rectus abdominis myocutaneous free flap proved to be a reliable and expeditious method of restoring function and acceptable cosmesis. We believe this technique should be routinely considered in the reconstruction of these defects.
Facial nerve function after partial superficial parotidectomy: An 11‐year review (1987‐1997)
Authors: Witt Robert L.
Published: November 2005

Permanent facial nerve dysfunction is a potential complication of every parotid surgery. Partial superficial parotidectomy, a conservative resectioning that requires neither dissection of the full facial nerve nor excision of the superficial lobe, produces lower rates of facial nerve dysfunction and soft tissue deformity than the traditional method. This report describes a single surgeon's experience with partial superficial parotidectomy from 1987 to 1997. Fifty‐nine patients with mobile, benign, and low‐grade malignant tumors, limited to the superficial lobe, underwent partial superficial parotidectomy with selective nerve dissection. Adequate margins were obtained, based on the premise that the tumor‐to‐nerve margin is often the true one. No patients had permanent nerve paralysis or paresis, and only 10 incurred transient facial nerve paresis. Age, histology, and sex were not significant factors in postoperative facial nerve function. No patients had recurrences.
Training the physician‐scholar in otolaryngology‐head and neck surgery
Authors: Nadol Joseph B. ,   Resident Education Committee of the Society of University Otolaryngologists
Published: November 2005

The Resident Education Committee of the Society of University Otolaryngologists constructed a questionnaire for young academic otolaryngologist‐head and neck surgeons to better understand their training background and to garner their opinions concerning adequacy or deficiencies in various aspects of that training. The questionnaire was mailed to 145 individuals who were in academic posts for 5 years or fewer in 1997. There was an overall response rate of 88.3%. Of the 128 respondents, 89% identified additional training, most commonly a clinical fellowship, in preparation for an academic career. The median number of hours per week devoted to professionally related activity was 61, of which two thirds was spent in direct patient care. The most common source of funds to pursue research activities was intradepartmental resources. Most individuals were satisfied with their jobs, although one quarter were considering leaving academic practice within the year. The single most important reason motivating selection of an academic career was a desire to teach. Details of the specific training and competencies and recommendations for improvement in resident training were obtained. Specific recommendations were generated for improving the training of future academic otolaryngologists; these recommendations include clarity of job description, a single track for clinical training for academicians and nonacademicians, more training in pertinent skills including research training, protected time for research, and amelioration of some of the downsides of academic life.
Effects of vasoactive topical agents on the survival of dorsal skin flaps in rats
Authors: Smith Daniel K. , Dolan Robert W.
Published: November 2005

OBJECTIVE

To evaluate 3 vasoactive topical agents regarding their ability to improve the survival of random skin flaps in rats.

METHOD

Thirty‐five adult Sprague‐Dawley rats had a single 9 × 2 cm random skin flap raised with topical application of a white petroleum ointment (control group), prostaglandin E2, minoxidil, or nitroglycerin to the flap. The effect of the agents on the viability of the flaps was evaluated.

RESULTS

The control group had an average survival area of 60.8% ± 7.9%. The nitroglycerin and minoxidil groups were not significantly different, with an average area of survival of 60.1% ± 8.1% and 63.3% ± 4.7%, respectively. The prostaglandin E2 group had average area of survival of 74.2% ± 10.5% (P = 0.002).

CONCLUSION

Prostaglandin E2 demonstrated a significant increase in flap survival. Nitroglycerin ointment and minoxidil had no beneficial effects when compared with control.
Evidence of possible localized specific immunoglobulin E production in middle ear fluid as demonstrated by ELISA testing
Authors: Hurst David S. , Weekley Melissa , Ramanarayanan Madhava P.
Published: November 2005

To determine whether IgE in the middle ear represents a passive transudate from the serum or may be produced within the middle ear itself, paired effusion and serum from 18 atopic children with otitis media with effusion were tested by micro‐ELISA for specific IgE to 12 allergens. Elevated effusion concentrations of specific IgE were present in 83.3% (15 of 18) of atopic patients, but only 30% (64 of 214) of the serum antibodies appeared in the effusion. The data show that in atopic children with otitis media with effusion, there is no relation between a patient's serum and effusion level of IgE for specific antibodies (P < 0.001), suggesting that IgE in middle ear effusion is not a transudate but more likely reflects an active localized process in atopic patients.
Interactive effects of the middle ear pathology and the associated hearing loss on transient‐evoked otoacoustic emission measures
Authors: Koike Kazunari J. , Wetmore Stephen J.
Published: November 2005

Sixty‐three children aged 4 to 17 years were examined by tympanometry, pure‐tone audiometry, transient‐evoked otoacoustic emissions (TEOAEs), and otoscopy to evaluate the effects of middle ear pathologies and the associated hearing loss on TEOAEs. TEOAE measures were highly specific (93.8%) in identifying normal ears that passed both audiometric and tympanometric criteria. The sensitivity for identifying abnormal ears was also reasonable (83.3%). The effects of the middle ear abnormality were most significant, regardless of the degree of hearing loss, when the tympanogram was type B with normal volume measures, which is associated with reduced eardrum mobility and middle ear fluid. The middle ear conditions producing the greater negative pressure, which in turn led to more conductive hearing loss, also produced more TEOAE failures. The mere presence of an open ventilation tube was not a determining factor for absent TEOAEs because 60% of the open ventilation tubes had normal TEOAEs. Provided that the clinician understands the effects of middle ear pathologies on otoacoustic emissions, TEOAEs can be a great asset for diagnosis of both otologic and audiologic disorders.
Transplanted fetal fibroblasts: Survival and distribution over time in normal adult dermis compared with autogenic, allogenic, and xenogenic adult fibroblasts
Authors: Hebda Patricia A. , Dohar Joseph E.
Published: November 2005

Cell therapy is a widely applicable therapeutic approach using cells and cell elements, frequently from fetal or young animals, for their beneficial effects. This study evaluated the host response to and tolerance of transplanted fetal skin fibroblasts. Cultured fibroblasts from adult rabbit skin (autogenic and allogenic), 21 ‐day fetal rabbit skin (allogenic), and adult pig skin (xenogenic) were labeled with a fluorescent vital dye CM‐Dil, injected intradermally into the dorsal skin of adult rabbits at multiple sites and then biopsied over an 8‐week period. Each cell type showed a biphasic distribution curve with an early phase (0 to 28 days) and a late phase (28 to 56 days). In the early phase, cells showed a rise and fall in total cell density (reflecting an increase and then a decrease in total cell number), followed by a slow decrease in cell density with cells still detectable at 56 days. Fetal cells showed the highest survival at the end of the study. None of the groups showed clinical or histologic signs of acute inflammation or rejection. This study demonstrated that (1) transplanted fibroblasts are well tolerated by an immunologically competent host, (2) CM‐Dil‐labeled cells are detectable in vivo for at least 8 weeks, and (3) fetal fibroblasts have a distribution and survival profile that is distinct from that of adult fibroblasts.
Fate of rigid fixation in pediatric craniofacial surgery
Authors: Berryhill Wayne E. , Rimell Frank L. , Ness John , Marentette Lawrence , Haines Stephen J.
Published: November 2005

The advantages of rigid fixation in adult craniofacial surgery are well documented, and implanted hardware is not routinely removed unless specifically indicated. There is a tendency, however, to remove hardware in children because of concerns with growth restriction, plate migration, and the lack of information on the fate of miniplates when used in pediatric craniofacial surgery. It has been our practice during the past decade not to remove hardware in children unless specifically indicated. Our study included a total of 121 procedures in 96 children, with an average age of 3.9 years and an average follow‐up of 5 years. We placed 375 titanium plates and 1944 screws from 3 manufacturers. Complications encountered in children with titanium plates were as follows: 5 cases of delayed growth and 1 instance of restricted growth, 4 screw migrations (none intracranial), 9 palpable plates causing pain, 3 fluid accumulations over plates, 2 cases of meningitis, and 8 instances of plate and screw removal from the above complications. Twenty‐two of 96 patients (23%) had a total of 27 complications from 121 procedures (22%). There were 6 cases in which pain precipitated removal of hardware, 1 case of an excessively mobile plate, and 1 case of documented growth restriction requiring removal; therefore our overall reoperation rate for plate removal was 8%, with no intracranial plate or screw migration.
Assessment of nasal mucosa blood supply by quantitative endoscopic imaging of back‐scattered light: International Editor
Authors: Prokopakis Emmanuel P. , Balas Costas J. , Christodoulou Panayotis N. , Gourtsoyiannis Nicolas C. , Tosca Androniki D. , Helidonis Emmanuel S.
Published: November 2005

In this article we present a method for the objective assessment and monitoring of tissue blood supply using a specially developed endoscopic imaging colorimeter that enables quantitative color modeling of the back‐scattered light during endoscopic examination. Tissue blood volume changes in the nasal mucosa, induced by xylometazoline hydro‐chloride nasal spray, were evaluated with this method. It was found that quantitative imaging provides sensitive, reproducible, and reliable means for the monitoring and mapping of tissue blood supply and is easy to use routinely. The results showed that saturation decreases with time, being the most sensitive color parameter to the vasocon‐striction procedure. It appears that objective indexes for optical tissue characterization and analysis may be promising in the understanding of the pathophysiology of tissue changes and in the objective evaluation of their response to different therapeutic schemes.
Relationship of human papillomavirus to ploidy in squamous cell carcinomas of the head and neck
Authors: Rodrigo Juan Pablo , Alvarez Ignacio , MartíNez José Antonio , Lazo Pedro Sánchez , Ramos Sofía , Suárez Carlos
Published: November 2005

To establish the relationship between the presence of human papillomavirus (HPV) gene sequences and the development of genetic abnormalities, 31 squamous cell carcinomas of the head and neck were studied for the presence of HPV types 6b and 16 and the DNA content by flow cytometry. Eighteen (58%) cases were aneuploid. HPV DNA was present in seven (22.5%) tumors. Five of them were positive for the HPV type 6b and two for the HPV type 16. Aneuploidy was correlated with poorly differentiated tumors. No correlation was found between the presence of HPV, DNA content, or tumor differentiation. Consequently, the presence of HPV gene sequences does not seem to be related to a higher incidence of genetic abnormalities in squamous cell carcinomas of the head and neck.
Sinonasal lymphoma
Authors: Fajardo‐Dolci German , Magaña Rogelio Chavolla , Bautista Enrique Lamadrid , Huerta Daniel
Published: November 2005

The clinical course of 49 patients with the diagnosis of non‐Hodgkin's lymphoma were studied in the Department of Otolaryngology of the Hospital General de Mexico between December 1986 and March 1997. The most frequent clinical symptoms in these patients were: nasal obstruction, rhinorrhea, fever, weight loss, cervical lymph adenopathy, rhinopharyngeal tumor, ulceration on the palate and periorbital cellulitis. In 73% of the patients in this series the primary presentation was nasal. Sixty‐six percent of the patients were classified as intermediate grade lymphoma according to the New Working Formulation, and 33% were in a I B state according to the Ann Arbor predominant immunotype was B cell in 63% of the cases. An extensive review of the literature is also presented.
Partial Labyrinthectomy with Hearing Preservation: Frequency‐Specific Data Using Tone‐Burst Auditory Brain Stem Response
Authors: ERIC E. SMOUHA , MASAYUKI INOUYE
Published: November 2005

Surgical approaches to the inner ear with hearing preservation have valuable implications for neurotologic surgery. In a previous study in guinea pigs, we demonstrated that click‐evoked auditory brain stem responses (ABRs) were preserved after transection and plugging of 1 or more semicircular canals but were lost after entering the vestibule (Smouha EE, et al. Otolaryngol Head Neck Surg 1996;114:777–784). A limitation of that study was that click‐evoked ABR might not represent the function of the entire cochlea. In this study we used tone‐burst ABR to determine thresholds across a broad range of frequencies (2 to 24 kHz) before and after surgical entry into the labyrinth at the lateral semicircular canal, ampulla, and vestibule. Serial measurements were made, and a sham surgery group was used as a control. The results obtained with tone‐burst ABR generally agreed with those previously obtained with click stimuli. Tone‐burst ABR thresholds were similar across most frequencies tested. Transection of the lateral semicircular canal resulted in preservation of ABR thresholds. Ampullectomy had a variable effect on ABR thresholds. Vestibulotomy usually resulted in substantial hearing loss. We conclude that hearing can be preserved across a range of frequencies after selective surgery of the inner ear. Surgical entry into the membranous labyrinth near the vestibule is the critical factor contributing to hearing loss after partial labyrinthectomy.
Validation of a Voice Outcome Survey for Unilateral Vocal Cord Paralysis
Authors: RICHARD E. GLIKLICH , ROBERT M. GLOVSKY , WILLIAM W. MONTGOMERY
Published: November 2005

Current methods to assess voice outcomes in patients with unilateral vocal cord paralysis (UVCP) are limited by expense, reliability, or lack of a true patient‐relevant focus. The purpose of this study was to develop and validate a patient‐based, disease‐specific instrument, the Voice Outcome Survey (VOS), that is brief, reliable, and sensitive to real clinical change in patients with UVCP. Fifty‐six consecutive patients with uncompensated UVCP and without complicating comorbid illness received the VOS, the Medical Outcome Study Short Form 36‐Item Health Survey (SF‐36), and a voice laboratory analysis before and 6 months after type I thyroplasty. Overall, reliability of the VOS was excellent (r = 0.87, P< 0.0001). The VOS index was significantly (P < 0.05) correlated to subscales of the SF‐36 including social functioning (SF) (r = 0.56) and physical role functioning (r = 0.35), as well as changes in objective voice measures such as phonation time (r = 0.51) and average intensity (r = 0.44). The VOS index was the most sensitive measure to clinical change after surgery (standardized response means: VOS, 1.92; phonation time, 0.68; SF, 0.58; physical role functioning, 0.53; intensity, 0.51). The VOS is a brief, valid, reliable, and highly sensitive measure of disease‐specific health status in patients with UVCP.
Establishing the Etiology of Childhood Hearing Loss
Authors: OHLMS LAURIE A. , CHEN AMY Y. , STEWART MICHAEL G. , FRANKLIN DANIEL J.
Published: November 2005

The cause of hearing loss in children is often difficult to identify. We evaluated a cohort of 114 children (47 boys, 67 girls) referred with newly diagnosed hearing loss (non–otitis media) to identify factors predictive of etiology and type of hearing loss. Clinical (history and physical examination), laboratory, and radiographic data were collected. One hundred children (87.7%) had sensorineural hearing loss, and 14 (12.3%) had conductive or mixed hearing loss. The cause of hearing loss was identified in 54 children (48%). Patients with isolated aural atresia (n = 7) or with a known diagnosis of congenital cytomegalovirus infection (n = 21) were excluded from further data analysis. We conducted statistical analysis to identify factors predictive of the cause and type of hearing loss. Clinical factors that aided in identifying a cause included abnormal physical examination findings (p= 0.001) and craniofacial anomalies (p = 0.006). Computed tomography of the temporal bones was the only diagnostic test predictive of cause (p < 0.001). Factors predictive of the type of hearing loss detected (sensorineural vs. conductive or mixed) were abnormal physical examination findings (p = 0.01) and craniofacial anomalies (p = 0.004). An exhaustive laboratory or radiographic workup did not prove beneficial in identifying the etiology of hearing loss in our series.
Morphometric Analysis of Horizontal Canal Nerves of Chronically Diabetic Rats
Authors: MYERS STEVEN F. , TORMEY MARY C. , SUSAN AKL
Published: November 2005

Horizontal canal nerves of 3‐, 6‐, 9‐, and 12‐month‐diabetic rats were compared with those of age‐matched controls. The myelin sheaths of the horizontal canal nerves in diabetic rats were thinner than those of age‐matched controls (mean ± SD 0.63 ± 0.04 mm [n = 16] vs. 0.71 ± 0.05 mm [n = 9]; p< 0.0001, one‐tailed t test). Regression analysis revealed that myelin sheath thickness did not correlate with severity of diabetes, but myelin thinning did occur as a function of the duration of diabetes (p < 0.05, regression ANOVA). The progression of myelin thinning over time is consistent with the possibility of an accelerated decline in vestibular function with age in diabetic patients. That myelin thinning did not correlate with the severity of diabetes suggests that this thinning is not directly related to the aging effects attributed to nonenzymatic glycosylation of myelin proteins. Multivariate analysis revealed a significant difference between diabetic and control groups when fiber diameter and intrasheath diameter were considered together (p < 0.008, canonical discriminant‐function analysis). Diabetic and control groups did not differ significantly in total nerve fiber counts. In the diabetic group, however, nerve fiber counts were higher in animals with higher blood glucose levels (p< 0.02, linear‐regression ANOVA; r2 = 0.49). The finding of higher nerve fiber counts in more severely diabetic rats is consistent with an earlier transmission electron microscopic finding of false myelinated nerve fiber profiles in micrographs from more severely diabetic rats. These false profiles are believed to represent phagocytosis‐like Schwann cell reactions against their own myelin, triggered by excess myelin glycosylation.
Tracheal Transplantation: Defining the Vascular Territory of the Canine Cranial Thyroid Artery
Authors: SHAARI CHRISTOPHER M. , GANNON PATRICK J. , SALMERON JESSE , SANDERS IRA , URKEN MARK L.
Published: November 2005

The management of long‐segment tracheal stenosis remains an unsolved clinical problem that has significant implications for the survival of some patients and the quality of life of others. However, recent advances in microvascular tissue transfer may allow tracheal transplantation to be used as a treatment option. Studies in dogs have demonstrated that the reanastomosis of the cranial thyroid artery (CTA) after the transplantation of a short segment of trachea sustains cartilage viability. However, the distal perfusion zone of the CTA within the canine trachea has not been described. Hence it is unclear what length of trachea can be safely harvested, with use of the CTA as the donor artery, without risking ischemia of the distal trachea. This study determined the perfusion territory of the CTA by use of latex or dye infusion via the thyroid branches of the CTA. Findings in five perfusion‐fixed cadaver mongrel dogs (8 to 12 kg) were studied. In each dog, both common carotid arteries were dissected and the CTAs identified. The right CTA was ligated and the left common carotid artery was ligated cranial to the CTA. The left common carotid artery was perfused for 10 minutes under 100 mm Hg pressure with black india ink/saline solution (20:1000 ml) or with blue latex solution. Perfusion territories were determined by grossly and microscopically measuring the region of stain in the endolaryngeal and endotracheal airways. The results demonstrated that up to 18 ipsilateral rings of the canine trachea are perfused after injection of dye under physiologic pressure into the CTA. Contralateral staining was also noted, but to a lesser degree. These results suggest that the canine CTA may perfuse, on average, a 16‐ to 17‐ring tracheal segment.