bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical Study of the Aerodynamic Effects of Septoplasty and Partial Lateral Turbinectomy
Authors: Ozlugedik Samet , Nakiboglu Gunes , Sert Cuneyt , Elhan Alaittin , Tonuk Ergin , Akyar Serdar , Tekdemir Ibrahim
Published: February 2009

Objectives: To investigate, first, the effects of septal deviation and concha bullosa on nasal airflow, and second, the aerodynamic changes induced by septoplasty and partial lateral turbinectomy, using computational fluid dynamics (CFD).

Methods: A three‐dimensional model of a nasal cavity was generated using paranasal sinus computed tomography images of a cadaver with concha bullosa and septal deviation. Virtual septoplasty and partial lateral turbinectomy were performed on this model to generate a second model representing the postoperative anatomy. Aerodynamics of the nasal cavity in the presence of concha bullosa and septal deviation as well as postoperative changes due to the virtual surgery were analyzed by performing CFD simulations on both models. Inspiratory airflow with a constant flow rate of 500 mL/second was used throughout the analyses.

Results: In the preoperative model, the airflow mostly pass through a narrow area close to the base of the nasal cavity. Following the virtual operation, a general drop in the maximum intranasal air speed is observed with a significant increase of the airflow through right middle meatus. While in the preoperative model the greatest reduction in pressure is found to be in the localization of anterior septal deviation on the right side and confined to a very short segment, for the postoperative model, it is observed to be in the nasal valve region in both nasal cavities. Following septoplasty and partial lateral turbinectomy, total nasal resistance is reduced significantly.

Conclusions: CFD simulations promise to make great contributions to understand the airflow characteristics of healthy and pathologic noses. Before surgery, planning for any specific intervention using CFD techniques on the nasal cavity model of the patient may help foreseeing the aerodynamic effects of the operation and might increase the success rate of the surgical treatment.
Caloric Function After Endolymphatic Sac Surgery
Authors: Ulubil S Arif , Eshraghi Adrien A. , Telischi Fred F. , Angeli Simon I. , Balkany Thomas J. , Joy Jennifer J.
Published: February 2009

Objective: To evaluate the effect of endolymphatic sac surgery on vestibular functions using caloric testing on electronystagmography (ENG).

Study Design: Retrospective chart review.

Methods: The medical records of 21 adult patients with unilateral Ménière's disease who underwent endolymphatic sac surgery between 1998 and 2004 were reviewed. With use of ENG, the absolute value of the caloric response of the operated ear (i.e., the cool + warm irrigation response) and the degree of reduced vestibular response (RVR) rates as indicators of caloric functions were compared before and after surgery. Average follow‐up was 17 (6–52) months.

Results: The mean change in RVR after surgery was found to be 2.9%. In total, there were six (28.5%) patients who had an RVR increase more than 10%. Of those, there were three (14.2%) patients who demonstrated an RVR increase more than 20%. Only one (4.8%) patient had an RVR increase more than 30%. Total loss of vestibular function was not observed in any of the patients. There were three (14.2%) patients who exhibited a decrease of more than 10% in their RVR. In two (9%) patients, the contralateral ear was shown to have less vestibular function than the operated side on ENG postoperatively (in one case, the absolute caloric nystagmus response remained the same in the operated ear, and in the other case, the response increased on the surgical side). When we evaluated the absolute caloric responses of the operated ear only, we found no statistical difference between the pre‐ and postoperative values (P = .219). Early results of vertigo control and hearing outcomes were comparable with those in the literature.

Conclusion: Endolymphatic sac surgery does not appear to be a vestibular destructive procedure, and it is a therapeutic alternative for patients with Ménière's disease who have failed medical treatment. This is important given the possibility of bilateral disease in some patients.
Management and Outcome of Patients With Mucoepidermoid Carcinoma of Major Salivary Gland Origin: A Single Institution's 30‐Year Experience
Authors: Aro Katri , Leivo Ilmo , Mäkitie Antti A.
Published: February 2009

Background: Mucoepidermoid carcinoma (MEC) is one of the most frequent epithelial malignancies of the salivary glands. Prediction of clinical outcome of MEC is challenging.

Material and Methods: We retrospectively reviewed 52 cases of MEC of major salivary gland origin diagnosed at the Department of Otolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland, during a 30‐year period of 1976 to 2005. Criteria used for diagnosis were those of World Health Organization classifications valid at each time point, and criteria for grading were those recommended by Armed Forces Institute of Pathology fascicle (1996). Since 1993, the degree of cell proliferation was used at our institution as an adjunct tool when grading MEC. The majority of cases occurred in the parotid gland (n = 47, 90%) followed by the submandibular gland (n = 5, 10%).

Results: We had 39% high‐grade (HG), 14% intermediate‐grade (IMG), and 44% low‐grade (LG) MECs. T categories were T1, n = 18; T2, n = 16; T3, n = 9; T4, n = 9. Forty‐nine (94%) patients were treated with curative intent. These patients underwent surgery, and 24 (49%) patients received postoperative radiotherapy. Follow‐up time varied from 6 months to 9 years. Forty‐five percent of HG‐MEC patients and 67% of IMG‐MEC patients developed locoregional failures or distant metastases during a 3‐year follow‐up as opposed to none of the LG‐MEC patients. Of MEC patients with N0 neck, two HG‐MEC patients and one IMG‐MEC (8%) patient developed regional recurrence during follow‐up.

Conclusions: Patient outcome in the different grades of MEC suggests a need for overview of the treatment protocol, especially with regard to LG‐MEC and IMG‐MEC. The apparently unusual occurrence of locoregional failures and metastases in LG‐MEC suggests a restrictive approach in surgical management. However, the frequent occurrence of such failures in IMG‐MEC warrants an aggressive approach with these tumors.
Otolaryngologist–Head and Neck Surgeon‐Performed Ultrasonography for Parathyroid Adenoma Localization
Authors: Gurney Theresa A. , Orloff Lisa A.
Published: February 2009

Objective: To demonstrate the efficacy of otolaryngologist–head and neck surgeon‐performed ultrasonography (US) for the preoperative localization of parathyroid adenomas.

Methods: A retrospective chart review of all patients evaluated by office‐based US for the localization of surgery‐proven parathyroid adenomas from October 2004 through February 2007.

Results: A total of 29 patients underwent preoperative US localization. Twenty‐three (79%) were females, and six (21%) were males. The age of patients ranged from 27 to 85 years of age. The size range of adenomas detected as measured by US was 0.5 to 2.7 cm. Pathology specimen measurements ranged from 0.3 to 3.4 cm. A total of 30 parathyroid adenomas were found. US identified 90% of the parathyroid adenomas to the correct side, left or right. In addition, US localized the parathyroid adenomas to the correct quadrant, superior or inferior, 83% of the time. Challenges in accurate localization were associated with patient obesity, presence of thyroid carcinoma, and multinodular thyroid disease. For comparison, sestamibi scans performed on the same patients localized the parathyroid adenoma to the correct side only 71% of the time and to the correct quadrant 61% of the time.

Conclusions: Otolaryngologist–head and neck surgeon‐performed US can accurately identify the location of parathyroid adenomas and is a useful tool for preoperative planning.
Obstructive Sleep Apnea in an Infant With Prominent Glossopharyngeal Muscles: Therapy and Outcome
Authors: Shadfar Scott , Digoy G P.
Published: February 2009

We present a case of prominent glossopharyngeal muscles causing severe obstructive symptoms in a 3‐month‐old child. Preoperative sleep studies and dynamic microdirect laryngoscopy were used in evaluation of the patient. Postoperative sleep studies confirmed a substantial reduction in apneic events after release of the muscle folds. The literature addresses the variant anatomy, and treatment options are discussed. To our knowledge, this is the first case report of prominent glossopharyngeal muscles leading to apneic events. We propose that in patients with prominent glossopharyngeal folds, surgical release may significantly improve symptoms of sleep apnea and in severe cases prevent tracheostomy.
Aerodynamic, Acoustic, and Vibratory Comparison of Arytenoid Adduction and Adduction Arytenopexy
Authors: McNamar Justin , Montequin Douglas W. , Welham Nathan V. , Dailey Seth H.
Published: February 2009

Hypothesis: Adduction arytenopexy (AP) with thyroplasty provides improved physiologic placement of the vocal fold and therefore provides improved acoustic, aerodynamic, and vibratory function as compared with arytenoid adduction (AA) with thyroplasty.

Methods: Five cadaveric human larynges were prepared by removing supraglottic tissues and fixing the nontest vocal fold medially on the cricoid facet with a needle in a physiologic phonating position. Each test vocal fold was then sequentially tested using an excised larynx phonation system, first with AA with silastic medialization and then converted to AP without changing the contralateral fold position or silastic wedge. The excised larynx setup allowed for simultaneous collection of data, specifically subglottic pressure (including measurement of phonation threshold pressure [PTP]), mean airflow, acoustic output, and full‐frame high‐speed digital video.

Results: Aerodynamic evaluation was similar for each group with similar subglottic pressure versus output curves. Conditions involving AP typically had PTP values that were 80% of that for comparable AA conditions. Acoustic evaluation revealed differences between the two groups. Each AA was found to be vibrating with two dominant frequencies with their associated harmonics. Each AP vibrated at a single dominant frequency with its harmonics.

Conclusion: AP provides improved vocal outcomes by decreasing system noise and decreasing PTP, which may lead to a stronger glottal signal with decreased vocal effort.
Regional Metastases in Well‐Differentiated Thyroid Carcinoma: Pattern of Spread
Authors: Yanir Yoav , Doweck Ilana
Published: February 2009

Objectives/Hypothesis: To determine the pattern of spread of WDTC to regional lymph nodes, in patients who presented with clinically positive nodes.

Study Design: Retrospective chart review.

Materials and Methods: Between October 2001 and December 2006, a total of 27 consecutive patients (12 males, 15 females) with clinical evidence of cervical metastasis of well‐differentiated thyroid carcinoma (WDTC) underwent 28 neck dissections (ND) with a mean follow‐up 33.7 months. Papillary carcinoma was found in 24 patients and follicular carcinoma in 3.

All neck dissection specimens were separated during surgery into levels, and analysis was done with respect to the levels of the neck.

Clinical and demographic parameters were correlated to the pathologic parameters, including number of pathologic nodes, size of tumor, and the patient's age, with univariate and multivariate analysis.

Results: The mean number of pathologic nodes in ND specimen was 6.7. The predominant site of metastasis was level VI (95%), followed by level III (68%), level IV (57%), and level II (54%). Metastases above the XI nerve were found in 7% of the patients. Level V showed 20% of nodal metastasis. A correlation was found between size of primary tumor and number of positive pathologic lymph nodes (P = .02) and an inverse correlation between the age of the patient and the number of pathologic nodes (P = .043).

Conclusions: The high incidence of metastatic disease in levels II through VI supports the recommendation for posterolateral and anterior ND in patients with WDTC and clinically positive nodes. The correlation between tumor size, the age of the patient, and the number of positive nodes is an interesting finding that warrants further study.
Cigarette Smoke Activates NFκB and Induces Muc5b Expression in Mouse Middle Ear Cells
Authors: Preciado Diego , Lin Jezhin , Wuertz Beverly , Rose Mary
Published: February 2009

Objectives: Cigarette smoke exposure is a significant risk factor in the development of otitis media (OM). Nuclear factor kappa B (NF‐κB) is a ubiquitous transcription factor known to mediate cigarette smoke effects on gene regulation in multiple cell types. The MUC5B mucin gene contains several putative NF‐κB sites in its promoter and is the predominant mucin expressed in human OM. We hypothesized that in vitro stimulation of a recently developed model system, murine middle ear epithelial cells (MEEC), with cigarette smoke condensate (CSC) activates NF‐κB and subsequently induces Muc5b gene expression.

Methods: Luciferase reporter assays, electromobility shift assays (EMSA), and quantitative microplate transcription factor assays (TFA) were performed to evaluate NF‐κB activation with CSC in immortalized murine MEEC (mMEEC). Reverse transcriptase polymerase chain reaction (RT‐PCR) assays and quantitative real time RT‐PCR were performed to determine whether time course CSC stimulation upregulates Muc5b mRNA levels in differentiated mMEEC. Luciferase reporter assays were performed to determine whether CSC activates the Muc5b promoter.

Results: Reporter assays, EMSA, and TFA demonstrated three‐ to five‐fold dose‐dependent activation of NF‐κB with CSC in mMEEC. CSC stimulation likewise increased Muc5b mRNA abundance and induced reporter activity 1.8‐ to 4.8‐fold in plasmids containing −556 and −255 base pairs upstream of the Muc5b transcriptional start site in mMEEC.

Conclusions: CSC activates NF‐κB in immortalized MEEC. Furthermore, this activation correlates with CSC‐induced Muc5b promoter activation and gene expression. Taken together, these results hint that much as in lung cells, the activation of mucins by cigarette smoke is mediated in part by NF‐κB.
Temporal Bone Study of Trisomy 13 Syndrome
Authors: Fukushima Hisaki , Schachern Patricia A. , Cureoglu Sebahattin , Paparella Michael M.
Published: February 2009

The temporal bones of a 23‐week‐old female who had multiple congenital anomalies and bilateral hearing loss with trisomy 13 syndrome were evaluated under light microscopy.

In the left cochlea, spiral ganglion cells and cochlear nerve fibers are absent. In the right ear, an abnormal branch of the singular nerve passes between the utricle and lateral semicircular canals and separates the two portions, one to the flattened crista of the lateral semicircular canal, the other to the utricular macula. This is a rare report describing a patient with abnormalities in three nerves, including the facial, vestibular, and cochlear nerves.
Effect of Aging on Blood Flow in Rat Larynx
Authors: Russell John A. , Nagai Hiromi , Connor Nadine P.
Published: February 2009

Objective/Hypothesis: Age‐associated muscular changes and fatigue have been shown to affect phonatory function. Reductions in blood flow with aging could translate to reductions in oxidative capacity within laryngeal muscles and increased fatigability. We tested the hypothesis that there would be increased capillary red blood cell (RBC) velocity and a reduction of capillary density in the thyroarytenoid (TA) muscle of senescent rats.

Study Design/Methods: Ten male Fisher 344/Brown Norway rats in two age groups were used: young adult (9 mo) and old (28–30 mo). Sixteen additional young and old rats were used in a fluorescent microsphere experiment that examined blood flow rates before and after a surgical manipulation. With use of a specially equipped intravital microscope, in vivo measurements of capillary geometry and flow were obtained, including RBC velocity, capillary density, tortuosity, and number of branch points.

Results: There was an age‐related reduction in capillary surface area as evidenced by reduced lineal density of capillaries. In addition, reduced RBC transit time was suggested by the reduction in branch points found with age. There was no change in RBC velocity with aging. The surgical method used to expose the TA muscle for blood flow recordings did not significantly affect resultant blood flow measurements.

Conclusions: We developed a method to evaluate in vivo laryngeal microvasculature. We found age‐related changes in microvascular geometry within the TA muscle of the rat that could affect blood flow to this critical muscle of phonation and airway protection. These microvascular changes could contribute to age‐related laryngeal dysfunction.
Outcomes Studies of Epiglottic and Base of Tongue Prolapse in Children
Authors: Yellon Robert F. , Borland Lawrence M.
Published: February 2009

Objectives: The purpose of this study was to compare previously reported flexible fiberoptic laryngoscopy (FFL) findings of a grading system for children with epiglottic and base of tongue (EBT) prolapse with findings at follow‐up FFL. Surgical outcomes and tracheotomy decannulation are also reported.

Study Design: Retrospective medical record review.

Methods: Fourteen children with EBT prolapse had transnasal FFL in the supine position on at least two occasions. Findings were graded for initial versus most recent FFL. The previously published EBT prolapse grading system was reapplied. Mean age was 8.7 years at the last evaluation. Mean interval between initial and most recent FFL was 1.9 years.

Results: At follow‐up FFL, six (43%) children had the same grade of EBT prolapse, five (36%) had a milder grade, and three (21%) had a more severe grade. Five (36%) children were decannulated, and nine (64%) children remain tracheotomy dependant. Of nine children who had surgery, four (44%) were decannulated. Eight (89%) of nine children who were not decannulated have a history of developmental delay (P < .03). Twelve (86%) children had gastroesophageal reflux disease, and six (43%) had abnormal swallowing function.

Conclusions: The grading system was successfully reapplied to compare initial with follow‐up findings in a cohort of children with EBT prolapse. Gastroesophageal reflux disease and swallowing dysfunction are common in this population. Judicious surgery may have some efficacy for EBT prolapse in selected patients. Many children with EBT prolapse still require tracheotomy, especially those with developmental delay.
Ototoxicity of Triethanolamine Polypeptide (Cerumenex) in the Chinchilla
Authors: Daniel Sam Joseph , Sahmkow Sofia Isabel , Munguia Raymundo , Schloss Melvin , Akache Fadi
Published: February 2009

The use of earwax softeners and cerumenolytics to unblock the external auditory canal is increasing. Although reports on their effectiveness are available, data about their effect on hearing are limited.

Objective: To assess the effect of ototopic triethanolamine polypeptide oleate condensate 10% (Cerumenex) on hearing.

Study Design: Prospective, randomized, controlled trial in a chinchilla animal model.

Methods: Tympanostomy tubes were inserted in five chinchillas, and hearing was assessed with distortion product otoacoustic emissions (DPOAE) between 1 and 9 kHz prior to application and at days 1, 4, 30, and 100 postototopic application of Cerumenex. One ear received Cerumenex; the other ear served as control. Postmortem scanning electron microscopy was performed to assess the cochlear hair cells.

Results: A reduction in the mean DPOAE signal was shown in the ears treated with Cerumenex from the first day after treatment and throughout the study. Almost all tested frequencies were affected. Swelling, crusting, and fluid were observed in four of the five experimental ears. One animal also developed facial paralysis in the experimental side. Electron microscopy showed damage of the outer and inner hair cells in the Cerumenex‐treated ears.

Conclusions: In the chinchilla, when a tympanic perforation is present, Cerumenex causes a reduction in DPOAE signal and damage to the cochlear hair cells. Caution should be observed when prescribing this agent if the status of the tympanic membrane is unknown. Furthermore, its use without medical prescription should be discouraged because of the risk of ototoxicity and severe inflammatory reaction.
History of Voice Rehabilitation Following Laryngectomy
Authors: Bień Stanisław , Rinaldo Alessandra , Silver Carl E. , Fagan Johannes J. , Pratt Loring W. , Tarnowska Czesława , Towpik Edward , Weir Neil , Folz Benedikt J. , Ferlito Alfio
Published: February 2009

Introduction: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow.

Material and Methods: The world literature was reviewed using various Internet and medical search engines and library facilities. Landmark articles were identified and summarized.

Results: A coherent history of voice rehabilitation following laryngectomy was constructed.

Discussion: The methods employed to reestablish voice after extirpation of the larynx may be grouped into the categories of: esophageal speech, surgical methods of creating competent tracheo‐pharyngeal shunts to create lung powered voice with and without the use of prosthetic devices to prevent aspiration, “near‐total” resection of the larynx with dynamic phonatory shunt, and the use of external pneumatic or electrical devices to create sound which is then transmitted through the oral cavity and pharynx.

Conclusion: For the past two decades, simple shunt devices inserted either primarily, at the time of laryngectomy, or later as a secondary procedure, have mainly supplanted the other methods of voice rehabilitation, with the exception of an occasional patient who has acquired good esophageal speech, or for whom external devices may be the only practical method of voice production.
Vascular Anatomy of Anterolateral Thigh Flap
Authors: Malhotra Kavita , Lian Timothy S. , Chakradeo Vinaya
Published: February 2009

Objectives: To understand the vascular anatomy of the anterolateral thigh (ALT) free flap. To anatomically determine whether including a 2‐cm cuff of vastus lateralis muscle (VLM) incorporates musculocutaneous perforators in the harvest of the ALT free flap.

Study Design: Anatomic study on human cadavers.

Methods: Twenty‐seven cadaver thighs were dissected. Musculocutaneous perforators from the vascular pedicle of the ALT free flap were identified. The distance from the anterior border of the VLM to the point where perforators entered the muscle was measured.

Results: An average of four musculocutaneous perforators to the ALT free flap were identified per thigh. The distance from the anterior border of the VLM to the point where perforators entered the muscle ranged from 0.1 to 7 cm, with the mean distance being 1.80 cm. Sixty‐four percent of perforators entered the VLM within 2 cm of the muscle's anterior border. At least one perforator entered the VLM within 2 cm of the muscle's anterior border per thigh.

Conclusions: Most musculocutaneous perforators to the ALT free flap enter the VLM within 2 cm of the muscle's anterior border, thus providing for an anatomic basis for including a 2 cm cuff of VLM when harvesting the ALT free flap. By including a 2 cm cuff of VLM, tedious dissection of individual musculocutaneous perforators is unnecessary, thereby increasing the ease of dissection and expediting the harvest of the ALT free flap.
Pediatric Myringoplasty: Factors That Affect Success—A Retrospective Study
Authors: Sckolnick Joshua S. , Mantle Belinda , Li Jia , Chi David H.
Published: February 2009

Objective: To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Children's Hospital of Pittsburgh from 2000 to 2005.

Study Design: Retrospective chart review at an academic tertiary‐care children's hospital.

Methods: Charts were reviewed for 604 children, ages 1 to 18 years old, with complete records who underwent myringoplasty by the pediatric otolaryngology practice at Children's Hospital of Pittsburgh of UPMC from 2000 to 2005, totaling 777 procedures.

Results: Significant variables include patient age, number of prior tubes, perforation etiology (P < .000), presence of a retained tube (P < .000) as well as tube type (P = .016), graft material (P = .001), and history of Down syndrome (P = .035). Nonsignificant variables include season of procedure (P = .599), status of adenoid tissue (P = .910), prior otorrhea (P = .175), as well as perforation location (P = .318) and duration (P = .150).

Conclusions: Proper patient and graft material selection can affect the outcome of myringoplasty procedures. Practical implications from these data suggest that Gelfoam myringoplasty is more successful than either paper patch or fat graft closures, with a 90.8% success rate (P = .001). Myringoplasty should not be deferred during the winter months as the season of procedure does appear to not affect the success of closure (P = .60). Similarly, the presence or absence of adenoid tissue did not affect the success of closure (P = .91).
Thoracic Duct Embolization: A New Treatment for Massive Leak After Neck Dissection
Authors: Patel Neel , Lewandowski Robert J. , Bove Michiel , Nemcek Albert A. , Salem Riad
Published: February 2009

Chylothorax results from injury to the thoracic duct or one of its branches. It is an uncommon but possibly serious complication of thoracic or head and neck surgery. We report a case of thoracic duct transection complicating a total laryngectomy with bilateral selective neck dissection for subglottic squamous cell carcinoma. High‐output Jackson Pratt drainage was noted, resulting in patient hypovolemia that was unresponsive to volume resuscitation. Treatment consisted of percutaneous embolization of the thoracic duct proximal to the transection that subsequently normalized chylous output.
A Thin Tracheal Silicone Washer to Solve Periprosthetic Leakage in Laryngectomies: Direct Results and Long‐Term Clinical Effects
Authors: Hilgers Frans J. M. , Soolsma Jessica , Ackerstaff Annemieke H. , Balm Fons J. M. , Tan I Bing , van den Brekel Michiel W. M.
Published: February 2009

Objectives: Assessment of the immediate results and long‐term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage.

Patients and Methods: Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom‐made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later.

Results: There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8–330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38–240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient.

Conclusions: In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.
Incidence of Thyroid Cancer in Residents Surrounding the Three Mile Island Nuclear Facility
Authors: Levin Roger J.
Published: February 2009

Objectives/Hypothesis: On March 28, 1979, the worst nuclear exposure incident in U.S. history occurred near Harrisburg, PA. Small quantities of xenon and iodine radioisotopes were released into the environment from the Three Mile Island (TMI) nuclear power plant. The Pennsylvania Department of Health (PDoH) implemented a TMI Population Registry, including 32,135 individuals within a 5‐mile radius of TMI, to track possible health effects to the local population. Although no increase in cancer mortality has been noted in this cohort, cancer incidence has not been tracked. Given the long latency period for the development of thyroid cancer after exposure to low‐level radiation exposure, it is plausible that an increase in thyroid cancer incidence might just now be occurring.

Study Design: Retrospective analysis of the Pennsylvania Cancer Registry Dataset for Thyroid Cancer using the Epidemiological Query and Mapping System (EpiQMS) search engine. EpiQMS is an interactive health statistics Website that can produce numbers, rates, graphs, charts, maps, and county profiles using various demographic variables (age, sex, race, etc.) from birth, death, cancer, and population datasets for the state and counties or regions of Pennsylvania.

Methods: Eighteen years of data (1985–2002) on thyroid cancer incidence were obtained from the PDoH. The three at‐risk counties of Dauphin, York, and Lancaster were analyzed with regard to observed numbers of thyroid cancer cases versus expected incidence. Although the nuclear accident at TMI occurred in 1979, 1985 was chosen as the starting point for data analysis because that is when the PDoH began maintaining cancer incidence records.

Results: In the first year available for evaluation (1985), there were 11 new thyroid cancer cases in each of the at‐risk counties (Dauphin, York, Lancaster). By 2002, the incidence had increased to 29 in Dauphin County, 81 in Lancaster County, and 69 in York County. The increase in thyroid cancer in Dauphin County is not above what would be expected for both the local population growth and the increase in thyroid cancer incidence in the U.S. population in general. Thyroid cancer incidence was greater than expected in York County for all but 1 year between 1995 and 2002. Lancaster demonstrated a marked increase in thyroid cancer incidence over expected norms throughout the study period. An increase greater than 50% was noted in certain years.

Conclusions: Thyroid cancer incidence has not increased in Dauphin County, the county in which TMI is located. York County demonstrated a trend toward increasing thyroid cancer incidence beginning in 1995, approximately 15 years after the TMI accident. Lancaster County showed a significant increase in thyroid cancer incidence beginning in 1990. These findings, however, do not provide a causal link to the TMI accident.
Predictive Factors for Central Compartment Lymph Node Metastasis in Thyroid Papillary Microcarcinoma
Authors: Lee Sang‐Hyuk , Lee Seung‐Suk , Jin Sung‐Min , Kim Jin‐Hwan , Rho Young‐Soo
Published: February 2009

Objective: We examined the incidence of nodal involvement and attempted to determine the predictive factors for central compartment lymph node (LN) metastasis in thyroid papillary microcarcinoma (PMC).

Study Design: Retrospective chart review.

Methods: We undertook a retrospective study of 52 patients treated between January 2000 and December 2005 for PMC by total thyroidectomy and elective central compartment LN dissection with or without comprehensive lateral neck dissection (n = 9). There were 45 women and 7 men whose mean age was 47.6 ± 11.5 years. The following criteria were used to study the predictive value of central compartment LN metastasis: sex, age, multifocality of the tumor, extracapsular spread (ECS), the involvement of the lateral neck LN, tumor size, and tumor location.

Results: In 16 of 52 (31%) patients, central compartment LN metastasis was found. With use of univariate and multivariate analysis, ECS, lateral LN metastasis, and tumor size (>5 mm) were independent correlates of central compartment metastasis. Sex, age, multifocality, and tumor location were not associated with central compartment LN metastasis and did not significantly influence the predictive value of these variables.

Conclusions: We found a significant association among ECS, lateral LN metastasis, tumor size (>5 mm), and central compartment LN metastasis in patients with PMC. A prophylactic neck dissection of the central compartment should be considered particularly in patients with ECS of the tumors, metastatic LN in the lateral neck, and a greater than 5 mm tumor size.
Phonovibrogram Visualization of Entire Vocal Fold Dynamics
Authors: Lohscheller Jörg , Eysholdt Ulrich
Published: February 2009

Objectives: High‐speed (HS) video recordings are the up‐to‐date method for visualizing irregular vocal fold vibrations. However, perceptive evaluation during offline replay is time consuming and shows high inter‐rater variability.

Method: A visualization procedure is presented that extracts vocal fold vibrations from HS videos and transfers the motion information into a set of three phonovibrogram (PVG) images that make visual vocal fold displacements (PVG‐0), velocities (PVG‐1), and accelerations (PVG‐2).

Results: The principles of PVG computation as well as their application to three clinical examples (normal voice, laryngeal nerve paralysis, functional voice disorder with vocal nodules) are presented. For normal and dysphonic subjects, the PVG images show the characteristics of vocal fold vibrations as concern the dynamic patterns of displacements, velocities, and accelerations.

Conclusion: The PVG approach makes visual the entire range of motion of vibrating vocal fold edges in easy‐to‐read color images for differentiation of normal and pathologic voices. PVG images are printable and can be stored on a hard‐disc drive, enabling the documentation of the course of voice disorders that is essential for evidenced‐based medicine. PVG visualization has the potential to overcome the subjective quality of assessing HS videos, which makes it a valuable tool with broad clinical application.
Ascorbic Acid Reduces Noise‐Induced Nitric Oxide Production in the Guinea Pig Ear
Authors: Heinrich Ulf‐Rüdiger , Fischer Ilka , Brieger Jürgen , Rümelin Andreas , Schmidtmann Irene , Li Huige , Mann Wolf J. , Helling Kai
Published: February 2009

Objectives: Noise‐induced hearing loss can be caused, among other causes, by increased nitric oxide (NO) production in the inner ear leading to nitroactive stress and cell destruction. Some studies in the literature suggest that the degree of hearing loss (HL) could be reduced in an animal model through ascorbic acid supplementation. To identify the effect of ascorbic acid on tissue‐dependent NO content in the inner ear of the guinea pig, we determined the local NO production in the organ of Corti and the lateral wall separately 6 hours after noise exposure.

Study Design: Prospective animal study in guinea pigs.

Methods: Over a period of 7 days, male guinea pigs were supplied with minimum (25 mg/kg body weight/day) and maximum (525 mg/kg body weight/day) ascorbic acid doses, and afterwards exposed to noise (90 dB sound pressure level for 1 hour). The acoustic‐evoked potentials were recorded before and after noise exposure. The organ of Corti and the lateral wall were incubated differently for 6 hours in culture medium, and the degree of NO production was determined by chemiluminescence.

Results: Ascorbic acid treatment reduced the hearing threshold shift after noise exposure depending on concentration. When the maximum ascorbic acid dose was substituted, NO production was significantly reduced in the lateral wall after noise exposure and slightly reduced in the organ of Corti.

Conclusions: Oral supplementation of the natural radical scavenger ascorbic acid reduces the NO‐production rate in the inner ear in noisy conditions. This finding supports the concept of inner ear protection by ascorbic acid supplementation.
Nasal Pepsin Assay and pH Monitoring in Chronic Rhinosinusitis
Authors: Ozmen Süay , Yücel Omer Taskin , Sinici Incilay , Ozmen Omer Afsin , Süslü Ahmet Emre , Oğretmenoğlu Oğuz , Onerci Metin
Published: February 2009

Objectives/Hypothesis: The primary objective of this study was to determine the relationship between chronic rhinosinusitis (CRS) and laryngopharyngeal reflux (LPR). We also investigated the diagnostic value of pepsin in nasal lavage by means of fluorometric assay as compared with 24‐hour dual‐probe pH monitoring.

Study Design and Methods: This is a controlled, prospective study from a retrospective dataset of 33 patients recruited for endoscopic sinus surgery between 2005 and 2006 in a tertiary care referral center (Hacettepe University Medical Center). All patients underwent 24‐hour dual‐probe pH monitoring and nasal lavage fluid investigation for pepsin. A fluorometric pepsin assay using casein‐fluorescein isothiocyanate in nasal lavage fluid was used to detect LPR. The control group included 20 patients who were proven not to have sinusitis.

Results: A higher incidence of pharyngeal acid reflux events was found in patients with CRS (29 of 33, 88%) compared with the control patients (11 of 20, 55%). The difference was statistically significant (P = .01). The fluorometric pepsin assay was correlated to the results of 24‐hour dual‐probe monitoring for LPR diagnosis with a 100% sensitivity and 92.5% specificity. These data suggest that an association between CRS and LPR is present and that the detection of pepsin in nasal lavage fluid may provide a noninvasive and feasible method of LPR screening.
Spiral Ganglion Degeneration Patterns in Endolymphatic Hydrops
Authors: Bixenstine Paul J. , Maniglia Mauricio P. , Vasanji Amit , Alagramam Kumar N. , Megerian Cliff A.
Published: February 2009

Objectives: The mechanistic association between endolymphatic hydrops (ELH) and hearing loss (HL) is unclear. Although ELH severity has been shown to correlate in some studies with HL, injury of vital structures, including hair cells and the cochlear nerve, have failed to demonstrate correlation with ELH severity. The goal of this study is to evaluate the hypothesis that spiral ganglion cell degeneration is the principle pathologic site of ELH‐related cochlear injury, correlates with ELH severity, and is most profound in the apical region.

Study Design: Surgical induction of ELH in the guinea pig model was followed by histologic confirmation of ELH and subsequent correlation with segmental spiral ganglion cell densities.

Methods: Guinea pigs (N = 14) were subjected to unilateral ELH induction and killed after 4 to 6 months. ELH severity and spiral ganglion densities were obtained using computer‐aided morphometric analysis. Densities were normalized by calculating a spiral ganglion degeneration index (DI) for each animal.

Results: The apical spiral ganglion demonstrated significantly greater degeneration than that noted in the basal spiral ganglion (DI: 1.93 vs. 1.13; P = .004). The degree of spiral ganglion degeneration in the apex correlates well with a total hydrops index (P = .006) and an apical hydrops index (P = .003). Basal spiral ganglion degeneration however, does not correlate well with hydrops severity (total hydrops index: P > .05; basilar hydrops index: P > .05).

Conclusions: ELH‐related pathology appears to focus initially on the apical spiral ganglion and the degree of deterioration correlates well with the severity of ELH. These findings mirror some reports in the human condition, and imply that the mechanism of cochlear injury in ELH and secondary dysfunction appears to be a neural toxicity that begins in the apex of the cochlea.
Modified Nasal Specula and Flexible Holder for Endoscopic Nasal Surgery
Authors: Ushio Munetaka , Nakaya Muneo , Kondo Kenji , Suzuki Mitsuya , Yamasoba Tatsuya
Published: February 2009

The use of an endoscope in nasal surgery has now extended to surgery on the nasal septum as well as to sinus surgery. We devised the use of the modified nasal specula with Yasargil's flexible holder to resolve the technical problems in using an endoscope for septal surgery. One nasal speculum has two plates for connecting to the Yasargil's flexible holder. This speculum allows the surgeon to use both hands freely and also functions as a guide for stabilizing an endoscope. Another nasal speculum has two long adjustable wings. This speculum can widen the working space between the cartilage or bone of the nasal septum and detached mucosa. Our modified nasal specula are readily applicable to resolve the problems such as unstable endoscope and narrow working space in septal surgery under endoscopic view.
Desirudin Reduces the Rate of Microvenous Thrombosis in a Rat Model
Authors: Lewis Carol M. , Deschler Daniel G.
Published: February 2009

Objectives: In an effort to evaluate pharmacologic agents for optimal anticoagulant prophylaxis in patients undergoing free tissue transfer, we evaluated the efficacy of desirudin (Canyon Pharmaceuticals, Hunt Valley, MD), a recombinant hirudin that acts as a direct thrombin inhibitor, using a rat model of microvenous thrombosis.

Study Design: Randomized, blinded study using an in vivo rat model of microvenous failure.

Methods: Thirty‐two rats received either desirudin or saline in a randomized, blinded fashion 30 minutes prior to performance of a standardized thrombogenic procedure on rat femoral veins. Bleeding time, vessel patency, and presence of clot within the anastomosis were subsequently assessed. Appropriate statistical analyses were then performed.

Results: There was a significant increase in vessel patency in rats treated preoperatively with desirudin compared to controls receiving saline (96.9% vs. 53.1%, P < .001). In evaluating patent vessels for non‐occluding clot, 41.2% of control rats had non‐obstructive clot at the site of anastomosis, versus 3.2% of rats treated with desirudin (P = .002). Bleeding times were longer in desirudin‐treated rats than those that received saline (7.17 ± 3 minutes vs. 5.15 ± 1.2 minutes, P = .027).

Conclusions: The use of preoperative desirudin increases the rate of microvascular anastomotic patency, decreases the occurrence of non‐occluding clot, and increases bleeding time in an in vivo rat model, indicating potential efficacy in patients undergoing microvascular free tissue transfer.
Long‐Term Efficacy of Microdebrider‐Assisted Inferior Turbinoplasty With Lateralization for Hypertrophic Inferior Turbinates in Patients With Perennial Allergic Rhinitis
Authors: Chen Yu‐Lin , Tan Ching‐Ting , Huang Hung‐Meng
Published: February 2009

Objectives: The aim of the study was to evaluate the long‐term efficacy of microdebrider‐assisted inferior turbinoplasty with lateralization (MAITL) compared to submucosal resection for hypertrophic inferior turbinates.

Study Design: Surgical outcomes were evaluated with respect to visual analogue scale, anterior rhinomanometry, and saccharin test results.

Methods: From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR group, each comprised of 80 patients. Ten patients who did not display any nasal discomfort served as normal controls. For the submucosal resection group, patients underwent submucosal resection of the inferior turbinate, whereas patients in the MAITL group underwent microdebrider‐assisted inferior turbinoplasty with lateralization. Assessments (visual analogue scale, anterior rhinomanometry, and saccharin test) were conducted prior to the surgery and 1, 2, and 3 years after completion of surgery.

Results: Compared to preoperative values, subjective complaints including nasal obstruction, sneezing, rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in both groups (P < .05 for all). Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years postoperatively in both groups (P < .05 for all). Saccharin transit time was significantly decreased (P < .05 for all) compared to preoperative values 1, 2, and 3 years after surgery in both groups.

Conclusion: Microdebrider‐assisted inferior turbinoplasty with lateralization appears to be as effective as submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have had substantial nasal obstruction.
Epinephrine/Lidocaine Injection Vs. Saline During Endoscopic Sinus Surgery
Authors: Cohen‐Kerem Raanan , Brown Stephen , Villaseñor Luis Velazquez , Witterick Ian
Published: February 2009

Objectives: To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.

Design: A double‐blind randomized controlled trial.

Methods: Patients were assigned into two groups and were injected with either epinephrine 1:100,000 and lidocaine 1% or saline alone during endoscopic nasal surgery under general anesthesia. Pledgets soaked in epinephrine 1:1,000 were used throughout the procedure in both groups. Hemodynamic measurements and catecholamine blood levels were obtained.

Results: Ten patients were randomized to the epinephrine group and 12 to the saline group. We were able to measure epinephrine and norepinephrine levels following injection in all patients. Epinephrine levels were similar in both groups immediately after injection; however, 15 minutes following injection, epinephrine was significantly higher in saline‐injected patients. Mean arterial pressure and heart rate were affected by epinephrine and norepinephrine levels immediately after injection but were never elevated over the normal range. Heart rate was higher (P < .05) in the saline injected group than in the epinephrine group throughout the measurement period. The surgeons believed that the surgical field was bloodier in saline‐injected patients (P < .05) however objective estimation of blood loss showed no difference.

Conclusions: Injection of epinephrine/lidocaine mixture does not produce higher blood levels of epinephrine when compared to saline injection and did not induce any harmful side effects. We postulate that the combination with lidocaine 1% may reduce the patients' stress and thus prevent higher catecholamine levels.