bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneously Presenting Head and Neck and Lung Cancer: A Diagnostic and Treatment Dilemma
Authors: Kuriakose M. A. , Loree T. R. , Rubenfeld A. , Anderson T. M. , Datta R. V. , Hill H. , Rigual N. R. , Orner J. , Singh A. , Hicks W. L.
Published: November 2003

Objectives/Hypothesis
Synchronous tumors are defined as malignancies presenting within 6 months of the index tumors. A significant subset of patients present at initial evaluation with malignant tumors of both the head and neck (head and neck squamous cell carcinoma) and the lung, which are termed simultaneous primaries. The management and treatment outcomes in this cohort of patients have not been clearly defined and are the subject of the present review.

Study Design Retrospective chart review of previously untreated patients.

Methods From January 1974 to December 1997, a total of 2964 patients were treated for mucosal squamous cell carcinoma of the head and neck. Forty‐two patients fulfilled the criteria for synchronous head and neck and lung malignancy. Of these, 27 patients had simultaneous tumors of the head and neck and the lung. This cohort of patients (n = 27) was stratified into three treatment groups. Patients in group A (n = 10) had resectable head and neck and lung primaries treated with curative intent. Group B (n = 8) was composed of patients who could have been treated with curative intent but declined and were given only palliative therapy. Patients in group C (n = 9) were candidates for only palliative treatment.

Results The estimated 5‐year disease‐specific survival in group A was 47%, whereas patients in group B had a 5‐year disease‐specific survival of only 13% (P = .05). There were no survivors beyond 1 year in group C. The presence of mediastinal adenopathy in patients in group A portended poor clinical outcome. There was an estimated 5‐year disease‐specific survival of 51% in patients with no preoperative evidence of mediastinal adenopathy (n = 7), whereas 67% of patients with radiological evidence of mediastinal adenopathy died (two of three patients).

Conclusion The presence of simultaneous head and neck squamous cell carcinoma and pulmonary malignancies should not be a deterrent to aggressive surgical therapy because a potentially satisfactory outcome can be expected in these patients.
Compositional Difference in Middle Ear Effusion: Mucous Versus Serous
Authors: Chung Myung‐Hyun , Choi Jae Young , Lee Won‐Sang , Kim Hee‐Nam , Yoon Joo‐Heon
Published: November 2003

Objectives Serous otitis media is usually responsive to medical treatment, whereas mucoid otitis media is not. The present study was undertaken to elucidate the compositional difference between serous and mucoid effusion and to investigate whether MUC5AC acts as a major mucin in the middle ear mucosa with mucoid otitis media.

Study Design This study involved a chemical analysis of middle ear effusion and immunostaining of the middle ear mucosa.

Methods Middle ear effusion samples were collected from 27 patients with mucoid otitis media and 18 patients with serous otitis media. The levels of mucin, lysozyme, secretory immunoglobulin A, and interleukin‐8 were measured by dot blotting or enzyme‐linked immunosorbent assay. Periodic acid–Schiff and immunohistochemical staining with monoclonal anti‐MUC5AC antibody were performed on the serial sections of middle ear mucosa with mucoid otitis media.

Results Mucoid effusions contained higher levels of mucin, lysozyme, secretory immunoglobulin A, and interleukin‐8 than did serous effusions. Immunohistological study revealed that MUC5AC mucin was expressed in only a small portion of the goblet cells of middle ear mucosa with mucoid otitis media.

Conclusions The study suggests that both serous secretions and mucin might make the middle ear effusion more viscous and that mucins other than MUC5AC might have a major role in the viscosity of middle ear effusion. Further study is necessary to identify the major mucins in the middle ear effusion of otitis media with effusion.
Videofluoroscopic Upper Esophageal Sphincter Function in Elderly Dysphagic Patients
Authors: Kendall Katherine A. , Leonard Rebecca J.
Published: November 2003

Objectives/Hypothesis The intent of the study was to identify and characterize abnormalities of the timing and extent of upper esophageal sphincter (UES) opening in an elderly population complaining of dysphagia.

Study Design A retrospective review of dynamic swallow studies performed on patients greater than 65 years of age without an obvious medical or surgical cause for their dysphagia.

Methods Measures of UES opening timing and extent in the patient population were compared with those from 60 young, normal control subjects and 23 elderly control subjects. The relationship of UES function and other swallowing abnormalities was also evaluated.

Results No decrease in the size of UES opening was identified in the patient population. The coordination of UES opening relative to the position of the bolus in the pharynx was normal. UES opening was prolonged and was correlated with poor pharyngeal clearing suggestive of weak pharyngeal constriction.

Conclusion No primary abnormality of UES function was identified in this elderly dysphagic patient population.
A New Paramedian Approach to Arytenoid Adduction and Strap Muscle Transposition for Vocal Fold Medialization
Authors: Su Chih‐Ying , Lui Chun‐Chung , Lin Hsin‐Ching , Chiu Jeng‐Fen , Cheng Chu‐An
Published: November 2003

Objective To develop a prosthesis‐free medialization laryngoplasty for the treatment of glottal incompetence.

Study Design Twenty‐two consecutive patients with glottal incompetence underwent vocal fold medialization using a new paramedian approach to arytenoid adduction and/or strap muscle transposition.

Methods Under local anesthesia, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally, the inner perichondrium was opened, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2‐0 or 3‐0 Prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium and the thyroid cartilages sutured back into place. Pre‐ and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, noise‐to‐harmonic ratio, and maximal phonation time, as well as assessments of voice quality.

Results Vocal improvement was obtained in 95% (21 of 22) of patients. There was a significant improvement (P <.05) in all parameters except shimmer. No major complications were noted in any patient, except for dyspnea in one patient resulting from arytenoid overrotation.

Conclusion The results suggest that a paramedian approach to arytenoid adduction combined with strap muscle transposition is a safe and effective method for treating glottal incompetence, particularly in patients with unilateral paralytic dysphonia.
Glut3 Expression in Biopsy Specimens of Laryngeal Carcinoma Is Associated With Poor Survival
Authors: Baer Susan , Casaubon Luis , Schwartz Mary R. , Marcogliese Andrea , Younes Mamoun
Published: November 2003

Objectives/Hypothesis The aim of the study was to determine the clinical significance of the expression of Glut1 and Glut3 proteins in biopsy specimens of squamous cell carcinoma (SCC) of the larynx.

Study Design A retrospective study.

Methods Using immunohistochemistry, we immunostained sections of formalin‐fixed, paraffin‐embedded tissues from 48 biopsies of invasive SCC of the larynx for Glut1 and Glut3. The percentages of positive cells were recorded, then correlated with overall patient survival using the Kaplan‐Meier method and the Breslow‐Gehan‐Wilcoxon test for statistical significance.

Results All cases were positive for Glut1, and Glut1 expression was not associated with survival difference at any cut‐off value. Eighteen (38%) of the cases were Glut3‐negative and 30 (62%) were Glut3‐positive. Glut3‐positive cases were associated with poorer survival than Glut3‐negative cases (P = .0336). No significant difference was found between Glut3‐negative and Glut3‐positive groups in respect to sex, tumor site (glottic vs. supraglottic), nodal or distant metastasis, or treatment modality. However, there were significantly more poorly differentiated tumors in the Glut3‐positive group than in the Glut3‐negative group (27% vs. 0%, respectively;P = .0182, Fisher's Exact Test). After poorly differentiated tumors were excluded from the survival analysis, Glut3 immunoreactivity remained a significant marker of poor prognosis (P = .0385).

Conclusion Immunohistochemical detection of Glut3 in biopsy specimens of SCC of the larynx is a marker of poorer prognosis.
Growth Factors and Their Receptors in the Middle Ear Mucosa During Otitis Media
Authors: Palacios Sean D. , Pak Kwang , Rivkin Alexander Z. , Bennett Thecla , Ryan Allen F.
Published: November 2003

Objective The hyperplastic response of the middle ear mucosa during bacterial otitis media is thought to be mediated by the actions of growth factors and their respective receptors. The purpose of the study was to explore the expression of growth factors known to stimulate epithelial cells in other systems, as well as their receptors, in the middle ear mucosa during otitis media.

Study Design Expression of mRNA growth factors and receptors was measured over time after inoculation of the rat middle ear with bacteria.

Methods The middle ears of 12 male Sprague‐Dawley rats were injected with 105/mL Haemophilus influenzae strain 3655 (nontypeable, biotype II). Three rats were killed at 6, 24, 48, and 72 hours. Three untreated rats were also killed to serve as negative controls. The middle ear mucosa samples were surgically removed and homogenized. Reverse transcription‐polymerase chain reaction was performed on each sample with primers for rat epidermal growth factor, epidermal growth factor receptor (ErbB), heparin binding epidermal‐like growth factor, hepatocyte growth factor, hepatocyte growth factor receptor, keratinocyte growth factor, betacellulin, amphiregulin, and neuregulin‐α.

Results Hepatocyte growth factor and epidermal growth factor receptor primers demonstrated polymerase chain reaction products of the expected size that were not displayed in the normal middle ear mucosa. Keratinocyte growth factor and hepatocyte growth factor receptor demonstrated polymerase chain reaction products at all time points tested. Betacellulin and neuregulin‐α products were present at all time points except 72 hours after infection.

Conclusions The results of the study support a role for growth factors in the middle ear mucosa during otitis media. These bioactive ingredients contribute to mucosal hyperplasia.
Management of Carotid ‘Blowout’ With Endovascular Stent Grafts
Authors: Warren Frank M. , Cohen James I. , Nesbit Gary M. , Barnwell Stanley L. , Wax Mark K. , Andersen Peter E.
Published: November 2003

Objectives/Hypothesis Since 1992, endovascular techniques for vascular occlusion and stenting have evolved significantly. Endovascular occlusion of the carotid artery has been used in the management of carotid “blowout.” Although it seems logical to expand this application to the use of arterial stents to repair rather than occlude the artery when cerebral cross‐circulation is inadequate, concerns remain regarding the placement of a foreign body in a contaminated field. The purpose of the present report is to describe our experience with endovascular stents for control of carotid hemorrhage.

Study Design Retrospective case review.

Methods Retrospective review of three cases of acute or threatened carotid hemorrhage managed with endovascular stent placement.

Results Two patients presented with acute carotid blowout, and one patient with a probable sentinel bleed. All patients previously had been heavily treated with surgery and irradiation: Two had developed pharyngocutaneous fistulas, and one had an open wound filled with tumor that surrounded the carotid artery. All were thought to be at significant risk for stroke if the carotid artery was occluded. In all three patients, stent placement resolved the acute hemorrhage. Mean duration of follow‐up was 8.3 months. In two patients, the stent became exposed, ultimately thrombosed or extruded, or both. The third patient had no residual sequelae of stenting but died 3 months later.

Conclusion When an unacceptable risk of cardiovascular accident makes occlusion unwise, acute carotid hemorrhage can be successfully managed with directed placement of endovascular stents, but the long‐term sequelae of placing these foreign bodies in a field with ongoing contamination make this a temporizing rather than permanent measure for use while more definitive long‐term solutions are pursued.
Medical Malpractice and Cancer of the Larynx
Authors: Lydiatt Daniel D.
Published: November 2003

Objective To analyze the frequency, clinical characteristics, and legal outcomes of malpractice litigation initiated by patients with cancer of the larynx.

Study Design Retrospective review of 23 jury verdict reports from 11 states.

Method Jury verdict reviews from 1976 to 1997 were obtained from a computerized legal database compiled from all state and federal civil court decisions. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, allegations of wrongdoing, and provide case summaries.

Results Delays in diagnosis were alleged in 19 of 23 (83%) suits. Hoarseness was present in 10 of 19 (53%), a neck mass in 3 of 19 (16%), and no biopsy was taken in 11 of 19 (58%) of those delayed. Mean age was 47 years, with a peak incidence in the general population of 70 to 74 years. Laryngectomy was alleged to be a result or complication of delay in 12 of 19 (63%). Over half of the patients delayed received compensation, and over half of the defendants were in general practice. Outcome was poor with a 35% mortality and a total of 47% either dead of disease or alive with disease. Complications, incorrect diagnosis, and informed consent did not play a significant role in initiating litigation.

Conclusions The delayed diagnosis of cancer of the larynx associated with litigation is frequently seen in younger patients presenting with hoarseness or neck masses. These patients frequently have poor outcomes. Patients with symptoms of cancer of the larynx must be aggressively evaluated regardless of age. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.
Augmentation of Vestibular Evoked Myogenic Potentials: An Indication for Distended Saccular Hydrops
Authors: Young Yi‐Ho , Wu Chen‐Chi , Wu Chih‐Hsiu
Published: November 2003

Objective/Hypothesis Vestibular evoked myogenic potential (VEMP) testing has become a well‐established test to explore the sacculo‐collic pathways in human. The aim of the present study is to establish a clinical indication for saccular hydrops by VEMP testing.

Study Design Prospective study.

Methods Ten patients (three men and seven women) with Meniere's disease and 10 patients (four men and six women) with sudden deafness were admitted and given pure‐tone audiometry and VEMP testing daily. Interaural amplitude difference over the sum of amplitudes of both ears was measured, and when the ratio exceeded 0.36, the test result was coined “augmented VEMP.”

Results During admission, three hydropic ears presented with augmented VEMP test results, with increased interaural amplitude difference ratio (mean difference ratio, 0.40 ± 0.03). Seven hydropic ears had steady VEMP test results, with a mean interaural amplitude difference ratio of 0.15 ± 0.07. Compared with the normal control ears, all had steady VEMP test results, with a mean interaural amplitude difference ratio of 0.14 ± 0.11, which is significantly different from the hydropic ears with augmented VEMP test results (P <.05). In another 10 patients with sudden deafness, all had positive steady VEMP test results, with their mean interaural amplitude difference ratio of 0.14 ± 0.12, which is similar to that in the control ears.

Conclusions Augmented VEMP test results are an indication of distended saccular hydrops, whose distended wall is in contact with the footplate. VEMP testing may be beneficial in differentiating the initial stage of Meniere's disease and sudden deafness.
Clinical Presentation of Allergic Fungal Sinusitis in Children
Authors: McClay John E. , Marple Brad , Kapadia Lav , Biavati Michael J. , Nussenbaum Brian , Newcomer Mark , Manning Scott , Booth Tim , Schwade Nathan
Published: November 2003

Objective To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults.

Study Design Retrospective chart and computed tomography review.

Methods The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present.

Results Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty‐eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty‐five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species.

Conclusions Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.
Human Leukocyte Antigens and Prognosis in Patients With Head and Neck Cancer: Results of a Prospective Follow‐up Study
Authors: Tisch M. , Kyrberg H. , Weidauer H. , Mytilineos J. , Conradt C. , Opelz G. , Maier H.
Published: November 2003

Background Prognostic information is essential for optimal treatment of patients with head and neck cancer. We studied the relationship of class I and class II human leukocyte antigens (HLA) on prognosis in patients with head and neck cancer.

Methods HLA‐A, ‐B, ‐C and ‐DR antigens were determined in 209 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. The patients were subjected to follow‐up investigations for a period of 5 years.

Results Five‐year survival rates in relation to tumor stage varied between 86% for stage I tumors and 28% for stage IV tumors (P <.0001, log‐rank trend test). The HLA‐A11 antigen showed a significant negative correlation with survival. While the 5‐year survival of 124 HLA‐A11‐negative patients was 58%, none of the 17 HLA‐A11‐positive patients survived 5 years (P = .0002). A significant negative correlation with survival was also observed for HLA‐DR6. While the 5‐year survival rate of 106 HLA‐DR6‐negative patients was 60%, it was only 40% in 35 HLA‐DR6‐positive patients (P = .0313).

Conclusions If the findings of our study can be confirmed, HLA‐A11 and HLA‐DR6 might become clinically important supplemental prognostic markers in head and neck cancer.
Treatment of Benign Positional Vertigo Using the Semont Maneuver: Efficacy in Patients Presenting Without Nystagmus
Authors: Haynes David S. , Resser John R. , Labadie Robert F. , Girasole Christopher R. , Kovach Bradley T. , Scheker Luis E. , Walker Donald C.
Published: November 2003

Objective To evaluate and compare the efficacy of the Semont liberatory maneuver on “objective” benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix‐Hallpike positioning versus “subjective” BPPV defined as vertigo without nystagmus in Dix‐Hallpike positioning.

Study Design Retrospective chart review.

Methods One hundred sixty‐two patients with positional vertigo during Dix‐ Hallpike positioning were identified. Patients were evaluated for the presence or absence of nystagmus. All patients underwent the Semont liberatory maneuver. The patient's condition at follow‐up was documented at 3 weeks as complete, partial, or failure. Repeated procedures were performed if necessary.

Results There were 127 cases of objective BPPV and 35 cases of subjective BPPV. Overall, 90% of all patients tested had significant improvement of their vertigo after 1.49 maneuvers on average. Improvement was seen in 91% of patients with objective BPPV after 1.59 maneuvers on average, compared with 86% in subjective BPPV after 1.13 maneuvers on average (χ2 test, not significant [P = .5]). Patients with a history of traumatic origin or cause had an overall success rate of 81% compared with 92% for nontraumatic causes or origins (χ2 test, not significant [P = .1]). Recurrences were seen in 29% of patients after a successful initial maneuver; however, 96% of these patients responded to further maneuvers. Four patients with persistent symptoms after conservative management underwent posterior semicircular canal occlusion with resolution of symptoms.

Conclusion The Semont liberatory maneuver provides relief of vertigo in patients with positional vertigo, even in patients without objective nystagmus.
Antiangiogenic and Chemopreventive Activities of Celecoxib in Oral Carcinoma Cell
Authors: Wang Zhi , Fuentes Cesar F. , Shapshay Stanley M.
Published: November 2003

Objectives Chemoprevention is a promising strategy to inhibit carcinoma before invasive tumors develop, but a new molecular target is desirable. Celecoxib is a newly developed cyclo‐oxygenase (COX)‐2 inhibitor with significantly less toxicity. The study was conducted to determine whether celecoxib is effective and safe in prevention of oral cancer. The antiangiogenic activity of celecoxib was studied to explore the potential mechanism involved.

Study Design Randomized animal study.

Methods The study consisted of two phases. In the phase 1, 10 mice were used to determine the efficacy and safety of celecoxib with intradermal inoculation with oral carcinoma cells. The 10 mice were equally divided into two groups 5 mice (30 inoculated sites) in each group to receive 1,500 parts per million (ppm) celecoxib mixed in with the diet or to eat a normal diet, respectively, for 21 days. In phase 2, 10 more mice were inoculated to determine the effect of celecoxib on angiogenesis. Five mice received 3,000 ppm celecoxib in the diet, with the other five mice as control animals. The antiangiogenic activity was evaluated by comparing the density of newly growing microvessels after the inoculation.

Results The results indicated that celecoxib significantly delayed cell growth and reduced tumor volume. There was statistical significance in the quantity of new vasculature in the tumor sites between the two groups. No toxic effect was found by means of measurement of body weight loss and microscopic dissection of organs.

Conclusions The study provided the first evidence to show the chemopreventive efficacy of celecoxib on oral cancer in a nude mouse model. Clinical trials are warranted to determine the efficacy in humans.
Basic Fibroblast Growth Factor in Human Saliva Decreases With Aging
Authors: Westermark Anders , Pyykkö Ilmari , Magnusson Mikael , Ishizaki Hisayoshi , Jäntti Pirkko , van Setten Gysbert
Published: November 2003

Objective Basic fibroblast growth factor (bFGF) has significant properties in wound healing and tissue repair and is suggested to be of importance for the maintenance of mucosal integrity in the upper digestive tract. The purpose of the present study was to identify any age‐dependent variations in the concentration of bFGF in human saliva.

Study Design Non‐prospective, cross‐sectional pilot study.

Methods The study was based on findings from 182 healthy volunteers with ages ranging from 4 to 97 years. Mixed saliva samples were obtained by drooling. The saliva concentration of bFGF was determined with a commercially available enzyme‐linked immunosorbent assay kit.

Results The mean saliva concentration of bFGF was 0.41 pg/mL with no gender differences. In persons aged 4 to19 years, the mean concentration was 0.72 pg/mL; in those aged 20 to 65 years, 0.33 pg/mL; and in those aged 66 to 97 years, 0.005 pg/mL. These age‐dependent differences were highly significant. In the youngest group the saliva concentration of bFGF varied more than in the other groups.

Conclusions The saliva concentration of bFGF varies with individual age, with the highest levels among young individuals, even levels during a mature phase of life, and low levels toward the end of the life cycle. This strongly suggests a physiological implication of bFGF in saliva.
A Preliminary Report on Micronized AlloDerm Injection Laryngoplasty
Authors: Pearl Adam W. , Woo Peak , Ostrowski Rosemary , Mojica Jackie , Mandell David L. , Costantino Peter
Published: November 2003

Objectives To report the preliminary data of voice and quality‐of‐life improvement after micronized AlloDerm injection laryngoplasty in patients with unilateral vocal cord paralysis.

Study Design A prospective study was conducted in patients with unilateral vocal cord paralysis who underwent injection laryngoplasty with micronized AlloDerm.

Methods Preoperative and postoperative patient evaluation consisted of videostrobolaryngoscopy, computer voice analysis, airflow, and voice handicap index (VHI) assessment. All injections were conducted with the patient under general anesthesia using the Storz injector system and a 22‐gauge spinal needle.

Results Fourteen patients received injection with an average amount of 0.641 mL. Twelve patients were available for evaluation. Initial results at 4 weeks (n = 12) showed significant increase in habitual phonation time from 3.84 to 6.72 seconds (P <.01) and a decrease in airflow from 0.616 to 0.295 L/s (P <.01). The VHI rating improved from 62.8 to 37.5 (P <.01). Jitter and shimmer also improved significantly (P <.05). Stroboscopic findings showed complete closure of glottic gap in 10 patients with excellent return of mucosal wave on the injected side. The mucosal wave return after injection was rapid with little evidence of tissue reaction. Postoperative follow‐up at 3 months (n = 8) demonstrated slight resorption of the material, but sustained excellent voice was noted in 87.5%. Minimal morbidity and tissue reaction were noted.

Conclusions Micronized AlloDerm appears to be a safe new material that is suitable for injection laryngoplasty. Long‐term results are pending.
The Reliability of the Assessment of Endoscopic Laryngeal Findings Associated With Laryngopharyngeal Reflux Disease
Authors: Branski Ryan C. , Bhattacharyya Neil , Shapiro Jo
Published: November 2003

Objective To determine the reliability of the assessment of laryngoscopic findings potentially associated with laryngopharyngeal reflux disease (LPRD).

Study Design Prospective randomized blinded study.

Methods One hundred twenty video segments of rigid fiberoptic laryngeal examinations were prospectively analyzed by five otolaryngologists blinded to patient information and were scored according to several variables potentially associated with LPRD. Separate assessments of the degree of erythema and degree of edema were scored on a five‐point scale for the anterior commissure, membranous vocal fold, and interarytenoid region. Similarly, interarytenoid pachydermia, likelihood of LPRD involvement, and severity of LPRD findings were assessed. For each of these scored physical findings, inter‐rater and intrarater reliabilities were determined.

Results The inter‐rater reliabilities of the laryngoscopic findings associated with LPRD were poor. Intraclass correlation coefficients were 0.161 and 0.461 for edema of the arytenoids and membranous vocal folds, respectively (P <.001). Intraclass correlation coefficients were 0.181 and 0.369 for erythema of the arytenoids and membranous vocal folds, respectively (P <.001). Raters demonstrated poor agreement as to the severity of LPRD findings (intraclass correlation coefficient, 0.265) and the likelihood of an LPRD component for dysphonia (intraclass correlation coefficient, 0.248). Similarly, intrarater reliability was extremely variable for the various physical findings, with Kendall correlation coefficients ranging from −0.121 to 0.837.

Conclusions Accurate clinical assessment of laryngeal involvement with LPRD is likely to be difficult because laryngeal physical findings cannot be reliably determined from clinician to clinician. Such variability makes the precise laryngoscopic diagnosis of LPRD highly subjective.
Angled Endoscopic Laryngeal Surgery: A New Technique for Diagnosis, Surgery, and CO2 Laser Application
Authors: Morgado Plínio Ferreira , Pontes Paulo A. L.
Published: November 2003

Objective To present the development and application of a new technique to perform cold and laser laryngeal surgery.

Study Design A prospective study of 11 patients submitted for endoscopic laryngeal surgery.

Methods The technique used an endoscope with a 45° upward curve of its distal end; a set of angled instruments including an intraoral retractor, scissors, and forceps; and a surgical CO2 laser microtip. Eleven patients with laryngeal diseases and an indication for microsurgery underwent angled endoscopic laryngeal surgery successfully. Four patients underwent laser surgery. The CO2 laser was set between 0.5 and 2.0 W at normal exposure times and delivered distally through a lens composition within the angled handpiece.

Results The lesions were precisely treated with minimal bleeding. The excised areas healed promptly, and no excessive scarring from laser application has been observed in a 5‐month postoperative video laryngoscopy follow‐up. No major morbidity and no worsening of the voice occurred in any of the patients. A wide‐angle view with a greater depth of field than the surgical microscope and a three‐dimensional view were obtained as a result of the use of an endoscope in this technique; visualization of undersurfaces and an unobstructed visual field have been a result of the endoscope use as well. A beam waist ranging between 200 and 350 μm was produced.

Conclusions The approach described in the present study may help the laryngologist overcome some of the shortcomings and difficulties in laryngeal surgery, especially when dealing with patients in whom adverse anatomy and certain clinical conditions contraindicate microlaryngoscopy. Because of a delivery of laser waves at shorter distances from the lesions, a more precise tissue exeresis with minimal disturbances to the vocal folds might be accomplished as a result of the smaller beam waist produced. Distal delivery of laser waves also reduces the risks of stray laser beam striking nontargeted areas. Long‐term studies with a larger number of patients are necessary.
Tissue‐Engineered Cartilage on Biodegradable Macroporous Scaffolds: Cell Shape and Phenotypic Expression
Authors: Baek Chung‐Hwan , Lee Jong‐Chan , Jung Yong‐Gi , Ko Ye‐Jeung , Yoon Jun Jin , Park Tae Gwan
Published: November 2003

Objective The purpose of the study was to establish in vitro culture of chondrocytes on biodegradable, poly(D,L‐lactic‐co‐glycolic acid) [PLGA] scaffolds.

Study Design Laboratory experiment using cartilage of rat rib and biodegradable scaffolds.

Methods Chondrocytes were cultured on a poly‐hydroxyethyl methacrylate (poly‐HEMA)–coated dish, proliferated, and transferred into the PLGA scaffolds. Phenotypic expression of cells was examined according to the condition of poly‐HEMA coating. Morphological, biochemical, and immunohistochemical characteristics of cells cultured within PLGA scaffolds were also examined.

Results Chondrocytes cultured on a poly‐HEMA–coated dish aggregated into distinct nodules containing large clusters of spherical cells and showed cartilage‐specific phenotype, collagen type II. The results of immunostaining and reverse transcriptase–polymerase chain reaction of cells cultured within PLGA scaffolds showed cartilage‐specific morphological appearance and structural characteristics such as lacunae and expression of collagen type II.

Conclusion The chondrocytes cultured on a poly‐HEMA–coated dish and PLGA scaffolds showed chondrocyte‐specific phenotypes and morphological appearance.
Chronic Maxillary Sinusitis of Dental Origin: Is External Surgical Approach Mandatory?
Authors: Lopatin Andrey S. , Sysolyatin Svyatoslav P. , Sysolyatin Pavel G. , Melnikov Mikhail N.
Published: November 2003

Objective The study evaluated a minimally invasive endoscopic shaver‐assisted technique for treatment of chronic maxillary sinusitis of dental origin.

Study Design A retrospective multicenter chart review was performed at two clinics of all patients who had a diagnosis of chronic maxillary sinusitis of dental origin and were treated using the technique.

Methods The patients were divided into two main groups: patients with and without chronic oral antral fistula. Data from the patients were collected and analyzed.

Results Seventy patients aged 16 to 62 years had surgery using the endoscopic technique. Thirty‐nine patients presented with oral antral fistula of different locations, the most common being third molar fistula (26 cases). Foreign bodies were found in 21 sinuses, among them teeth roots (in 11), dental fillings (in 7), and packs (in 3). Fungal ball was found in six sinuses. The surgical technique included retrograde resection of the uncinate process, enlargement of the natural maxillary ostium posteriorly, and removal of the polyps and foreign bodies from the sinus through the middle meatal antrostomy window. Approach through the oral antral fistula facilitated additional access to the alveolar recess. Removal of polyps from the alveolar recess was performed using the microdebrider, which was introduced through the fistula under endoscopic control through the nasoantral window. The fistula was closed in two layers. Good results were obtained in all but four patients in terms up to 3 years. No complications occurred. Overall recovery rate after primary surgery was 94.7%.

Conclusion Endoscopic approach to chronic maxillary sinusitis of dental origin is a new, reliable method associated with less morbidity and lower incidence of complications.
A Novel Connexin 26 Compound Heterozygous Mutation Results in Deafness
Authors: Harris Kevin C. , Erbe Christy B. , Firszt Jill B. , Flanary Valerie A. , Wackym Phillip A.
Published: November 2003

Objective Mutations of the gap junction beta 2 (GJB2) gene coding for the protein connexin 26 account for up to 50% of nonsyndromic sensorineural hearing loss (NSHL), with specific mutations associated with distinct ethnic groups. A biracial family with nonsyndromic sensorineural deafness consistent with autosomal recessive inheritance was examined for connexin 26 (Cx26) mutations.

Study Design Prospective observational study.

Methods A family consisting of a Caucasian mother and a Chinese father with two of six children affected by NSHL was examined for Cx26 mutations. Peripheral blood lymphocyte DNA was used to amplify by polymerase chain reaction the Cx26 coding region, followed by mutation detection enhancement gel screening and complete sequencing. Phenotypic characterization using audiometric testing was completed for all children and both parents.

Results The two affected children were found to be compound heterozygotes for Cx26 mutations, displaying a previously unreported combination of 35delG and 235delC. The parents were each unaffected heterozygotes consistent with their ethnic heritage, specifically, the Caucasian mother a 35delG heterozygote and the Chinese father a 235delC heterozygote.

Conclusions Connexin 26 mutations account for a significant proportion of NSHL worldwide, with specific mutations linked to distinct ethnic groups. Genetic analysis of a biracial family with NSHL revealed a novel 35delG/235delC compound heterozygous state in phenotypically affected children. These results highlight the usefulness of Cx26 mutation screening for genetic counseling and suggest that the 235delC mutation is present in China as it is in Japan and Korea.
Exertional Dizziness and Autonomic Dysregulation
Authors: Staab Jeffrey P. , Ruckenstein Michael J. , Solomon David , Shepard Neil T.
Published: November 2003

Objectives To define the clinical characteristics and treatment of dizziness induced by physical exertion and to investigate autonomic nervous system function in exertional dizziness.

Study Design Retrospective case series from a review of 1400 patients evaluated for dizziness at a neurotology referral center, identifying those with predominantly exertional symptoms.

Methods Records of patients with exertional dizziness were screened to eliminate those with known vestibular deficits, cardiopulmonary illnesses, and psychiatric disorders. The clinical characteristics, evaluation results, and treatment of nine patients with purely exertional dizziness were described.

Results The cohort included 4 male and 5 female patients (age range, 13–53 y) with symptoms for 1 to 8 years. Only one patient had a history of autonomic symptoms: phlebotomy‐induced syncope in childhood. No patient was taking medications that caused dizziness or orthostasis. All patients experienced “spacey” or “foggy” head sensations without vertigo during exertion. Provocative activities ranged from standing upright for extended periods to running and swimming. On examination, voluntary hyperventilation provoked moderate symptoms in all patients (without nystagmus or anxiety), although no patient had spontaneously occurring, hyperventilation‐related complaints. Seven patients underwent autonomic testing. Tilt table tests (n = 5) produced severe symptoms in one patient and mild symptoms in two patients. Sodium lactate infusions (n = 6) provoked marked symptoms in four patients and moderate symptoms in one patient. All were treated for autonomic dysregulation. Seven patients improved substantially and resumed all of their premorbid activities. Two improved slightly.

Conclusions In nine patients with exertional dizziness, autonomic challenges were provocative, and medications for autonomic dysregulation were effective. Exertional dizziness may be a clinical manifestation of autonomic nervous system dysregulation.
Impact of Cochlear Implants on the Functional Health Status of Older Adults
Authors: Francis Howard W. , Chee Nelson , Yeagle Jennifer , Cheng Andre , Niparko John K.
Published: November 2003

Objectives To assess the impact of cochlear implantation on quality of life changes in older adults aged 50 years and above.

Study Design Retrospective study by questionnaire and chart review.

Methods Forty‐seven patients aged 50 to 80 years (mean age, 63.4 y [SD = 8.6 y]), who have multiple‐channel cochlear implants received at The Listening Center at Johns Hopkins Hospital, completed the Ontario Health Utilities Index Mark 3 survey and a questionnaire on quality of life changes. Health utility scores before and after cochlear implantation were measured, and audiologic data before implantation and at 6 months and 1 year after implantation were analyzed.

Results Cochlear implantation in older adults is associated with a mean gain in health utility(P <.0001) of 0.24 (SD = 0.33), which corresponds to a favorable cost‐utility of $9530 per quality‐adjusted life‐year. Improvements in hearing and emotional health attributes were primarily responsible for this increase in health‐related quality of life measure. There was a significant increase in speech perception scores at 6 months after surgery (P <.0001 for both CID sentence and monosyllabic word tests) and a strong correlation between the magnitude of health utility gains and the postoperative increase in speech perception scores (r = 0.45, P <.05).

Conclusions Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost‐effective intervention in this population. Improvements in speech perception are predictive of gains in health‐related quality of life and associated emotional benefits after cochlear implantation.
Round Window Gentamicin Absorption: An In Vivo Human Model
Authors: Becvarovski Zoran , Bojrab Dennis I. , Michaelides Elias M. , Kartush Jack M. , Zappia John J. , LaRouere Michael J.
Published: November 2003

Objective/Hypothesis Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured.

Study Design A prospective study.

Methods Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative). The lateral semicircular canal and vestibule were opened, and by means of a microsyringe, labyrinthine fluid was aspirated. A sample of serum was also drawn. In all patients cerebrospinal fluid was also drawn. The samples were analyzed using a standard chemistry analyzer.

Results Intratympanic gentamicin diffused through the round window membrane and achieved concentrations in the labyrinthine fluid ranging from 0 to 16 mg/L. Intratympanic gentamicin was absorbed into the systemic circulation in 4 of 11 patients with serum levels ranging from 0.3 to 0.4 mg/L. No gentamicin was detected in the cerebrospinal fluid.

Conclusions Intratympanic gentamicin diffuses rapidly through the round window membrane and achieves significant levels in the inner ear. Thus, this new model can be used to assess round window permeability to clinically relevant medications such as steroids and ototopical antibiotics.
Intraoperative Assessment of Perilymphatic Fistulas With Intrathecal Administration of Fluorescein
Authors: Gehrking Eckard , Wisst Frank , Remmert Stephan , Sommer Konrad
Published: November 2003

Objectives Assessment of perilymphatic fistulas remains a diagnostic problem. Because of a lack of reliable clinical tests, exploratory tympanotomy is necessary to detect membrane leaks in the middle ear. To improve objectivity in the intraoperative visualization of perilymphatic fistulas, we used intrathecal fluorescein for perilymph staining to increase the sensitivity and specificity of diagnosis of perilymphatic fistulas.

Study Design Prospective study in the setting of a tertiary, referral, and academic center.

Methods Twenty‐eight patients with suspected traumatic, idiopathic, iatrogenic, or inflammatory perilymphatic fistulas were admitted for exploratory tympanoendoscopy for perilymphatic fistula detection. Twenty‐five to 100 mg sodium fluorescein 10%, diluted with cerebrospinal fluid, was administered by lumbar puncture 2.5 to 23.5 hours before tympanoendoscopy. The oval and round window niches were microscopically and endoscopically observed with white and blue light, using specific filters.

Results In two patients (7%), obvious fluorescence was detected behind the round window membrane with blue light. Direct observation of perilymph in stapedectomy and in semicircular canal fistula revealed no staining. Neurological complications of intrathecal fluorescein, as reported by other authors, were not observed.

Conclusions Probably because of a different patency of the cochlear aqueduct, intrathecal fluorescein for intraoperative detection of perilymphatic fistula resulted in a significant perilymph staining in only a few patients. Considering the possible complications of this method, we would not recommend it for routine evaluation of perilymphatic fistula.
Dysrhythmia of Caloric Nystagmus
Authors: Proctor Leonard R. , Lam Anthony P.
Published: November 2003

Objectives Objectives of the study were 1) to determine the prevalence and characteristics of dysrhythmia, 2) to identify associations between dysrhythmia and other patient variables, and 3) to determine whether dysrhythmia is more a characteristic of individuals than simply a correlate of alertness or response intensity.

Study Design Cross‐sectional.

Methods Review of records from 150 patients undergoing the caloric test.

Results Dysrhythmia severe enough to interfere with accurate analysis of the caloric test was present in 40% of the cases. Individuals were entered into an “orderly” group (n = 67) or a “dysrhythmic” group (n = 83) and were 5.8 times more likely to remain in the same group on a second visit than to change groups. Stronger response scores were associated with less dysrhythmia. Higher caloric‐induced vertigo scores were associated with both stronger response scores and lower dysrhythmia scores. Cases in the dysrhythmic group were 3.8 times more likely to have abnormal caloric test results than individuals in the orderly group.

Conclusions Dysrhythmia frequently interferes with valid and accurate interpretation of the caloric test. Current methods of “mental alerting” frequently fail to eliminate dysrhythmia. The presence of dysrhythmia appears to be a strong predictor of an abnormal caloric test result, and there is a moderate correlation between dysrhythmia and response intensity. Nevertheless, our results suggest that dysrhythmia is specific to individuals, rather than simply a manifestation of peripheral vestibular disease or a correlate of alertness or response intensity.
Sphenoid Encephaloceles: Disease Management and Identification of Lesions Within the Lateral Recess of the Sphenoid Sinus
Authors: Lai Stephen Y. , Kennedy David W. , Bolger William E.
Published: November 2003

Objectives Encephaloceles usually involve herniation of frontal lobe tissue through an anterior cranial fossa defect into the ethmoid sinus or nasal cavity. Encephaloceles can also result from temporal lobe herniation through a middle fossa defect into the sphenoid sinus. Within the sphenoid, encephaloceles are thought to occur most commonly in the central or midline aspect of the sinus. Lateral sphenoid encephaloceles, especially within the lateral aspect of the sphenoid sinus when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. The objectives of the study were to review our experience with sphenoid encephaloceles to understand the relative frequency and the locations in which they occur within the sphenoid sinus and to report our experience in caring for patients with this condition.

Study Design Retrospective review.

Methods Retrospective review of patient records and operative reports from 1991 to 2000.

Results Twelve patients were treated for intrasphenoid encephaloceles during a 10‐year period. Eight patients had lesions located in the lateral recess of the sphenoid sinus. Surgical repair was undertaken in all 12 cases using endoscopic techniques. In 11 of 12 cases, the repair was successful with follow‐up times of 12 to 69 months (mean follow‐up, 31.9 mo).

Conclusions Temporal lobe encephaloceles in the lateral sphenoid sinus have been reported rarely in the literature. Careful preoperative evaluation and localization of the sphenoid defect are critical for the selection of the optimal surgical approach for repair of the skull base defect. Our 10‐year experience represents the largest group of patients treated endoscopically for intrasphenoid encephaloceles reported to date.