bluuebunny/crossref_metadata_2025 huggingface dataset:
S240 – Human Cochlear Implant Histopathology
Authors: Xu Helen , Pollak Natasha , Cureoglu Sebahattin , Paparella Michael M
Published: August 2008

Objectives

1) To exam the histopathology of multichannel cochlear implant temporal bones. 2) To evaluate the relationship of residual spiral ganglion cell counts to clinical hearing performance.

Methods

8 temporal bones from 4 cochlear implant patients were examined histologically. Paired comparisons were made between implanted and nonimplanted temporal bones. Clinical performance data was obtained from patient charts.

Results

There were varying amounts of inflammation (fibrosis and ossification) in the basal turn of the cochlear in all implanted temporal bones. Trauma to the facial nerve at facial recess site was noticed in 1 case. Compared with nonimplanted ears, 2 implanted bones with less than 10‐year duration of implantation had no significant changes of spiral ganglion cell population. One case with prolong implant duration (15 years) showed about 36% decrease of spiral ganglion cells at the implanted site. The case with best speech recognition (89% with CID sentence) had the highest residual spiral ganglion cells (30% of normal spiral ganglion cell population). 2 cases with poor clinical performance (< 10% with CID sentence) had the residual spiral ganglion cells at 11% and 22%. The case with moderate clinical performance (30% with CID sentence) had 14% of normal spiral ganglion cell population. Surviving dendrites varied from 5% to 30% among 4 cases with no relationship to clinical performance.

Conclusions

Our findings suggest prolonged implantation may affect spiral ganglion cell population. There is no reverse relationship between residual spiral ganglion cells in implanted temporal bones to clinical speech performance observed from our limited cases.
S244 – Intraoperative ABR after Myringotomy and Tube Placement
Authors: Sturgill Nanette , Yorgason Joshua G , Park Albert H
Published: August 2008

Objectives

Understand the utility of intraoperative ABR testing after myringotomy and tube placement.

Methods

We performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t‐tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery.

Results

15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABR

Conclusions

Patients who undergo ioABR testing show a significant improvement of dB level on follow‐up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.
S245 – Pulmonary Complications after Coblation Tonsillectomy
Authors: Wilhelm Michael J , Boseley Mark E
Published: August 2008

Objectives

1) Evaluate an institutional experience with postoperative pulmonary complications using the Coblator (ArthroCare Corp, Sunnyvale, CA), for pediatric tonsillectomy. 2) Understand how to minimize and prevent pulmonary complications following coblation tonsillectomy.

Methods

Case series of 4 tonsillectomy patients who developed clinical signs of aspiration following surgery, from October 2006 to January 2008.

Results

4 pediatric patients were reported in this case series. All 4 experienced perioperative fever, tachycardia, pulmonary desaturation, and cough following tonsillectomy using the Coblator. In 1 case, the patient had course respirations, a chest x‐ray demonstrating diffuse pulmonary infiltrates, and was unable to maintain his oxygen saturations without supplemental oxygenation. In all cases, the symptoms, to include fever, resolved by post‐operative day 2. No long‐term sequelae were noted. In all cases, the patients were intubated using an uncuffed endotracheal tube.

Conclusions

Pulmonary aspiration is a possible adverse consequence of oropharyngeal pooling of saline while performing a tonsillectomy using the Coblator. Pediatric patients in whom an uncuffed endotracheal is used are more likely to aspirate the irrigation. Recognition of this potential complication allows the surgeon to take the necessary precautions to avoid this complication by using a throat pack, trendelenberg positioning, and avoidance of pooling of irrigation in the oropharynx.
S247 – Mediastinitis in Infants: Role of the Otolaryngologist
Authors: Shah Rahul K , Choi Sukgi S
Published: August 2008

Objectives

To describe mediastinitis from retropharyngeal abscess in 3 infants.

Methods

Case reports of 3 patients.

Results

3 patients presented in a span of 2 winter months to a tertiary care, pediatric, inner‐city hospital. The patients were 8 months, 9 months, and 18 months old. All presented with retropharyngeal phlegmon on CT scan, were started on clindamycin and cefotaxime, and monitored as in‐patients for 2–4 days prior to surgery. Interval CT scans revealed progression to retropharyngeal abscess with mediastinal extension. One patient's retropharyngeal abscess was drained trans‐orally, one externally, and one required a combined approach. 2 of the 3 patients required video‐assisted thoracoscopic debridement of the mediastinitis. 2 cultures grew out methicillin‐resistant staphylococcus aureus, while one grew out methicillin‐sensitive staphylococcus aureus (all were clindamycin sensitive). The patients' peak white blood cell counts were 18.4, 30.2, and 44.9 thousand. All 3 patients survived and were discharged on long‐term antibiotics.

Conclusions

Despite appropriate initial empiric antibiotic therapy, all 3 patients developed retropharyngeal abscess with mediastinal extension. The otolaryngologist should maintain vigilance when treating infants with intravenous antibiotics for a deep neck space infection, liberal use of imaging studies should be performed to monitor progression of the infection, a significantly elevated white blood cell count should be interpreted with caution, and initial empiric therapy should include clindamycin. Despite the adult literature that quotes a 50% mortality rate from mediastinitis, infant mediastinitis may be a different disease process, as all 3 of our patients survived.
S250 – Otogenic Lateral Sinus Thrombosis: A Review of 7 Cases
Authors: Ryan Jesse T. , Preciado Diego A , Pena Maria T , Zalzal George H
Published: August 2008

Objectives

Otogenic lateral sinus thrombosis (LST) is a rare but serious intracranial complication of acute or chronic otitis media (OM). Mortality rates for LST are quoted as 8–25% in most recent larger case series. Controversy exists regarding the surgical and medical management of LST. We sought to clarify this by reviewing our experience in patients who presented with otogenic LST in the past 5 years.

Methods

A retrospective chart review was conducted. 7 patients were identified and charts were examined for presentation, co‐existing intracranial complications, treatment, cultured organisms, and outcome.

Results

Patients most commonly presented with fever (5/7), otalgia (5/7), and mastoid tenderness (4/7). Co‐existing intracranial complications were present in 4/7 patients, including meningitis (1/7), epidural abscess (2/7), otitic hydrocephalus (2/7), and cavernous sinus thrombosis (1/7). All patients received IV antibiotics and underwent mastoidectomy with unroofing of the sigmoid sinus, and tympanostomy tube placement. Thrombectomy was not performed on any patient. Anticoagulation was used on 5/7 patients without complication. Streptococcus sp. was the most common organism isolated (2/7). All patients recovered well without major sequelae. One patient with cavernous sinus thrombosis and otitic hydrocephalus had a persistent right visual field deficit.

Conclusions

In this limited series, we demonstrate good outcomes by emergently treating LST from an otitic source with mastoidectomy and unroofing of the sigmoid sinus, IV antibiotics, and selective anticoagulation. We did not find thrombectomy to be necessary.
S251 – Facial Symptoms Related to Allergic Rhinitis in U.S. Children
Authors: Derebery M Jennifer , Meltzer Eli O , Boyle John
Published: August 2008

Objectives

In addition to general symptoms related to nasal congestion, common secondary symptoms of allergic rhinitis (AR) include headache, facial pain/pressure, and ear pain/pressure. The prevalence of secondary AR symptoms in U.S. children is described herein.

Methods

The prevalence of headache, facial pain/pressure, and ear pain/pressure in children with and without AR was studied in Pediatric Allergies in America, a national survey of parents of 500 children with current symptoms of nasal allergies and 504 children without nasal allergies (aged 4 to 17 years) among 35,757 U.S. households. Children aged 10 to 17 years were also interviewed, in addition to their parents.

Results

Parents report that the occurrence of headaches (55% vs 18%), facial pain/pressure (29% vs 3%), and ear pain/pressure (24% vs 5%) is more frequent in children with AR, compared with those without, respectively. These figures represent an approximately 3‐fold increase in headaches, nearly a 10‐fold increase in facial pain/pressure, and an approximately 5‐fold increase in ear pain/pressure in children suffering from presumed AR, compared with children without AR. Furthermore, headache (59%; 63%), facial pain/pressure (53%; 54%), and ear pain/pressure (56%; 44%) were rated moderately or extremely bothersome by more than half of parents and older children (aged 10 to 17 years) who reported experiencing these symptoms, respectively.

Conclusions

The Pediatric Allergies in America survey suggests that children with presumed AR may suffer significant headache, facial pain/pressure, and ear pain/pressure from nasal allergy symptoms that are not shared by children without nasal allergies.
S257 – Complications in Pediatric Adenoidectomy
Authors: Carr Michele M , Sarah Pesek
Published: August 2008

Objectives

1) To determine the rate of complication following adenoidectomy without tonsillectomy. 2) To determine how the rate of complication varies between pediatric patients under 36 months of age and those from 37 months to 17 years.

Methods

The charts of 253 patients ages 6 months to 17 years who underwent adenoidectomy without associated tonsillectomy between July 2003 and January 2007 at the Hershey Medical Center were reviewed for any complication following the procedure. Comparison was made between the group under 36 months of age and the group older than 36 months.

Results

At least 1 complication was encountered in 24.9% of the patients. However, complications requiring extra attention such as a prolonged hospital stay or visit to the emergency department affected only 6.32% of the patients. The most common intra‐operative complications was lip abrasion, the most common early post‐operative one was fever, and the most common late complication was a diagnosis of otitis media. No statistically significant difference in the rates of complications was seen between patients under 36 months of age vs. those over.

Conclusions

Though the rate of complications due to adenoidectomy is fairly high, the rate of more serious complications is low. There is no statistically significant difference in rate of complication between the age groups studied.
S260 – Orbital Cellulitis in 465 Children: A Review of 465 Cases
Authors: Ryan Jesse T , Sumit Bose , Preciado Diego A
Published: August 2008

Objectives

Orbital cellulitis (OC) represents a group of conditions ranging from periorbital inflammation to subperiosteal/orbital abscess (SPOA) and cavernous sinus thrombosis. Improvements in imaging studies and endoscopic techniques have led to continued controversies regarding the medical and surgical management of these. We sought to clarify this by reviewing our experience with patients admitted to our institution with OC during a 6‐year period.

Methods

465 admissions with a diagnosis of OC were identified in the last 6 years. Charts were reviewed for presentation, radiologic evaluation, medical management, surgical treatment, and outcome.

Results

Of the 465 patients, 189 were treated in the emergency room and 276 were admitted to the hospital. CT scan was performed on 240 patients. Subperiosteal or orbital abscess was noted in 70 patients. Of these, 47 were treated medically and 23 had surgery. Surgery was performed endoscopically in 7 patients, open in 9 patients, through a combined approach in 6 patients, and was not documented in 1 case. Patients treated surgically were older (8.5 vs. 6.2 years, p=0.018) and had a longer hospital course (11.3 vs. 6.6 days, p=0.002) than those treated medically. WBC count on admission was similar between groups. Patients with large abscesses, defined as greater than 10mm, were more likely to require surgical intervention than patients with small abscesses (Greek chi 2, p<0.001).

Conclusions

Small SPOA in younger children can successfully be treated medically, while older patients with larger abscesses are more likely to require surgical intervention, in many cases through an open approach.
S261 – Development of the Ethmoidal Fovea during Intrauterine Life
Authors: Lopez Norberto , Martínez‐Burckhardt Rodolfo , Nuñez‐Castruita Alfredo , Bermúdez‐Barba María Victoria , Saldívar‐Rodríguez Donato , Guzmán‐López Santos
Published: August 2008

Objectives

To analyze embryological development of the ethmoidal fovea and the horizontal ethmoidal plate and measure the thickness of the latter during the various stages of gestation, and whether to determine if, during the intrauterine life, there are different types of fovea according to the Keros classification.

Methods

A retrospective, descriptive, and comparative study was made using 92 human fetuses. Morphometry was made and inferential statistics and correlations and autocorrelations during different stages were done.

Results

The morphological structures of the fovea are recognized during the 14th week. In 32‐week‐old fetuses measurements of the fovea did not vary in proportion to the rest of the structures. In all the specimens studied, the type of roof was type I, agreeing with Keros' classification. As for the measurements of the thickness of the fovea, width and length of the crista Galli apophysis, they were significant (p <0,001), strongly supporting their growth in relation to the crown‐caudal length.

Conclusions

As for the various anatomic variants that are observed in the adults, according to Keros' classification, there were no variants in all the fetuses studied as such variants we can assure, at least in the population studied, that these appear until after birth upon development of the middle third of the face.
S263 – Serum IGF‐1 Changes in Early Post‐Adenotonsillectomy Period
Authors: Majidi Mohammadreza , Kamran Ghafarzadegan , Mosugan Pourhamzeh , Nadia Hassanzadeh
Published: August 2008

Objectives

Increase in serum insulin‐like growth factor‐1(IGF‐1)level is one of the proposed mechanisms for growth improvement after adenotonsillectomy, but time period for this increase is unclear. This study was conducted to determine the effect of adenotonsillectomy on serum IGF1 level in early postoperative period.

Methods

Children 3 to 10 years of age who underwent adenotonsillectomy because of upper airway obstruction entered the study; weight and height were recorded at the time of surgery. Serum IGF‐1 level was measured before and 3 weeks after surgery. Wilcoxon test was used for comparison of preoperative and postoperative IGF‐1 levels.

Results

The study population included 14 boys and 9 girls with the mean age of 6.74±1.76 years. Serum IGF‐1 levels increased significantly (p<0.001)from 159.08± 79.83 ng/ml before adenotonsillectomy to 252.26± 131.17 ng/ml three weeks after surgery. All patients (3 girls and 3 boys) with serum levels below normal range had normal values 3 weeks after surgery.

Conclusions

This study showed that the effect of adenotonsillectomy on growth improvement based on hormonal factor is initiated in early stage after surgery.
S267 – Analysis of Balance and Gait Parameters in Healthy Subjects
Authors: Echeverria Lorena , Paradinas Manuel Rodriguez , Pellico Luis Gómez , Rivera Teresa , Martin Asuncion Bosch , De Oca Fernandez Leticia Montes
Published: August 2008

Objectives

1) Describe gait parameters in healthy women walking, eyes opened and eyes closed. 2) Describe normal values of static and dynamic balance under the same conditions. The purpose of this study is to get reference values in gait and balance. This objective is to compare (in the second phase) our results with the data of patients affected by vestibular hypofunction before and after rehabilitation.

Methods

We carried out a pilot study with 22 healthy women. 3‐dimensional video motion analysis system and posturography was used to measure our parameters. Our subjects walked on an instrumented walkway, giving us information about kinetic and kinematic variables (overall cadence, gait velocity, foot progression angle, stride width, stride length, stance and swing ratio). We also had measured stability variables such as postural stability index in static and dynamic conditions (fall risk). Statistical analysis was performed using Student's t‐test for matched pairs and Anova test.

Results

Overall cadence was greater on open eyes condition (x= 118,67 steps/minute; SD= 7,23) than on closed eyes condition (x= 115,93; SD=7,74). This difference was significant (p=0.019). Same result occurred in average gait velocity (p value less than 0.05). Postural stability index in open eyes conditions was significantly better than in closed eyes conditions (p value less than 0.05). The others variables measured were determined and no significant differences were found.

Conclusions

In this study we set up the reference values in gait and balance parameters in healthy women. Overall cadence, gait velocity, and postural stability index are decreased in closed eyes condition.
S268 – Cost‐Effective Balloon Sinuplasty
Authors: Lomeo Paul E , Finneman Judith
Published: August 2008

Objectives

Balloon sinuplasty is a new procedure that is gaining popularity in the United States. However, with all new technology, there is an increase in cost. Balloon sinuplasty increases the overhead for the facility where it is being performed and does not affect reimbursement. To decrease the cost of new technology, the physician, facility, and the company must all think of creative methods to acheive this goal.

Methods

In our institution, we had 60 patients that had balloon sinuplasties performed, with all of them involving both maxilary and frontal sinus. Re‐useable olive‐tip cannula was used instead of the company's recommended disposable guide catheter for the frontal and maxillary sinuses. In using the olive‐tip as a guide catheter, the guide wire and balloon catheter are easily directed to the opening of both the maxillary and frontal sinus.

Results

The outcome from all 60 patients was successful, with none returning for revision. In using the olive‐tip cannula instead of the disposable catheter guide for the maxillary and frontal sinuses, there was a savings of $37,500 for the institution.

Conclusions

The use of an olive‐tip cannula from the basic FESS set decreases the cost of performing balloon sinuplasty. This suction‐tip can replace the catheter guide without compromising the surgical procedure and is easy to use by the experienced sinus surgeon. There was a cost savings of $625 per procedure when using an olive‐tip cannula instead of the company's recommended catheter guide.
S269 – Anterior Cerebral Artery Syndrome: A Silent Killer in ESS
Authors: Charbonneau Nicolas , Kilty Shaun , Moumdjian Robert , Al‐Macki Khalil , Maleki Mohammad , Desrosiers Martin
Published: August 2008

Objectives

This presentation will help the physician optimize their management of this rare complication.

Methods

Presentation of a case series from our experience with the management of 3 endonasal surgery complications of intracranial hemorrhage due to anterior cerebral artery trauma. We present a review of the literature and propose an algorithm for the prompt and appropriate management of this complication.

Results

The recognition of actual or potential intracranial vascular injury following trauma to the skull base during endonasal surgery requires prompt identification and management that extends beyond that of simple CSF leak repair. During the immediate post‐operative period, identification of the extent of injury with neurovascular imaging studies and early neurosurgical consultation is essential. Intermediate peri‐operative management focuses on the prevention of the additional complications of intracranial infection, an intracranial hematoma, and pseudoaneurysm formation by using staged angiography. Long‐term management focuses on optimizing a patient's functional outcome with selective use of MRI to evaluate brain healing while assessing the risk for developing a convulsive disorder.

Conclusions

Awareness of the potential for trauma to the anterior cerebral artery complex following skull base penetration during endonasal surgery will allow a surgeon to better anticipate and manage its potential sequelae, thereby reducing the risk of an unfavorable outcome.
S271 – The Use of Erbium Doped Glass Fiber Laser in Septoplasty
Authors: Prokopakis Emmanuel P , Bourolias Constantinos , Velegrakis George , Sobol Emil , Helidonis Emmanuel
Published: August 2008

Objectives

To evaluate the efficacy of Erbium doped glass fiber laser in patients undergoing cartilage reshaping under local anesthesia.

Methods

A prospective study was conducted in 64 patients undergoing laser nasal septal cartilage reshaping. Micro‐surgical sponges soaked in a tetracaine solution plus adrenalines were applied in each side of the nose for 10 minutes before the procedure. The cartilage of nasal septum was straightened and fixed in the median position using a modified nasal speculum. An optothermomechanical contactor with transparent indenter and thermocouple sensor was placed on septal regions of maximum mechanical stress. Patients were asked to evaluate the severity of pain during the procedure on a visual analog scale. A rhinomanometric evaluation was conducted prior to and after the procedure. All patients were asked to evaluate the improvement of their symptoms. All patients' data and potential complications were put in a database and were statistically assessed.

Results

Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes.

Conclusions

Septal cartilage reshaping is an easy, painless, and bloodless method using an Erbium doped glass fiber Laser. Laser device LSC‐701 (Arcuo Medical Inc.) is an effective, safe, and inexpensive medical equipment.
S273 – Does Nasal Obstruction Mean that the Nose Is Obstructed?
Authors: Kjaergaard Thomas , Cvancarova Milada Småstuen , Steinsvåg Sverre
Published: August 2008

Objectives

To what extent a sense of nasal obstruction correlates with objective measures for nasal space and air flow is still a matter of controversy. Knowledge about this is important in the evaluation of nasal complaints and the planning of treatment. The primary objectives of our study were to evaluate the relationship between subjective nasal blockage and 1) acoustic rhinometry (AR), and 2) Peak Nasal Inspiratory Flow (PNIF).

Methods

2341 consecutive patients referred to ENT specialist for evaluation of obstructive sleep apnea, snoring, or nose‐related complaints were included in this cross‐sectional study. Subjects underwent AR and nasal flow measurements (PNIF). Subjective grading of nasal obstruction was obtained by a Visual Analogue Scale (VAS). Associations between VAS recordings and measurements of PNIF and AR were evaluated with multivariate analysis using linear regression, adjusting for age, sex, body mass index, asthma, allergy and smoking history. The study was conducted in the period 2005–2007.

Results

The sense of nasal obstruction was correlated to volumes in both anterior and middle segments of the nasal cavities (p<0,001), to minimal cross‐sectional areas in middle segments, and for the nasal airway as a whole (p<0,001) and to PNIF (p<0,001).

Conclusions

The present study indicates that there are significant correlations between the subjective sensation of nasal obstruction and the corresponding measures for space and air flow. We conclude that AR and PNIF are valuable objective investigational tools correlating well with the sensation of nasal obstruction.
S282 – Localization of Nitric Oxide Synthase in Nasal Mucosa
Authors: Yoda Shigetoshi , Hisaki Fukushima , Suetaka Nishiike , Dai Shibata , Harada Tamotsu
Published: August 2008

Objectives

Several studies have reported that inducible nitric oxide synthase (iNOS) was expressed within the epithelial cell of the trachea in asthmic patients and asthmic model animals. However, neither appearance nor localization of iNOS in the nasal mucosa of allergic rhinitis has been examined. This research clarifies expression and the localization of iNOS in the nasal mucosa of allergic rhinitis by using the allergic model mice.

Methods

Allergic rhinitis was induced in male mice at 6 weeks of age using purified Japanese cedar pollen allergen (Cry j 1). Cry j 1 was injected 2 times into the abdomen (day 0 and 4) and administered intranasally for 7 consecutive days (day 9–15). On day 22, the expression and localization of iNOS in nasal mucosa of both allergic rhinitis model and control mice were examined by immunohistochemistry.

Results

In control mice, the expression of iNOS was localized in olfactory nerve, nasal gland beneath the respiratory epithelium and vascular endothelial cells. In allergic rhinitis group, the expression of iNOS was not only localized in olfactory nerve, nasal gland, and vascular endothelial cells, but also in olfactory epithelium and respiratory epithelium.

Conclusions

The expression of iNOS was increased in olfactory epithelium and respiratory epithelium of allergic rhinitis mice compared with controls.
S284 – Impact of Asthma and Atopy on Smell in Nasal Polyposis
Authors: Alobid Isam , Benitez Pedro , Guilemany Jose Maria , de Haro Josep , Picado Cesar , Bernal‐Sprekelsen Manuel S , Miret Joaquim Mullol I
Published: August 2008

Objectives

Nasal polyposis is a chronic inflammatory disease of the nose and paranasal sinuses mucosa that has negative impact on sense of smell. The aim of this study was: 1) to evaluate the sense of smell in patients with severe nasal polyposis; and 2) to evaluate the role of asthma and atopy on the sense of smell.

Methods

We studied 222 patients with severe nasal polyposis (GIII Lildholt) with mean age of 49±14 years. Smell test of BAST‐24 has been used for I (I‐CN) and V (V‐CN) cranial nerves analysing detection, identification, and forced choice. The results were compared with healthy subjects (n=120).

Results

54% were asthmatics and 30% had atopy (positive prick test). All of smell test characteristics were worse than healthy subjects (p<0.05) for: detection (I‐CN=37% vs 99%; V‐CN=34% vs 98%), identification (I‐CN=15% vs 55%; V‐CN= 17% vs 59%), and forced choice (I‐CN= 18% vs 77%; V‐CN= 16% vs 43%). Asthmatics had poorer sense of smell (p<0.05) than non‐asthmatics: detection (I‐CN=27% vs 48%; V‐CN=27% vs 41%), identification (I‐CN=11% vs 19%) and forced choice (I‐CN= 13% vs 24%). There were no significant differences between aspirin‐tolerant and aspirin‐sensitive asthmatics or between patients with and without atopy.

Conclusions

These results demonstrated that patients with severe nasal polyposis have an important diminution of sense of smell (detection, identification, and forced choice) and that asthma but not atopy has a negative impact on sense of smell.
S289 – Effect of Pterygopalatine Injection on EBL in Sinus Surgery
Authors: Bublik Michael , Eloy Jean A , Tse Brian , Jose W Ruiz , Casiano Roy R
Published: August 2008

Objectives

We compare estimated blood loss (EBL) during functional endoscopic sinus surgery between patients receiving transoral pterygopalatine fossa and transnasal infiltration (combined) to patients receiving only transnasal infiltration. Variables such as CT‐stage, revision surgery, presence of polyps, and operative time are considered.

Methods

Injection with 1% lidocaine with 1:100,000 epinephrine was performed through the greater palatine foramen and transnasally in the “combined” study group (20 patients) and only transnasally in the control group (22 patients). Charts, operative reports, and CT scans were reviewed and demographic data as well as pertinent information were collected. Patients were followed up and all additional procedures and events were recorded.

Results

12 females and 8 males, average age of 48, underwent combined injections; 16 males and 6 females (average age of 50) were in the control group. Using the Wilcoxon/ Kruskal‐Wallis Tests (Rank Sums), mean EBL calculated for the combined injection group was 347ml and 493ml for the transnasal injection group (CI 0.95, p=0.093). Average ratio of EBL over OR time was 2.89 ml/min for the combined group and 4.11 ml/min for the control group. We also compare EBL between groups in patients with polyps, endoscopic and CT stage, and revision cases. No complications were reported.

Conclusions

Combined injection of the pterygopalatine fossa and nasal cavity appears to be a safe and relatively simple method to decrease EBL during sinus surgery, but initial data analysis shows that the difference did not reach statistical significance.
S296 – Thyroidectomy for Goiter Improves Obstructive Sleep Apnea
Authors: Agrama Mark T
Published: August 2008

Objectives

Evaluate the effects of total thyroidectomy for euthyroid goiter causing tracheal compression on the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). Demonstrate a relationship between tracheal compression and OSA.

Methods

A retrospective study of 8 patients with euthyroid goiter causing tracheal compression who had moderate or severe OSA. Between January 2004 and December 2007, 8 patients with these conditions were treated in a community hospital by the author. At least 1 compressive symptom (dysphagia, dyspnea, and/or orthopnea) was reported by all patients. Computed tomography of the neck and chest was used to confirm the extent of goiter and tracheal compression. OSA was confirmed with preoperative polysomnography. Total thyroidectomy was performed. Postoperative polysomnography was obtained after 90 days. Outcome measures were changes in compressive symptoms and AHI using paired t test.

Results

All 8 patients reported symptomatic control of compressive symptoms after thyroidectomy. 7 of 8 patients demonstrated postoperative improvement of AHI. The mean postoperative AHI decreased significantly from 52.1 to 36.6 (P < 0.05).

Conclusions

Total thyroidectomy for goiter causing tracheal compression can significantly improve symptoms and AHI in those patients who have OSA. Evaluation of patients with OSA should include screening for tracheal compression from goiter.
S300 – Comparison of Endoscopy Diagrams for Obstructive Sleep Apnea
Authors: Nakajima Masami , Woodson B Tucker
Published: August 2008

Objectives

Most methods of waking and sedated sleep endoscopy evaluating the upper airway in obstructive sleep apnea inconsistently predict surgical results. Goals of exam have been to identify levels of obstruction or levels of tissue vibration. Examinations provide little information on airway structure. A novel method of describing airway collapse using airway structures has been developed. The objectives of this study are to compare sleep and wake examination: 1) during inspiration, and 2) expiration.

Methods

A retrospective review evaluated waking and sedated clinical endoscopic endoscopy. Clinical endoscopic examination was performed supine at end expiration. Sedated endoscopy used propofol anesthesia evaluated the airway during both inspiration, expiration, and with elimination of airway mechanoreceptors. Defined structural butressess included salpingo/palatopharyngeus, levator, and uvular muscle groups for the epi‐pharynx and the epiglottis, lateral hypopharynx, vallecular and proximal tongue base for the hypopharynx. Structures were scored on 3 and 4 point scales with agreement indicating exact matching.

Results

Severity of obstruction scored higher on sedated exam than clinical exam. Structural agreement in epipharynx was 52%, 29%, and 24%, and in hypopharynx, 48%,24%, and 38%. False negative and positive assessment occurred in epipharynx (levator 30% and uvula 40%) but not in hypopharynx.

Conclusions

Consistent with a greater loss of muscle tone during sleep, exact agreement between wake and sleep exams was low, however, supine end expiratory exam predicted patterns of airway collapse in hypopharynx. Pattern of collapse in epipharynx is confounded by ventilation during wake.
S301 – ZPPP Combined with RF Surgery for Moderate/Severe OSAHS
Authors: Lin Hsin‐Ching , Friedman Michael
Published: August 2008

Objectives

To retrospectively investigate the outcomes of Z‐palatopharyngoplasty (ZPPP) combined with radiofrequency (RF) surgery for the treatment of moderate/severe obstructive sleep apnea/hypopnea syndrome (OSAHS).

Methods

43 patients with moderate/severe OSAHS who failed CPAP therapy and then underwent ZPPP combined with RF tongue base reduction were enrolled in this study. The subjective symptoms and objective PSG parameters were collected preoperatively and 6 months postoperatively. Statistical analysis was determined by paired t‐test.

Results

2 females and 41 males (mean, 39 years) had a minimum follow‐up of 6 months and complete data available for analysis. None of the patients had perioperative or postoperative complications. No long‐term velopharyngeal insufficiency was encountered. The classical success rate was 60.5% (26/43). 6 months after the treatment, the Epworth sleepiness scale changed from 12.8 ± 5.1 to 10.0 ± 4.3 (P = 0.002). The apnea/hypopnea index (/hr.), lowest oxygen saturation (%), and bedpartner's snoring visual analog scale (0–10) changed from 51.5 ± 25.4 to 23.4 ± 24.7, 75.5 ± 10.4 to 82.1 ± 10.9, 8.4 ± 1.6 to 2.9 ± 1.6, respectively (all p<0.0001).

Conclusions

This study shows the significant benefits of ZPPP combined with RF surgery in moderate/severe OSAHS patients.
Skeletal Muscle Regeneration: MSC versus Satellite Cells
Authors: Stern‐Straeter Jens , Stephanie Juritz , Bran Gregor , Riedel Frank , Sadick Haneen , Hörmann Karl , Goessler Ulrich R.
Published: August 2008

Problem

Differentiating stem cells into the myogenic linage in order to create functional muscle tissue is a challenging endeavour. In this work, adipose‐derived mesenchymal stem cells (MSC) and satellite cells derived from muscle biopsies were compared regarding proliferation and myogenic differentiation potential under standardized cell culture conditions. This data was obtained in order to discover the most promising type of stem cell for regeneration of muscle tissue and to determine the optimal culture conditions for later clinical use.

Methods

Human MSC were isolated from adipose tissue, and primary human skeletal myoblasts were extracted from muscle biopsies by enzymatic digestion. Proliferation was analysed using the AlamarBlue® assay. Gene expression of marker genes – such as Myogenin, Myo D, Myf 5 and MHC – were analysed by RT‐PCR. Immunostainings against desmin and sarcomeric‐actin were performed as differentiation markers.

Results

MSC cell cultures showed a greater proliferation rate compared with satellite cell cultures. In both stem cell cultures, myogenic differentiation/heritage could be verified by immunostainings against the muscle‐specific marker desmin. Gene expression and protein analysis revealed a more stable differentiation of human satellite cell cultures.

Conclusion

Characterization of both human MSC cultures and satellite cell cultures – and thereby an understanding of myogenesis – might lead to their clinical usage in skeletal muscle tissue engineering. The results in this study appear to indicate that human satellite cell cultures have a more stable differentiation under in vitro conditions and that they might offer a greater potential for skeletal muscle tissue engineering purposes.

Significance

Our study contributes to the understanding of myogenic differentiation of MSC and satellite cells and helps to improve culture systems for later clinical utilization.
Tissue Engineered Human Septal Cartilage in a Murine Model
Authors: Chang Angela , August Sage , Schumacher Barbara L , Gregory Williams , Sah Robert L , Watson Deborah
Published: August 2008

Problem

Tissue engineering of human nasal septal cartilage represents an alternative technique for creating large quantities of autologous material for use in reconstructive surgery of the head and neck. Septal neocartilage constructs developed in vitro by the alginate method have demonstrated cartilaginous extracellular matrix production, but their biocompatibility and development in vivo remains largely unknown.

Methods

A murine model was used to examine the behavior of neocartilage constructs in vivo. Chondrocytes collected from donors undergoing septoplasty were expanded in monolayer and suspended in alginate beads for three‐dimensional culture in media containing human serum and growth factors. After in vitro incubation for 5 weeks, the neocartilage constructs were implanted subcutaneously in the dorsum of athymic mice for 30 days (n=3). The mice were sacrificed and the constructs were explanted for assessment of cell viability, gross morphology, and histology.

Results

The mice survived and tolerated the implant well. Infection and extrusion were not observed. Neocartilage constructs maintained their general shape and size, and demonstrated cell viability after implantation. Explanted constructs were firm and opaque, sharing closer semblance to native septal tissue relative to the gelatinous, translucent pre‐implant constructs. On hematoxylin and eosin staining, the explanted constructs exhibited distinct morphologies characteristic of native tissue, which were not observed in pre‐implant constructs.

Conclusion

Neocartilage constructs are viable in an in vivo murine model. The morphologic and histologic features of explanted constructs more closely resemble native septal tissue when compared to pre‐implant constructs.

Significance

Septal neocartilage constructs are biocompatible and demonstrate potential for in vivo maturation with eventual clinical application.
Detecting Aberrantly Methylated Genes in HNSCC Saliva
Authors: Sethi Seema , Chen Kang‐Mei , Benninger Michael S , Worsham Maria J
Published: August 2008

Problem

Aberrant promoter hypermethylation of multiple tumor suppressor genes is an early event in carcinogenesis of HNSCC. Saliva is a non‐invasive sample which has immense potential for use in molecular screening and early diagnosis of head and neck cancers due to ease of collection, patient compliance allowing repeatabililty. We evaluated saliva DNA for simultaneous detection of promoter hypermethylation in multiple genes in HNSCC cases and compared them with normal controls.

Methods

Saliva was collected in a prospective cohort of 37 study subjects: 27 HNSCC patients and 10 normal controls. Saliva DNA was interrogated for aberrant methylation status using a multicandidate gene probe panel. 35 unique genes related to HNSCC were simultaneously examined of which 22 were tumor suppressor genes. Methylation‐specific multiplex ligation‐dependent probe amplification (MS‐MLPA) assay was used.

Results

Of the 22 tumor suppressor genes examined simultaneously in the saliva DNA of the study subjects, four HNSCC cases showed aberrant promoter hypermethylation in one or more genes. Aberrantly methylated genes included TIMP3, APC, MLH1, RARB and CDKN1B, CDKN2B, GSTP1, CD44, and ESR. aberrant methylation of CDKN2B was observed in 3/4 cases and GSTP1 in 2/4 cases. Only one of the 10 controls had aberrant methylation of CDKN2B.

Conclusion

In this exploratory study, MS‐MLPA identified multiple aberrantly methylated genes simultaneously in the same assay run. The most important advantage is its utility as a high throughput multi‐gene screening approach requiring very small amounts of DNA, unlike more laborious single gene methods such as MSP.

Significance

Epigenetic signatures from MS‐MLPA profiling, upon subsequent validation as diagnostic or prognostic biomarkers, can become reduced to a more definitive candidate gene panel of only a few key genes for early detection and screening of HNSCC.

Support

HFHS A10236; NIH R01 DE15990.
Levels of Oxidative Damage in Thyroid Neoplasia
Authors: Young Orla G , O'Sullivan Jacintha N , O'Connell Rohana , Thomas Crotty , Curran Aongus J.
Published: August 2008

Problem

To assess levels of oxidative damage: DNA adduct (8 oxo dG) and lipid peroxidation (4HNE) in follicular carcinomas (FTC), papillary carcinomas (PTC) and follicular adenomas (FTA) and their corresponding matched normal tissue.

Methods

Using tissue microarrays and immunohistochemistry, we examined expression levels of nuclear and cytoplasmic (mitochondrial) 8 oxo dG and 4HNE in matched tumor and normal tissues from 16 FTC's, 15 PTC's and 39 FTA's.

Results

There were higher levels of mitochondrial 8 oxo dG expression in the FTA, FTC and PTC tissue compared to matched normal tissue (p values <0.001, <0.001, <0.03, respectively). This trend remained significant for the levels of mitochondrial 4HNE expression in these groups. (All p values < 0.01.) The levels of nuclear 4HNE expression were elevated in FTA and FTC compared to matched normal tissue (p values <0.001, <0.01, respectively). In contrast, the levels of nuclear 8 oxo dG expression was only statistically significant in the FTA group compared to matched normal tissue. Comparing all three groups to each other, there were higher levels of nuclear 8 oxo dG expression in FTA compared to FTC (p<0.01). This difference was not detected for 4HNE expression.

Conclusion

Oxidative stress is a key feature of benign and malignant thyroid neoplasms. Interestingly, levels of oxidative damage are higher in adenoma compared to the carcinoma groups.

Significance

The higher levels of oxidative damage in thyroid adenoma compared to carcinoma groups indicates the accumulation of this damage is an early event which could promote further genomic instability with subsequent risk of mutational events.
Short‐Term Culture and In‐Vivo Modeling of Primary HNSCC
Authors: Whigham Amy , Brandee Brown , Kochiashvili Avtandyl , Netterville James L , Burkey Brian B , Sinard Robert J , Yarbrough Wendell G
Published: August 2008

Problem

Head and neck squamous cell carcinoma (HNSCC) accounts for 4% of annual U.S. cancer deaths. In‐vivo models exist using established HNSCC lines, but currently there is no such model that allows consistent growth of HNSCC from primary tumors.

Methods

Primary HNSCC tissue was obtained from 103 patients at biopsy/resection, disaggregated and seeded onto collagen‐coated plates in keratinocyte growth media with 10% FBS, additives and antibiotics. After short‐term growth in culture, cells were transferred to denuded rat tracheas and implanted subcutaneously in nude mice. Indirect immunofluorescent staining using antibodies specific to cytokeratin, vimentin and nuclear Ku was performed to determine cell lineage and origin.

Results

Cultured cells exhibited morphology consistent with epithelial or stromal derivation. 80% of cultures had viable cells present at 10 days and 24% were maintained 30 days or longer. 5 cultures (5%) proliferated after multiple passages and thrived on uncoated plates in the absence of mesenchymal cells. The xenograft model was able to successfully establish tumors in vivo from 59% of primary tumors. Immunostaining for nuclear Ku and cytokeratin confirmed human origin and epithelial cell lineage, respectively.

Conclusion

The high success rate indicates that selective growth and survival pressures for short‐term culture of primary HNSCC may be considerably less than for establishment of cell lines. Additionally, the techniques permit tumor‐derived epithelial and mesenchymal cells to be cultured simultaneously. Preliminary data for the in‐vivo trachea xenograft model is promising. A luciferase lentiviral system has been created to allow monitoring of tumor growth in vivo with serial live animal imaging.

Significance

These short‐term culture techniques may more accurately characterize both the biological diversity of HNSCC and tumor‐stromal cell interactions. Once optimized, the trachea xenograft model can be used to determine the in‐vivo response of a heterogeneous group of HNSCC to standard and novel therapies.

Support

Funds provided by an endowment for the Barry Baker Laboratory for Head and Neck Oncology, the Vanderbilt Ingram Cancer Center Endowed Professorship Fund, and the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation.
Tonsillolith: Not Just a Stone But a Living Biofilm
Authors: Krespi Yosef P , Arora Anil , Longwell Mark , Nistico Laura , Hall‐Stoodley Luanne , de Beer Dirk , Stoodley Paul
Published: August 2008

Problem

To study the morphology and activity of tonsilloliths ex vivo, using confocal microscopy and microelectrodes. Understanding the similarities of tonsilloliths to dental biofilm by demonstrating oxygen respiration, de‐nitrification, and acid production.

Methods

Tonsilloliths were harvested from several patients with cryptic pockets and sent to the laboratory under sterile conditions. The tonsilloliths were examined by confocal microscopy to determine the presence and distribution of bacteria. Microelectrodes (dissolved oxygen, nitrous oxide, and pH) were used to measure the rates of aerobic and anaerobic respiration, and acid production, when exposed to saliva (10%) and after sucrose and fluoride addition.

Results

Morphologically, the tonsilloliths were similar to dental‐plaque biofilms, containing ‘corn‐cob’ structures, filaments and cocci. The microorganisms respired both oxygen and nitrate in physiological concentrations. The oxygen concentration in the center of the tonsillolith (500 microns) was depleted to approximately 1/10th that of the overlying fluid. The addition of 10% sucrose resulted in the production of acid within the tonsillolith by dropping the pH from 7.3 to 5.8 at a depth of 200 microns. On addition of fluoride (1000 pm) the pH increased to 6.1, suggesting that fluoride suppressed the acid fermentation of sucrose. The profiles showed, aerobic respiration near the top, de‐nitrification slightly lower and acidification towards the center. The tonsillolith therefore, had stratified layers, similar to dental (and other) biofilms. The depletion of oxygen and acid production following addition of sucrose may encourage the proliferation of anaerobic/acidophilic bacteria within the tonsillolith.

Conclusion

Tonsilloliths exhibit biofilm structure and the formation of chemical gradients through physiological activity.

Significance

While complete or intracapsular tonsillectomy is an option for treating chronic cryptic infections, understanding the morphology and biofilm characteristics of tonsilloliths may stimulate scientists in using limited or non‐surgical remedies in treating chronic cryptic infections in the future.

Support

This study was funded by Valam and Philips Oral Healthcare.