bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of pharyngeal stimulation on the motor function of the esophagus and its sphincters
Authors: Bardan Eytan , Saeian Kia , Xie Pengyan , Ren Junlong , Kern Mark , Dua Kulwinder , Shaker Reza
Published: November 2003

Objectives/Hypothesis: Sensory impulses from the pharynx induce contraction of the upper esophageal sphincter CUES), relaxation of the lower esophageal sphincter (LES), and inhibition of peristalsis. To determine 1) the magnitude of UES contractile response to threshold volume of fluid that induces LES relaxation and 2) the effect of rapid pharyngeal air stimulation on LES resting pressure and its concurrent influence on the UES and progression of esophageal peristalsis. Methods: Eleven healthy volunteers (age, 31 ± 2 y) were studied by concurrent UES, esophageal‐body, and LES manometry. Results: At a threshold volume of 0.3 ± 0.05 mL, injections of water into the pharynx directed posteriorly, resulted in complete LES relaxation. Duration of these relaxations averaged 19 ± 1 seconds. In 10 of 11 subjects, these relaxations were accompanied by a simultaneous increase in UES resting tone that averaged 142% ± 27% above preinjection values. Pharyngeal stimulation by rapid air injection resulted in complete LES relaxation in ft of the 11 subjects (threshold volume, 14 ± 6 mL). Five of 8 developed a concurrent mild increase in resting UES pressure (17% ± 6% above preinjection values) (P < .05). Pharyngeal water injection inhibited the progression of the peristaltic pressure wave at all tested sites and in all subjects, but pharyngeal air injection in only 2 of the 11 studied subjects. Conclusions: The inhibitory effect of pharyngeal water injection on LES resting pressure is accompanied by a substantial contractile effect on the UES. Although stimulation of the pharynx by rapid air injection may induce LES relaxation, its inhibitory effect on esophageal peristalsis and stimulatory effect on UES pressure are negligible compared with that of water injection.
Fourth branchial arch sinus: Clinical presentation, diagnostic workup, and surgical treatment
Authors: Yang Caroline , Cohen James , Everts Edwin , Smith James , Caro James , Andersen Peter
Published: November 2003

Objectives/Hypothesis: Abnormalities of the fourth branchial arch are much less common than those of the second arch and present in a different manner. The authors report their experience with five cases of fourth arch sinuses. Methods: Retrospective chart review of patients at a tertiary care center. Results: All patients presented in the first or second decade of life, and all but one had left‐sided neck involvement. Four patients presented with recurrent low neck inflammatory episodes, and one with respiratory compromise. Diagnostic studies performed included ultrasound, computed tomography (CT) scan, barium swallow, magnetic resonance imaging, and fine‐needle aspiration. Barium contrast studies and CT scan were the most useful in demonstrating a fourth arch sinus tract preoperatively. Surgical treatment with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the lateral piriform sinus to facilitate complete sinus tract excision was successful in all patients. Conclusion: The clinical history of recurrent low neck inflammatory episodes in young patients, especially on the left side, should raise the suspicion of this entity. Investigation using barium swallow in combination with CT scanning is useful. Excision of the sinus tract taking care not to injure the recurrent laryngeal nerve is curative.
Prognostic significance of p53 gene mutations in laryngeal cancer
Authors: Chomehai Joseph S. , Du Wei , Sarkar Fazlul H. , Li Yi W. , Jacobs John R. , Ensley John F. , Sakr Wael , Yoo George H.
Published: November 2003

Objective/Hypothesis: We examined whether p53 gene mutations were predictive of clinical behavior in laryngeal cancer. Study Design: Retrospective study of 45 patients with laryngeal cancer from 1985 to 1997. Methods: DNA was extracted from tumor tissue and subject to polymerase chain reaction single‐strand conformational polymorphism (PCR‐SSCP) as well as DNA sequencing. The clinical outcome was correlated to the presence or absence of a p53 mutation. Results: The p53 gene was analyzed by direct DNA sequencing and was found to be mutated in 33% (15/45) of patients. The presence of a p53 mutation was associated with a significant improvement in overall survival (80% vs. 43%, P < .03) and a trend toward improved disease‐free survival (87% vs. 60%, P = .08). When other prognostic factors were adjusted, multivariate analysis revealed a trend toward improvement in overall survival as well as disease‐free survival. Conclusion: Depending on the location of a p53 mutation, the suppressive functions or clinical outcome may or may not be affected. Fifty‐three percent of mutations were detected in nonconserved regions as opposed to 17% as reported in colon cancer. In colon cancer, mutations in conserved regions of the p53 gene predicted a poorer survival, whereas nonconserved gene mutations were not predictive. In our group of patients, p53 mutations predicted a better prognosis, which may be due to a large proportion of mutations that lie within nonconserved areas. The predictive power of p53 gene mutations may depend on functional loss and inactivation of highly conserved areas and must be tested in a prospective trial.
Otogenic intracranial infections in adults
Authors: Barry Béatrix , Delattre Jérome , Vié François , Bedos Jean‐Pierre , Géhanno Pierre
Published: November 2003

Objective: To assess the type and bacteriology of otologic diseases associated with bacterial meningitis in adults. Method: Retrospective review of 79 patients over an 18‐year period. Results: Acute otitis media was diagnosed in 32 patients, chronic otitis in 29 (16 with cholesteatoma), and cerebrospinal fluid leak in 18. Streptococcus pneumoniae was a common cause of meningitis‐complicating acute otitis media (69%) or cerebrospinal fluid leak (50%), whereas other bacteria or negative cultures were found in the cerebrospinal fluid of patients with chronic otitis. Surgery was performed promptly in 26 patients; four patients died. Conclusions: Early diagnosis of otogenic bacterial meningitis is essential to allow appropriate antimicrobial treatment. Antimicrobials active on gram negative bacilli and anaerobes should be used in patients with chronic otitis. An emergency surgical procedure is required in patients whose neurologic or infectious status fails to improve under antimicrobial treatment.
Middle ear pathologic changes associated with chronic anaerobic sinusitis in rabbits
Authors: Kennedy Cynthia A. , Jyonouchi Harumi , Kajander Keith C. , Sun Sining , Rimell Frank L.
Published: November 2003

Objective/Hypothesis: To study the histopathologic changes in association with the inflammatory/immune response present in the middle ears of a rabbit model of unilateral chronic anaerobic sinusitis. Study Design: New Zealand white rabbits, two at each experimental time point. Normal rabbits and sham‐operated animals served as controls. Methods: Left maxillary sinusitis was induced by inoculating Bacteroides fragilis surgically after closure of the ostium. Cultures, lavages, and mucosa were harvested from bilateral middle ear and sinus cavities at 1, 2, 3, and 4 weeks following inoculation. Parameters analyzed include tissue for histopathologic study, immunoglobulin G antibody (IgG Ab) against B fragilis, and lactate dehydrogenase (LDH) levels in lavage samples, interferon gamma (IFNγ) messenger RNA (mRNA) expression in mucosal tissue, and bacterial culture. Results: Despite closure of the ostium of the left sinus, mild to moderate dissemination of B fragilis into the right sinus and left and right ears were observed in some but not all rabbits (2/8,5/7, and 2/8, respectively). Histopathologic changes in the right sinus and middle ears were much less severe in contrast to the severe inflammatory changes in the left sinus. An immune response against B fragilis appeared to occur in the sinuses and ears bilaterally independent of bacterial dissemination, as evidenced by a rise of IgG Ab in lavage fluid and detection of IFNg mRNA. Neither control nor sham‐operated animals had detectable levels of IFNg mRNA or IgG Ab. In B fragilis–inoculated rabbits, the magnitude of IgG Ab responses was equivalent in the right and left ear, independent of B fragilis dissemination; IgG Ab levels in the middle ear positively correlated to each other (P < .01) and to the levels in the sinuses (P < .01 and P < .01). LDH levels were closely associated with bacterial growth and degree of tissue inflammation. Conclusion: This reproducible model of chronic sinusitis provides an opportunity to study the middle ear infection and inflammatory/immune responses occurring with sinusitis. Our results indicate bilateral middle ear mucosal immune responses to an elicited sinus infection, independent of B fragilis dissemination.
A Meta‐Analysis of Swimming and Water Precautions
Authors: Lee Dennis , Youk Ada , Goldstein Nira A.
Published: November 2003

Objective: To reconcile conflicting reports concerning the incidence of otorrhea in children with tympanostomy tubes who swim without ear protection.

Study Selection: Articles were identified by MEDLINE search, Current Contents, and references from review articles, textbook chapters, and retrieved reports. Controlled trials of water precautions following tympanostomy tube placement were selected by independent observers and scored on 10 measures of study validity. Five English‐language articles met all inclusion criteria.

Data Extraction: Data were abstracted for an endpoint of otorrhea following swimming without ear protection with a minimum follow‐up of 6 weeks.

Data Synthesis: Pooled analysis of 619 children revealed a rate difference of −5.04 (95% confidence interval [CI], −11.62 to 1.54). No significant difference in the incidence of otorrhea was noted between patients who swam without ear protection and nonswimmers.

Conclusion: There is no increase in incidence of otorrhea in children who swim without ear protection compared with children who do not swim following tympanostomy tube placement.
Amplification of RNA From Archival Human Temporal Bone Sections
Authors: Ohtani Fumio , Furuta Yasushi , Iino Yukiko , Inuyama Yukio , Fukuda Satoshi
Published: November 2003

Background: The amplification of DNA from celloidin‐embedded human temporal bone sections by polymerase chain reaction (PCR) has been applied to some auditory diseases, such as herpes zoster oticus and hearing loss caused by the mutations of mitochondrial DNA. However, few studies have reported detection of RNA from temporal bone sections.

Objectives: Because RNA analysis from temporal bone sections may elucidate the development of the diseases in the auditory, vestibular, and facial nerves, the authors investigated whether RNA in these sections can be amplified by reverse transcription (RT)‐PCR.

Methods: Sections that were formalin‐fixed, decalcified, and embedded between 1972 and 1986 were used. Nucleic acid was extracted from the celloidin‐embedded temporal bone sections and subjected to RT‐PCR. Human α‐tubulin RNA was reverse transcribed to cDNA and amplified by nested PCR using two sets of primers that were designed to distinguish cDNA from genomic DNA based on the presence of an intron between the primers.

Results: Human α‐tubulin RNA was detected in 11 of 14 temporal bone sections (79%) by RT‐PCR. RNA was detected in even the oldest sections, which were processed in 1972.

Conclusions: These results indicate that RNA can be analyzed from archival celloidin‐embedded human temporal bone sections.
Evaluation of Endoscope Sheaths As Viral Barriers
Authors: Baker Karen H. , Chaput Maria P. , Clavet Clark R. , Varney George W. , To Theresa M. , Lytle C. David
Published: November 2003

Objectives: Evaluate ENT endoscope sheaths as barriers to virus passage.

Study Design: “Defective” sheaths covering an endoscope were challenged with virus to determine how many virus particles could be recovered from the endoscope.

Methods: Sheaths with small laser‐drilled holes (2 to 30 μm) were challenged with high‐titer virus suspensions (108 viruses/mL). The inside of the sheath and the endoscope were separately rinsed to recover any virus that penetrated through the hole in the sheath. In an attempt to assess the possible importance of holes in the sheaths, a sequential test was conducted with an initial virus challenge outside a defective sheath (30‐micron hole in the sheath), after which the possibly contaminated endoscope was removed and inserted into a second defective sheath (with a 20‐micron hole at the same location) to determine whether the contaminating virus would pass outward through the second sheath.

Results: Small volumes of virus‐containing fluid penetrated through the hole, e.g., 500 virus particles passed through one of three 30‐μm holes. A significant fraction of those virus particles was occasionally found on the endoscope after removal from the sheath. Similar results were obtained with sheaths that had small tears (34‐84 μm in length, from punctures with fine wires). Although some virus penetration could occur during the initial challenge contaminating the endoscope, no virus was detected passing outward through the second sheath.

Conclusions: Use of a sheath combined with intermediate level disinfection should provide a safe instrument for ENT endoscopy.
Peer Review: Studying the Major Otolaryngology Journals
Authors: Bhattacharyya Neil
Published: November 2003

Objective: To determine if the otolaryngology literature is comparable to other surgical specialty journals with respect to quality and types of articles published.

Methods: The four major otolaryngology journals‐Annals of Otology, Rhinology and Laryngology, Archives of Otolaryngology‐Head and Neck Surgery, Laryngoscope, and Otolaryngology‐Head and Neck Surgery‐were studied for 6‐months and examined for the following variables: 1) proportion of clinical or basic science research, 2) proportion of prospective or retrospective studies, 3) types of statistics used, 4) sample sizes of the studies, and 5) proportion of single case reports. A composite group of surgical specialty journals consisting of Journal of Bone and Joint Surgery, Neurosurgery, and Ophthalmology was also studied for the same time period. The otolaryngology journals and other specialty journals were compared with respect to each of these variables, after which the comparison was conducted within the group of otolaryngology journals.

Results: Analysis of 905 articles, comprising 508 articles from the four major otolaryngology journals and 397 articles from the composite of the other specialty journals, was conducted. No significant difference in the proportion of single case reports between the otolaryngology journals (15.0%) and the other specialty journals (12.8%) was noted (P = .364). The otolaryngology journals had a significantly higher proportion of basic research than the other specialty journals (27.4% vs. 14.5%, P < .001) as well as a higher percentage of prospective studies (62.1% vs. 49.0%, P = .001). The studies in the otolaryngology journals had a much lower mean sample size than those in the other specialty journals (70.2 vs. 373.8, P = .010). No difference between the two groups was found in the use of statistics (P = .228). Among the otolaryngology journals, Laryngoscope was found to publish fewer single case reports than the other three journals, and Annals of Otology, Rhinology and Laryngology had the highest proportion of prospective studies (P = .031 and .012, respectively). No differences were found for sample sizes and use of statistical analysis (P = .266 and P .710, respectively) among the otolaryngology journals.

Conclusions: The otolaryngology literature compares quite favorably with the literature of other surgical specialties, excelling in prospective studies and basic science research. It only lags with respect to sample size. The study composition among the different major otolaryngology journals is largely similar with respect to basic study parameters, suggesting comparable quality among the journals.
Clinical evidence for dystrophin dysfunction as a cause of hearing loss in locus DFN4
Authors: Pfister Markus H. F. , Apaydin Fazil , Turan Onur , Bereketoglu Muslum , Bilgen Vecihi , Braendle Uwe , Kose Suheyla , Zenner Hans‐Peter , Lalwani Anil K.
Published: November 2003

Objective: Locus DFN4 is an X‐linked nonsyndromic hearing loss locus originally mapped to Xp21.2. Recently, we have mapped deafness in a second family from Turkey to the same region, refining the location to within the Duchenne muscular dystrophy (DMD) locus. The objective of this study was to characterize the clinical phenotype of the Turkish family with comprehensive audiovestibular testing and high‐resolution temporal bone computerized tomography. Methods: Fourteen members of a three‐generation family were studied in detail including two deaf affected males. Members of the family underwent general physical and otologic examination, vestibular testing, pure‐tone audiometry, otoacoustic emissions, and immitance testing. An affected male underwent high‐resolution computerized tomography of the temporal bone, electroretinogram (ERG), electromyography, electroneurography, and determination of serum creatinine phosphokinase level. Results: Affected males were congenitally deaf with normal vestibular function. Carrier females showed a mild sensorineural hearing loss affecting all frequencies and absent otoacoustic emissions. Otoacoustic emissions in a younger, 3‐year‐old carrier girl were normal. In an affected male, ERG demonstrated subnormal scotopic b‐wave typically seen in DMD. Computerized tomography of the temporal bone was normal. With the exception of the ERG finding, there was no clinical or laboratory evidence of DMD or Becker muscular dystrophy (BMD). Conclusion: The abnormal ERG in the Turkish family in conjunction with mapping of the DFN4 locus to within DMD strongly suggests that a defect in dystrophin is responsible for the hearing loss in this family. Patients with DMD and BMD should be screened systematically for sensorineural hearing loss. This family provides additional evidence for the critical role of cytoskeletal proteins in normal hearing.
Expression of protein p27 is associated with progression and prognosis in laryngeal cancer
Authors: Fan Guo‐Kang , Fujieda Shigeharu , Sunaga Hiroshi , Tsuzuki Hideaki , Ito Nobuhisa , Saito Hitoshi
Published: November 2003

Objective: A cyclin‐dependent kinase inhibitor, p27kip1, is recognized as a negative regulator of the cell cycle. To clarify whether immunohistochemical detection of p27 might provide prognostic information, we investigated the expression of p27 in laryngeal squamous cell carcinoma (SCC). Study Design: A retrospective study of patients was performed in 109 cases of laryngeal SCC. In addition, we investigated the expression of p53 and granulocyte colony‐stimulating factor receptor (GCSF‐R) to examine the prognostic significance of them in the same samples. Methods: Immunohistochemical staining by specific monoclonal antibodies was performed using the avidin‐biotin‐peroxidase complex technique. Results: Advanced tumor size and clinical stage and the occurrence of lymph node metastasis were associated with the absence of p27 expression, but not correlated with p53 expression and GCSF‐R expression. The overall 5‐year survival rate in the p27‐positive group was significantly higher than that in the p27‐negative group. In the Cox proportional hazard model, p27 was demonstrated to be the most powerful prognostic factor among gender, tumor size, lymph node metastasis, stage of disease, and p53 and GCSF‐R expression. Conclusions: We concluded that assessment of p27 expression is useful as a prognostic factor for laryngeal SCC and of value in selecting patients with laryngeal SCC for aggressive therapy.
Vocal fold proteoglycans and their influence on biomechanics
Authors: Gray Steven D. , Titze Ingo R. , Chan Roger , Hammond Thomas Hale
Published: November 2003

Objective/Hypothesis: To examine the interstitial proteins of the vocal fold and their influence on the biomechanical properties of that tissue.Study Design: Anatomic study of the lamina propria of human cadaveric vocal folds combined with some viscosity testing.Methods: Identification of proteoglycans is performed with histochemical staining. Quantitative analysis is performed using an image analysis system. A rheometer is used for viscosity testing. Three‐dimensional rendering program is used for the computer images.Results: Proteoglycans play an important role in tissue biomechanics. Hyaluronic acid is a key molecule that affects viscosity.Discussion: The proteoglycans of the lamina propria have important biological and biomechanical effects. The role of hyaluronic acid in determining tissue viscosity is emphasized. Viscosity, its effect on phonatory threshold pressure and energy expended due to phonation is discussed.Conclusion: Proteoglycans, particularly hyaluronic acid, play important roles in determining biomechanical properties of tissue oscillation. Future research will likely make these proteins of important therapeutic interest.
Surgical management of thyroid masses: Assessing the need for frozen section evaluation
Authors: Lin Ho‐Sheng , Komisar Arnold , Opher Elana , Blaugrund Stanley M.
Published: November 2003

Objective/Hypothesis: To determine the need for intraoperative frozen section to guide the extent of thyroid surgery in the presence of an adequate preoperative fine‐needle aspiration (FNA) finding. Methods: Charts of patients who presented from 1995 to 1998 to the two senior authors were reviewed. A total of 82 patients were found who satisfied the inclusion criteria of having both an adequate FNA and frozen section. The extent of surgery was based on the frozen section finding for all the patients in this study. The authors looked at the number of cases in which the surgical management would be changed if the frozen section was not obtained and the surgical decision was based only on preoperative FNA and intraoperative findings. Results: FNA revealed papillary carcinoma in 18 patients that was confirmed by intraoperative frozen section and final pathology. In the remaining 64 patients, the FNA diagnosis was either benign or suspicious. When routine frozen section was done, 61 of these 64 patients were found to have either benign pathology or pathological diagnosis that was deferred to permanent section. Only three patients were found to have malignancy on frozen section that was missed by FNA. Of these three patients, two had obvious findings of malignancy at the time of surgery. This leaves only one patient with carcinoma that was missed by FNA and intraoperative findings but detected by the intraoperative frozen section. Conclusion: Of the 82 patients in this study, only one extra case of malignancy would be missed by elimination of the routine use of intraoperative frozen section. The authors conclude that the routine use of intraoperative frozen section may be unnecessary. The use of an adequate preoperative FNA together with sound clinical judgment at time of surgery can adequately guide the extent of surgical resection.
Open bedside tracheotomy in the intensive care unit
Authors: Wang Steven J. , Sercarz Joel A. , Blackwell Keith E. , Aghamohammadi Mazda , Wang Marilene B.
Published: November 2003

Objective: To demonstrate that open bedside tracheotomy is an efficient, safe, and cost‐effective procedure. Study Design: Retrospective review of more than 200 open bedside tracheotomies performed at UCLA Medical Center, Harbor‐UCLA Medical Center, and West Los Angeles VA Medical Center from 1995 to 1998. Methods: The only personnel required for the procedure were an attending or senior resident and a junior resident or intern, as well as the respiratory therapist to withdraw the endotracheal tube. No anesthetist or scrub nurse was present for any of the procedures. The procedure took an average of 15 to 25 minutes. Patients were followed for 30 days after surgery to determine the incidence of complications. Results: The incidence of major complications related to the procedure, including hemorrhage and myocardial infarction, was less than 1%. The incidence of minor complications, including moderate bleeding at the tracheotomy site, was 4%. Overall mortality within 30 days was 8%, but was not related to the tracheotomy for any patients in this series. The charge for the procedure was $233 for the tracheotomy tube supplies and instruments. This cost compares favorably with an average charge of more than $3000 for the procedure in the operating room and about $1000 for a percutaneous tracheotomy kit. Conclusion: Review of our experience demonstrates that open bedside tracheotomies can be performed more efficiently and economically than operating room tracheotomies. The safety of this procedure is comparable to percutaneous tracheotomy but at a decreased cost. Key Words: Tracheotomy, percutaneous tracheotomy
Facial nerve rehabilitation after radical parotidectomy
Authors: Reddy Pavan G. , Arden Richard L. , Mathog Robert H.
Published: November 2003

Objective: Examine functional outcomes in patients undergoing radical parotidectomy and facial nerve grafting. Identify factors that may affect rehabilitation in these patients. Study Design: Retrospective chart review and photographic analyses of 12 patients undergoing radical parotidectomy with interposition nerve grafts for facial nerve reconstruction. Methods: Data obtained for each patient regarding age, sex, histology of parotid neoplasm, cable graft source, administration of postoperative radiotherapy, and treatment for eye rehabilitation. Functional outcomes were assessed with the House‐Brackmann grading system at 6 months, 1 year, and 2 years after surgery. Results: All nerve grafts were harvested from cervical plexus sensory nerves with microscopic epineural repair performed for all neurorrhaphies. Overall, 9 of 12 patients achieved a grade III 2 years after surgery. All patients under age 30 obtained a grade III. Of the seven patients receiving postoperative radiation, five achieved a grade III. Older patients often required surgical procedures to facilitate eye closure. Conclusions: Facial nerve rehabilitation after radical parotidectomy can be successfully achieved with cervical plexus interposition nerve grafts. Postoperative radiotherapy did not appear to affect return of function, and younger patients consistently achieved good functional outcomes after nerve grafting. Older patients frequently require surgical procedures for eye rehabilitation after radical parotidectomy. Key Words: Radical parotidectomy, facial nerve, facial nerve rehabilitation, interposition nerve grafts, functional outcome.
An anatomical study of anastomoses between the laryngeal nerves
Authors: Sañudo Jose‐Ramón , Maranillo Eva , León Xavier , Mirapeix Rosa‐María , Orús Cesar , Quer Miquel
Published: November 2003

Objective: To systematize the anatomy of the connecting branches between laryngeal nerves. Methods: Microdissection of 90 larynges obtained from necropsies (57 men and 33 women; age range, 41–95 y). Results: Anastomoses between the internal and recurrent nerves appeared in four different patterns: 1) Galen's anastomosis, as the connection between the dorsal branches of both nerves (100%); 2) arytenoid plexus, as the connection between the arytenoid branches of both nerves, in relation with the arytenoid muscle, and divided in a deep part (100%) and a superficial part (86%); 3) cricoid anastomosis, previously only described in cows, located in the front of the cricoid lamina (6/10 cases); and 4) thyroarytenoid anastomosis, as the connection of a descending branch of the internal laryngeal nerve and an ascending branch of the recurrent nerve (14%). Anastomosis between the internal laryngeal and the external laryngeal nerves appeared as a connecting branch throughout the foramen thyroideum (21%). Anastomosis between the external laryngeal and recurrent nerves appeared as a connecting branch throughout the cricothyroid muscle (68%). Conclusion: At least two anastomoses (Galen's anastomosis and arytenoid plexus) appeared in 21% of hemilarynges, and 79% of cases had three or more anastomoses between the laryngeal nerves. The different prevalence of this complex anastomotic pattern suggests functional differences in the sensory and motor innervation of individual subjects. Key Words: Larynx, innervation, anastomosis, nerves.
Pulmonary function after total laryngectomy
Authors: Hess Markus M. , Schwenk Ragnhild A. , Frank Wolfgang , Loddenkemper Robert
Published: November 2003

Objective: To present data on pulmonary function in 59 laryngectomees using a specially designed silicone adapter for connection of the stoma to the bodyplethysmograph. Study Design: Prospective assessment of pulmonary function in 59 patients, and comparison of lung function before and after bronchodilator testing in selected cases. Methods: The usefulness of the adapter was examined. Data of patients with airway obstruction were tabulated according to large airway obstruction (LAO), peripheral airway obstruction (PAO), and small airway disease (SAD) types. Results: Findings show that pulmonary airway obstruction was present in 81% of patients and normal pulmonary function was present in only 11 of the 59 participants (19%). LAO was found in 25%, PAO in 17%, and SAD in 39% of cases. Emphysema was diagnosed in 14% of cases within the above‐mentioned LAO and PAO groups. Improvement of pulmonary function was achieved in 12 of 16 laryngectomees with airway obstruction, when a bronchodilator aerosol was administered. In 60% of cases with LAO and PAO, the laryngectomees did not know of any marked obstruction of their airways, and only 10% of those knowing about their obstruction received appropriate medical treatment. Conclusions: These results suggest that 42% of the laryngectomees tested may have benefited from further medical treatment. After laryngectomy, pulmonary function assessment was performed elsewhere in 1 of 59 cases. In light of the high prevalence of airway obstruction in laryngectomees, more frequent postoperative assessments of pulmonary function should be offered to prevent or to reduce impairment of respiratory function in this postlaryngectomy vulnerable pulmonary status. Further studies are also needed to determine the effects of therapeutic intervention, e.g., assessment of therapy outcome and influence on quality of life. Key Words: Adapter, bodyplethysmography, bronchodilator response, laryngectomy, pulmonary function.
Cochlear Implantation in Children With Enlarged Vestibular Aqueducts
Authors: Bent John P. , Chute Patricia , Parisier Simon C.
Published: November 2003

Objectives: This report details our experience with cochlear implantation in children with both profound sensorineural HL (SNHL) and enlarged vestibular aqueducts (EVAs). It seeks to determine if the abnormal anatomy of EVA predisposes to any adverse events during or after cochlear implantation. Study Design: A retrospective review. Methods: Charts were reviewed for details of the procedure, complications, and audiologic outcome. Results: Between 8/25/93 and 9/16/98, 10 children with EVAs received cochlear implants, of whom 8 children (5 males, 3 females; mean age 7.8 y) had audiologic follow‐up of at least 6 months. The implant was inserted without difficulty in all patients. Pulsatile clear fluid via the cochleostomy was observed in five patients, but was easily controlled in each instance. There have been no major complications, although two patient had shortlived postoperative vestibular symptoms and one child has experienced an intermittent pulsing sensation in her head. Speech perception measures were obtained using a battery of tests that assessed the children's ability to perceive speech in both open‐ and closed‐set formats. Two patients were excluded because the implant was placed within the last 6 months. Of the remaining eight children identified with EVAs, seven (86%) demonstrated open‐set word recognition. Conclusions: These favorable results may be attributed in part to HL that occurs relatively late in childhood, allowing implantation in postlingual candidates. Cochlear implantation can be safely and effectively performed in children with SNHL associated with EVAs.
Orbital Measurement in Black and White Populations
Authors: Barretto Roberto L. , Mathog Robert H.
Published: November 2003

Objective: Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups. Study Design: Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center. Methods: Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test. Results: A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23 ± 2.26 mm as compared with 17 ± 2.65 mm for white males (P > .025). Black females demonstrated a mean projection of 17.27 ± 1.44 mm as compared with 15.98 ± 2.22 mm for white females (P > .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH. Conclusions: These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.
An External Landmark for the Anterior Commissure
Authors: Adams Jeff , Gross Neil , Riddle Seth , Andersen Peter , Cohen James I.
Published: November 2003

Objective: The ability to predict the level of the true vocal cords based on external landmarks is crucial to the success of many laryngeal surgical procedures. This study examines the reliability of one such landmark on the thyroid cartilage. Methods: Twenty‐four cadaver larynges were examined. A pin was placed through the landmark, best described as a small diamond shaped area of color change and surface depression along the anterior midline of each thyroid cartilage through which travels a very small unnamed artery. The endolaryngeal position of the pin was checked with a flexible nasopharyngoscope. Results: In all 24 cadavers, the pin entered the larynx at the anterior commissure, just above or at the level of the true vocal cords. Conclusions: This external landmark reliably predicts the position of the true vocal cords. It serves as a useful adjunct to existing external landmarks used to direct thyroid cartilage cuts in laryngeal procedures.
Characterization of Cyclooxygenase in Laryngeal Papilloma by Molecular Techniques
Authors: Robinson Ann B. , Das Sanjoy K. , Bruegger Daniel E. , Hoover Larry A. , Sanford Thomas R.
Published: November 2003

Objectives: Demonstrate the induction of cyclooxygenase‐2 (COX‐2) in laryngeal papilloma. Discuss the possible causal role of COX‐2 in papilloma formation. Consider the potential for treatment of papilloma using selective COX‐2 inhibitors. Study Design: Molecular biological analysis of COX‐1 and COX‐2 in laryngeal papilloma. Methods: Tissue samples from five patients with recurrent respiratory papillomatosis (RRP) were analyzed by in situ hybridization, immunohistochemical staining, and reverse transcription polymerase chain reaction (RTPCR) techniques. Results: In situ hybridization to COX‐2 mRNA showed strong autoradiographic signal surrounding fibrovascular cores. COX‐1 autoradiographic signal was low intensity or nondetectable. Normal buccal mucosa biopsies showed low‐density or nondetectable autoradiographic signal for both COX‐1 and COX‐2 mRNAs. In situ hybridization results were corroborated by RT‐PCR studies. Levels of COX‐2 mRNA were 13‐fold more than those in normal mucosa. Immunohistochemical staining for COX‐1 and COX‐2 showed a similar pattern to that seen with in situ hybridization in both normal and papilloma tissues. Conclusions: There is an elevation of COX‐2 expression in papilloma tissues. This may represent a causal role of COX‐2 in the formation and proliferation of laryngeal papilloma. There may also be a role for selective COX‐2 inhibition for the treatment of RRP.
Upper Aerodigestive Tract Liposarcoma: Report on Four Cases and Literature Review
Authors: Mandell David L. , Brandwein Margaret S. , Woo Peak , Som Peter M. , Biller Hugh F. , Urken Mark L.
Published: November 2003

Objective: To report on the clinical behavior, histopathology, treatment, and prognosis of laryngeal, hypopharyngeal, and cervical esophageal liposarcomas.

Study Design: Retrospective reviews of pathology files and hospital records at a tertiary care hospital and a retrospective search of the English‐language literature.

Methods: Cases of upper aerodigestive tract (UADT) liposarcoma with adequate histopathologic documentation and clinical information were included for review.

Results: Four cases of UADT liposarcomas were identified. The literature review revealed 26 cases of laryngeal liposarcomas, 7 cases of hypopharyngeal liposarcomas, and 6 cases of esophageal liposarcomas: the mean age at presentation was 55.8 years, the male:female ratio was 5:1, and 60% of the patients presented with dysphagia. Eighty‐six percent of tumors had low‐grade histologic findings. The recurrence rate after primary resection was 50%. Recurrence correlated with surgical procedure rather than with histologic subtype; 94.7% of recurrences happened after simple excision. Distant metastases occurred in three patients; two of them died of the disease.

Conclusions: The literature supports that UADT liposarcomas are rare and usually of low‐grade histologic type. The rate of metastatic disease and tumor‐related mortality is low. However, high recurrence rates have been noted, particularly when less radical surgery is employed.
Utilization of Panoramic Radiographs to Evaluate Short‐Term Complications of Mandibular Fracture Repair
Authors: Childress Curtis S. , Newlands Shawn D.
Published: November 2003

Objectives/Hypothesis: Detection of complications after mandibular fracture repair is generally based on the clinical examination. However, postoperative evaluation of the patient often includes imaging of the repaired mandible. At our institution, the majority of patients with mandibular fracture have had at least one panoramic mandible radiograph taken post‐operatively. The purpose of this study was to assess whether these radiographic studies contributed to detection of complications and thereby had an impact on the clinical course of the patient.

Study Design: Retrospective review.

Methods: The available medical records over a 5‐and‐a‐half‐year period of all patients who were treated at our institution for a fractured mandible were reviewed. Patients included in the study were those who were followed for at least 2 months and two postoperative visits.

Results: Our series of 289 patients included 25 patients with complications. Of these patients, 24 had postoperative panoramic radiographs. All of the complications were discovered based on history and physical examination. In six of the patients with complications, the panoramic radiograph was suspicious for a complication. There were five false‐positive studies of the 240 postoperative studies performed in patients without complications. No complications were diagnosed based on radiography.

Conclusions: After surgical treatment of mandibular fractures, panoramic radiographs add little to the physical examination and history toward the detection of complications. We believe that panoramic radiographs need not be used routinely, but may be reserved for patients who have complaints or physical findings suggestive of complications.
Increased Stability of Airflow Following Botulinum Toxin Injection
Authors: Finnegan Eileen M. , Luschei Erich S. , Gordon James D. , Barkmeier Julie M. , Hoffman Henry T.
Published: November 2003

Objectives: The purpose of this study was to determine whether stability of airflow, as well as mean airflow, increased following botulinum toxin injection to laryngeal and extralaryngeal muscles in persons with spasmodic dysphonia (SD), some with associated vocal tremor (VT).

Study Design: Aerodynamic data were collected from five subjects before and at 2, 4, and 8 weeks after they received treatment by each of two different arms in an injection protocol in a crossover study. One arm of the protocol involved treatment of the thyroarytenoid muscles only. The other arm involved treatment of both the thyroarytenoid muscles and the strap muscles.

Methods: Measures of mean airflow and coefficient of variation (COV) of airflow during phonation were obtained. A decrease in the COV of airflow would indicate increased stability of phonatory airflow.

Results: Before treatment, all subjects with SD/VT exhibited mean airflows that were similar to controls. The COV of airflow ranged from normal to substantially elevated. Following botulinum injection, mean airflow characteristically increased and COV of airflow decreased.

Conclusions: This finding suggests there is a change in the type, as well as the level, of activity in the muscles of speech production following botulinum toxin injection. The increase in airflow stability identified could be due to increased stability of the laryngeal system and possibly of the respiratory system as well.
Conductive Hearing Loss Results in a Decrease in Central Auditory System Activity in the Young Gerbil
Authors: Tucci Debara L. , Cant Nell B. , Durham Dianne
Published: November 2003

Objectives/Hypothesis: The impact of childhood conductive HL (CHL) on development of auditory function has long been debated. The present study was conducted to define and compare the consequences of CHL and cochlear ablation (CA) in young and adult animals, using 2‐deoxyglucose (2‐DG) uptake as a measure of metabolic activity. It was hypothesized that, for both ages, CHL would result in a decrease in activity in the major ascending central auditory system pathway of the manipulated ear, but that this decrease would be significantly less than that observed with CA.

Study Design: Sham‐controlled study of metabolic effects of CHL during sound stimulation.

Methods: Gerbils (aged 21 days or adult), underwent malleus removal, CA, or a sham procedure. Young animals survived either 48 hours or 3 weeks; adults survived 3 weeks. Each age/survival CHL group contained eight animals; otherwise, each group (CA and sham) contained five animals, for a total number of 54. At the appropriate survival time, animals were given an intracardiac injection of 14C‐2‐DG, and sacrificed under anesthesia after 45 minutes of exposure to normal laboratory sounds. Tissue sections were prepared for exposure to x‐ray film for optical density measurements, and alternate sections stained for identification of nuclei. Measurements from auditory nuclei of experimental animals were corrected against an unaffected control area (abducens nucleus) and compared with measurements taken from animals in the sham group. Auditory evoked potential thresholds to both air‐ and bone‐conducted stimuli were obtained in a second group of neonatal and adult animals.

Results: Both CHL and CA resulted in a marked decrease in 2‐DG uptake in the major ascending projection of the manipulated ear, in both the neonatal and adult animals. In young animals, effects of CHL and CA were similar. Effects of CHL in adult animals were less marked and significantly different from either effects of CHL in young animals or effects of CA in adult animals. HL following malleus removal only was purely conductive and ranged from 38 to 55 dB across frequency.

Conclusions: Results suggest that, particularly in young animals, a unilateral CHL may have profound effects on metabolic activity in the central auditory system.
Second Laryngeal Cancers in Previously Treated Larynges
Authors: McGuirt W. Frederick , Ray Mark
Published: November 2003

Objectives: To review the management and outcome of patients with new second primary cases of laryngeal cancer occurring more than 3 years after the initial cancer was treated.

Study Design: Retrospective review of 855 patients with newly diagnosed and treated laryngeal cancers.

Methods: Charts were reviewed and tabulated for occurrence of second primary laryngeal tumors, method of treatment for the index and second primary laryngeal tumors, and effect of smoking status or cessation of smoking.

Results: Of the 855 patients, 532 patients retained their larynx; of these 377 lived more than 3 years and thus were at risk for a second new primary cancer. Of these 377 patients at risk, 19 or 5.1% developed second primary tumors. The rate of second primary disease was lower in patients whose index laryngeal cancer was treated by irradiation (4.3%) compared with those treated surgically (9.2%). However, surgical treatment of second primary laryngeal tumors resulted in far higher rates of laryngeal voicing (82%) compared with irradiation (33%).

Conclusion: When possible, management of the index primary tumor by endoscopic resection has resulted in the highest future retention of laryngeal speech, leaving all treatment options available should a second laryngeal cancer occur. Lifelong follow‐up of patients with laryngeal cancer for secondary primary tumors is important. Second primary tumors were equally distributed between patients who continued to smoke and ceased to smoke after their index primary lesion was diagnosed.
Maxillary Sinus Mucoceles: Clinical Presentation and Long‐Term Results of Endoscopic Surgical Treatment
Authors: Busaba Nicolas Y. , Salman Salah D.
Published: November 2003

Objective: To describe the clinical presentation of maxillary sinus mucoceles, understand their pathogenesis, and determine the long‐term efficacy of the endoscopic surgical treatment.

Study Design: Retrospective review.

Methods: Thirteen consecutive patients who presented with maxillary sinus muco(pyo) celes were studied. Subjects with history of preceding sinus/nasal surgery or facial trauma were excluded. The presenting signs and symptoms, radiological findings, and surgical management were reviewed.

Results: There were six women and seven men with an age range of 31 to 71 years. Two patients had environmental allergies. Nine patients complained of cheek pressure or pain, six of nasal obstruction, and eight of nasal drainage. On endoscopic nasal examination, the medial wall of maxillary sinus was bulging with prolapsed middle meatal mucosa in 10; drainage was seen in 7, but none had polyps. The sinus involvement was limited to the maxillary sinus and the ipsilateral ethmoid on computed tomographic studies in 10 cases. Patients were treated with endoscopic ethmoidectomy, middle meatal antrostomy, and marsupialization of the mucocele. Intraoperative cultures grew organisms in five patients. Postoperative follow‐up ranged between 10 and 66 months. Two patients required lysis of adhesions in the middle meatus, and one, revision antrostomy. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa at latest follow‐up. The presenting symptoms resolved or improved in 12 cases.

Conclusions: The etiology of maxillary sinus mucoceles is not well understood. Mechanical obstruction or allergy or both do not seem to play an important role. An infectious origin is also not supported by the above data. Endoscopic sinus surgery is a reliable therapeutic measure with a favorable long‐term outcome.