bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Radiation in the Treatment of Advanced Juvenile Angiofibroma
Authors: Lee Jivianne T. , Chen Peter , Safa Afshin , Juillard Guy , Calcaterra Thomas C.
Published: November 2003

Objectives/Hypothesis To demonstrate the efficacy of external beam radiation therapy as a primary treatment modality for the management of patients with advanced juvenile nasopharyngeal angiofibroma (JNA).

Study Design Retrospective chart review.

Methods The medical records of 130 patients with the diagnosis of JNA seen at UCLA Medical Center over a 41‐year period (1960–2000) were retrospectively reviewed.

Results One hundred thirty cases of JNA have been seen at UCLA Medical Center from 1960 to 2000. One hundred two were treated with surgical resection, 1 refused therapy, and the remaining 27 received radiation (3000–5500 cGy) as their primary mode of treatment. Fifteen percent (4 of 27) of the irradiated patients developed recurrent tumor 2 to 5 years later. Long‐term complications occurred in 4 patients (15%) and consisted of growth retardation, panhypopituitarism, temporal lobe necrosis, cataracts, and radiation keratopathy.

Conclusions External beam radiation therapy represents an effective mode of treatment for patients with advanced JNA. Although the latency period may be long, we think the likelihood of potentially fatal complications developing at the radiation dosages we recommend is less than the risk of significant morbidity and mortality associated with surgical intervention in these cases.
Esophageal Pressure Monitoring in Detection of Sleep‐Disordered Breathing
Authors: Virkkula Paula , Silvola Juha , Maasilta Paula , Malmberg Henrik , Salmi Tapani
Published: November 2003

Objective The aim was to study the value of esophageal pressure monitoring combined with limited polygraphic recording (oxygen saturation, respiratory and leg movements, airflow, body position, and snoring sound) in diagnosis of sleep‐disordered breathing.

Study Design A prospective study of consecutive patients with snoring was carried out.

Methods Sixty‐seven patients underwent an overnight study on ward. Patients with normal oxygen desaturation index and any periodic breathing disturbances combined with elevated esophageal pressure were further studied with complete polysomnography.

Results The patient compliance with esophageal catheter was 87%. Esophageal pressure monitoring increased effectively the detection of sleep‐disordered breathing with limited polygraphic recording. Sixty‐seven percent of the patients with normal oxygen desaturation index and respiratory‐related esophageal pressure variation had sleep‐disordered breathing on complete polysomnography. Increased esophageal pressure variation was significantly related with oxygen desaturation index and obstructive sleep apnea diagnosis (P <.001). All together, 48% of the mainly nonobese snorers had objective findings of sleep‐disordered breathing. Patients with upper airway resistance syndrome were few. Fifteen percent of the patients had periodic leg movements. Neither subjective or objective sleepiness nor snoring or obesity adequately exposed sleep‐disordered breathing in this material.

Conclusion Esophageal pressure monitoring increases markedly the diagnostic value of limited polygraphic recording as a screening study for sleep‐disordered breathing.
Obstructive Sleep Apnea: A Comparison of Black and White Subjects
Authors: Meetze Keith , Gillespie M. Boyd , Lee Fu‐Shing
Published: November 2003

Objective To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group.

Study Design Cross‐sectional retrospective review.

Setting University‐based sleep disorders laboratory.

Methods The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level.

Results Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P = .005). Black males with OSA have significantly lower oxygen saturations than white males (P = .025).

Conclusion Black males who present to the otolaryngologist‐head and neck surgeon for evaluation of sleep‐disordered breathing may be at increased risk of severe OSA.
Functional Analysis After Supracricoid Partial Laryngectomy With Cricohyoidoepiglottopexy
Authors: Bron Luc , Pasche Philippe , Brossard Edgar , Monnier Philippe , Schweizer Velérie
Published: November 2003

Objectives To assess prospectively speech and swallowing function in a series of 17 patients after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

Study Design Retrospective study.

Methods From 1983 to 1996, 69 patients at Department of Otolaryngology—Head and Neck Surgery, CHUV (Lausanne, Switzerland) underwent a supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Seventeen of them (25%) could be contacted and accepted participation in a functional evaluation that included a questionnaire to document their present nutritional status and diet. A formal voice evaluation was also performed, which included psychoacoustic evaluation of vocal qualities, fundamental frequency parameters, phonation intensity range, phonatory quotient (vital capacity divided by maximum phonation time), and a laryngeal video laryngoscopy performed with a rigid endoscope.

Results Median postoperative follow‐up was 66 months (range, 12–152 mo). Nine of 17 patients (53%) recovered a normal diet with no increased incidence of aspirations. Seven of 17 had minor limitations such as no peanuts, dry bread, or rice. Two of 17 patients were restricted to pureed food. Assessment of voice showed a clearly decreased mean fundamental frequency at 70.1 Hz (normal range, 121–211 Hz) and a narrowed frequency range of phonation with a mean value of 8.8 semitones (normal value, 27). Forty‐two percent of the patients went back to their normal professional life after the operation. Among the 10 who did not, 3 (16%) retired and 7 actually had to give up their profession, because of the modification of their voice or general asthenia and age close to retirement.

Conclusion Restoration of laryngeal function after supracricoid partial laryngectomy with cricohyoidoepiglottopexy is satisfactory. Although most of the patients seem to recover normal swallowing function, severe voice alterations appear to be inevitable.
Long‐Term Results of Small Fenestra Stapedectomy Compared With Large Fenestra Technique
Authors: Esquivel Carlos R. , Mamikoglu Bulent , Wiet Richard J.
Published: November 2003

Objectives/Hypothesis A comparison is made of the postoperative long‐term hearing results of small fenestra stapedectomy versus large fenestra techniques. Several reports in the literature favor improved hearing results in small fenestra stapedectomy compared with large fenestration and/or total stapedectomy.

Methods A retrospective review of 34 patients who had stapedectomy performed by the same surgeon between 1982 and 1992. All patients have been followed for up to 10 years postoperatively.

Results In 18 ears of 17 patients, surgery was performed with small fenestra technique, and 17 ears of 17 patients had total stapedectomy or posterior‐half fenestration. After small fenestra stapedectomy, initial average air–bone gap at 500, 1000, and 2000 Hz was 9 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated to 4% over the study period. Speech reception thresholds declined 15%. After total or posterior‐half stapedectomy the average air–bone gap at 500, 1000, and 2000 Hz was 5 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated 8% and 18% for the small fenestra and large fenestra groups, respectively, over time. Statistically, there was no difference in hearing deterioration rate between these two groups.

Conclusions An experienced surgeon can obtain excellent results using either large or small fenestra technique for otosclerosis. After initial successful closure of the air–bone gaps at all measured frequencies, hearing thresholds over the study period were stable for both groups.
Opening Plugged Tympanostomy Tubes
Authors: Westine John G. , Giannoni Carla M. , Gajewski Byron , Antonelli Patrick J.
Published: November 2003

Objective To determine the most effective solvents for dissolving plugged tympanostomy tubes.

Study Design In vitro laboratory study.

Methods Twelve solvents (including ototopical antibiotics and water) were applied to fluoroplastic tympanostomy tubes (n = 260) plugged with dried mucoid middle ear effusion in an ear canal–tympanic membrane model. Time to clearance of the tympanostomy tubes was both visually and tympanometrically determined.

Results Vinegar (P = .0030) and hyaluronidase solutions (P = .0030) were significantly better solvents than water.

Conclusion Vinegar and hyaluronidase solutions are more likely to clear plugged tympanostomy tubes than water and ototopical antibiotics, but vinegar is the preferred solution because of its known relative safety for use in the ear.
Endoscopic Sinus Surgery for Inflammatory Maxillary Sinus Disease
Authors: Busaba Nicolas Y. , Kieff David
Published: November 2003

Objective/Hypothesis The role of endoscopic sinus surgery for treating chronic maxillary sinusitis is well established. The purpose of the study is to determine the efficacy of endoscopic sinus surgery in the treatment of maxillary sinus inflammatory disease that includes mucoceles, retention cysts, and antrochoanal polyps.

Study Design This is a retrospective review of 32 consecutive patients who underwent endoscopic sinus surgery for mucoceles (n = 21), retention cysts (n = 5), or antrochoanal polyps (n = 6).

Methods The medical records were reviewed for patient demographics, presenting symptoms, and type of operation. Surgical outcome was determined by resolution of symptoms, recurrence of disease, and need for revision or additional surgery.

Results Ethmoidectomy with middle meatal antrostomy was performed in all patients; 28 patients had additional middle turbinectomy. Postoperative follow‐up ranged from 6 months to 4 years. The operation resulted in resolution of symptoms and a patent antrostomy on long‐term follow‐up in all cases of mucoceles. No case required revision surgery. On the other hand, the disease recurred in three patients (60%) with retention cysts and three patients (50%) with antrochoanal polyps despite patent antrostomies. The recurrences occurred 3 to 6 months after the surgery. The recurrent cases of antrochoanal polyps required Caldwell Luc procedures. The three failures in cases of retention cysts were successfully managed with repeated office endoscopic marsupialization through a patent antrostomy.

Conclusions Endoscopic sinus surgery is an effective treatment for mucoceles, with favorable long‐term outcome. Maxillary retention cysts commonly recur after endoscopic sinus surgery. However, the recurrence can be managed in the office through a patent antrostomy. Endoscopic sinus surgery may be offered as initial surgical treatment for antrochoanal polyps, but a Caldwell Luc operation may be needed for recurrent disease.
Autologous Transplantation of Fascia Into the Vocal Fold as a Treatment for Recurrent Nerve Paralysis
Authors: Nishiyama Koichiro , Hirose Hajime , Iguchi Yoshiaki , Nagai Hiromi , Yamanaka Jun , Okamoto Makito
Published: November 2003

Objectives To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure.

Study Design Technical modifications were made in transplantation of the temporal fascia into the paralyzed vocal fold. Eight patients underwent the surgery, and their phonatory function was examined preoperatively and postoperatively.

Methods The following surgical techniques were applied to prevent the falling‐off of the graft: 1) a roll‐shaped fascia graft was prepared before the transplantation and 2) a pocket was made within the lamina propria mucosa using a newly devised special elevator. The maximum phonation time and airflow rate during sustained phonation (in four cases) were measured, and perceptual evaluation of voice quality was made using the GRBAS scale by speech pathologists before and after the surgery.

Results All the cases showed no evidence of falling‐off of the graft. Elongation of the maximum phonation time and improvement in voice quality were obtained in all cases postoperatively.

Conclusion The method proved to be useful for the treatment of glottal insufficiency due to recurrent nerve paralysis.
Monopolar Electrocautery in Adenoidectomy as a Possible Risk Factor for Grisel's Syndrome
Authors: Tschopp Kurt
Published: November 2003

Objectives/Hypothesis Grisel syndrome is a nontraumatic atlantoaxial subluxation after an inflammatory process in the upper cervical region. It results from a peripharyngeal infection as well as a rare complication following adenotonsillectomy. After the introduction of monopolar suction electrocautery in adenoidectomy, an increased incidence of Grisel's syndrome has been observed. The purpose of the study was to evaluate monopolar suction electrocautery as a possible risk factor.

Study Design Retrospective chart review along with current measurements of monopolar and bipolar electrocautery during adenoidectomy.

Methods The charts of 1431 consecutive cases of adenoidectomy were reviewed before (n = 710) and after (n = 721) the introduction of monopolar suction electrocautery for intraoperative hemostasis. Moreover, energy of delivered current of electrocautery was measured in 30 pediatric patients during adenoidectomy.

Results Three cases of Grisel's syndrome occurred as a postoperative complication in 721 adenoidectomies (0.4%) after the introduction of monopolar suction electrocautery. In contrast, no Grisel's syndrome was observed in 710 procedures before the use of monopolar electrocautery. Current measurements demonstrate an almost fourfold higher level of electrical energy using monopolar electrocautery compared with bipolar coagulation for bleeding control in adenoidectomy.

Conclusion Monopolar suction cautery in adenoidectomy may be considered as a risk factor for Grisel's syndrome.
Sinonasal Undifferentiated Carcinoma: The Search for a Better Outcome
Authors: Musy Pierre Y. , Reibel James F. , Levine Paul A.
Published: November 2003

Objective To evaluate the clinical outcomes of a standardized treatment approach for sinonasal undifferentiated carcinoma (SNUC).

Study Design Single‐center, retrospective case series.

Methods Fifteen patients with newly diagnosed SNUC were seen in the Department of Otolaryngology‐Head and Neck Surgery at the University of Virginia from 1991 to 2000. Long‐term follow‐up on five additional patients diagnosed between 1986 and 1991 was also analyzed.

Results Overall, 10 patients were treated with curative intent with neoadjuvant chemoradiotherapy followed by craniofacial resection (CFR). The majority of the remainder was treated with palliative radiotherapy or chemoradiotherapy alone. Four patients who underwent CFR are currently free of disease at 4, 36, 49, and 164 months postoperatively. The 2‐year survival of all evaluable patients, regardless of treatment, was 47%. Two‐year survival was 64% in the group treated by CFR and 25% in the group treated with chemo‐ and/or radiotherapy (P = .076).

Conclusion For patients with good performance status and limited intracranial or intraorbital disease, we continue to advocate initial chemoradiotherapy followed by craniofacial resection. Patients who are deemed inoperable as a result of advanced disease may nevertheless experience significant palliation with chemoradiotherapy only.
In Vivo Diagnosis of Persistent and Recurrent Nasopharyngeal Carcinoma by Contact Endoscopy
Authors: Pak Martin Wai , To Ka Fai , Leung Sing Fai , van Hasselt Charles Andrew
Published: November 2003

Objective To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.

Study Design Prospective study to examine 64 consecutive patients who have been irradiated for nasopharyngeal carcinoma in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany [7215 AA, 0°, and 7215 BA, 30°; 23 cm long. 4 mm in diameter]).

Methods The superficial cells of the posterior walls of the nasopharynx were stained with 1% methylene blue and examined with contact rhinoscopes with the patient under local anesthesia at high magnifications (×60 and ×150). Biopsy of the areas under examination was performed. The contact endoscopic images were analyzed and correlated with the corresponding histological sections of the biopsy tissues.

Results Contact endoscopy was performed in 64 patients (54 men; mean age, 42 y) with the use of local anesthesia. Four patterns of contact endoscopic findings were identified: squamous metaplasia (43 cases), postirradiation atypia (10), granulation tissue (6), and malignancy (5). In the last group, the nasopharynx appeared normal in two patients (40%). The findings of contact endoscopy correlated well with the histological findings (kappa reliability coefficient = 0.847;P <.001; diagnostic accuracy, 92.1%). For prediction of persistent and recurrent disease, the sensitivity and specificity of endoscopic findings were both 100%.

Conclusion Contact endoscopy is an accurate, reliable office‐based procedure that allows for in vivo and in situ diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.
Myringotomy Delays the Tympanic Membrane Recovery in Acute Otitis Media: A Study in the Rat Model
Authors: Spratley Jorge , Hellström Sten , Eriksson Per‐Olof , Pais‐Clemente Manuel
Published: November 2003

Background/Hypothesis Acute otitis media is a major cause of visits to pediatric health care providers. Myringotomy in uncomplicated acute otitis media is debatable today. The study addressed this problem through the otomicroscopic and histopathological observations of the events occurring in the tympanic membrane during the first week after myringotomy.

Study Design Randomized study in an experimental animal model.

Methods Under anesthesia, the left middle ear of 36 Sprague‐Dawley rats was inoculated with Streptococcus pneumoniae type 3. Forty‐eight hours later, at day 0, four animals were immediately killed and the remaining animals were randomly assigned into a myringotomy group (n = 16, myringotomy on the left ear) and a non‐myringotomy group (n = 16, otomicroscopy without myringotomy). Otomicroscopy and killings were performed in series of four animals from each group at days 1, 2, 4, and 7 after myringotomy. Tympanic membranes were collected after fixation and processed for light and electron microscopy.

Results All inoculated ears showed a manifest acute otitis media at day 0. An intense infiltration by inflammatory cells and edema distorted severely the tympanic membrane structure. These findings decreased the following days. However, inflammation as evaluated by the thickness and the cytoarchitecture of the tympanic membrane layers, recovered significantly faster in the membranes in the non‐myringotomy group. At day 7, all tympanic membranes in the myringotomy group were closed by a hypertrophic keratinizing epithelium and a remodeling connective tissue layer, whereas the animals in the non‐myringotomy group had a residual edema in the lamina propria.

Conclusions The present infectious model induced an intense inflammatory reaction within the entire structure of the tympanic membrane. Myringotomy provoked a delayed recovery from the inflammatory process within the tympanic membrane. Therefore, if applicable to human conditions, the use of myringotomy in the management of acute otitis media should be restricted to selected cases of acute otitis media.
The Diagnostic Utility of an Electronic Nose: Rhinologic Applications
Authors: Thaler Erica R.
Published: November 2003

Objective/Hypothesis The thesis explores the applicability of electronic nose technology in medical decision‐making. Specifically, the studies undertaken in the thesis were designed to test the ability of the electronic nose to assist in diagnostic questions encountered in the field of rhinology.

Study Design Three separate studies were undertaken. All involved analysis of specimens by the electronic nose, obtained either in vitro or in vivo: known matched sets of cerebrospinal fluid and serum, bacterial samples from known plated specimens, and culture swabs taken from patients suspected of having rhinosinusitis who also had a matched standard bacterial culture taken from the same site. The goal of analysis was to determine whether the electronic nose was able to identify or categorize specimens or groups of specimens.

Methods Each specimen was tested using the organic semiconductor‐based Cyranose 320 electronic nose. Data from the 32‐element sensor array were subjected to principal‐component analysis to depict differences in odorant patterns. Distinction of specimens was identified by calculation of Mahalanobis distance.

Results The electronic nose was able to distinguish serum from cerebrospinal fluid in pure isolates as well as in isolates collected on small cottonoid pledgets at amounts of 0.2 mL or greater. It was also able to distinguish between control swabs and bacterial samples as well as among bacterial samples collected in vitro. Preliminary work suggests that it may be able to distinguish between presence and absence of bacterial infection in specimens collected on nasal swabs.

Conclusions The electronic nose is able to distinguish reliably between cerebrospinal fluid and serum sampled in small amounts, may be able to identify presence and type of bacterial pathogen in vitro, and is able to identify presence or absence of bacteria on nasal swabs. Because this information is available immediately, the electronic nose may be a powerful new technology for diagnostic use, not only for rhinologic purposes but in many other aspects of medicine as well.
Retinoblastoma–Cyclin‐Dependent Kinase Pathway Deregulation in Vestibular Schwannomas
Authors: Lasak John M. , Welling D. Bradley , Akhmametyeva Elena M. , Salloum Mariah , Chang Long‐Sheng
Published: November 2003

Objectives The purpose of the study was to identify genes of the retinoblastoma protein (pRb)–cyclin‐dependent kinase (CDK) pathway that are deregulated in vestibular schwannomas when compared with normal vestibular nerve tissues.

Study Design Expression profiles in eight vestibular schwannomas (four sporadic tumors, one neurofibromatosis type 2 tumor, and three cystic tumors) and a paired normal vestibular nerve from one of the eight patients were chosen. Genes examined included the retinoblastoma susceptibility gene (Rb‐1); cyclins D1, D2, A, and E; the CDK inhibitors p18, p19, and p27; CDK2 and CDK6; transcription factors E2F‐4, E2F‐5, and DP‐1; and the neurofibromatosis type 2 gene.

Methods Total RNA samples were extracted from normal vestibular nerve and vestibular schwannoma tissues and used to generate radiolabeled complementary DNA (cDNA) samples. Labeled cDNA probes were then hybridized to cDNA microarray filters. The hybridization signal was captured and quantified. Differential gene expression profiles between the normal vestibular nerve and vestibular schwannoma were compared. Real‐time polymerase chain reaction and immunohistochemistry were used to further confirm the cDNA microarray data.

Results Among genes in the pRb‐CDK pathway, CDK2 was substantially underexpressed in seven of the eight vestibular schwannoma tumors examined. Quantitative RNA expression analysis using real‐time polymerase chain reaction also showed consistent downregulation of CDK2 in the tumors. Anti‐CDK2 antibody stained predominantly in the vestibular nerve and ganglion cells but only weakly in the vestibular schwannoma tissues.

Conclusions The pRb‐CDK pathway was altered in all vestibular schwannoma tumors examined, with CDK2 significantly downregulated in seven of the eight tumors. Further investigation into the regulatory mechanisms governing CDK2 expression may lead to a better understanding of vestibular schwannoma tumorigenesis.
Vestibular Evoked Myogenic Potentials in Delayed Endolymphatic Hydrops
Authors: Young Yi‐Ho , Huang Tsung‐Wei , Cheng Po‐Wen
Published: November 2003

Objective/Hypothesis Vestibular evoked myogenic potential (VEMP) has become an established test to explore the sacculo‐collic reflex. The study aims to investigate the VEMPs in cases of delayed endolymphatic hydrops because greatly dilated saccule was observed in histopathological specimens of delayed endolymphatic hydrops.

Study Design Prospective study.

Methods Twenty patients with delayed endolymphatic hydrops were subjected to pure‐tone audiometry, caloric testing, and VEMP test. Delayed VEMP was defined as the latency of peak I exceeding 22.6 milliseconds or of peak II exceeding 33.1 milliseconds. Interaural amplitude difference over the sum of amplitudes of both ears was measured, and when the ratio exceeded 0.36, it was identified as augmented VEMP or depressed VEMP depending on whether the amplitude of the lesioned side was greater or less than the opposite side.

Results The VEMP test revealed that 9 patients (45%) were normal, 6 (30%) exhibited absent VEMPs, and 5 (25%) displayed abnormal VEMPs, including delayed VEMPs in 2, depressed VEMPs in 2, and augmented VEMPs in 1. The caloric test indicated that 9 (47%) of the 19 ears exhibited normal caloric response, whereas 10 ears displayed abnormal caloric responses including canal paresis in 8 and absent caloric response in 2. Six ears had preserved both the caloric response and the VEMPs, whereas no ear demonstrated both absent caloric response and absent VEMPs.

Conclusions The residual caloric as well as saccular functions after ear insult may determine whether delayed endolymphatic hydrops will occur. These findings suggest that patients with sudden deafness or juvenile unilateral total deafness should undergo caloric testing and VEMP test to predict the occurrence of delayed endolymphatic hydrops in the future.
Tympanometric Findings in Patients With Enlarged Vestibular Aqueducts
Authors: Sato Eisuke , Nakashima Tsutomu , Lilly David J. , Fausti Stephen A. , Ueda Hiromi , Misawa Hayato , Uchida Yasue , Furuhashi Atsushi , Asahi Kiyomitsu , Naganawa Shinji
Published: November 2003

Objectives The purpose of this study was to study systematically some relationships between the resonance frequency of the middle‐ear transmission system and the volume of the endolymphatic duct and sac in patients with an enlarged vestibular aqueduct (EVA).

Study Design Prospective study.

Methods Thirteen patients (24 ears) with EVA, 17 subjects (29 ears) with normal hearing, and 17 patients (21 ears) with sensorineural hearing loss without EVA served as experimental subjects. Standard pure‐tone audiometry, standard clinical tympanometry (using a 226‐Hz probe tone), and multifrequency tympanometry were performed on each ear. Magnetic resonance imaging was used to determine the area of the cochlear modiolus and the volume of the endolymphatic duct and sac.

Results The audiometric configurations for most patients sloped downward from the low to the high frequencies. A significant air‐bone gap was computed at each of these test frequencies. Multifrequency tympanometry yielded resonance frequencies for the patients with EVA that was significantly lower than those measured for the control subjects. In general, for patients with EVA, the resonance frequency of the middle ear system decreased as the volume of the endolymphatic duct and sac increased. This inverse relation was significant (correlation coefficient = −0.483, P = .0157). However, there was no correlation between resonance frequency and the degree of cochlea modiolar deficiency.

Conclusions Clinically, our findings suggest that EVA probably should be included in the differential diagnosis for a patient who presents with a moderate to severe mixed hearing loss, a normal tympanogram at 226 Hz, and a resonance frequency that is abnormally low.
Cytokine Profiles in a Rat Model of Otitis Media With Effusion Caused by Eustachian Tube Obstruction With and Without Streptococcus pneumoniae Infection
Authors: Hebda Patricia A. , Piltcher Otavio B. , Swarts J. Douglas , Alper Cuneyt M. , Zeevi Adriana , Doyle William J.
Published: November 2003

Objective Cytokine expression was studied in a rat model of otitis media with effusion.

Methods The left eustachian tube was obstructed (eustachian tube obstruction [ETO]) in 84 rats. Forty‐two ears were challenged with Streptococcus pneumoniae, and those rats were treated from day 2 to day 7 with ampicillin. Twelve rats (6 per group) were killed on days 1, 2, 7, 21, 35, 56, and 112; mucosa was harvested and assayed for interleukin‐1β (IL‐1β), tumor necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), interferon‐γ (IFN‐γ), transforming growth factor‐β (TGF‐β), monocyte chemoattractant protein‐1 (MCP‐1), and interleukin‐8 (IL‐8) gene expression, and effusion was assayed for IL‐1β, TNF‐α, IL‐6, IL‐10, and macrophage inflammatory protein‐2 (MIP‐2) protein.

Results Most cytokines were detectable in the effusion from infected ears with ETO on days 1 and 2 only. MIP‐2 exhibited a biphasic response. Only effusion MIP‐2 was consistently detected in uninfected ears with ETO. Three patterns of mucosal cytokine messenger RNA (mRNA) upregulation were observed: isolated early (IL‐1β, IL‐8), isolated late (TNF‐α, IFN‐γ), and biphasic (MCP‐1, IL‐6, TGF‐β) responses. Early cytokine mRNA upregulations were observed only in the infected ears with ETO, whereas late upregulations were observed in both groups.

Conclusions Early expression of the assayed cytokines occurred only in ears with active infection. For both groups, a late upregulation of cytokine message but not protein was documented. The profile of cytokine expression during otitis media episodes may be useful in defining etiology, disease stage, and prognosis.
High‐Resolution Magnetic Resonance Imaging of Human Cochlea
Authors: Silver Robert D. , Djalilian Hamid R. , Levine Samuel C. , Rimell Frank L.
Published: November 2003

Objectives High‐resolution MRI (MRI) of human inner ear structures provides several advantages over other imaging modalities. High‐resolution visualization of inner ear ultrastructure in a noninvasive manner may provide important information about inner ear disease that is not obtainable in other ways. The study was performed to demonstrate the capabilities of MRI at high resolution on the human cochlea, vestibular structures, and facial nerve. Comparative analyses of MRI anatomy with that seen on histological dissection were made. The aim of the study was to define the anatomy of human cadaveric cochlea using a 9.4‐Tesla magnetic resonance scanner, currently the most powerful magnetic resonance magnet available.

Study Design Experimental pilot study of cadaveric human cochleae.

Methods Serial scanning using a 9.4‐Tesla magnetic resonance imager on normal preserved and fresh cadaveric inner ears was performed in different planes.

Results The images revealed detailed anatomy of the modiolus, utricle, saccule, semicircular canals, and facial nerve. Specifically, identifiable structures within the cochlea included the osseous spiral lamina, Reissner's membrane, membranous spiral lamina, spiral ligament, and others.

Conclusions Data established through the acquisition of images from cadaver cochlea, facial nerve, and vestibular complex provide a foundation for developing steps for testing temporal bones and, eventually, patients with Meniere's disease and other inner ear disease. The present ongoing project will provide information on baseline images of the inner ear using high‐resolution MRI.
Reduction of Diplopia Following Endoscopic Orbital Decompression: The Orbital Sling Technique
Authors: Metson Ralph , Samaha Mark
Published: November 2003

Objective Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression.

Study Design Case‐control.

Methods Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow‐up was 3.3 ± 1.3 years (range, 1.7–5.1 y).

Results The incidence of new‐onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [P = .038]). No patients in the orbital sling group developed new‐onset diplopia following surgery. Of the eight patients with pre‐existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 ± 1.1 mm vs. 5.0 ± 1.9 mm, respectively [P = .98]).

Conclusions The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.
The Fate of Mastoid Obliteration Tissue: A Histopathological Study
Authors: Linthicum Fred H.
Published: November 2003

Objectives To demonstrate the histopathological fate of tissues used for mastoid obliteration over a period of 30 years.

Study Design Retrospective histopathological analysis of archival temporal bone microscopic sections.

Methods From the database of the laboratory, the 17 temporal bones from subjects who had undergone mastoid obliteration procedures were identified. The microscopic appearance of the obliteration tissue was described, and microphotographs made of significant findings.

Results Fat and bone chips, or paté, retained their bulk in the obliterated space, whereas subcutaneous tissue and muscle lost bulk but seemed to promote healing. Some substances, such as bone wax, used for hemostasis and buried under obliteration tissue, were found to produce a subclinical inflammatory reaction, but other materials, such as Surgicel and Gelfoam, did not.

Conclusions Fat and bone chips, or paté, used as mastoid obliteration tissue, retained their bulk and identity, whereas subcutaneous tissue and muscle did not.
Submucosal Bipolar Radiofrequency Thermal Ablation of Inferior Turbinates: A Long‐Term Follow‐up With Subjective and Objective Assessment
Authors: Bäck Leif J.J. , Hytönen Maija L. , Malmberg Henrik O. , Ylikoski Jukka S.
Published: November 2003

Objective To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy.

Study Design Prospective, nonrandomized study and outpatient treatment.

Methods Twenty patients (age range, 23–77 y; median age, 52 y) enrolled in the study. There was one dropout. All the patients had nasal blockage despite medical treatment. Bipolar radiofrequency thermal ablation was delivered to inferior turbinates at 100 kHz with a voltage root mean square value of 168 to 182. The preoperative and postoperative nasal functions were investigated by immediate and long‐term visual analogue scale (VAS) scores of symptom parameters, olfactory thresholds, saccharine transit time, rhinomanometry, and acoustic rhinometry. The follow‐up was conducted at 1 week and 3, 6, and 12 months.

Results The VAS scores of subjective complaints (nasal discharge, itching, sneezing, crusting) decreased, and the VAS scores of evaluation of the effectiveness (frequency of nasal obstruction, degree of nasal obstruction, and patient satisfaction) increased statistically significantly in the 12‐month follow‐up without relapses. There were no adverse effects on nasal epithelial clearance time and olfactory functions. In rhinomanometry the changes in total nasal resistance and response to the vasoconstrictor agent were not statistically significant. In acoustic rhinometry the change in the sum of both nasal cavity volumes from nostril to 5 cm was statistically significant 6 and 12 months after the treatments. The difference between the preoperative and postoperative vasoconstrictive effect was not statistically significant.

Conclusion The bipolar radiofrequency thermal ablation of inferior turbinates is a promising alternative, which should be considered when planning inferior turbinate interventions.
Nasal Nitric Oxide in Children: A Novel Measurement Technique and Normal Values
Authors: Daya Hamid , Qian Wei , McClean Pat , Haight James , Zamel Noel , Papsin Blake C. , Forte Vito
Published: November 2003

Objectives To develop and standardize a technique for measuring nasal nitric oxide (NO) output in children and to determine normal values in this population.

Study Design Prospective study evaluating a new technique for measuring nasal nitric oxide in a cohort of normal patients and a cohort of patients with nasal disease.

Methods Nasal NO was measured using an aspiration technique, aspirating room air through the nasal cavities by means of a Teflon nozzle placed in one nasal vestibule while maintaining velopharyngeal closure using a party “blow‐out” toy

Results Nasal NO measurements were performed in 45 children (mean age, 11.0 y; age range, 3.2–17.6 y) There were 20 girls and 25 boys. All children were able to perform the maneuvers necessary for measurement of nasal NO output. Among the subgroup of normal healthy children (30), there was considerable variation in NO output between subjects, with a mean NO output of 481 nL/min and an SD of 283 nL/min.

Conclusions Nasal NO can be readily measured in children using the presented technique. There is considerable variability in the values for nasal NO output in normal children.
Intraoperative Electromyography for Identification of the Trapezius Muscle Innervation: Clinical Proof of a New Anatomical Concept
Authors: Kierner Antonius C. , Burian M. , Bentzien S. , Gstoettner W.
Published: November 2003

Objective/Hypothesis There is still considerable controversy among surgeons on trapezius muscle innervation. In addition, the rate of unexpected postoperative trapezius pareses is unacceptably high. Recent anatomical findings might answer most of the questions. The objective of the present study was to clinically prove the recent anatomical findings, especially the concept of the innervation of the descending part of the trapezius muscle.

Study Design Intraoperative electromyography of the spinal accessory nerve and its branches in the posterior triangle of the neck.

Setting Intraoperative electromyography was performed during 17 modified radical neck dissections on 14 patients of both sexes ranging in age from 44 to 68 years (mean age, 56 y). Potentials were registered through pairs of needle electrodes placed in each of the three parts of the trapezius muscle. Intraoperatively, the spinal accessory nerve and its fine cranial branch passing toward the descending part of the muscle were identified and stimulated in the posterior triangle of the neck.

Results Stimulation of the fine cranial branch of the spinal accessory nerve led to a clearly visible and recordable contraction in the descending part of the trapezius muscle in all patients. Stimulation of the main trunk of the spinal accessory nerve in the posterior triangle of the neck distal to the above‐mentioned branching led to a clearly visible and recordable contraction in the transverse and ascending parts of the muscle.

Conclusions The results strongly support recent anatomical findings showing that, functionally, the most important descending part of the trapezius muscle is innervated by a fine single branch arising from the spinal accessory nerve in the posterior triangle of the neck. This may help to prevent more patients undergoing modified radical neck dissections from shoulder‐arm syndrome.
The ‘Butterfly’ Graft in Functional Secondary Rhinoplasty
Authors: Clark J. Madison , Cook Ted A.
Published: November 2003

Objective To describe a surgical technique (the conchal cartilage “butterfly” graft) which, when used in properly selected patients, has been found to be a dependable method for alleviation of postrhinoplasty internal nasal valve dysfunction.

Study Design Retrospective chart review.

Methods Analysis of consecutive patients with weakness and/or collapse of the upper lateral cartilages following rhinoplasty. Seventy‐two patients (37 women and 35 men, age range 17–76 y) had severe nasal obstruction and were found to have indications for this procedure. All patients had undergone at least one rhinoplastic procedure. All patients were followed for a minimum of 2 years after surgery.

Results All 72 patients experienced significant subjective improvement in relative nasal obstruction. Two patients (3%) reported less than total resolution of their difficulty breathing through their nose; the remaining 70 patients (97%) reported complete resolution of their nasal airway problems. No patients reported their postoperative nasal obstruction as the same or worse than their preoperative baseline. Sixty‐two patients (86%) reported improvement in the appearance of their nose, 8 patients (11%) felt that their appearance was unchanged, and 2 patients (3%) felt that the appearance of their nose was made worse by the procedure.

Conclusions Patients presenting with nasal obstruction after rhinoplasty are frequently found to have collapse and/or weakening of their upper lateral cartilages with resulting nasal valve dysfunction. The conchal cartilage “butterfly” graft is a technique which, when properly performed during revision rhinoplasty, yields predictable functional and cosmetic results with minimal morbidity.
‘Defatting’ Tracheotomy in Morbidly Obese Patients
Authors: Gross Neil D. , Cohen James I. , Andersen Peter E. , Wax Mark K.
Published: November 2003

Objectives/Hypothesis Standard‐sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the “defatting” tracheotomy.

Study Design Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy.

Methods Medical charts were reviewed for indications, demographics, body mass index, tracheotomy‐related complications, and decannulation results.

Results The average age of patients was 50 years (age range, 34–77 y). The mean preoperative body mass index was 55.9 (range, 39.2–73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow‐up time of survivors was 23 months. The overall tracheotomy‐related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation.

Conclusions Defatting tracheotomy is a safe technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.
The Efficacy of Corticosteroids in Postparotidectomy Facial Nerve Paresis
Authors: Lee Kimberly J. , Fee Willard E. , Terris David J.
Published: November 2003

Objective To determine whether the administration of perioperative corticosteroids is effective in ameliorating facial nerve paresis after parotidectomy.

Study Design Prospective, randomized, double‐blinded, placebo‐controlled clinical trial at a university medical center.

Methods Patients scheduled for parotidectomy and who met inclusion criteria were invited to enroll in the protocol. They were stratified according to the anticipated surgery (superficial or total parotidectomy) and then received one of two doses of dexamethasone (0.51 or 1.41 mg/kg divided into three doses) or placebo solution immediately preoperatively and then every 8 hours for 16 hours postoperatively. The facial nerve was graded for proportion (percentage) of function at each of the four major regions (frontal, orbital, midface and upper lip, and lower lip). The early postoperative function and rate of return of function were compared among the treatment groups.

Results Forty‐nine patients were enrolled and evaluated (18 in the control group, 16 receiving low‐dose dexamethasone, and 15 receiving high‐dose dexamethasone). No therapeutic advantage of dexamethasone treatment could be appreciated with respect to the degree of early postoperative nerve function (81.3% for control patients vs. 69.5% for dexamethasone‐treated patients [P = .239]). Similarly, the median time to recovery of complete facial nerve function was 60 days in the control group and was 150 days in the dexamethasone‐treated patients.

Conclusions Dexamethasone administration in patients undergoing parotidectomy is not justified. Despite the relatively modest risk profile of dexamethasone, we were unable to demonstrate any benefit in patients who were treated with either low‐dose or high‐dose steroids compared with placebo‐treated patients in a randomized, controlled trial.