bluuebunny/crossref_metadata_2025 huggingface dataset:
Ear Candles‐Efficacy and Safety
Authors: Seely Daniel R. , Quigley Suzanne M. , Langman Alan W.
Published: November 2003

Ear candles are a popular and inexpensive alternative health treatment advocated for cerumen removal. A hollow candle is burned with one end in the ear canal with the intent of creating negative pressure and drawing cerumen from the ear. If effective, significant savings could result from the use of ear candles. This study evaluates the efficacy and safety of this alternative method for cerumen management. Tympanometric measurements in an ear canal model demonstrated that ear candles do not produce negative pressure. A limited clinical trial (eight ears) showed no removal of cerumen from the external auditory canal. Candle wax was actually deposited in some. A survey of 122 otolaryngologists identified 21 ear injuries resulting from ear candle use. Ear candles have no benefit in the management of cerumen and may result in serious injury.

Laryngoscope, 106:1226‐1229, 1996
Enhanced Reliability and Renewed Applications of the Deltopectoral Flap in Head and Neck Reconstruction
Authors: Kingdom Todd T. , Singer Mark I.
Published: November 2003

Bakamjian introduced the deltopectoral skin flap in 1965, and thereafter it was used extensively for reconstructive surgery of the head and neck. Flap failure rates of 10% to 25% were reported, necessitating the development of alternative methods of reconstruction and eventually relegating the flap to historical references. Since 1991, we have used the deltopectoral flap in 24 patients for reconstruction after head and neck tumor surgery. Simple technical modifications have been used to enhance the reliability of this flap, with no observed failures or even partial flap loss. The deltopectoral flap remains a versatile and reliable tissue source that can be used simultaneously with the pectoralis major myocutaneous flap for a variety of complex head and neck reconstructions.

Laryngoscope, 106:1230‐1233, 1996
Tympanostomies With Tubes: The Parent Perspective
Authors: Urben Susan L. , Nichols Richard D.
Published: November 2003

Successful physician‐patient encounters satisfy patient and family member needs beyond the effect on the disease process itself. To evaluate that aspect of care in children with chronic and recurrent acute otitis media with effusion, surveys regarding perceptions of health, socioeconomic issues, and other aspects of postoperative status were sent to the parents of 637 children who underwent tympanostomies with tubes in 1994. Three hundred one (47.3%) were returned. Responses included perceptions of improved health (87%), improvement in socioeconomic factors (75%), overall satisfaction with the results of the operation (93%), and willingness to consent to the operation given similar problems in another child (87%). There were no significant differences in responses with regard to patient gender, length of follow‐up, or multiple operations. These results suggest that patient and family needs are satisfied by tympanostomies with tubes.

Laryngoscope, 106:1269‐1273, 1996
Bupivacaine for Postoperative Analgesia Following Endoscopic Sinus Surgery
Authors: Friedman Michael , Venkatesan T. K. , Lang David , Caldarelli David D.
Published: November 2003

This prospective study was conducted to examine pain after endoscopic sinus surgery (ESS). The hypothesis was that a long‐acting anesthetic agent would result in patients experiencing less pain in the 24‐hour postoperative period and therefore needing fewer oral analgesics. We randomized 100 patients undergoing ESS to receive either lidocaine (1% or 2%) with epinephrine or bupivacaine (0.25% or 0.5%) with epinephrine as an anesthetic and for a sphenopalatine block. Postoperative pain was assessed with a standard numeric pain assessment scale at baseline and at 2, 6, and 24 hours after surgery. The use of analgesics during this period was also documented. We compared the results between patients receiving bupivacaine and those receiving lidocaine, as well as between patients who required nasal packing and those who did not. We discovered that in general, pain after ESS was less severe than expected. We further found that the type of anesthetic used did not significantly affect postoperative pain; pain score changes and use of analgesics were similar between the two anesthesia groups. Postoperative pain was also similar between the “packing” and “no packing” groups. Although patients receiving packing had consistently lower increases in pain (and in fact many patients in this group had decreases in pain from baseline), none of the differences between group means was statistically significant.
Screening for Obstructive Sleep Apnea in Patients Presenting for Snoring Surgery
Authors: Pradhan Pratik S. , Gliklich Richard E. , Winkelman John
Published: November 2003

Excessive mortality is associated with obstructive sleep apnea (OSA). Therefore it is important to diagnose OSA in patients presenting for snoring surgery. A prospective study was performed to develop screening models to detect OSA compared with universal polysomnography for sensitivity and cost. Multivariate analysis of 150 consecutive patients was based on clinical data, questionnaire data, and polysomnography. Two screening models obtained 100% sensitivity and reduced the need for polysomnograms. Cost savings of screening based on clinical data was projected to be $35 to $80 per patient using reported prevalence rates of OSA among snorers. A screening model for OSA using clinical data alone is more cost‐effective than one that combines these data with pulse oximetry data, but savings over universal polysomnography were modest.
Staged Repair of Cervical Tracheoesophageal Fistulae
Authors: Shaari Christopher M. , Biller Hugh F.
Published: November 2003

Acquired, nonmalignant tracheoesophageal (TE) fistulae are most often iatrogenic or trauma induced. When a cervical TE fistula is complicated by tracheal stenosis or malacia, a single‐stage repair of the fistula and tracheal defect is usually advocated. Complications of this single‐stage repair, which occur in 25% to 50% of patients, are secondary to either excess tension at the tracheal anastomosis or the presence of inflammation at the time of tracheal anastomosis. Complications include recurrent tracheal stenosis, pneumonia, or a recurrent TE fistula.

This report describes the senior author's techniques of reconstructing the trachea when tracheal stenosis complicates a TE fistula. These techniques are illustrated in two case reports of patients with postintubation TE fistulae. Current methods of tracheal reconstruction in this setting are reviewed. The incidence of postoperative complications may decrease if tracheal reconstruction is delayed until the fistula is successfully closed.
The Effect of Topical Vasodilating Agents on Microvascular Vessel Diameter in the Rat Model
Authors: Kerschner Joseph E. , Futran Neal D.
Published: November 2003

Topical vasodilating agents maximize blood flow and prevent vasospasm in microvascular tissuetransfer procedures. Two commonly used agents are papaverine and lidocaine. Although these drugs have vasodilating properties, no studies have directly compared their vasodilating abilities in a controlled, in vivo model. We used videomicroscopy and direct microscopic measurements to compare the vasodilating capacity of papaverine, 1% lidocaine, and saline solution in the femoral artery of Sprague‐Dawley rats. Degree of maximum dilation, ability to sustain dilation, average dilation over a 10‐minute period, and time to achieve maximum dilation were considered. Both papaverine and lidocaine were found to be superior to saline solution as vasodilating agents. Papaverine was found to sustain vasodilation longer than lidocaine, suggesting that it is a superior vasodilating agent in microvascular anastomoses.
Differentiation Between Schwannoma of the Vagus Nerve and Schwannoma of the Cervical Sympathetic Chain by Imaging Diagnosis
Authors: Furukawa Masaki , Furukawa Madoka K. , Katoh Kiyoshi , Tsukuda Mamoru
Published: November 2003

Ultrasonography, computed tomography, and magnetic resonance imaging were performed to differentiate preoperatively between schwannomas of the vagus nerve and schwannomas of the cervical sympathetic chain by observing the position of schwannomas in regard to the surrounding blood vessels. Ultrasonography also permitted direct visualization of the vagus nerve, so its position relative to the schwannoma could be examined.

In schwannomas of the vagus nerve the schwannoma grew between the common carotid artery and the internal jugular vein or between the internal carotid artery and the internal jugular vein, resulting in an increase in the distance between the artery and vein (separation). In schwannomas of the cervical sympathetic chain, no separation was observed between the internal jugular vein and the common carotid artery or internal carotid artery.

Ultrasonography with a 7.5‐MHz transducer showed the derivation of the tumor from the vagus nerve in schwannomas of the vagus nerve but showed the vagus nerve on the tumor surface in schwannomas of the cervical sympathetic chain.
The Outcome of Vestibular Nerve Section for Intractable Vertigo: The Patient's Point of View
Authors: Reid Colin B , Eisenberg Robert , Halmagyi G. Michael , Fagan Paul A.
Published: November 2003

To document the outcome of vestibular nerve section from the patient's point of view we reviewed 102 patients who had undergone vestibular nerve section 1 to 10 years after operation. Only 3 patients had experienced further vertigo attacks: 2 of these were cured by a further, this time translabyrinthine vestibular nerve section; 1 patient developed multiple sclerosis. In contrast, about 50% of patients developed some subjective problem with balance while standing or walking; in 15% it was present all the time and of moderate severity. Despite this, over 85% of patients reported that they felt much better or back to normal after the operation and were satisfied with the outcome. The development and application of objective preoperative measures of vestibular and, in particular, vestibulospinal function might improve patient selection for vestibular nerve section and thus reduce the number of dissatisfied patients.
Pediatric Aerodigestive Foreign Body Injuries Are Complications Related to Timeliness of Diagnosis
Authors: Reilly J. , Thompson J. , MacArthur C. , Pransky S. , Beste D. , Smith M. , Gray S. , Manning S. , Walter M. , Derkay C. , Muntz H. , Friedman E. , Myer C.M. , Seibert R. , Riding K. , Cuyler J. , Todd W. , Smith R.
Published: November 2003

Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi‐institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis(>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries(e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow‐up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.
Rehabilitation of Patients with Extended Facial and Craniofacial Resection
Authors: Mathog Robert H. , Shibuya Terry , Leider Jeffrey , Marunick Mark
Published: November 2003

Surgery of benign and malignant disease of the nose and sinuses can result in disfigurement and disability. Many patients have speech, mastication, and swallowing problems, anosmia, and pain. If the orbit is retained, visual loss, dystopia, diplopia, and epiphora can occur.

This study reviews the senior author's experience with 34 patients over the last 18 years. Group and case analyses demonstrate that in patients with cancer, the eye can be preserved if one anatomical boundary is retained beyond a negative frozen section margin. Dystopia can be prevented by reconstruction of the floor with skin and fascial grafts or flaps. Epiphora can be reduced by repair of the medial canthus and dacryocystorhinostomy. Evidence is presented for prosthetic management of speech and swallowing and restoration of cheek contour. Case examples are used to illustrate the surgical techniques.
Expression of the RET/PTC Fusion Gene as a Marker for Papillary Carcinoma in Hashimoto's Thyroiditis
Authors: Wirtschafter Ari , Schmidt Richard , Rosen David , Kundu Nandita , Santoro Massimo , Fusco Alfredo , Multhaupt Hinke , Atkins Joseph P. , Rosen Marc R. , Keane William M. , Rothstein Jay L.
Published: November 2003

Hashimoto's thyroiditis is an inflammatory disease of the thyroid gland with autoimmune etiology.1 Patients afflicted with Hashimoto's have a higher risk of thyroid malignancies such as papillary thyroid carcinoma.2 In the present study, we investigated the frequency of papillary thyroid carcinoma specific genes in patients diagnosed with Hashimoto's disease. The newly identified oncogenes RET/PTC1 and RET/PTC3 provide useful and specific markers of the early stages of papillary carcinoma as they are highly specific for malignant cells. Using a sensitive and specific reverse transcriptase‐polymerase chain reaction (RT‐PCR) assay, we found messenger RNA(mRNA) expression for the RET/PTC1 and RET/PTC3 oncogenes in 95% of the Hashimoto's patients studied. All Hashimoto's patients presenting without histopathologic evidence of papillary thyroid cancer showed molecular genetic evidence of cancer. These data suggest that multiple, independent occult tumors exist in these patiens at high frequency.
Functional Endoscopic Sinus Surgery and 109 Mycetomas of Paranasal Sinuses
Authors: Klossek Jean‐Michel , Serrano Elie , Péloquin Louis , Percodani Josiane , Fontanel Jean‐Pierre , Pessey Jean‐Jacques
Published: November 2003

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow‐up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow‐up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.
Major Patterns of Laryngeal Electromyography and Their Clinical Application
Authors: Yin Shengguang S. , Qiu William W. , Stucker Fred J.
Published: November 2003

Laryngeal electromyography (LEMG) is clinically valuable in the evaluation of laryngeal dysfunction and vocal fold immobility. To facilitate clinical application of this electrophysiologic test, a detailed description of modified LEMG techniques is presented. The techniques were applied for simultaneous bilateral recordings of the thyroarytenoid, cricothyroid, and posterior cricoarytenoid muscles. The basic patterns of LEMG are classified into three different types: normal, neuropathy, and myopathy. In an attempt to characterize these patterns, we have reported eight LEMG‐documented cases: unilateral laryngeal paralysis, bilateral laryngeal paralysis, cricoarytenoid joint dislocation, cricoarytenoid joint ankylosis, laryngeal myopathy, pharyngeal paralysis (soft palate paralysis), spasmodic dysphonia, and unilateral laryngeal paralysis with anastomosis. The significance of the major LEMG patterns is discussed.
Computed Tomography and Magnetic Resonance Diagnosis of Allergic Fungal Sinusitis
Authors: Manning Scott C. , Merkel Marie , Kriesel Kevin , Vuitch Frank , Marple Bradley
Published: November 2003

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2‐weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.
Delphian Lymph Node in Laryngeal Carcinoma: A Whole Organ Study
Authors: Thaler Erica R. , Montone Kathleen , Tucker John , Weinstein Gregory S.
Published: November 2003

The incidence of Delphian or cricothyroid lymph node involvement in laryngeal carcinoma was studied in whole organ sections of 92 laryngectomy specimens. Histologic examination revealed that of the 92 whole organ sections, 8 were noted to have cricothyroid node involvement (8.7%). All 8 patients had submucosal involvement of the conus elasticus, 7 had involvement of the subglottic mucosa, and 6 had invasion of the cricoid cartilage. Four of the 8 patients with cricothyroid node involvement died of the disease, 3 of whom had stomal recurrence. None of the patients who died of disease had surgical management of the paratracheal lymph nodes or postoperative radiation therapy. The benefit of surgical margins of the paratracheal lymph node bed as well as the role of radiation therapy are discussed.
Minimally Invasive Head Holder to Improve the Performance of Frameless Stereotactic Surgery
Authors: Bale Reto J. , Vogele Michael , Freysinger Wolfgang , Gunkel Andreas R. , Martin Arno , Bumm Klaus , Thumfart Walter F.
Published: November 2003

Frameless stereotactic procedures crucially depend on the firmness of immobilization. Once registered, shifting of the patient leads to inaccuracy, and the patient registration has to be realigned. To overcome the drawbacks of conventional invasive fixation for neurosurgery and the widely accepted fixation with surgical tape in ENT, the Vogele‐Bale‐Hohner (VBH) head holder has been developed. It permits rigid, noninvasive fixation of the head by using an individualized dental cast attached to the upper jaw by vacuum. Oral intubation is uncomplicated. In addition, a special registration device providing well defined reference points can be mounted to the mouthpiece. We report the first promising clinical applications of this device.
Genetic and Clinical Features of Sensorineural Hearing Loss Associated With the 1555 Mitochondrial Mutation
Authors: Usami Shin‐ichi , Abe Satoko , Kasai Miyo , Shinkawa Hideichi , Moeller Benjamin , Kenyon Judy B. , Kimberling, William J.
Published: November 2003

Five Japanese families showing aminoglycoside‐induced hearing loss were genetically as well as clinically investigated. A mitochondrial mutation at nucleotide 1555 was found in 28 out of 32 subjects. One hundred American control subjects did not show any evidence of the mutation at nucleotide 1555, suggesting that the 1555 A→G (A1555G) mitochondrial mutation may be found more frequently among populations in the Asian continent. Many subjects who harbor this mitochondrial mutation exhibit a mild, high‐frequency, progressive hearing loss even without aminoglycoside injection. The results presented here appear to support the hypothesis that the A1555G mutation may play a more general role in causing hearing loss.
Growth Patterns of Piriform Sinus Carcinomas
Authors: Zbären Peter , Egger Christine
Published: November 2003

Advances in functional surgery have encouraged many head and neck surgeons to treat piriform sinus carcinomas, whenever possible, by conservation surgery. An increased understanding of the histopathologic growth pattern and spread of piriform sinus carcinomas is needed to define criteria for appropriate application of voice preservation surgery. The purpose of this study was to analyze the patterns of tumor spread to laryngeal and parapharyngeal structures. A total of 42 specimens obtained by laryngopharyngectomy were subjected to a whole‐organ section study. Carcinomas confined to the lateral wall tended to extend laterally beyond the thyroid ala and rarely infiltrated the intrinsic laryngeal muscles. As a result, conservation surgery could be possible in many cases, including T4 carcinomas. Carcinomas confined to the medial wall or occupying the whole piriform sinus tended to infiltrate laryngeal structures early, and hemilaryngeal fixation was observed in 61% of these cases; tumor spread to the contralateral side in 64%. The hemilarynx fixation was due to an invasion of intrinsic laryngeal muscles. An isolated perineural or cricoarytenoid joint involvement was never observed. For these tumors, conservation surgery would be inadequate in most cases, as they often present extensive laryngeal involvement with spread to the contralateral side.
A Cost‐Effective and Rational Surgical Approach to Patients With Snoring, Upper Airway Resistance Syndrome, or Obstructive Sleep Apnea Syndrome
Authors: Utley David S. , Shin Edward J. , Clerk Alex A. , Terris David J.
Published: November 2003

The past decade has seen several innovations in the surgical techniques available for treatment of patients with sleep‐disordered breathing. Outpatient techniques such as laser‐assisted uvulopalatoplasty (LAUP) and more aggressive procedures designed to address hypopharyngeal and base of tongue obstruction (genioglossus advancement and hyoid myotomy) have been developed and proven successful. We describe the efficacy of LAUP for snoring (72.7%), upper airway resistance syndrome (81.8%), and mild (mean[±SD] respiratory disturbance index [RDI] = 12 ± 8.1) obstructive sleep apnea (41.7%) in 56 patients who underwent 132 LAUP procedures in a 26‐month period. Thirty‐two patients with more significant obstructive sleep apnea (mean RDI = 41.8 ± 23.1) underwent multilevel pharyngeal surgery consisting of genioglossus advancement and hyoid myotomy combined with uvulopalatopharyngoplasty. The surgical success rate in this group of patients was 85.7% when commonly accepted criteria were applied. We recommend a stratified surgical approach to patients with sleep‐disordered breathing. Progressively worse airway obstruction marked by multilevel pharyngeal collapse and more severe sleep‐disordered breathing is treated with incrementally more aggressive surgery addressing multiple areas of the upper airway.
Efficacy and Cost‐Effectiveness of Multihole Fine‐Needle Aspiration of Head and Neck Masses
Authors: Mui Stanley , Li Tsuan , Rasgon Barry M. , Hilsinger Raymond L. , Rumore Greg , Puligandla Balaram , Sawicki John
Published: November 2003

To determine whether the specimen from fineneedle aspiration (FNA) biopsy of head and neck masses has greater diagnostic accuracy when using multihole needles than when using conventional, single‐hole needles, we did a prospective, randomized, single‐blinded study comparing diagnoses obtained using both types of needles in FNA biopsies of head and neck masses. Eighty‐eight patients served as their own controls and had 91 FNA biopsies with both multihole and single‐hole, 22‐gauge needles. Order of biopsy was randomized and was unknown to the cytopathologist. No statistically significant differences were noted in quantity of specimen material obtained, quality of fixation, or diagnostic value between the multihole and conventional needle. We found no advantage in using the more costly multihole needle in FNA biopsy of head and neck masses.
An Efficiency Comparison of Four Heat and Moisture Exchangers Used in the Laryngectomized Patient
Authors: Grolman Wilko , Blom Eric D. , Branson Richard D. , Schouwenburg Paul F. , Hamaker Ronald C.
Published: November 2003

Bypassing the upper airway places the burden of humidification on the lower airway. For this reason passive heat and moisture exchangers (HMEs) are used in the laryngectomized patient in an attempt to minimize the effect of lost upper airway function. We measured efficiency and airflow resistance and calculated the costs of four HMEs used in the laryngectomized patient. The HMEs were measured according a modified International Standards Organization (ISO) 9360 standard. The airflow resistance was measured at flow rates of 15, 30, and 60 L/min. The measurements were repeated three times. Costs were calculated with two realistic scenarios. The study found that there are significant differences in moisture output and airflow resistance between the HMEs tested. There are major daily cost differences between these devices. This study shows that filter material and size influence the HME's moisture output efficiency and airflow resistance considerably. The construction differences and filter and housing type have great influence on the HME's daily costs. We believe that knowledge of the efficiency in combination with the average daily costs of the HMEs allows the clinician to make a balanced choice of which filter to use.
Three‐Dimensional Image‐Guided Endonasal Surgery With a Microdebrider
Authors: Gunkel Andreas Rüdiger , Freysinger Wolfgang , Martin Arno , Völklein Claudia , Bale Reto Josef , Vogele Michael , Thumfart Walter Franz
Published: November 2003

We report the first intraoperative use of a microdebrider as a stereotactic three‐dimensional (3D) navigation instrument in paranasal and frontobasal surgery. The microdebrider uses rotating blades and an integrated suction device for controlled removal of tissue under video‐endoscopic view. The ISG Viewing Wand uses the patient's computed tomography/magnetic resonance (CT/MR) data and a 3D reconstruction thereof and a highprecision position‐sensitive mechanical arm for intraoperative three‐dimensional navigation. We have linked the microdebrider to the Viewing Wand to transform it into a continuously available intraoperative stereotactic localizing device. We discuss the problems related to this extension of the Viewing Wand and demonstrate the practical use in an exemplary polypectomy.
Ingestion of Caustic Hair Relaxer: Is Endoscopy Necessary?
Authors: Cox Artemus J. , Eisenbeis John F.
Published: November 2003

Hair relaxer, a commercially available alkaline product, is commonly the offending agent in caustic ingestion. These patients often experience oral cavity and facial burns; however, no clinically significant esophageal injuries have been reported. Therefore, we questioned the therapeutic and economic efficacy of the “standard treatment protocol” that includes hospitalization and endoscopic evaluation. Twenty‐six patients over a 7‐year period presented to our institution having ingested hair relaxer. Presenting signs and symptoms, esophageal findings, and cost of the standard treatment protocol were reviewed. Also, we analyzed the caustic potential and current packaging of hair relaxer. Our findings support modifications in the standard treatment protocol for hair relaxer ingestion including elimination of hospitalization and endoscopy in most patients. We also question compliance with childproof packaging laws and suggest avenues for prevention of hair relaxer ingestion.
Pediatric Respiratory Papillomatosis: Prognostic Role of Viral Typing and Cofactors
Authors: Rimell Frank L. , Shoemaker David L. , Pou Anna Maria , Jordan Jeanne A. , Post J. Christopher , Ehrlich Garth D.
Published: November 2003

Children with recurrent respiratory papillomatosis vary greatly in their clinical disease course. Many have mild disease with eventual remission while others present with an early aggressive airway obstructive course. This study consisted of 24 pediatric patients whose specimens underwent polymerase chain reaction analysis for cytomegalovirus (CMV), herpes simplex virus (HSV), and human papillomavirus (HPV) type. Nineteen of 24 specimens contained enough DNA for this study. None of the specimens were found to contain DNA from HPV‐16, ‐18, ‐31, ‐33; CMV; or HSV, which contrasts with our previous findings in adults. Ten patients were infected by HPV‐11 and seven of these underwent tracheotomy because of an aggressive tumorigenic clinical course. Nine patients were infected by HPV‐6 alone of whom only two required a tracheotomy (P = 0.05, Fisher's Exact Test). The early airway obstructive course associated with HPV‐11, however, had no bearing on achieving eventual disease remission, with decannulation achieved in eight of nine children.
A New Technique for Hypoglossal‐Facial Nerve Repair
Authors: Atlas Marcus D. , Lowinger David S.G.
Published: November 2003

Hypoglossal reinnervation of the facial nerve may be required after a proximal facial nerve injury. The classic hypoglossal‐facial graft procedure involves transection of the donor hypoglossal nerve, resulting in hemiglottic paralysis that, in association with paralysis of other cranial nerves, may cause speech and swallowing difficulties. Multiple lower cranial nerve palsies in conjunction with facial paralysis, as may occur after procedures such as skull base surgery, contraindicate the use of such techniques. The successful use of XII‐VII “interposition jump grafts” without hemiglossal weakness has been described However, a prolonged recovery period and weaker facial reanimation have been seen. In order to attain maximum facial reinnervation while preserving hypoglossal function, we have developed a new technique of XII‐VII repair. This method involves mobilization of the intratemporal portion of the facial nerve remnant, achieving a single anastomosis with the hypoglossal nerve, which has been partially incised. This technique has been used in three patients to date, with 6 to 11 months follow‐up. In all cases facial tone and symmetry have been restored and voluntary facial expression accomplished. The authors conclude that by employing the techniques described highly satisfactory cosmetic and functional results may be expected, without compromising hypoglossal nerve function.
Revision Stapedectomy: Intraoperative Findings, Results, and Review of the Literature
Authors: Han Wade W. , Incesulu Armagan , McKenna Michael J. , Rauch Steve D. , Nadol Joseph B. , Glynn Robert J.
Published: November 2003

Seventy‐four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology‐Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air‐bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss(large residual air‐bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure‐tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air‐bone gaps. These results were compared with previously published data.
Vestibular Nerve Section: Long‐term Follow‐up
Authors: Pappas Dennis G. , Pappas Dennis G.
Published: November 2003

Vestibular nerve section is considered an effective modality in the treatment of refractory and incapacitating vertigo. Typically nerve section results are described on the basis of short‐term follow‐up. We have reviewed 41 cases of vestibular nerve section spanning an 18‐year period. Although the majority of cases involved classic Meniere's disease, delayed endolymphatic hydrops, vestibular neuritis, and Meniere's syndrome secondary to head trauma were also included. Surgical approaches included translabyrinthine (20 cases), retrolabyrinthine (14 cases), retrosigmoid (six cases), and middle fossa (one case) procedures. Postoperative follow‐up time averaged 102 months, with 46% of patients followed for a minimum of 9 years. Results are reported according to standards set forth by the American Academy of Otolaryngology‐Head and Neck Surgery. Vertigo was cured or markedly improved in 88% of cases (90% in patients with Meniere's disease) at 18 to 24 months postoperatively. These vertigo results were sustained at the time of latest follow‐up. Functional level was also preserved over time despite the development of bilateral symptoms in several cases. The rate of bilateral disease reached 22% of cases. Although vertigo results remained stable, long‐term follow‐up of successful hearing preservation cases demonstrated deterioration over time. Postoperative continuation of medical treatment is urged to optimize and sustain the vestibular neurectomy result.
Acoustic Effect of Malleus Head Removal and Tensor Tympani Muscle Section on Middle Ear Reconstruction
Authors: Asai Masanori , Roberson J.B. , Goode Richard L.
Published: November 2003

In the reconstruction of ears with a missing incus, an incus replacement prosthesis (IRP) is commonly used to connect malleus and stapes. In some cases, it is necessary to resect the malleus head and/or section the tensor tympani muscle (TTM) tendon. The acoustic effects of these maneuvers have not been well studied. We performed experiments in a temporal bone model to measure the effect of these maneuvers on middle ear sound transmission. Measurements of umbo and stapes displacement were made before and after malleus head removal and TTM section plus incus replacement with an IRP. After malleus head removal, there was a peak gain in stapes displacement of 6 dB below 0.5 kHz and 8 dB above 2.5 kHz. TTM section had a similar but lesser effect. A clinical example is described.
Prognostic Indicators for Squamous Cell Carcinoma of the Oral Cavity: A Clinicopathologic Correlation
Authors: Gluckman Jack L. , Pavelic Zlatko P. , Welkoborsky Hans‐Jurgen , Mann Wolf , Stambrook Peter , Gleich Lyon , Wilson Keith , Righi Paul , Portugal Louis G. , McDonald John , Biddinger Paul , Steward David , Gartside Peter
Published: November 2003

Fifty‐three patients with T1 squamous cell cancer of the floor of mouth and ventral surface of the tongue with a known clinical outcome were retrospectively analyzed and arbitrarily divided into “aggressive” and “nonaggressive” groups based on their clinical behavior. Various host and tumor factors were then evaluated in an attempt to determine whether the tumor behavior could have been predicted. The paraffin‐embedded tumor specimens were evaluated for tumor differentiation, tumor thickness and tumor invasion, microvessel density, and p53 expression. In addition, a composite morphologic grading score was obtained by combining cell differentiation, nuclear polymorphism, mitosis activity, depth of infiltration, type of infiltration, and lymphatic infiltration. No single technique appeared capable of identifying “aggressive” behavior, although possibly an evaluation of composite factors might show promise in the future.
Internal Jugular Vein Patency in Patients Undergoing Microvascular Reconstruction
Authors: Wax Mark K. , Quraishi Huma , Rodman Susan , Granke Ken
Published: November 2003

The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long‐term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.
Laryngopharyngeal Sensory Testing With Modified Barium Swallow As Predictors of Aspiration Pneumonia After Stroke
Authors: Aviv Jonathan E. , Sacco Ralph L. , Mohr J.P. , Thompson J.L.P. , Levin Bruce , Sunshine Susan , Thomson Jeanne , Close Lanny G.
Published: November 2003

Improved diagnostic tests that can accurately identify subjects at high risk for aspiration pneumonia (AP) are needed. One measure of this accuracy is the false‐negative rate (FNR), which determines the failure of a test to identify a group at high risk. This study compares FNRs for AP among dysphagic stroke patients for two prognostic techniques: modified barium swallow (MBS) alone and MBS combined with laryngopharyngeal sensory discrimination testing(MBS + LPSDT). MBS and LPSDT were performed within 4 weeks of stroke in 20 subjects who were prospectively followed for at least 2 years to identify the frequency of AP. MBS identified 10 patients as not at risk based on the finding of no aspiration on initial MBS; four of these patients developed AP (FNR = 40%). MBS + LPSDT identified five patients as not at risk based on the findings of neither aspiration nor bilateral sensory deficits; none of these patients developed AP (FNR = 0%). The combination of MBS criterion (aspiration) with the LPSDT criterion (bilateral sensory deficits) improves prognostication of outcome in dysphagic stroke patients by identifying a subgroup at high risk for developing AP (nonaspirators with bilateral deficits).
Endoscope‐Assisted Second‐Stage Tympanomastoidectomy
Authors: Youssef Tarek F. , Poe Dennis S.
Published: November 2003

Intact canal wall mastoidectomy techniques for cholesteatoma are often followed by a planned second look for residual disease and possible ossicular reconstruction. Endoscopic techniques may reduce morbidity but introduce new concerns. Twenty‐five consecutive second‐look procedures were performed from July 1994 to July 1996 utilizing endoscopes in 19 cases and avoiding or terminating their use in the others because of known difficult anatomy, inadequate exposure, or excessive bleeding. Thirteen cases were prospectively explored first through a planned exclusively endoscopic approach and then opened for a conventional second look in comparison. In one of the 13 cases, endoscopy was abandoned. There were no cases in which endoscopy yielded a false‐negative result. Endoscopes underestimated the size of recurrence in one case. Our experience, indications, and precautions for endoscope‐assisted second‐stage tympanomastoidectomy are presented.
Validation of Objective Measures for Facial Paralysis
Authors: Helling Tiffany D. , Gail Neely J.
Published: November 2003

A shift from subjective scales to objective measures of facial paralysis requires physical models against which to validate and calibrate the new objective techniques. The purpose of this report was to demonstrate such a model and to test the capacity of an objective computer system to accurately measure physical change. The physical model consisted of an advancing edge of a spreading gelatin film. The model was measured in submillimeter increments. Concurrent measurements were made using the computed system. Ten trials were conducted. The objective system proved to be exquisitely sensitive (0.03 mm) and highly correlated with the physical criterion model (Pearson's product moment correlation coefficient [r]=0.9849). Sensitive and calibrated objective methods of analysis of facial motion are crucial to the design of clinical trials, clinical studies of nerve regeneration, and comparisons of reanimation techniques.
Gastroesophageal Reflux, Motility Disorders, and Psychological Profiles in the Etiology of Globus Pharyngis
Authors: Hill John , Stuart Robert C. , Fung Hin K. , Ng Enders K.W. , Cheung Fanny M. , Chung Sidney C.S. , Andrew van Hasselt C.
Published: November 2003

The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24‐hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty‐six patients with globus pharyngis underwent 24‐hour ambulatory pH monitoring, esophageal manometry, and esophagogas‐troduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non‐ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24‐hour esophageal pH monitoring (P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis.
Plasticity of the Extracranial Facial Nerve
Authors: Anand Vinod K.
Published: November 2003

Although the expansion properties of peripheral nerves have been a matter of considerable study in recent years, investigations of the plasticity of cranial nerves, including the facial nerve, have been lacking. Clinicians, however, have long recognized the tenacity of facial nerve function in patients with slow‐growing benign tumors that enormously distort the nerve. An experimental study was designed to assess whether tissue expansion techniques can be applied to the extracranial portion of the facial nerves of cats. In eight cats the frontozygomatic branch of the facial nerve was expanded by stages in seven sessions over a period of 40 days. The length of the nerve increased an average of 95% without significantly impairing nerve function. Pressure changes in the expander averaged 75 mm Hg during each stage of expansion. Electroneurography was performed after each injection of the expander. Statistical analysis of these data did not show consistent evidence of demyelination or denervation, and all but one cat exhibited a normal blink reflex and had normal electromyographic findings at the end of the experiment. Histologic examination of the expanded nerves, however, did show inflammatory changes, intraneural edema, and occasional demyelination.
Murine Model of Interleukin‐8‐Induced Otitis Media
Authors: Johnson Michael , Leonard Gerald , Kreutzer Donald L.
Published: November 2003

Interleukin‐8 (IL‐8), a potent inflammatory mediator that is thought to control leukocyte recruitment and activation during inflammatory reactions, has been implicated in a variety of inflammatory diseases. Recent studies in our laboratory have demonstrated the presence of IL‐8 in chronically inflamed human middle ear effusions. These data have led us to hypothesize that IL‐8 is responsible for the leukocyte recruitment seen in otitis media. Because the effect of IL‐8 on the middle ear mucosa has not been investigated and therefore its role in middle ear inflammation is not known, we investigated the ability of IL‐8 to directly induce inflammation in the murine middle ear. For these studies, ICR mice were used to test the hypothesis that IL‐8 could directly induce inflammation in the middle ear. Murine middle ears received 8‐mL transtympanic injections of human IL‐8 (25 mg/mL) in saline, heat‐killed Streptococcus pneumoniae (1 × 108/mL), or normal saline. Temporal bones were removed at 1, 4, 8, 24, and 48 hours, decalcified, and processed for histologic examination. Noninjected murine temporal bones served as controls. Normal saline‐injected ears demonstrated little to no change as compared with temporal bones from noninjected ears. IL‐8‐injected ears histologically demonstrated thickening of the epithelial layer and subepithelial space (SES), with inflammatory cell infiltration in the SES peaking at 4 to 8 hours and resolving by 48 hours. Bacteria‐injected ears demonstrated findings similar to, although not as extensive as, those found in IL‐8‐injected ears (i.e., inflammatory reactions peaked at 8 to 24 hours and resolved by 72 hours). Our results demonstrate that IL‐8 is a potent inducer of middle ear inflammation and support the concept that IL‐8 may be one of the key cytokines responsible for the leukocyte accumulation and activation seen in otitis media.
Monitoring Eustachian Tube Opening: Preliminary Results in Normal Subjects
Authors: Mondain Michel , Vidal Dominique , Bouhanna Sylvie , Uziel Alain
Published: November 2003

Sonometry studies the changes of sound intensities induced by the eustachian tube opening in the external meatus when a constant sound is applied in the nasal cavity. The function of the eustachian tube is not disturbed by the test procedure. An original portable device with a high signal‐to‐noise ratio has been developed in our lab. This device was able to detect a 6‐dB sound pressure level (SPL) signal in a 100‐dB SPL noise. Longduration recordings of auditory tubal openings could be performed. This work presents the data found in normal subjects. One hundred twenty healthy ears were recorded. Eustachian tube openings were detected in 62.5% of the cases. Of the 1777 openings recorded, the average opening duration was 430 ms ± 183 ms. The average number of eustachian tube openings was 21.7 ± 16.4 (for 15 minutes). All swallowing did not necessary open the eustachian tube. This work shows that this new device allows long‐duration recording of eustachian tube function in everyday life conditions.
Three‐Dimensional Endoscopic Mode for Observation of Laryngeal Structures by Helical Computed Tomography
Authors: Yumoto Eiji , Sanuki Tetsuji , Hyodo Masamitsu , Yasuhara Yoshifumi , Ochi Takashi
Published: November 2003

We produced high‐quality three‐dimensional (3D) endoscopic images of the larynx using helical scanning computed tomography. Subjects included two normal volunteers and 10 patients: five with laryngeal cancer, four with unilateral recurrent laryngeal nerve (RLN) palsy, and one with atrophied vocal folds. Two vertically split hemilaryngeal images were displayed together with the oral and tracheal views. Although motion artifacts were seen in four patients, laryngeal structures including the vocal fold, ventricular fold, and ventricle were clearly identified in all subjects. In the patients with cancer, axial images showing the extent of the tumor in each patient provided more information than 3D endoscopic images. In the patients with RLN palsy and atrophied vocal fold, combination of 3D endoscopic and cross‐sectional images offered more diagnostic information than axial images alone.
Acute Sinusitis in the Rabbit: A New Rhinogenic Model
Authors: Marks Steven C.
Published: November 2003

The objective of this study was to create a rhinogenic model of sinusitis using an implanted foreign body in the nasal cavity of the rabbit. The study design was a prospective controlled trial of the experimental design. In this model an obstructing foreign body was placed into the nasal cavity and then impregnated with pathogenic bacteria. This model was studied histologically using wholemount techniques. Quantitative assessment of the degree of inflammation was made for the maxillary and ethmoid sinus and for overall effect for each animal. Bacteriologic study was performed in a limited number of animals. The results indicated that a significant infection develops in about half of animals. This peaks in intensity between 1 and 2 weeks after implantation and subsequently subsides with some evidence of long‐term changes present after 4 weeks. It is concluded that this is a viable and perhaps preferable animal model to study sinusitis. Further investigation is necessary to completely characterize this model.