bluuebunny/crossref_metadata_2025 huggingface dataset:
Preservation of Function and Histologic Appearance in the Injured Glottis With Topical Mitomycin‐C
Authors: Spector Jared E. , Werkhaven Jay A. , Spector Nicole C. , Huang Shan , Page Robert N. , Baranowski Bryan , Luther Matthew , McGehee Bartley , Reinisch Lou
Published: November 2003

Objective: To evaluate the functional and histological effects of a single application of topical mitomycin‐C after laser injury in the posterior canine glottis. Study Design: A prospective, randomized study of 16 canines. Methods: A supersaturated (1%) solution of topical mitomycin‐C was applied to a unilateral, laser‐induced injury near the cricoarytenoid joint in eight dogs. The mitomycin‐soaked pledget was placed immediately after induction of the injury and was left in contact with exposed cartilage for 3 minutes. The opposite side was not injured to provide an internal control. In eight additional dogs, the same laser injury was allowed to heal untreated. After 6 weeks, the animals were sacrificed and their larynges harvested. Arytenoid adduction sutures were placed bilaterally, and the force required to bring the vocal folds to midline was measured for each side using tensiometry. Gross and microscopic histological analysis was performed. Statistical analysis was accomplished using a two‐tailed Student t test of unpaired samples, and the Wilcoxon Signed Rank Test where appropriate. Results: The mitomycin‐C treated larynges demonstrated improved cricoarytenoid joint mobility (P = .007), decreased granulation tissue development (P = .03), and complete prevention of secondary “vocal granuloma” formation (P = .0004) when compared with eight dogs with identical laser injuries allowed to heal untreated. No complications were noted. Conclusions: This study demonstrates functional preservation and improved histological appearance of the injured glottis after a single treatment with topical mitomycin‐C. Potential applications of these findings include prophylactic use of topical mitomycin‐C on glottic insults that commonly progress from granulation tissue formation to scarring and decreased vocal fold function.
Hyaluronic Acid (With Fibronectin) As a Bioimplant for the Vocal Fold Mucosa
Authors: Chan Roger W. , Titze Ingo R.
Published: November 2003

Objectives: To measure the viscoelastic shear properties of hyaluronic acid, with and without fibronectin, and to compare them with those of the human vocal fold mucosa and other phonosurgical biomaterials. Methods: Viscoelastic shear properties of various implantable biomaterials (Teflon, gelatin, collagen, fat, hyaluronic acid, and hyaluronic acid with fibronectin) were measured with a parallel‐plate rotational rheometer. Elastic and viscous shear properties were quantified as a function of oscillation frequency (0.01–15 Hz) at 37°C. Results: The shear properties of hyaluronic acid were relatively close to those of human vocal fold mucosal tissues reported previously. Hyaluronic acid at specific concentrations (0.5%–1%), with or without fibronectin, was found to exhibit viscous shear properties (viscous shear modulus and dynamic viscosity) similar to those of the average male and female vocal fold mucosa. Conclusions: According to a theory that establishes the effects of tissue shear properties on vocal fold oscillation, phonation threshold pressure (a measure of the ease of phonation) is directly related to the viscous shear modulus of the vibrating vocal fold mucosa. Therefore, our findings suggest that hyaluronic acid, either by itself or mixed with fibronectin, may be a potentially optimal bioimplant for the surgical management of vocal fold mucosal defects and lamina propria deficiencies (e.g., scarring) from a biomechanical standpoint.
Relationship of the Facial Nerve to the Tympanic Annulus: A Direct Anatomic Examination
Authors: Adad Basil , Rasgon Barry M. , Ackerson Lynn
Published: November 2003

Objective: To examine the relation of the facial nerve to the only identifiable surgical landmark in the external auditory canal.

Institution: Communitybased teaching hospital.

Study Design: Examination of formalin‐fixed human temporal bones.

Background: The transcanal approach is often used in tympanoplasty, canaloplasty, hypotympanotomy, and removal of tumors of the external auditory canal (EAC), such as exostoses and osteomas. Surgery of the EAC places the facial nerve at risk for injury as the nerve courses vertically in the posterior canal wall. Few articles have described the relation of the facial nerve's course to the tympanic annulus, the only identifiable landmark in the EAC. This study is the first to document the relationship of the course of the facial nerve with respect to the tympanic annulus by direct anatomic measurement of the temporal bone.

Methods: Thirty‐seven formalin‐fixed cadaver temporal bones were studied after skeletonization of the facial nerve and tympanic annulus.

Results: The facial nerve coursed lateral to the plane of the annulus in 70% of specimens, always in the posteroinferior quadrant. The nerve also coursed anterior to a plane through the most posterior point of the annulus in 73.1% of specimens, also exclusively in the posteroinferior quadrant. The course of the nerve was quite variable with respect to the annulus.

Conclusions: The facial nerve is most vulnerable to injury in the posteroinferior quadrant in transcanal surgery. The annulus is not a reliable landmark for the facial nerve. Anecdotal evidence is cited and recommendations are offered.
Modified Neck Dissection for Metastatic Nonseminomatous Testicular Carcinoma
Authors: Weisberger Edward C. , McBride Lawrence C.
Published: November 2003

Objective: To examine the role of neck dissection in the treatment of metastatic stage 3 nonseminomatous germ‐cell tumors (NSGCTs) of testicular origin.

Method: A retrospective review was made of 45 patients with metastatic NSGCT who underwent 48 unilateral and 3 bilateral neck dissections. Only level III‐VI nodes were dissected, often with concomitant or staged mediastinal dissection, thoracotomy, and/or retroperitoneal node dissection. Occasionally, resection of the clavicle, jugular vein, or subclavian artery, or a combination of these, was required to eradicate the disease.

Results: There were only four instances of recurrence in dissected necks. There was one case of dedifferentiation of mature teratoma to adenocarcinoma. Patients who were followed for a mean period of 32 months had a disease‐free survival of 72%. Prognosis for patients with stage 3 disease but negative preoperative tumor markers (α‐fetoprotein and human chorionic gonadotropin) was excellent, with 97% of these patients having no evidence of disease at follow‐up. Factors having a negative impact on survival included positive tumor markers, elements of germ‐cell cancer in excised nodes, and a neck mass that represents late relapse of disease.

Conclusion: Modified neck dissection has a demonstrated role in the treatment of metastatic NSGCT. It prevents reversion of mature teratoma to malignant germ cell tumor with minimal morbidity. Aggressive resection of disease is indicated, often in conjunction with thoracic surgery, to eradicate disease extending into the chest. There is an excellent prognosis in patients with negative preoperative serologic tumor markers.
Fosfomycin Does Not Inhibit the Tumoricidal Efficacy of Cisplatinum
Authors: Jordan Jennifer A. , Schwade Nathan D. , Truelson John M.
Published: November 2003

Objectives: This study investigates the effect of fosfomycin on the tumoricidal efficacy of cisplatinum.

Study Design: Prospective study utilizing the FaDu squamous cell carcinoma cell line and a nude mouse tumor xenograft model.

Methods: Tumor cell growth was assessed in vitro in the presence of cisplatinum and/or fosfomycin utilizing the MTT assay. An optimal cisplatinum dose and dosing schedule was established in a nude mouse tumor xenograft model of squamous cell carcinoma. Using this model, fosfomycin was tested at three dosages and tumor growth monitored over 4 weeks.

Results: Mice treated with cisplatinum and fosfomycin had smaller tumors than those treated with cisplatinum alone (P < .01).

Conclusions: This study is the first demonstration that fosfomycin does not inhibit the tumoricidal efficacy of cisplatinum in vivo. This suggests that fosfomycin may be useful in preventing cisplatinum‐induced ototoxicity and nephrotoxicity in humans without altering the tumor response rate.
Treatment of Parkinson Hypophonia With Percutaneous Collagen Augmentation
Authors: Berke Gerald S. , Gerratt Bruce , Kreiman Jody , Jackson Katherine
Published: November 2003

Objectives: It has been estimated that more than 70% of patients with Parkinson disease experience voice and speech disorders characterized by weak and breathy phonation, and dysarthria. This study reports on the efficacy of treating Parkinson patients who have glottal insufficiency.

Study Design and Methods: Thirty‐five patients underwent collagen augmentation of the vocal folds for hypophonia associated with Parkinson disease, using a new technique of percutaneous injection with fiberoptic guidance. Patient response to the collagen augmentation was determined by telephone survey.

Results and Conclusions: The procedure required minimal patient participation and was safely performed on all the patients who were studied. Results of the survey indicated that 75% of patient responses demonstrated satisfaction with the technique, compared with 16% of patient ratings reflecting dissatisfaction. These results were moderately correlated with the duration of improvement of the dysphonia. Results of this preliminary evaluation demonstrate that voice deficits in Parkinson disease are amenable to vocal fold augmentation. Because this procedure requires minimal patient participation and can be safely performed in an office setting, it may also be useful in other severely debilitating neuromotor diseases that result in glottal insufficiency and hypophonia.
Histologic and Physiologic Effects of Electrocautery, CO2 Laser, and Radiofrequency Injury in the Porcine Soft Palate
Authors: Courey Mark S. , Fomin Denilson , Smith Timothy , Huang Shan , Sanders David , Reinisch Lou
Published: November 2003

Objectives: This study was undertaken to compare the effects of electrosurgery, CO2 laser, and radiofrequency on the histological structure and physiological properties of the soft palate. These surgical techniques are used for stiffening and reducing the soft palate in the treatment of snoring and mild sleep apnea.

Study Design: Fifteen pigs were divided into five groups.

Methods: Group 1 underwent electrosurgery incision of the lateral soft palate and excision of the uvula. Group 2 underwent the same procedure with the CO2 laser. Group 3 underwent CO2 laser ablation of the midline soft palate mucosa. Group 4 underwent radiofrequency volumetric reduction. Group 5 served as control. After 5 weeks the animals were sacrificed. Soft palate mucosa and muscle were subjected to tensiometric and histological analysis. Statistical analysis of tensiometric measurements was done with an ANOVA using a Bonferroni‐Dunn correction.

Results: Tensiometric measurements of the mucosa were increased over normal controls when the surgical technique resulted in mucosal disruption. When the surgical technique resulted in primarily muscle disruption (radiofrequency) tensiometric measurements of the muscle were increased over controls. Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased at the site of the primary injury.

Conclusions: The type of injury produced resulted in identifiable patterns of physiological and histological change. Understanding of the effects of available surgical techniques is important in guiding our choice of surgical approach and allows us to better counsel our patients on their surgical options.
Prognostic Significance of p27 Expression in Carcinoma of the Oral Cavity and Oropharynx
Authors: Venkatesan T. K. , Kuropkat Christiane , Caldarelli David D. , Panje William R. , Hutchinson James C. , Chen Shande , Coon John S.
Published: November 2003

Objective: To study the role of p27, a cyclin‐dependent kinase inhibitor, as a prognostic indicator in squamous cell carcinoma of the oral cavity and oropharynx.

Study Design: Retrospective review of 35 patients with squamous cell carcinoma of the oral cavity and oropharynx who presented to Rush‐Presbyterian‐St. Luke's Medical Center, Chicago, Illinois, between 1986 and 1995.

Methods: Inclusion criteria were the availability of clinical information, archival pretreatment biopsy material, and a minimum follow‐up of 24 months. p27 staining was scored for frequency and intensity of tumor cell expression following immunoperoxidase staining using standard techniques. Samples of squamous epithelium from the uvula of 15 nonsmoking patients without past or present squamous cell carcinoma were used as normal controls.

Results: The association of p27 staining and other factors with response to treatment was evaluated by Fisher's Exact Test and with overall and disease‐free survival by the Kaplan‐Meier method with multivariate Cox regression. Low levels of p27 expression correlated significantly with unfavorable treatment response (P < .0001), shorter overall survival (P = .0001), and shorter disease‐free survival (P = .003). Tumor site (alveolus) was also associated with shorter disease‐free (though not overall) survival, but the association with p27 was independent of stage and site in multivariate analysis.
Hearing and Otopathology in Crouzon Syndrome
Authors: Orvidas Laura J. , Fabry Lee B. , Diacova Svetlana , McDonald Thomas J.
Published: November 2003

Objectives: To better establish the incidence and types of otologic and auditory abnormalities in patients with Crouzon syndrome.

Study Design: Retrospective chart review of the otologic and auditory findings of patients diagnosed with Crouzon syndrome who were seen at our institution between 1978 and 1994.

Methods: Charts were reviewed and data recorded on patient sex, family history, appearance, auricular abnormalities, auditory findings, history of otologic disease, and follow‐up.

Results: Nineteen patients were identified with the diagnosis of Crouzon syndrome: 12 males and 7 females. Twelve cases represented spontaneous mutations. Eight patients had abnormalities involving the external ear: from malalignment of the pinna (6 patients) to external auditory canal atresia (1 patient). Ten patients had documented hearing loss: 4 with conductive hearing loss, 2 with a mixed hearing loss, and 4 with a sensorineural hearing loss, the etiologies of which ranged from ossicular fixation and serous otitis media to unknown sensorineural deficits.

Conclusions: Patients with Crouzon syndrome can exhibit various pathological features of the ear. Although external malformations are unusual, middle ear disease and hearing loss are common. We advocate close otologic and audiologic follow‐up in these patients and note a higher frequency of sensorineural hearing loss than previously reported. Recent genetic advances may allow more accurate and earlier diagnosis of this syndrome.
Straight Midline Mandibulotomy Revisited
Authors: Amin Milan R. , Deschler Daniel G. , Hayden Richard E.
Published: November 2003

Objective: Describe recent experience with a simplified modification of the traditional mandibulotomy approach.

Study Design: Retrospective chart review.

Methods: Charts were reviewed retrospectively for 17 consecutive patients who underwent this approach over a 3‐year period as a part of treatment for oral and oropharyngeal malignancies.

Results: No cases of bony nonunion, plate exposure, or other complications related to the mandibulotomy occurred in the postoperative phase.

Conclusions: The modified straight midline mandibulotomy approach is simple and provides safe access for the treatment of oral and oropharyngeal tumors while minimizing postoperative morbidity.
A Novel, Biodegradable Polymer Conduit Delivers Neurotrophins and Promotes Nerve Regeneration
Authors: Hadlock Tessa , Sundback Cathryn , Koka Rahul , Hunter Daniel , Cheney Mack , Vacanti Joseph
Published: November 2003

Objective/Hypothesis: A wide variety of substances have been shown to promote neuritic extension after nerve injury. An obstacle to achieving the maximal benefit from these substances has been the difficulty in effectively delivering the substances over a protracted time course that promotes maximal, directed growth. In this study the delivery of a growth‐promoting substance through a biodegradable conduit, using materials originally designed for drug delivery applications, was hypothesized to promote more robust neural regeneration than through conduits lacking the substance. The objectives of this study were to create a growth factor‐loaded biodegradable nerve guidance conduit, and to assess in vivo nerve regeneration through the conduit compared with that through conduits lacking the substance.

Materials/Methods: Inosine, a purine analogue thought to promote axonal extension following neural injury, was loaded into cylindrical polymer foams composed of a polylactide‐co‐glycolide copolymer. First, in vitro extravasation of inosine was measured over a several week period using spectrophotometry. Second, the foams were fashioned into single‐channel cylindrical nerve guidance conduits via a novel, low‐pressure injection molding technique. The conduits were then used to bridge 7‐mm defects in the rat sciatic nerve (n=8). Control conduits lacking inosine were implanted into another set of animals as controls (n=12).

Results: In vitro spectrophotometric measurements indicated appreciable leaching of inosine from the loaded foams over a period of at least 9 weeks. In the in vivo model, after 10 weeks, a higher percentage cross sectional area composed of neural tissue existed through the inosine‐loaded conduits compared with controls (mean 44%, SD 7.5% vs. 36%, SD 8.6%, respectively). A difference was also found in mean fiber diameter between the two groups, with the inosine‐loaded tubes showing a statistically significantly larger diameter than controls (P < .05).

Conclusions: A nerve regeneration conduit was successfully created that delivers growth promoting substances over a protracted time course. In an in vivo model, the presence of inosine, a purine analogue, yielded neural regeneration whose histological features suggest possible superior long‐term motor function.
Early Polysomnographic Findings and Long‐Term Subjective Results in Sleep Apnea Patients Treated With Laser‐Assisted Uvulopalatoplasty
Authors: Walker Regina Paloyan , Garrity Thomas , Gopalsami Chellam
Published: November 2003

Objectives/Hypothesis: To examine the long‐term results of laser‐assisted uvulopalatoplasty (LAUP) for the treatment of patients with obstructive sleep apnea syndrome (OSAS).

Study Design: One hundred eighty‐two OSAS patients treated with LAUP were followed for an average of 4 years. Of these patients, 131 have completed treatment. Complete polysomnographic data are available on 48 patients. Five patients were eliminated owing to nasal surgery performed during the period between the preoperative and postoperative sleep studies, thus 43 patients were included who had only LAUP treatment. Another three patients were eliminated because their postoperative polysomnograms were performed less than 6 weeks after the last procedure. Complete long‐term subjective data are available on 31 patients.

Methods: Between July 1993 and July 1998, 1038 patients were evaluated for LAUP treatment for snoring and OSAS. Of the 1038 patients, 409 were treated with LAUP and the remaining 629 were treated with other surgical procedures, devices, or behavior modification. The 40 patients who underwent only LAUP treatment for OSAS and have complete polysomnographic data are the focus of this study.

Results: The significant objective polysomnographic findings include a decrease in the respiratory disturbance index (RDI) from 25.0 ± 2.8 to 15.3 ± 2.9 (P = < .0001), and a decrease in the apnea index (AI) from 14.6 ± 2.6 to 9.0 ± 2.4 (P = .00248). In addition, the percentage of time spent in rapid eye movement (REM) sleep significantly increased after LAUP, from 13.3% ± 1.0 to 17.6% ± 1.4 (P = .0149). The long‐term subjective results indicate that the presenting complaints were improved after LAUP in 74.9% ± 4.1 with a mean follow‐up of 4.04 years ± 72 days (median, 4.63 y).

Conclusions: LAUP remains a safe and effective treatment for carefully selected patients suffering from OSAS. Five years after LAUP was introduced in the United States, objective polysomnographic data demonstrate reduction in the RDI and increased time spent in REM sleep after treatment. In addition, the long‐term subjective results show that the presenting symptoms were no longer present in 75% of patients treated with LAUP.
Effects of Middle Turbinate Medialization on Olfaction
Authors: Friedman Michael , Tanyeri Hasan , Landsberg Roy , Caldarelli David
Published: November 2003

Objective/Hypothesis: Turbinate medialization techniques have gained popularity in an attempt to prevent turbinate lateralization. Theoretically, adhesions between the septum and middle turbinate will prevent lateralization but may compromise airflow to the olfactory neuroepithelium and affect the sense of smell. No studies have addressed this issue. The objective of this study is to evaluate effects of middle turbinate medialization on olfaction.

Study Design: A prospective controlled study of olfaction before and after middle turbinate medialization using the University of Pennsylvania Smell Identification Test (UPSIT) and patient questionnaires.

Methods: Fifty patients underwent endoscopic sinus surgery (ESS) with middle turbinate medialization and preservation. The caudal end of the middle turbinate and the opposing septal mucosa were abraded with a microdebrider for iatrogenic synechia formation in an attempt to avoid lateralization of the middle turbinate. Each of the patients underwent preoperative assessment with a questionnaire and UPSIT. All patients were reevaluated approximately 5 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. The preoperative and postoperative questionnaire responses were compared for subjective analysis. Objectively, The preoperative and postoperative UPSIT scores were compared using the Student t test.

Results: The questionnaires showed that the study population's subjective sense of smell either did not change or improved compared with the preoperative state. Objectively, there was a mean increase of UPSIT scores after surgery. This difference was not statistically significant (P = .4).

Conclusion: Middle turbinate medialization has no detectable adverse effect on olfaction.
Lateral Thigh Free Flap for Head and Neck Reconstruction
Authors: Hayden Richard E. , Deschler Daniel G.
Published: November 2003

Objectives: To present the technique of lateral thigh free flap reconstruction in the head and neck and review the use of this procedure in 58 head and neck defect reconstructions.

Study Design: Retrospective review in the setting of a tertiary, referral, and academic center.

Methods: Retrospective review of patient records in cases of lateral thigh free flap reconstruction for head and neck defects. Records were reviewed for patient age, gender, pathologic findings, type of reconstruction (pharyngoesophageal, glossectomy, oropharyngeal, or external soft tissue defects), recipient and donor‐site complications, and flap failure.

Results: Fifty‐eight patients underwent lateral thigh flap reconstruction from 1984 to 1997. Patient age ranged from 10 to 76 years. Thirty‐nine patients were men, and 19 were women. Forty‐three flaps were used for pharyngoesophageal reconstruction, nine for glossectomy defects, two for oropharyngeal defects, and four for external, soft tissue defects. All resections were for squamous cell carcinoma, except one case of recurrent hemangiopericytoma. One flap failure occurred from venous thrombosis (1.7%). Forty‐two of 43 pharyngoesophageal defects were successfully reconstructed (97.6%). Five temporary salivary leaks were noted, but no frank fistulas occurred. One fistula occurred in the oropharyngeal reconstruction group. Four minor donor‐site complications were noted (6.9%).

Conclusion: This series demonstrates the low donor‐site morbidity, as well as the reliability and versatility, of the lateral thigh free flap for head and neck reconstruction.
Myosin Heavy Chain Composition in Human Laryngeal Muscles
Authors: Shiotani Akihiro , Westra William H. , Flint Paul W.
Published: November 2003

Objectives: Myosin heavy chain (MHC) composition of human thyroarytenoid (TA), lateral cricoarytenoid (LCA), interarytenoid (IA), vocalis, posterior cricoarytenoid (PCA), and cricothyroid muscles were examined using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS‐PAGE) and Western bolt techniques. The presence of superfast MHC was also assessed using antibodies directed against the extraocular MHC.

Study Design: MHC protein was analyzed using fresh human laryngeal muscles.

Methods: Laryngeal muscles excised from cadavers were processed for SDS‐PAGE. The composition of MHC isoforms was determined by densitometry. Western blot was carried out to identify specific bands.

Results: MHC types IIA and IIB are the predominant MHC components in human laryngeal muscles. The adductor muscles‐TA, LCA, and IA‐have a higher percentage of type IIB MHC and a lower percentage of type I when compared with the abductor‐PCA. The rank file order for type IIB MHC composition (TA>LCA≥IA>PCA) is the same in all specimens. A band migrating between type IIA and type I was observed in several specimens. Although similar to type IIL in rats, this atypical band did not react with antiextraocular MHC antibody on Western blot.

Conclusion: Characterization of laryngeal muscles determined by the composition of MHC is correlated with function and neural input. Human laryngeal muscle is characterized by a predominance of fast‐type MHCs in laryngeal closing muscle and mixed fast‐slow type MHCs in respiratory and phonatory muscle groups. Although an atypical myosin band similar to type IIL (superfast) MHC in rat was identified, it did not react with anti‐extraocular MHC antibody.
Progressive Cochleovestibular Impairment Caused by a Point Mutation in the COCH Gene at DFNA9
Authors: Bom Steven J.H. , Kemperman Martijn H. , De Kok Yvonne J.M. , Huygen Patrick L.M. , Verhagen Wim I.M. , Cremers Frans P.M. , Cremers Cor W.R.J.
Published: November 2003

Objectives: Analysis of phenotype‐genotype correlation.

Study Design: Family study.

Methods: Auditory and vestibulo‐ocular functions were examined in a Dutch family with autosomal dominantly inherited sensorineural hearing impairment caused by a 208C>T mutation in the COCH gene, located in chromosome 14q12‐q13 (DFNA9). Linear regression analysis of individual longitudinal hearing threshold data (n = 11) on age was performed.

Results: Fifteen of the 16 genetically affected persons could be evaluated. They all developed hearing and vestibular impairment symptoms‐and in many cases also cardiovascular disease‐in the fourth to fifth decade. At the low frequencies (0.25‐2 kHz), hearing loss started at the age of about 40 years and showed an average annual progression of approximately 3 dB, finally resulting in profound hearing losses. In two exceptional cases, annual progression attained levels of up to 24 dB. At the high frequencies (4‐8 kHz), the average threshold increased from about 50 dB at the age of 35 years to about 120 dB at the age of 75 years (which amounts to 1.8 dB annual threshold increase). All affected individuals tested showed normal ocular motor functions. The patients older than 46 years generally showed absence of the vestibulo‐ocular reflex, but their cervico‐ocular reflex was enhanced compared with normal subjects, whereas those aged 40 to 46 years showed either severe vestibular hyporeflexia or unilateral caloric areflexia.

Conclusion: These findings suggest a gradual development of cochleovestibular impairment caused by the new mutation found.
Head and Neck Cancer in CNonsmokers: A Distinct Clinical and Molecular Entity
Authors: Koch Wayne M. , Lango Miriam , Sewell Duane , Zahurak Marianna , Sidransky David
Published: November 2003

Objectives/Hypothesis: Clinical and molecular patterns of head and neck squamous cell carcinoma (HNSCC) in nonsmokers and smokers may be different. Analysis of these patterns may improve understanding and management of this disease.

Study Design: three hundred five subjects were included (46 nonsmokers, 29 former smokers, and 230 smokers). Subsets were analyzed for p53 mutation, human papillomavirus (HPV), and loss of heterozygosity (LOH) at 10 chromosomal loci.

Methods: Clinical information was analyzed for common patterns of disease among the groups. The p53 gene was sequenced, and polymerase chain reaction was used to detect HPV DNA and LOH at two microsatellite markers for each loci. The χ2 test was used to assess differences in genetic alterations between groups, logistic regression to examine the independence of association of tobacco exposure with each alteration, and Kaplan Meier estimates and the log‐rank statistic to assess differences in survival.

Results: Nonsmokers included a disproportionate number of women, oral cavity (especially tongue) tumors, and very young or old individuals. Smokers had more tumors of the larynx, hypopharynx, and floor of mouth. The rate of p53 mutation was much greater in smokers; the percentage with HPV was marginally lower. The percentage of LOH at 3p, 4q, and 11q13, and the overall average number of chromosomal losses, was significantly lower in nonsmokers' tumors. Survival did not vary with smoking or age.

Conclusions: The clinical and genetic features of HNSCC are distinct between groups defined by tobacco use. Tumors of nonsmokers contain a lower frequency of common genetic alterations, suggesting that the underlying changes in these tumors may remain undiscovered.
A Method for Quantitative Assessment of Vestibular Otopathology
Authors: Merchant Saumil N.
Published: November 2003

Background: Quantitative studies of the vestibular system using serial sections from human temporal bones have been limited because it has been generally difficult to reliably differentiate hair cells from supporting cells and type I from type II hair cells.

Objectives: 1. To develop a new method to overcome the above limitations and permit quantitative assessments of types I and II vestibular hair cells in archival temporal bone sections. 2. To demonstrate that this method is reliable, valid, and repeatable. 3. To describe the advantages of this method compared with other traditional techniques. 4. To discuss the potential of this method to provide new insight into the etiology, pathology, and pathophysiology of vestibular disorders.

Study Design: Examination of archival human temporal sections prepared for conventional light microscopy.

Methods: The method used Nomarski (differential interference contrast) microscopy to permit visualization of the cuticular plate and stereociliary bundle, to allow unambiguous identification of hair cells. Types I and II hair cells were distinguished by their morphological characteristics. The method was used to measure the density of types I and II hair cells in each vestibular sense organ. Raw‐density counts were corrected for potential double counting using Abercrombie's formula.

Results: Intrarater and interrater reliability was strong as judged by high Pearson and Spearman correlation values (P < .01). Abercrombie's formula was shown to be valid by comparison with counts made by an unbiased calibration technique using the optical disector principle (correlation coefficients > 0.9, P < .01).

Conclusions: The method described in this report has several advantages when compared with alternative techniques such as surface preparations. The method is applicable to archival bones, permits simultaneous evaluation of the rest of the labyrinth, is relatively inexpensive, and does not preclude other techniques of study (e.g., polymerase chain reaction and immunostaining). Case studies of temporal bones with aminoglycoside ototoxicity and Meniere's disease are used to show how this method has the potential to provide new insight into the pathology and pathophysiology of vestibular disorders.
Margins of Partial Cricotracheal Resection in Children
Authors: Walner David L. , Stern Yoram , Cotton Robin T.
Published: November 2003

Objective: To review the surgical margins of partial cricotracheal resection in our series of patients. This includes specific anatomic detail as to each superior and inferior resection margin. To apply this information and access the utility of partial cricotracheal resection for the treatment of subglottic stenosis.

Study Design/Methods: A retrospective review was performed of 38 children with severe subglottic stenosis who underwent partial cricotracheal resection. Information was obtained with regard to the specific anatomic location of the superior and inferior resection margins, the grade of subglottic stenosis preoperatively, the type of stenting material used postoperatively, and other surgical details specific to each procedure.

Results: The superior resection margins were generally to the superior aspect of the cricoid cartilage but as high as the undersurface of the true vocal folds in a minority of patients. Inferior resection margins were generally to the second tracheal ring. Length of resection varied, but was as long as 3.0 cm in one patient. Overall surgical success based on decannulation was > 86%.

Conclusion: Partial cricotracheal resection is a safe and successful procedure for the treatment of subglottic stenosis. The margins and length of resection should be tailored specifically for each patient; and special considerations must be taken when extensive resection to the level of the true vocal folds is required. Safe airway management in the postoperative period is essential.
Management of Lateral Sinus Thrombosis
Authors: Syms Mark J. , Tsai Paulus D. , Holtel Michael R.
Published: November 2003

Objectives: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis.

Study Design: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis.

Methods: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed.

Results: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation.

Conclusion: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.
Ossiculoplasty in Young Children With the Applebaum Incudostapedial Joint Prosthesis
Authors: Schwetschenau Eric Leland , Isaacson Glenn
Published: November 2003

Objective: To evaluate the performance of the Applebaum incudostapedial joint prosthesis in young children in terms of hearing results and long‐term stability despite continuing eustachian tube dysfunction and otitis media.

Study Design: Retrospective review of all Applebaum prostheses placed in children at our institution from June 1993 to June 1998.

Results: In 1993 Applebaum proposed the use of a hydroxylapatite ossicular prosthesis as an alternative to incus interposition for the repair of incudostapedial discontinuity. We have used this prosthesis exclusively for the repair of such defects in children over the past 5 years. Among 12 operated ears, all healed, all prostheses remain in place (average duration, 2.6 y), and all children have excellent hearing (mean air‐bone gap, 15 dB; range, 5‐25 dB).

Conclusions: The Applebaum incudostapedial joint prosthesis restores conductive hearing even in young children. It has been stable in the face of recurrent otitis media and has not interfered with revision surgery. Placement of the prosthesis at primary cholesteatoma surgery should be considered in children.
Pierre Robin Sequence: Secondary Respiratory Difficulties and Intrinsic Feeding Abnormalities
Authors: Cruz Michael J. , Kerschner Joseph E. , Beste David J. , Conley Stephen F.
Published: November 2003

Objective: There is considerable variation in opinion regarding the optimal management of patients with Pierre Robin sequence (PRS). No single method of airway intervention or feeding strategy is universally appropriate and effective. This study was performed to examine methods used for airway and feeding management and to identify specific problems encountered.

Study Design: A retrospective study of 252 patient charts between 1989 and 1997 at Children's Hospital of Wisconsin.

Methods: Patient information was collected regarding perinatal history, genetics evaluation, and airway and feeding evaluations and intervention. A group of 47 patients was determined as having PRS.

Results: Secondary respiratory difficulties, defined as respiratory abnormalities in addition to the expected PRS obstruction, were identified in 23% of patients. Also, intrinsic feeding abnormalities not associated with airway obstruction were identified in 11% of patients. Analysis by Fisher's Exact Test revealed patients with a syndromic diagnosis to have a significantly higher rate for tracheotomies and gastrostomy tube placement (P = .041, and P = .0004, respectively). Syndromic patients were also found to have significantly lower Apgar scores and longer hospital stays. Positioning techniques, tongue‐lip adhesion, and tracheotomy were also employed effectively with specific indications and specific difficulties that need to be considered.

Conclusion: Patients with PRS require thorough airway and feeding evaluation. Those with additional syndromic diagnoses demonstrate higher rates of more invasive interventions. Patients with PRS must undergo individualized approaches with consideration of multiple factors for successful management.
Diagnostic Yield of High‐Resolution Computed Tomography for Pediatric Sensorineural Hearing Loss
Authors: Antonelli Patrick J. , Varela Adrian E. , Mancuso Anthony A.
Published: November 2003

Objectives/Hypothesis: In recent years, relatively subtle inner ear anomalies have become apparent using high‐resolution computed tomography (CT). The purpose of this study was to determine the diagnostic yield of high‐resolution CT for pediatric sensorineural hearing loss (HL) (SNHL).

Methods: A review was performed on the records of all children (<18 y of age) who had undergone CT of the temporal bones over a 5‐year period, since the introduction of current CT techniques.

Results: Three hundred eighty‐three studies were performed in 351 subjects. The indication for the CT was SNHL or mixed HL in 157 children. Forty‐nine (31%) of these studies revealed significant inner ear findings. Large vestibular aqueducts (LVAs) were reported in 15%, commonly in association with cochlear modiolar deficiencies. Modiolar deficiencies (11%) and other cochlear dysplasias (12%) followed LVA in frequency. The incidence of inner ear dysplasia in children with perinatal or postnatal risk factors was only slightly lower than those without (22% vs. 32%, P > .05). The rate of dysplasias did not correlate with SNHL severity, pattern of HL, or type of HL (mixed vs. sensorineural).

Conclusions: These findings suggest that radiographic imaging has a relatively high diagnostic yield in children with SNHL. These findings may be of value in counseling patients and guiding the management of their SNHL.
Aural Symptoms and Signs of Temporomandibular Disorder in Association With Treatment Need and Visits to a Physician
Authors: Kuttila Seppo , Kuttila Maraana , Le Bell Yrsa , Alanen Pentti , Jouko Suonpää
Published: November 2003

Objectives: To analyze associations between aural symptoms and clinical signs of and treatment need for temporomandibular disorders, as well as visits to a physician, in a Finnish population.

Study Design: A longitudinal study of a random sample of adults.

Methods: Four hundred eleven subjects (203 men and 208 women aged 25, 35, 45, 55, or 65 years at baseline) were examined and interviewed at three consecutive examinations at 12‐month intervals, and a questionnaire on visits to physician during the preceding 12 months was completed.

Results: The aural symptoms were common. The prevalence of otalgia without infection varied between 12% and 16%, while the prevalence of tinnitus and fullness of ears was 12% to 17% and 5% to 9%, respectively. Women had more aural symptoms than men. When compared with the other subjects, the subjects with aural symptoms more often had masticatory muscles that were tender to palpation or temporomandibular joint signs. Subjects with obvious treatment need for temporomandibular disorders had more aural symptoms than subjects in the other treatment need subgroups. They also visited a physician more often because of otalgia than the subjects with otalgia in the other treatment need subgroups.

Conclusions: In patients with otalgia, infectious otolaryngologic diseases should be ruled out. Then the patients without infection should be remitted to a dentist with stomatognathic experience. In the absence of temporomandibular disorders, further medical consultations (e.g., otorhinolaryngological, neurological, physiatric, and psychiatric) are indicated.
Utility of Laboratory Testing in Autoimmune Inner Ear Disease
Authors: Hirose Keiko , Wener Mark H. , Duckert Larry G.
Published: November 2003

Objectives: To assess the utility of various laboratory tests used to diagnose autoimmune inner ear disease.

Study Design: Retrospective study of 82 patients evaluated at the University of Washington Otology Clinic from 1996 through 1998 with review of clinical history, laboratory tests, audiograms, response to therapy, and final diagnoses.

Methods: Charts were reviewed for presenting history and initial workup including test results for erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), C1q binding assay, anticardiolipin antibody (aCL), antineutrophil cytoplasmic antibody (ANCA), microhemagglutinin assay for Treponema pallidum (microhemagglutination assay), Lyme disease titers, and the Western blot for heat shock protein 70 (hsp 70).

Results: The Western blot for hsp 70 is the best test for predicting corticosteroid responsiveness. The sensitivity was low at 42%, although the specificity was 90%, and the positive predictive value of this test was excellent at 91%. The ESR was as good as the CRP in detecting acute‐phase reactants. The other, more specific tests in the laboratory panel (aCL, ANCA, MHA, and Lyme disease titers) did not detect any new cases of autoimmune disease in addition to those which were already identified by an abnormal ESR.

Conclusions: A diagnostic test panel for autoimmune inner ear disease should include an ESR and the Western blot for hsp70. More specific laboratory testing for systemic disease is warranted when the ESR is elevated. In patients with a positive Western blot, a trial of corticosteroid therapy can be given with good conviction because the test is quite specific. However, many people who are Western blot negative may also respond to corticosteroid therapy because the test lacks sensitivity.
Terminal Differentiation of Epithelial Cells in Middle Ear Cholesteatoma: Investigation of Patterns of Expression of Protein Kinase C‐δ and Protein Kinase C‐η
Authors: Miyazaki Hidemi , Kojima Hiromi , Tanaka Yasuhiro , Shiwa Masanori , Koga Tomohiko , Moriyama Hiroshi
Published: November 2003

Objectives: The objective of this study was to elucidate the differentiation mechanism of keratinocytes in cholesteatoma.

Study Design: To achieve the objective, we analyzed the expressions of various cellular proteins: the delta and eta isoforms of protein kinase C (PKCδ and PKCη), which are thought to play key roles in signal transduction in differentiation; cytokeratin 1 (CK1) and cytokeratin 10 (CK10) (cytoskeletal constitutive proteins); and involucrin (a marker of differentiation).

Methods: The materials used in this study were tissue specimens obtained from cholesteatoma epidermis, normal external ear canal skin, normal inguinal skin, and psoriatic skin. Immunohistochemical staining techniques were applied to compare the expressions of the above proteins (i.e., PKCδ, PKCη, CK1, CK10 and involucrin) in those various tissues.

Results: No clear differences in the patterns of expression of PKCδ and PKCη were found between the cholesteatoma epidermis and the normal external ear canal skin. These proteins were expressed mainly in the stratum spinosum and stratum granulosum, and their patterns of expression were almost the same as those of the CK1, CK10, and involucrin proteins.

Conclusion: The findings of this study indicate that the terminal differentiation of keratinocytes in the cholesteatoma epidermis is the same as in normal skin tissues. It was concluded that the growth of epidermis which has undergone hyperproliferation of keratinocytes because of increased levels of various cytokines is being regulated by means of normal terminal differentiation.
Meniere's Disease: The Incidence of Hydrops in the Contralateral Asymptomatic Ear
Authors: Conlon Brendan J. , Gibson William P. R.
Published: November 2003

Objective: This study analyzes the incidence of endolymphatic hydrops in the asymptomatic contralateral ear of patients with classic Meniere's disease.

Study Design: A retrospective study of 3000 subjects who underwent electrocochleography (ECOG) from 1988 to 1998.

Methods: The presence of endolymphatic hydrops was determined by use of ECOG recordings, which were made through a transtympanic recording needle situated in the round window niche. Analysis was made of the 1‐kHz tone‐burst summation potential (SP), and comparison was made between asymptomatic contralateral “Meniere's ears” (n = 144) and asymptomatic normal “control ears” (n = 114).

Results: Results demonstrated that more than 10% of the contralateral asymptomatic Meniere's ears have an ECOG recording that is highly suggestive of the presence of endolymphatic hydrops. In contrast, less than 2% of the control population demonstrate abnormal ECOG recordings. Furthermore, 15% of the population of contralateral Meniere's ears lie above the 95th percentile of the control population for 1‐kHz tone‐burst (100 dB) SP negativity.

Conclusions: This study suggests that a high percentage of patients who have what appears to be unilateral Meniere's disease have evidence of endolymphatic hydrops in the contralateral asymptomatic ear. This finding has important clinical relevance for the management of patients in whom destructive surgery is planned and further highlights the importance of electrocochleography in the diagnosis and management of this disease process.