bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylactic treatment after ventilation tube insertion: Comparison of various methods
Authors: Golz Avishay , Ghersin Tamar , Joachims Henry Zvi , Westerman S. Thomas , Gilbert Liane M. , Netzer Aviram
Published: November 2005

Otitis media is recognized as one of the most common diseases of childhood. Insertion of tympanostomy tubes for the treatment of otitis media is the most frequently performed otologic operation, and postoperative otorrhea is its most common complication. Many authors have suggested various reasons for posttympanostomy otorrhea, and many different prophylactic treatments were proposed in recent years to prevent this bothersome and frustrating complication. This retrospective study was designed to investigate and compare the efficacy of various prophylactic treatments and to define the most effective method of reducing the rate of postoperative otorrhea. (Otolaryngol Head Neck Surg 1998;119:117–20.)
Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery
Authors: Vasama Juha‐Pekka , Mäkelä Jyrki P. , Ramsay Hans A.
Published: November 2005

We recorded auditory‐evoked magnetic responses with a whole‐scalp 122‐channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50‐msec 1‐kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure‐tone average in the affected ear was 57 dB hearing level; the mean postoperative pure‐tone average was 17 dB. The 100‐msec auditory‐evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125‐30.)
Microdebrider‐assisted uvulopalatoplasty
Authors: Tarabichi Muaaz
Published: November 2005

This report describes 3 years’ experience with the microdebrider as a safe and reasonable alternative to CO2 laser for uvulopalatoplasty. The cost and compact size of the equipment, as well as the ease of surgery, are the main advantages for microdebrider‐assisted surgery. (Otolaryngol Head Neck Surg 1998;119:131‐3.)
Role of vestibular adaptation in vestibular rehabilitation
Authors: Herdman Susan J.
Published: November 2005

Recovery of gaze and postural stability in human beings with vestibular deficits is well documented. The mechanisms that contribute to this recovery form the basis for the exercises used in the rehabilitation of these patients. These mechanisms include the central preprogramming of eye movements and of postural responses, the potentiation of the cervico‐ocular reflex, modification of saccadic eye movements, and the substitution of visual and somatosensory cues for the lost vestibular cues. The mechanism most successful in contributing to recovery, however, is probably adaptation of the vestibular system itself. Understanding the various compensatory mechanisms and their limitations for improving gaze and postural stability should lead to more effective treatment of these patients. (Otolaryngol Head Neck Surg 1998;119:49–54.)
Palisaded encapsulated neuroma of the nasal fossa
Authors: Mayorga Marta , Acebo Elvira , Val‐Bernal J. Fernando
Published: November 2005

Palisaded encapsulated neuroma (PEN) is a benign, cutaneous, or juxtacutaneous nerve sheath tumor with characteristic clinical, pathologic, and immunohisto‐chemical findings described by Reed et al.1 in 1972. The lesion appears as a slowly growing asymptomatic nodule, almost exclusively on the face.2 Rarely it is found in other locations, such as the neck, shoulder, upper arm, trunk, foot, oral cavity,2–6 and glans penis.7 To the best of our knowledge, no case of this lesion has been described in the nasal mucosa.
Acoustic Mechanisms
Authors: Whittemore Kenneth R. , Merchant Saumil N. , Rosowski John J.
Published: November 2005

The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall‐up and canal wall‐down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall‐up procedures, canal wall‐down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262‐8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall‐down procedure. We conclude that as long as the middle ear air space is aerated and has a volume greater than 0.7 ml, canal wall‐down mastoidectomy should generally cause less than 10 dB changes in middle ear sound transmission relative to the canal wall‐up procedure. (Otolaryngol Head Neck Surg 1998;118:751‐61.)
Aural Symptoms and Hearing Loss in Patients with Lupus
Authors: Sperling Neil M. , Tehrani Kevin , Liebling Anne , Ginzler Ellen
Published: November 2005

OBJECTIVE

Systemic lupus erythematosus causes widespread tissue injury from deposition of immune complexes. The prevalence of aural symptoms in this disease was evaluated.

METHODS

The presence of tinnitus, hearing loss, and fluctuating hearing was evaluated by a self‐directed questionnaire in patients aged 65 or less from a lupus clinic. Patients reporting aural symptoms were compared with those reporting none, by use of demographics and disease duration. Comparison was also made with historic serologic data. Audiometry was offered to all patients with lupus reporting aural symptoms and was completed in 10.

RESULTS

Twenty‐six (31%) of 84 patients with lupus reported aural symptoms. Patients reported a combination of symptoms: unilateral hearing loss with or without tinnitus in 13 (15%) of 84 and bilateral hearing loss with or without tinnitus in 14 (17%) of 84. No statistical difference was measured between symptomatic and asymptomatic patients when compared by average age, duration of disease, history of noise exposure, head trauma, and infectious ear diseases. Statistically significant differences were detected only when comparing average creatinine and C3 levels. Of those patients tested by audiometry, 7 of 10 had abnormal pure‐tone thresholds. Asymmetric findings were present in 6 of these 7 patients tested.

CONCLUSION

Aural symptoms are prevalent among patients with lupus. Asymmetric symptoms and hearing loss are most common. The cause may relate to immune‐complex disease and/or vasculitis.
Ondansetron Versus Droperidol or Placebo to Prevent Nausea and Vomiting after Otologic Surgery
Authors: Jellish W. Scott , Leonetti John P. , Fluder Elaine , Thalji Zuhair
Published: November 2005

This study compares the preoperative administration of ondansetron with that of droperidol or saline solution for the prevention of nausea and vomiting in otologic surgery patients. A total of 120 otherwise healthy individuals were randomly assigned to receive either saline solution, ondansetron (4 mg intravenously), or droperidol (25 μg/kg intravenously) before anesthetic induction. Intraoperative and postanesthesia care unit times were recorded along with incidence of nausea, vomiting, pain, nausea and recovery scores, and the administration of rescue antiemetics. Similar assessments were made during the next 24 hours. Demographics were similar, but more males received ondansetron. Anesthetic recovery scores were lower after administration of droperidol than after ondansetron. Incidence of nausea was similar between groups, but severity was greater with placebo and droperidol than with ondansetron. More vomiting occurred with placebo than with ondansetron or droperidol. No intergroup differences in rescue antiemetic administration were noted, however. Twenty‐four hours later, more patients receiving placebo had nausea or vomited than patients receiving droperidol or ondansetron. Fewer women in the ondansetron group vomited than in the other two groups. Ondansetron 4 mg intravenously is as effective as droperidol and better than saline solution in preventing nausea and vomiting in patients undergoing otologic surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter postanesthesia care unit times was noted after ondansetron therapy. (Otolaryngol Head Neck Surg 1998;118:785–9.)
Psychological Distress
Authors: Van Swearingen Jessie M. , Cohn Jeffrey F. , Turnbull Joanne , Mrzai Todd , Johnson Peter
Published: November 2005

The relationship between facial neuromotor system impairment, disability, and psychological adjustment is not well understood. This study was designed to explore the relation between impairment and disability and the impact of psychological adjustment on the relation for individuals with disorders of the facial neuromotor system. We studied outpatients (n = 48; mean age, 49.0; SD = 16.3; range, 18 to 84 years) with a facial neuromotor disorder and acute or chronic facial paralysis. Measures of impairment (Facial Motion Assay, House‐Brackmann scale, and Facial Grading System), disability (Facial Disability Index, physical and social well‐being subscales), and psychological adjustment (Beck Anxiety Inventory, Beck Depression Inventory) were administered. Bivariate correlations between impairment and disability measures indicated impairment was positively correlated with physical and social disability (r = 0.44, p < 0.01; r = 0.39, p < 0.05, respectively). Stepwise regression analysis to predict disability indicated physical disability was predicted by impairment and the interaction of impairment and psychological distress (R2 = 0.425; F = 12.57; df = 2, 34; p = 0.002). Psychological distress, and not impairment and the interaction of impairment and distress, was the single predictor of social disability (R2 = 0.274; F = 13.23; df = 1, 35; p = 0.001). Psychological distress was a moderator of the relation between impairment and physical disability and a mediator of the relation between impairment and social disability for individuals with facial neuromotor disorders. Assessment and interventions targeted for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders. (Otolaryngol Head Neck Surg 1998;118:790–6.)
Comparison of Multi‐Test Device Skin Testing and Modified RAST Results
Authors: Levine Jonathan L. , Mabry Richard L. , Mabry Cynthia S.
Published: November 2005

The initial purpose of this study was to determine the potential correlation between allergy test results obtained with the Multi‐Test skin testing method and the radioallergosorbent test (RAST) blood test (used as a “standard”). Twenty patients with a history and physical examination findings suggestive of inhalant allergy underwent both a Multi‐Test system screen (14 antigens plus histamine and glycerine controls) and RAST testing. The relationship between wheal size and Multi‐Test system grade for each antigen and the corresponding RAST class was studied. The correlation between positive Multi‐Test system and RAST results was poor, with an average agreement by antigen of 56.26% and overall agreement of 67.86%. However, the overall agreement between negative Multi‐Test system results (≠1+) and negative RAST results (≠class I) was 95.15%, with an average agreement by antigen of 83.99%. On the basis of results of this preliminary study, it appears that a negative Multi‐Test system result indicates that significant inhalant allergy is unlikely, whereas a positive Multi‐Test system result necessitates follow‐up with more definitive testing by additional skin testing or RAST. (Otolaryngol Head Neck Surg 1998;118:797–9.)
Comparison of Inflammatory Cell Profile and Th2 Cytokine Expression in the Ethmoid Sinuses, Maxillary Sinuses, and Turbinates of Atopic Subjects with Chronic Sinusitis
Authors: Kamil Asma , Ghaffar Omar , Lavigne François , Taha Rame , Renzi Paolo M. , Hamid Qutayba
Published: November 2005

Chronic sinusitis is a common disease characterized by persistent inflammation of the sinus mucosa. This study was undertaken to investigate immunopathologic findings in biopsy specimens from the ethmoid sinuses, maxillary sinuses, and inferior nasal turbinates of 14 allergic subjects with chronic sinusitis. The composition of the inflammatory infiltrate in the three tissue sites was examined by immunocytochemistry with anti‐CD3 (total T cells), anti‐CD4 (helper T cells), anti‐CD8 (suppressor T cells), anti‐MBP (eosinophils), antitryptase (mast cells), and antichymase (mast cells) antibodies. These revealed a significant increase in the T‐cell helper/suppressor ratio and eosinophils in the ethmoid sinus mucosa compared with those in the maxillary sinus mucosa and the inferior turbinate. Eosinophil numbers were also higher in the maxillary sinus than in the inferior turbinate. Mast cells were present in significantly higher numbers in the ethmoid sinus and inferior turbinate biopsy sections than in the maxillary sinus. With antisense, radiolabeled riboprobes, we used in situ hybridization to examine the expression of interleukin‐4 and interleukin‐5 transcripts. The density of cells expressing interleukin‐4 transcripts was significantly higher in the inferior turbinate biopsy sections than in those from the ethmoid and maxillary sinuses. In addition, the number of interleukin‐4 mRNA—positive cells was higher in the ethmoid than in the maxillary sinus mucosa. The density of interleukin‐5 mRNA—positive cells was significantly higher in the ethmoid and maxillary sinuses than in the inferior turbinate. The results of this study indicate (1) a more intense inflammatory response in the ethmoid sinus than in the maxillary sinus and inferior turbinate in allergic chronic sinusitis and (2) different inflammatory responses in the upper airways that are dependent on the anatomic site. These findings have potential implications in the design of new therapeutic interventions for allergic chronic sinusitis. (Otolaryngol Head Neck Surg 1998;118:804–9.)
Transforming Growth Factor‐α with Insulin Induces Proliferation in Rat Utricular Extrasensory Epithelia
Authors: Kuntz Alice L. , Oesterle Elizabeth C.
Published: November 2005

Hair cell loss in the human inner ear leads to sensorineural hearing loss and vestibular dysfunction. Recent studies suggest that exogenous addition of growth factors, for example, transforming growth factor‐α with insulin, may stimulate the production of new supporting cells and hair cells in the mature mammalian vestibular sensory epithelium. Before any growth factor can be seriously considered for the treatment of clinical problems related to hair cell loss, its effects on the extrasensory epithelia must also be fully explored. The aim of this study was to determine whether transforming growth factor‐α and insulin stimulate cell proliferation in rodent vestibular extrasensory epithelia. The cell proliferation marker, tritiated thymidine, was infused along with transforming growth factor‐α, insulin, or transforming growth factor‐α plus insulin into the inner ears of adult rats via osmotic pumps. Effects of the test agents were assessed on normal and drug‐damaged utricles. Drug damage was produced by delivering gentamicin directly into the inner ear before the infusion of test agent. Animals were killed 4 or 10 days after pump placement. Utricles were sectioned, processed for autoradiography, and examined for labeled cells within the extrasensory epithelia. In normal animals, transforming growth factor‐α plus insulin stimulated DNA synthesis in all regions of the extrasensory epithelia, suggesting that these agents are mitogenic for these tissues. (Otolaryngol Head Neck Surg 1998;118:816‐24.)
Box and Whisker Plots for Graphic Presentation of Audiometric Results of Conductive Hearing loss Treatment
Authors: Govaerts Paul J. , Somers Thomas , Offeciers F. Erwin
Published: November 2005

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery has published guidelines for the reporting of audiometric results of middle ear interventions. It recommends the reporting of several audiometric variables by means of two summary parameters: means and standard deviation. This article advocates the use of other summary statistics, namely the median, quartiles, and extremes, because they do not require a normal distribution of the audiometric data and they are not sensitive to variations of the extreme values. On the basis of the exploratory data analysis, we propose a graphic method to present the Committee's variables in terms of their summary statistics. This “multiple box and whisker plot” offers a detailed and accurate overview of six variables in one graph. (Otolaryngol Head Neck Surg 1998;118:892–5.)
Completion Thyroidectomy for Differentiated Thyroid Carcinoma
Authors: CHAO TZU‐CHIEH , JENG LONG‐BIN , LIN JEN‐DER , CHEN MIIN‐FU
Published: November 2005

Completion thyroidectomy is performed because of a deferred diagnosis of differentiated carcinoma of the thyroid or a significant thyroid remnant after initial operation. During a period of 6 years, data from 40 patients with differentiated thyroid carcinoma undergoing completion thyroidectomy were retrospectively reviewed. There were 4 men and 36 women (1:9), and the average age was 39.6 ± 1.9 years (range, 20 to 62 years). The indications for the initial surgery were a solitary thyroid nodule in 36 (90%) patients, multi‐nodular goiter in 3 (7.5%) patients, and Graves' disease in 1 (2.5%) patient. Three patients underwent completion thyroidectomy during the same hospital stay. In the remaining 37 patients, completion thyroidectomy was performed 4 to 252 days (44.1 ± 7.8 days) after the initial operation. The length of hospital stay for the initial operation was not different from that for completion thyroidectomy (5.1 ± 0.3 days vs. 5.2 ± 0.3 days). The length of time needed to accomplish the initial operation was not different from that required for the completion thyroidectomy (122 ± 7.5 minutes vs. 110.8 ± 5.9 minutes). There was no 30‐day peri‐operative mortality. The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 3 (7.5%) patients, permanent hypoparathyroidism in 1 (2.5%) patient, transient recurrent laryngeal nerve palsy in 1 (2.5%) patient, and permanent recurrent laryngeal nerve palsy in 1 (2.5%) patient. On the other hand, one transient recurrent laryngeal nerve palsy and one transient hypoparathyroidism occurred at the initial operation. Completion thyroidectomy is a safe procedure to remove the thyroid remnant. (Otolaryngol Head Neck Surg 1998;118:896–9.)
Effect of intravenous calcitonin gene‐related peptide antagonist on the laryngeal chemoreflex in piglets
Authors: Bauman Nancy M. , Wang Deqiang , Jaffe Debra A. , Sandler Anthony D. , Luschei Erich S.
Published: November 2005

The laryngeal chemoreflex (LCR) is characterized by mixed apnea and cardiovascular instability and is elicited by applying water to the laryngeal mucosa of developing animals. The LCR may be fatal in very young animals, and the reflex has been postulated as a possible mechanism of sudden infant death syndrome. Several antagonists have been found to alter the severity of the LCR, but the primary neurotransmitters involved in mediating the reflex response are not yet well understood. This study investigates the effect, on the LCR, of the pharmacologic antagonism of calcitonin gene‐related peptide (αCGRP), a neurochemical found in abundance in the mammalian laryngeal mucosa and its innervating system. The LCR was elicited in 10 mixed breed piglets, 17.7 days of age (12 to 22 days), before and during infusion of αCGRP 8‐37, a pharmacologic inhibitor of αCGRP and cardiorespiratory and laryngeal responses were compared. The duration of obstructive apnea decreased from 17.9 to 9.8 seconds (P < 0.03) in the presence of αCGRP 8‐37. Mean central apnea did not change for the group (P > 0.05), although it was completely inhibited in 2 animals. Cardiovascular changes were not significantly altered by the αCGRP inhibitor. αCGRP appears to play a regulatory role in the apneic response of the LCR, particularly its obstructive component, but not the cardiovascular response.
Systemic reactivation of otitis media with effusion in a rat model
Authors: Jewett Brian S. , Prazma Jiri P. , Hunter Shannon E. , Rose Austin S. , Clark J. Madison , Sartor Balfour R. , Pillsbury Harold C.
Published: November 2005

OBJECTIVE

This study addresses the interaction of bacterial antigens, specifically peptidoglycan‐polysaccharide (PG‐PS) and lipopolysaccharide (LPS), in the induction and reactivation of mucoid middle ear effusions.

METHODS

Twenty‐seven rats underwent eustachian tube obstruction before inoculation of the middle ear bulla with PG‐PS. Three weeks later, after resolution of all middle ear effusions, 6 rats were randomly selected and euthanized as the first control group (control I). The remaining 21 animals were randomly assigned to 3 groups that received intravenous injections of Krebs Ringer (control II), PG‐PS, and LPS, respectively. These rats were euthanized 2 days after intravenous injection. Middle ear mucin production and histologic changes were measured in all animals.

RESULTS

The mean concentrations of mucin were 0.94 ± 0.52 mg/mL, 0.41 ± 0.87 mg/mL, 16.33 ± 3.67 mg/mL, and 1.15 ± 0.41 mg/mL in the control I, control II, PG‐PS, and LPS groups, respectively. Thus the mean concentration of mucin in the middle ear lavage samples was significantly greater in rats that were injected intravenously with PG‐PS than in rats in other groups (P < 0.05). Histologic analyses demonstrated a greater degree of goblet cell hyperplasia in the PG‐PS group than in other groups.

CONCLUSIONS

This is the first animal model of recurring otitis media with effusion in which a systemic injection of PG‐PS was used to reactivate a middle ear effusion in rats previously primed with a transtympanic injection of PG‐PS. This study suggests that after otitis media with effusion has resolved, it may be reactivated by the presence of bacterial antigens and/or cytokines in the systemic circulation.
Effects of sound pressure levels on fundamental frequency in tracheoesophageal speakers
Authors: Deschler Daniel G. , Doherty E. Thomas , Reed Charles G. , Singer Mark I.
Published: November 2005

The quality of tracheoesophageal (TE) voice after laryngectomy is dependent on numerous factors. The relative contribution of specific variables is not well described. To evaluate the modulation of fundamental frequency (F0)—pitch—in TE speakers after total laryngectomy and voice restoration, we instructed 11 TE speakers to complete a series of vocal tasks under standardized conditions. All patients underwent standard laryngectomy with appropriate neck dissection and full‐course radiation therapy. Each speaker produced 4 sustained phonations at distinct levels. Sound pressure level (SPL)—intensity—and F0 measurements were taken for each level. Statistical analysis to assess the relative effect of SPL on F0 demonstrated a statistically significant effect. However, the knowledge of SPL allowed only a 9% greater prediction of F0, indicating that factors other than SPL are integral to the modulation of F0 by TE speakers. These data lend further support to the theory that TE voice is an active process incorporating the myoelastic properties of the pharyngoesophageal segment as well as the properties of aerodynamic flow.
Penicillin‐nonsusceptible pneumococcus in acute otitis media in New York City
Authors: Haddad Joseph , Saiman Lisa , Chin Nai‐Xun , DELLA‐Latta Phyllis
Published: November 2005

OBJECTIVE

To determine the proportion of children with acute otitis media (AOM) presenting in our catchment area in New York City who were infected with nonsusceptible Streptococcus pneumoniae and to determine the susceptibility of these organisms to penicillins and other antibiotics commonly used to treat AOM.

SETTING

Ambulatory clinics and the emergency department of a tertiary care, inner‐city medical center.

PATIENTS

During a 2‐year period from 1993 to 1995, 115 children (aged 6 months to 12 years) with AOM underwent tympanocentesis. Patients did not receive antibiotics for at least 1 week before tympanocentesis.

RESULTS

Thirty‐one children were infected with S pneumoniae, and 83.9% of isolates were susceptible to penicillin. Of the 16.1% strains that were nonsusceptible, most (4 of 5 strains) were intermediately resistant, and only 1 exhibited high‐level resistance to penicillin. Of all the cephalosporins tested, only cefotaxime had consistent activity against the intermediately resistant strains. Notably, all nonsusceptible pneumococci were inhibited by macrolides.

CONCLUSIONS

This study provides unique reference data for nonsusceptible Streptococcus pneumoniae in children with AOM and documents that newer cephalosporin agents are not active against all of these strains.
Long‐term impact of functional endoscopic sinus surgery on asthma
Authors: Senior Brent A. , Kennedy David W. , Tanabodee Jirayu , Kroger Hans , Hassab Mohammed , Lanza Donald C.
Published: November 2005

Using objective and subjective criteria, we performed a study to assess the long‐term impact of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis and asthma at an average follow‐up of 6.5 years. One hundred twenty patients who underwent FESS for chronic rhinosinusitis were followed up for an average of 6.5 years (range 6.0 to 10.6 years). Seventy‐two (60%) patients responded to a follow‐up questionnaire, and 30 (42%) of them reported a history of asthma. Subjective levels of improvement and assessments of medication need were evaluated and statistically assessed with parametric and nonparametric methods. Of these 30 patients, 27 (90%) reported that their asthma was better than it had been before FESS, 6.5 years ago. Average reported improvement increased from 49% at 1.1 years after surgery to 65% at 6.5 years after surgery. Asthma attacks declined in 20 of 27 (74.1%). Medication use for asthma showed similar improvement, with approximately half reporting less inhaler usage and nearly two thirds reporting less oral steroid use. This study demonstrates that a combination of FESS, careful postoperative care, and appropriate medical therapy for chronic rhinosinusitis has a favorable long‐term effect on asthma in patients with symptomatic chronic sinusitis. In this study asthma severity, frequency of attacks, and medication need were all improved.
Voice target time in Parkinson's disease: A preliminary report
Authors: Jiang Jack , Lin Emily , Sheynin Boris , Hanson David G.
Published: November 2005

A target‐matching paradigm was developed to assess the vocal equivalents of reaction and movement time in Parkinson's disease. Six patients with Parkinson's disease and 6 age‐ and gender‐matched control subjects were asked to enunciate /pa/ to reach a target frequency and intensity level in response to a light stimulus. The stimulus and acoustic responses were simultaneously recorded. Measures included laryngeal reaction time, time between stimulus and phonation onset; frequency voice target time, time from phonation onset to target level of frequency; and amplitude voice target time, time from phonation onset to target level of intensity. The 2 subject groups were significantly differentiated by laryngeal reaction time (t = −299.67, df = 10, P = 0.005) and frequency voice target time (t = −148, df = 10, P = 0.014). These data suggest voice target time is a viable tool for assessing the effects of neurologic disorders on voice execution in Parkinson's disease.
Posterior wall augmentation for treatment of velopharyngeal insufficiency
Authors: Gray Steven D. , Pinborough‐Zimmerman Judith , Catten Michael
Published: November 2005

Velopharyngeal insufficiency (VPI) can be treated surgically with various operations. This article describes the use of a superiorly based folded pharyngeal flap for posterior wall augmentation to treat VPI. This is a retrospective study indicating that a folded flap to augment the posterior wall is likely to be as effective as other surgical techniques to treat small velopharyngeal gaps. Patients selected for this procedure had very good velar motion. Postoperative nasometric zoo passage scores improved by an average of 18 over preoperative scores. Additionally, a correlation was found between age and nasometry improvement after surgery. Younger patients did better. Patients in whom VPI was caused by adenoidectomy did well. The 2 syndromic patients did not do as well when treated with this type of operation.
Second Place—Resident Basic Science Award 1998: Steroid‐responsive Cochlear Dysfunction in the MRL/lpr Autoimmune Mouse
Authors: Wobig Roger J. , Kempton J. Beth , Trune Dennis R.
Published: November 2005

Corticosteroids historically have been used to treat autoimmune sensorineural hearing loss, although little is known of how steroids restore normal inner ear function. Therefore, to identify a potential model for this field of research, this study examined the effects of prednisolone on auditory brain stem response thresholds in the MRL/lpr mouse model of autoimmune sensorineural hearing loss. Mice treated with prednisolone after auditory threshold elevations demonstrated significant improvement and stabilization of thresholds compared with untreated controls. MRL/lpr mice treated with steroids before the onset of autoimmune disease and cochlear dysfunction demonstrated decreased serum immune complexes, higher survival rates, and lower auditory thresholds compared with untreated controls. These positive results suggest the autoimmune mouse may be useful for studies of steroid‐responsive mechanisms of the cochlea in autoimmune sensorineural hearing loss, as well as any hearing disorder in which steroid therapy is currently used. (Otolaryngol Head Neck Surg 1999;121:344‐7.)
Third Place—Resident Basic Science Award 1998: Effects of Glutamine on Head and Neck Squamous Cell Carcinoma
Authors: Erickson Rick , Ross David , Medina Jesus
Published: November 2005

Glutamine supplements are being studied as protectants against the mucositis associated with radiation therapy of head and neck squamous cell carcinoma. Glutamine is an important amino acid for the maintenance of healthy gut function and nitrogen transport. It is also a preferred energy source for many types of tumors through an altered Krebs cycle. The effects of glutamine supplements on the growth of head and neck squamous cell carcinoma have not been studied. Eighteen nude mice were implanted with one established cell line, and 18 were implanted with another. The mice were paired and fed either a glutamine‐rich or a glutamine‐poor diet. There was not a statistically significant difference in the growth rates of the xenografts or in the weight gain of the mice between the diet groups. These findings are encouraging for the continued use of glutamine supplements in patients with head and neck squamous cell carcinoma.
Endoscopic Partial Inferior Turbinoplasty
Authors: Van Delden Mahlon R. , Cook Paul R. , Davis William E.
Published: November 2005

Endoscopic partial inferior turbinoplasty with a microdebrider has been introduced as an alternative to other inferior turbinectomy techniques for the treatment of nasal airway obstruction. Between June 1994 and December 1997, 100 patients underwent endoscopic partial inferior turbinoplasty. Concurrent septoplasty was performed in 81 patients, and functional endoscopic sinus surgery was performed in 43 patients. Synechiae formation in 12 patients was the most common complication and resolved in nearly all cases. Postoperative improvement in nasal patency occurred in 93% of the patients. In the 48 patients for whom preoperative subjective scores were available, a significant difference was noted when comparing preoperative and postoperative subjective and outcome scores of nasal patency (P < 0.0001). Patients with underlying allergy and chronic sinusitis tended to have lower outcome scores. Postoperative rhinomanometry was obtained in 21 patients and revealed a normalized mean total nasal resistance of 0.23 Pa/mL/second. This improved to 0.17 Pa/mL/second with topical decongestion (P = 0.0029), revealing the retention of the turbinate mucosa's vasoactive capability. We conclude that endoscopic partial inferior turbinoplasty provides a good alternative to other inferior turbinectomy techniques and is associated with excellent outcomes and minimal morbidity.
Evaluation of the Efficacy of 2‐ Versus 3‐Dimensional Computed Tomography
Authors: Franco Ramon A. , Fedok Fred G. , Brown Daniel B. , Mamourian Alexander C.
Published: November 2005

Simulated 3‐dimensional (3‐D) representation of computerized data is a valuable diagnostic tool in evaluation of tumors of the central nervous system. Several reports exist regarding the clinical value of 3‐D imaging, but there is little objective evidence to quantify improved performance from the images. The purpose of this study was to quantify the efficacy of simulated 3‐D versus 2‐D image interpretation in a nonclinical model. A 3‐tiered, 3‐D model was constructed, and objects were placed in varied positions. CT was then performed on each of the models. Fifty‐three subjects were shown the CT images and asked to reconstruct the model as depicted by either 2‐D or simulated 3‐D images. Performance between subject groups was different depending on clinical experience. In addition, it was found that the 3‐D representation of data allowed for a significantly faster performance of the task of image interpretation and reconstruction of the model.
Strial Dysfunction in the MRL‐Faslpr mouse
Authors: Ruckenstein Michael J. , Milburn Mark , Hu Lydia
Published: November 2005

The MRL‐Faslpr mouse, a model of multisystemic autoimmune disease, has been proposed as a potential model of autoimmune inner ear disease. Cochlear pathology, consisting of hydropic degeneration of the stria vascularis, has been documented to occur coincident with the establishment of systemic disease in this animal. Because the cochlear pathology is restricted to the stria, this study was designed to evaluate whether the endocochlear potential (EP) would be diminished in these animals because of a loss in strial Na,K‐ATPase. Experimental (MRL‐Faslpr) mice, with established systemic disease, had auditory brain stem response thresholds and EPs recorded. MRL‐+/+ mice served as controls. Animals were then euthanized, and their cochleas were processed for immunohistologic assay for the α1 and β2 subunits of Na,K‐ATPase. Density of staining was evaluated by use of quantitative means with densitometry image analysis of digitized images. MRL‐Faslpr mice revealed significant elevations in auditory brain stem response thresholds and reductions in EPs but no reductions in Na,K‐ATPase levels, as evidenced by immunohitochemical assay. The reduction of EP likely occurs as a result of cellular degeneration within the stria vascularis and likely results from an abrogation of the strial perilymph/endolymph barrier and not from a reduction in strial Na,K‐ATPase levels.
Protein Phosphatases 1 and 2A Maintain Endothelial Cells in a Resting State, Limiting the Motility that is Needed for the Morphogenic Process of Angiogenesis
Authors: Gabel Steven , Benefield Janet , Meisinger Jeremy , Petruzzelli Guy J. , Young M. Rita I.
Published: November 2005

Angiogenesis that is induced by cancers, including those of the head and neck, requires endothelial cells to shift from a nonmotile resting state to an increased level of motility. Using a human micro‐vascular endothelial cell line, this study shows the importance of the serine/threonine protein phosphatases 1 (PP1) and 2A (PP2A) in restricting endothelial cell motility. Treatment of endothelial cells with increasing concentrations of the PP1 and PP2A inhibitor okadaic acid resulted in cell rounding and increased motility, which was accompanied by cytoskeletal disorganization involving a loss of filamentous β‐tubulin and F‐actin. These effects occurred at okadaic acid levels that selectively inhibit PP2A and became more prominent with higher levels that inhibit both PP2A and PP1. This study shows the importance of PP1 and PP2A in maintaining cytoskeletal organization, thereby limiting endothelial cell motility, and suggests that pharmacologic approaches to enhance PP1 and PP2A activities may be useful in preventing key events of the angiogenic process.
Cell Proliferation Activity and Kinetic Profile in the Prognosis and Therapeutic Management of Carcinoma of the Pharynx and Larynx
Authors: Sampedro Andrés , Álvarez César , Martínez José Antonio , Suárez Carlos , Alonso‐Guervós Marta , De Los Toyos Juan Ramón
Published: November 2005

Prognosis and management of carcinoma of the pharynx and larynx is now based on the morphologic analysis of the tumor spreading, differentiation grading, and type of microscopic invasion. The DNA ploidy status and the cell proliferation activity analyzed by flow cytometry give us complementary information about the prognosis and the management and support of the patients. We performed a study of 91 cases of carcinoma of the larynx and pharynx by means of flow cytometry. Forty‐three patients were treated by surgery alone, and 48 patients also received radiotherapy. Fifty‐five were aneuploid (60%); this percentage increased to 74% in the pharynx area and fell to 47% at the larynx level. The aneuploid tumors showed worse behavior in the patients treated by surgery alone compared with those who also received radiotherapy. The S‐phase fraction was high in aneuploid tumors, in positive lymph nodes, and in advanced stages. The S‐phase fraction was higher in poorly differentiated tumors. In patients treated by surgery alone, we noticed that by combining both cytometric variables two different kinetic profiles could be defined related to the patients' behavior. The diploid tumors with a low S phase had the greatest rates of survival, whereas diploid tumors with a high rate of S phase and aneuploids had a lower rate.
Surgical Considerations Regarding Cochlear Implantation in the Congenitally Malformed Cochlea
Authors: Ito Juichi , Sakota Takeshi , Kato Hiroshi , Hazama Michio , Enomoto Masao
Published: November 2005

A 4‐year‐old girl with congenital profound deafness underwent cochlear implant surgery. Preoperative CT and MRI revealed that her inner ears had common‐cavity or aplasia‐type malformation. The bilateral internal auditory meatus were markedly narrowed. Audiometric examination demonstrated that only slight residual hearing remained in the low‐frequency range and that a hearing aid would be of no benefit. Cochlear implantation was performed in her left ear. Because of the abnormal position of the facial nerve, the routine facial recess approach could not be performed. A canal‐wall‐down mastoidectomy was performed, and multichannel cochlear implant electrodes were inserted by careful drilling of the bony wall of the semicircular canal area. All 22 electrodes were completely inserted into the cavity. The patient can perceive sounds and her hearing ability is progressively improving.
Q‐Switched Neodymium: Yttrium‐Aluminum‐Garnet Laser Treatment of Lentigo Maligna
Authors: Orten Steven S. , Waner Milton , Dinehart Scott M. , Bardales Ricardo H. , Flock Stephen T.
Published: November 2005

Lentigo maligna is a premalignant lesion of atypical melanocytes that typically arises on the head and neck of elderly patients. It is considered a melanoma in situ with a significant risk for transformation to invasive lentigo maligna melanoma. Surgery is the preferred method of treatment; however, because of the advanced age of the typical patient with lentigo maligna, the frequency of complicating medical problems, and the cosmetic or functional aspects of treatment, surgical excision is not always feasible. The purpose of this pilot study was to evaluate the efficacy and safety of Q‐switched neodymium:yttrium‐aluminum‐garnet laser treatment of lentigo maligna. Eight patients were treated with 532 and/or 1064 nm wavelengths from the laser. All patients showed a response to laser therapy, and 2 patients treated with 1 treatment from each wavelength had complete eradication of the LM, with no evidence of recurrence in 42 months. Further study is warranted, but Q‐switched neodymium:yttrium‐aluminum‐garnet laser is a promising alternative treatment for lentigo maligna.
Use of the Superior Meatus and Superior Turbinate in the Endoscopic Approach to the Sphenoid Sinus
Authors: Bolger William E. , Keyes Alan S. , Lanza Donald C.
Published: November 2005

Endoscopic surgery of the posterior ethmoid and sphenoid sinuses can present the operator with a considerable challenge. Although endoscopic training and physician experience have increased significantly in the past decade, surgical complications such as optic nerve trauma and cerebrospinal fluid leak still occur. Surgeons reporting such complications cite a lack of orientation within the dissection field as a primary cause. Because endoscopic sinus surgery is now being performed more routinely, surgical strategies designed to reduce the risk of complications are more important than ever. An anatomic landmark that could reliably orient the dissection within the posterior ethmoids and guide the surgeon to the sphenoid sinus could reduce the possibility of such adverse outcomes. In our experience identification of the superior meatus and superior turbinate provides a reliable landmark within the dissection field that can ensure surgical orientation to the operator. This technique allows safe, reliable dissection of the posterior ethmoids and an efficient approach to the sphenoid sinus, especially in patients undergoing revision surgery. In this article our technique for the identification and definition of the superior meatus and superior turbinate is presented, and the advantages of using this landmark in sinus surgery are discussed. In our experience identification of the superior meatus, superior turbinate, posterior skull base, and medial orbital wall defines a parallelogram‐shaped box, which delineates the sphenoid face. This box provides the necessary orientation to guide the surgeon's entrance into the sphenoid sinus through the posterior ethmoid sinus (as Messerklinger described). Techniques for identifying the superior turbinate and meatus and for entering the sphenoid are detailed.
Postoperative Hemorrhage after Tonsillectomy: Use of Ketorolac Tromethamine
Authors: Agrawal Amit , Gerson Carol Roberts , Seligman Ilana , Dsida Richard M.
Published: November 2005

Recent reports have associated an increased incidence of bleeding after tonsillectomy with the perioperative use of ketorolac tromethamine. To review this association, we examined the hospital and office records of 310 pediatric patients who underwent tonsillectomy with or without adenoidectomy at our institution during a 2‐year period. Of these patients, 213 received ketorolac administered as a single dose at the conclusion of the procedure. The remaining 97 patients did not receive ketorolac. The frequency of postoperative hemorrhage was not found to differ significantly between these 2 groups (2.3% vs. 3.1% respectively, P = 0.71). Furthermore, the average time to discharge after surgery was significantly shorter in those patients who received ketorolac than in those who did not (8.5 hours vs. 12.5 hours, respectively, P < 0.0001). The frequency of overnight hospital stays was also significantly lower in those patients who received ketorolac (16.0% vs. 31.6%, respectively, P < 0.01). Concern over the potential for increased hemorrhage after tonsillectomy has led several authors to caution against the use of ketorolac in this setting. In our study, however, the use of ketorolac was not found to increase the incidence of posttonsillectomy hemorrhage and furthermore was associated with a significant decrease in the length of hospital stay as well as a decreased likelihood of overnight hospital stay after surgery.
Trigeminal Schwannomas: The Role of the Neurotologist in Multidisciplinary Management
Authors: Friedman Rick A. , Pensak Myles L. , Osterhaus David , Tew John M. , Van Loveren Harry R.
Published: November 2005

Trigeminal neuromas are slow‐growing benign tumors representing approximately 10% of all intracranial neuromas and less than 0.5% of all intracranial tumors. Historically, excision of these tumors through traditional neurosurgical routes—including the frontotemporal transsylvian, subtemporal‐intradural, subtemporal‐transtentorial, or sub‐occipital approaches—has resulted in an unsatisfactorily high rate of recurrence. In this study we compare contemporary skull base/neurotologic approaches with conventional procedures for trigeminal neuroma extirpation.
Squamous Cell Carcinoma of the Buccal Mucosa
Authors: Strome Scott E. , To Wyatt , Strawderman Myla , Gersten Kevin , Devaney Kenneth O. , Bradford Carol R. , Esclamado Ramon M.
Published: November 2005

The purpose of this study was to establish treatment criteria for patients with early‐stage squamous cell carcinoma of the buccal mucosa. Thirty‐one patients were analyzed in a retrospective fashion. Distribution of patients according to tumor stage was relatively even. Within 5 years recurrent disease developed in nearly 80% of evaluable patients. There was a 100% overall incidence of local disease recurrence for patients with stage I and II tumors treated with wide local excision alone and followed up for more than 2 years. On the basis of these data, we conclude that wide local excision for early‐stage buccal carcinoma is associated with a high local failure rate. Possible causes for failure and alternative treatment approaches are discussed.
Subcranial Approach to Tumors of the Anterior Cranial Base: Analysis of Current and Traditional Surgical Techniques
Authors: Moore Charles E. , Ross Donald A. , Marentette Lawrence J.
Published: November 2005

Tumors of the anterior cranial base have previously required a craniofacial resection to allow adequate tumor extirpation. An analysis of current and traditional techniques demonstrates a significant reduction in operative time, complication rate, and intensive care unit and total hospital length of stay with the use of the subcranial approach as compared with the traditional frontal craniotomy and lateral rhinotomy approach. The subcranial approach is both cost and time efficient and provides comparable morbidity and mortality rates.