bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Results with Hydroxylapatite Middle Ear Implants
Authors: Goldenberg Robert A. , Driver Mark
Published: November 2005

PURPOSE

This study evaluated long‐term results in patients who had ossicular reconstruction with a Goldenberg hydroxylapatite implant.

METHODS

A total of 233 patients underwent implantation; of these, 77 had 5‐year or longer follow‐up and are the subjects of this study of long‐term hearing results. All 233 patients were included for analysis of extrusion rate and postoperative otorrhea.

RESULTS

The hearing success rate at long‐term follow‐up was 56.8%; the mean air‐bone gap was 21.1 dB. Prosthesis extrusion occurred in 5.29% of the 233 patients, and visible slippage occurred in 7.7%. Overall, 50.6% of patients met the criteria for successful hearing, which included no extrusion and a dry ear. Better hearing before surgery and presence of the malleus long process were factors associated with a successful hearing result, as was tympanoplasty alone and canal wall up tympa‐nomastoidectomy.

CONCLUSION

Hydroxylapatite hybrid prostheses provide stable hearing results over time with low extrusion and a dry ear overall.
Prevalence of Unsuspected Acoustic Neuroma Found by Magnetic Resonance Imaging
Authors: Anderson Timothy D. , Loevner Laurie A. , Bigelow Douglas C. , Mirza Natasha
Published: November 2005

OBJECTIVES

Acoustic neuromas (ANs) comprise 6% of intracranial tumors. Population and autopsy studies have widely divergent estimates of AN incidence. With widespread use of MRI, asymptomatic ANs will be identified, which should improve estimates of the prevalence of this tumor.

METHODS

The reports of all brain MRI scans during a 5‐year period were retrospectively searched for the diagnosis of AN. MRIs obtained because of a suspicion of AN were discarded, leaving only the unsuspected ANs.

RESULTS

A total of 24,246 MRI studies were performed during this time period. Seventeen patients had unsuspected ANs. Eight tumors were smaller than 1 cm, 6 were between 1 and 2 cm, and 3 were 2 cm or larger. For all MRI scans, we found 7.0 unsuspected ANs per 10,000 brain MRI studies (0.07%).

CONCLUSION

The true prevalence of AN is likely greater than the 10 per million per year previously reported. This implies that there may be a larger number of asymptomatic ANs than previously suspected.
Tumor Size and Pretreatment Speech and Swallowing in Patients with Resectable Tumors
Authors: Colangelo Laura A. , Logemann Jeri A. , Rademaker Alfred W.
Published: November 2005

The pretreatment relationship of tumor burden to speech and swallowing function in 230 patients with oral or oropharyngeal cancer before surgery was assessed. Reduced articulation, reduced conversational understandability, or self‐reported dysphagia were present in at least 34% of patients before treatment. Videofluoroscopy showed at least 9% of patients had reduced swallowing efficiency on liquid, paste, or cookie boluses. By use of regression techniques, the percentages of the oral tongue and of the anterior floor of mouth affected by neoplasm were found to be significantly related to reduced articulation; T stage and the percentage of the oral tongue affected with tumor were mildly related to reduced understandability; tumor volume and having soft palate affected by neoplasm were significantly related to self‐reported dysphagia; and percentages of affected oral tongue and of affected tongue base were significantly related to reduced swallowing efficiency. Tumor burden may contribute to functional deficits at diagnosis in patients who have resectable tumors.
Malignant Peripheral Nerve Sheath Tumors of the Head and Neck: Analysis of Prognostic Factors
Authors: Loree Thom R. , North James H. , Werness Bruce A. , Nangia Rina , Mullins Alan P. , Hicks Wesley L.
Published: November 2005

Malignant peripheral nerve sheath tumors of the head and neck region are uncommon and may be associated with neurofibromatosis or occur in a sporadic manner. This is a retrospective review of 17 patients with these tumors who were treated at a single institution. Analysis of clinical and pathologic factors that influenced outcome was performed. There were 9 men and 8 women. Seven patients had a history of neurofibromatosis. Radiotherapy was implicated as a possible etiologic factor in 4 patients. The neck was the most frequently involved site. Overall survival at 5 years was 52%. Survival was improved for women and for patients with low‐grade tumors. Age, tumor site, and size had no impact on survival. Survival was worse for patients with neurofibromatosis than for those with the sporadic form of the disease (P= 0.02). Survival was calculated by the method of Kaplan and Meier. The significance of such results was based on results of the log rank test. Local recurrence correlated with tumor size and resection margin status. No local recurrences occurred in those patients who had negative margins of resection and received adjuvant radiotherapy. Tumor grade was predictive of the development of distant metastases. Negative margins of resection are essential for obtaining local control, and the addition of adjuvant radiotherapy may be beneficial in this group. Salvage surgery for local recurrence is possible in some patients.
Comparison of Open, Percutaneous, and Translaryngeal Tracheostomies
Authors: Maccallum Patricia L. , Parnes Lorne S. , Sharpe Michael D. , Harris Chris
Published: November 2005

INTRODUCTION

With 3 tracheostomy techniques currently available, controversy exists regarding which is safest and most economical. Percutaneous (PDT) and the new translaryngeal (TLT) tracheostomies are cited as more cost‐effective than the traditional open surgical procedure because they are bedside techniques. Our objective was to compare the perioperative and postoperative complications of the 3 techniques.

STUDY DESIGN

This was a prospective trial involving 100 consecutive patients who underwent tracheostomy between April and December of 1997 at the London Health Sciences Centre and St Joseph's Health Centre in London, Canada.

RESULTS

Fifty open tracheostomies were performed. Indications included prolonged ventilation (n = 42), airway protection (n = 5), pulmonary hygiene (n = 2), and sleep apnea (n = 1). A tension pneumothorax was the one significant intraoperative complication. Fifteen postoperative complications occurred, most notable of which was a 2‐L hemorrhage at 24 hours. Thirty‐seven TLTs were performed, 20 in patients with coagulopathy. Indications were prolonged intubation (n = 27), airway protection (n = 9), and pulmonary hygiene (n = 1). One intraoperative complication of accidental decannulation occurred. One postoperative complication, a pretracheal abscess, occurred in a decannulated transplant patient 2 weeks after the procedure. Thirteen PDTs were performed. Indications were prolonged intubation (n = 6), airway protection (n = 6), and tracheal toilet (n = 1). No significant complications occurred.

CONCLUSIONS

TLT and PDT have fewer complications than the traditional open technique. TLT appears to have the greatest utility in the coagulopathic patient.
Botulinum Toxin Injection of the Cricopharyngeus Muscle for the Treatment of Dysphagia
Authors: Ahsan Syed F. , Meleca Robert J. , Dworkin James Paul
Published: November 2005

OBJECTIVE

This study was conducted to evaluate, subjectively and objectively, the diagnostic and therapeutic effects of botulinum toxin (Botox) in patients with dysphagia caused by cricopharyngeus (CP) muscle spasm and/or hypertonicity.

METHODS

A retrospective chart review was done of 5 patients with normally functioning larynges treated with CP Botox injection for dysphagia caused by perceived spasm. Subjective measures of swallowing function after injection were obtained with a patient questionnaire. Objective data were obtained both before and after surgery by one or more of the following tests: modified barium swallow study, manometry, videostroboscopy, and fiberoptic endoscopic evaluation of swallowing. Quality‐of‐life measures were obtained with a swallowing rating scale.

RESULTS

Overall, all patients had initial improvement in swallowing after Botox injection. The duration of benefit was from 2 to 14 months. There were no complications. Four of 5 patients had long‐term benefits, as evidenced by decreased or eliminated aspiration symptoms, removal of tracheotomy, ability to eat solid foods, and weight gain. One patient continues to have poor swallowing function.

CONCLUSION

Botox injection of the CP muscle to treat dysphagia is effective in patients with underlying muscle spasm or hypertonicity. A positive response to Botox can also help confirm the diagnosis of CP muscle spasm.
Nitric Oxide is a Mediator of the Late‐Phase Response in an Animal Model of Nasal Allergy
Authors: Durland William F. , Lane Andrew P. , Durland Kimberly W. , Smith Timothy L. , Johnson Kenneth L. , Prazma Jiri , Pillsbury Harold C.
Published: November 2005

The presence of nitric oxide (NO) in the nose is well documented; however, the role of this molecule in nasal physiology is still poorly understood. Our laboratory has previously demonstrated that NO is a mediator of the immediate secretory response to an intranasal histamine challenge in a rat model of nasal allergy. Histamine challenge, however, does not elicit a late‐phase response (LPR). To study the role of NO in the LPR, we developed a model of nasal allergy in which brown Norway rats are actively sensitized to the allergen ovalbumin and later challenged intranasally with either phosphate‐buffered saline solution (vehicle), ovalbumin in vehicle, or ovalbumin and the NO synthase inhibitor N‐nitro‐L‐arginine methyl ester. In each experiment, nasal lavage samples were collected 30, 120, 240, and 360 minutes after challenge. Lavage samples were analyzed for albumin content by ELISA, inflammatory cell concentration with a hemocytometer, and evidence of inflammation by light microscopy. Blocking NO synthesis with N‐nitro‐L‐arginine methyl ester significantly inhibited both albumin exudation and inflammatory cell influx into the nasal cavity during the LPR. These data suggest that NO plays a role in the LPR of nasal allergy.
Correlation of Neural Cell Adhesion Molecules with Perineural Spread of Squamous Cell Carcinoma of the Head and Neck
Authors: Vural Emre , Hutcheson James , Korourian Soheila , Kechelava Sofia , Hanna Ehab
Published: November 2005

Perineural spread (PNS) is a poor prognostic factor associated with increased risk of local recurrence and nodal metastasis and reduced survival of patients with squamous cell carcinoma of the head and neck (SCCHN). There is some evidence to indicate that neural cell adhesion molecules (NCAMs) may play a role in PNS of a variety of tumor types. We performed this study to investigate whether NCAM expression can be used as a predictor of PNS in SCCHN. The surgical specimens of 66 patients with SCCHN were evaluated with monoclonal IgG antibody immunoperoxidase staining for NCAM. Of the 41 specimens with PNS, 38 (93%) showed evidence of NCAM expression. In contrast, only 9 specimens (36%) without PNS expressed NCAMs. The difference in NCAM expression between the study and control groups was statistically significant (P > 0.01).
Surgical Treatment of Labyrinthine Fistula Caused by Cholesteatoma
Authors: Soda‐Merhy Antonio , Betancourt‐Suárez Miguel Angel
Published: November 2005

In a 144‐month period, 27 cases of labyrinthine fistula (LF) were seen, and 360 mastoid operations were performed; the LF prevalence was 7.5%. Primary symptoms were hypoacusis, otorrhea, vertigo, tinnitus, and otalgia. All patients underwent preoperative CT scans and preoperative audiometry. LF diagnosis was made before surgery for 93% of patients on the basis of symptoms, signs, and imaging studies. With respect to surgical technique, the canal‐wall‐down procedure was performed in 92%, and the canal‐wall‐up procedure was performed in 8%. In 88% of patients the fistula was located in the horizontal semicircular canal. In 96% of patients the cholesteatoma matrix was removed, and the fistula was sealed; in 4% of patients the matrix was left. With a follow‐up of 13 years, vertigo disappeared in 96% of patients, and hearing remained unchanged in 70% of patients. Further complications of chronic otitis media existed in approximately half of the patients with LF. Open surgery with removal of the cholesteatoma matrix and sealing of the fistula with temporalis fascia in a canal‐wall‐down manner is a safe procedure that can make vertigo disappear and helps to preserve cochlear function.
Acoustic Analysis of the Voice in Phonatory Fistuloplasty after Total Laryngectomy
Authors: Arias Mariano Rosique , Ramón José Luis , Campos Matilde , Cervantes Juan Jiménez
Published: November 2005

A comparative study of the voice with sustained phonation of the vowel /a/ was made in 3 groups of male patients: (1) 20 patients receiving total laryngectomy for epidermoid carcinoma of the larynx who had acquired good voice quality after a phonatory fistuloplasty with a Herrmann voice prosthesis; (2) 20 patients undergoing total laryngectomy for epidermoid carcinoma of the larynx who had learned esophageal speech; and (3) 20 subjects with normal voices. Statistical analysis yielded significant differences in fundamental voice frequency between the 3 groups, with the patients with phonatory prostheses revealing the closest to a normal voice. For other parameters used, such as jitter, shimmer, and harmonics/noise ratio, voice quality with a phonatory prosthesis was similar to that obtained with esophageal speech.
Hearing Results in the Second Stage of Open Mastoidectomy: A Comparison of the Different Techniques
Authors: Cristóbal Fernando , Gómez‐Ullate Rafael , Cristóbal Isabel , Arcocha Alfredo , Arroyo Ramón
Published: November 2005

OBJECTIVE

The goal of this study was to compare the hearing results obtained through different hearing‐restoration techniques in open‐cavity mastoidectomy.

METHODS AND MATERIAL

A total of 116 ears operated on during the second stage of open mastoidectomy were studied. The hearing gain was registered as the difference between preoperative and 1‐year postoperative conversational frequency means (500, 1000, 2000 Hz). High‐pitched frequencies (4000 Hz) were used equally. Two groups of studies were carried out: in one study the stapes was intact, and in the other the stapes arch was absent. The columella techniques we examined, from a hearing point of view, are total and partial ossicular replacement prostheses, ossiculoplasty, cartilage with or without perichondrium, and the myringostapediopexy.

RESULTS AND CONCLUSIONS

In the group of patients in whom the stapes was intact, the differences in high‐pitched frequencies found between the different techniques were negligible, but the differences were quite significant in conversational frequencies, where the partial ossicular replacement prosthesis turned out to be the technique with the worst results. In ears in which only the footplate was present, the total ossicular replacement prosthesis gave better results than any other technique, both in conversational frequencies and in 4000‐Hz frequency.
Complications of Postoperative Radiation Therapy after Partial Laryngectomy in Supraglottic Cancer: A Long‐Term Evaluation
Authors: Laccourreye Ollivier , Hans Stéphane , Borzog‐Grayeli Ali , Maulard‐Durdux Catherine , Brasnu Daniel , Housset Martin
Published: November 2005

This retrospective study, based on a series of 90 patients with invasive squamous cell carcinoma of the supraglottis, was designed to document the functional outcome and complications after postoperative radiation therapy following partial laryngeal surgery. The surgical procedure was a standard supraglottic laryngectomy in 62 patients and a supracricoid partial laryngectomy in 28 patients. All of the patients had an unremarkable postoperative course and achieved locoregional control. The average dose delivered to the remaining larynx was 51.2 Gy (range 25‐71 Gy). The average dose delivered to the neck was 50.6 Gy (range 2270 Gy). The patients were treated at 180‐cGy per fractions in a continuous course technique with a cobalt 60 beam. In 5 patients (5.5%) complications led to cessation of postoperative radiation therapy, and the total dose delivered to the remaining larynx and neck was less than 40 Gy. All patients were followed up for a minimum of 10 years or until death. The 5‐, 10‐, and 15‐year actuarial survival estimates were 71.5%, 44.3%, and 36.3%, respectively. The 5‐, 10‐, and 15‐year actuarial severe complication estimates were all 11.2%. Overall, severe complications occurred in 15 patients. Severe complications led to death in 3 patients (3.3%), permanent gastrostomy in 3 (3.3%), and permanent tracheostomy in 1 (1.1%). A severe complication never resulted in completion of total laryngectomy. In univariate analysis, the mean dose delivered to the larynx was the only variable statistically related to the incidence of a severe complication. The mean dose delivered to the larynx was statistically higher(P= 0.014) in patients who had severe complications (60 Gy) than in patients who did not (50 Gy).
Skin Prick Test Reactivity to Foods in Adult Malaysians with Rhinitis
Authors: Gendeh Balwant Singh , Murad Shahnaz , Razi Azizah Mohd , Abdullah Nasaruddin , Mohamed Abdullah Sani , Kadir Khalid Abdul
Published: November 2005

The aim of the study was to determine the incidence of food and house dust mite (HDM) allergy in patients with nasal congestion and rhinorrhea attending the Otorhinolaryngology Clinic, National University of Malaysia, Kuala Lumpur. This was a prospective matched, controlled study of patients skin prick tested with commercial food and common aeroallergens. The participants were 148 Malaysian adults with symptoms of nasal congestion and rhinorrhea and 113 adult Malaysian control subjects without rhinitis symptoms. The skin prick test (SPT) was used to evaluate 11 foods common to the Malaysian diet and 3 HDM inhalants. Forty‐eight percent of the patients with rhinitis had positive SPT results to foods, compared with 4.4% of control subjects (P > 0.05). The most commonly implicated foods were shrimp (48%) and rice (30%), which are common in the Malaysian diet. Seventy‐two percent of rhinitis patients had positive SPT results to HDM, compared with 22.2% of control subjects (P > 0.05). Patients with rhinitis also had significantly more gastrointestinal problems than control subjects (P > 0.05). The incidences of HDM and food allergy are significantly greater in Malaysian adults with rhinitis symptoms than in control subjects without rhinitis. The effect of avoidance or immunotherapy awaits further study.
Therapeutic Dilemmas in the Management of Thyroid Cancer with Laryngotracheal Involvement
Authors: Kim Kwang Hyun , Sung Myung‐Whun , Chang Keun‐Ho , Kang Beom‐Seung
Published: November 2005

Invasion of the larynx and trachea by thyroid cancer is an uncommon but difficult problem. There is no consensus on indication for or extent of surgery, particularly when there is a requirement for airway reconstruction. From 1989 through 1996, we treated 22 patients with thyroid carcinoma with invasion of the larynx and trachea. Seventeen of these patients had recurrent disease. We applied radioactive iodine therapy after regional ablative surgery to resectable tumors with or without lung metastasis, larynx‐preserving surgery to extraluminal or small intraluminal tumors restricted to the short segment of trachea, or total laryngectomy to recurrent tumors deeply invading the cartilage framework of the larynx. We performed arytenoid adduction or thyroplasty in one stage if the recurrent laryngeal nerve was paralyzed or resected intraoperatively. We could get relatively good survival and functional results by aggressive surgical treatment in 20 patients, but the disease was inoperable in 2 patients. It is stressed that head and neck surgeons who have to deal with cancer of the thyroid should not only be familiar with various techniques of airway reconstruction and voice rehabilitation but also must be aware of the biologic behavior of the thyroid carcinoma.
Treatment of tinnitus with electrical stimulation
Authors: Steenerson Ronald L. , Cronin Gaye W.
Published: November 2005

The purpose of this study was to evaluate the treatment of tinnitus with electrical stimulation. Five hundred patients with tinnitus were treated with probe electrical stimulation. Causes of tinnitus were sensorineural hearing loss (303 patients), Meniere's disease (88), infection (25), head trauma (39), acoustic trauma (25), ototoxicity (4), and chemotherapy (2). Treatment involved 6 to 10 transcutaneous treatment electrical stimulation sessions biweekly. Fifty‐three percent of patients showed decreases in their tinnitus as measured by a subjective rating scale. With a 3‐month follow‐up, 72% had no loss of benefit. Thirteen patients had temporary increases in their tinnitus. Two patients had permanent increases. Probe electrical stimulation seems to offer some benefit in about half the patients treated for annoying tinnitus.
Prospective study of tympanic membrane retraction, hearing loss, and multifrequency tympanometry
Authors: Li Yaoli , Hunter Lisa L. , Margolis Robert H. , Levine Samuel C. , Lindgren Bruce , Daly Kathleen , Giebink G. Scott
Published: November 2005

Tympanic membrane retraction is a significant sequela of OME and has been linked clinically to atelectasis, ossicular erosion, and cholesteatoma. We investigated important factors for prediction of tympanic membrane retraction in a prospective study of 112 children. After 4 to 6 years of follow‐up, 12% of ears had pars tensa retraction without atrophy, and 28% had various degrees of retraction with atrophy. Mild pars flaccida retraction was present in 23%, and severe pars flaccida retraction was present in 12%. Retraction severity was related to hearing level and multifrequency tympanometry. Three factors were significantly related to retraction severity: type of tube, male sex, and percent of visits in the second year with abnormal tympanograms. This study shows that type of tube was the most important factor in long‐term outcome after tympanostomy tube treatment of OME.
Voice quality after narrow‐margin laser cordectomy compared with laryngeal irradiation
Authors: Delsupehe Kathelijne G. , Zink Inge , Lejaegere Maryline , Bastian Robert W.
Published: November 2005

Voice quality remains the issue often used to support preference for radiotherapy in treatment of early glottic cancer. We therefore conducted a perceptual voice study in 2 groups, one treated with radiotherapy for malignant disease and the other with narrow‐margin laser cordectomy for either malignant or extensive benign lesions. Sequential patients, 12 treated with radiotherapy and 30 with CO2 laser excision, were included. Voice samples were recorded before and at intervals after surgery. Ratings of validated judges were used for statistical analysis of various voice characteristics at each time point. Voice deteriorated temporarily after surgery as compared with the radiated group; however, at 6 and 24 months no significant differences were found between the groups. Preferential use of narrow‐margin laser cordectomy for appropriate early glottic tumors can be supported not only for oncologic reasons but also on the basis of voice results, cost, and efficiency considerations. (Otolaryngol Head Neck Surg 1999;121:528–33.)
Predictive markers for response to chemotherapy, organ preservation, and survival in patients with advanced laryngeal carcinoma
Authors: Bradford Carol R. , Wolf Gregory T. , Carey Thomas E. , Zhu Shaobo , Beals Theodore F. , Truelson John M. , Mcclatchey Kenneth D. , Fisher Susan G.
Published: November 2005

OBJECTIVE

A systematic retrospective study of the largest randomized trial of induction chemotherapy and radiation for advanced laryngeal cancer was undertaken to determine whether specific tumor or biologic factors were predictive of chemotherapy response, organ preservation, or survival.

METHODS

The variables analyzed included clinical and histologic factors, immunohistochemical expression of proliferating cell nuclear antigen and p53, and adjusted DNA index measurements. Variables were evaluated for correlation with outcomes of tumor response, organ preservation, and survival.

RESULTS

Multivariate analysis revealed that the best predictor of complete response to induction chemotherapy was low T class. The full multivariate model for predicting larynx preservation in patients treated with induction chemotherapy plus radiation shows that T class, p53 overexpression, and elevated proliferating cell nuclear antigen index were independent predictors of successful organ preservation.

CONCLUSIONS

These predictive markers should be included in future clinical trials of advanced laryngeal cancer to determine their usefulness prospectively.
Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood
Authors: Kim Michael K. , Pawel Bruce R. , Isaacson Glenn
Published: November 2005

OBJECTIVE

The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide‐field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens.

METHODS

We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure.

RESULTS

We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow‐up of 9 months to 6 years. All have acceptable functional and cosmetic results.

CONCLUSION

An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.
Safety of home‐based and office allergy immunotherapy: A multicenter prospective study
Authors: Hurst David S. , Gordon Bruce R. , Fornadley John A. , Hunsaker Darrell H.
Published: November 2005

During a 1‐year period, 27 otolaryngic allergy practices recorded all systemic reactions to immunotherapy resulting from 635,600 patient visits and 1,144,000 injections. Sixty percent of injections were given at home. Major systemic reactions were observed after 0.005% of injections. There were no hospitalizations or deaths. Eighty‐seven percent of major reactions began within 20 minutes of injection. Frequently observed risk factors for major reactions were buildup phase of immunotherapy, active asthma, and first injection from a treatment vial. Home and office injections had similar rates of total systemic reactions, but home‐based immunotherapy had far fewer major reactions. Home‐based immunotherapy was found to be safe. The methods and precautions used to treat patients with this degree of safety are specified and discussed.
Effect of nasal surgery on the nasal cavity as determined by acoustic rhinometry
Authors: Kemker Bryan , Liu Xiling , Gungor Anil , Moinuddin Rizwan , Corey Jacquelynne P.
Published: November 2005

Acoustic rhinometry (AR) was used to objectively measure the success of septoplasty in relieving nasal obstruction caused by septal deviation. In addition, the patients were given a questionnaire to subjectively assess symptoms of congestion, rhinorrhea, and sneezing. Patients diagnosed with a septal deviation requiring surgery to eliminate obstruction were enrolled in this study. A septal deviation often results in concomitant sinonasal or respiratory problems that require septoplasty plus other surgeries to treat the patient effectively. AR measurements for patients who underwent septoplasty or septoplasty plus other surgeries were taken before and after surgery. To avoid confounding results caused by different levels of congestion, we used only postdecongestant values to analyze the data and only the side of the nose with the smaller volume for analysis. Patients in the septoplasty‐only group showed a statistically significant (P < 0.01) increase in volume as measured by AR, a decrease in the symptom of congestion, and a decrease in the symptom of rhinorrhea. Patients who had septoplasty plus other sinonasal procedures showed significant increases in volume and cross‐sectional area (CSA) 3, whereas CSAs 1 and 2 increased also, but not significantly.
Decreased neuropeptide release may play a role in the pathogenesis of nasal polyps
Authors: Anil Gungor , Fuad M. Baroody , Robert M. Naclerio , Steven R. White , Jacquelynne P. Corey
Published: November 2005

In this in vivo prospective, controlled study, we have examined the capsaicin‐induced levels and secretion patterns of the colocalized neuropeptides substance P, calcitonin gene‐related peptide (CGRP), and neurokinin A in nasal secretions of subjects with nasal polyps, and we compared these with secretion patterns from healthy subjects and from subjects with allergic rhinitis. Capsaicin was used to elicit neuropeptide release. The neuropeptide levels were measured by an ELISA technique. For substance P, subjects with nasal polyps responded very poorly to capsaicin stimulation. The atopic group was more reactive to capsaicin stimulation than control subjects. For CGRP the increase was immediate in all groups. Atopic subjects and subjects with polyps had a less pronounced but sustained response to capsaicin stimulation. CGRP levels in atopic subjects and those with polyps were restored rapidly. Atopic subjects had higher neurokinin A levels with an immediate and sustained response to capsaicin. Control subjects had higher levels than those with polyps, but both groups were nonresponsive to capsaicin stimulation.
Modification of the inner flange of the Paparella type II ventilation tube for easier insertion
Authors: Vural Emre , Yorulmaz Irfan , Dornhoffer John L.
Published: November 2005

A simple modification of the inner flange of the Paparella type II ventilation tube is described to provide easier and faster insertion.
Development of the Allergy Outcome Survey for allergic rhinitis
Authors: Kemker Bryan J. , Corey Jacquelynne P. , Branca Joseph , Gliklich Richard E.
Published: November 2005

The Allergy Outcome Survey (AOS) is a reliable measure used to monitor patients with allergic rhinitis. It was developed for and included in the Outcomes Measures of Immunotherapy in Allergic Rhinitis (OMIAR‐1) project, designed to study the benefits of immunotherapy in the treatment of allergic rhinitis. Preliminary results indicate that AOS is specific, brief, reliable, and easy to use. Also, it is useful for evaluating change with therapy and can be used alone as a performance metric or in combination with other measures as part of a more complete outcomes monitoring system. As the OMIAR‐1 study progresses, more information will be available on the advantages and limitations of the AOS.
Effects of discrimination difficulty on cognitive event‐related brain potentials in patients with cochlear implants
Authors: Okusa Masako , Shiraishi Takayuki , Kubo Takeshi , Nageishi Yasuhiro
Published: November 2005

Cognitive event‐related brain potentials (ERPs) recorded during a 2‐tone discrimination (oddball) task were examined in 8 patients with cochlear implants. The aim of this study is to investigate the effects of discrimination difficulty formed by 4 conditions of stimulus contrast: the target stimuli were set at 2000, 1500, 1200, or 1100 Hz, and nontarget stimuli were set at 1000 Hz throughout. The averaged ERPs recorded after the target stimuli revealed N100, P200, N200, and P300 peaks, whereas those after the nontarget stimuli showed only N100 and P200 peaks. The peak latencies of the ERP components of early information processings (N100 and P200) were not significantly increased among the 4 conditions. In contrast, the latencies of late cognitive components (N2b and P300, whose peak latencies were longer than 250 msec) and reaction times were significantly increased as target discriminability decreased. In conclusion, early information processings were not delayed by the discrimination difficulty, but cognitive processings were delayed in patients with cochlear implants. Because the N2b amplitude, which is considered to be associated with controlled processings, was much larger than that previously reported from subjects with normal hearing, it is suggested that patients with cochlear implants make a considerable effort to process their poor auditory information.
Effects of influenza A virus on lectin‐binding patterns in murine nasopharyngeal mucosa and on bacterial colonization
Authors: Hirano Takashi , Kurono Yuichi , Ichimiya Issei , Suzuki Masashi , Mogi Goro
Published: November 2005

To clarify the role of viral infection in otitis media, we intranasally inoculated mice with influenza A virus and examined histologic changes in the nasopharyngeal mucosa using a battery of lectins. Additionally, live Haemophilus influenzae o r Streptococcus pneumoniae was injected into the nasopharynx after virus inoculation, and the clearance of bacteria from the nasopharynx was examined. Staining of the mucous blanket and epithelial cell surfaces in the nasopharynx with peanut agglutinin, succinyl wheat‐germ agglutinin, and Bandeiraea simplicifolia agglutinin was significantly enhanced with intranasal virus inoculation when compared with that in control animals. The nasopharynx was moderately stained with Maachia amurensis agglutinin and wheat‐germ agglutinin in control animals, and the staining was enhanced after virus inoculation. These findings were most remarkable 5 and 9 days after virus inoculation. The numbers of bacteria cultured from the nasopharynx were significantly increased when bacteria were injected 5 days after virus inoculation. These results suggest that an alteration in the glycoconjugate structure lining the nasopharyngeal mucosa caused by the influenza virus might be associated with the reduction in bacterial clearance. (Otolaryngol Head Neck Surgery 1999;121:616–21.)
Treatment of malignant neoplasms of the parotid gland
Authors: Magnano Mauro , Fernando Gervasio Carmine , Cravero Luigi , Machetta Giacomo , Lerda Walter , Beltramo Giancarlo , Orecchia Roberto , Ragona Riccardo , Bussi Mario
Published: November 2005

In this study we evaluated the effects of surgical and radiotherapy treatment on local control in 126 patients with malignant tumors of the parotid gland. The most frequently observed malignant tumors were high‐grade tumors (68%). Surgical treatment was performed in 81 patients (83.5%). Total conservative parotidectomy was the most frequent procedure (74%), and radiotherapy was performed in 81 patients (83.5%). The global survival rate was approximately 54% at 5 years, whereas disease‐free survival was 47% at 5 years. No statistically significant difference in survival rate was found between conservative (52% at 5 years) and radical treatment of the seventh cranial nerve (43% at 5 years). The incidence of recurrent cancer was 25.7% (25 of 97), of which 88% developed during the first 2 years. We report some of the clinical and histologic factors that can influence the prognosis of the disease. (Otolaryngol Head Neck Surg 1999;121:627–32.)
Management of acute inflammatory childhood stridor
Authors: Damm Michael , Eckel Hans Edmund , Jungehülsing Markus , Roth Bernhard
Published: November 2005

BACKGROUND AND OBJECTIVE

Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life‐threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases.

MATERIALS AND PATIENTS

During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction.

RESULTS

Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out‐of‐hospital cardiorespiratory arrest.

CONCLUSION

Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.
Traumatic Optic Neuropathy: Result in 45 Consecutive Surgically Treated Patients
Authors: Li Kasey K. , Teknos Theodoros N. , Lai Amy , Lauretano Arthur M. , Joseph Michael P.
Published: November 2005

The management of traumatic optic neuropathy remains controversial. In this report, we present the results of 45 patients treated with extracranial optic nerve decompression after at least 12 to 24 hours of corticosteroid therapy without improvement. Vision improved in 32 patients after surgery (71%), and the mean percentage of improvement from preoperative visual deficit was 40.7% ± 6.9% (median improvement 41.2%). Worsening of vision occurred in none of the patients as a result of the surgery, and no intraoperative or postoperative complications were encountered. We present a treatment protocol for traumatic optic neuropathy with the use of megadose corticosteroids and optic nerve decompression.
Vestibular Compensation in Guinea Pigs Given Intravenous Lidocaine after Unilateral Labyrinthectomy
Authors: Hung Richard T. , Harvey Steven A. , Millen Steven J.
Published: November 2005

Intravenous lidocaine has been reported to alleviate vertigo in Meniere's disease and suggested as a possible antivertigo agent after unilateral labyrinthectomy in a study of cats. To further evaluate the effects of intravenous lidocaine on the acute phase of postural compensation, we subjected 13 pig‐mented guinea pigs to unilateral labyrinthectomy. Seven received intravenous lidocaine (4 mg/kg) immediately after labyrinthectomy. The other six served as controls and received an equivalent‐volume injection of normal saline solution. Total body curvature, trunk curvature, yaw head tilt, and roll head tilt were measured at frequent intervals for up to 30 hours after surgery. Both groups had immediate difficulties with posturing that gradually improved. The lidocaine group tended to exhibit delayed postural compensation, but this was only statistically significant for roll head tilt. These results do not show improvement in postural compensation from unilateral labyrinthectomy after the administration of intravenous lidocaine. A species‐specific effect on the vestibular pathways is suggested, and we conclude that further evaluation of lidocaine and the vestibular system is warranted.
Treatment of Malignant Neoplasms of the Lateral Cranial Base with the Combined Frontotemporal‐Anterolateral Approach: Five‐Year Follow‐Up
Authors: Bigelow Douglas C. , Smith Peter G. , Leonetti John P. , Backer Robert L. , Grubb Robert L. , Kotapka Mark J.
Published: November 2005

Technical advances in accessing the lateral cranial base have permitted disease in this area previously deemed inoperable to be resected. The procedures required to effect an oncologically adequate resection are often long and accompanied by the potential for serious, even life‐threatening, complications. Although it has been demonstrated that such disease can be extirpated, the question of whether such heroic surgery improves long‐term survival remains unanswered. We retrospectively reviewed the records of 25 patients who underwent a combination of frontotemporal craniotomy with other, more conventional, anterolateral procedures (eg, infratemporal fossa approach, maxillectomy, orbitectomy, mandibulopharyngectomy) to resect stage IV malignant disease of the lateral to midcranial base between 1983 and 1990. Perioperative deaths occurred in 2 patients, 1 patient died of unrelated causes free of disease, and 2 patients were lost to follow‐up, leaving 20 patients with a minimum 5‐year evaluation. Five (25%) of the 20 patients we monitored were free of disease. Of those patients in whom recurrent disease developed, local control was achieved in about 50%; however in 80% of those with recurrence, metastatic disease developed. Surgical treatment of selected stage IV malignant disease of the lateral to midcranial base appears to have provided long‐term disease‐free survival to 25% of patients in this series who would otherwise have had little hope of survival.
Current Treatment Practices for Early Laryngeal Carcinoma
Authors: DiNardo Laurence J. , Kaylie David M. , Isaacson Jon
Published: November 2005

OBJECTIVE

Controversy regarding the management of early laryngeal carcinoma persists in the absence of a definitive comparison of treatment modalities. This study examines the basic management practices for early laryngeal cancer among the American Academy of Otolaryngology–Head and Neck Surgery membership with an emphasis on the role of conservation surgery.

METHODS

Questionnaires were randomly distributed to 3000 members with 1000 responses. The results were collated and statistically evaluated with multivariable frequency analysis.

RESULTS

For operable supraglottic tumors, supraglottic laryngectomy was advocated by 41.6% of those responding. Definitive radiation therapy was suggested by 5.3% of participants and total laryngectomy by 1.4%. Explanation of treatment options with the patient deciding the therapy was selected by 48.3% of responders. For suitable glottic tumors, hemilaryngectomy was recommended by 37.1%, definitive radiation therapy by 8.1%, total laryngectomy by 1.9%, and patient choice by 50.4% of members completing the survey. When patients were left to weigh the treatment options, surgery was much less likely to be chosen than if it was advocated by the physician. Trends were evident according to practice region and setting, but these variables did not correlate strongly with physician recommendations. However, date of residency completion and rating of available radiation oncology services were significant factors. The evaluation of postoperative considerations in laryngeal conservation surgery demonstrated large variability in the definition of a close margin and the perceived need for additional therapy.

CONCLUSIONS

The varied practice patterns among the American Academy of Otolaryngology–Head and Neck Surgery membership reflect the lack of a comparative outcome analysis for the treatment of early laryngeal carcinoma. Consequently, the full reliance on patient choice, which is more pronounced among young physicians, and cost considerations may have the greatest impact on the future treatment of this disease.
Effect of Temperature on Lateral Wall Mechanics of the Guinea Pig Outer Hair Cell
Authors: Chen Amy Y. , Brownell William E.
Published: November 2005

The outer hair cell is thought to enhance the sensitivity of mammalian hearing. Its lateral wall consists of 3 concentric layers: an outermost plasma membrane, a cortical lattice, and an innermost collection of flattened membranes called the subsurface cisternae. The cytoplasm requires positive pressure for full expression of the outer hair cell's electromotility. Using micropipette aspiration, we investigated the mechanics of the guinea pig's outer hair cell lateral wall at room temperature (22°C) and at the guinea pig's body temperature (39°C). Although there was a 10% decrease in stiffness parameter with an increase from room to body temperature, the difference was not statistically significant; values ranged from 0.45 to 0.65 dyne/cm. With sufficient negative pressure, the cytoplasmic membrane is separated from the rest of the outer hair cell's lateral wall, a process that leads to vesiculation of the plasma membrane. Vesiculation occurs at a lower pressure than at body temperature. Our results demonstrate that the stiffness parameter of the outer hair cell lateral wall at body temperature is similar to that at room temperature. However, the plasma membrane's attachment to the cortical lattice is greatly altered by temperature. The decrease in strength of membrane attachment at body temperature may result from a change in membrane fluidity, making it more easy for membrane attachment sites to break free and permit vesiculation. Whether the tethering of the plasma membrane to the cortical lattice is lost under clinically pathologic conditions deserves future study.
Utility of Portable Chest Radiographs as a Predictor of Endotracheal Tube Cuff Pressure
Authors: Valentino Joseph , Myers Robert K. , Baker Michael D. , Woodring John H.
Published: November 2005

Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure of intensive care unit patients 124 times immediately before portable chest radiography. On 64 of these radiographs we measured the width of the tracheal air column below the tip of the endotracheal tube and at the maximal diameter of the endotracheal tube balloon. We then analyzed the relationship of cuff pressure to tracheal dilation. The results of ANOVA of tracheal dilation for three groups (safe, borderline, and unsafe cuff pressures) were significant. Large overlapping ranges existed in each group. Regression analysis confirmed a linear relationship between cuff pressure and tracheal dilation (r = 0.435, p >0.001). Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure. (Otolaryngol Head Neck Surg 1999;120: 51‐6.)