bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of death among male veterans who received residential treatment for PTSD
Authors: Drescher Kent D. , Rosen Craig S. , Burling Thomas A. , Foy David W.
Published: November 2003

Previous studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4–5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at‐risk patient population through harm reduction interventions and improved continuity of care.
Temporal Bone Findings in Alzheimer's Disease
Authors: Sinha Uttam K. , Saadat Daryoush , Linthicum Fred H. , Hollen Kristen M. , Miller Carol A.
Published: November 2003

Sensorineural hearing loss has been reported in Alzheimer's disease (AD) and a topographically specific pattern of degeneration in the central auditory system has been described. Although peripheral visual and olfactory systems have been extensively studied, there is no report of peripheral auditory system abnormalities in AD patients. Comparison of temporal bones from eight AD patients with those from eight non‐AD controls revealed a significant difference in the percentage of remaining hair cells, peripheral processes, and spiral ganglion cells in the basal cochlear turn but no significant differences in the overall percentage between the two groups. Furthermore, special stains (thioflavin S and Bielschowsky's silver impregnation) of temporal bone nervous tissue from AD patients did not show neuritic plaques and neurofibrillary tangles. It is unclear whether the differences between the two groups in the basal portion of the cochlea are due to AD or some other process, such as presbycusis. However, lack of significant degeneration in other parts of the cochlea and absence of neurofibrillary tangles and neuritic plaques in all eight patients may suggest that the peripheral auditory system, unlike the peripheral visual and olfactory systems, is not involved in AD. A larger sample of AD patients is necessary to clarify the peripheral auditory system findings in the present study.
The Oculocephalic Response in the Evaluation of the Dizzy Patient
Authors: Harvey Steven A. , Wood Douglas J.
Published: November 2003

The oculocephalic response (OCR) is a simple office maneuver that assesses the vestibulo‐ocular reflex (VOR). An abnormal response is manifested clinically as refixation saccades following a rapid horizontal head movement. Because little attention has been given to the OCR in the literature, a prospective study was undertaken with 112 consecutive patients who presented with dizziness and underwent OCR testing followed by caloric evaluation. Agreement was good between the OCR and caloric evaluation (κ = 0.44). Specificity was quite high (97%); sensitivity was found to be less (39%). Positive (68%) and negative (90%) predictive values of the OCR illustrate that the clinician can often anticipate the results of caloric testing based on this response. This easily performed test of the VOR is a useful tool in the evaluation of the dizzy patient.
The Extended Lateral Arm Free Flap for Head and Neck Reconstruction
Authors: Ross Douglas A. , Thomson J. Grant , Restifo Richard , Tarro John M. , Sasaki Clarence T.
Published: November 2003

The lateral arm free flap (LAFF) has been chosen by some head and neck reconstructive microsurgeons to be their fasciocutaneous free flap of choice. The qualities of this flap have been suggested to include its consistent vascular anatomy, its thin and pliable nature, and its reinnervation capabilities, as well as its low donor site morbidity and ease of closure. During the past year we have performed 14 head and neck reconstructions using the extended LAFF (ELAFF). We present our indications for its use and review its shortcomings. Although the ELAFF does have its limitations, including variability in its flap thickness and donor vessel size, it unquestionably is an important flap in head and neck reconstruction and is our flap of choice for soft tissue reconstruction.
Mastoid Surgery in the Only Hearing Ear
Authors: Perez de Tagle Juan Ramon V. , Fenton John E. , Fagan Paul A.
Published: November 2003

Every otologic procedure carries the risk of damage to the inner ear. On the other hand, cholesteatoma and uncontrolled tubotympanic disease can lead to partial or total sensorineural loss, as well as intracranial complications. Our experience of the surgical management of eight patients with an only hearing ear is presented. There were no dead ears in this series and no significant worsening of inner ear function. The air conduction pure‐tone average was worse in two patients without change in bone condition. Of the eight patients, six wear a hearing aid with success and two patients manage without an aid. The present small series confirms that patients at risk of anacusis from cholesteatoma or chronic suppurative otitis media can be offered, in experienced tertiary referral units, a safe method of stabilizing the ear and preserving useful hearing.
The Effect of Tympanic Membrane Perforation Size on Umbo Velocity in the Rat
Authors: Bigelow Douglas C. , Swanson Paul B. , Saunders James C.
Published: November 2003

The tympanic membrane (TM) in adult rats was surgically exposed and laser interferometry was used to measure TM velocity at the umbo for frequencies between 1.0 and 40.0 kHz. Velocity measures were obtained for five conditions: TM intact, and four progressively larger holes cut into the posterior region of the membrane. Photomicrographs of each condition were used to calculate the percentage of pars tensa lost to the perforation. The relation between TM velocity and stimulus sound pressure level (SPL) was also examined for each of the conditions. The results revealed a systematic loss in low‐frequency velocity as perforation size increased. These observations were consistent with clinical reports of low‐frequency hearing loss in the perforated human TM. The rat appears to be a successful model for studying this form a conductive pathology.
Tracheal Neovascularization
Authors: Veríssimo de Mello‐Filho Francisco , Mamede Rui Celso Martins , Velludo Maria A.S. Llorach
Published: November 2003

Tracheal segmental free grafts always tend to undergo necrosis with consequent occlusion of the airway. Revascularized grafts are impossible to carry out, since the trachea is devoid of a major vascular pedicle that would permit microvascular reconstruction. On the other hand, neovascularized grafts carry a potential for success but have not been sufficiently studied.

Neovascularization of a six‐ring circumferential tracheal segment (CTS) was studied in dogs using a sternohyoid muscle (SM) flap. Three different procedures were carried out. In group 1 the six‐ring CTS was inside a free graft. In group 2 the SM was freed from its proximal connection and rotated to wrap a corresponding six‐ring CTS; it was then sutured and left in place for 21 days. After this period it was again approached, and the six‐ring CTS was sectioned and sutured back in place, leaving the distally pedicled SM untouched. In group 3 an identical procedure was carried out, but the SM flap was left with a proximally rather than a distally based flap.

All surviving animals were followed up for at least 1 year, and the results were analyzed by clinical and tracheoscopic observations and by macroscopic and microscopic studies after the animals were killed.

All animals in group 1 died within 18 days; the studies showed necrosis and occlusion of the CTS. In groups 2 and 3 there was no degenerative change of the CTS, whose aspect was close to normal on macroscopic and microscopic examination.

We conclude that the free CTS graft is totally inviable. In contrast, neovascularization of the CTS occurs when the segment is first wrapped around with an SM flap. This ensures CTS viability and opens new perspectives for homotransplantation.
The Swallowing Side Effects of Botulinum Toxin Type A Injection in Spasmodic Dysphonia
Authors: Sedory Holzer Susan E. , Ludlow Christy L.
Published: November 2003

Botulinum toxin type A (BOTOX®) injection of the thyroarytenoid muscle is used to control speech symptoms in patients with adductor spasmodic dysphonia. Transient difficulty in swallowing liquids is a common treatment side effect. Laryngeal movement durations were measured during swallowing in 13 adductor spasmodic dysphonia patients undergoing treatment and in 6 normal control subjects in order to determine the following: 1. whether, prior to the injection, laryngeal movement durations were longer in the spasmodic dysphonia patients than in the control subjects; 2. whether movement durations increased following the injections; 3. whether preinjection swallowing difficulties related to postinjection swallowing measurements and postinjection patient reports of swallowing problems.

A piezoelectric movement transducer was shown to be accurate for noninvasive measurement of laryngeal movement duration in relation to muscle onset and offset for hyoid elevation and relaxation. Before botulinum toxin type A injection, no significant differences in swallowing duration were found between the patient and control groups. Four patients with swallowing complaints prior to injection had longer laryngeal movement durations than the other spasmodic dysphonia patients and the control subjects. Following injection, laryngeal movement durations increased in the patients with spasmodic dysphonia, and eight patients reported dysphagia for an average of 2 weeks.

Relationships were found between the patients' initial reports of swallowing problems and increased laryngeal movement durations before and after botulinum toxin type A injection. Those patients initially reporting swallowing difficulties had severe dysphagia for 2 weeks after the injection. Patient reports of dysphagia prior to injection may indicate a greater likelihood of significant dysphagia following thyroarytenoid injection with botulinum toxin type A.
Vocal Capacities in Esophageal and Tracheoesophageal Speakers
Authors: Max Ludo , Steurs Wendy , de Bruyn Wendy
Published: November 2003

The present study investigated the vocal capacities of adult men who had undergone total laryngectomy. Esophageal (N = 10) and tracheoesophageal (N = 10) speakers were compared for the parameters maximum phonation time (MPT), maximum number of syllables that could be spoken on one air intake (SYLLS), dynamic range (DYN), frequency range (FREQ), and maximum intensity level (MIL). Statistical analyses yielded significant between‐group differences for the parameters MPT, SYLLS, and MIL but not for DYN and FREQ. Thus, although the groups did not differ with respect to range of intensity and frequency measures, maximum performance on the durational and intensity measures was always less for the esophageal speakers than for the tracheoesophageal speakers. Pearson's product‐moment correlations among these parameters were remarkably different for esophageal and tracheoesophageal subjects, suggesting that phonatory and aerodynamic factors interact differently in the two groups.
Computer‐Assisted Clinimetric Tool for the Study of Facial Expression
Authors: Holman Melisa L. , Neely J. Gail , Joaquin Allen H.
Published: November 2003

Clinimetrics is the measurement of clinical phenomena; more specifically, it is mensuration, the act of acquiring and labeling basic raw data that is used to describe or measure symptoms, signs, and other distinctly clinical phenomena.1

Over the last 5 years, a new computer method for measuring facial expression has been developed. Refinement and validation of this technique are necessary before clinical applications are appropriate.

Four hundred fifty data points from two human observers and the computed method were compared with one another by using indices of location, dispersion, and association within the framework of the logical construct of validity.

These results suggest that the computed method is valid. This new method may be nearly ready for clinical applications as a primary or adjunctive clinimetric tool.
Quantitative Study of Vestibulotoxicity Induced by Gentamicin or Cisplatin in the Guinea Pig
Authors: Nakayama Meiho , Riggs Landon C. , Matz Gregory J.
Published: November 2003

Although aminoglycoside vestibulotoxicity is well established, the question of cisplatin vestibulotoxicity is controversial. The goals of this study were 1. to determine whether cisplatin induces vestibulotoxicity as measured histologically, and 2. to compare the vestibulotoxicity between gentamicin and cisplatin. Guinea pigs' vestibular end‐organ hair bundles in control, gentamicin, and cisplatin groups were compared.

In the lateral cristae of the cisplatin group, hair bundles decreased 21% on the central apex portion. In the gentamicin group, a slight decrease (17%) of hair bundles on the striola from the utricular maculae was observed, as was severe damage on the entire cristae, especially on the central apex (70%).

These results indicate that gentamicin and cisplatin may not influence vestibular function of the otolithic membrane. However, gentamicin may severely damage and cisplatin may slightly damage the crista ampullaris hair bundles.
Scintigraphic Quantification of Aspiration Reduction With the Passy‐Muir Valve
Authors: Stachler Robert J. , Hamlet Sandra L. , Choi Jinho , Fleming Susan
Published: November 2003

The Passy‐Muir “speaking” tracheostomy valve has been noted to aid in swallowing, based on videofluoroscopy to assess aspiration. In this study scintigraphy was used to quantify the amount of material aspirated.

Eleven patients were studied who currently had tracheostomy in place and were either known to aspirate or were suspected of aspirating. Most were post‐treatment head and neck cancer patients who were tumor free at the time of testing. Swallowing was evaluated using videofluoroscopy and scintigraphy. Videofluoroscopy was performed to assess anatomy and determine whether aspiration had occurred. Seintigraphic testing was then performed when the patient had the one‐way valve on, and again with it off and tracheostomy open.

Following a swallow, the amount (%) of aspirate with the valve in place was found to be significantly less than with the tracheostomy open.

A one‐way valve can be helpful in reducing aspiration in patients who are at risk for aspiration and who require that their tracheostomy be open.
Oral Lichen Planus and Its Association With Squamous Cell Carcinoma: An Update on Pathogenesis and Treatment Implications
Authors: Duffey Dianne C. , Eversole L.R. , Abemayor Elliot
Published: November 2003

Lichen planus of the oral mucosa (OLP) is characterized by lymphocytic mucositis, basal cell lysis, and lymphocyte transmigration into the epithelial compartment. Some reports have suggested a high incidence of oral squamous cell carcinoma (OSCCA) in OLP patients and have implicated OLP as a premalignant lesion. We describe five cases of OSCCA arising in patients with preexisting OLP. At our institution, the incidence of OSCCA in patients with OLP aproximates that reported in other series. The immunopathologic basis for OLP, its potential association with malignancy, and the variable clinical picture of OSCCA in patients with OLP are reviewed. Specific recommendations are given for treatment and follow‐up of lesions, including the role of future testing with viral and oncogene markers.
Intraoperative Electrophysiologic Monitoring of the Recurrent Laryngeal Nerve
Authors: Eisele David W.
Published: November 2003

Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve was performed with a commercially available device consisting of an endotracheal tube with integrated stainless‐steel‐wire surface EMG electrodes positioned at the level of the true vocal cords. Forty‐two recurrent laryngeal nerves were successfully monitored with this system in 31 patients undergoing thyroidectomy or parathyroidectomy. In all cases, evoked EMG responses were elicited by direct electrical recurrent laryngeal nerve stimulation. Stimulus thresholds for evoked responses ranged from 0.2 to 0.6 mA (mean 0.3 mA) for the 37 nerves with preoperative ipsilateral normal vocal cord mobility. Mechanically evoked potentials with acoustic signals were also detected during the surgical procedures related to recurrent laryngeal nerve manipulation. It may be concluded that surface electrode monitoring of the recurrent laryngeal nerve with this system provides a simplified, noninvasive technique that is as sensitive as monitoring with intramuscular laryngeal electrodes.
Mucociliary Clearance Following Segmental Tracheal Reversal
Authors: Delaere Pierre R. , Liu Ziying , Delanghe Geertrui , Gyselen Kristien , Jorissen Mark , Feenstra Louw
Published: November 2003

Ciliated tracheal epithelium is arranged in a polarized pattern oriented according to the inferior‐superior axis of the trachea and is responsible for the transport of mucus toward the larynx. In this study, ciliary beat orientation and the influence of external factors on mucociliary clearance direction were studied in rabbit inverted cervical tracheas.

The animals displayed normal respiration postoperatively. After 16 weeks, airway clearance was studied by observation of the movement of silicone particles placed in the inverted segment and in normal parts of the ciliated epithelium. Cilia exhibited unidirectional and coordinated movement within inverted tracheal segments. As shown by the direction of effective flow produced by beating cilia and by scanning electron microscopy, the cilia in the inverted segment beat in the opposite direction from the cilia in the remainder of the trachea. This study demonstrated that ciliary orientation is irreversibly determined, but the reversal of ciliary beating within the cervical trachea had no adverse effects on the survival of the animals.
Pathogenesis of Middle Ear Adhesions
Authors: Cayé‐Thomasen Per , Hermansson Ann , Tos Mirko , Prellner Karin
Published: November 2003

Middle ear adhesions are well‐known to the ear surgeon, although data on etiology, pathogenesis, and significance are lacking in current literature. This study on experimental acute otitis media presents histopathological data on these aspects. Pneumococci were inoculated in the right middle ear bulla of 25 rats; the left ear served as control. At days 4, 8, 16, 90, and 180, respectively, 5 rats were decapitated, and the bullae were removed, opened, and stained with periodic acid‐Schiff (PAS)/alcian blue. The entire middle ear mucosae were dissected from the bone, embedded as whole mounts in colophonium chambers, and examined by light microscopy. Representative parts of the mucosae were sectioned and examined in the same way. All inoculated ears from day 8 and later (20 in total), contained mucosal adhesions of various sizes, shapes, and locations. None were found in control ears. The site of predilection for the development of adhesions was the hypotympanum, followed by the anterior epitympanum, the attic, the drum, the interossicular spaces, and the tubal orifice. Based on present histopathological findings, we conclude that the middle ear adhesion is a pathological phenomenon caused by infection, and we propose a six‐stage hypothesis of pathogenesis: 1. Localized epithelial rupture; 2. Prolapse of subepithelial tissue; 3. Epithelialization of the prolapse, resulting in a polypous/fold‐like prominence; 4. Growth and elongation of the prominence; 5. Fusion of the end/tip of the prominence with another part of the mucosa; 6. Formation of an adhesion.
Echo‐Planar Magnetic Resonance Imaging of Deglutitive Vocal Fold Closure: Normal and Pathologic Patterns of Displacement
Authors: Gilbert Richard J. , Daftary Shrenik , Woo Peak , Seltzer Sharon , Shapshay Stanley M. , Weisskoff Robert M.
Published: November 2003

Abnormalities of vocal fold closure during deglutition predispose to aspiration due to impairment of airway protection. Conventional assessment of deglutitive vocal fold motion with laryngoscopy does not permit visualization through a complete adduction‐abduction cycle. We determined spatiotemporal patterns of deglutitive vocal fold adduction through echo‐planar magnetic resonance imaging in 15 normal volunteers and 6 patients with vocal fold paralysis. In normal volunteers, deglutitive vocal fold adduction was synchronized with laryngeal elevation, with complete vocal fold closure at the apex. Patients with unilateral vocal fold paralysis demonstrated reduced elevation and medial movement of the involved vocal fold. At maximal laryngeal elevation the uninvolved vocal fold attained a position superior to the paralyzed fold, resulting in level differences and an interglottic gap. Patients with bilateral vocal fold paralysis demonstrated reduced elevation and medial movement of both vocal folds. These findings indicate that normal and abnormal patterns of vocal fold displacement can be distinguished noninvasively through the use of echo‐planar imaging.

Laryngoscope, 106:568‐572, 1996
Comparison of Clinical Evaluation and Computed Tomographic Diagnostic Accuracy for Tumors of the Larynx and Hypopharynx
Authors: Thabet Hossam M. , Sessions Donald G. , Gado Mokhtar H. , Gnepp Douglas A. , Harvey Joseph E. , Talaat Mohammed
Published: November 2003

Ninety‐five patients with laryngeal and hypopharyngeal cancer were examined and staged preoperatively by clinical evaluation (CE) and computed tomography(CT). The CE and CT staging were compared to each other and to the pathologic(PT) staging of the tumors. The CT staging showed high accuracy in staging transglottic (88%), supraglottic (68%), and oropharyngeal tumors invading the larynx (68%) when compared to the PT findings. The CT staging was less effective in evaluating glottic tumors (46%), both overstaging (12%) and understaging (20%) cases. Combined CE‐CT evaluation showed higher accuracy in staging all tumors (84%) compared to CE alone (52%) or CT alone (68%). The findings suggest that combined CE‐CT should be used to evaluate laryngeal and hypopharyngeal tumors.

Laryngoscope, 106:589‐594, 1996
Preventive Management of Cerebrospinal Fluid Leakage in Translabyrinthine Surgery
Authors: Meyerson Lance R. , Monsell Edwin M. , Rock Jack P.
Published: November 2003

A simple technique can be used to prevent cerebrospinal fluid (CSF) leakage through the nose and the wound in translabyrinthine surgery. This method, evolved from Glasscock's technique of packing the eustachian tube, adds only 5 to 10 minutes to the procedure. The procedure was modeled in the temporal bones of 20 human cadavers, and the findings are described. With this technique, no nasal CSF leaks occurred in a consecutive series of 25 patients who underwent acoustic tumor surgery. Factors thought to be necessary for the success of the technique are discussed.

Laryngoscope, 106:610‐613, 1996
A Histopathologic Review of Temporal Bone Exostoses and Osteomata
Authors: Fenton J. E. , Turner J. , Fagan P. A.
Published: November 2003

It is widely accepted that external auditory canal exostoses and osteomata are separate clinical entities that differ in their gross appearance. Disagreement still exists as to whether external auditory canal exostoses and osteomata should be considered similar or separate histopathologic entities. A chart review was performed of all patients who had external auditory canal exostoses or temporal bone osteomata excised from January 1991 to November 1994 at St. Vincent's Hospital, Sydney. A histologic examination was undertaken with a blind study method of the patients whose pathological specimens were suitable for assessment. Eight exostoses and five osteomata were available for examination. The results of this study demonstrate that exostoses and osteomata of the external auditory canal cannot be reliably differentiated by routine histopathological examination.

Laryngoscope, 106:624‐628, 1996
The Communicating Vein and Its Use in the Radial Forearm Free Flap
Authors: Valentino Joseph , Funk Gerry F. , Hoffman Henry T. , McCulloch Timothy J.
Published: November 2003

Thrombosis is the most frequent cause of failure in microvascular free‐tissue transfer. The large communicating vein of the cubital fossa connects the deep and superficial venous drainage of the radial forearm free flap (RFFF). This vein allows the surgeon to simultaneously drain both systems by means of the large veins of the cubital fossa. We prospectively collected data on the venous anatomy of the cubital fossa in 40 consecutive RFFFs over a 3‐year period. We then retrospectively reviewed available data from the 14 cases preceding the cases in the prospective series. At least 78% of our patients had a communicating vein that facilitated dual venous drainage; 87% of our RFFFs were drained by both the superficial and deep venous systems, and 90% of our RFFFs had two or more venous anastomoses. We had no RFFF failures in our series of 54 flaps. We present our venous anatomy findings in this series of forearms as well as the venous anastomoses of our 54 patients. The surgical‐flap harvest, including the communicating vein and its use, may provide an advantage in the dependability and quality of venous outflow.

Laryngoscope, 106:648‐651, 1996
Expanded Polytetrafluoroethylene Augmentation of the Lower Face
Authors: Sherris David A. , Larrabee Wayne F.
Published: November 2003

Most options for rejuvenation of the lower face use soft‐tissue fillers that augment the appropriate sites. Each of these options has associated risks and benefits. The U.S. Food and Drug Administration recently approved the use of expanded polytetrafluoroethylene (E‐PTFE) as a soft‐tissue filler in the face.

From January 1991 through December 1993, the authors used E‐PTFE soft‐tissue patches for lower facial augmentation in 41 patients at 115 implant sites. Postsurgical follow‐up has ranged from 2.5 to 4.5 years; during this time, complications have occurred in 4 patients. One implant had to be removed because of a seroma (1 patient), 4 implants required further secondary augmentation (2 patients), and 1 implant required revision because of malposition (1 patient). There have been no cases of implant infection, extrusion, long‐term inflammation, or capsule formation.

In this article, the authors review the technical aspects of E‐PTFE use and discuss issues relating to the long‐term efficacy of this new option for soft‐tissue augmentation. The technique is also compared with other options for rejuvenation of the lower face.
Evaluation of Random Skin Flap Survival in a Porcine Model
Authors: Pratt Michael F.
Published: November 2003

The pathophysiology of random skin flap necrosis in the pig model was studied the effects of several drugs on skin flap survival were examined. The investigated drugs included acetylsalicylic acid (ASA), pentoxifylline (PTX), prostaglandin E2 (PGE2), and an experimental 21‐aminosteroid, U‐74389G. Each drug altered different parameters known to be associated with tissue necrosis.

Demonstrated mechanisms of skin flap failure included the alteration of erythrocyte flexibility and platelet function and the activation of neutrophils with resultant accumulation of damaging oxygen‐free radicals. Random skin flap survival did not improve with ASA but did improve significantly with PTX, PGE2, and U‐74389G.

The results of this study underscore the importance of neutrophil‐mediated necrosis in the pathophysiology of skin flap failure. The data further demonstrate the need to develop drugs aimed at reversing or preventing the tissue damage from oxygen‐free radicals in order to enhance the survival of random skin flaps.
Myology of the Pharyngoesophageal Segment: Gross Anatomic and Histologic Characteristics
Authors: Kelly James H. , Kuncl Ralph W.
Published: November 2003

Although numerous studies have been performed on the function and dysfunction of the pharyngoesophageal segment, few studies have investigated features of the musculature in this area. Thus, the purpose of this study was to systematically examine the structure (gross anatomy and histology) in this area and to relate these findings to the functions of the pharyngoesophageal segment.

Twenty‐one autopsy and surgery patients underwent careful measurement and observation of 1. the vertical (cephalad‐caudad) height of the cricopharyngeus muscle (CP); 2. the presence or absence of Killian's dehiscence; and 3. the separation or blending of the CP with the upper esophageal circular muscles. Of the 21 subjects, muscle specimens were removed from 8 (4 autopsy, 4 surgical) to include a muscle strip from the upper esophageal circular muscles, CP, and inferior pharyngeal constrictor and submitted to a battery of histological and histochemical tests.

Gross anatomic measurements of the vertical height of the CP were substantially longer than those reported elsewhere. Killian's dehiscence was shown to be present in fewer than one third of the specimens. Histology of these muscles also showed significant differences from the muscles discussed in other published reports, particularly when fresh and autopsy material were compared. These specialized muscles, therefore, require further detailed study.
Avascular Tympanojugular Paraganglioma
Authors: Balli Ruggero , Dallari Stefano , Bergamini Giuseppe , Maiorana Antonio
Published: November 2003

The avascular paraganglioma described in this article appears to be the second such tumor reported in the international literature and the first to be reported in the tympanojugular region. Despite a highly suggestive history and clinical appearance, the tumor showed no signs of vascularization on radiologic studies. The pathologic postoperative study confirmed the diagnosis of paraganglioma with extensive stromal fibrosclerosis and without the typical well‐vascularized thin fibrous septa. In the authors' opinion, this observation is notable because of the difficulties encountered in the correct diagnostic interpretation of an avascular mass in the tympanojugular region. In such cases, the possibility of a paraganglioma should always be considered.
Age Dependency of the Composition of Immunocompetent Cells and the Expression of Adhesion Molecules in Rat Laryngeal Mucosa
Authors: Jecker Peter , Ptok Martin , Pabst Reinhard , Westermann Jürgen
Published: November 2003

Clinical evidence shows that laryngeal infections in infants differ significantly from those in adults. Therefore, the composition of the mucosal immune system (granulocytes, macrophages, dendritic cells, natural killer cells, and T and B lymphocytes) and the epithelial expression of class II‐MHC molecules and adhesion molecules ICAM‐1, VCAM‐1, and E‐selectin were studied in the larynx of newborn, 5‐week‐old, and 3‐year‐old rats.

With the exception of macrophages, the immunocompetent cells began to immigrate into the laryngeal mucosa after birth, indicating that the laryngeal mucosa in newborn rats is immature. In contrast, ICAM‐1 was already expressed. The number of immunocompetent cells and the expression of epithelial class II‐MHC and ICAM‐1 increased with age. Immunocompetent cells and epithelial class II‐MHC and ICAM‐1 expression were mainly detected in the subglottic region, but were almost absent in the vocal fold region.
Intraoperative Identification of Laryngeal Nerves With Laryngeal Electromyography
Authors: Mermelstein Mariana , Nonweiler Rebecca , Rubinstein Eduardo H.
Published: November 2003

The laryngeal nerves are at risk during thyroid surgery, and several techniques have been described for their intraoperative identification to minimize potential damage. Nerve protection is based on the electromyographic recording from the muscles innervated by the laryngeal nerves, and that electrical activity is picked up by various techniques. We evaluated an electrode attachment to the endotracheal tube that provides a stable method for continuous recording of the laryngeal electromyogram. In addition, we tested various modalities of electrical stimulation in the region where the nerves are located, identified the most reliable evoked electromyographic activity, and characterized the wave form and latency. The results, obtained in 28 patients scheduled for thyroid and parathyroid surgery, indicate that the technique of recording from electrodes attached to the endotracheal tube is safe and reliable. Insulated bipolar forceps or a monopolar electrode was used to deliver low‐voltage pulses (1 to 3 V) at 1 to 2 pulses/s generated by either battery‐operated or optically isolated stimulators. The most unequivocal recordings were obtained with the monitoring equipment set to the nerve‐conduction velocity modality, with the sweep set at 2 msec/cm. The technique clearly differentiated the evoked electromyographic responses obtained from the superior or recurrent laryngeal nerve and was easily performed with no perioperative complications.
Nasofrontal Duct Reconstruction With Silicone Rubber Sheeting for Inflammatory Frontal Sinus Disease: Analysis of 164 Cases
Authors: Amble Finn R. , Kern Eugene B. , Neel H. Bryan , Facer George W. , McDonald Thomas J. , Czaja Judith M.
Published: November 2003

The authors reviewed their experience in reconstructing the nasofrontal duct with thin silicone rubber sheeting in patients who had chronic inflammatory frontal sinus disease. The 164 patients were divided into four groups. The patients in group 1 had the traditional modified Lynch procedure, while those in group 2 had certain technical variations of the modified Lynch operation. The patients in the other two groups had major technical variations: those in group 3 had a primary osteoplastic flap approach and those in group 4 had revisions of failed osteoplastic flap with fat obliteration operations.

Surgical indications included mucopyocele (87 patients), chronic frontal sinusitis (71 patients), osteomyelitis (2 patients), acute sinusitis (2 patients), and subacute sinusitis (2 patients). Follow‐up averaged 47 months. At their last clinic visit, 157 patients (96%) were asymptomatic. Forty‐six revision procedures were performed in 30 patients (18% of initial cases). There were no major complications. Nasofrontal duct reconstruction using thin silicone rubber sheeting is technically straightforward, safe, and effective.

Laryngoscope, 106:809‐815, 1996
Cost Utility of the Multichannel Cochlear Implant in 258 Profoundly Deaf Individuals
Authors: Wyatt J. Robert , Niparko John K. , Rothman Margaret , deLissovoy Gregory
Published: November 2003

Cost utility analysis is a method of cost‐effectiveness analysis which provides results in terms of cost per quality‐adjusted life‐year (QALY). Cost utility for the multichannel cochlear implant was calculated using Ontario Health Utilities Index data from 229 Nucleus 22‐channel implant users and 32 cochlear implant candidates awaiting surgery.

The health utility of the implanted group was greater than that of the candidate group by 0.204 (P<.0001). Use of this figure in a cost utility calculation indicates that cochlear implantation costs approximately$15,928 per QALY provided. Sensitivity analysis, a technique which systematically varies the assumptions underlying the calculations, suggests a range for the true value of between $12,000 and $30,000. This compares very favorably with other medical interventions.

It is concluded that profound hearing loss has a significant effect on quality of life, and measurement of the changes that result from cochlear implant use indicates that this technology provides significant improvements and is quite cost‐effective.

Laryngoscope, 106:816‐821, 1996
Criteria for Success in Pediatric Functional Endonasal Sinus Surgery
Authors: Younis Ramzi T. , Lazar Rande H.
Published: November 2003

Functional endonasal sinus surgery (FESS) is widely used in the treatment of chronic sinusitis in adults and children. Although success rates of 80% to 93% have been reported, no criteria for success or improvement have been suggested. Standardized measures are needed to assess the outcome of FESS and to compare the results obtained by different surgical teams and for various patient groups. After reviewing the charts of 500 pediatric patients who underwent FESS between July 1987 and June 1992, the authors of this study formalized criteria for assessing the outcome of surgery.

Laryngoscope, 106:869‐873, 1996
Transpharyngeal Approach to Base of Tongue Tumors: A Comparative Study
Authors: Nasri Sina , Oh Young , Calcaterra Thomas C.
Published: November 2003

Tumors of the tongue base have been traditionally removed by resecting the mandible or using a translabial transmandibular approach. These procedures involve significant morbidity including lip and chin scars, malocclusion, compromised deglutition, chronic aspiration, and altered speech articulation. Therefore alternative techniques have been described to minimize the morbidity associated with transmandibular tongue resection.

A retrospective analysis of patients with base of tongue tumors treated at the University of California, Los Angeles, Medical Center between 1981 and 1994 was undertaken. Thirteen patients were treated using a transpharyngeal approach compared with 18 patients who underwent a transmandibular resection. There was no difference in terms of survival or tumor‐free margins. However, there was a significant difference in function (P<.05). Patients who underwent transpharyngeal resection had significantly better speech and swallowing and less aspiration compared with those who underwent transmandibular resection of tumors.
Effect of Hyperbaric Oxygenation on Existing Oral Mucosal Carcinoma
Authors: McDonald Kathleen R. , Bradfield Joseph J. , Kinsella John K. , Kumar Druv , Mader Jon A. , Hokanson James A. , Calhoun Karen H.
Published: November 2003

Hyperbaric oxygen therapy (HBO) is used to treat some complications of head and neck carcinoma treatment. Several patients treated with HBO have had rapid growth of a clinically cured squamous cell carcinoma. Prior studies have produced conflicting evidence about the effect of HBO on tumor growth. This study was undertaken to determine the effects of HBO on established squamous cell carcinoma. Forty Golden Syrian hamster cheek‐pouch carcinomas were induced with the established chemical carcinogen 9,10‐dimethyl‐1,2‐benzanthracene. Twenty hamsters underwent 30 HBO dives for 60 minutes each to 2.81 atm, while 20 served as controls. At necropsy, animals receiving HBO therapy had significantly smaller tumors (P<.05) and showed a trend toward fewer cervical metastases (P<.06). HBO therapy with coexistent carcinoma inhibited the established tumor's growth.
Microsporidian Sinusitis in Patients with the Acquired Immunodeficiency Syndrome
Authors: Rossi Renée M. , Wanke Christine , Federman Micheline
Published: November 2003

Sinusitis in patients with human immunodeficiency virus (HIV) infection usually arises from the same organisms that are infective in the nonimmunosuppressed population. The authors of this article report that optimal antimicrobial treatment and functional endoscopic sinus surgery failed to eradicate sinonasal disease in three of five patients with acquired immunodeficiency syndrome (AIDS) and refractory sinusitis. The sinonasal disease was manifested by congested, edematous, and polypoid mucosa, often with a superimposed bacterial infection from ostial obstruction. After tissue was sent for electron microscopy (EM), the patients were eventually diagnosed with microsporidiosis of the sinonasal cavities.

Microsporidia are obligate intracellular protozoans that have been seen in AIDS patients with diarrhea. These protozoans have only recently been identified in sinonasal tissue. Microsporidia are often missed on routine histopathology.

The authors present case reports on their five AIDS patients with refractory sinusitis. The management of refractory sinusitis in the HIV‐infected population, including mandatory EM of sinonasal tissue, is also discussed.
Hearing Loss in Turner Syndrome
Authors: Sculerati Nancy , Oddoux C. , Clayton C. Mark , Lim Jessica W. , Oster Harry
Published: November 2003

A retrospective study was undertaken to answer the following questions: Is the sensorineural hearing loss (SNHL) in Turner syndrome progressive? Can the occurrence of hearing loss be explained by the parental origin of the intact X chromosome? Twenty‐four individuals recruited through the Turner Syndrome Society completed a questionnaire and submitted sufficient medical records to determine their otologic status. The majority (21/24) have had problematic otitis media (OM), and two thirds (16/24) have SNHL.

In seven of the Turner subjects (age range: 12 to 51 years), gradual progressive SNHL began in late childhood or early adulthood. Molecular techniques showed no correlation between parental origin of the retained X chromosome and hearing status in 17 Turner subjects and at least one of their parents. SNHL and frequent OM appear to be independent variables that are both present in Turner syndrome. It is postulated that the presence of unpaired genes on the X chromosome may account for hearing loss and other phenotypic abnormalities seen in this syndrome.
Management of Airway Obstruction in Cicatricial Pemphigoid
Authors: Lazor John B. , Varvares Mark A. , Montgomery William W. , Goodman Max L. , Mackool Bonnie T.
Published: November 2003

Cicatricial pemphigoid is a chronic vesiculobullous disease of the mucosal epithelium that primarily involves the oral cavity and the eyes. The clinical and histologic features are identical to those of bullous pemphigoid, and these features often can be nonspecific for other disease processes. It is not unusual for a period of 1 year or more to elapse before a diagnosis is made. The diagnosis of cicatricial pemphigoid requires characteristic lesions and histopathologic evidence of immunoglobulin deposition along the basement membrane, as well as a high index of suspicion. The authors detail a case of cicatricial pemphigoid resulting in airway obstruction and present the treatment required for both stabilization of the airway and resolution of the disease process.
Age‐related Alterations in the Auditory Brainstem Responses and the Compound Action Potentials in Guinea Pigs
Authors: Nozawa Izuru , Imamura Shun‐ichi , Fujimori Isao , Hashimoto Kaori , Shimomura Shin‐ichi , Hisamatsu Ken‐ichi , Murakami Yoshihiko
Published: November 2003

The auditory brainstem response (ABR) and the eighth nerve compound action potential (CAP) were measured using click stimuli to investigate the agerelated alteration in the auditory function in 66 guinea pigs consisting of four age groups. With advancing age, a gradual elevation of the thresholds in both the ABR and CAP was clearly seen, together with the prolonged latencies for waves I, II, III, and IV to clicks at 95 dBpeSPL in the ABR. There were some individual differences in either threshold elevation or latency prolongation of both the ABR and CAP in aged guinea pigs. These findings suggest that the effect of individual differences on degenerative aging processes of the auditory system should be considered in selected aged animals, although a significant elevation of the neural auditory threshold is clearly found with advancing age as a whole.
Factors Related to Quality of Life and Functional Status in 50 Patients With Head and Neck Cancer
Authors: Long Steven A. , D'Antonio Linda L. , Robinson Ernest B. , Zimmerman Grenith , Petti George , Chonkich George
Published: November 2003

Quality of life (QOL) and functional status (FS) have become important outcome measures in cancer therapy. Valid and reliable instruments recently have been developed for examining QOL and FS in patients with head and neck (HN) cancer. The present study evaluated the relationships of QOL and FS to physical and psychological variables assumed to affect QOL and FS. Fifty patients were evaluated up to 6 years after HN cancer surgery using one general QOL instrument and three HN‐specific instruments. Analysis of variance showed physical variables such as tumor site to be related to HN‐specific scores, while psychosocial variables such as marital status were related to general QOL scores (P≤.05). Several relationships were seen between physical or psychosocial variables and FS or QOL measures; however the relationships were not as strong or direct as expected.
Early Eyelid Rehabilitation in Facial Nerve Paralysis
Authors: Linder Thomas E. , Pike Virginia E. , Linstrom Christopher J.
Published: November 2003

Upper‐lid gold‐weight insertions and lowerlid‐shortening procedures are standard surgical techniques used to restore eyelid function and protect the cornea in patients with facial nerve paralysis. Different opinions exist in the literature regarding the correct timing and the morbidity of these interventions. The retrospective analysis of 45 patients over a 5‐year period revealed extrusion of the gold weight in one (2.2%) patient and delayed infections in three (6.6%). Sixty percent of all gold‐weight insertions were performed within 4 weeks after the onset of facial nerve paralysis. We strongly favor gold‐weight insertion, often combined with lower‐lid‐shortening procedures, as a simple, reliable, reversible, and successful technique for early rehabilitation of the paralyzed eyelid. Using these guidelines, we have markedly reduced the need for tarsorrhaphies.
Association of Otitis Media With Effusion and Allergy as Demonstrated by Intradermal Skin Testing and Eosinophil Cationic Protein Levels in Both Middle Ear Effusions and Mucosal Biopsies
Authors: Hurst David S.
Published: November 2003

This study was performed to ascertain the role of allergy, as defined by skin testing and histochemical markers, in the pathogenesis of otitis media with effusion (OME). A historical perspective of allergy as it relates to OME is presented. The study included 89 patients: 48 with persistent effusion but no recent acute infection, 25 with purulent OME complicated by a superimposed infection, and 16 control subjects. All 89 patients had persistent effusion for more than 2 months and subsequently required the placement of tympanostomy tubes.

Allergy was defined using the radioallergosorbent test (RAST), serum immunoglobulin E (IgE) levels, and skin tests. Allergies were present in 97% of the patients with nonacute OME. The relationship between allergy and OME was corroborated clinically in 89% of patients and was also substantiated by elevated levels of effusion eosinophil cationic protein (ECP) in 87.5% of OME patients. Histologically, polyclonal antibody staining for ECP demonstrated the presence of eosinophils in middle ear mucosal biopsy specimens.

This study confirms that OME is a sign of allergic inflammation in the middle ear that is associated with an increase in eosinophils and a concomitant release of ECP into the effusion in individuals with allergy demonstrated by skin testing.
Acquired Maxillary Sinus Hypoplasia: A Consequence of Endoscopic Sinus Surgery?
Authors: Kosko James R. , Hall Bruce E. , Tunkel David E.
Published: November 2003

The effects of functional endoscopic sinus surgery (FESS) on sinus and midfacial development remain unclear. The authors report five children who, at a median age of 30 months, underwent FESS for refractory sinusitis. Three of the children had cystic fibrosis, and two had asthma. Preoperative computed tomographic (CT) scanning showed symmetric maxillary sinus development with varying degrees of mucosal disease.

At a mean of 42 months after surgery, CT scans were obtained to evaluate recurrent symptoms in the five children. The scans showed unilateral maxillary hypoplasia in four children and bilateral maxillary sinus hypoplasia in one child. No child had clinically apparent facial asymmetry or midfacial hypoplasia.

The authors also discuss the factors involved in maxillary sinus pneumatization, the possible effects of sinus surgery on sinus development, and the clinical implications of “acquired” maxillary sinus hypoplasia.

Laryngoscope, 106:1210‐1213, 1996