bluuebunny/crossref_metadata_2025 huggingface dataset:
S194 – Pharyngeal Thickness in Young and Elderly Normal Subjects
Authors: Aminpour Shervin , Fuller Scott , Rebecca Leonard , Belafsky Peter C
Published: August 2008

Objectives

Previous research has demonstrated pharyngeal size and constriction differences between normal young and elderly adults. Evidence suggests that the pharynx of elderly subjects dilates and does not constrict as well as younger persons. The distance between the larynx and the hyoid at rest is greater in the elderly, as is the anterior‐posterior width of the pharynx maximally expanded. We have noticed that the pharynx of elderly persons appears to atrophy with age. The purpose of this investigation was to compare pharyngeal wall thickness in young vs. elderly persons.

Methods

Videofluoroscopic swallow studies were performed on 82 normal adults under the age of 65 years and on 89 normal adults over the age of 65. Measures of posterior pharyngeal wall thickness (PWT) were determined at rest and at the same point during maximum constriction of the pharynx on a 20‐cc bolus swallow. Data were compared with the independent samples t‐test.

Results

No gender differences were identified for the younger or elderly groups. Mean PWT at rest was. 40cm (±. 08) for the younger group and 30cm (±. 08) for the elderly (p <0.01). Pharyngeal wall thickness measured at the same point during maximum constriction was 1.08cm (±38) for the younger group and. 92cm (±36) for the elderly (p <0.01).

Conclusions

Data from the current study suggest that the posterior pharyngeal wall is thinner in elderly individuals older than 65 as compared to younger adults. These differences may help explain differences in pharyngeal strength, swallowing efficiency, and safety in the elderly.
S196 – Phonation and Electric Activity in Adductor Dystonia
Authors: Silveira Paula Lorenzon , De Biase Noemi , Korn Gustavo Polacow , Vilanova Luiz Celso , Padovani Marina , Moraes MIriam , Madazio Glaucya
Published: August 2008

Objectives

To compare the degree of dysphonia's severity with the latency between the electrophysiological activation of the TA muscle and the phonation onset in patients with adductor laryngeal dystonia.

Methods

21 patients with adductor dystonia and 15 controls underwent laryngeal electromyography (EMG) exam of the left TA muscle. The latency time was registered from rise of the electric activity of the TA muscle until the phonation onset. Perceptual evaluation of voice quality was performed for the study group and judged by consensus of three speech‐pathologists/voice specialists. The evaluation considered 4 tasks: 1) sustained vowel /e/ in habitual pitch and loudness; 2) sustained vowel /i/ in ascending and descending glissando; 3) sustained vowel /i/ at high pitch; 4) phrases including words with voiced and voiceless phonemes. The dysphonia's severity degree was classified in the following scale: 0 ‐; no alteration perceived; 1 ‐; mild degree; 2 ‐; moderate degree; 3 ‐; severe degree. The Spearman's Correlation Test was used to compare the latency time values and the dysphonia's severity degree (p<0,05).

Results

The average latency time registered for patients with mild dysphonia was 332ms, for moderate dysphonia it was 426ms, and for the severe group was 791ms (p=0.02*).

Conclusions

The latency time was significantly and directly related to the degree of dysphonia's severity.
S218 – Treatment Failures in Acute Otitis Externa
Authors: Roland Peter S , Wall G. Michael , McLean Celeste , Stroman David
Published: August 2008

Objectives

Understand treatment failure rates of cipro‐floxacin/steroid‐ vs. Neomycin/Polymyxin B/Hydrocortisone (NPH)‐containing ear drops against the two major pathogens in acute otitis externa (AOE), Pseudomonas aeruginosa and Staphylococcus aureus.

Methods

Retrospective analysis of clinical studies involving NPH versus either 0.3% ciprofloxacin/0.1% dexamethasone (CDX)(2 trials, 1998–1999) or 0.2% ciprofloxacin/1% hydrocortisone (CHC) (3 trials, 1994–1996) in the treatment of patients diagnosed with AOE. Patients were randomized to treatment with either CHC, CDX (both bid) or NPH (tid), 3–4 drops per ear for 7 days. Microbiology specimens were collected from infected ears prior to the initiation of therapy, and at exit visit if there were any clinical signs of infection.

Results

The therapy failure rate of P. aeruginosa for CDX and CHC was 6.7% (20/300) versus NPH at 12.8% (39/306), p = 0.017. The failure rate of S. aureus for CDX and CHC was 9.2% (6/65) vs. NPH at 8.3% (4/48), p = 0.87. In no instance of treatment failure was the pre‐therapy pathogen resistant in vitro to the antibiotics used to treat the infection. All of the persisting P. aeruginosa and S. aureus isolates were susceptible to fluoroquinolones and neomycin/polymyxin B.

Conclusions

Based on data from 5 separate AOE clinical trials, ciprofloxacin‐containing ear drops, CDX and CHC, provided significantly greater eradication (93.3%) of P. aeruginosa compared to NPH ear drops (87.2%). There was no significant difference in the rate of eradication of S. aureus between the two groups of ear drops.
S237 – Computerized Tomography in the Prediction of CSF Gusher
Authors: Rothholtz Vanessa S , Mafee Mahmood F , Young Nancy M
Published: August 2008

Objectives

1) Identify anatomic variations of the temporal bone in children with and without cochlear malformations who experienced an intra‐operative cerebrospinal fluid (CSF) gusher at the time of cochlear implantation. 2) Compare the anatomic findings in the current study to those described in prior studies.

Methods

A retrospective case‐controlled chart review was performed on patients undergoing cochlear implant surgery. Computerized tomography images were analyzed in a single‐blind fashion for characteristics and measurements of both the right and left cochlea, internal auditory canal, cochlear aperture, facial nerve canal, vestibular aqueduct, cochlear aqueduct, oval window, round window, vestibule, mastoid, tegmen tympani and semi‐circular canals. After verifying equal variances, data was statistically evaluated utilizing the paired 2‐tailed t test with criterion for statistical significance set at p < 0.05.

Results

The average age at implantation for this series of children was 4 years old. 70% of patients had cochlear malformations. 25% of patients had an abnormal internal auditory canal (IAC) and 30% had a widened cochlear aperture. Most patients with an abnormal IAC had an abnormal cochlear aperture; however, some patients with a normal IAC also had an abnormal cochlear aperture. Correlations between the temporal bone anatomy and the incidence of CSF gushers will be discussed.

Conclusions

Specific characteristics of the temporal bone anatomy may lead to an increased incidence of CSF gusher in cochlear implant surgery. Computerized tomography of the temporal bone can assist in the surgeon in evaluation and planning for cochlear implantation.
S243 – An Interactive 3D Game of the Pterygopalatine Fossa
Authors: Javan Ramin , Bryan Jeun , Payne Spencer C
Published: August 2008

Objectives

Develop an interactive computer simulation of complex structures of the head and neck that would assist the teaching of relevant anatomy.

Methods

Areas of the head and neck with complex spatial relationships were selected and their anatomical relationships were confirmed. Graphical representations of these areas were created, performed, and integrated into a virtual gaming environment through various software components. A variety of adjunctive teaching materials were also developed and laid over this virtual environment to reinforce the complex relationships.

Results

A 3D simulation was successfully created which allows users to freely move throughout a virtual environment framed by key and complex anatomy of the head and neck. Both this movement and visualization of the environment in all directions is provided through simultaneous use of the mouse and keyboard. Navigation through the game‐space is assisted by a dynamically updated ‘anatomical’ compass. A combination of accurate structural depictions and conceptual representations of cavities and spaces with rooms, hallways, doors and/or windows was employed. Structures can be identified and educational information through adjunctive media can be displayed with simple point‐and‐click techniques. Gaming features were also employed to provide entertainment value, with the expectation that this would reinforce the anatomical concepts.

Conclusions

Virtual simulation of the complex anatomy of the head and neck may be an effective means to offset the cost and limited availability of cadaveric dissection. We describe here the development of such a simulated environment employing an interactive gaming construct which, to our knowledge, has not been previously described elsewhere.
S248 – Supraglottoplasty for Laryngomalacia with Sleep Apnea
Authors: Zafereo Mark E , Taylor Rodney J , Pereira Kevin D
Published: August 2008

Objectives

To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea.

Methods

10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre‐ and postoperative mean data were calculated, and comparisons were made with a Student's T‐test.

Results

All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow‐up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05).

Conclusions

Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.
S266 – Review of Endoscopic Findings in Children with GERD
Authors: Lemonnier Lori A , Koscica Jovana , Coticchia James M
Published: August 2008

Objectives

Many children with gastroesophageal reflux will initially present with respiratory symptoms including cough, stridor, increased work of breathing, apneic events, and recurrent episodes of croup. Despite a growing body of literature that suggests a correlation between airway pathology and GERD, there still remains much controversy. Our objective is to systematically review published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease.

Methods

A systematic review was performed of 19 articles relating the presence of gastroesophageal reflux disease in the pediatric population to findings on endoscopic airway evaluation. These were identified through a structured PubMed search of English language literature using the key terms laryngopharyngeal reflux, extraesophageal reflux, and gastroesophageal reflux. Only those articles studying endoscopic findings in the pediatric population were included.

Results

All studies evaluated the subjects for the presence of gastroesophageal reflux. The most commonly utilized methods of diagnosis include barium esophagram, video fluoroscopy, gastric scintiscan, 24 hour pH probe, and esophageal biopsy. Arytenoid, postglottic and vocal fold edema and erythema, lingual tonsil hypertrophy, laryngomalacia, and subglottic stenosis are among the endoscopic findings most frequently identified in disease‐positive patients.

Conclusions

Certain commonly encountered findings on endoscopic evaluation of the larynx and trachea performed in children presenting with respiratory symptoms do indeed demonstrate a correlation with presence of gastroesophageal reflux and may indicate that antireflux therapy should be considered in the treatment of this population of patients.
S275 – Nasal Morphology and Nasal Patency in Leprosy Patients
Authors: Larrosa Maria Teresa Torres , Peréz Luis Jorge Peréz , Toro Juan‐Jose Artazkoz‐del
Published: August 2008

Objectives

1) To assess the impact of multi‐drug leprosy therapy on the development of nasal deformities and nasal airway patency. 2) Evaluate the nasal morphology and nasal patency in leprosy patients treated with the multidrug therapy in comparison with patients treated with 1 drug therapy and a group of healthy volunteers.

Methods

In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug, and 22 were treated with multi‐drug therapy, while 24 subjects formed a control group. We used anterior rhinoscopy to analised the morphology of the nose. We meassured the nasal inspiratory and expiratory resistance of the right and left nostrils and total nasal inspiratory and expiratory resistance at a transnasal pressure of 150 Pa. by using active anterior rhinomanometry. The statistical analysis was carried out using the Varianza analisys.

Results

The nasal structures in the 1‐drug therapy group underwent bone and cartilaginous resorption with an increase in nasal resistances. We found significant statistical differences between the resistance values obtained in this group and the control group (p<0,05). In the multidrug therapy group, the morphology of the nose remains as in healthy patients. No significant statistical differences were found between the resistance values obtained in the multidrug therapy patients and the control group (P>0,05).

Conclusions

The multidrug therapy prevents developing nasal deformities and maintains a normal nasal airflow.
S276 – Nasal Sinus Diseases Demonstrating Ophthalmologic Symptoms
Authors: Tsuzuki Kenzo , Takebayashi Hironori , Nishimura Masashi , Fukazawa Keijiro , Sakagami Masafumi
Published: August 2008

Objectives

This study reviewed the clinical features of paranasal sinus diseases demonstrating ophthalmologic manifestations.

Methods

Between April 1995 and December 2007, we performed endoscopic sinus surgery (ESS) in 106 patients with paranasal sinus diseases presenting with ophthalmologic symptoms. There were 57 men and 49 women, aged 56.4 years (10 − 86 years). Diagnosis was based on the pre‐ and intraoperative findings. Patients with symptoms due to tumors were excluded from this study.

Results

Of 106 patients, loss of visual acuity was most frequently observed in 40 patients (37.7%). Other symptoms were eyelid swelling (28.3%), diplopia (18.9%), constriction of the visual field (13.2%), exophthalmos (13.2%), ocular pain (12.3%), external ophthalmoplegia (3.8%), and epiphora (1.9%). The symptoms involved in paranasal sinus cysts were found in 67 patients (63.2%), those in bacterial sinusitis in 36 patients (34.0%), those in fungal sinusitis in 2 patients, and those in Wegener's granulomatosis in 1 patient. The 38 patients (35.8%) were diagnosed as rhinogenic optic neuropathy, and most of them (32/38 patients, 78.9%) initially referred to ophthalmologists. Major lesions were observed in anterior and posterior ethmoid sinus (40 patients, 37.7%). For the treatment, external approaches were required in 11 patients (10.4%). During the postoperative course, reoperation (ESS) was required in 3 patients (2.8%) because of recurrence in the sphenoid sinus, whereas the other 103 patients had an uneventful course.

Conclusions

Pre‐ and postoperative observation by not only otolaryngologists, but also ophthalmologists, is recommended in order to perform minimally invasive surgery and to avoid recurrence.
S279 – Augmentation Rhinoplasty with Permacol and Cartilage Grafts
Authors: Thinakararajan Thirupathirajan , Srinivasan Venkat R
Published: August 2008

Objectives

Assessment of outcome and patient satisfaction following augmentation rhinoplasty with cartilage & Permacol and safety of Permacol.

Methods

Permacol is a biomaterial derived from porcine dermis, modified by chemical processing. Patients with Permacol augmentation were compared with a historical cohort of patients who had cartilage augmentation. Patients, who had cartilage grafts, were retrospectively reviewed for a period of 3 years, from 2001 to 2004. Patients in the Permacol group were prospectively studied from 2003 to 2006. The senior author performed all operations. All the patients had supra‐tip depression. The outcome was measured by clinical assessment, evaluation of photographs, and patient satisfaction.

Results

A total 24 patients had augmentation rhinoplasty‐12 with cartilage and 12 with Permacol. Their age ranged from 19 to 54 years (mean 30). The mean follow‐up for cartilage grafts was 33 months and for Permacol 26 months, with a minimum of 12 months for both groups. Cartilage grafts were harvested from the septum in 7 patients and from the pinna in 5 patients. All 12 patients with cartilage augmentation had satisfactory outcome. In the Permacol group, 11 out of 12 were satisfactory with the outcome. In 1 patient, Permacol graft extruded within 2 months.

Conclusions

Permacol graft compared very well, in terms of outcome and safety, with cartilage for augmentation of nasal dorsum. Apart from 1 case of extrusion (8%), there were no other complications. Permacol graft is readily available and easy to handle and contour. Long‐term follow‐up is needed for further assessment.
S293 – Does Tobacco Smoking Influence Smell Function?
Authors: Ribeiro João , Paiva Sofia , Cerejeira Rui , Soares Vera , Gapo Carla , Romão José , Paiva António
Published: August 2008

Objectives

Many diseases with great prevalence in the population occur with disorders of smell funtction. However, assessment of olfactory function in patients with disorders of smell is frequently neglected in the otolaryngology routine consultation. One of the effects of tobacco consumption is a change in the nasal mucosa. It has been hypothesized that tobacco smoke consumption modifies olfactory levels of these people.

Methods

Prospective clinical study with 56 consecutive healthy volunteers, submitted to a previously validated protocol of olfactometry composed by a quantitative and a threshold test. Our population was constituted of an equal number of tobacco smokers and controls, between 16 and 78 years old (average 38,3 years), age and sex paired.

Results

The substance more frequently identified was naphthalene (94%), followed by menthol (88%), while the least times correctly identified had been the cinnamon and talcum (65%). The test of butanol showed a statistically significant difference (3.73±0.50 in smokers vs 4.34±1.00 in nonsmoking, p=0.02). This test presented a significant correlation with the smoking habit (r=‐0.59, p< 0.01). The supraliminary test showed no significant differences between the 2 groups. There was no significant difference between genders.

Conclusions

We observed a significant statistical correlation between the tobacco smoking and the test of butanol, which confirms the subjective sense of former smokers when experiencing again the aromas that have been altered. Our study showed the quantitative difference imposed by tobacco smoking. Smokers presented lower olfaction levels than non‐smokers, keeping, however, a similar discriminative ability.
S295 – Palate Length, Tonsil Size, and Sleep Apnea Severity
Authors: Bhattacharyya Neil
Published: August 2008

Objectives

Determine the relationships between soft tissue oropharyngeal measurements and obstructive sleep apnea severity.

Methods

A prospective series of adult patients undergoing surgical theraphy for obstructive sleep apnea (OSA) was studied. Tonsil size (graded 0 to 4+) and median (palatal spineuvula tip) and lateral (posterior hard palate‐free edge soft palate) dimensions of the soft palate were directly measured transorally at the time of surgery. From the preoperative polysomnographic and the medical record, respiratory disturbance index (RDI), lowest oxygen saturation (LSat) and body mass index (BMI) were determined. The relationships between both RDI and LSat and tonsil size and palatal dimensions was determined with multivariate linear regression adjusted for BMI.

Results

88 patients were enrolled. The mean (±)95% confidence interval values for the median and lateral soft palate lengths were 4.71 (±) 0.14 cm and 3.73 (±) 0.12 cm, respectively; the mean tonsil size was 1.8 (±) 0.3. The mean RDI and LSat were 44.0 (±) 5.6 events/hour and 84.7 (±) 2.4%, respectively. On multivariate regression, only BMI significantly predicted RDI (p=0.003); median (p=0.210) and lateral (p=0.507) palate lengths and tonsil size (p=0.860) did not. For the LSat, both BMI and tonsil size were significant predictors (p<0.001 and p=0.017, respectively); median and lateral lengths were not (p=0.251 and p=.376, respectively).

Conclusions

Adjusted for BMI, soft palate length does not consistently predict sleep apnea severity. Adjusted for BMI, tonsil size predicts the LSat but not the RDI. These results highlight difficulties associated with correlating soft tissue anatomy with sleep apnea severity.
S297 – Nasal Surgery for Obstructive Sleep Apnea Syndrome
Authors: Li Hsueh‐Yu , Wang Pa‐Chun
Published: August 2008

Objectives

Using evidence‐based methodology, we report the literature review findings concerning nasal surgery and OSAS.

Methods

The MedLine, EMBRASE, Cochrane databases are searched (1960‐; 2008) using subject headings “nasal surgery,” “sleep apnea,” “snoring,” or “sleep disorder.” Letters to editor, case reports, review articles, and non‐English publications are excluded. Data extracted from these articles are used for critical appraisal and are analyzed using meta‐analysis and data‐synthesis technology.

Results

Patients pooling revealed gender distribution (90% male), with a mean age of 48 years, and respiratory disturbance index (RDI) ranged from 6.2 to 83.6 event/hr. Baseline BMI spanning from 25.9 to 35.7 kg/m2 was recorded in 10 articles. Total nasal resistance from 2.7 to 5.8cm H2O/L/S was measured in 5 articles. In 13 articles, nasal surgery is the only procedure that applied to patients. 5 articles report significant improvement in AHI; 2 of nasal‐surgery only and 3 of nasal with oropharyngeal surgery. The success rate was statistically significant between “nasal surgery‐only” and “nasal with oropharynx surgeries‐together” articles (15.8–57% vs 40–82%, P=0.03). Although significant improvement in nasal obstruction and concomitant quality of life were mentioned in aforementioned articles, there were no universal measures to present a coherent analysis.

Conclusions

Nasal surgery might be efficacious in treating OSAS‐related symptoms. However, the meta‐analysis does not support the efficacy of exclusive nasal surgery for sleep apnea in regard to the success rate. Heterogeneity in small study population and incoherence of outcomes measures limit the study and warrant further research.
S302 – Prevalence of Depression in Otolaryngology Patients
Authors: Epstein Victoria A. , Fishman Andrew J , Chandra Rakesh K
Published: August 2008

Objectives

Several chronic intractable medical conditions are associated with depression. We sought to determine and compare the prevalence of depressive diagnoses and antidepressant use in various subsets of otolaryngology patients.

Methods

A large tertiary care, university‐based, EMR database was queried. The study group included over 12,000 distinct otolaryngology patients who were analyzed in 3 groups: group 1 (tinnitus, vertigo, peripheral vertigo, positional vertigo), group 2 (chronic sinusitis, allergic rhinitis, deviated septum), and group 3 (sleep apnea related diagnoses). The number of patients with depressive diagnosis and/or taking antidepressive medications was determined.

Results

Overall, 30% of patients either had been diagnosed with a depressive illness or took antidepressants. The prevalence of depression was 13% in Group 1, 10% in Group 2, and 14% in Group 3. The percent of patients on antidepressant medications was 21%, 15%, and 28% respectively. The primary encounter diagnosis with the highest incidence of depression and antidepressive medication use was sleep apnea with insomnia (21%, 46%).

Conclusions

Otolaryngology patients exhibited a greater prevalence of depression and antidepressant use than is observed in the general population. Highest prevalence was found in patients with inner ear disease and sleep apnea. Depression may be a cause of significant comorbidity in patients with chronic intractable otolaryngic conditions.
Frontal Sinus Posterior Table Fractures in a Goat
Authors: Maturo Stephen C , Brennan Joseph , Weitzel Erik K
Published: August 2008

Problem

The goal of this study was to investigate how patency of the nasofrontal outflow tract would affect the healing of the frontal sinus in the setting of displaced, posterior table fractures in the adult goat (Capra Hircus).

Methods

Prospective animal study. Posterior table fractures were created in twenty adult goats (Capra Hircus). The nasofrontal outflow tract was obstructed in 10 goats and left patent in 10. Gross, radiologic, and histological evaluation was carried out at six months post operatively.

Results

All posterior table fractures healed without gross or radiological evidence of mucosal ingrowth. Obstruction of the nasofrontal outflow tract resulted in an increased rate of mucocele formation. Histological analysis did not reveal significant mucosal ingrowth in either group.

Conclusion

An occluded nasal frontal outflow tract leads to an increase rate in mucocele formation at 6 months. There is no gross or radiographic evidence that mucosal ingrowth into the posterior table occurs at 6 months. These findings would suggest that not all significantly displaced posterior table fractures need to be surgically addressed if the nasofrontal outflow tract is patent.

Significance

Posterior frontal sinus table fracture treatment is based on poorly controlled animal studies from 30 years ago and small case series reports. Our aim in this study was to determine changes in the frontal sinus at 6 months after a displaced, comminuted frontal sinus fracture was created. We hope to provide evidence demonstrating that not all posterior table fractures need to be treated, especially if the nasofrontal outflow tract is intact.
Oncolytic Vaccinia Virus Gene Therapy for HNSCC
Authors: Tysome James Russell , Alusi Ghassan , Lemoine Nick , Wang Yaohe
Published: August 2008

Problem

Oncolytic viral therapy a promising new strategy for the treatment of cancer and an oncolytic adenovirus was first licensed for head and neck squamous cell carcinoma (HNSCC). However, the outcomes of clinical trials with viral monotherapy have been disappointing. Oncolytic vaccinia virus represents an attractive alternative as its replication is less dependent than adenovirus on the genetic make‐up of tumor cells and it has been used safely as the smallpox vaccine in millions of patients.

Methods

The potency and replication of vaccinia virus and adenovirus were compared in a panel of HNSCC cell lines in vitro before assessing the tumor selectivity of systemically delivered vaccinia virus in vivo. In order to increase antitumor potency, a novel vaccinia virus expressing the angiogenesis inhibitory endostatin‐angiostatin fusion protein was constructed. The expression and function of this protein was confirmed in vitro and antitumor efficacy assessed in vivo.

Results

Oncolytic vaccinia virus was more potent than adenovirus against all HNSCC cell lines and displayed high selectivity for cancer cells, sparing normal cells both in vitro and in animal tumour models in vivo. Vaccinia virus expressing the endostatin‐angiostatin fusion protein inhibited new blood vessel formation as well as tumour growth by oncolysis. The protein was expressed in virus‐infected HNSCC cells and demonstrated function by the inhibition of human umbilical vein epithelial cell proliferation and tube formation in vitro. Treatment of nude mice bearing FaDu HNSCC xenografts significantly prolonged survival when compared to the oncolytic adenovirus ONYX‐015 used previously for HNSCC.

Conclusion

This novel vaccinia virus is a promising therapeutic agent for HNSCC, which improved survival in tumour bearing mice and requires further evaluation in vivo.

Significance

The combination of an oncolytic vaccinia virus that delivers tumor‐specific angiogenesis inhibition may prove to be an effective treatment for patients with HNSCC, with the potential for systemic delivery to treat metastatic disease.

Support

Cancer Research UK, Royal College of Surgeons of England, Barts and the London Trustees.
Anatomy of the Transarcuate Approach to the Petrous Apex
Authors: Lee Alice D , Hamidi Sanaz , Djalilian Hamid R
Published: August 2008

Problem

The petrous apex is considered to be one of the most difficult areas of the temporal bone to approach surgically. We present data describing the dimensions of a transarcuate approach to the petrous apex, as measured on high resolution computed tomography.

Methods

Measurements of the mean dimensions and ranges through the crura of the superior semicircular canal were made. The measurements were obtained from high‐resolution computed tomography images of 30 temporal bones in 19 consecutively presenting patients with a pneumatized posterior petrous apex cell tract on CT. Measurements were obtained with the use of the standard PACS (picture archiving and communication system) software.

Results

The mean anterior‐posterior space in the superior semicircular canals without transcrural pneumatization was 4.96±0.39 mm. The mean superior‐ inferior dimension was 4.98±0.48 mm. The same measurements in canals with pneumatized intercrural tracts were 5.17±0.51 mm and 5.11±0.62 mm respectively. The mean anterior‐posterior distance and superior‐inferior distance of the intercrural air tracts themselves were 2.09±0.57 and 2.01±0.45mm. There was a statistically significant difference in the anterior‐posterior size between the pneumatized and non‐pneumatized canals but not in the superior‐inferior distance.

Conclusion

Pneumatized bones demonstrate a slight increase in the subarcuate dimensions as compared to non‐pneumatized bones. The transarcuate approach is a viable one for drainage and biopsy of the petrous apex.

Significance

Our study demonstrates that the transarcuate approach is anatomically possible for drainage of the petrous apex with minimal risk to the superior semicircular canal. This would be especially useful for the drainage of cholesterol granulomas of the petrous apex or biopsy in this area.
Cemented Titanium Ventilation Tube in the Chinchilla
Authors: Kuhn Jeffery J , Anderson Scott R , Strasnick Barry
Published: August 2008

Problem

The use of long‐term ventilation tubes in patients with chronic eustachian tube dysfunction is an acceptable form of initial surgical treatment. Despite improvements in composition and design, early extrusion, occlusion, and need for repeated procedures continue to be frequent problems encountered in the course of treatment. The purpose of this study was to develop a novel technique for establishing permanent middle ear ventilation. The study was conducted following the refinement of surgical techniques and long‐term follow‐up in a pilot group of animals.

Methods

Heat cautery myringotomy was used to expose the middle ear space in both ears of 15 chinchillas. A titanium ventilation tube was fixed to the medial wall of the hypotympanum in each ear using OtoMimix hydroxyapatite bone cement. At four months, both ears in 12 animals were re‐explored and the integrity of the cemented tube was assessed clinically. One animal was euthanized and the temporal bones obtained for histopathologic analysis.

Results

A stable fixation of the titanium tube to the medial wall of the hypotympanum was demonstrated in 23 of 24 ears at four months re‐exploration. The titanium tube‐bone cement fixture was covered with healthy vascularized mucosa in all ears. Two ears showed mild mucosal inflammation adjacent to the fixed tube. The histologic findings will be reviewed.

Conclusion

The use of hydroxyapatite bone cement to permanently secure a titanium tube to the middle ear wall appears to have some promise as a technique for establishing long‐term ventilation of the middle ear space. A prototype titanium tube is currently being developed for this purpose.

Significance

By incorporating the proven technologies of titanium implants and hydroxyapatite bone cement, this study provides a novel technique for establishing a permanent means of middle ear ventilation.

Support

The ventilation tubes (Gyrus ENT LLC) and bone cement (Walter Lorenz Surgical, Inc.) were supplied by their respective manufacturers.
Alterations In Immunity After Total vs Partial Tonsillectomy
Authors: Bitar Mohamed A , Rameh Charbel E , Ataya Nour , Najarian Alik , Chakhtoura Marita , Abdelnoor Alex Michael
Published: August 2008

Problem

Palatine tonsils are secondary lymphoid organs active in sampling antigens entering the upper respiratory tract and in producing immunoglobulin (Ig) both locally and distally through migrating tonsillar B cells. Their size has been found to be directly proportional to the number of B and T cells. The aim of this study is to compare the change in serum and saliva Ig levels after total and partial tonsillectomy.

Methods

Children with obstructive tonsils and/or adenoid undergoing total or partial tonsillectomy were recruited in a pilot study. Patients with history of recurrent infections or immunodeficiency were excluded. Blood and saliva samples were obtained immediately preoperatively and at the 1st follow‐up visit. Serum Ig's (G,M&A) concentrations were determined using radial immunodiffusion. Saliva secretory IgA was measured using an Enzyme Immuoassay (EIA).

Results

Twenty five patients (13 partial and 12 total) were included. There were no statistically significant changes in serum Ig's levels after total or partial tonsillectomy, except for IgM which increased (1.317 to 1.632 g/L) after partial tonsillectomy, more significantly in males, in those aged 5 years and older, and when the postoperative samples were taken within a 2 month‐period. Moreover, there was statistically non‐significant decrease in secretory IgA level after both total and partial tonsillectomy.

Conclusion

The effect of partial or total tonsillectomy on immunoglobulin level seems reassuring. The increase in IgM and the non‐significant decrease in SIgA may represent a kind of immunological readjustment after tonsillar surgery.

Significance

This is the first study (to our knowledge) that compares the changes in immunoglobulin levels (in serum & saliva) after partial vs. total tonsillectomy. The obtained results are preliminary and are reassuring to the parents and physicians who have concerns regarding the immunological sequalae of tonsillectomy in children. A longer follow up will be done in a larger future study.

Support

This study was supported by Medtronic.
Effects of Humidification on a CPAP Experimental Rat Model
Authors: Vilaseca Isabel , Martinez Vidal Brigida Meritxell , Montserrat Josep Maria , Marta Torres , Isaac Almendros , Farre Ramon
Published: August 2008

Problem

Introduction: Rhinitis is a potential side effect of nasal continuous positive airway pressure (nCPAP) when applied to patients with obstructive sleep apnea. In the clinical setting, air humidification is regularly applied to treat these symptoms, but its benefits are controversial and human confounding factors may make it difficult to draw definitive conclusions. Animal models could therefore be useful. Objectives: To study the effects of air humidification as a mechanism that may reduce nasal inflammation during the application of nCPAP with or without an oral leak.

Methods

The study was divided into two phases. Phase I: 36 anesthetized Sprague‐Dawley rats (300–360g) were subjected to nCPAP = 10cmH2O (n=12), sham‐CPAP (n=12) and nCPAP with 100% air humidification (n = 12) for 5 hours. Nasal scraping was carried out on all the rats and Wright staining was performed to detect neutrophils. Phase II: The same procedure was applied to 33 rats exposed to nCPAP (n=11), nCPAP with a controlled mouth airleak (n=11) and nCPAP‐airleak with 100% air humidification (n=11).

Results

Percentage of neutrophils in nucleated cells in the nasal scrapings was significantly (p=0.017) higher after 5 hours of nCPAP (0.96±0.90%) than in the control group (0.27±0.2%). When humidification was applied, the percentage of neutrophils was similar to that observed in the CPAP group (0.95±0.9%; p=0.97). When leakage was added there were no significant differences in the neutrophil count compared to nCPAP (0.75±0.5%; p=0.70). The application of humidified air to the rat with mouth airleak did not change the neutrophil count (1.17±1.2%; p=0.60).

Conclusion

Air humidification applied to an acute animal model of nCPAP with and without an oral air leak does not seem to reduce nasal inflammation.

Significance

The study is an intent to clarify the objective effects of the addition of air humidification into a CPAP device, in order to reduce rhinitic symptoms.

Support

Supported by FIS PI050194, by CIBERRes, and in part by Ministerio de Ciencia y Tecnología (SAF2005‐00110 and SAF2004‐00684).
R407 – Prognostic Factors in Salvage Surgery
Authors: Chedid Helma Maria , Lehn Carlos Neutzling , Porsani Alex Freitas
Published: August 2008

Problem

The main cause of uncontrolled disease of the squamous cell carcinoma of upper aerodigestive tract is the loco‐regional recurrence. Salvage surgery is a good option of treatment. The aim of this paper is to assess the prognostics factors in the patients with tumors of oral cavity and oropharynx treated with surgery and undergoing salvage surgery.

Methods

Retrospective study of 276 patients treated with surgery associated or no with postoperative radiation therapy. The patients were excluded when they presented distant metastasis, second primary tumors or previous oncological treatment. Statistic analysis: tests Chi‐quadrado and Fisher.

Results

The average follow‐up was 35.3 months, and 127 patients developed loco‐regional recurrences being 76 patients approached with salvage surgery. In 65% of the patients, the salvage surgery was in the oral cavity due to the higher predominance of exclusive local relapse. The main indications of salvage surgery were in patients with early clinical stage (I/II) and loco‐regional recurrence. The clinical factors prognostics in the univariate analysis were the sites of tumors (p=0.004), clinical stage of loco‐regional recurrence (p=0.0001), initial clinical stage (p=0.01) and previous radiotherapy (p=0.04) and the independent clinical factors prognostics in the multivariate analysis were clinical stage of loco‐regional recurrence (p=0.005), site of the primary tumor (p=0.003) and previous radiotherapy (p=0.01).

Conclusion

The tumor sites, previous radiotherapy and the clinical stage of loco‐regional recurring were independent clinical factors prognostics.

Significance

The assessment of the clinical factors in the patients submitted salvage surgery.
R422 – EMMPRIN as a Novel Target in Head and Neck Cancer
Authors: Safavy Seena , Nichole Dean , Newman John Robert , Wenyue Zhang , Weeks David Michael , Helman Emily E , Buchsbaum Donald J. , Rosenthal Eben L
Published: August 2008

Problem

To determine if blocking EMMPRIN function in vivo inhibits tumor growth alone or when combined with radiation therapy in a preclinical model of head and neck squamous cell carcinoma (HNSCC).

Methods

Immunodeficient mice bearing SCC‐1 subcutaneous xenografts were sorted into four treatment groups: anti‐EMMPRIN antibody alone, anti‐EMMPRIN antibody in combination with radiotherapy, radiotherapy alone, and untreated control groups (n = 7 per group). Each animal in the treatment groups received a total dose of 1.2 mg of antibody and/or 12 Gy of 60Co radiation, biweekly over three weeks. To investigate possible mechanisms of action for anti‐EMMPRIN therapy, xenograft samples from the control group and antibody alone group were analyzed for proliferation (Ki67) and apoptosis (TUNEL). Furthermore, the expressions of EMMPRIN induced cytokines were assessed by ELISA, including IL‐1?, IL‐6, IL‐8, and VEGF.

Results

Two weeks after completion of treatment, mean tumor surface area for the antibody alone group was smaller than the untreated group (P = 0.0006), as was the radiation alone group (P = 0.0029), while combination therapy yielded optimal results (P = 0.0003). Anti‐EMMPRIN antibody treated tumors had a significant reduction in proliferation (P = 0.007), and analysis of in vivo apoptosis by TUNEL assay showed a higher number of cells undergoing apoptosis in the treatment group (18%) vs. untreated (5%; P = 0.087), although this failed to reach statistical significance. Treatment of xenografted tumors resulted in decreased expression of IL‐1? (P = 0.0079), IL‐6 (P = 0.077), IL‐8 (P= 0.1481), and VEGF (P = 0.0538) when compared to animals receiving no treatment.

Conclusion

This data suggests that blocking EMMPRIN function in vivo inhibits tumor cell proliferation and sensitizes tumor xenografts to radiation in vivo.

Significance

EMMPRIN may represent a novel target for treatment in head and neck cancer.

Support

This work was supported by grants from the National Cancer Institute (NCI K08CA102154) and the National Institute of Health (2T32 CA091078‐06).
R423 – Electrochemical Dissolution of Salivary Calculi
Authors: Schatton Robert , Stanek Adam P , Moheb Afshin , Kempf Hans Georg , Schatton Helmut
Published: August 2008

Problem

Minimally invasive therapies of sialolithiasis have been developed to avoid complications of sialadenectomy like nerve injury or frey's syndrome. Sialendoscopy and extracorporeal shock wave lithotripsy are used to manage stone removement and fragmentation. The size of salivary calculi often limits minimally invasive treatment. Chemical and electrolytic dissolution have been used successfully to reduce the diameter of sialoliths in vitro. The aim of this study was to compare the effect of electrolitholysis (ELL) and the combination of ELL with chemolitholysis on salivary calculi.

Methods

Eleven submandibular calculi (7‐19mm diameter) were halved. These halves were randomised to the ELL group and the ELL combined with chemolitholysis group. The calculi were placed in a glass tube and two platinum electrodes (0.5mm diameter) were brought in contact with their surfaces. For the ELL group isotonic sodium chloride was used as rinsing solution whereas calculi of the ELL combined with chemolitholysis group were rinsed with diluted acetic acid (0.6%, pH 2.78). Electrical current (30mA, 14V) with periodic current reversal was applied to the electrodes for three hours. To determine the extent of dissolution, the calculi were weighed and photographed before and after the treatment.

Results

The mean weight reduction of salivary calculi was 14,7±5,8 mg (19,9±8,4%) after ELL and 16,2±8,8 mg (23,1 ±20,5%) after ELL combined with chemolitholysis respectively. The differences were not statistically significant. The corrosive effect of both methods could be shown by morphologic changes of the calculi.

Conclusion

In this study a comparable weight reduction of salivary calculi was achieved using ELL alone or ELL combined with chemolitholysis with diluted acetic acid. These methods could be helpful to diminish the size of salivary calculi within the scope of minimally invasive treatment of sialolithiasis. Further investigations should be done.

Significance

Basic research.
R426 – Muscle‐Nerve‐Muscle Neurotization of the Rat Larynx
Authors: Bader Bradford A , Oh Sang Su , Old Matthew Owen , Corey Joseph M , Feldman Eva L , Hogikyan Norman D
Published: August 2008

Problem

The ability to reliably restore physiologic movement to a paralyzed vocal fold is not yet in hand. Muscle‐nerve‐muscle (M‐N‐M) neurotization is a process whereby axons sprouting from within an innervated muscle are directed toward a denervated muscle via a neural conduit. Given the paired laryngeal musculature, M‐N‐M neurotization holds promise for restoring physiologic vocal fold movement in cases of unilateral paralysis. This study is aimed at exploring the effectiveness of M‐N‐M neurotization in a rat model.

Methods

Twelve Sprague‐Dawley rats were divided equally into Control and M‐N‐M groups. The left recurrent laryngeal nerve was transected in both groups, and in the M‐N‐M group a nerve graft was interposed between the innervated right thyroarytenoid (TA) muscle and the denervated left TA muscle via bilateral laryngeal windows. Vocal fold mobility was serially documented pre‐ and post‐operatively by video‐assisted endoscopy. The rats will be sacrificed at 6 weeks and immunohistochemistry used to quantify percent nerve‐motor endplate contact in the left TA muscles. Myelinated axons per cross‐section of the nerve graft will be counted.

Results

The initial surgical and endoscopic procedures were successful in all rats. Immunohistochemical data, endoscopic findings, and axon counts in the M‐N‐M grafts will be presented as measures of reinnervation, with comparisons between groups for percent nerve‐motor endplate contact and endoscopy data.

Conclusion

M‐N‐M grafts can be performed in a rat laryngeal model and the degree of successful neurotization can be determined by this analysis paradigm.

Significance

This study contributes new data toward the eventual goal of restoring movement to the paralyzed vocal fold.

Support

This project is supported by the University of Michigan's Program for Neurology Research and Discovery and the Department of Otolaryngology ‐ Head and Neck Surgery.
R436 – Association Between Chronic Otitis Media and Otosclerosis
Authors: Cureoglu Sebahattin , Rie Nomiya , Shigenobu Nomiya , Patricia Schachern , Morita Norimasa , Kariya Shin , Nishizaki Kazunori , Paparella Michael M
Published: August 2008

Problem

In a previous clinical study, the incidence of chronic otitis media in cases of otosclerosis was reported to be less than that observed in patients without otosclerosis. Histopathologically, we can detect minimal changes such as histological otosclerosis or silent otitis media which are not detected clinically. The purpose of this study is to reveal the association of otosclerosis and chronic otitis media by evaluating human temporal bones, histopathologically.

Methods

1235 human temporal bones were reviewed for this study. In order to match patients with otosclerosis, patients with chronic otitis media were limited to 16 to 92 years of age. The incidence of otosclerosis (clinical otosclerosis, histological otosclerosis) and chronic otitis media, either clinical (tympanic membrane perforation) or silent (without perforation) were analyzed.

Results

There was no statistically difference between the incidence of chronic otitis media in temporal bones with and without otosclerosis.

Conclusion

The association of chronic otitis media and otosclerosis appears to be a coincidental.

Significance

The incidence of chronic otitis media in cases of otosclerosis is not less than that observed in cases of chronic otitis media in cases without otosclerosis.

Support

International Hearing Foundation, Hubbard Foundation, Starkey Foundation.