bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2‐18f‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography
Authors: Farber Leonard A. , Benard Francois , Machtay Mitchell , Smith Robin J. , Weber Randal S. , Weinstein Gregory S. , Chalian Ara A. , Alavi Abass , Rosenthal David I.
Published: November 2003

Objectives/Hypothesis: Fluorodeoxyglucose positron emission tomography (FDG‐PET) has been proposed as a sensitive method to diagnose and stage various malignancies. We assessed the efficacy of FDG‐PET imaging in distinguishing tumor persistence/recurrence from posttreatment changes following radiation therapy for squamous carcinomas of the head and neck. Study Design: Retrospective analysis of IDG‐PET results compared with biopsy results or outcome, or both. Methods: Twenty‐eight patients who had undergone radiation therapy with or without surgery for treatment of squamous cell carcinoma were studied with FDG‐PET imaging. There was clinical suspicion for recurrence in each patient, but no obvious mass or lesion to biopsy was found on physical examination or anatomic imaging. The results of FDG‐PET imaging were compared with those of biopsy or clinical follow‐up of at least 6 months, or both. Results: FDG‐PET imaging was positive in 13 patients, and the presence of active disease was confirmed in 12. Two thirds of the 12 received further cancer treatment. There were 15 negative FDG‐PET images. Thirteen of these were confirmed true‐negative images, but two studies were false‐negative images. The sensitivity and specificity of FDG‐PET were 86% and 93%, respectively, with positive and negative predictive values of 92% and 87%, respectively. The overall accuracy was 89%. Conclusion: FDG‐PET imaging is a useful modality to distinguish tumor persistence/recurrence from radiation‐induced tissue changes in the neck following treatment for head and neck cancer. FDG‐PET can identify patients who may benefit from further treatment, and may lead to improved outcome for individual patients. Key Words: Fluorodeoxyglucose; head and neck cancer: positron emission tomography; squamous cell carcinoma.
What Your Colleagues Think of Tympanostomy Tubes—28 Years Later
Authors: Todd N. Wendell
Published: November 2003

Objective: Assess the changing opinions of otolaryngologists about tympanostomy tubes, including indications, tube material and shape and size, placement sites, and complications. Study Design: Crosssectional survey, compared to the same survey done 28 years earlier. Method: Questionnaires mailed to the 441 active fellows and 86 candidates of the Triological Society. Response rate 69.3%. Results: The preference for polyethylene has decreased from 75% to 13% of respondents. Preferred insertion sites are more anterior. The proportion of respondents who have seen a permanent perforation as a consequence has increased from 26% to 93%. The proportion of respondents who have seen a tube‐attributable cholesteatoma has increased from 8% to 38%. The average tube duration has increased from 4 months to 18 months. Teflon and Silastic are now the materials most often used. As 28 years earlier, about 19% of patients get a subsequent tympanostomy tube. Anesthetics most commonly used now are general or topical phenol. Conclusion: The consensus on several aspects of tympanostomy tubes has changed during 28 years. Controversy continues about the indications for using tubes. Although not a not cure‐all for otitis media, tympanostomy tubes have proved useful.
Ototoxicity of Topical Gentamicin Preparations
Authors: Bath Andrew P. , Walsh Rory M. , Bance Manohar L. , Rutka John A.
Published: November 2003

Objective: To document that commercially available topical gentamicin‐containing eardrops carry a risk of ototoxicity if they reach the middle ear through a tympanic membrane defect. Study Design: Clinical study, retrospective case‐note review. Setting: Department of Otolaryngology, The Toronto Hospital, University of Toronto. Patients: Sixteen patients were identified with well‐documented histories, physical findings and laboratory investigations consistent with topical gentamicin‐induced ototoxicity. One patient with incapacitating unilateral Meniere's disease underwent successful intentional vestibular ablation using topical gentamicin/steroid drops. Results: In all cases of inadvertent ototoxicity, patients had used the drops for longer than 7 days (average 20.7 d) prior to symptoms developing. All patients developed vestibulotoxicity that was confirmed on ENG testing. Only 1 patient had a noticeable worsening of cochlear reserve. Deliberate and successful therapeutic ablation of vestibular function in a patient with unilateral Meniere's disease confirms the vestibulotoxic nature of commercially available topical gentamicin preparations. Conclusions: Physicians should consider the potential for ototoxicity if gentamicin‐containing eardrops (and by extrapolation all topical aminoglycoside drops) are used for longer than 7 days in patients with a tympanic membrane defect. These preparations should not be used in the presence of healthy middle ear mucosa and should be discontinued shortly after the discharge has stopped. It is important to recognize that toxicity is primarily vestibular rather than cochlear.
Facial Nerve Function After Petrosectomy
Authors: Häusler Rudolf , Caversaccio Marco , Zbären Peter
Published: November 2003

Objectives: Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation‐decompression, forward or backward rerouting, and facial nerve suture and grafting. Study Design: Fifty‐six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy. Methods: The treatment of the facial nerve included 15 denudation‐compressions, 23 denudation‐compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House‐Brackmann grading system was used for facial nerve evaluation. Results: Normal or nearly normal facial nerve function was obtained in facial nerve denudation‐decompression with and without rerouting (House‐Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). Conclusions: Our results show that petrosectomy with denudation‐decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.
Transmucosal Fine‐Needle Aspiration Diagnosis of Intraoral and Intrapharyngeal Lesions
Authors: Shah Saurabh B. , Singer Mark I. , Liberman Eva , Ljung Britt‐Marie
Published: November 2003

Objectives: The effectiveness of fine‐needle aspiration biopsy (FNAB) for the diagnosis of neck, thyroid, and salivary gland masses is well documented. Very few reports explore the potential of an intraoral FNAB approach for the diagnosis of submucosal lesions. We describe our technique and present case examples of pertinent differential diagnostic entities. We recommend an expanded role for FNAB of the oral cavity and oropharynx.

Study Design: Retrospective review.

Methods: A uniform technique was employed for transmucosal FNAB of 76 patients with intraoral masses. In applicable cases, cytology results were compared with traditional biopsy methods and permanent histopathologic specimens for accuracy.

Results: Our experience demonstrates the high sensitivity (93%) and specificity (86%) of intraoral FNAB when compared with biopsy by conventional means. FNAB provides distinct advantages for the cytologic diagnosis of submucosal lesions, which may be difficult to reach and adequately sample through conventional biopsy. FNAB of the tonsil and tonsillar fossa provides a safe and effective means of diagnosing both lymphoma and squamous cell cancer. Transmucosal FNAB via the mouth led to rapid diagnosis of a number of benign and malignant lesions. Applying this uniform FNAB technique, we had no significant complications.

Conclusion: We recommend transmucosal FNAB as an effective means for highly accurate diagnosis of submucosal lesions of the oral cavity and oropharynx.

Clinical Relevance: Traditional biopsy techniques in the oral cavity may require anesthesia and may have diagnostic difficulties, particularly for submucosal lesions. Transmucosal FNAB overcomes these shortcomings by providing a minimally invasive means to rapid diagnosis of intraoral lesions.
Expression of eIF4E During Head and Neck Tumorigenesis: Possible Role in Angiogenesis
Authors: Nathan Cherie‐Ann O. , Franklin Scott , Abreo Fleurette W. , Nassar Raja , de Benedetti Arrigo , Williams J. , Stucker Fred J.
Published: November 2003

Objective: The translation initiation factor eIF4E (4E) when overexpressed in mammalian cells results in their oncogenic transformation. 4E facilitates the synthesis of two powerful tumor angiogenic factors (VEGF and FGF‐2) by selectively enhancing their translation. 4E is overexpressed not only in all head and neck squamous cell cancers but also in some dysplastic margins. Tumorigenesis in the head and neck is proposed to be a multistep process preceded by clinically evident precancerous lesions. Molecular events underlie the histological changes that herald transformation. We wanted to study the role of 4E in tumorigenesis and further elucidate its causal role in angiogenesis.

Methods: An immunohistochemical analysis with antibodies to 4E, VEGF, and basic (b)‐FGF was performed on 115 specimens of the head and neck representing various stages of histological progression of malignancy. This was correlated with mean vessel density (MVD) using factor VIII.

Results: There were 41 cases of hyperplasia and low‐grade dysplasia, 40 cases of high‐grade dysplasia and 34 cases of cancer. There was a significant increase in the percent of cases expressing 4E from low‐grade dysplasia through tumor. However, for VEGF and b‐FGF the significant increase was only seen between the tumor group and dysplastic groups and no significant increase was noted between low‐grade and high‐grade dysplasia. There was a significant increase in MVD from low‐ (10.7 ± 1) to high‐grade grade dysplasia (18.0 ± 2.3). This increase was even more striking for the 4E positive cases.

Conclusion: 4E elevation is correlated with progressive cell transformation in the head and neck. Its correlation with VEGF, b‐FGF, and MVD potentates its possible role in angiogenesis.
Extracranial Drainage of Cerebrospinal Fluid: A Study of Beta‐Transferrins in Nasal and Lymphatic Tissues
Authors: Solomon Philip , Chen Joseph , D'Costa Mario , Gilbert Ralph , Davidson Jean , Johnston Miles
Published: November 2003

Objective: To determine whether an alternative route of cerebrospinal fluid (CSF) drainage exists through the nasal mucosa and the cervical lymphatic system.

Study Design: A prospective study was carried out on 18 patients at a university teaching hospital.

Methods: Ten patients undergoing routine endoscopic sinus surgeries and eight patients undergoing neck dissections were recruited for this study. Tissues were sampled from the middle turbinate, nasopharynx, and upper septum in the first group; jugulodigastric lymph nodes and nasopharyngeal tissues were obtained from the second group. Specimens were subjected to immunofixation electrophoresis in an attempt to identify the presence of beta‐1 and beta‐2 transferrins. Serum samples were obtained from each subject to serve as controls.

Results: All tissue specimens contained beta‐1 transferrin; none showed evidence of beta‐2 transferrin.

Conclusion: Using this technique, an alternate route of CSF drainage through the nose and the cervical lymphatic system could not be confirmed. Nevertheless, a new technique of performing immunofixation in solid tissues for the purpose of beta‐transferrin identification is described.
Impact of Neck Dissection on Quality of Life
Authors: Kuntz Alice L. , Weymuller Ernest A.
Published: November 2003

Objectives: For decades, the gold standard for treatment of cervical metastasis was radical neck dissection (RND). Current oncologic philosophy allows for treatment of appropriately staged neck disease with modified radical neck dissection (MRND) or selective neck dissection (SND). The purposes of this study were to determine the impact of various forms of neck dissection on patients' quality of life (QOL) and to evaluate the responsiveness of the University of Washington (UW) QOL shoulder domain.

Study Design: Prospective accumulation of QOL data from patients treated for head and neck cancer at UW.

Methods: Eighty‐four patients were identified from the UW QOL registry who had undergone neck dissection and had completed pretreatment and posttreatment QOL questionnaires at 6 and 12 months.

Results: Compared with pretreatment scores, the MRND and RND groups reported worse shoulder function at 6 and 12 months (P < .0005). The MRND group reported greater shoulder disability at 6 months compared with the SND group (P = .002), but by 12 months, there was no difference between the two groups. Shoulder function for the RND group was worse than the SND group at 6 and 12 months (P = .004). There was a trend toward decreased pain after treatment in the SND and MRND groups. There were no significant differences in subjective appearance, activity, recreation, chewing, swallowing, or speech in the three groups after treatment.

Conclusions: Consistent with findings of published functional studies, this study confirmed that the three forms of neck dissection affect patients' QOL differently. This study demonstrates that the UW QOL shoulder domain is a responsive instrument in assessing the effect of neck dissection on shoulder function.
Management of Tracheostomal Stenosis
Authors: Wax Mark K. , Touma B. Joseph , Ramadan Hassan H.
Published: November 2003

Background: Tracheostomal stenosis following laryngectomy is a distressing complication with major effects on patient rehabilitation. Management ranges from stenting with a prosthetic device to surgical revision. The goal is a widely patent stoma that is amenable to tracheoesophageal puncture.

Objective: Review the long‐term results of different methods of tracheostomal revision.

Methods: Review of 43 patients with symptomatic tracheostomal stenosis. End point was ability to function with no artificial stenting of their stoma.

Results: Forty‐three patients underwent 55 revisions. The male‐to‐female ratio was 1.3:1.0. The age range was from 38 to 81 years (mean age, 59.5 y). Median time to revision was 11 months following the initial surgical procedure (range, 1‐150 mo). Thirty‐three patients underwent one revision; eight patients, two revisions; and two patients, three revisions. In 40 of 43 patients (93%) revision was successful. Of the last 21 patients who underwent revision, 18 had tracheoesophageal punctures placed. Fifteen developed excellent tracheoesophageal speech. The initial rates of success for these procedures were as follows: advancement flaps, 8 of 9; Z‐plasty, 13 of 15; V‐Y inset, 8 of 8; other procedures, 2 of 4; and dilation, 2 of 7 (P < .05 for dilation vs. all others). The ultimate success rates for these procedures were as follows: advancement flaps, 8 of 11; Z‐plasty, 15 of 18; V‐Y inset, 12 of 13; other procedures, 3 of 6; and dilation, 2 of 7. Other procedures and dilation were inferior (P < .05) compared with advancement flap, Z‐plasty, and V‐Y insets.

Conclusion: Tracheostomal stenosis can be successfully managed in a multitude of ways.
Effects of Age, Body Mass Index, and Gender on Nasal Airflow Rate and Pressures
Authors: Crouse Ulla , Laine‐Alava M. T.
Published: November 2003

Objectives: The purpose of this study was to evaluate the variation of airflow rate and oral‐nasal pressure with age, body mass index (BMI), and gender (i.e., to evaluate whether the effects of age, BMI, and gender on airflow rate and pressures are convergent with their effects on nasal cross‐sectional area and resistance).

Study Design: A cross‐sectional study of 332 subjects (214 female and 118 male subjects) aged 16 to 82 years.

Methods: The aerodynamic measurements of nasal airflow rate and nasal and oral pressures were performed by posterior rhinomanometry. Age, gender, weight, and height were recorded for each subject, and the BMI was calculated. The effects of age, BMI, and gender on airflow rate and nasal and oral pressures were estimated by ANOVA.

Results: Nasal airflow rate and oral and nasal pressures increased with increasing BMI. In addition, the mean values of airflow rate and pressures were significantly higher in male than in female subjects. Increasing age was related to increased oral pressure, but was not associated with airflow rate or nasal pressure.

Conclusions: This study suggests that, on the contrary to the findings in children and adolescents, BMI and gender should be taken into consideration when measuring the patency of upper airway in adults.
Esthesioneuroblastoma: Reflections of a 21‐Year Experience
Authors: Levine Paul A. , Gallagher Richard , Cantrell Robert W.
Published: November 2003

Objectives: To evaluate the results of standardized treatment of esthesioneuroblastoma at a single institution during a 21‐year period and calculate pertinent parameters, i.e., metastatic disease (local, regional, distant), disease‐free survival, and complications of treatment.

Study Design: A retrospective review was conducted of all patients treated at a single institution from September 1976 through May 1998.

Methods: Only those patients who received their complete evaluation and treatment at our institution were included in this analysis. Thirty‐five patients met this criterion. In addition, results of epidemiological, pathological, and molecular analyses were evaluated to seek accurate indicators for clinical outcomes.

Results: Six percent of patients presented with cervical metastatic disease, but ultimately 25.7% developed at least one episode of cervical metastases; 14.3% of patients developed a local recurrence an average of 6 years after diagnosis; and 37% of the patients ultimately developed at least one episode of metastatic disease. The disease‐free survival for this cohort of 35 patients was 80.4% at 8 years. CNS complications occurred in 25.7% of the patients, 22.9% had orbital complications, 20% had systemic posttreatment problems, 18.2% had chemotoxic sequelae, 8.6% had infectious complications, and 14.3% had cosmetic sequelae. No epidemiological, pathological, or molecular factors appeared to be more accurate clinical indicators than the Kadish staging system.

Conclusions: This series of esthesioneuroblastoma patients (N=35) reflects an 8‐year disease‐free survival of 80.4%, representing a significant number of patients treated and followed at one institution for an extended period of time. No valuable pathological or molecular indicators to predict aggressive clinical behavior were found. The average time interval before recurrent disease developed was more than 6 years, far greater than that expected for other sinonasal malignancies. Therefore, extended follow‐up is necessary for this patient group.
Repair of a Rodent Nasal Critical‐Size Osseous Defect With Osteoblast Augmented Collagen Gel
Authors: Toung James S. , Ogle Roy C. , Morgan Raymond F. , Lindsey William H.
Published: November 2003

Objectives/Hypothesis: Facial skeletal defects are a common challenge for the otolaryngologist. Type I collagen gels have shown promise in the repair of nonhealing critical size defects (CSDs) of facial bone by providing scaffolding for new bone growth by osteoblasts at the defect perimeter. The objective of the present study was to evaluate the effect that suspending osteoblasts within a type I collagen gel has on the repair of a rodent facial CSD.

Study Design: Randomized controlled trial using a rodent model.

Methods: A previously described facial CSD was created by removing the nasalis bones with a cutting burr to the level of the nasal mucosal membranes on 18 Sprague‐Dawley rats. Groups of six animals were treated with an implant containing either 300 μg of type I collagen gel, 12 × 105 osteoblasts suspended within type I collagen gel, or 12 × 105 fibroblasts suspended within type I collagen gel for comparison. After 30 days the animals were examined at necropsy with planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness.

Results: All animals had complete coverage with a thin layer of bone. Histological sectioning revealed an increased thickness in the osteoblast augmented group. Radiodensitometric measurements revealed a statistically significant increase in bone repair in the osteoblast group compared with the collagen‐only group (P ≤ .0005) and the fibroblast group (P ≤ .04).

Conclusion: Type I collagen gels augmented with an osteoblastic suspension significantly enhance the repair of nasal CSDs in a rodent model. The use of cultured bone precursor cells represents a leap forward in osteoengineering.
Repair of an Osseous Facial Critical‐Size Defect Using Augmented Fibrin Sealant
Authors: Tholpady Sunil S. , Schlosser Rodney , Spotnitz William , Ogle Roy C. , Lindsey William H.
Published: November 2003

Objective: Osseous defects of the head and neck are a common challenge for the otolaryngologist. To develop improved reconstructive options, osteoconductive engineering experiments are being conducted. A nasal critical‐size defect (CSD) model has previously been described in which less than 7% bone healing is observed over 6 months. An implant containing fibrin sealant with and without osteoprogenitor cells is evaluated in this model.

Study Design: Randomized controlled trial using a rodent model.

Methods: A nasal CSD was surgically created in 18 male retired breeder Sprague‐Dawley rats. Six animals were not implanted with any material, six received fibrin sealant consisting of fibrin (25 mg/mL) and thrombin (1000 U/mL), and six were implanted with fibrin sealant and rat calvarial osteoprogenitor cells (1.8 × 106 cells/mL). Thirty days later, the animals were examined at necropsy by planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness.

Results: A thin layer of bone covered the defect in all of the treated animals. A statistically significant increase in bone density (P < .05) between fibrin sealant plus osteoprogenitor cells and each of the other groups was shown using radiodensitometric analysis. Histological analysis also confirmed this difference.

Conclusion: Osteoprogenitor cells contained within fibrin sealant result in a greater augmentation of bone regeneration than controls or fibrin sealant alone.
Endoscopic Surgical Management of Sphenoid Sinus Disease
Authors: Rosen Frederick S. , Sinha Uttam K. , Rice Dale H.
Published: November 2003

Objectives: To assess the outcome of functional endoscopic sphenoid sinus surgery, and to determine the predictors of outcome.

Study Design: Retrospective chart review of 651 consecutive endoscopic sinus procedures performed between 1992 and 1997.

Setting: USC University Hospital, University of Southern California, Los Angeles.

Materials and Methods: Seventy‐four patients (11.4% of all endoscopic procedures) with sphenoid sinus disease were selected. All 74 patients were mailed a sinusitis‐specific questionnaire, and 46 of them (62.2%) responded. Outcome measures derived from clinician ratings were applied to all 74 patients, and those derived from self‐report were applied to 46. Outcome measures were determined from patient questionnaires at a minimum of 6‐month postoperative follow‐up, operative complications, and clinician perceptual ratings. Patient questionnaires addressed general patient satisfaction, symptom score, and medication usage. A statistical analysis was performed using χ2 test, linear regression, and one‐way nonparametric ANOVA.

Results: Favorable surgical outcomes based on general patient satisfaction (84.8%, n = 39) and clinician perceptual rating (78.4%, n = 58) were noted. Minor postoperative complications were noted in 10 patients (13.5%) and 8 patients (10.8%) needed revision endoscopic procedures during follow‐up. Of the complications, eight (80%) occurred in revision endoscopic procedures. The use of an expanded, sinus‐specific symptom score revealed far fewer favorable outcomes (56.5%, n = 26). Seven outcome predictors were established, although none of the predictors held for more than one of the six outcome measures used.

Conclusion: Endoscopic sphenoid sinus surgery is safe and effective. An expanded symptom score is recommended to assess the outcome of this procedure.
Recovery of Laryngeal Sensation After Superior Laryngeal Nerve Anastomosis
Authors: Blumin Joel H. , Ye Ming , Berke Gerald S. , Blackwell Keith E.
Published: November 2003

Objectives/Hypothesis: Reliable motor reinnervation has been show in multiple laryngeal transplant studies; however, sensory reinnervation of the larynx after nerve anastomosis has yet to be demonstrated. The role of sensory nerve anastomosis in the transplanted larynx in unknown, but is thought to be necessary to provide airway protection. A canine model was developed to examine the possibility of reformation of sensory pathways in the larynx after nerve section and anastomosis.

Study Design: Randomized controlled experiment.

Methods: Ten canines were randomly assigned to two groups. Hydrochloric acid‐induced laryngospasm was demonstrated in every dog. All dogs then had their necks explored, and the internal branch of the superior laryngeal nerve was identified and transected bilaterally. Following nerve section all dogs were retested for an acid‐induced laryngospasm reflex. The control group had their wounds closed and were then awakened from anesthesia. The study group underwent microscopic anastomosis of their sensory nerves. Following a 6‐month period the two groups of dogs were compared for the presence of the laryngospasm reflex.

Results: No dog in the control group had a response to the acid. All dogs in the study group had some response to the acid, although none of them had return of true laryngospasm.

Conclusion: We concluded that sensory reinnervation does occur after nerve anastomosis, but the recovery of sensation may be incomplete or altered.
Morphological Assessment of the Soft Palate in Habitual Snoring Using Image Analysis
Authors: Reda Mohamed , Sims Andrew J. , Collins Melanie M. , McKee Gary J. , Marshall H. , Kelly Peter J. , Wilson Janet A.
Published: November 2003

Objectives: Define differences in palatal and uvular dimensions between habitual snorers and healthy nonsnoring control subjects. Document the changes in palatal configuration after different types of palatoplasty.

Study Design: A prospective controlled clinical study was performed analyzing video recordings of the soft palate and oropharynx of 251 subjects (121 habitual snorers, 79 patients after laser‐assisted uvulopalatoplasty ([LAUP], and 51 healthy volunteers).

Methods: The recordings were captured using a rigid endoscope with a reference measure applied to the soft palate and a mark at the junction of the soft and hard palate. Four parameters were studied in the captured pictures after correction for the distortion deformity in fiberoptic endoscopic images: 1) length of soft palate, 2) length of uvula, 3) width of uvula, and 4) distance between posterior pillars.

Results: Analysis showed that habitual snorers, compared with healthy volunteers have significantly increased soft palate length (P = .00001), increased uvula length (P = .0002) and width (P = .00001), and narrowed oropharyngeal isthmus (distance between the posterior pillars) (P = .04). In patients studied after LAUP, the length of the soft palate is significantly shorter (P = .00001) than in the preoperative cohort, and the oropharyngeal isthmus is significantly narrower (P = .00001). Moreover, this latter distance is significantly narrower (P = .00001) when compared with healthy volunteers.

Conclusions: Habitual snorers have a long soft palate, a long wide uvula, and a narrowed oropharyngeal isthmus. LAUP shortens and tightens the elongated palate and causes a further reduction in the space between the posterior pillars.
Ho:YAG Laser Treatment of Hyperplastic Inferior Nasal Turbinates
Authors: Leunig Andreas , Janda Philip , Sroka Ronald , Baumgartner Reinhold , Grevers Gerd
Published: November 2003

Objectives: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long‐term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates.

Methods: Eighty‐five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty‐two of these patients were included in this clinical study and were followed for 1 year.

Results: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire.

Conclusions: Ho:YAG‐laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.
Abrasive Esophageal Cytology for the Oncological Follow‐Up of Patients With Head and Neck Cancer
Authors: Pellanda Antonio , Grosjean Pierre , Leoni Sandra , Mihaescu Anca , Monnier Philippe , Pasche Philippe
Published: November 2003

Objectives: The occurrence of a second primary cancer in the esophagus in patients with head and neck squamous cell carcinoma is frequent and is associated with a poor prognosis. The aim of this study was to evaluate the yield of abrasive esophageal cytology as a means of screening for metachronous cancer of the upper aerodigestive tract.

Study Design: We retrospectively reviewed the results of abrasive esophageal cytology performed twice yearly for the screening of patients with prior head and neck cancer.

Methods: From 1987 to 1996, 320 patients treated for head and neck cancer underwent 1,673 abrasive cytology examinations of the esophagus during a mean follow‐up period of 4 years. Cytological results were classified as negative, suspect, or positive for malignancy.

Results: Twenty‐five patients without symptoms had one or more suspect or positive cytologic findings, leading to 29 endoscopic examinations. These revealed 20 premalignant or early malignant lesions of the esophagus (2 dysplasias, 18 squamous cell carcinomas), 2 glandular carcinomas, and 10 clinically unsuspected oral or pharyngeal carcinomas. In seven patients, positive cytological results were associated with clinically visible head and neck cancer. Of the 34 patients with suspect cytological results for malignancy, 10 had no evidence of tumor at endoscopy and 24 had no endoscopic examination because of refusal or because suspected cells were not found in additional examinations. Negative results on cytological examination were found for 254 patients throughout their follow‐up, and none of them developed esophageal cancer during a mean follow‐up period of 3 years.

Conclusions: For patients with head and neck cancer, abrasive sponge cytology is useful for detecting esophageal cancer at an early stage. In addition, it may reveal unsuspected second primaries or recurrences in the head and neck region.
Application of Antioxidants and Other Agents to Prevent Cisplatin Ototoxicity
Authors: Rybak Leonard P. , Whitworth Craig , Somani Satu
Published: November 2003

Objective/Hypothesis: To review the recent data from experiments performed in this laboratory to test the hypothesis that cisplatin ototoxicity is related to depletion of glutathione and antioxidant enzymes in the cochlea and that the use of antioxidants or protective agents would protect the cochlea against cisplatin damage and prevent hearing loss.

Study Design/Methods: Data were reviewed from experiments performed in this laboratory. Control rats were treated intraperitoneally with cisplatin 16 mg/kg. Experimental rats were given cisplatin in combination with one of the following protective agents: diethyldithiocarbamate, 4‐methylthiobenzoic acid, ebselen, or lipoic acid. Animals in each group underwent auditory brainstem response (ABR) threshold testing before and 3 days after treatment. Cochleae were removed after final ABR testing and analyzed for glutathione and activities of the enzymes superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and malondialdehyde.

Results: Rats in the control group receiving cisplatin were found to have significant ABR threshold shifts. This was accompanied by a reduction of glutathione and the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase, catalase, and glutathione reductase) and an elevation of malondialdehyde. Experimental animals had preservation of ABR thresholds and levels of glutathione, antioxidant enzyme activity, and malondialdehyde that were similar to untreated animals.

Conclusion: Cisplatin ototoxicity appears to be initiated by free‐radical production, which causes depletion of glutathione and antioxidant enzymes in the cochlea, and lipid peroxidation, manifested by an increase in malondialdehyde. These effects were blocked by each of a series of antioxidant compounds given in combination with cisplatin. A mechanism for cisplatin ototoxicity is elaborated with a proposed plan of chemoprevention using agents with different mechanisms of action. These substances could be used alone or in combination to reduce the severity of cisplatin ototoxicity in patients.
Neural Response Telemetry With the Nucleus CI24M Cochlear Implant
Authors: Shallop Jon K. , Facer George W. , Peterson Ann
Published: November 2003

Objectives: To review our intraoperative and post‐operative testing protocol for cochlear implant patients. This study describes the methodologies and applications of a new technique called neural response telemetry (NRT) for the Nucleus CI24M cochlear implant system. NRT uses radiofrequency telemetry technology to measure the action potentials of the auditory nerve.

Study Design: We have developed a specific protocol for intraoperative testing of the implant device before, during, and after implantation. This includes device integrity tests, visual detection of electrical stapedius muscle reflexes (VESR), and NRT.

Methods: Our methodologies use the commercial software (Windows‐based Diagnostic and Programming System [WIN‐DPS] and NRT) for the Nucleus CI24M. We describe the details of our protocol used on all of the patients (14 adults and 14 children) who received CI24M implants at Mayo Clinic (Rochester, MN). Our protocol correlates the NRT threshold with the behavioral responses for each patient on at least four electrodes.

Results: From August 1, 1998, to December 31,1998, we completed electrode integrity tests, NRT, and VESR testing intraoperatively on 12 patients with the Nucleus CI24M. We have measured normal implant function on all 28 of our CI24M patients with one exception. One of our children had a device failure after approximately 4 months as a result of head trauma. We have also obtained NRT results from an additional 10 patients postoperatively.

Conclusions: The measurement of device and electrode array function is quite simple with the CI24M software. These measurements can be obtained intraoperatively as well as postoperatively. We conclude that VESR and NRT measurements can be very helpful in programming for patients with cochlear implants, especially children, because they provides us with target settings for the speech processor.
Outcomes of Emergency Surgical Airway Procedures in a Hospital‐Wide Setting
Authors: Gillespie M. Boyd , Eisele David W.
Published: November 2003

Objective: To review the circumstances, complications, and outcomes of emergency surgical airway procedures and to compare the relative merits of cricothyroidotomy and tracheotomy for airway control in a hospital‐wide patient population.

Study Design: Retrospective review.

Methods: Patient data were obtained from the inpatient charts and electronic patient records of 35 patients who required an emergency surgical airway over a 6‐year period at an urban medical center.

Results: Emergency cricothyroidotomy and tracheotomy were successfully performed in 34 of 35 patients (97%). Orotracheal intubation was successfully achieved in one patient with a failed cricothyroidotomy. The overall complication rates for emergency cricothyroidotomy and tracheotomy were similar (20% and 21%, respectively). Inpatients requiring an emergency surgical airway had a higher complication rate (32% vs. 0%) but better overall survival (91% vs. 46%) than patients treated in the emergency department. No long‐term complications were observed from emergency cricothyroidotomies that were not converted to tracheotomies.

Conclusion: The establishment of an emergency surgical airway by either tracheotomy or cricothyroidotomy is effective with low overall morbidity. The need to convert every emergency cricothyroidotomy to a tracheotomy should be reevaluated.
Laryngomalacia and Its Treatment
Authors: Olney Daniel R. , Greinwald John H. , Smith Richard J. H. , Bauman Nancy M.
Published: November 2003

Objective: To determine 1) airway outcome of infants with laryngomalacia who do not undergo routine direct laryngoscopy (DL) and bronchoscopy (B), 2) the age at resolution of laryngomalacia, and, 3) outcome of supraglottoplasty as a function of the type of laryngomalacia and the presence of concomitant disease.

Study Design: Retrospective chart review.

Methods: The records of all infants diagnosed with laryngomalacia by flexible fiberoptic laryngoscopy (FFL) between 1990 and 1998 in the Department of Otolaryngology‐Head and Neck Surgery, University of Iowa (Iowa City, IA) were reviewed. The type of laryngomalacia was designated by a new classification scheme (types 1‐3) based on the site of supraglottic obstruction and the type of supraglottoplasty indicated, should the patient later require surgical intervention. The log rank test was used to compare age at resolution and outcome between types of laryngomalacia and between infants with isolated laryngomalacia versus those with additional congenital abnormalities and/or severe neurological compromise.

Results: The type of laryngomalacia was evident in 48 of the 58 charts reviewed and included type 1 (57%), type 2 (15%), type 3 (13%), or combined types (15%). Twenty percent had severe neurological compromise and/or multiple congenital anomalies. The median time to resolution of stridor in these patients was not significantly delayed when compared with infants who had isolated airway anomalies (36 and 72 wk, respectively, vs. 36 wk for isolated laryngomalacia; P < .4). Time to resolution did not correlate with the type of laryngomalacia. In 22 infants, clinical symptoms or findings suggested a synchronous airway lesion, and direct laryngoscopy and bronchoscopy were performed. In 11 infants, a second airway lesion was diagnosed (in four cases by FFL and in 7 cases by direct laryngoscopy and bronchoscopy). Complications did not arise in infants who did not undergo direct laryngoscopy and bronchoscopy. Eleven infants with severe laryngomalacia required surgical intervention. The success of supraglottoplasty did not correlate with the type of laryngomalacia or the presence of other congenital anomalies.

Conclusions: Routine direct laryngoscopy and bronchoscopy as part of the evaluation of laryngomalacia are not warranted. Performing these procedures should be based on clinical and physical evidence of a concomitant airway lesion. In general, laryngomalacia will resolve within the first year of life, even in children with multiple congenital anomalies and/or severe neurological compromise. The proposed classification scheme is advantagous in that it is simple and correlates the site of obstruction with the surgical procedure most likely to effect a cure, should the patient require a supraglottoplasty. Surgical management is necessary in approximately 15% to 20% of affected infants.
Management Implications of Evaluating the N2 and N3 Neck After Organ Preservation Therapy
Authors: Strasser Mark D. , Gleich Lyon L. , Miller Mary Ann , Saavedra Harold I. , Gluckman Jack L.
Published: November 2003

Objectives/Hypothesis: To determine if metastatic squamous cell carcinoma with proliferative potential persists in N2 and N3 necks after conventional radiation.

Study Design: Retrospective case series.

Materials and Methods: We identified 17 patients from our head and neck tumor database who underwent organ‐preserving radiotherapy for primary aerodigestive squamous cell cancer and N2‐3 regional metastasis. Archival tissue from these 17 neck specimens was evaluated for routine histopathologic evidence of tumor, as well as immunohistochemically for cytokeratin and Ki‐67 activity. An assay for apoptosis was also performed on 10 of the specimens.

Results: Routine H&E evaluation suggested metastatic cancer in 11 of 17 irradiated neck specimens. Cytokeratin immunostaining confirmed squamous cell carcinoma in these 11 necks as well as 1 additional specimen that had tested H&E negative. Ki‐67 staining demonstrated proliferating tumor in 3 of 17 necks. The apoptosis assay confirmed regions of apoptosis in all of the specimens analyzed.

Conclusions: The discovery of proliferating cancer cells in 3 of 17 irradiated specimens (18%) supports the practice of planned neck dissection after primary radiotherapy for patients with pretherapeutic N2+ metastatic disease.
Profound Hearing Loss Attributable to Cochlear Nerve Disease: Diagnosis With Combination of Otoacoustic Emission and Magnetic Resonance Imaging
Authors: Ogura Masaki , Kawase Tetsuaki , Ikeda Katsuhisa , Oshima Takeshi , Furuta Susumu , Takahashi Shoki , Takasaka Tomonori
Published: November 2003

Objective: To detect the causes of deafness based on the combined findings of auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAEs), and three‐dimensional Fourier transformation‐constructive interference in steady state (3DFT‐CISS) magnetic resonance imaging (MRI).

Study Design: Retrospective review of the medical records of 13 patients with unilateral profound hearing loss since childhood.

Methods: Subjects were tested with pure‐tone audiometry, ABR, DPOAEs, and 3DFT‐CISS imaging.

Results: No significant components of ABR were observable in any of the deaf ears. In 10 cases, the cochlear nerves of the deaf ears were found to be as normal as the healthy sides by 3DFT‐CISS imaging, and no significant levels of DPOAEs were recorded. In the other three cases, no apparent cochlear nerves were identified by 3DFT‐CISS imaging. Although no significant levels of DPOAEs were observable in two cases with cochlear nerves invisible by the MRI study, almost the same level of DPOAEs as that in the healthy side was recorded in the last case.

Conclusions: In the last particular case, the cochlear nerve seemed to be mainly responsible for the profound deafness. 3DFT‐CISS imaging in combination with preexisting audiological measures may provide direct evidence for the cochlear nerve disease.
Fish Bones at the Cricopharyngeus: A Comparison of Plain‐Film Radiology and Computed Tomography
Authors: Palme Carsten E. , Lowinger David , Petersen Alexander J.
Published: November 2003

Objectives: To compare and contrast the use of plain film radiology and computed tomography (CT) scanning in the detection of fish bones at the level of the cricopharyngeus.

Study Design: Prospective study of 30 different fish bones placed at the level of the cricopharyngeus in a fresh human cadaver head and neck specimen and imaged using both plain films and CT scans.

Methods: Thirty different bones from 10 different local species of fish were selected and grouped as small, medium, or large in size. Both plainfilm and CT images of the bones were reported by a radiologist as A, easily seen; B, seen on close inspection; or C, not seen. Results were analyzed using McNemar's test.

Results: CT scanning was superior to plain‐film radiology in demonstrating the presence of fish bones at the level of the cricopharyngeus (P < .0001, McNemar's test, df = 1 when comparing report type A with B and C).

Conclusion: The superior usefulness of CT scans in demonstrating the presence of fish bones lodged at the cricopharyngeus has been clearly shown in this study; therefore we advocated its use in selected cases.
Prevention of Nausea and Vomiting After Middle Ear Surgery: Granisetron Versus Ramosetron
Authors: Fujii Yoshitaka , Tanaka Hiroyoshi , Kobayashi Noriaki
Published: November 2003

Objective/Hypothesis: Middle ear surgery is associated with a relatively high incidence of postoperative nausea and vomiting. This study was undertaken to compare the efficacy of ramosetron with granisetron for preventing nausea and vomiting after middle ear surgery.

Study Design: Prospective, randomized, double‐blind study.

Methods: In a randomized, double‐blind manner, 100 ASA I patients (69 women), aged 23 to 65 years, received either ramosetron 0.3 mg or granisetron 3 mg intravenously (n = 50 of each) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used. Postoperative nausea and vomiting and safety assessments were performed continuously during the first 24 hours (0‐24 h) and the next 24 hours (24‐48 h) after anesthesia.

Results: A complete response, defined as no nausea and vomiting and no need for another rescue medication, during the first 24 hours after anesthesia (0‐24 h) occurred in 90% of patients receiving ramosetron and in 86% of patients receiving granisetron, respectively (P = .379); the corresponding incidence rates in the second 24 hours after anesthesia (24‐48 h) were 90% and 66% (P = .003). No clinically important adverse events were observed in either group.

Conclusion: Prophylactic use of ramosetron is more effective than granisetron for long‐term prevention of nausea and vomiting after middle ear surgery.