bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Acellular Dermis in the Prevention of Frey's Syndrome
Authors: Govindaraj Satish , Cohen Michael , Genden Eric M. , Costantino Peter D. , Urken Mark L.
Published: November 2003

Educational Objective At the conclusion of this presentation, the participant should be able to discuss the indications and advantages of using acellular dermis in the prevention of post‐parotidectomy gustatory sweating (Frey's Syndrome).

Introduction Gustatory sweating is a common postoperative problem and a challenge to treat. The purpose of this study was to evaluate the role of acellular dermis in preventing post‐parotidectomy gustatory sweating.

Methods Sixty‐four patients were randomly assigned to two groups. Group I consisted of 32 patients who underwent a superficial lobe parotidectomy. Group II consisted of 32 patients who underwent a superficial lobe parotidectomy and underwent intraoperative placement of acellular dermis within the parotid bed, between the skin flap and the remaining parotid tissue. The implanted volume of acellular dermis was determined by the amount required to aesthetically restore lateral facial contour. All 64 patients were evaluated for gustatory sweating by identical phone and mail questionnaires. Thirty randomly chosen patients (group I = 15, group II = 15) were evaluated using a modified Minor's Starch‐Iodine Test (MSIT). In all 30 patients, the MSIT was administered to both sides of the face.

Results The responses to questionnaires (N = 64) demonstrated the subjective presence of gustatory sweating in 3 of 32 patients (9.3%) in group I, whereas group II demonstrated a subjective incidence in 1 of 32 patients (3.1%). The objective incidence determined by those who underwent the MSIT (n = 30) revealed a 40% (6) and 0% incidence of Frey's Syndrome in groups I and II, respectively. The complication rate in group I was 9% (3 seromas) and in group II it was 25% (7 seromas and 1 wound infection).

Conclusions Acellular dermis appears to be an effective method for preventing post‐parotidectomy gustatory sweating, despite its higher complication rate.
Quantitative Analysis of Videostroboscopic Images in Presbylarynges
Authors: Bloch Isac , Behrman Alison
Published: November 2003

Objective/Hypothesis Age‐related dysphonia, or presbylarynges, is often identified as the cause of voice disorders in older individuals. It is a diagnosis of exclusion that typically includes the subjective videostroboscopic findings of vocal fold bowing or atrophy and incomplete glottal closure. We hypothesize that vocal fold bowing correlates directly with glottal gap in patients with presbylarynges and that these characteristics may be quantified objectively using measures obtained from videostroboscopic images.

Study Design Retrospective analysis of patient data and prospective analysis of control subjects.

Methods The quantitative measures of bowing index and normalized glottal gap, as well as a novel measure, normalized laryngeal outlet, were calculated from the videostroboscopic examinations of 46 patients with presbylarynges and 20 normal control subjects.

Results The mean bowing index values from the presbylarynges and control groups differed significantly, although there was overlap of individual values between groups. Bowing index values did not consistently predict normalized glottal gap values. Mean normalized laryngeal outlet values of the patients with presbylarynges were significantly smaller than those of the control group.

Conclusions Bowing does not consistently predict the extent of glottal gap. Therefore, other presbylaryngeal changes are probably contributing to incomplete glottal closure, which are not well‐visualized stroboscopically, so the finding of bowing is not sufficiently specific to identify presbylarynges. The significantly smaller normalized laryngeal outlet values suggest that this identifies a compensatory strategy for glottal gap to optimize vocal function. This is a novel finding that contrasts with medial ventricular fold squeezing, which is more routinely sought and is typically considered a maladaptive compensatory strategy. Despite the advantages of quantitative stroboscopic measures, limitations in reliability limit their clinical utility.
Use of the Round Window Microcatheter in the Treatment of Meniere's Disease
Authors: Hoffer Michael E. , Kopke Richard D. , Weisskopf Peter , Gottshall Kim , Allen Keith , Wester Derin , Balaban Carey
Published: November 2003

Objectives/Hypothesis Transtympanic gentamicin is an increasingly popular treatment for Meniere's disease. The present report examines the 2‐year follow‐up of our first 27 patients with Meniere's disease treated with the use of microdose gentamicin through the Round Window Microcatheter. We applied the 1995 American Academy of Otolaryngology—Head and Neck Surgery criteria to this patient group to analyze the results of treatment.

Study Design This study is an evaluation of consecutive patients with predetermined data collection on each patient.

Methods Patients with confirmed Meniere's disease underwent placement of the Round Window Microcatheter, which was filled with 10 mg/mL gentamicin, after placement into the round window niche was confirmed. Ten milligrams per milliliter of gentamicin was injected into the catheter by hand on two occasions after device placement in the first several patients. The remaining patients had continuous infusion of 10 mg/mL gentamicin at 1μL/h for the next 10 days. The catheter was removed 10 days after placement. All patients underwent an extensive set of hearing and vestibular tests on several occasions before, during, and after treatment.

Results In the patients in the study, vertigo was eliminated in 92.6%, with 3.7% of patients (1/27) demonstrating a mild permanent threshold shift in hearing. Tinnitus and pressure were significantly reduced in more than 65% of patients. Only one patient demonstrated a reduction of vestibular function after treatment.

Conclusions Results of this study on this group of patients indicate that vertigo can be controlled in the long term using microdose gentamicin without a significant reduction in cochlear or vestibular function in most of the patients in our series. Our results are compared with the published literature examining transtympanic injection. In addition, the underlying science supporting this type of treatment is examined.
Autoimmune Sensorineural Hearing Loss in Young Patients: An Exploratory Study
Authors: Tomasi Jean‐Paul , Lona Alain , Deggouj Naïma , Gersdorff Michel
Published: November 2003

Objectives P0 protein is expressed exclusively in myelinating Schwann cells of the peripheral nervous system. In a previous study from our laboratory, 27% of patients with sensorineural hearing loss (SNHL) had antibodies to P0 protein in their serum. The purpose of the present exploratory study was to examine the relationship between the clinical presentation of SNHL among children and young adults (age range, 5–30 y) and the presence of serum anti‐P0 antibodies.

Study Design The data were collected by retrospective questionnaires from Belgian otolaryngologists.

Methods Patients were divided for comparison into two groups according to the presence or absence of anti‐P0 antibodies.

Results Analyses of clinical data and audiometric results indicated that a progressive hearing loss was more frequently recorded in the patients in the anti‐P0 antibody–positive group (82% [14 of 17]) than in those in the anti‐P0 antibody–negative group (35% [6 of 17]) (P <.005).

Conclusions Thus, in the age group in the present study, autoimmune SNHL (as measured in the present study by the presence of anti‐P0 antibodies) is more frequently associated with progressive than with sudden hearing loss. The implications of this finding for preventive screening of hearing loss in children and young adults are discussed.
Microbiology of Normal External Auditory Canal
Authors: Stroman David W. , Roland Peter S. , Dohar Joseph , Burt Wayne
Published: November 2003

Objectives To isolate and characterize bacteria and fungi from the healthy ear and to obtain susceptibility profiles on each bacterial isolate.

Study Design Prospective.

Methods Specimens were collected from the external canals and cerumen of healthy subjects. Species‐level identification was obtained by combining phenotypic and genotypic data. End‐point minimal inhibitory concentration testing was performed using National Committee for Clinical Laboratory Standards recommended methods.

Results One hundred sixty‐four subjects were cultured. Seventeen canal and 16 cerumen specimens showed no growth. One hundred forty‐eight cerumen specimens yielded 314 organisms, including 23 fungi. One hundred forty‐seven canal specimens yielded 310 organisms, including 7 fungi. Of 291 bacteria isolated from cerumen, 99% were Gram‐positive. Of 302 bacteria isolated from the canal, 96% were Gram‐positive. Staphylococci were 63% of both the cerumen bacteria and the canal bacteria. Coryneforms represented 22% of the bacteria in cerumen and 19% in the canal. Turicella
otitidis was the primary coryneform isolated from both the canal and the cerumen. Streptococci‐like bacteria were 10% from the cerumen, 7% from the canal. In both cerumen and canal, Alloiococcus
otitis was more than 95% of the streptococci‐like bacteria. Fifteen gram‐negative organisms were isolated from the canal and cerumen, including four Pseudomonas aeruginosa strains. The percentages of Staphylococcus epidermidis isolates that had high‐level resistance (≥8 μg/mL) were as follows: to neomycin, 28% from cerumen and 11% from the canal; to oxacillin, 28% from cerumen and 25% from the canal; and to ofloxacin, 15% from cerumen and 19% from the canal.

Conclusions Turcella otitidis and A. otitidis were present with a much higher frequency than previously described, lending evidence that they be considered normal otic flora. Corynebacterium auris, previously reported only in children, was isolated from normal adults.
Long‐Term Stapedectomy Results With the McGee Stapes Prosthesis
Authors: Raske Molly , Welling John D. , Gillum Timothy , Welling D. Bradley
Published: November 2003

Objective To report long‐term follow up on patients undergoing stapedectomy with the McGee stapes prosthesis.

Study Design A retrospective case series.

Methods Charts recording 170 stapedectomies (120 primary and 50 revision stapedectomies) from 1989 to 1999 were analyzed, and audiometric data and the findings at repeat exploration reported.

Results Over a 10‐year period, 11.2% of patients had failure of their initial air‐bone gap closure with the McGee piston. Seventy‐seven percent (in 10 of 13 patients) of McGee pistons that failed were found to have the platinum ribbon displaced laterally from the incus and the piston pushed out of the stapedotomy. The failure rate was not significantly different (P = .72) from that in our patients who underwent placement of a Robinson cup prosthesis (9.5%), but the pattern of displacement was unique. Failures occurred earlier with the McGee piston (average time to failure of 2.5 y) than with the Robinson cup (average time to failure of 8.6 y).

Conclusion The McGee piston was found to have a unique pattern of dislocation that is likely related to the malleable nature of the platinum ribbon and loosening of the crimped “shepherd's crook” over time.
Use of Reconstructed Sagittal Computed Tomography Images to Plan Middle Cranial Fossa Surgery
Authors: Olson Krista L. , Manolidis Spiros , Hayman L. Anne , Chan Ling‐Ling , Taber Katherine H.
Published: November 2003

Objective To facilitate planning in temporal bone surgery for the middle cranial fossa approach by using sagittal reconstructed temporal bone computed tomography images.

Study Design Comparison of anatomic measurements on random high‐resolution, reformatted computed tomography scans of the temporal bone.

Methods High‐resolution computed tomography of 10 normal temporal bones in the axial and coronal planes was obtained, and two‐dimensional sagittal reconstructions were performed using a commercial software program. Eight anatomical relationships between neural and/or vascular structures were measured. Representative images were inverted to recreate the plane of the middle cranial fossa approach.

Results Anatomical relationships among the vestibule, superior semicircular canal, internal auditory canal, internal carotid artery, and middle cranial fossa exhibited a high SD in the 10 subjects. The sample size and the large range for the eight anatomical relationships precluded the detection of a significant difference between right and left temporal bones or sex and age of the patient.

Conclusion The present report presents a novel, practical measurement protocol for rapidly evaluating important individual anatomical differences in patients before middle cranial fossa surgery. Inverted sagittal reconstructions facilitate presurgical planning for the middle cranial fossa approach by 1) assessing critical anatomical relationships before surgery and 2) providing customized measurements between vital landmarks and the first in vivo measurements. This decreases the likelihood of surgical mishaps and improves teaching by providing the first in vivo measurements of practical anatomical relationships in the sagittal plane.
Endoscopic Neck Dissection in Human Cadavers
Authors: Dulguerov Pavel , Leuchter Igor , Szalay‐Quinodoz Ildiko , Allal Abdelkarim S. , Marchal Francis , Lehmann Willy , Fasel Jean H. D.
Published: November 2003

Objective To evaluate the feasibility and efficacy of endoscopic neck dissection (END) in human cadavers.

Study Design Experimental self‐controlled study.

Methods END on five human cadavers through three openings: one for the camera, one for the dissecting instrument, and one for a grasping one. The tissue specimens removed were divided into traditional neck groups (I to V). After the completion of END, open neck dissection was performed using standard surgical techniques and the remaining tissue within each neck group was retrieved. The important neck structures (carotid artery, internal jugular vein, cranial nerves X, XI, and XII, phrenic nerve) were evaluated for lesions. A pathologist evaluated each specimen, without knowing its exact origin in terms of neck group or side, and type of surgical technique used. For each specimen, the number of retrieved lymph nodes and their anatomic integrity was analyzed.

Results Ten neck dissections were performed on 5 cadavers, without any major difficulty. An injury of the internal jugular vein occurred twice and once the phrenic nerve was cut. Little tissue was usually left for open surgical dissection. The average number of retrieved lymph nodes by endoscopy was 4.9 ± 2.7 (mean ± standard deviation). Completion open neck dissection retrieved an additional 0.5 ± 0.5 lymph nodes. Efficacy of END was 92 ± 10%. The majority of retrieved lymph nodes were intact but exhibited important postmortem autolysis artifacts.

Conclusions Endoscopic neck dissection is possible in human cadavers and is free of lesions to major structures. The majority of neck lymph nodes can be removed endoscopically.
Thyroarytenoid Muscle Maintains Normal Contractile Force in Chronic Vocal Fold Immobility
Authors: Johns Michael M. , Urbanchek Melanie , Chepeha Douglas B. , Kuzon William M. , Hogikyan Norman D.
Published: November 2003

Background Denervation of skeletal muscle typically results in irreversible denervation atrophy over time. This finding has generated controversy as to the efficacy of reinnervation procedures for chronic vocal fold immobility related to recurrent laryngeal nerve injury.

Objective To test the hypothesis that chronic vocal fold immobility after recurrent laryngeal nerve injury does not result in diminished maximal isometric force generation in the thyroarytenoid muscle.

Study Design Adult random‐bred cats underwent either unilateral laryngeal denervation (n = 6) or sham surgery (n = 6). After 6 months, videolaryngoscopy was performed followed by in vitro measurement of maximal isometric tetanic force produced by the thyroarytenoid muscle.

Results All animals in the denervation group showed right vocal fold paralysis after the initial denervation operation; none of these animals had return of appropriately phased movement with respiration. Four had intermittent disorganized twitching movements. One had these movements plus an occasional weak adduction, and one had no movement. Normal vocal fold mobility was observed in 6 of 6 animals undergoing sham surgery. The maximal isometric tetanic force measured from the thyroarytenoid muscle in the sham group was 438 mN (±92 mN standard deviation [SD]). The maximal isometric tetanic force measured from the thyroarytenoid muscle in the chronically immobile group was 405 mN (±107 mN SD). Differences were not statistically significant.

Conclusion Maximal isometric force in the thyroarytenoid muscle is not diminished in chronic vocal fold immobility after recurrent laryngeal nerve injury. We conclude that the possibility for restoration of contractile force to the chronically immobile thyroarytenoid muscle exists. This finding supports the pursuit of reinnervation procedures in the treatment of chronic vocal fold immobility.
Real‐Time, Cine Magnetic Resonance Imaging for Evaluation of the Pediatric Airway
Authors: Faust Russell A. , Remley Kent B. , Rimell Frank L.
Published: November 2003

Background Standard magnetic resonance imaging (MRI) and computed tomographic (CT) modalities are limited in their ability to image dynamic organs. New real‐time, dynamic, cine magnetic resonance imaging (CMRI) techniques have the potential to image moving structures.

Objective We therefore investigated the feasibility of using CMRI techniques to dynamically image the human airway, to assess laryngeal and tracheal patency and function.

Methods A cohort of 10 pediatric patients, 10 adult patients, and 10 normal volunteers underwent routine static MRI, as well as CMRI using a Siemens 1.5 T Vision system (Siemens, Erlangen, Germany). Patients also underwent endoscopic evaluation. Cine axial, coronal, and sagittal sequences of the larynx and trachea were obtained during quiet respiration, as well as during a variety of provocative maneuvers.

Results CMRI readily demonstrated normal vocal cord mobility and tracheal stability in normal volunteers. Abnormal vocal mobility was easily appreciated using the CMRI imaging system. Similarly, dynamic effects of tracheomalacia were clearly demonstrated using CMRI. Dynamic extrinsic tracheal compression resulting from mass lesions or anomalous vasculature was also visualized using CMRI.

Conclusions Cine MRI of the airway has the potential to provide novel data regarding laryngeal and tracheal patency and function. This evolving modality may serve as a valuable adjunct to static MR and CT imaging, as well as endoscopy, in the assessment of the airway.
The Sternocleidomastoid Flap—Its Indications and Limitations
Authors: Kierner A. C. , Zelenka I. , Gstoettner W.
Published: November 2003

Hypothesis The sternocleidomastoid (SCM) flap seems to be a practicable but underestimated flap for reconstructive and plastic surgery of the head and neck.

Objectives To determine in which situations the SCM flap may represent a reliable alternative to other flaps used in head and neck surgery.

Study Design Meta‐analysis of the complete literature on the SCM flap.

Setting All literature found dealing with the SCM flap was reviewed, with special emphasis placed on the indications and success rates reported. The data presented are compared with our own morphologic findings and their putative clinical implications.

Results Four types of SCM flap have been described: the muscle flap, the myocutaneous flap, the myoperiosteal flap, and the myosseus or osteomuscular flap. The SCM flap was either superiorly or inferiorly based. The SCM muscle flap was used in a total of 72 patients with only 1 major complication and 7 minor complications. The complication rate, therefore, is 11%. The applications of the muscle flap involved prevention of Frey's syndrome, closure of orocutaneous fistulae and soft tissue deficiencies, closure of pharyngocutaneous and cervical esophageal fistulae, and reconstruction of the tongue. Furthermore, Conley reported on the use of the SCM muscle flap in a group of 30 patients to reanimate the face, reconstruct oral cavity defects, protect the carotid and innominate artery, and even to aid shoulder elevation after poliomyelitis. The SCM myocutaneous flap seems to be the most common application, with a total of 138 patients. All in all, a total of 29 complications (21%) was reported, with partial skin necrosis by far the most frequent. Total failure of the flap has been described in 10 patients (7%). The SCM myocutaneous flap was used for closure of defects of the mouth as well as oro‐, pharyngo‐, and tracheocutaneous fistulae, facial reconstruction, reconstruction of mastoid defects, and reconstruction of the laryngotracheal complex in children. The SCM myosseus or osteomuscular flap was reported in 23 patients. Flap necrosis is reported in 1 case (4%). The SCM osteomuscular flap was used to reconstruct defects of the lower jaw in all patients. The SCM myoperiosteal flap was used in a total of 49 patients. The complication rate reported is 6% (3 cases). The myoperiosteal flap was used for reconstruction of the laryngotracheal complex in adults and for esophagopharyngeal reconstruction and fistula repair.

Conclusions The data presented in previous literature is well correlated with our own morphologic findings. In comparison of the different techniques applied with the assumptions drawn on the basis of our own anatomic findings, it becomes evident that the SCM flap is only a useful tool in limited indications and under certain precautions.
Clinical Study of Botulinum‐A Toxin in the Treatment of Sialorrhea in Children With Cerebral Palsy
Authors: Suskind Dana L. , Tilton Ann
Published: November 2003

Objective To assess the safety and efficacy of intraglandular (parotid and submandibular) botulinum‐A toxin (BTX‐A) in the treatment of sialorrhea in children with cerebral palsy (CP).

Study Design Prospective, open‐label, dose‐escalation study.

Setting Tertiary care Children's Hospital.

Patients Twenty‐two subjects between 8 and 21 years of age with CP and significant sialorrhea.

Intervention/Technique The first 12 subjects were injected in only the submandibular gland and the second 10 in the submandibular and parotid glands. Injections were performed under ultrasound localization. The first group (divided into 3) received a total of 10, 20, or 30 units of BTX‐A. The second group (divided into 3) received a standard of 30 units in the submandibular gland and 20, 30, or 40 units in the parotid glands.

Main Outcome Measure(s) Drool quantification using a pre‐ and postinjection “drool rating scale,” dental roll weights, and “drool quotient.” Swallowing was evaluated pre‐ and postinjection with a formal speech therapy evaluation.

Results All subjects successfully underwent BTX‐A injections without local or systemic complications. There were no adverse effects on swallowing. Objective “drool quantification” with dental rolls was extremely difficult in this population. Most indicative of results was the “drool rating” questionnaire and the “drool quotient.”

Conclusions BTX‐A is a potentially safe and promising, minimally invasive treatment for sialorrhea in children with cerebral palsy.
Efficacy of Single‐Dose Dexamethasone as Adjuvant Therapy for Acute Pharyngitis
Authors: Wei Julie L. , Kasperbauer Jan L. , Weaver Amy L. , Boggust Andrew J.
Published: November 2003

Hypothesis Pharyngeal inflammatory pain is reduced by a single dose of dexamethasone.

Study Design Prospective, randomized, double‐blinded, placebo‐controlled study.

Methods From August 1998 to July 2000, a total of 118 patients were enrolled. We compared placebo (n = 37), a 10‐mg single dose of intramuscular injection of dexamethasone (n = 39), and a 10‐mg single dose of oral dexamethasone (n = 42). All patients were given oral antibiotics and had bacterial throat cultures.

Results Complete telephone follow‐up 12 hours after treatment was available in 111 patients, and 24‐hour follow‐up data were available in 116. The change in pain visual analogue scale scores (pretreatment score minus 12‐h follow‐up score) reported by patients who were given either intramuscular (median score, 4; mean score ± SD, 4.2 ± 2.3) or oral dexamethasone (median score, 3; mean score ± SD, 3.8 ± 2.3) was significantly greater than that of the patients who were given placebo (median score, 2; mean score ± SD, 2.1 ± 2.0) (P <.001 and P = .002, respectively). This difference in improvement was also evident when the percentage of change was compared in the three treatment arms at 12‐hour and 24‐hour follow‐up. Patients who were given dexamethasone had the onset of pain relief a median of 4 hours earlier than those who were given oral and intramuscular placebo (P = .029). Statistically significant differences among the three treatment arms were confirmed when a bacterial pathogen was identified (n = 47) but not in a subset that did not have a pathogen identified.

Conclusions Single‐dose dexamethasone appears to be a safe, effective, and inexpensive adjunctive treatment for acute pharyngitis in patients 15 years of age and older. Patients treated with intramuscular or oral dexamethasone had significant relief of pain (relative to baseline) compared with patients who were given placebo. Identification of a bacterial pathogen had a significant impact on the response to dexamethasone.
Recovery After Tonsillectomy in Adults: A Three‐Week Follow‐up Study
Authors: Salonen Aarre , Kokki Hannu , Nuutinen Juhani
Published: November 2003

Objective To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge.

Study Design A prospective, longitudinal study of 102 patients undergoing tonsillectomy.

Methods All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3‐mg/kg continuous infusion over 24 hours, and oxy‐codone for rescue analgesia. Twenty‐five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol–codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities.

Results No pre‐emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3–24 days) and the median of analgesic treatment was 12 days (range, 5–25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2–24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred.

Conclusions The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol–codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.
Advantages of Recurrent Laryngeal Nerve Identification in Thyroidectomy and Parathyroidectomy and the Importance of Preoperative and Postoperative Laryngoscopic Examination in More Than 1000 Nerves at Risk
Authors: Steurer Martin , Passler Christian , Denk Doris M. , Schneider Berit , Niederle Bruno , Bigenzahn Wolfgang
Published: November 2003

Objectives/Hypothesis Recurrent laryngeal nerve palsy (RLNP) is a major obstacle in thyroid and parathyroid surgery. Therefore, methods that reduce the number of temporary and, especially, permanent recurrent laryngeal nerve palsies are of great interest. One promising way to ensure the integrity of the recurrent laryngeal nerve (RLN) is to identify the nerve always. The first question raised in the present study was whether RLN preparation reduces the number of recurrent laryngeal nerve palsies or whether it introduces additional risks. Second, from former cases we know that the absence of postoperative hoarseness does not exclude RLNP, nor does postoperative hoarseness exclusively imply RLNP. Besides, misdiagnosis is not uncommon. Therefore, preoperative and postoperative laryngoscopic examination was given attention.

Study Design Patients were investigated 1 to 7 days before and 3 to 7 days after surgery. When an RLNP was identified, patients were followed up in a 2‐week rhythm the first few times and every 6 to 8 weeks thereafter until RLNP resolved or it was considered premanent after 2 years.

Methods We prospectively investigated 608 surgical patients with 1080 nerves at risk. Because different diseases might have different rates of postoperative RLNP, we analyzed benign thyroid disease (680 nerves at risk), thyroid malignoma (321 nerves at risk), and hyperparathyroidism (79 nerves at risk) separately. Patients undergoing primary surgery (no prior thyroid surgery) and secondary interventions (there were one or more thyroid operations before this intervention) were evaluated separately.

Results We found 3.4%, 7.2%, and 2.5% of temporary recurrent laryngeal nerve palsies per nerve in the benign thyroid disease, thyroid malignoma, and hyperparathyroidism groups, respectively. The prevalence of recurrent laryngeal nerve palsies in these groups was 0.3%, 1.2%, and 0%, respectively. Conforming with other studies, the total number of recurrent laryngeal nerve palsies (temporary and permanent) was not increased compared with cases with no RLN preparation, whereas the number of permanent recurrent laryngeal nerve palsies was markedly reduced. An RLN was always identifiable. Astonishingly, the restitution of an RLNP was up to 2 years in duration; however, most restitutions occurred within the first 6 months. Thirty cases of hoarseness appeared or were intensified after surgery and were not caused by RLNP. Eleven cases of postoperative RLNP had no detectable hoarseness.

Conclusions Besides indirect laryngoscopy, videostroboscopy should be performed in all cases with no evident bilateral normal laryngeal function or normal voice. Otherwise, the incidence of false‐positive or false‐negative diagnosis of RLNP is likely to be increased.
Inverting Papilloma of the Temporal Bone
Authors: Pou Anna M. , Vrabec Jeffrey T.
Published: November 2003

Objectives Inverting papilloma of the temporal bone is exceedingly rare. The objective is to familiarize the clinician with the clinical presentation and prognosis of this entity.

Study Design Retrospective case study and literature review.

Methods Published reports of inverting papillomas originating in the temporal bone were reviewed in conjunction with two cases presenting at the University of Texas Medical Branch (Galveston, TX).

Results Inverting papillomas of the temporal bone are frequently associated with persistent middle ear effusion and ipsilateral sinonasal tumors and display a higher incidence of malignancy.

Conclusions Successful management of these tumors requires an aggressive surgical resection. Adjuvant radiation therapy is recommended in patients with malignant changes.
Risk Factors and Demographics in Patients With Spasmodic Dysphonia
Authors: Schweinfurth John M. , Billante Mark , Courey Mark S.
Published: November 2003

Objectives Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia.

Study Design Retrospective patient survey of 168 patients with a known diagnosis of spasmodic dysphonia who completed questionnaires at the time of interval botulinum toxin injection.

Methods Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first‐degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of χ2 values.

Results In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty‐five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P = .0001). Thirty percent of patients directly associated onset of spasmodic dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic dysphonia. Twenty‐six percent of patients had an essential tremor compared with 4% of first‐degree relatives (P = .0001), and 11% had associated writer's cramp compared with 2% of relatives (P = .02). Less than 1% of patients described a history of toxic exposure or electrical injury.

Conclusions The majority of patients with spasmodic dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic dysphonia. Patients with spasmodic dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.
Successful Cochlear Implantation in Prelingual Profound Deafness Resulting From the Common 233delC Mutation of the GJB2 Gene in the Japanese
Authors: Matsushiro Naoki , Doi Katsumi , Fuse Yuka , Nagai Kenichi , Yamamoto Koichi , Iwaki Takako , Kawashima Takayuki , Sawada Ayako , Hibino Hiroshi , Kubo Takeshi
Published: November 2003

Objectives Recently, we identified three novel mutations of the GJB2 gene in Japanese families with autosomal‐recessive non‐syndromic deafness. 1 Seven of 11 mutated chromosomes (63.6%) contained a 233delC allele, suggesting that the 233delC mutation is the most common mutation of the GJB2 gene in the Japanese population. After it was recognized that cochlear implantation (CI) is of benefit to children with prelingual deafness, we have had a number of prelingual pediatric CI patients. Because children carrying the homozygous 233delC mutation show bilateral prelingual profound deafness, they could be enrolled in the CI program at Osaka University Graduate School of Medicine. The purposes of this study were 1) to analyze the occurrence of the GJB2 mutations in our 15 prelingual pediatric CI patients in whom the cause of non‐syndromic deafness was unknown, and 2) to evaluate the auditory function and postoperative speech perception with CI of those GJB2‐related deaf subjects.

Study Design Retrospective analysis.

Methods Mutation analysis of the GJB2 gene by direct sequencing was performed with genomic DNA from 15 children born profoundly deaf as a result of unknown causes and implanted with CI. Intraoperative electrically evoked auditory brainstem response (EABR) and intra‐/postoperative EAP were measured. The speech perception was evaluated with Infants and Toddlers Meaningful Auditory Integration Scale (IT‐MAIS).

Results and Conclusions We identified 4 CI patients (26.7%) out of 15 children carrying the homozygous 233delC mutation. Intra‐ and postoperative evaluation of the auditory system revealed almost intact cochlear and retrocochlear auditory function in these 4 patients. Postoperative auditory testing indicates that their speech perception had become significantly higher in comparison with that of other prelingual CI patients. These results suggest that prelingual deaf children carrying the homozygous 233delC mutation of the GJB2 gene can benefit from CI.
Relationship Between Mastoid Pneumatization and Middle Ear Barotrauma in Divers
Authors: Uzun Cem , Adali Mustafa K. , Koten Muhsin , Yagiz Recep , Aydin Salih , Cakir Bilge , Karasalihoglu Ahmet R.
Published: November 2003

Objectives/Hypothesis Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (s elf‐c ontained u nderwater b reathing a pparatus) divers.

Study Design Prospective, blinded.

Material and Methods Twenty‐four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x‐ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization.

Results ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2.

Conclusion Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.
Impact of Functional Endoscopic Sinus Surgery on Symptoms and Quality of Life in Chronic Rhinosinusitis
Authors: Damm Michael , Quante Gero , Jungehuelsing Markus , Stennert Eberhard
Published: November 2003

Objectives Chronic rhinosinusitis restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery modifies patients symptom profiles and quality of life.

Study Design Open prospective clinical trial.

Methods Questionnaires were given to 279 patients included in the series, who underwent sinus surgery at the Department of Otorhinolaryngology—Head and Neck Surgery, University of Cologne (Cologne, Germany) from 1995 to 1999. Patients assessed typical chronic rhinosinusitis–associated symptoms and restricted quality of life preoperatively and postoperatively using ranking scales (scales ranging from no to intolerable complaints). Statistical analyses were performed with the Wilcoxon test and Spearman rank correlation coefficient.

Results Quality of life was restricted by chronic rhinosinusitis in 94% of all patients preoperatively and ranked as severe or intolerable in 74%. Leading symptoms of chronic rhinosinusitis were nasal obstruction in 92% and postnasal drip in 87%. Furthermore, patients reported dry upper respiratory tract syndrome in 68%, hyposmia in 66%, headache in 64%, and asthmatic complaints in 34%. After a mean postoperative follow‐up of 31.7 months, an amelioration of quality of life was achieved in 85%, no change in 12%, and a deterioration in 3%. The ranking of restricted quality of life improved from “severe” to “mild” (P <.01) in the mean. Mainly responsible for this improvement was the postoperative decrease of nasal obstruction (84%), headache (82%), and postnasal drip (78%) (all P <.01), which correlated significantly with nasal obstruction (r = 0.59), headache (r = 0.39), and postnasal drip (r = 0.55), respectively (all P <.01) with better quality of life.

Conclusions The leading complaints within the symptom profile of patients with chronic rhinosinusitis are airway obstruction and postnasal drip. The restriction of quality of life in patients with chronic rhinosinusitis is mainly caused by these symptoms, which can be improved in excellent fashion by functional endoscopic sinus surgery in the majority of patients, achieving better quality of life in the long term.
Mixed Nasal Mucus as a Model for Sinus Mucin Gene Expression Studies
Authors: Ali Mahmoud S. , Wilson J. A. , Pearson Jeffrey P.
Published: November 2003

Objective/Hypothesis It is necessary to obtain sinus mucus from the paranasal sinus cavities to study mucin gene expression occurring in the sinuses during chronic sinusitis. This requires an invasive procedure to access the sinus cavity. There are embryological as well as histological similarities between nasal and sinus epithelia; therefore, we postulated that the mucin expression in the secreted nasal and sinus mucins might be similar. Nasal mucus, which can be obtained easily, could then replace sinus mucus in these studies.

Study Design Sinus and nasal mucus from six patients with chronic sinusitis were analyzed in this study.

Methods High‐molecular‐weight glycoproteins (mucins) were isolated and purified by sequential density gradient centrifugation in caesium chloride (CsCl). Enzyme‐linked immunosorbent assay was performed to identify the antigenic identity of these mucins.

Results The MUC2, MUC5AC, and MUC5B mucin genes were all expressed in the nasal and sinus mucus secretions. Antigenic studies showed an inverse relationship between MUC2 and MUC5AC expression in nasal and sinus mucus secretions. The MUC5B gene was the major mucin gene expressed in sinus mucus but not in nasal mucus. Expression of MUC2 was significantly higher in sinus mucus. Expression of MUC5AC was different between nasal and sinus mucus.

Conclusions Individual mucin expression in sinus and nasal mucus was markedly different. From this preliminary study, we conclude that nasal mucus is not a suitable substitute for sinus mucus in sinus mucin gene studies and that different pathological processes are taking place in nasal and sinus tissue in chronic sinusitis.
Laryngeal Adductor Reflex and Pharyngeal Squeeze as Predictors of Laryngeal Penetration and Aspiration
Authors: Aviv Jonathan E. , Spitzer Jaclyn , Cohen Manderly , Ma Guoguang , Belafsky Peter , Close Lanny G.
Published: November 2003

Objectives The contribution of laryngopharyngeal (LP) sensory deficits to the outcome of swallowing and the relationship between sensory and motor deficits in the laryngopharynx is unclear. The study purpose is to determine if patients with LP sensory and motor deficits are at increased risk for laryngeal penetration and aspiration during swallowing, and to determine the relationship between pharyngeal motor weakness and LP sensory deficits.

Materials and Methods Endoscopic evaluation of swallowing with sensory testing was performed on 122 dysphagic patients who were prospectively divided into two groups. The control group was 76 patients with normal sensitivity, determined by an intact laryngeal adductor reflex (LAR) on air pulse stimulation of the mucosa innervated by the superior laryngeal nerve. The study group was 46 patients with severe sensory deficits, determined by an absent LAR. Each group was given puree followed by thin liquid, noting presence or absence of laryngeal penetration and aspiration. Pharyngeal muscle strength was assessed by noting presence or absence of pharyngeal contraction during voluntary adduction of the vocal folds (pharyngeal squeeze).

Results In control subjects, with purees, 6 of 76 (7.90%) penetrated and 3 of 76 (3.94%) aspirated; with thins, 26 of 76 (34.2%) penetrated and 13 of 76 (17.1%) aspirated. In the absent LAR group, with purees, 39 of 46 (84.8%) penetrated and 32 and 46 (69.6%) aspirated; with thins, 46 of 46 (100%) penetrated and 43 of 46 (93.5%) aspirated. For both consistencies, the differences in prevalence of penetration and aspiration between groups was significant (P <.0001, χ2). In control subjects, pharyngeal squeeze was impaired in 17 of 76 (22.4%), with penetration of puree in 6 of 17 (35.3%) and aspiration in 3 of 17 (17.6%). In the absent LAR group, squeeze was impaired in 41 of 46 (89.1%), with penetration of puree in 39 of 41 (95.1%) and aspiration in 32 of 41 (78.0%). The difference in the prevalence of pharyngeal weakness between groups was significant (P <.0001). The difference in the prevalence of penetration and aspiration was higher in the absent LAR/impaired contraction cohort than in the normal sensation/impaired contraction cohort (P <.0001).

Conclusion Absence of the LAR and impaired pharyngeal squeeze puts patients with dysphagia at high risk for laryngeal penetration and aspiration compared with patients with an intact LAR and intact pharyngeal squeeze. There is a strong association between motor and sensory deficits in the laryngopharynx.
Near‐Total Laryngectomy in Advanced Laryngeal and Pyriform Cancers
Authors: Pradhan Sultan A. , D'Cruz Anil K. , Pai Prathamesh S. , Mohiyuddin Azeem
Published: November 2003

Objective To demonstrate the oncologic and physiological safety of near‐total laryngectomy (NTL), its success in voice conservation, and its versatility for use in extensive resections that necessitate pharyngoplasty, and even in post‐radiation recurrences.

Study In this study of 137 cases of NTL for cancer of the larynx (45 cases) and pyriform (92 cases), 86.9% were stage T3/T4 and 60.6% were N+. A total of 8.8% had extended pharyngeal resections necessitating patch pharyngoplasty (ENTLP). In 10.9% cases, NTL was used as salvage of post‐radiation failures. Concurrent neck dissection was performed in 99 cases.

Results A total of 70.1% was alive and disease‐free at the last follow‐up ranging from 12 months to 104 months (median, 35 mo). A total of 7.3% had local/locoregional recurrences and 11.7% had purely regional recurrences. The local control rate for post‐radiation salvage with NTL was 93.3%. A total of 88.6% developed communicable speech, and the speech success rate was 100% in 12 cases of ENTLP. Complications included major wound dehiscence with total shunt breakdown in 2 cases (1.5%), pharyngeal leak requiring surgical intervention in 7 cases (3.6%), significant aspiration through the shunt necessitating completion laryngectomy in 1 case (0.7%), and complete shunt stenosis in 9 cases (6.6%).

Conclusion The study shows that NTL is an oncologically safe voice conservation procedure in advanced, lateralized laryngeal and pyriform cancers treated not only per primum, but also in carefully selected post‐radiation failures. It has a high success rate of speech development even in those cases requiring extensive pharyngeal resections. Major complications were acceptably low.