bluuebunny/crossref_metadata_2025 huggingface dataset:
CO2Laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold
Authors: Laccourreye Ollivier , Escovar Maria‐Isabel Paz , Gerhardt Jean , Hans Stéphane , Biacabe Bernard , Brasnu Daniel
Published: November 2003

Objective/Hypothesis: A clinical evaluation of CO2laser endoscopic posterior partial transverse cordotomy (EPPTC) in patients with severely compromised airway due to bilateral paralysis of the vocal fold.Study Design: An inception cohort of 25 patients over a 10‐year period.Methods: The CO2laser EPPTC was unilateral in 15 patients and bilateral in 10. Variables were tested for potential statistical relation to successful rehabilitation of the airway.Results: The use of the CO2laser never resulted in adverse side effects. Complications were not encountered. A one‐step, successful restoration of the airway was achieved in 68% (17/25) of patients. In univariate analysis, the CO2laser EPPTC was statistically more likely to be successful if bilateral EPPTC was performed (P= .018). None of the following variables—age, sex, cause of bilateral paralysis, prior treatment, laser parameters, and duration of postoperative antibiotherapy and oral steroids—was statistically related to a successful restoration of the airway. Revision CO2laser EPPTC, performed in six patients, resulted in an overall 92% (23/25) rate for a successful restoration of the airway. The overall tracheotomy rate was 8% (2/25).Conclusion: The authors' data confirm the safety, ease of performance, and efficiency of the CO2laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bilateral CO2laser EPPTC statistically increases the likelihood of restoring the airway in a one‐step surgical procedure.
Fibro‐osseous lesions of the external auditory canal
Authors: Ramírez‐Camacho Rafael , Vicente Javier , Berrocal José Ramón García , Cajal Santiago Ramón Y
Published: November 2003

Objectives: To differentiate a novel type of benign circumscribed bone lesion of the external auditory canal from those described previously, such as exostoses and osteomas. Study Design: Information was obtained from computed tomography (CT) images, surgical findings, and pathologic study. Methods: Five patients (26 to 82 years old) who presented a hard, round, unilateral, skin‐covered mass occluding the external auditory canal to varying degrees were studied. A CT study carried out before resection of the lesions by curettage disclosed the absence of a bony connection to the underlying structures. All the tissue specimens underwent pathologic study. Results: CT and surgical findings demonstrated the absence of a connective pedicle. The pathologic findings showed lesions consisting of an osteoma‐like bone formation with sparse osteoblastic areas; mature lamellar bone was observed in three cases, bone marrow containing adipose tissue and hematopoietic remnants in two, and a dense, collagenous stroma in another. They all showed irregular trabeculae, bordered by osteoid osteoblasts. In no case was there evidence of a relationship to the cartilaginous tissue or to the bony structures of the external auditory canal. Conclusions: The data obtained from the clinical, CT, surgical, and pathologic findings suggest the existence of a lesion unlike those previously known, possibly related to ossifying reactions in other parts of the organism.
Efficacy of Treatments for Posterior Canal Benign Paroxysmal Positional Vertigo
Authors: Cohen Helen S. , Jerabek Jaroslav
Published: November 2003

Objective: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo.

Study Design: This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal.

Methods: Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment.

Results: The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma.

Conclusions: These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.
Objective Aerodynamic and Acoustic Measurement of Voice Improvement After Phonosurgery
Authors: Giovanni Antoine , Revis Joana , Triglia Jean‐Michel
Published: November 2003

Hypothesis: Objective analysis of the outcome of phonosurgery is needed to allow comparison of different surgical techniques or indications, or both. We tried to demonstrate that measurement of mean oral airflow during the production of a sustained vowel could be used in combination with acoustic measurements such as jitter or shimmer for assessment of voice improvement after phonosurgery.

Study Design: This prospective study included 27 consecutive patients who underwent phonosurgery during a 3‐month period.

Method: Perceptual analysis served as the “gold standard.” Objective measurements (oral airflow, jitter, shimmer) on the most stable portion of a sustained vowel /a/ were made using the EVA system (SQ‐Lab, Aix‐en‐Provence, France).

Results: Oral airflow was significantly greater in patients with poor perceptual results than in patients with good perceptual results. Jitter and shimmer were not significantly different because of the dispersion of the values. Discriminant factorial analysis showed that a combination of jitter, shimmer, and oral airflow was able to identify patients with good or poor perceptual results in 77% of cases.

Conclusions: Oral airflow allows simple, quick, and reliable assessment of the outcome of phonosurgery and can be used in everyday clinical practice.
Postparotidectomy facial nerve paralysis: Possible etiologic factors and results with routine facial nerve monitoring
Authors: Dulguerov Pavel , Marchal Francis , Lehmann Willy
Published: November 2003

Objective: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. Study Design: A prospective, nonrandomized study. Methods: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph‐based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House‐Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. Results: The overall incidence of facial paralysis (HB > 1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. Conclusions: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph‐based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.
Age‐related changes in orofacial force generation in women
Authors: Mchenry Monica A. , Minton John T. , Hartley Leila L. , Calhoun Karen , Barlow Steven S.
Published: November 2003

Objectives: This study was designed to assess the effect of age on orofacial force generation. Study Design: Forty women participated in a cross‐sectional design, with 10 in each age group from 20 to 39, 40 to 59, 60 to 79, and 80 to 100 years of age. Methods: Measures of force generation were obtained for the upper lip, lower lip, tongue, and jaw. Results: There were no statistical differences among age groups, probably because of large individual variability within groups. Trends indicated a decline, particularly after age 80 years. Conclusion: Although trends in the data suggest some decline in the function of orofacial structures with age, it is unlikely that these changes would noticeably affect functional communication.
Clinical application of fluorescence in situ hybridization for chromosome 11q13 analysis in head and neck cancer
Authors: Alavi Sassan , Namazie Ali , Calcaterra Thomas C. , Wang Marilene B. , Srivatsan Eri S.
Published: November 2003

Objective: Squamous cell carcinoma of the head and neck (HNSCC) still has one of the lowest 5‐year survival rates. Despite advances in diagnosis, treatment, and research, survival rates have not improved in recent years. This report examines the utility of fluorescence in situ hybridization (FISH) in detecting chromosome 11q13 amplification in HNSCC and in evaluating the correlation between 11q13 amplification and tumor behavior. Study Design: This study used FISH to determine the incidence of 11q13 amplification in 20 HNSCCs and 10 normal controls from the same patients. Tumor touch preparations and paraffin‐embedded tissues from the same patient samples were used for comparative analysis. Both single and dual color FISH was performed. Methods: Repetitive chromosome 11 specific alpha satellite DNA probe and chromosome 11q13 specific probe cyclin D1 were used for the FISH analysis. Results: Experiments revealed amplification of chromosome 11q13 in three fresh touch preparations. FISH on paraffin tissues showed amplification in two additional samples. Intensity of amplification, as high as 20 copies per nucleus, was observed in paraffin preparations, whereas a maximum of only six copies was seen in fresh preparations. Amplification was not detected in any of the normal samples. All five cases with 11q13 amplification had metastases and four of these were from poorly differentiated tumors. In the nonamplified cases, 5 of 15 had metastases and 2 of 15 was poorly differentiated. Conclusions: The present study indicates that FISH is a useful technique for detecting molecular changes such as amplification of chromosome 11q13 in HNSCC. FISH in paraffin preparations allows for accurate measurement of intensity of amplification and makes it possible for the evaluation of a large collection of archival material. The data also suggest that 11q13 amplification is correlated with poorly differentiated tumors and metastasis. Thus FISH has the potential to be a valuable diagnostic/prognostic tool in head and neck cancers. Key Words: Head and neck tumors, FISH, chromosome 11q13.
Rhinosinusitis and atopy in patients infected with HIV
Authors: García‐Rodríguez Javier F. , Corominas Mercè , Fernández‐Viladrich Pedro , Monfort José L. , Dicenta Manuel
Published: November 2003

Hypothesis: Rhinosinusitis is common during HIV infection; its prevalence is uncertain and could probably be related to clinical features, immunoallergological status, and diagnostic criteria. Methods: Seventy‐four patients hospitalized with HIV infection were prospectively evaluated for the presence of rhinosinusitis based on clinical findings, nasal endoscopy, or paranasal sinus computed tomography (CT). Immune status, nasal smear, features of atopy (based on the prick test), and its contribution to sinusal inflammatory pathology were also evaluated. Results: Most patients were severely immunosuppressed: CD4+ 155 ± 201 cells/mL and 12 ± 11% (mean ± SD). Thirty‐five percent of the patients presented at least two criteria of rhinosinusitis (clinical findings, nasal endoscopy, and CT: 35%; clinical findings and CT: 50%; nasal endoscopy and CT: 15%). CT scan showed multiple sinus involvement, opacification over 25% of the total volume of the maxillary sinus in 50% of patients, and opacification of the sphenoidal sinus in 40% of cases. Atopy was present in 18% of patients, a figure which reflects the expected prevalence in our geographic area. Two independent predictors were associated with a higher probability of rhinosinusitis: bilateral absence of maxillary infundibular patency (odds ratio, 7.5; 95% CI = 2.03–27.9) and low total count (odds ratio, 0.99; 95% CI = 0.99–1.00) or percentage of CD4+ (odds ratio, 0.93; 95% CI = 0.88–1.00). Conclusions: There is a high prevalence of rhinosinusitis in HIV‐infected individuals. This finding is related to a decreased cellular immunity, but it does not appear to be related to IgE‐related immediate hypersensitivity. Nasal endoscopy should be the first‐step diagnostic test. However, when clinical suspicion exists and endoscopy fails to explain symptoms, CT scan is a valuable adjunct to establish this diagnosis. Key Words: rhinosinusitis, HIV, atopy, endoscopy, computed tomography.
Laser management of oral leukoplakias: A follow‐up study of 70 patients
Authors: Schoelch Michael L. , Sekandari Nahid , Regezi Joseph A. , Silverman Sol
Published: November 2003

University of California, Department of Stomatology, School of Dentistry, San Francisco, California.

Objectives/Hypothesis: To assess the efficacy of laser therapy for the management of premalignant oral lesions. Study Design: The study group consisted of seventy consecutive laser‐treated patients with oral leukoplakia. The microscopic diagnosis included idiopathic focal keratosis, dysplasias of all grades, and verrucous hyperplasia (proliferative verrucous leukoplakia). Thirty‐nine patients had some degree of microscopic dysplasia and six demonstrated high‐risk proliferative verrucous leukoplakia. The clinical appearances of the lesions were white (homogeneous leukoplakia) in 48, red and white (erythroleukoplakia) in 8, and verrucous in 14. There were 38 men and 32 women in this group. The average age was 63 years (range, 31–90 y). Methods: Lasers employed were the CO2 and Nd:YAG lasers, and standard laser safety protocols were used. Results: There was no postoperative infection, hemorrhage, or paresthesia. Two patients developed pyogenic granulomas in their surgical sites. Fifty‐five of 70 patients were followed for more than 6 months; follow‐up averaged 32 months (range 6–178 mo). Twenty‐nine patients had complete control of their lesions; 19 patients had small recurrences removed with subsequent laser surgeries, leading to control; 2 patients had complete recurrences; and 5 patients developed squamous cell carcinoma at the lesion site. Verrucous lesions had an especially high rate of recurrence (83%), with 9 of 12 ultimately controlled with subsequent surgeries. Conclusions: Laser surgery of oral leukoplakia is an effective tool in a complete management strategy that includes careful clinical follow‐up, patient education to eliminate risk factors and report suspicious lesions, and biopsy of suspicious lesions when appropriate. However, recurrence and progression to cancer remain a risk. Key Words: oral cancer, laser, CO2, Nd:YAG, leukoplakia.
Osteosarcoma of the head and neck: A review of the johns hopkins experience
Authors: Ha Patrick K. , Eisele David W. , Frassica Frank J. , Zahurak Marianna L. , McCarthy Edward F.
Published: November 2003

Objective: To determine factors including treatment modalities which influence survival in patients with osteosarcoma of the head and neck.Study Design: Retrospective clinicopathologic study of 27 patients with osteosarcoma of the head and neck.Methods: The clinical charts and pathology slides were reviewed on 27 patients who had osteosarcoma of the head and neck between 1946 and 1998. The following variables were examined for their effect on survival: age of diagnosis, site of tumor, presentation, race, sex, prior radiation exposure, retinoblastoma history, margin status, and method of treatment.Results: The average age at the time of diagnosis of the patients was 37.6 years (range, 7–82 y). The sex distribution was similar with 14 male and 13 female patients. Eight of 27 patients had osteosarcoma of the mandible, 9 of 27 had osteosarcoma of the maxilla and paranasal sinuses, and in 10 of 27 patients osteosarcoma occurred elsewhere, including the temporal bones, occipital bones, and orbit. The overall 2‐year survival was 66% with a 5‐year survival rate of 55%.Conclusions: Positive surgical margins and a high tumor grade were found to have a statistically deleterious effect on overall survival. There was no detectable effect on survival of age, race, sex, prior radiation exposure, tumor site, and tumor cell type. It was not possible to differentiate between the different adjuvant treatment modalities because of the small numbers in the study.Key Words: Bone, malignancy, osteogenic sarcoma, radiation therapy, surgery.
Anti‐Endothelial Autoantibodies in Patients With Sudden Hearing Loss
Authors: Ottaviani Fabrizio , Cadoni Gabriella , Marinelli Luca , Fetoni Anna Rita , De Santis Antonella , Romito Anna , Vulpiani Paola , Manna Raffaele
Published: November 2003

Objectives/Hypothesis: Sudden hearing loss (HL) can be caused by autoimmune disorders localized to the inner ear or secondary to systemic immune diseases. Studies in autoimmune animal strains showing HL have reported changes in the cochlear stria vascularis. The authors investigated the presence of antiendothelial cell antibodies (AECA) to see if immunemediated vasculitis may play a role in human sudden HL. Study Design: A prospective study in patients with sudden HL. Methods: Fifteen consecutive patients (mean age, 32 y) affected by sudden HL and 14 normal subjects were included. Patients with familial deafness and metabolic diseases were excluded. Extensive audiovestibular, imaging, microbiological, immunological, and routine examinations were performed. AECA were detected on rat kidney tissue sections on the sera collected at −20°C. Results: AECA were positive in 8 of 15 patients (53%) (2 of 5 men and 6 of 10 women), thus differing significantly from the normal control population, in which only 2 of 14 tested AECA positive (P = .023). Conclusions: In patients with sudden HL, immune‐mediated vascular damage can have a pathogenetic role and AECA might represent a serological marker of vasculitis.
Is Epistaxis Evidence of End‐Organ Damage in Patients With Hypertension?
Authors: Neto José Faibes Lubianca , Fuchs Flávio Danni , Facco Sandro Rogério , Gus Miguel , Fasolo Leonardo , Mafessoni Rafael , Gleissner Ana Luiza
Published: November 2003

Objectives/Hypothesis: To study the association between history of mild to severe epistaxis with different stages of hypertension and with other evidence of target organ damage in a sample of patients attending an outpatient hypertension clinic, controlling for potential confounding factors. Study Design: A survey of adult patients with hypertension. Methods: A consecutive sample of 323 adults with hypertension was studied. The main outcome measures were history of adult epistaxis, high blood pressure, duration of hypertension, nasal abnormalities, and fundoscopic and electrocardiogram abnormalities. Results: Ninety‐four patients (29.1% of the whole sample) reported at least one episode of nosebleed after 18 years of age. Of these, 59 (62.8%) needed medical assistance to control at least one of the episodes. The history of epistaxis was not associated with blood pressure classified according to the World Health Organization/International Society of Hypertension paradigm or classified as severe or not severe. There was a trend of an association between history of epistaxis and duration of hypertension. The history of severe epistaxis (epistaxis that needed medical assistance) was not associated with blood pressure classified as severe or not severe and with duration of hypertension. More patients with left ventricular hypertrophy had a positive history of adult epistaxis. There was no association between history of epistaxis or history of severe epistaxis and fundoscopic abnormalities. Among the abnormalities detected at rhinoscopy, only the presence of enlarged septal vessels was associated with history of epistaxis. The presence of enlarged septal vessels was strongly and independently associated with history of epistaxis in the logistic regression model. Duration of hypertension and left ventricular hypertrophy showed a trend for an association with the history of epistaxis in the adult life. Conclusions: A definite association between blood pressure and history of adult epistaxis in hypertensive patients was not found. The evidence for an association of duration of hypertension and left ventricular hypertrophy with epistaxis suggests that epistaxis might be a consequence of long‐lasting hypertension. The association between the presence of enlarged vessels at rhinoscopy with history of epistaxis in hypertensive patients is a novel observation that needs to be addressed in future observations.
A New Transnasal Approach to Endoscopic Marsupialization of the Nasolabial Cyst
Authors: Su Chih‐Ying , Chien Chih‐Yen , Hwang Chung‐Feng
Published: November 2003

Objective: Nasolabial cyst is a mucus‐secreting, nonodontogenic cyst in the nasofacial area. It is usually situated behind the ala nasi, extending backward beneath the nasal floor into the inferior meatus and forward into the labio‐gingival sulcus behind the upper lip. Patients with nasolabial cysts generally undergo surgical removal of the cyst via a transoral sublabial approach. This article reports a simple, less invasive surgical procedure for the treatment of nasolabial cysts. Study Design: A transnasal endoscopic marsupialization method was designed to treat patients with nasolabial cysts. From 1996 through 1998, 16 consecutive patients underwent this new surgical procedure. Methods: With patients under local anesthesia, the roof of the cyst, which was firmly attached to the mucous membrane of the anterior nasal floor, was removed transnasally with a sickle knife and scissors. Under the guidance of a nasoendoscope, the opening of the cyst was widened with bite forceps. Meanwhile, the cut edges of the nasal mucosa and the epithelium lining of the cyst were adequately matched. The nose was then loosely packed. Results: All but 1 of the 15 patients were successfully treated with this technique, and the whole surgical procedure was usually completed within 15 to 20 minutes. Postoperative endoscopic and radiological findings revealed that the cyst was replaced by an air‐containing sinus with a persistent opening at the anterior or anterolateral nasal floor. There has been no evidence of mucus accumulation in the newly created sinus or recurrence of the cyst during a mean follow‐up of 16 months. Conclusions: Transnasal endoscopic marsupialization is a simple and effective surgical procedure for treatment of nasolabial cysts.
Transforming Growth Factor‐α and Rhinitis
Authors: Lam Samuel M. , Zhu De‐Fen , Ahn Jeffrey M.
Published: November 2003

Objectives: Transforming growth factor‐α (TGF‐α) has been implicated in diverse physiologic and pathophysiologic functions including immunological, inflammatory, and neoplastic processes. TGF‐α has been localized in the hyperproliferative, inflammatory environment of chronic otitis media, cholesteatoma, and asthmatic airways. TGF‐β1, which must be present with TGF‐α to transform fibroblasts, has been found in rhinitic mucosa and in asthma in prior studies. The authors sought to identify whether TGF‐α also played a role in the inflammatory cascade and fibrosis of rhinitis. Study Design: A nonrandomized, prospective study was carried out in which samples of inferior turbinate and nasal polyps from rhinitic and nonrhinitic patients were subjected to immunohistochemistry and Western blotting to determine the presence of TGF‐α. Methods: Twenty‐seven subjects undergoing surgery for rhinitis, obstructive sleep apnea, nasal fracture, and rhinoplasty were recruited for this study, the latter three groups acting as controls. Immunohistochemical and Western blotting techniques were employed to identify the presence of TGF‐α in inferior‐turbinate and nasal‐polyp samples of rhinitic subjects. Results: Immunohistochemistry demonstrated the selective staining of TGF‐α in the basement membrane and extracellular matrix, including lymphatic, vascular, and glandular structures, in most turbinate samples and the absence of staining in corresponding controls. Further, TGF‐α was isolated to a discrete 30‐kD band in both inferior turbinate and polyp tissues by Western blotting without staining in the corresponding controls. Conclusions: These results suggest that TGF‐α may play a role in the inflammatory derangement of rhinitis.
Use of Endoscopically Placed Expandable Nitinol Tracheal Stents in the Treatment of Tracheal Stenosis
Authors: Ducic Yadranko , Khalafi Reza S.
Published: November 2003

Objective: To evaluate the potential utility of a new endoscopically placed expandable tracheal stent in the treatment of benign symptomatic stenoses of the cervical trachea. Study Design: Pilot study utilizing a prospectively followed case series. Methods: An initial group of six patients undergoing stent placement was examined with rigid and flexible endoscopy under anesthesia immediately following stent placement and at postoperative 6 to 8 weeks. Subsequently each patient was followed clinically for a minimum of 6 months. Results: All stents were well tolerated with no observed complications. Immediate reversal of symptomatic airway obstruction without the need for adjunctive tracheotomy was noted in every patient. At 6 weeks, endoscopic confirmation of complete intraluminal mucosalization without formation of any granulation tissue or scar bands within the stented areas was noted in each case. Conclusions: This preliminary pilot study supports the use of nitinol expandable tracheal stents as an alternative in the treatment of benign symptomatic tracheal stenoses.
Deterioration of Olfaction and Gustation As a Consequence of Total Laryngectomy
Authors: Van Dam Frits S.A.M. , Hilgers Frans J.M. , Emsbroek Geta , Touw Frederieke I. , Van As Corina J. , De Jong Nynke
Published: November 2003

Introdution: After total laryngectomy the absence of a nasal airflow results in a decrease in olfaction and perception of flavors. Materials and Methods: Odor perception was assessed in 63 laryngectomized patients with two different olfactory tests. The methods used by patients to smell were observed during olfactory testing. Patients' judgment about their olfaction and gustation was assessed by means of a structured questionnaire, semistructured interview, and self‐rating. Results: Based on the results of the olfactory tests, patients were categorized as “smellers” and “nonsmellers.” Approximately one third of the patients were able to smell the odorous substances used in the olfactory tests. The smellers more often used a variety of methods to smell than the nonsmellers (P > .002); in most patients the method consisted of active use of facial muscles. Patients appeared well able to judge their own odor perception. Compared with the smellers, the nonsmellers judged their odor perception as worse (P > .003) and reported a more severe decrease in gustation after the operation (P > .033). The results of this study in laryngectomized patients confirm the interrelation between olfaction and gustation: the nonsmellers reported a poorer gustation and a more severe decrease in gustation and appetite than both the smellers and a reference group of elderly persons (P > .05). Patients who reported a deterioration of olfaction and gustation tended to experience negative consequences such as the inability to smell smoke, leaking gas, or agreeable odors. Conclusion: Olfaction and odor‐related flavor sensation are seriously deteriorated after total laryngectomy.
Effects of Activated Macrophages and Fibroblast Growth Factor on Random Skin Flap Survival in Swine
Authors: Bach Kevin K. , Cupp Craig , Brewster Douglass , Wester Derin , Keefe Michael
Published: November 2003

Objective: To examine the effect of application of activated autologous macrophages and basic fibro‐blast growth factor (FGF) on random skin flap survival in swine. Design: A randomized nonblinded controlled trial. According to a standard design, six dorsally based, random‐pattern skin flaps were raised in each of 12 Yorkshire pigs. Methods: Twenty‐five milliliters of blood is harvested from each animal 20 to 24 hours prior to flap creation. Monocytes are isolated, placed in culture medium, and then activated by the addition of platelet‐derived growth factor (PDGF) and tissue growth factor beta (TGF‐β). Following an 18‐hour incubation period, the monocytes are decanted and quantified, and their viability confirmed. These cells are then infused into the wound bed of the treatment flaps immediately following flap creation, and FGF is added prior to flap closure. The position of treatment and control flaps is systematically varied with regard to anterior‐to‐posterior and side‐to‐side flap positions within each animal. The area of superficial flap necrosis is evaluated on postoperative day 7, digitally scanned, and analyzed using graphics software. Control flaps are elevated similarly, but receive no placebo treatment. Results: Two‐way analysis of variance (ANOVA) demonstrated nonsignificant differences between pig side and anterior, middle, and posterior flap positions within treatment and control flap groups. Using side and position pooled data, a one‐way ANOVA showed no statistically significant differences between treatment and control flaps. Conclusions: The cellular and biochemical events following creation of a surgical wound are complex and incompletely understood. Our attempt to augment the natural role of the macrophage in wound healing by employing cytokines to activate these cells and to accelerate their arrival by implanting them into the wound bed failed to enhance flap survival. Further study is warranted to ascertain the details of wound healing, particularly with respect to cytokine concentrations and the timing of their roles, if we are to find a clinically applicable means of enhancing flap survival.
Corticosteroid Pharmacokinetics in the Inner Ear Fluids: An Animal Study Followed by Clinical Application
Authors: Parnes Lorne S. , Sun Ai‐Hua , Freeman David J.
Published: November 2003

Objective: Autoimmune disease (e.g., Cogan syndrome) and other inflammatory inner ear diseases may ravage the labyrinth if not treated aggressively with antiinflammatory medication. Corticosteroids are the mainstay of treatment, yet, partly because of the existence of the blood—labyrinthine barrier, the ideal drug, dose, and route of administration are currently unknown. Study Design: In the present study, we established cochlear fluid pharmacokinetic profiles of hydro‐cortisone, methylprednisolone, and dexamethasone in the guinea pig following oral, intravenous, and topical (intratympanic) administration. High‐performance liquid chromatography was used to determine the drug concentrations, and comparisons were made with simultaneous pharmacokinetic profiles from blood and cerebrospinal fluid. Results: Our findings demonstrated a much higher penetration of all three drugs into the cochlear fluids following topical application as compared with systemic administration, with methylprednisolone showing the best profile. Discussion: The results suggested that intratympanic administration of corticosteroids might be more efficacious while avoiding high blood levels and therefore the deleterious side effects of systemic use. Clinical Application: Thirty‐seven patients with various inner ear disorders causing sensorineural hearing loss were subsequently treated using intratympanic corticosteroids, 20 with dexamethasone, and 17 with methlyprednisolone. Patients with immune‐mediated hearing losses showed the best results, with notable improvement also seen in several cases of a “sudden deafness.” No benefit was seen in patients with cochlear hydrops or those with sudden deterioration of a preexisting hearing loss. Three patients developed a transient otitis media related to the treatments, easily controlled with antibiotics. There were no cases of treatment‐induced hearing loss and no permanent tympanic membrane perforations. Conclusions: Overall, injection of intratympanic corticosteroids for the treatment of hearing loss in inner ear disorders appears to be both safe and highly effective for certain disorders. The concept of this technique is supported by animal experimental data. The findings from the present study warrant further clinical application and experimental investigation.
Adjunctive Use of Endoscopy During Acoustic Neuroma Surgery
Authors: Wackym Phillip A. , King Wesley A. , Poe Dennis S. , Meyer Glenn A. , Ojemann Robert G. , Barker Fred G. , Walsh Patrick R. , Staecker Heinrich
Published: November 2003

Objective/Hypothesis: In specific clinical situations, endoscopes offer better visualization than the microscope during acoustic neuroma (vestibular schwannoma) surgery and can therefore decrease the incidence of the postoperative complications of cerebrospinal fluid (CSF) leakage and recurrence of tumor. This study was undertaken to determine if the use of adjunctive endoscopy provides complementary information to the operating surgeon during surgery for acoustic neuromas.

Method: Seventy‐eight patients with acoustic neuromas underwent tumor excision by two neurotologists (P.A.W., D.S.P.), together with their respective neurosurgical partners, via a retrosigmoid (suboccipital) approach (n=68), translabyrinthine approach (n=7), or middle cranial fossa approach (n=3). Endoscopy with a rigid glass lens endoscope was used during tumor removal to examine posterior fossa neurovascular structures, and after tumor excision to inspect the internal auditory canal (IAC), inner ear, and middle ear, depending on the approach used. One of the authors (D.S.P.) has not used adjunctive endoscopy during resections via the translabyrinthine and middle cranial fossa approaches, and therefore, these cases were excluded from the data collection and analysis.

Results: Complete tumor excision was achieved in 73 patients. Endoscopy allowed improved identification of tumor and adjacent neurovascular relationships in all cases. In addition, residual tumor at the fundus of the IAC (n=11) and exposed air cells (n=24) not seen with the microscope during retrosigmoid approaches were identified endoscopically. In one of the translabyrinthine cases, the endoscope allowed identification of open air cells not visualized with the microscope. None of the 78 patients developed CSF rhinorrhea. Incorporating the endoscope did not significantly increase operative time.

Conclusions: Endoscopy can be performed safely during surgery to remove acoustic neuromas. The adjunctive use of endoscopy may offer some advantages including improved visualization, more complete tumor removal, and a lowered risk of CSF leakage.
A Review of Randomized Clinical Trials in Tinnitus
Authors: Dobie Robert A.
Published: November 2003

Objectives:Review reports of randomized clinical trials (RCTs) in tinnitus to identify well‐established treatments, promising developments, and opportunities for improvement in this area of clinical research.

Study Design:Literature review of RCTs (1964‐1998) identified by MEDLINE and OLD MEDLINE searches and personal files.

Methods:Studies were compared with the RCT criteria of Guyatt et al.5for quality of design, performance, and analysis; “positive” results were critically examined for potential clinical relevance.

Results:Sixty‐nine RCTs evaluated tocainide and related drugs, carbamazepine, benzodiazepines, tricyclic antidepressants, 16 miscellaneous drugs, psychotherapy, electrical/magnetic stimulation, acupuncture, masking, biofeedback, hypnosis, and miscellaneous other nondrug treatments. No treatment can yet be considered well established in terms of providing replicable long‐term reduction of tinnitus impact, in excess of placebo effects.

Conclusions:Nonspecific support and counseling are probably helpful, as are tricyclic antidepressants in severe cases. Benzodiazepines, newer antidepressants, and electrical stimulation deserve further study. Future tinnitus therapeutic research should emphasize adequate sample size, open trials before RCTs, careful choice of outcome measures, and long‐term follow‐up.
Unintentional Parathyroidectomy During Thyroidectomy
Authors: Lee Nina J. , Blakey John D. , Bhuta Sunita , Calcaterra Thomas C.
Published: November 2003

Objectives: In the United States thyroidectomy is a frequently performed surgery by both general and head and neck surgeons. Even the most experienced thyroid surgeon, however, has probably received a pathology report stating that an incidental parathyroid gland or parathyroid tissue was found in the submitted thyroidectomy specimen. The aim of this report is to explore some of the pathologic and clinical characteristics of unintentional parathyroidectomy during thyroidectomy.

Study Design: A retrospective review was performed of thyroidectomies performed at the University of California, Los Angeles, Center for the Health Sciences between 1989 and June 1998 which had pathology reports showing parathyroid tissue contained within the thyroidectomy specimen. This excluded any tissue submitted separately to be evaluated for parathyroid tissue and parathyroid tissue removed unintentionally during a thyroidectomy for a different procedure such as a laryngectomy or surgery for parathyroid disease.

Methods: The pathology slides were reviewed to determine the incidence of unintentional parathyroid tissue removal, the size of the parathyroid tissue found within the thyroid specimen, the location of the parathyroid tissue (extracapsular, intracapsular, intrathyroidal), and whether this unintentional parathyroidectomy during thyroidectomy caused clinical consequences.

Results: Four hundred fourteen applicable thyroidectomies were performed during this time with 45 (11%) discovered cases of unintentional parathyroidectomy during thyroidectomy. Twenty‐five (56%) cases were discovered during thyroidectomy for benign disease, and 20 (44%) during thyroidectomy for malignant thyroid disease. All the parathyroid tissue was normal and was found in extracapsular (58%), intracapsular (20%), or intrathyroidal (22%) locations. Of these 45 cases, recurrent laryngeal nerve paralysis was found only in two patients who had the nerve resected intentionally during the thyroidectomy, and none of the patients developed permanent hypocalcemia.

Conclusions: Incidental parathyroid gland tissue was reported in 11% of the thyroidectomies performed in our series, without the clinical consequence of hypocalcemia. The majority (78%) of this parathyroid tissue was found in the extracapsular and intracapsular locations; therefore it is possible that these parathyroid glands may be identified and preserved with more meticulous inspection of the thyroid capsule during and after thyroidectomy to decrease the incidence of unintentional parathyroidectomy during thyroidectomy in the future.
Glottographic Measures Before and After Levodopa Treatment in Parkinson's Disease
Authors: Jiang Jack , Lin Emily , Wang Jian , Hanson David G.
Published: November 2003

Objectives: Investigate the usefulness of acoustic and glottographic measures for detecting effects of levodopa (L‐dopa) treatment on vocal function of individuals with idiopathic Parkinson's disease.

Study Design: Compare recordings of vowels sustained at a target comfortable loudness level obtained before and after L‐dopa treatment from 15 individuals with idiopathic Parkinson's disease showing signs of tremor.

Methods: A simultaneous acoustic, airflow, and electroglottographic recording technique was employed to record vowels phonated by subjects before and after L‐dopa treatment. Algorithms were developed to derive from the recorded signal measures of fundamental frequency, SPL, airflow rate, speed quotient (ratio of glottal opening to closing time time), and short‐ and long‐term phonatory instability. A series of paired Student t tests or signed rank tests were performed to compare the pretreatment and posttreatment groups on these measures.

Results: Measures of speed quotient, acoustic shimmer (cycle‐to‐cycle amplitude perturbation), and the extent of tremor derived from acoustic intensity contours were found to significantly decrease after medication. Sound pressure level tended to increase after medication. The acoustic jitter (cycle‐to‐cycle frequency perturbation) and the extent of tremor derived from airflow signals did not significantly differentiate between premedication and postmedication voices.

Conclusions: Objective measures of acoustic and electroglottographic signals are useful in monitoring the pharmacologic response of Parkinson's disease, reflecting decrease of laryngeal rigidity and short‐ and long‐term acoustic amplitude fluctuation after L‐dopa treatment.
Otosclerosis in the 1960s, 1970s, 1980s, and 1990s
Authors: Lippy William H. , Berenholz Leonard P. , Burkey John M.
Published: November 2003

Educational Objective:The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years.

Study Design:Retrospective chart review.

Setting:Private otology practice.

Patients:Randomized selection of 400 patients (100 per decade) from 15,372 who underwent stapedectomy over the past four decades.

Outcome Measures:Extent of cochlear involvement, bilaterality of disease, length of history, degree of hearing loss, and pathological findings are noted.

Results:The decreasing incidence of footplates necessitating drillouts is discussed. Changing audiometric patterns at presentation such as decreased pure‐tone average hearing thresholds and smaller air‐bone gaps are also reviewed.

Conclusion:This review demonstrates the changing patterns of presentation of otosclerosis over the past 37 years and will help guide the stapes surgeon into the year 2000.
A Patient‐Benefit Evaluation of Unilateral Congenital Conductive Hearing Loss Presenting in Adulthood: Should It Be Repaired?
Authors: Sperling Neil M. , Patel Nilesh
Published: November 2003

Objective: To evaluate subjective and objective outcomes of surgical therapy in congenital conductive hearing loss (HL) presenting in adulthood. The impact of hearing restoration on quality of life (QOL) for these patients may differ from those with acquired HL.

Study Design: Retrospective review of five patients treated surgically.

Methods: Standard audiometry was completed. Patients completed a subjective questionnaire as well as subjective (open‐set) questions. A seven‐point Likert scale was used for closed‐set responses with 1 representing the worst possible outcome and 7 being best.

Results: The average four‐frequency improvements in pure‐tone average and air‐bone gap were 18 dB (range, 7‐29 dB) and 16 dB (range, 2‐30 dB), respectively. An average score was obtained for each closed‐set question. The highest‐scoring items were for overall improvement of QOL (average score, 6), followed by perceived improvement in hearing (average score, 5.6). Other positive responses were improved ability to use the telephone (four of five patients) and improved localization of sound (four of five patients). Negative subjective responses included prolonged dysequilibrium in two of five, prolonged adjustment period in three, and dysgeusia in one patient.

Conclusion: Important components of outcome are likely to escape our review if only objective measures are used to evaluate surgical outcomes. These results suggest that improved hearing in this population provides specific improvements in lifestyle and is perceived as a significant improvement in overall QOL.
Cortical Representation of Swallowing in Normal Adults: Functional Implications
Authors: Mosier Kristine , Patel Rakesh , Liu Wen‐Ching , Kalnin Andrew , Maldjian Joseph , Baredes Soly
Published: November 2003

Objective: Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects.

Study Design: Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques.

Methods: Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross‐correlation analysis. One‐way and two‐way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence.

Results: Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks.

Conclusions: Activation of the primary motor and somatosensory cortices, as well as other sensory‐motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.
Histologic Findings of Silastic Medialization in the Canine Model
Authors: Simpson C. Blake , Seshul Merritt , Lennington Wayne , Juliao Saul , Netterville James L.
Published: November 2003

Objectives: Examine the long‐term histological effects of Silastic medialization using a canine model.

Study Design: Prospective study evaluating the effects of Silastic medialization in six canine larynges.

Methods: Two subject groups were evaluated. The first group of four dogs underwent recurrent laryngeal section followed by Silastic medialization on the paralyzed side and placement of a smaller implant on the mobile side. Two of the dogs were sacrificed at 9 months and two at 2 years. The second subject group consisted of two additional dogs who underwent Silastic medialization followed by removal of the implants at 7 months and were sacrificed 18 months later. The larynges were then processed, sectioned in the axial plane, and examined microscopically.

Results: Histological findings of both the mobile and paralyzed sides showed a thin (<0.5 mm) fibrous capsule surrounding the implant and minimal inflammatory response. Vocal fold mobility was maintained in all cases in which the recurrent laryngeal nerve was left intact. Capsule formation and inflammatory response were similar in all cases.

Conclusions: Minimal tissue reactivity over a prolonged period of time suggests that long‐term results of Silastic medialization remain stable in paralyzed and mobile vocal folds for up to 2 years. Similar tissue response in the subjects in which the Silastic block was removed also suggests that Silastic medialization is a reversible procedure.