bluuebunny/crossref_metadata_2025 huggingface dataset:
Antifungal Activity Against Allergic Fungal Sinusitis Organisms
Authors: Bent John P. , Kuhn Frederick A.
Published: November 2003

A review of more than 50 allergic fungal sinusitis (AFS) patients indicates that most patients experience postoperative recurrences once weaned from oral steroids, leaving a glaring need for improved treatment. Topical antifungal therapy has not been described for AFS, but it could potentially lower fungal antigen loads via postoperative irrigations. No information exists to direct the choice of antifungal agent. The purpose of this study was to identify the appropriate drug to use for postoperative irrigations in AFS patients.

Twenty‐two fungal cultures grown from 15 AFS patients were studied for in vitro susceptibility to five common antifungal drugs: ketoconazole, amphotericin B, itraconazole, nystatin, and fluconazole. Results demonstrated that ketoconazole and amphotericin B were the most effective. Clinical trials are indicated to evaluate the efficacy of these drugs as a supplement to current AFS treatment.
Prognostic Factors Affecting Outcome in Lower Gingival Carcinoma
Authors: Overholt S. Mark , Eicher Susan A. , Wolf Pat , Weber Randal S.
Published: November 2003

Squamous cell carcinoma of the lower gingiva is a rare lesion that frequently invades the mandible. To determine the factors that affect local disease control and overall survival, a retrospective review of 155 previously untreated patients was performed. Primary lesions larger than 3 cm (P = .021) and persistently disease‐positive surgical margins (P = .027) were found to be associated with decreased local control rates. Survival was adversely affected by advanced T stage (P =.001), positive initial and final surgical margins (P = .004), mandibular invasion (P = .014), and cervical metastases (P<.001). Extent of mandibular resection, tumor extension beyond the lower gingiva, recent dental extractions in the region of the primary, perineural invasion, and histologic grade did not affect local control or survival. Although lower gingival carcinoma tends to involve the mandible, our findings indicate that tumor size is more important than mandibular invasion in predicting local disease control. Larger tumors that have a greater propensity for local recurrence and poorer survival require a more extensive surgical resection.
Otitis Media in Children With Cochlear Implants
Authors: Luntz Michal , Hodges Annelle V. , Balkany Thomas , Dolan‐Ash Shelly , Schloffman Jerry
Published: November 2003

Fifty children who received a cochlear implant between 1991 and 1995 were evaluated for incidence of acute otitis media (AOM). Thirty‐seven (74%) children had AOM before implantation and 8 (16%) after implantation. All children who had AOM after implantation had a history of AOM. A subgroup of 14 children required ventilating tubes for recurrent AOM before implantation. Five(35.7%) in this group had AOM after implantation. The incidence and severity of AOM decreased after implantation. All episodes of postimplant AOM were successfully treated with routine oral antibiotics, and no infectious complications occurred. A history of recurrent AOM should not inordinately delay cochlear implantation.
The Learning Curve for Acoustic Tumor Surgery
Authors: Buchman Craig A. , Chen Douglas A. , Flannagan Patrick , Wilberger Jack E. , Maroon Joseph C.
Published: November 2003

Although operative experience is considered to be critically important in the surgical management of acoustic tumors, little objective evidence substantiates this claim. The present study was undertaken to determine whether a learning curve exists for acoustic tumor surgery.

The first 96 acoustic tumor patients managed surgically by a new neurotologic team were retrospectively reviewed. A significant improvement (P<.0003; F=6.32) in the ability to achieve good(grade II or better) postoperative facial nerve function was identified. Improving trends for complete resection rate and hearing preservation were documented, and the incidence of cerebrospinal fluid (CSF) leaks declined; however, statistical significance was not achieved.

For postoperative facial nerve function, approximately 60 cases were necessary before the new team achieved results similar to those of highly experienced surgeons. The frequencies of complete resection, CSF leaks, hearing preservation, stroke, and mortality were comparable to those of experienced neurotologic teams. The findings of this study may have implications for both patient care and physician training.
Optimal Concentration of Epinephrine for Vasoconstriction in Neck Surgery
Authors: Dunlevy Timothy M. , O'Malley Timothy P. , Postma Gregory N.
Published: November 2003

The addition of epinephrine to local anesthetics decreases bleeding, reduces systemic toxicity, and increases duration of action. However, epinephrine has significant side effects. Four concentrations of epinephrine were compared to determine the minimum concentration required for maximal vasoconstriction. Eighty‐one subjects undergoing surgical procedures with general anesthesia were injected with 1% lidocaine containing varying concentrations of epinephrine. Blood flow measurements were then made at 1‐minute intervals for 10 minutes using a laser Doppler flowmeter. There were no differences in blood flow reduction between epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000. However, epinephrine 1:800,000 provided significantly less vasoconstriction. We recommend using an epinephrine concentration of 1:200,000 or 1:400,000 to provide optimal initial hemostasis while minimizing potential side effects.
Stapedectomy in the Pediatric Patient
Authors: Murphy Terrence P. , Wallis Donna Lynn
Published: November 2003

The purpose of this study was to evaluate and compare the results of stapedectomy in pediatric patients with otosclerosis and tympanosclerosis.

A retrospective review of 14 patients (15 ears) who underwent stapedectomy from 1993 to 1995 was conducted. In 5 ears stapedectomy for tympanosclerosis was performed; 9 patients had otosclerosis and 1 had Treacher Collins syndrome.

Patients were evaluated for preoperative and postoperative air‐bone gaps, preoperative and postoperative speech reception thresholds, postoperative air conduction hearing improvement, and preoperative and postoperative speech discrimination.

Children with otosclerosis who underwent stapedectomies had an average postoperative airbone gap of 16 dB with an average air conduction hearing improvement of 17.6 dB. Children with tympanosclerosis who underwent stapedectomies had an average air‐bone gap of 14 dB with an average air conduction hearing improvement of 28 dB.

Stapedectomy is a safe and effective treatment for otosclerosis and tympanosclerosis in pediatric patients.
Lipoid Meningitis Due to Aseptic Necrosis of a Free Fat Graft Placed During Neurotologic Surgery
Authors: Hwang Peter H. , Jackler Robert K.
Published: November 2003

We present two unusual cases of aseptic postoperative lipoid meningitis resulting from necrosis of a free fat graft placed into a skull base craniotomy defect. Two patients underwent translabyrinthine resection of acoustic neuroma and received abdominal fat grafts to ablate the surgical defect. Both patients presented postoperatively with persistent cerebrospinal fluid (CSF) wound leak and severe headache. Computed tomography demonstrated hydrocephalus and widely dispersed intracranial fat droplets throughout the CSF circulation. Both patients ultimately required CSF diversion for management of persistent communicating hydrocephalus. The clinical and radiographic correlates of lipocephalus and lipoid meningitis are presented, and a review of free fat graft physiology is discussed.
Paroxysmal Laryngospasm Secondary to Gastroesophageal Reflux
Authors: Loughlin Christopher J. , Koufman James A.
Published: November 2003

Over a 2‐year period (1992 to 1994), 12 consecutive adult patients with paroxysmal laryngospasm were prospectively studied. All had had other symptoms of gastroesophageal reflux (GER); however, only 4 (33%) experienced symptoms of heartburn. Each patient underwent fiberoptic laryngeal examination, barium swallow/esophagography, and ambulatory, 24‐hour, double‐probe pH monitoring(pH‐metry).

Eleven (92%) of the 12 patients had evidence of GER on examination, and 10(83%) had abnormal pH‐metry, including 3 who demonstrated pharyngeal reflux while having normal total acid exposure times in the esophageal probe. All the patients responded to antireflux treatment, using dietary and lifestyle modifications and omeprazole, with complete cessation of the laryngospastic episodes.

This study documents the role of GER in the etiology of paroxysmal laryngospasm, it highlights the advantages of double‐probe pH‐metry in diagnosing this extraesophageal manifestation of GER, and it demonstrates that antireflux therapy with omeprazole is effective in controlling GER‐induced laryngospasm.
Intratympanic Gentamicin for Treatment of Intractable Meniere's Disease: A Preliminary Report
Authors: Rauch Steven D. , Oas John G.
Published: November 2003

Topical administration of aminoglycoside antibiotics in the middle ear can achieve “chemical labyrinthectomy” in patients with intractable Meniere's disease. Herein we report our results of intratympanic gentamicin therapy in 21 patients using two different dosing protocols, twice weekly and twice daily(b.i.d.). Both hearing and vertigo outcome were evaluated. Complete control of episodic vertigo was achieved initially in 20 of 21 patients (95.2%). However, 6 of 20 responders (30%) developed relapsing symptoms within 12 months. Retreatment was successful in 75% of these patients. Overall, hearing was preserved or improved in 62% of cases, worse in 24%, and not yet tested in 14%. When the cumulative dose of gentamicin was ≤4 injections in the first week, only 1 of 14 (7.1%) lost hearing. Intratympanic gentamicin offers better risk/benefit outcome than other invasive therapies for intractable Meniere's disease.
Influence of Age on the ‘Nasal Cycle’
Authors: Mirza Natasha , Kroger Hans , Doty Richard L.
Published: November 2003

The nasal cycle is classicially defined as a side‐to‐side fluctuation in nasal engorgement and airflow, with period lengths ranging from approximately 1 to 5 hours. This cycle, as well as its variants (e.g., cyclic changes on one side of the nose only), is produced by alterations in autonomic tone of the nasal vasculature and reportedly correlates with a number of ultradian rhythms, including asymmetries in left:right cerebral electroencephalographic (EEG) activity and differential performance on visual/spatial psychological tasks. Since the pacemaker for the nasal cycle is believed to lie within the suprachiasmatic nucleus of the hypothalamus, and this nucleus evidences degeneration in later life, we sought to determine whether the nasal cycle or its variants changes with age. To achieve this end, we used a liquid crystal thermography exhalation monitor to measure relative airflow of the two nasal chambers at 15‐minute intervals for 6 hours in 60 people representing four age categories: 18 to 29 years (n=12); 30 to 49 years (n=15); 50 to 69 years(n=13); and 70 to 85 years (n=20). Overall, the proportion of subjects exhibiting the alternating rhythmicity associated with the classic nasal cycle decreased with age. No association was present between nasal cycle parameters and scores on the Mini‐Mental State Examination (MMSE). The results suggest that the classic nasal cycle may be a marker for age‐related central nervous system changes.
Otolaryngologic Manifestations of Sarcoidosis: Presentation and Diagnosis
Authors: Shah Udayan K. , White Judith A. , Gooey John E. , Hybels Roger L.
Published: November 2003

Neuro‐otologic manifestations of sarcoidosis are rare. Dizziness in particular is a rare presenting complaint of the patient afflicted with this systemic granulomatous disorder. Head and neck and sinonasal presentations of this disease are more common. We reviewed our experience with six such patients who presented for management of their otolaryngologic (ORL) manifestations in order to delineate the involvement of the otolaryngologist in the treatment and diagnosis of these patients, with a focus upon the relevant tests and procedures in the otolaryngologist's de novo diagnosis of sarcoidosis. Studies ordered in the course of otolaryngologic evaluation and their utility in the diagnosis of sarcoidosis by the otolaryngologist are reviewed and classified into useful, supportive, and ancillary. The otolaryngologist played an important role in diagnosis, with four of six patients diagnosed to have sarcoidosis on the basis of their otolaryngologic presentations. Biopsy was performed by the otolaryngologist for diagnosis of sarcoidosis in all four of these cases. Steroids were central to treatment. Oral steroid therapy was the principal treatment: both patients with neuro‐otologic sarcoid were sucessfully managed with oral steroids. Intralesional steroids were necessary to treat the skin lesion. One of six patients patients experienced complications related to steroid use.
Uvulopalatopharyngoplasty Versus Laser‐Assisted Uvulopalatoplasty for the Treatment of Obstructive Sleep Apnea
Authors: Walker Regina Paloyan , Grigg‐Damberger Madeleine M. , Gopalsami Chellam
Published: November 2003

Uvulopalatopharyngoplasty (UPPP) was the first surgical procedure specifically designed to address the palatal abnormalities seen in many patients with obstructive sleep apnea syndrome (OSAS). For adult apneic patients, UPPP remains the most commonly performed operation. Beginning in 1993, laser‐assisted uvulopalatoplasty (LAUP) was introduced for the treatment of snoring and sleep apnea. LAUP differs from UPPP because it is performed in the office using only local anesthesia, thus being very cost‐effective.

Seventy‐nine patients with OSAS underwent surgical treatment: 38 treated with LAUP and 41 with UPPP. The overall surgical response rate, defined as a>50% reduction in the postoperative respiratory disturbance index (RDI), was achieved in 21 (51.2%) of UPPP‐treated and 18 (47.4%) of LAUP‐treated patients. The RDI decreased from 30.3 ± 3.7 to 22.2 ± 4.4 events/h in the LAUP patients and from 52.1 ± 5.0 to 25.5 ± 2.7 events/h in the UPPP patients. The lowest oxyhemoglobin saturation (LSaO2) increased from 72.8 ± 2.1 to 80.9 ± 1.3% in the UPPP patients; there was no change in the LAUP patients.

Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopalatal insufficiency in both groups. In the carefully selected OSAS patient, LAUP should be considered a surgical alternative to UPPP. LAUP may actually be preferable to UPPP in certain cases because LAUP is cost‐effective, does not require a general anesthetic or hospitalization, has very few associated complications, and time lost at work is minimal.
Reliability of Disposable Intraoperative Facial Nerve Stimulators
Authors: Randall David A. , Wester Derin C. , Hunsaker Darrell H.
Published: November 2003

Facial nerve injury is one major morbidity of surgery performed along the course of this nerve. Surgeons frequently employ stimulators to identify and protect the nerve. Both disposable devices as well as larger, reusable stimulators are available. Despite their common use, relatively little documentation exists regarding the safety and reliability of these devices. We tested the electrical output of the four disposable, single‐use motor nerve stimulators that are marketed in the United States. We found that each produced consistent stimulus output over time. One stimulator slightly exceeded the manufacturer's listed output while three devices produced significantly less voltage and current than specified by the manufacturer.
Kikuchi's Disease: Report of Three Cases and an Overview
Authors: Nikanne Elina , Ruoppi Pirkko , Vornanen Martine
Published: November 2003

We describe, to our knowledge, the first native Finnish patients with Kikuchi's histiocytic necrotizing lymphadenitis. The diagnosis was based in all cases on histopathological findings in openbiopsy. The disease was first detected in Japan in 1972, but in Scandinavia, until this decade, there had been no cases reported.

Our patients were young, otherwise healthy women who had cervical lymphadenopathy, fever, and fatigue as their main symptoms. In two of them, the disease was mild and subsided spontaneously within 2‐6 months. One patient with more fulminant lymphadenopathy was treated with antimicrobial and antiinflammatory drugs. She became symptomless in 3 months.

The cause of Kikuchi's disease is unknown. A viral or postviral hyperimmune reaction has been proposed as its etiology. Malignant lymphoma and systemic lupus erythematosus are differential diagnoses. Histopathological findings are pathognomonic and pathologists must be aware of its typical characteristics.
Tenuous Airway in Children With Trisomy 21
Authors: de Jong Andrew L. , Sulek Marcelle , Nihill Michael , Duncan Newton O. , Friedman Ellen M.
Published: November 2003

Multiple congenital anomalies are closely linked to Down syndrome(trisomy 21). Cardiac malformations are found in 40% of patients, a large number of whom will require a major surgical procedure. The importance of postextubation stridor in these children is frequently underestimated. A retrospective review of 99 trisomy 21 patients who underwent cardiovascular surgery revealed postextubation stridor in 24 (24.2%). Significant factors for the development of stridor included younger age (P=0.04), lower growth percentile for weight (P=0.03), and increased frequency of reintubation(P=0.04). Subglottic stenosis was found in 6 (6.1%). In 4 of these patients, an endotracheal tube of larger diameter than predicted for age was used. All 6 patients were less than the 10th percentile for weight. We conclude that Down syndrome patients deserve special considerations and modifications of standard intubation techniques for successful airway management.
Ki‐67 As a Prognostic Marker in Adenoid Cystic Carcinoma Assessed With the Monoclonal Antibody MIB1 in Paraffin Sections
Authors: Nordgård Ståle , Franzén Gunnar , Boysen Morten , Halvorsen Tore B.
Published: November 2003

The monoclonal antibody MIB1 recognizing the Ki‐67 antigen in formalin‐fixed, paraffin‐embedded tissue was used to study the proliferative activity in 44 adenoid cystic carcinomas of the salivary glands. The antigen expression was compared with clinical factors, histopathological grading, and prognosis. The Ki‐67 value was significantly higher in tumors from patients suffering from treatment failure than in nonfailures (P < 0.001). The Ki‐67 expression was also higher in tumors exhibiting areas more than 30% of the solid growth pattern and higher in sinonasal tumors than in other locations. By Cox regression analysis, Ki‐67 more than 4% was the strongest prognostic indicator (P
<0.005). Clinical stage and violation of surgical margins were also found to be independent significant prognostic indicators. We conclude that Ki‐67 expression estimated by the use of MIB1 is a powerful tool for predicting the short‐term prognosis for patients with adenoid cystic carcinoma.
Head and Neck Manifestations of Plasma Cell Neoplasms
Authors: Nofsinger Yoon Choi , Mirza Natasha , Rowan Philip T. , Lanza Donald , Weinstein Gregory
Published: November 2003

Multiple myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma are plasma cell neoplasms. They represent distinct manifestations of a disease continuum, whereby the clinical findings are critical to diagnosis. Plasma cell neoplasms are histologically similar, and distinguishing one from the other has significant implications for treatment and survival. Plasma cell neoplasms are relatively unusual malignancies of the head and neck region. We present a case series of plasma cell neoplasms involving the skull base, paranasal sinus, larynx, and mandible as an introduction to a complete review of the literature on plasma cell neoplasms of the head and neck area.
Malformation and Stenosis of the Cricoid Cartilage in Association With Larsen's Syndrome
Authors: Hoeve Hans J. , Joosten Koen F.M. , Bogers J.J.C. , Hazebroek Frans W.J. , Pfenninger Jürg , van der Voort Edwin , Leijala Mauri
Published: November 2003

Three patients with the typical features of Larsen's syndrome are described. All three developed severe respiratory symptoms caused by a congenital subglottic stenosis. Tracheotomy and treatment of the stenosis by means of laryngotracheoplasty resulted in complete collapse of the cricoid cartilage and the proximal tracheal skeleton. Lack of rigidity of the laryngeal and tracheal cartilages in patients with Larsen's syndrome could well be responsible for this failure. Surgical treatment consisted of resection of the stenotic and collapsed areas and end‐to‐end anastomosis. This therapy was eventually successful in all three patients.
Tracheotomy and the Intensive Care Unit Patient
Authors: Henrich Douglas E. , Blythe William R. , Weissler Mark C. , Pillsbury Harold C.
Published: November 2003

Transportation of the intensive care unit (ICU) patient to the operating room for tracheotomy has been implicated as an unnecessary source of complications and has been cited as a relative indication for percutaneous tracheotomy. However, there is very little evidence in the literature to support this claim. We evaluated 100 consecutive patients who were transported from the ICU to the operating room for tracheotomy. There were no complications related to patient transportation. A total of five complications occurred, all unrelated to patient transportation. Two patients receiving pressure control ventilation developed a pneumothorax on postoperative days 7 and 8, respectively. There were three minor complications directly related to the tracheotomy: peristomal cellulitis, tracheitis, and hemorrhage of less than 25 cc on postoperative day 1. The minor complications were treated appropriately and resolved without any adverse sequelae. We provide a detailed review of 100 consecutive ICU patient tracheotomy cases and compare this with 109 tracheotomies in non‐ICU patients. Transportation of the ICU patient does not appear to increase the risk of complications during tracheotomy and should not be cited as a cause of complications in the percutaneous tracheotomy literature. The results with standard surgical tracheotomy in the controlled setting of the operating room should serve as the standard by which other procedures are judged.
Subtotal Parotidectomy: A 10‐Year Review (1985 to 1994)
Authors: Helmus Christian
Published: November 2003

A subtotal parotidectomy is a conservative resection in which less than a superficial lobectomy is performed and less than a full facial nerve is dissected. From 1985 to 1994, 146 subtotal parotidectomies were performed for a variety of benign and limited, low‐grade malignant tumors. The procedure is based on the premises that adequate margins are necessary, that the procedure can be terminated when these margins are obtained, and that the true margin is usually the tumor‐to‐nerve margin. For selective neoplasms the subtotal parotidectomy has many advantages with results that equal or surpass the classic superficial lobectomy.
Cochlear Implantation in Common Cavity Malformations Using a Transmastoid Labyrinthotomy Approach
Authors: McElveen John T. , Carrasco Vincent N. , Miyamoto Richard T. , Linthicum Fred H.
Published: November 2003

The transmastoid facial recess approach has become the standard technique for cochlear implantation. Although this approach has been used for implantation in patients with common cavity deformities, it is not without increased risk to the facial nerve. Using a direct approach to the common cavity that circumvents the facial recess, we have successfully implanted four patients with common cavity deformities. An aberrant facial nerve in one patient would have precluded placement of the electrode array using standard cochlear implant techniques. As demonstrated in these four patients, the direct approach to the common cavity is an effective approach for placement of the electrode array, minimizes risk to the facial nerve, and may decrease the likelihood of postoperative cerebrospinal fluid leaks. Intraoperative video footage demonstrates the feasibility and facility of this approach in patients with common cavity deformities.
Individualizing Hearing Preservation in Acoustic Neuroma Surgery
Authors: Arriaga Moisés A. , Chen Douglas A. , Fukushima Takanori
Published: November 2003

Surgical series of hearing preservation in acoustic neuroma usually emphasize a team's results with one particular technique. This report reviews acoustic neuroma outcomes of individualizing the surgical approach to patient and tumor characteristics. This study reviews 60 consecutive hearing preservation acoustic neuroma surgeries in a total series of 330 acoustic neuromas. Tumor sizes ranged from 0.3 to 4 cm in patients ranging from 23 to 74 years of age. Middle fossa surgery was performed in 57%, retrosigmoid in 43%. Overall, measurable hearing was preserved in 77%, and useful hearing in 67%. Among middle fossa cases, 85% had measurable and 74% had useful hearing. Among retrosigmoid surgeries, 65% had measurable hearing and 58% had useful hearing. Overall, long‐term facial nerve function was excellent (grade I or II) in 90% and poor (grade V or VI) in 2%. There was one case of bacterial meningitis(2%), and cerebrospinal fluid leaks requiring surgery occurred in four patients (7%). The hearing preservation and other outcome parameters in this series compare favorably with other reports. We believe that individualizing the surgical approach to the patient's tumor characteristics and clinical features contributed to the high rate of hearing preservation.
Laryngeal Evoked Brainstem Responses in Humans: A Preliminary Study
Authors: Yin Shengguang S. , Qiu William W. , Stucker Fred J. , Hoasjoe Denis K. , Aarstad Robert F. , Batchelor Barbara M.
Published: November 2003

Laryngeal evoked brainstem responses (LBRs) were recorded in normal human subjects in an attempt to develop a central laryngeal function test and enhance our understanding of neurolaryngologic disorders. The results showed that the human LBR consists of five positive peaks and five negative peaks reproducible within 10 ms after a vibratory stimulation to the superior laryngeal nerve (SLN). The waveform reproducibility was verified by blocking the SLN and topically anesthetizing the hypopharyngeal cavity. The morphology and latency of peak 5 were similar to results obtained in animal LBR experiments. It was concluded that a vibratory stimulation to the SLN was a noninvasive method to elicit far‐field potentials from the central laryngeal pathway. These findings encourage further effort to establish normative data and explore clinical correlations.
Pediatric Functional Endoscopic Sinus Surgery: Is a Second Look Necessary?
Authors: Mitchell Ron B. , Pereira Kevin D. , Younis Ramzi T. , Lazar Rande H.
Published: November 2003

Functional endoscopic sinus surgery (FESS) has become the surgical procedure of choice for the treatment of chronic sinusitis that is refractory to medical treatment. It has become routine to perform endoscopy in children under general anesthesia 2 to 3 weeks after FESS to facilitate examination and cleaning of the operative site. We compared the clinical outcome of 50 children who underwent FESS without a second‐look endoscopy with 50 children who underwent a routine second look. Patients with systemic disease (cystic fibrosis, immotile ciliary syndrome, immunoglobulin deficiency) or undergoing a revision procedure were excluded from the study. The results show that the postoperative improvement in nasal obstruction, nasal drainage, and chronic cough was the same for both groups. We conclude that in the vast majority of children without systemic disease and not undergoing a revision procedure, a second endoscopic procedure may not offer any apparent advantage.
Effect of Immunotherapy on Seasonal Changes in Serum‐Specific IgE and IgG4 in Patients With Pollen Allergic Rhinitis
Authors: Ohashi Yoshihiro , Tanaka Ayaki , Kakinoki Yasushi , Ohno Yoshiharu , Sakamoto Hirokazu , Kato Akifumi , Masamoto Tateo , Washio Yushi , Nakai Yoshiaki
Published: November 2003

Serum specific IgE and IgG4 in 70 patients with seasonal rhinitis caused by Japanese cedar pollens were determined before and during the pollen season. Seasonal increase rate in specific IgE was significantly smaller in the immunotherapy patients than the pharmacotherapy patients, and seasonal increase in specific IgG4 was significant in the immunotherapy patients only. Seasonal increase rate in specific IgE was not significantly different between the patients who responded markedly to short‐term immunotherapy and those who did not. On the other hand, seasonal increase rate in specific IgG4 was significantly different between them. In contrast, seasonal increase rate in specific IgE was significantly smaller in the patients who showed marked response to the long‐term immunotherapy than those who did not show marked response to the long‐term immunotherapy, but seasonal increase rate in specific IgG4 was not significantly different between them. In conclusion, our results suggest that modulation of specific IgG4 response and specific IgE response might be involved in the early and late symptom relief during immunotherapy, respectively. However, further studies might be necessary to definitively establish the clinical roles of specific IgE and specific IgG4 in immunotherapy.
Primary Laryngeal Lymphoma
Authors: Ansell Stephen M. , Habermann Thomas M. , Hoyer James D. , Strickler John G. , Chen Michael G. , McDonald Thomas J.
Published: November 2003

Primary laryngeal lymphoma is a very rare entity, with fewer than 50 cases reported in the English literature in the past 60 years. Close scrutiny of some of these case reports reveals that the larynx was not always the only site of involvement, thereby diminishing the total number of patients with primary laryngeal lymphoma to fewer than 35. The authors report a series of six patients, who were seen and evaluated at the Mayo Clinic between 1952 and 1995, with stage IAE non‐Hodgkin's lymphoma of the larynx. Three patients had large‐cell lymphomas according to the REAL (Revised European‐American Lymphoid) classification. The other three had a small lymphocytic lymphoma, follicular small cleaved lymphoma, and follicular mixed lymphoma. All patients received radiation therapy alone as initial therapy for their disease and all patients had a complete remission to initial therapy. Four patients subsequently relapsed and the histology at relapse was the same as the initial histology in all four patients. Five patients have died, three of lymphoma, with a median survival of 67 months (range, 40 to 228 months). In view of the heterogeneity of histologies in this group of lymphomas, the variability in duration of response, and the significant number of patients who died of their disease, it is more likely that primary laryngeal lymphoma is an unusual presentation of non‐Hodgkin's lymphoma than a separate disease entity. Despite the small number of patients in this study, the data would suggest that patients are best treated according to the histology of the lymphoma, rather than the limited stage and location of the disease.
Fibrosing Inflammatory Pseudotumors of the Central Skull Base
Authors: Sung Myung‐Whun , Kim Kwang Hyun , Lee Chang Ho , Moh Jee Hoon , Kim Woo Ho , Han Moon Hee
Published: November 2003

The most important step in the differential diagnosis of mass lesions of the central skull base is to rule out malignant neoplasms. However, nonneoplastic lesions, such as infections or nonspecific inflammatory lesions of the skull base, can mimic malignant processes. In this study, the authors analyzed seven cases of nonneoplastic noninfectious mass‐forming lesions involving the central skull base. In most cases, malignant processes were suspected at the initial phase of diagnostic work‐up, but subsequent histologic examinations revealed that these lesions consisted of inflammatory cells and fibrosis without neoplastic cells. Common manifestations were pain and other neurological symptoms related to the involved anatomical sites. A variety of neurological dysfunctions of the cranial nerves not including the olfactory and spinal accessory nerves were observed. No patient developed separate lesions outside the head and neck region. After the pathologic diagnosis, most of the patients were treated with oral steroid therapy, with initial doses of prednisolone, 60 to 100 mg/d. It was difficult to relate responsiveness to steroid therapy with the histologic degree of sclerosis, fibrosis, or chronicity of the disease in these cases. Otolaryngologists should be aware of this disease when making treatment decisions for their patients with skull base lesions.
Inhibitory Effect of Macrolides on Interleukin‐8 Secretion From Cultured Human Nasal Epithelial Cells
Authors: Suzuki Hideaki , Shimomura Akira , Ikeda Katsuhisa , Furukawa Masayuki , Oshima Takeshi , Takasaka Tomonori
Published: November 2003

The mechanism of macrolide therapy in chronic sinusitis patients is unclear. The authors studied the effect of macrolides on interleukin (IL)‐8 secretion from cultured human nasal epithelial cells. Epithelial cells harvested from the nasal polyps of patients with chronic sinusitis were primary‐cultured, and secreted IL‐8 in culture media was measured by enzyme immunoassay. The cells secreted considerable amounts of IL‐8 constitutively and in response to lipopolysaccharide. The secretion was significantly inhibited by 10−5 M of erythromycin, clarithromycin, roxithromycin, and josamycin. 10−6 M erythromycin still showed the inhibitory effect, whereas the same concentration of josamycin did not. These results indicate that macrolide antibiotics may act as an immunomodulator to reduce IL‐8 in inflammatory sites and, at least partially, account for the clinically discrepant effects between 14‐ and 16‐membered ring macrolides in long‐term low‐dose therapy for chronic sinusitis.
Reconstruction of the Soft Palate by Uvulopalatal Flap
Authors: Zohar Yuval , Buler Nora , Shvilli Ytshak , Sabo Reni
Published: November 2003

Surgical removal of the soft palate in cases of neoplastic disease has a functionally detrimental effect on the patient, resulting in rhinolalia and nasal regurgitation. The authors describe their original surgical technique for repairing the lateral soft palate defect using a uvulopalatal flap. The flap is readily available and the procedure is single staged and without sequela. The aim of this reconstructive procedure is to obtain a diminished soft palate defect by primary surgery. In five patients who underwent a partial excision of the soft palate, the surgical defect was corrected at the time of initial surgery by a uvulopalatal flap. In this technique, the surface of the defect was diminished, postoperative rhinolalia and regurgitation were unremarkable, and sometimes an obturator was obviated. Using a local myomucosal flap, the procedure is simple, safe, and effective.
Nonsyndromic Autosomal Dominant Progressive Sensorineural Hearing Loss: Audiologic Analysis of a Pedigree Linked to DFNA2
Authors: Kunst Henricus , Marres Henri , Huygen Patrick , Ensink Robert , Van Camp Guy , Van Hauwe Peter , Coucke Paul , Willems Patrick , Cremers Cor
Published: November 2003

An analysis was performed of the regression of the individual hearing threshold on age in the affected persons in a six‐generation Dutch family with nonsyndromic autosomal dominant sensorineural hearing loss, which showed linkage to the DFNA2(1p34) region, similar to at least four previously reported nonrelated families. The offset threshold was significantly higher at the high frequencies (around 30 dB at 2 to 8 kHz) than at the lower ones(approximately 0 dB at 0.25 to 1 kHz). Hearing impairment at the higher frequencies may therefore have been present already at birth or in early childhood. The regression coefficient, or the ‘annual threshold increase,’ expressed in dB/y, was about 1 dB/y on average, but the higher frequencies (1 to 8 kHz) showed significantly more rapid progression than the lower frequencies (0.25 to 0.5 kHz).
Tube Placement: A Prospective, Randomized Double‐Blind Study
Authors: Derkay Craig S. , Wadsworth J. Trad , Darrow David H. , Strasnick Barry , Thompson G. Kevin , O'Master Jennifer
Published: November 2003

Bilateral myringotomy with tympanostomy tube placement is the second most frequently performed pediatric surgical procedure, next to circumcision. Postoperative pain relief for children undergoing this procedure has been an ongoing concern. The authors undertook a prospective, randomized, double‐blind, placebo‐controlled clinical study in 200 consecutive children to investigate the efficacy of oral acetaminophen, acetaminophen with codeine, ibuprofen, and placebo administered preoperatively in relieving postoperative pain in children undergoing this procedure. All children received topical analgesia consisting of antibiotic eardrops mixed with 4% lidocaine intraoperatively. There was no significant difference in postoperative pain score between the four groups (
P
> 0.4447). Thus it is likely that the intraoperative administration of antibiotic eardrops mixed with 4% lidocaine is all that is required to alleviate postoperative pain in children undergoing myringotomy with tympanostomy tube placement. Preoperative oral analgesics are apparently of little added benefit.
Lateralized and Bilateral Olfactory Function in Patients With Chronic Sinusitis Compared With Healthy Control Subjects
Authors: Klimek Ludger , Hummel Thomas , Moll Bertram , Kobal Gerd , Mann Wolf J.
Published: November 2003

Results of this study demonstrated that a new olfactory test, the “Sniffin' Sticks,” can be used to distinguish hyposmic patients with chronic sinusitis (n = 63) from control subjects. Dirhinic testing yielded improved olfactory sensitivity compared with monorhinic testing. However, dirhinic results were not significantly different from results obtained for the best nostril.
Morphology of the Developing Human Endolymphatic Sac
Authors: Ng Matthew , Linthicum Fred H.
Published: November 2003

The adult human endolymphatic sac (ES) has been described as a complex network of interconnected tubules. Embryologic examination describes the human ES as a single‐lumen, pouch‐like structure. Transition from saccular shape to tubules during the entire fetal period has not been previously reported. Tubular ES structure is thought to be unique to humans. Animal investigations describe similar saccular appearance, but without tubules in mature sacs. The authors examined 45 human fetal temporal bones to trace ES development and reviewed six types of animal sacs. Results in humans reveal tubular structure as early as 26 weeks' gestation. Maturation variably occurred in the fetal period and postnatally. For the first time, the tubular system is noted in the animal, the rhesus monkey. These findings suggest that the tubular system may represent more advanced specialized function.
111Indium Pentetreotide Scan Detection of Familial Paragangliomas
Authors: Myssiorek David , Palestro Christopher J.
Published: November 2003

Approximately 10% of head and neck paragangliomas are familial. Magnetic resonance imaging (MRI) is reported to be the best method for screening these families. 111Indium pentetreotide (Octreoscan®) scintigraphy has been shown to be a sensitive indicator of neural crest tumors such as paragangliomas. Early diagnosis and treatment of familial paragangliomas (FP) would decrease the morbidity of tumor excision. Patients from two kindred with FP were scanned 24 hours after intravenous injection with approximately 6 millicuries of 111Indium pentetreotide. The entire body was imaged. Areas of increased uptake were further imaged with MRI. Altogether, five patients had positive 111Indium pentetreotide scans. Two unsuspected glomus tympanicums and bilateral carotid body tumors were identified. Three people tested had no abnormal uptake. There were no untoward reactions to the nuclide. 111Indium pentetreotide scanning is a safe, noninvasive method for early diagnosis of FP and is useful in detecting multicentric lesions. Patients suspect for FP are undergoing 111Indium pentetreotide imaging and followed up with MRI of the involved site if positive.
Prognostic Factors in Papillary and Follicular Thyroid Carcinomas
Authors: Godballe Christian , Asschenfeldt Pia , Jørgensen Karsten E. , Bastholt Lars , Clausen Per P. , Hansen Tine P. , Hansen Olfred , Bentzen Søren M.
Published: November 2003

To identify clinical and histologic prognostic factors and to investigate whether immunohistochemical detection of p53 expression might contain prognostic information, a retrospective study of patient and tumor characteristics was performed in 225 cases of papillary and follicular thyroid carcinomas. The analyses were based on cause‐specific and crude survival. In univariate analysis, age at diagnosis, tumor size, presence of distant metastases, histology (papillary contra follicular type), extrathyroidal invasion, necrosis in primary tumor, and p53 expression were significant prognostic indicators. For 211 patients (96%) all information was available and Cox's proportional hazard model was applied. The authors found that age, distant metastases, necrosis in primary tumor, extrathyroidal invasion, and p53 expression were significant prognostic factors. Analyses of cause‐specific and crude survival gave similar results. The authors conclude that age at diagnosis, presence of distant metastases, necrosis in primary tumor, and extrathyroidal invasion are important prognostic factors, and that immunohistochemical detection of p53 protein in the primary tumor is a significant and independent prognostic indicator, which might be of value in the treatment planning in patients with papillary or follicular thyroid carcinomas.
Effects of Scalpel, Electrocautery, and CO2 and KTP Lasers on Wound Healing in Rat Tongues
Authors: Carew John F. , Ward Robert F. , LaBruna Anthony , Torzilli Peter A. , Schley W. Shain
Published: November 2003

Objective: Evaluate wound healing of incisions created by the scalpel, electrocautery, CO2 laser, and potassium titanyl phosphate (KTP) laser in the upper aerodigestive tract in an animal model.

Study Design: Prospective randomized study in an animal model.

Methods: Postoperative oral intake, histologic depth of injury, and tensile mechanical strength were measured in rat tongues after creating incisions using a scalpel, electrocautery, CO2 laser, and KTP laser. An unpaired, two‐tailed Student's t‐test was used to compare results between the experimental groups.

Results: Oral intake, indirectly assessed by postoperative weight loss, by the third postoperative day was significantly decreased in the electrocautery (P = 0.004), CO2 laser (P = 0.001), and KTP laser (P = 0.0001) groups as compared with the scalpel group. The depth of the wound healing, as assessed by histologic examination, was successively greater for the scalpel (75 ± 13 μm), electrocautery (110 ± 10 μm), CO2 laser (145 ± 10 μm), and KTP laser (195 ± 23 μm) groups. However, this difference was only statistically significant for the CO2 laser (P = 0.006) and KTP laser (P = 0.01) groups relative to the scalpel group. Wounds created by the KTP laser had the lowest strength (76.5 ± 6.9 kPa) as compared with the CO2 laser (156 ± 28.4 kPa), electrocautery (153 ± 15.7 kPa), and scalpel groups (249 ± 61.8 kPa). This difference was only statistically significant for the KTP laser group (P = 0.02) when compared with the scalpel group.

Conclusions: Wounds created in the upper aerodigestive tract of rats by scalpels result in the least postoperative weight loss, tissue destruction, and decrease in tensile strength, whereas wounds created by the KTP laser demonstrated a significantly greater postoperative weight loss, depth of wounding, and decrease in tensile strength.
Dextranomeres in Hyaluronan (DiHA): A Promising Substance in Treating Vocal Cord Insufficiency
Authors: Hallén Lars , Dahlqvist Åke , Laurent Claude
Published: November 2003

The morphology of the rabbit vocal cord was studied after injecting a mixture of dextranomere microspheres in sodium hyaluronan solution (DiHA), two substances that are nonimmunogenic and biocompatible. DiHA is already in clinical use as a space filler in pediatric urology (Deflux R). Specimens from injected vocal cords were investigated by light microscopy at different time intervals up to 6 months after injection. On macroscopic examination a bulge was seen in the injected vocal cord, and on microscopic examination new fibrous connective tissue developed. Throughout the study a weak inflammatory reaction was observed, but no foreign body reaction. Hyaluronan disappeared from the injected site within 1 week, but the dextranomeres remained and were recovered intact up to 6 months after injection. The dextranomeres recruited fibroblasts that generated new collagen, resulting in endogenous soft tissue augmentation. It is conceivable that DiHA may become a useful injection material for treatment of vocal cord insufficiency.
Effect of Systemic Pretreatment With Betamethasone on the Bacterial Flora, Inflammatory Response, and Polyp Formation in Experimentally Infected Rabbit Maxillary Sinus Mucosa
Authors: Norlander Tomas , Kwon Sam‐Hyun , Henriksson Gert , Westrin Karl Magnus , Sandstedt Karin , Stierna Pontus
Published: November 2003

To investigate possible effects of corticosteroids on polyp formation and local bacterial colonization, pneumococcal sinusitis was experimentally induced in rabbits pretreated with betamethasone or saline. After 7 days, macroscopic polyps were counted post‐mortem and on histologic slides after serial sectioning. Histologic sections were also examined with light microscopy. Macroscopic polyps were significantly fewer in animals given betamethasone, while there was no difference regarding the number of microscopic polyps. Ingrowth of pathogenic microorganisms was found in five of eight rabbits given placebo but in none of the animals treated with corticosteroids (P < 0.05). The reduced number of pathogenic strains in these animals may be explained by a better‐preserved local host defense. The lower number of macroscopic polyps in the same animals could be because of a delayed mucosal repair and subsequent polyp formation.
Audiometric Results of Bilateral Bone‐Anchored Hearing Aid Application in Patients With Bilateral Congenital Aural Atresia
Authors: van der Pouw Kitty T.M. , Snik F.M. , Cremers Cor W.R.J.
Published: November 2003

The effect of bilateral application of bone‐anchored hearing aids (BAHAs) was examined in terms of directional hearing and speech recognition in quiet and in noise in four patients with bilateral congenital atresia who, out of pure necessity, had been using a unilateral bone‐conduction hearing aid since early life. This study comprised a prospective clinical evaluation in a single subject design; four patients with bilateral congenital atresia originating from the Nijmegen BAHA series participated. Three patients had Treacher Collins syndrome. All four patients had conductive, most probably, symmetrical, hearing loss. Recently these patients had applied for a second BAHA and were subsequently fitted bilaterally. With two BAHAs, all four patients showed significant improvement in sound localization. Also, speech perception in quiet showed significant improvement with bilateral application, and a significant improvement was found in speech perception in noise in three patients. These results suggest that patients with congenital conductive, symmetrical hearing loss will benefit from bilateral BAHAs.