bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of the Optimal Conditions for Laryngeal Pacing with the Itrel Ii Implantable Stimulator
Authors: Zealear David L. , Swelstad Matthew R. , Sant'Anna Geraldo D. , Bannister Roger A. , Billante Cheryl R. , Rodriguez Ricardo J. , Garren Kurt C. , Billante Mark J. , Champney Michael S.
Published: February 2003

OBJECTIVE

To determine the optimal stimulus paradigm, electrode orientation, and configuration of an implantable stimulator used to reanimate the posterior‐cricoarytenoid (PCA) muscle in case of bilateral vocal fold paralysis (BVFP).

STUDY DESIGN

Acute studies were conducted on 13 canines implanted with Itrel II systems with or without PCA innervation. PCA stimulus‐response characteristics were obtained by measuring stimulated vocal fold displacement endoscopically.

RESULTS

The denervated PCA was only 10% to 25% as responsive to stimulation as the innervated PCA. However, the response could be increased to 38% and 61% if the Itrel was modified to deliver 1 and 2 msec pulses, respectively. Stimuli delivered centrally to the muscle 5 mm from the median raphe improved performance.

CONCLUSION AND SIGNIFICANCE

The optimal stimulus paradigm identified in this study (1 msec pulses delivered at 30 to 40 Hz and 2 to 8.5 mA) has been applied to implanted BVFP patients and improved outcome. Information regarding optimal electrode orientation could also be important to future clinical trials.
Intrinsic Nasal Muscles and their Electromyographic Evaluation after External Septorhinoplasty
Authors: Ozturan Orhan , Ozcan Cemal , Miman Murat Cem
Published: February 2003

OBJECTIVES

Rhinoplastic surgery is performed for the improvement in the appearance of the nose, but it should not cause any detrimental effect on the intrinsic muscles. This study was conducted to evaluate the influence of the external rhinoplasty on intrinsic nasal muscles.

METHODS

Twenty‐one patients were operated on by external septorhinoplasty. Functions of the nasal muscles were assessed by electromyography in response to voluntary nasal movements in patients before and after surgery.

RESULTS

Postoperative electromyographic activities of the muscles were significantly less than pre‐operative measurements for all movements.

CONCLUSION

Influence of the surgical incisions, alterations of the sites of origin and/or insertion of the muscles, and the postoperative healing process can be incriminated for the decreased muscular activity. Nasal muscle function requires a better appreciation and respect for the achievement of the best aesthetic and functional results. The nasal valve reconstructive procedures should be applied routinely to compensate for this inevitable muscular involvement.
Determination of the “Incidental” Lund Score for the Staging of Chronic Rhinosinusitis
Authors: Ashraf Nomaan , Bhattacharyya Neil
Published: February 2003

OBJECTIVE

Determine normative values for the Lund score for computed tomographic (CT) scans of the paranasal sinuses.

METHODS

Patients undergoing CT of the paranasal sinus region for nonsinusitis causes were evaluated and staged according to the Lund‐MacKay system. Complete and near complete Lund scores were computed from these scans and the frequencies of incidental paranasal abnormalities were tabulated.

RESULTS

A total of 199 patients who underwent CT scans of the internal auditory canals, pituitary, or orbits demonstrated adequate visualization of the paranasal sinuses. In 91 patients, the imaging was sufficient to compute a complete Lund score with a mean of 4.26 (95% CI, 3.43 to 5.10). In 130 patients, all sinuses were adequately imaged except for the ostiomeatal complex. For this near complete group, the mean prorated Lund score was 4.26 (95% CI, 3.55 to 4.97). Both of these scores differed significantly from an expected score of zero (P < 0.001).

CONCLUSIONS

The Lund score in the general population is not 0. A Lund score ranging from 0 to 5 may be considered within an incidentally “normal” range, and should be factored into clinical decision‐making.
Harmonic Scalpel Tonsillectomy versus Electrocautery Tonsillectomy: A Comparative Pilot Study
Authors: Walker Renee A. , Syed Zubair A.
Published: February 2003

OBJECTIVE

Using quality of life criteria, this pilot study prospectively evaluates if the ultrasonic dissector coagulator's (Harmonic Scalpel [HS], Ethicon Endo‐Surgery, Inc, Cincinnati, OH) unique properties offer advantages over traditional electrocautery (EC) tonsillectomies with respect to return to regular diet, activity, and complications such as bleeding and dehydration.

METHODS

Over a 13‐month period, 316 tonsillectomies (161 EC and 155 HS) were evaluated. Return to regular diet, regular activity, and the use of postoperative pain medications were monitored via a brief questionnaire. Complications, such as increased perioperative and postoperative bleeding, were monitored by chart review. Statistical analysis of the questionnaire data was performed.

RESULTS

Seventy‐five (46.6%) of the patients in the EC group responded versus 97 (62.6%) in the HS group. The ages ranged from 1 to 19 years old. Return to regular diet in 24 hours was statistically significant when comparing HS and EC questionnaire responders, 44.3% versus 22.7%, respectively; as was 72 hours, HS (74.2%) and EC (46.7%). Twenty‐eight percent of the HS questionnaire responders versus 12% of EC resumed normal activity within 24 hours. The perioperative blood loss was equal in the 2 groups. There were 14 late bleeds; 9 were EC patients and 5 HS patients. Two HS patients and 4 EC patients had readmissions for dehydration.

CONCLUSIONS

It appears from this early pilot study that the Harmonic Scalpel tonsillectomy offers advantages of early return to diet and activity over standard electrocautery tonsillectomies. We report no difference in perioperative or postoperative bleeding.
The Basic Symptom Inventory–‐53 and its Use in the Management of Patients with Psychogenic Dizziness
Authors: Ruckenstein Michael J. , Staab Jeffrey P.
Published: February 2003

OBJECTIVE

To identify an accurate psychological screening questionnaire to assist in the management of patients with psychogenic dizziness.

STUDY DESIGN

Patients referred to the Balance Center of the University of Pennsylvania with a presumptive diagnosis of psychogenic dizziness based on neurotologic assessment were administered a Basic Symptom Inventory–‐53 (BSI–‐53) psychological screening questionnaire and were referred for psychiatric assessment. Neither the patients nor the psychiatrist were aware of the results of the BSI–‐53. The results of the neurotologic assessment, the BSI–‐53, and the psychiatric assessment were then compared for their degree of association.

RESULTS

Strong associations were demonstrated between the results of the BSI–−53 questionnaire and the results of the neurotologic and psychiatric assessments.

CONCLUSIONS

The BSI–‐53 is an easily administered, objective, and accurate tool useful in identifying the presence of psychopathology in patients thought to have psychogenic dizziness. It is recommended as a valuable addition to the battery of tests performed when evaluating the dizzy patient.
Hearing Preservation in Patients with Vestibular Schwannomas with Sudden Sensorineural Hearing Loss
Authors: Friedman Rick A. , Kesser Bradley W. , Slattery William H. , Brackmann Derald E. , Hitselberger William E.
Published: February 2003

OBJECTIVE

We evaluated hearing outcomes in patients with sudden hearing loss and vestibular schwannoma who underwent a hearing preservation operation for tumor resection in an effort to determine whether a history of sudden sensorineural hearing loss has an impact on subsequent hearing preservation surgery.

METHODS

Retrospective chart review of 45 patients operated between 1990 and 1998. Patients were divided into “Recovery” (n = 22) and “No Recovery” (n = 23) groups based on preoperative hearing recovery. Hearing preservation was assessed using the AAO‐HNS hearing classification system.

RESULTS

Measurable hearing was preserved in 73% of patients, with 47% having good postoperative hearing (AAO‐HNS Classes A‐B). There was no significant difference in hearing outcome from patients presenting with progressive hearing loss (45% Classes A‐B). There was also no difference in postoperative hearing between the “Recovery” and “No Recovery” groups.

CONCLUSIONS

Patients with sudden hearing loss and vestibular schwannoma have the same chance of hearing preservation after tumor removal as those with progressive loss. Preoperative recovery of hearing is not predictive of hearing preservation. Available data support the nerve compression theory as the mechanism of sudden hearing loss in patients with vestibular schwannoma.
Extracranial Lower Cranial Nerve Sheath Tumors
Authors: Leonetti John P. , Wachter Bryan , Marzo Sam J. , Petruzzelli Guy
Published: February 2003

OBJECTIVE

The purpose of this article is to review the clinicoradiographic features of lower cranial nerve sheath tumors and to outline surgical approaches that allow the safe and complete resection of these lesions.

METHODS

Thirteen patients with lower cranial nerve sheath tumors of the infratemporal fossa were surgically treated between 7/88 and 10/99. A retrospective chart analysis provided details pertaining to clinical manifestations, radiographic assessment, intraoperative findings, tumor histology, and postoperative results.

RESULTS

The most common presenting symptoms were neck pressure and voice change while sub‐mucosal palatal fullness and vocal cord paralysis were the most common presenting signs. All tumors were removed via lateral skull base approaches and the most common postoperative sequelae was dysphasia.

CONCLUSION

Lower cranial nerve sheath tumors of the infratemporal fossa usually reach considerable size before diagnosis because of a naturally slow growth rate in this relatively silent location. The safe surgical removal of these tumors, based on superior control of the internal carotid artery, can be achieved through the use of contemporary lateral skull base techniques.
Predictors of Weight Loss During Radiation Therapy
Authors: Beaver Mary Es , Matheny Keith E. , Roberts Dianna B. , Myers Jeffrey N.
Published: February 2003

OBJECTIVE

To define risk factors for weight loss or dehydration during radiation therapy (RT).

STUDY DESIGN AND SETTING

Retrospective chart review, academic tertiary care center.

RESULTS

The incidence of severe weight loss during RT was 32.7%, the incidence of dehydration was 10.9%, and the rate of prophylactic feeding gas‐trostomy tube placement was 32%. The patients most likely to suffer severe weight loss included patients with tumor sites of nasopharynx and base of tongue, those treated with chemoradiation, and patients with severe pretreatment weight loss. Prophylactic feeding gastrostomy tube placement before RT significantly reduced the incidence of severe weight loss and hospitalization during RT.

CONCLUSION

Severe weight loss and dehydration during RT for head and neck cancer is common. Prophylactic feeding gastrostomy tubes significantly reduce the incidence of severe weight loss and hospitalization for dehydration during RT when placed before onset of RT. Patients at risk for severe weight loss include those with severe pretreatment weight loss, tumors of the nasopharynx and base of tongue, or treatment with chemoradiation.
Air Caloric Computer System Application in Monitoring Vestibular Function Changes after Cochlear Implantation
Authors: Szirmai Ágnes , Ribári Otto , Répássy Gábor
Published: February 2003

INTRODUCTION

The computer‐based ENG system's analytical routine refinements are available only in research laboratories. The computer‐based system contains a stimulator for saccadic eye‐movement and an air caloric stimulator interconnected to the registration program and analysis software. Several authors have reported the preoperative and postoperative vestibular functions in cochlear implant patients. The safe examination of the operated ear and comparison of the preoperative and postoperative average slow phase velocities of the caloric nystagmus is possible using the air caloric computer system.

METHODS

The authors have used a computer‐based ENG system with caloric air stimulation, which is very useful for examination of the operated ear. The vestibular system of patients with total deafness was examined before and after the cochlear implantation. The results of 60 vestibular examinations of 64 patients are reported.

RESULTS

The vestibular function in the operated ear was found unchanged in 20 patients. In 14 patients the vestibular function was worse. In 16 patients the postoperative vestibular responsiveness improved. The detailed data analysis of 10 patients in whom preoperative and postoperative vestibular examination was similar was performed by the authors. The preoperative and postoperative average slow phase velocity values and the relative canal paresis was observed. The values demonstrated that the caloric responsiveness of the operated ear improved in few cases.

CONCLUSIONS

The computer‐based air caloric system is a useful and safe method in evaluation of the vestibular system changes after ear surgery. The reason of the improvement of vestibular responsiveness is not clear. The results need further investigation to solve the problem of vestibular responsiveness improvement after cochlear implantation.
The Cytoscan Model E‐II in Intraoperative Parathyroid Gland Identification in a Rabbit Model
Authors: Sofola Ifeolumipo O. , Pazos George A. , Buttolph Thomas B. , Casler John D. , Leonard David W.
Published: February 2003

BACKGROUND

Intraoperative parathyroid gland identification and preservation is often a challenge even in the hands of experienced surgeons as they could be indistinguishable from fat or thyroid tissue.

OBJECTIVE

The goal of this study was to demonstrate the use of the Cytoscan Model E‐II, which uses orthogonal polarization spectral (OPS) imaging technology, as an intravital microscope in identifying parathyroid glands intraoperatively and differentiating the parathyroid glands from fat and thyroid tissue in a rabbit model.

METHODS

The necks of 4 New England white rabbits were explored with the animals under a general anesthesia. The Cytoscan was used to obtain images of the vasculature of tissue suspected to be parathyroid, fat, and thyroid tissue. These were confirmed by histologic evaluation.

RESULTS

All tissues were correctly identified by the Cytoscan and confirmed by histologic analysis. There was an obvious difference in the images obtained of fatty tissue as compared with parathyroid tissues. There was also an appreciable difference between parathyroid and thyroid tissue based on the difference in vascularity.

CONCLUSIONS

OPS imaging technology can be used in identifying parathyroid glands based on the difference in vascularity from fat and the pattern and density of vessels when compared with thyroid tissue in a rabbit model.

SIGNIFICANCE

The Cytoscan may play a future role in real time intraoperative identification of human parathyroid glands. Future investigation is warranted.
Primary Tracheal Papillomatosis Presenting as Reactive Airway Disease
Authors: Valentino Joseph , Brame C. Blake , Studtmann Karl E. , Manaligod Jose M.
Published: February 2003

Typically patients with recurrent respiratory papillomatosis (RRP) initially manifest laryngeal disease with symptoms of hoarseness, weak cry, and stridor. Extralaryngeal spread is not uncommon, and distal progression may be facilitated by airway epithelial injury, inducing squamous metaplasia. Kashima et al1 found laryngeal papilloma in 97.9% of 417 patients with RRP, but tracheal papilloma only when there was a positive history of tracheostomy. Indeed the diagnosis of RRP may be delayed, as its clinical features often resemble those of more common respiratory disorders.2 We present an 11‐year‐old boy with no history or evidence of laryngeal papillomata who nevertheless was discovered to have extensive tracheal papillomas.
Biomechanical Properties of Tissue‐Engineered Cartilage from Human and Rabbit Chondrocytes
Authors: Park Stephen S. , Chi David H. , Lee Arnold S. , Taylor S. Ray , Iezzoni Julia C.
Published: February 2003

OBJECTIVE

To describe tissue‐engineered cartilage from rabbit and human chondrocytes.

STUDY DESIGN AND SETTING

Chondrocytes from rabbit and human ears were seeded onto a tem‐plate and implanted for 8 or 16 weeks of in vivo incubation.

RESULTS

For the 8‐week and 16‐week groups, the UTS for cartilage was 3.8 MPa and 3.7 MPa, stiffness was 62.4 MPa and 51.8 MPa, and resilience was 181.8 J/m3 and 109.1 J/m3, respectively. Experimental cartilage was significantly different from controls. From 5 human specimens, the UTS was 5.4 MPa, stiffness was 6.6 MPa, and resilience was 2.0 J/m3. The control had UTS of 8.8 MPa, stiffness of 12.2 MPa, and resilience of 2.9 J/m3. Histology showed mature cartilage but with a fibrovascular infiltrate and increased cellularity.

CONCLUSIONS

Mechanical properties of tissue‐engineered cartilage can be quantified and are less than that of controls.
Psychometric and Clinimetric Validity of the 20‐Item Sino‐Nasal Outcome Test (Snot‐20)
Authors: Piccirillo Jay F. , Merritt Michael G. , Richards Michele L.
Published: February 2003

A valid measure of rhinosinusitis health status and quality of life is required for the complete assessment of treatment effectiveness. The purpose of this study was to analyze the psychometric and clinimetric validity of the 20‐Item Sino‐Nasal Outcome Test (SNOT‐20), a disease‐specific, health‐related quality‐of‐life measure for rhinosinusitis. The SNOT‐20 is a modification of the 31‐Item Rhinosinusitis Outcome Measure, and it contains 20 nose, sinus, and general items. To complete the instrument, patients indicate how much they are affected in each area and identify the 5 most important items. The SNOT‐20 was completed by 102, 72, and 46 patients at the initial visit and at 6 months and 1 year after treatment commencement, respectively. Cronbach's α was 0.9; test‐retest scores were highly correlated (r = 0.9). Patients who were more affected had greater SNOT‐20 scores (P < 0.002), and patients who had improved had greater change scores (P < 0.04). Items identified as important had greater scores (P < 0.0001) and showed greater change scores (P < 0.0002). The SNOT‐20 is a valid outcome measure for patients with rhinosinusitis; it describes the health burden and is sensitive to clinical change.
Eustachian Tube Dysfunction after Tobacco Smoke Exposure
Authors: Dubin Marc G. , Pollock Hoke W. , Ebert Charles S. , Berg Eric , Buenting John E. , Prazma Jiri P.
Published: February 2003

OBJECTIVE

To examine the effects of tobacco smoke exposure on eustachian tube (ET) function.

STUDY DESIGN

ET pressures of Sprague Dawley Rats (n = 16) were measured after 1, 7, and 15 exposures and in control animals. Passive opening pressure, passive closing pressure, active clearance of positive pressure, and active clearance of negative pressure were measured. Mucociliary clearance times were also quantified (n = 32).

RESULTS

Passive opening and passive closing pressures of smoke‐exposed animals were greater than controls (P < 0.05). Passive opening pressure in smoke‐exposed animals increased with increasing exposure (P < 0.001). Animals with 1 exposure had an active clearance of positive pressure higher than controls (P = 0.005) and those with 7 and 15 exposures had more negative active clearance of negative pressure than controls (P = 0.002, 0.03) Mucociliary clearance time was significantly elevated in experimental animals with 7 exposures (P = 0.006).

CONCLUSIONS

Alterations in ET function exist in animals exposed to tobacco smoke.

SIGNIFICANCE

ET dysfunction after tobacco smoke exposure may predispose children to the development of otitis media.
Does the Addition of Hyperbaric Oxygen Therapy to the Conventional Treatment Modalities Influence the Outcome of Sudden Deafness?
Authors: Aslan Ismet , Oysu Cagatay , Veyseller Bayram , Baserer Nermin
Published: February 2003

OBJECTIVE

To investigate the therapeutic effects of the addition of hyperbaric oxygen (HBO) therapy to the conventional therapies in sudden deafness (SD) and to investigate the influence of patient age on the effectiveness of HBO therapy.

STUDY DESIGN AND SETTING

We undertook a retrospective review of 50 cases of SD treated at a tertiary university hospital. Twenty‐five patients (group 1) were treated with betahistine hydrochloride, prednisone, and daily stellate ganglion block. A second group (group 2) of 25 patients received the same basic treatment with the addition of HBO therapy.

RESULTS

The mean hearing gain was 20.0 dB in group 1 and 37.9 dB in group 2 (P < 0.05). In group 2 patients, the mean gains were 51.4 and 23.3 dB for those younger and older than 50 years (P < 0.05) and 48.9 and 14.5 dB for those younger and older than 60 years (P < 0.001), respectively. In patients older than 60 years, the mean gains were 14.5 and 14.4 dB in group 2 and group 1, respectively (P > 0.05).

CONCLUSIONS

The addition of HBO therapy to the conventional treatment significantly improves the outcome of SD, especially in patients younger than 50 years. Additional HBO therapy provides limited benefit in patients older than 50 years and no benefit in patients older than 60 years.
Phase III Clinical Trial Results with the Vibrant Soundbridge Implantable Middle Ear Hearing Device: A Prospective Controlled Multicenter Study
Authors: Luetje Charles M. , Brackman Derald , Balkany Thomas J. , Maw Jennifer , Baker R. Stanley , Kelsall David , Backous Douglas , Miyamoto Richard , Parisier Simon , Arts Alexander
Published: February 2003

OBJECTIVES

The goal of the study was to evaluate the performance of a semi‐implantable middle ear hearing device (Vibrant Soundbridge System [VSB]; Symphonix Devices, Inc).

STUDY DESIGN

A prospective, single‐subject, repeated‐measures multicenter study was conducted to determine the safety and efficacy of the VSB using analog and digital external processors. Measures included residual hearing, functional gain, speech recognition, acoustic feedback, occlusion, and patient self‐assessment to determine satisfaction, perceived performance, and device preference compared with an appropriately fit acoustic hearing aid. Fifty‐three adult subjects with moderate to severe sensorineural hearing loss were evaluated at 4 or more intervals after implantation.

RESULTS

Improvements in satisfaction, performance, and preference were statistically significant with the VSB, as was functional gain across all test frequencies (P < 0.001). Occlusion and feedback were virtually eliminated. Aided speech recognition was comparable between VSB and the hearing aid. Residual hearing was unchanged.

CONCLUSION

The VSB is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss.
Distortion‐Product Otoacoustic Emissions in Nonacoustic Tumors of the Cerebellopontine Angle
Authors: Mobley Steven Ross , Odabasi Onur , Ahsan Syed , Martin Glen , Stagner Bart , Telischi Fred F.
Published: February 2003

OBJECTIVES

The goal of the present study was to compare the frequencies of cochlear and noncochlear patterns of distortion‐product otoacoustic emissions (DPOAEs) in patients with nonacoustic (non‐AN) tumors of the cerebellopontine angle (CPA)/internal auditory canal with those in patients with acoustic neuroma (AN).

STUDY DESIGN AND SETTING

We conducted a prospective study of patients with non‐AN internal auditory canal/CPA tumors treated between 1992 and 1999 in a tertiary care setting. We collected data on behavioral pure tone average, speech discrimination score, acoustic immittance tests, DPOAEs, and tumor size. DPOAEs were divided into those with a cochlear or a noncochlear pattern. Comparisons were made with a control group of patients with AN of the CPA.

RESULTS

Twenty‐four patients were included in the study: 12 patients in the non‐AN group and 12 patients in the AN group. In the non‐AN group, 5 (42%) patients had a cochlear pattern and 7 (58%) had a noncochlear pattern. In the AN group, 7 (58%) patients had a cochlear pattern and 5 (42%) had a noncochlear pattern. The differences between the non‐AN and AN groups were statistically significant. In the non‐AN group, patients with a cochlear‐pattern DPOAE had significantly smaller tumors (P = 0.03) and a trend (P = 0.07) toward higher speech discrimination score. Age and pure tone average were not significantly different in the non‐AN tumor patients. In the AN group, none of the study parameters were significantly related to the pattern of DPOAE.

CONCLUSIONS

ANs appear to differ from other tumors of the CPA in their propensity to cause sensory versus neural hearing loss. A larger series of patients would be useful to confirm these preliminary findings.
Airway Complications of Infant Botulism: Ten‐Year Experience with 60 Cases
Authors: Anderson Timothy D. , Shah Udayan K. , Schreiner Mark S. , Jacobs Ian N.
Published: February 2003

OBJECTIVE

The study goal was to understand the incidence, etiology, and management of airway complications in infant botulism.

METHODS

We conducted a retrospective review of the period from January 1, 1987, to December 31, 1997.

SETTING

Urban tertiary care children's hospital.

RESULTS

Of 60 children with infant botulism, 37 (61.7%) required endotracheal intubation for a mean of 21 days. No patient required a tracheostomy. Airway complications (stridor, subglottic stenosis, granuloma formation) occurred in 5 (13.5%) of 37 patients, with 3 requiring surgical bronchoscopy. Of the 37 children, 14 (37.8%), including 4 with airway complications, had endotracheal tube leak pressures recorded. In 3 (50%) of 6 patients with measured leak pressures of greater than 40 cm H2O, airway complications developed. Complications did not develop in patients with leak pressures of less than 20 cm H2O. No correlation between length of intubation and complications could be established.

CONCLUSION

Airway complications in infant botulism may be accompanied by high leak pressures and can be managed with endoscopic techniques. The study data suggest that leak pressures should be measured on a regular basis and maintained at less than 20 to 25 cm H2O. A prospective trial to study this issue is warranted. Tracheotomy is not routinely necessary. A high index of suspicion, early diagnosis, and prompt intervention are required for the optimal management of airway complications in infant botulism.
Argon Beam Coagulation for Post‐Tonsillectomy Hemostasis
Authors: Bowling David M.
Published: February 2003

OBJECTIVE

The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post‐tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser.

METHODS

Two consecutive studies were performed as follows. In the first, a retrospective analysis of post‐tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient‐blind study of post‐tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random.

RESULTS: Post‐tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood‐streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total.

CONCLUSION

ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.
Duplicate Publication in the Field of Otolaryngology‐Head and Neck Surgery
Authors: Bailey Byron J.
Published: February 2003

OBJECTIVE

This study establishes the approximate prevalence and patterns of duplicate publication in the medical literature in the specialty of otolaryngology‐head and neck surgery.

STUDY DESIGN AND SETTING

All of the authors and articles published in the American Medical Association Archives of Otolaryngology‐Head and Neck Surgery were identified and listed for an 8‐year period. During this time, 1965 authors published 1082 articles in the Archives, and this same set of authors published a total of almost 50,000 articles during the 12‐year period between January 1977 and December 1988. Of the same set of 1965 authors, we picked 1000 at random and found that they had published a total of 24,353 articles. The titles of these articles were then screened for similar titles, and when similarities were noted, the complete articles were obtained when possible and compared for the degree and pattern of duplicate publication.

RESULTS

Of the 1000 authors studied, we found that 228 authors had published 938 articles with similar titles. We were able to obtain the full copy of 886 (94%) of the 938 articles in question, which were written by 226 (99%) of the 228 authors. We found that in the case of 25 authors, there was no duplication despite the similar titles, but in the case of 201 (20% of the 1000) authors, 644 articles were published with some degree of duplication (1.8% duplication rate).

CONCLUSIONS

The most common duplicate publication involves sequential publication of very similar data and conclusions. Duplicate publications failed to reference prior articles by the same author 32% of the time or referenced the prior articles only partially (11% of the time). Artificial segmentation of a single study into multiple arbitrary segments composed 20% of the duplicate publication. Duplicate publication across different specialties was noted to account for 4% of the instances. Most of the authors duplicated only once or twice, and most duplicators do reference their prior publications.

SIGNIFICANCE: Duplicate publication is an example of inappropriate academic conduct. Because it tarnishes the reputation of the duplicating author and represents an unfair practice in terms of displacing the work of others, efforts should continue to educate authors, particularly young academicians, to avoid the practice of duplicate publication.
Sleepy Driving: Accidents and Injury
Authors: Powell Nelson B. , Schechtman Kenneth B. , Riley Robert W. , Li Kasey , Guilleminault Christian
Published: February 2003

OBJECTIVE

The study goals were to evaluate the associated risks of driving and to assess predictors of accidents and injury due to sleepiness.

STUDY DESIGN

A cross‐sectional Internet‐linked survey was designed to elicit data on driving habits, sleepiness, accidents, and injuries during the preceding 3 years. Statistical analysis included logistic models with covariate‐adjusted P values of <0.01 (odds ratios and 95% confidence intervals or limits). Independent accident predictors were sought.

RESULTS

Responses from 10,870 drivers were evaluated. The mean ± SD age was 36.9 ± 13 years; 61% were women and 85% were white. The Epworth Sleepiness Scale overall baseline score was 7.4 ± 4.2 (for drivers with no accidents) and ranged to 12.7 ± 7.2 (for drivers with ≥ 4 accidents) (P = < 0.0001). Twenty‐three percent of all respondents experienced ≥ 1 accident. Among respondents who reported ≥ 4 accidents, a strong association existed for the most recent accident to include injury (P < 0.0001). Sleep disorders were reported by 22.5% of all respondents, with a significantly higher prevalence (35%, P = 0.002) for drivers who had been involved in ≥ 3 accidents.

CONCLUSION

Factors of sleepiness were strongly associated with a greater risk of automobile accidents. Predictors were identified that may contribute to accidents and injury when associated with sleepiness and driving.
Octogenarian Free Flap Reconstruction: Complications and Cost of Therapy
Authors: Blackwell Keith E. , Azizzadeh Babak , Ayala Carlos , Rawnsley Jeffrey D.
Published: February 2003

OBJECTIVE

The study goal was to document the reliability, incidence of complications, and cost of therapy for patients older than 80 years who undergo microvascular head and neck reconstruction.

PATIENTS AND METHODS

Thirteen octogenarians underwent free flap reconstruction of defects resulting from the treatment of head and neck cancer at an academic tertiary care medical center. The incidence of medical and reconstructive complications and the cost of hospitalization were compared with those for 99 younger patients who were treated during the same time period.

RESULTS

There were no cases of free flap failure or significant reconstructive complications in the octogenarians. The incidence of medical complications was 62% in the octogenarians and 15% in the younger patients. The average cost of therapy was $54,702 per octogenarian patient compared with $30,397 per younger patient. The increased incidence of medical complications and increased cost arose primarily from an increased severity of preoperative systemic illness in the octogenarians. However, controlling for comorbidity did not eliminate the discrepancy in medical complications between the octogenarians and the younger patients.

CONCLUSIONS

Although microvascular head and neck reconstruction in the elderly is very reliable, the incidence of medical complications and the cost of therapy are significantly increased in octogenarians.
Effectiveness of second‐generation fibrin glue in endonasal operations
Authors: Vaiman Michael , Eviatar Ephraim , Segal Samuel
Published: February 2003

We evaluated the efficacy and safety of the Quixil fibrin sealant after its application to endonasal operative sites. A total of 153 patients underwent nasal surgery. The rate of hemorrhagic complications was compared in the group with nasal packing and in the group in whom fibrin glue was used to stop postoperative bleeding. Our results indicate that the application of Quixil fibrin glue to the operative sites in various endonasal operations provides effective hemostasis and sealing. This fibrin glue is a more effective hemostatic agent than foam nasal packing and provides no complications, as can occur with packing. Patients with hypertension have no greater risk for postoperative bleeding if Quixil is used.
Can patient satisfaction with decisions predict compliance with surgery?
Authors: Parhiscar Afshin , Rosenfeld Richard M.
Published: February 2003

BACKGROUND

Patient satisfaction with treatment decisions is a discrete and measurable component of the satisfaction paradigm, distinct from satisfaction with health care services.

OBJECTIVE

The study goal was to determine if the Satisfaction With Decision (SWD) scale, a valid and reliable 6‐item survey, can predict patient compliance with surgery proposed by their otolaryngologist.

DESIGN

Prospective study using the SWD scale plus measures of office visit satisfaction, provider satisfaction, and disease‐specific quality of life.

SETTING

Metropolitan, private nonprofit hospital.

PATIENTS

The study population consisted of 151 patients scheduled for surgery, with a median age of 5.8 years and an age range of 0.6 to 65.3 years.

INTERVENTIONS

At the time surgery was scheduled, the decision‐maker completed a 12‐item questionnaire about satisfaction and quality of life that included the SWD scale. Noncompliant patients were contacted, and the specific reason for cancellation was ascertained.

RESULTS

The strongest predictor of surgical cancellation was the SWD survey score, with a median value of 4.8 for patients completing surgery compared with 3.8 for those who cancelled (P < 0.001). Patients with scores <4.0 had a 57% cancellation rate, whereas those with scores >4.0 had a 98% completion rate. Patients were also more likely to cancel if it was their first visit with the surgeon (P = 0.004) or if they were responsible for their own decisions (P = 0.007). Cancellations were not associated with office visit satisfaction, patient quality of life, or demographic characteristics of the decision‐maker.

CONCLUSIONS

Patients who are satisfied with their initial decision to undergo surgery are most likely to comply with planned therapy. Conversely, patients who score <4.0 on the SWD scale may benefit from additional preoperative counseling to increase the likelihood of compliance.
Autonomic dysfunction, vasomotor rhinitis, and extraesophageal manifestations of gastroesophageal reflux
Authors: Loehrl Todd A. , Smith Timothy L. , Darling Ronald J. , Torrico Laura , Prieto Thomas E. , Shaker Reza , Toohill Robert J. , Jaradeh Safwan S.
Published: February 2003

OBJECTIVE

Several recent reports suggest there may be a relationship between chronic rhinitis and extraesophageal manifestations of gastroe‐sophageal reflux (EER). It is hypothesized that this relationship is a result of autonomic nervous system (ANS) dysfunction.

STUDY DESIGN

Patients with isolated vasomotor rhinitis (VR), both VR and EER, and a control group were studied by a battery of tests designed to objectively evaluate ANS function. In addition all 3 groups underwent barium esophagogram and 4‐site (proximal pharynx, distal pharynx, proximal esophagus, and distal esophagus) ambulatory pH monitoring. Adult patients fulfilling diagnostic criteria for VR, and with both VR and EER underwent objective ANS testing in a recently developed ANS testing laboratory. The control group consisted of age‐ and sex‐matched adults without diagnostic criteria for VR or EER.

RESULTS

In patients with VR only (n = 9), 2 patients had a positive esophagogram, whereas a positive pharyngeal reflux probe was found in 1 and an abnormal composite autonomic scoring scale (CASS) was found in 8 (mean VR CASS = 1.750 vs control CASS 0.556, P =. 02). The group with VR and EER (n = 12) had a positive esophagogram in 10 patients, positive pharyngeal reflux by probe in 9, and all 12 had an abnormal CASS (mean CASS VR/EER = 2.909 vs CASS control = 0.556, P =. 001 and vs VR CASS = 1.750, P =. 05). The control patients (n = 9) had normal transesopohageal gastroduo‐denoscopy in 8, 1 had a positive pharyngeal probe study, and all 9 had a normal CASS. In addition ANS testing in patients with diagnostic criteria for both VR/EER revealed statistically significant evidence of an adrenergic deficit as compared with control patients on the basis of mean phase II blood pressure response to Valsalva maneuver (mean phase II VR/EER = −16.730 vs control = −7.780, P =. 05). In the VR only group, the phase II blood pressure decrease was greater than in control patients, but did not reach statistical significance (mean phase II VR = −9.370 vs control = − 7.780, P = 0.672).

CONCLUSION

Patients with VR and VR/EER have objective evidence of ANS dysfunction when compared with a group of age‐ and sex‐matched control patients. Patients with both VR/EER demonstrate a significantly greater degree of ANS dysfunction than patients with isolated VR. The mechanism by which VR and EER interact is not entirely clear, but ANS dysfunction is objectively associated with both disorders. In addition, patients with VR/EER seem to demonstrate hypo‐function of the adrenergic component of the ANS, in contrast to the generally held hypothesis that VR results from increased cholinergic activity. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.
Evidence‐based medicine in otolaryngology journals
Authors: Bentsianov Boris L. , Boruk Marina , Rosenfeld Richard M.
Published: February 2003

OBJECTIVE

We set out to assess, within the context of evidence‐based medicine, the levels of supporting evidence for therapeutic recommendations made in leading otolaryngology journals.

DESIGN

We used a cross‐sectional survey of clinical research articles published in 1999 in 4 high‐circulation otolaryngology journals.

OUTCOME MEASURES

We used study design methodology and level of evidence for clinical research articles with therapeutic recommendations. Outcomes were stratified by type of recommendation (positive vs negative) and by study focus (medical vs surgical therapy).

RESULTS

Of the 1019 articles identified, 737 (72%) were clinical research and 268 (36%) made therapeutic recommendations. Median sample size was modest (27 subjects), with only 38% of studies reflecting planned research and 22% including an internal control or comparison group. positive studies were 20 times more prevalent than negative ones, but were 69% less likely to have an internal control group (P =. 042) and 93% less likely to include confidence intervals (P =. 020). Moreover, the level of evidence for positive studies was lower than for negative studies (P =. 037), with twice as many negative recommendations supported by analytic research. Similarly, the level of evidence for operation was lower than for medical therapy (P <. 001), with 3 times as many medical recommendations supported by analytic research.

CONCLUSIONS

Most therapeutic recommendations in otolaryngology journals are on the basis of descriptive case series (80%) and least often on randomized controlled trials (7%). A dual standard appears to exist for negative versus positive studies and for medical versus surgical recommendations. Greater scrutiny of the breadth and quality of evidence levels supporting therapeutic recommendations is likely to occur as the popularity of—and demand for—evidence‐based medicine increases.

SIGNIFICANCE

Evaluation of levels of evidence in otolaryngology decision making.
Hydroxyapatite Cement Cranioplasty in Translabyrinthine Acoustic Neuroma Surgery
Authors: Arriaga Moisês A. , Chen Douglas A.
Published: February 2003

OBJECTIVES

Hydroxyapatite cement cranioplasty (HAC) after translabyrinthine resection of acoustic neuroma is a promising new technique for wound reconstruction. This study reviews the efficacy of HAC for the prevention of cerebrospinal fluid (CSF) leakage and the long‐term wound outcomes of HAC versus abdominal fat graft (AFG) reconstruction.

METHODS

This retrospective study of 108 consecutive acoustic neuromas operated on by Pittsburgh Ear Associates uses chart review, telephone interview, and mail questionnaire data. Fifty‐four patients received AFG dural repair, and 54 patients received HAC.

RESULTS

Seven AFG patients (12.5%) had CSF leaks versus 2 (3.7%) of the overall group of 54 HAC patients. However, none (0%) of the 47 HAC patients had CSF leakage with current HAC techniques. HAC also produced significantly less postauricular wound depression and superior cosmetic results in comparison with AFG. Although HAC patients experienced less postoperative discomfort, wound complications requiring medical or surgical intervention were extremely uncommon in both groups.

Conclusion: HAC offers significant CSF leakage control and long‐term cosmetic and comfort advantages over AFG alone. We recommend HAC as the standard closure technique for translabyrinthine acoustic neuroma surgery.
Surfer's Ear: External Auditory Exostoses are More Prevalent in Cold Water Surfers
Authors: Kroon David F. , Lawson M. Louise , Derkay Craig S. , Hoffmann Karen , McCook Joe
Published: February 2003

OBJECTIVE

The study goal was to demonstrate the prevalence and severity of external auditory exostoses (EAEs) in a population of surfers and to examine the relationship between these lesions and the length of time surfed as well as water temperature in which the swimmers surfed. It was hypothesized that subjects who predominantly surfed in colder waters had more frequent and more severe exostoses.

METHODS

Two hundred two avid surfers (91% male and 9% female, median age 17 years) were included in the study. EAEs were graded based on the extent of external auditory canal patency; grades of normal (100% patency), mild (66% to 99% patency), and moderate‐severe (<66% patency) were assigned. Otoscopic findings were correlated with data collected via questionnaires that detailed surfing habits.

RESULTS

There was a 38% overall prevalence of EAEs, with 69% of lesions graded as mild and 31% graded as moderate‐severe. Professional surfers (odds ratio 3.8) and those subjects who surfed predominantly in colder waters (odds ratio 5.8) were found to be at a significantly increased risk for the development of EAEs. The number of years surfed was also found to be significant, increasing one's risk for developing an exostosis by 12% per year and for developing more severe lesions by 10% per year. Individuals who had moderate‐severe EAEs were significantly more likely to be willing to surf in colder waters than were those who had mild EAEs (odds ratio 4.3).

CONCLUSIONS

EAEs are more prevalent in cold water surfers, and additional years surfing increase one's risk not only for developing an EAE but also for developing more severe lesions.
Maxillary Sinus Puncture and Culture in the Diagnosis of Acute Rhinosinusitis: The Case for Pursuing Alternative Culture Methods
Authors: Benninger Michael S. , Appelbaum Peter C. , Denneny James C. , Osguthorpe David J. , Stankiewicz James A.
Published: February 2003

OBJECTIVE

Traditional assessments of the microbial flora associated with acute bacterial rhinosinusitis have relied on maxillary sinus punctures (taps) and culture. These taps are now considered the gold standard for obtaining cultures and are used as the method of identifying bacterial pathogens in antimicrobial trials. Maxillary sinus taps are limited by discomfort to the patients and technical concerns. Because of these factors, the standard of performing taps has limited antibiotic trials and microbial surveillance. Alternatives to maxillary sinus taps have been explored.

STUDY DESIGN

We conducted a retrospective, systematic review of the literature from 1950 to 2000 of articles comparing culture techniques in the nose and paranasal sinuses for acute bacterial rhinosinusitis.

RESULTS

Nasal cultures have poor correlation to maxillary sinus cultures, whereas there is 60% to 85% concordance between endoscopically guided middle meatal cultures and maxillary sinus cultures. These studies, however, are all limited by small sample sizes and therefore are inadequate to make any concrete recommendations regarding the relative role of endoscopically guided middle meatal cultures as a formal method of pathogen identification in acute bacterial rhinosinusitis.

CONCLUSION

A formal prospective study with sufficient sample size to assess the concordance between the microbial flora of the maxillary sinus punctures and middle meatal cultures in acute rhinosinusitis is recommended.
A Review of Outcome Measurements for Voice Disorders
Authors: Hogikyan Norman D. , Rosen Clark A.
Published: February 2003

There has been great interest in the medical and associated communities in the development and use of patient‐based outcome measures such as quality‐of‐life and handicap indexes. This area of assessment of initial disability and response to subsequent treatment is especially applicable to the field of laryngology and voice disorders given the limitations of perceptual analysis and objective vocal function studies. In this review, we outline the development and importance of patient‐based outcome measures in general, and their application for voice disorders specifically. In addition, several voice‐specific instruments are discussed in detail and provided. One of the primary goals of this review is to educate and facilitate the future use of these simple but important patient‐based outcome instruments for otolaryngologists who care for patients with voice disorders.