bluuebunny/crossref_metadata_2025 huggingface dataset:
Morbidly Obese Patients With Severe Obstructive Sleep Apnea: Is Airway Reconstructive Surgery a Viable Treatment Option?
Authors: Li Kasey K. , Powell Nelson B. , Riley Robert W. , Zonato Adriane , Gervacio Lindsay , Guilleminault Christian
Published: November 2003

Objective To evaluate the outcomes of airway reconstructive surgery for the treatment of severe obstructive sleep apnea in the morbidly obese patient.

Methods Retrospective review of consecutively treated patients. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), cephalometric data, and complications.

Results Twenty‐one patients (13 men) with a mean age of 42.6 ± 7.9 years and mean BMI of 45 ± 5.4 kg/m2 were identified. The mean RDI improved from 83 ± 30.1 to 10.6 ± 10.8 events per hour with an improved mean apnea index from 38.4 ± 31.3 to 1.2 ± 1.8 events per hour. The mean LSAT improved from 63.9 ± 17.7% to 86 ± 7.9%. The mean BMI at the 6‐month postoperative polysomnographic recording was 43 ± 4.3 kg/m2 (P < . 001). Seventeen patients (81%) were successfully treated (RDI < 20 and with minimal desaturation < 90%). The mean follow‐up was 21.8 ± 15.4 months (range, 7–66 mo). Coexisting obesity‐hypoventilation syndrome was related to treatment failure in two patients. One patient noted recurrence of daytime fatigue after significant weight gain 4 years after surgery and the polysomnographic recordings demonstrated the recurrence of obstructive sleep apnea.

Conclusion Airway reconstruction is an effective treatment for severe obstructive sleep apnea in the morbidly obese patient. Careful patient selection and identifying potential coexisting obesity‐hypoventilation syndrome, as well as counseling on weight reduction and avoiding continual weight gain will improve treatment outcomes.
Microbiology of Healthy and Diseased Adenoids
Authors: Brook Itzhak , Shah Kiran , Jackson William
Published: November 2003

Objective To determine the qualitative and quantitative microbiology of core adenoid tissue obtained from four groups of 15 children each, with recurrent otitis media (ROM), recurrent adenotonsillitis (RAT), obstructive adenoid hypertrophy (OAH), and occlusion or speech abnormalities (controls).

Methods Core cultures of surgically removed diseased adenoids and of healthy controls were cultured for aerobic and anaerobic bacteria.

Results Polymicrobial aerobic‐anaerobic flora were present in all instances. Ninety‐four organisms were isolated from control specimens, and 148 from ROM, 142 from RAT, and 149 from OAH specimens. The predominant aerobes in all groups were α‐hemolytic and γ‐hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A β‐hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium species. The number, concentration and distribution of types of most organisms did not vary among the three groups of diseased adenoids. However, the number of those that are potential pathogens and those that produced β‐lactamase was lower in the control than the diseased adenoids (P < .001).

Conclusion The study highlights the importance of the bacterial load in the adenoids in contributing to the etiology of ROM, RAT, and OAH.
Fat Augmentation for Glottic Insufficiency
Authors: Hsiung Ming‐Wang , Woo Peak , Minasian Amy , Schaefer Mojica Jacqueline
Published: November 2003

Objectives Fat lipoinjection augmentation for glottic insufficiency has been used in patients with vocal fold paralysis. Relatively little information is available on the effectiveness of fat injection in patients with vocal atrophy, intubation trauma, and post‐hemilaryngectomy defects.

Study Design This paper retrospectively compares the efficiency of fat injection in patients with vocal cord paralysis (n = 9), vocal scar (n = 13), and vocal atrophy (n = 11).

Methods The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after fat augmentation in 33 patients.

Results Mean follow‐up time was 9.7 months. Nineteen patients had excellent results. Three patients had no change. Five patients had late failure. Six patients were lost to follow‐up. Phonatory function showed significant improvement in jitter, shimmer, noise‐to‐harmonic ratio, maximal phonation time, grade, asthenia, and breathiness (P < .05). Videolaryngostroboscopic rating showed significant improvement in right linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, vibratory behavior, and phase symmetry (P < .05). Anterior defects did better than posterior defects. Small vocal fold defects did better than large defects.

Conclusions Fat injection is a good autogenous implant and may be considered as an option in management of patients with vocal fold scar, defect, or atrophy. Reabsorption of fat is a problem, but the procedure may be repeated.
Endoscopic Terminal Dacryocystorhinostomy
Authors: Sham Cheuk Lun , Andrew van Hasselt Charles
Published: November 2003

Objective Traditional endoscopic dacryocystorhinostomy (DCR) involves creation of a lacrimal sac side hole that may close down in the presence of a partially patent lower lacrimal drainage system. Endoscopic terminal DCR is a modified DCR procedure designed to prevent this problem.

Methods From September 1996 to June 1999, 16 patients (17 sides) had endoscopic terminal DCR that involved resection of the lacrimal sac‐duct junction to achieve total separation of the lacrimal sac from the nasolarcrimal duct and creation of a terminal DCR opening.

Results Ten of the 17 DCRs were primary and 7 were revisions. The follow‐up ranged from 3 to 36 months. There were two failures. One failure was due to canalicular obstruction and the other was due to prolapse of orbital fat hindering proper fashioning of the mucosal flap. The overall success rate was 88%.

Conclusions Instead of creating a side hole in the lacrimal sac as proposed by most endoscopic DCR studies, we advocate total diversion of tear flow by performing a terminal DCR opening that would further improve the success rate of endoscopic DCR, particularly in cases of idiopathic and partial obstruction.
Sinus Tissue Pharmacokinetics After Oral Administration of Amoxicillin/Clavulanic Acid
Authors: Borges Dinis Paulo , Conceição Monteiro Maria , Luz Martins Maria , Silva Nuno , Gomes Augusto
Published: November 2003

Objectives The in vitro synergy of the amoxicillin/clavulanic acid combination has not always translated in vivo into clinical superiority compared with amoxicillin alone. Specifically, conflicting reports have disputed the superiority of the combination in the treatment of both acute otitis media and acute sinusitis. One possible reason for this may have to do with inadequate target tissue pharmacokinetics. To explore this possibility in the sinuses, we undertook the present investigation.

Study Design A randomized, open, single‐dose, sinus tissue pharmacokinetic study with oral amoxicillin/clavulanic acid.

Methods Twenty‐three adult patients with chronic rhinosinusitis who had been selected for surgery were randomly allocated to receive a tablet of 875/125 mg amo‐icillin/clavulanate 2 to 4 hours before surgery began. During the operation tissue samples were collected at specific sinonasal sites for determination of both amo‐icillin and clavulanic acid concentration levels.

Results Amoxicillin displayed adequate tissue levels throughout the sinuses, high enough to cover common susceptible pathogens. However, the presence of clavulanate was detected in only half of the sinonasal tissue samples.

Conclusions The kinetics of oral clavulanic acid apparently fails to provide a widespread anti–β‐lactamase activity capable of enhancing the activity of amoxicillin in all parts of the sinuses. Despite this, amoxicillin/clavulanic acid maintains a central role in the treatment of acute rhinosinusitis, because amoxicillin is still the most effective oral β‐lactam against Streptococcus pneumoniae, a particularly virulent and increasingly resistant upper respiratory tract pathogen. Also, as our data show, a concomitant anti–β‐lactamase activity can be expected to occur, although in an unpredictable fashion.
Pediatric Tracheotomies: Changing Indications and Outcomes
Authors: Carron Jeffrey D. , Derkay Craig S. , Strope Gerald L. , Nosonchuk Jane E. , Darrow David H.
Published: November 2003

Objective/Hypothesis To study the outcomes and complications associated with pediatric tracheotomy, as well as the changing trend in indications and outcomes since 1970.

Study Design Retrospective chart review at a major tertiary care children's hospital.

Methods On children who underwent tracheotomy at Children's Hospital of the King's Daughters (Norfolk, VA) between 1988 and 1998, inpatient and outpatient records were reviewed. Of 218 tracheotomies, sufficient data were available on 204. Indications for tracheotomy were placed into the following six groups: craniofacial abnormalities (13%), upper airway obstruction (19%), prolonged intubation (26%), neurological impairment (27%), trauma (7%), and vocal fold paralysis (7%).

Results The average age at tracheotomy was 3.2 ± 0.6 years. Although the prolonged intubation group was significantly younger than all others, the neurological impairment and trauma groups were significantly older. Decannulation was accomplished in 41%. Time to decannulation was significantly higher in the neurological impairment and prolonged intubation groups, but was significantly shorter in the craniofacial group. Complications occurred in 44%. Overall mortality was 19%, with a 3.6% tracheotomy‐related death rate. Comparison of our series to other published series of pediatric tracheotomies since 1970 shows fewer being performed for airway infections and more for chronic diseases, with a corresponding increase in duration of tracheotomy and decreased decannulation rates.

Conclusions Tracheotomy is a procedure performed with relative frequency at tertiary care children's hospitals. While children receiving a tracheotomy have a high overall mortality, deaths are usually related to the underlying disease, not the tracheotomy itself.
Endoscopically Monitored Percutaneous Dilational Tracheotomy in a Residency Program
Authors: R. Donaldson David , Emami Afshin J. , Wax Mark K.
Published: November 2003

Objectives/Hypothesis Endoscopically guided percutaneous dilational tracheotomy (PDT) has become a well‐established alternative to the more traditional open tracheotomy, yet its use by otolaryngologists is limited. As airway management specialists, otolaryngologists should be familiar with a wide range of definitive procedures, including PDT. Few otolaryngology programs teach the technique. The objective of the present study was to determine the complication rate and outcome of PDT after its introduction in a residency teaching program. We also wished to evaluate whether the time savings reported by experienced surgeons could be repeated in our setting.

Setting Tertiary referral teaching hospital.

Methods We prospectively reviewed our first 54 consecutive PDTs and compared them to 29 consecutive standard open tracheotomies, which were reviewed retrospectively.

Results Complications (13% vs. 33%, P = .030), operative time (12 vs. 24 min, P < .0001) and total procedure time (37 vs. 80 min, P < .001) were significantly reduced in the PDT group as compared with standard tracheotomy. Initial outcome data were equal in both groups .

Conclusions We found that PDT can be safely and effectively taught as part of an otolaryngology residency training program.
Frontal Sinus Stents
Authors: Freeman Stephen B. , Blom Eric D.
Published: November 2003

Objectives The formation of scar tissue, synechiae, or osteogenesis in the narrow frontal outflow tract after instrumentation of the frontal sinus has led to attempts to enlarge the frontal duct or stenting.

Study Design Prospective pilot study.

Results Sixty‐four Freeman frontal sinus stents were used to maintain patency in 46 patients. Stents were inserted using an endoscopic technique in 26 sinuses containing polyps, 20 with pansinusitis, and 18 cavities with stenosis of the frontal duct. External incisions with frontal sinusotomy were required to remove the stenosis and insert the stent in nine sinuses. Polypoid degeneration, granulation, purulent drainage, and lateralization of the middle turbinate were encountered infrequently. Frontal obliteration was subsequently required in six sinuses.

Conclusion The Freeman frontal sinus stent prevented blockage of the outflow tract in patients who had removal of disease in the sinus or duct or treatment of frontal stenosis.
Regulation of Immunoglobulin Secretion by Plasma Cells Infiltrating Nasal Polyps
Authors: Sánchez‐Segura Antonio , Antonio Brieva José , Rodríguez Carmen
Published: November 2003

Objective/Hypothesis To learn more about the role of plasma cells infiltrating nasal polyps in the pathogenesis of nasal polyposis, we examined their function by analyzing immunoglobulin (Ig) production and the factors implicated in the secretion.

Study Design A series of 19 consecutive nasal polyp tissue samples and, as a control, peripheral blood samples from the same patients, were studied by histopathological and immunological examination.

Methods Hematoxylin‐eosin and immunohistochemical staining was carried out to identify plasma cells infiltrating nasal polyps. Nasal polyp mononuclear cells (NPMNCs) were purified from nasal polyp tissue samples, and Ig‐secreting cells were identified in cytospin preparations stained with fluorescein isothiocyanate–conjugated antibodies against IgA, IgG, IgM, and IgE. Purified NPMNCs were cultured in basal conditions and after the addition of several stimuli. Ig secreted into the culture supernatants was evaluated by an enzyme‐linked immunosorbent assay.

Results Plasma cells accounted for an important fraction of the inflammatory infiltrate. The main Ig isotype synthesized by these cells was IgA, whereas little IgE was detected. In vitro cultures demonstrated that the plasma cells actively secreted Ig for a short period. When cytokine dependence was analyzed, interleukin‐10 (IL‐10) and tumor necrosis factor‐α (TNF‐α) were shown to be partially responsible for the Ig production. Dependence on CD95‐mediated apoptosis was not observed.

Conclusions Nasal polyp–infiltrating plasma cells are mainly IgA‐secreting cells, the latter property being related to the mucosal immune system. The IgA production is partly dependent on IL‐10 and TNF‐α. The absence of IgE‐secreting cells in most of the samples suggests that a type I hypersensitivity reaction is not essential for the development of nasal polyp.
In Vivo Interaction of Cis‐platinum and Fosfomycin on Squamous Cell Carcinoma
Authors: Tandy James R. , Tandy Richard D. , Farris Paul , Truelson John M.
Published: November 2003

Objectives/Hypothesis Cis‐platinum is the most frequently used chemotherapeutic agent for the treatment of head and neck squamous cell carcinoma (SCCA). Ototoxicity and nephrotoxicity continue to be the primary dose‐limiting toxicities encountered. Fosfomycin, a broad‐spectrum antibiotic, has been previously shown to be both otoprotective and nephroprotective against cis‐platinum toxicity. Previous in vitro work demonstrated that fosfomycin does not inhibit the tumoricidal actions of cis‐platinum. This study tests whether fosfomycin inhibits cis‐platinum in vivo.

Methods An SCCA cell line was grown in vivo in four groups of nude mice, which then received no treatment, standard‐dose cis‐platinum, high‐dose cis‐platinum, or high‐dose cis‐platinum with fosfomycin.

Results Fosfomycin did not inhibit the tumoricidal activity of cis‐platinum. Mice treated with fosfomycin also had longer survival, which is probably due to lessening of immediate cis‐platinum systemic toxicity.

Conclusion This study shows that fosfomycin in combination with cis‐platinum may be useful in treating advanced, and possibly relatively chemoresistant, SCCA of the head and neck.
Reconstruction of Nasal Defects Larger Than 1.5 Centimeters in Diameter
Authors: Park Stephen S.
Published: November 2003

Objective To review the repair of larger nasal defects (>1.5 cm in diameter) and the vascular supply to the forehead flap.

Study Design Retrospective chart review (1994–1999) and cadaver analysis of forehead flap vasculature.

Methods Chart review was made of patients with cutaneous nasal defects greater than 1.5 cm in diameter. An intravascular silicone cast was used to detail the arterial supply to forehead flaps focusing on contribution from the supratrochlear and angular vessels.

Results In 127 patients with nasal defects, 76 defects were greater than 1.5 cm in diameter and were repaired with a midline forehead flap (44 [58%]), paramedian forehead flap (3 [4%]), single‐stage midline forehead flap (8 [11%]), interpolated melolabial flap (5 [7%]), local nasal flap (7 [9%]), or skin graft (9 [12%]). All original defects were modified to some degree with an aggressive application of the nasal esthetic subunit principle. Forty‐three patients (57%) had cartilage grafts, 18 (24%) had a full‐thickness defect requiring repair of the internal lining, and 11 (14%) had some degree of complication, although no patient had full‐thickness necrosis of a flap or required a second flap. Analysis of the vascular pedicle to the midline and paramedian forehead flaps demonstrated significant contributions from the angular artery. Skin paddles from a midline and paramedian forehead flap had similar vascular arcades.

Conclusions Nasal reconstruction has reached a standard of consistent esthetic results with restoration of nasal function. The midline forehead flap is dependable and robust and leaves a donor site scar consistent with the principle of esthetic units.
Sphenoid Marsupialization for Chronic Sphenoidal Sinusitis
Authors: Donald Paul J.
Published: November 2003

Objectives To review experience with sphenoid marsupialization and describe the technique using new instrumentation.

Study Design Retrospective review of five cases of chronic sphenoid sinusitis that were resistant to standard medical and surgical methods, which were treated by sphenoid marsupialization.

Methods Charts were reviewed and patients were interviewed regarding postoperative resolution of symptoms.

Results Five cases of recalcitrant sphenoid sinusitis were reviewed. All patients had headache before surgery, and two had visual disturbance. In follow‐up ranging from 1 to 87 months, all were free of symptoms related to the sphenoid sinus.

Conclusions Marsupialization is an effective method of exteriorizing a chronically infected sphenoid sinus. The use of functional endoscopic sinus surgery instruments and the TAC attachment of the Midas Rex drill make this surgery possible.
Botulinum Toxin for Essential Tremor of the Voice With Multiple Anatomical Sites of Tremor: A Crossover Design Study of Unilateral Versus Bilateral Injection
Authors: Warrick Paul , Dromey Christopher , Irish Jonathan C. , Durkin Lisa , Pakiam Anthony , Lang Anthony
Published: November 2003

Objectives/Hypothesis To evaluate the relative efficacy of unilateral and bilateral injections of botulinum toxin injection (BOTOX) in the treatment of essential tremor of the voice (ETV).

Study Design Prospective open‐label crossover study.

Methods Patients referred to the Neurolaryngology Clinic at Toronto General Hospital with a diagnosis of ETV were eligible for the study. Patients were sequentially assigned to receive BOTOX as either a bilateral 2.5‐U or a unilateral 15‐U electromyography‐guided injection, followed by the alternative injection 16 to 18 weeks later. Acoustic, aerodynamic, and nasopharyngoscopic data were collected approximately 2, 6, 10, and 16 weeks after each injection. Patients were asked to provide a perceptual evaluation of BOTOX effects at the conclusion of the study.

Results Three of 10 patients demonstrated an objective reduction in tremor severity with bilateral injection, and 2 of 9 with unilateral injection. However, 8 of 10 patients wished to be re‐injected at the conclusion of the study. A reduction in vocal effort appeared to be coincident with reduction in laryngeal airway resistance after BOTOX injection.

Conclusions Using objective acoustic measures, only a small proportion of patients achieved benefit from BOTOX injection for ETV. However, a majority of patients in our study benefited from a subjective reduction in vocal effort that may have been attributable to reduced laryngeal airway resistance.
Assessment of Gustatory Function by Means of Tasting Tablets
Authors: Ahne Gabi , Erras Angelo , Hummel Thomas , Kobal Gerd
Published: November 2003

Objective To develop a simple test for the screening of gustatory function in clinical settings.

Study Design We tested 101 healthy volunteers (44 male and 57 female volunteers; mean age, 47 y) with the following gustatory test: the substances sucrose (sweet), citric acid (sour), sodium chloride (salty), and caffeine (bitter) were presented as tablets (diameter 4 mm) similar to common sweetener tablets. For quantitative assessment of whole‐mouth gustatory function we used six different dosages with dilutions of each tastant in 50% steps. The highest dosage could be easily detected (sucrose, 30 mg; citric acid, 3 mg; sodium chloride, 2 mg; caffeine, 2 mg), and the lowest concentration was within threshold range.

Methods Twenty‐eight tablets (si‐ different dosages of the four basic tastes plus four tasteless tablets) were tried in a randomized order. The entire test required 15 to 20 minutes. To evaluate the within‐subject test‐retest reliability, sessions were repeated after 1 week. Results were compared with those obtained by means of a conventional three‐drop, forced‐choice procedure using the method of ascending limits.

Results Results of the new gustatory test were significantly correlated with those obtained using the three‐drop, forced‐choice procedure (correlation coefficient [r] = 0.66, P < .001). In general, women performed better than men. Furthermore, younger subjects exhibited a significantly higher gustatory sensitivity in both tests compared with older subjects.

Conclusions This quantitative test of whole‐mouth gustatory function is easy to use, can be self‐administered, requires little time, and has a long shelf‐life. It appears to be suited for routine clinical assessment of gustatory function.
Increasing Use of the Scapula Osteocutaneous Free Flap
Authors: Coleman Sean C. , Burkey Brian B. , Day Terry A. , Randall Resser J. , Netterville James L. , Dauer Eileen , Sutinis Emily
Published: November 2003

Objectives To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity.

Study Design Retrospective review and prospective physical therapy evaluation.

Methods A computer database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive 2‐year intervals (1992–1999). A single physical therapist performed a structured evaluation of the donor site.

Results Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increased from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SOFF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm2 (range, 48–200 cm2) compared with 55.4 cm2 (range, 25–102 cm2) and 77.6 cm2 (range, 50–120 cm2) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as “mild,” for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as “not limited” or “limited a little” in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1° to 12° in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength.

Conclusions The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly.
Positron Emission Tomography With Fluorodeoxyglucose for Suspected Head and Neck Tumor Recurrence in the Symptomatic Patient
Authors: Lonneux Max , Lawson Georges , Ide Christophe , Bausart Raymond , Remacle Marc , Pauwels Stanislas
Published: November 2003

Objective To analyze the impact of positron emission tomography with fluorodeoxyglucose (FDG‐PET) in the treatment of patients suspected of having head and neck cancer recurrence.

Study Design Prospective and consecutive inclusion of 44 patients presenting with clinical symptoms suggestive of head and neck tumor recurrence.

Methods FDG‐PET was compared with combined computed tomography (CT) plus magnetic resonance imaging (MRI) procedures for the differential diagnosis between tumor recurrence and benign post‐therapeutic changes. For FDG‐PET, the potential additional value of semiquantitative indexes was studied. The impact on patient treatment (i.e., their ability to accurately select patients for panendoscopic exploration) was analyzed retrospectively for both CT+MRI and PET workups.

Results The diagnostic accuracy was found higher for PET than for combined CT+MRI: sensitivity ranged from 96% to 73%, specificity from 61% to 50%, and accuracy from 81% to 64% for PET and CT+MRI, respectively. The accuracy of FDG‐PET was the highest (94%) in patients included more than 12 weeks after the end of therapy. In 15 discordant cases, PET was correct in 11 and CT+MRI in 4. Patient selection for panendoscopic exploration and biopsy was correct in 79% and 50% of patients with FDG‐PET and CT+MRI, respectively. Quantification of FDG uptake had no additional value over visual analysis alone, although we found that a SUVlbm (standardized uptake value corrected for lean body mass) threshold of 3 could be helpful in patients scanned less than 12 weeks after the end of therapy.

Conclusion FDG‐PET has a major additional diagnostic value to CT+MRI for the evaluation of the symptomatic patient suspected of having head and neck cancer recurrence. PET could have a direct impact on management by correctly selecting patients in whom a panendoscopic exploration with biopsy is indicated.
Scanning Electron Microscopy Images and Energy‐Dispersive X‐Ray Microanalysis of the Stapes in Otosclerosis and Van der Hoeve Syndrome
Authors: Vallejo‐Valdezate Luis Angel , Martín‐Gil Jesús , José‐Yacamán Manuel , Martín‐Gil Francisco Javier , Gil‐Carcedo Luis Maria
Published: November 2003

Objective/Hypothesis The objective of this study was to evaluate the morphological and microchemical changes that affect sclerotic stapes in otospongiosis and van der Hoeve syndrome.

Methods A scanning electron microscope equipped with an energy‐dispersive x‐ray analyzer was used in the experiments.

Results In otosclerosis, focal lesions are poorly mineralized, with low calcium salt and reduced calcium‐to‐phosphorus (Ca/P) ratio (1.9:1). This finding correlates with a spongiotic type of lesion and indicates unstable mineralization with possible change from hydroxyapatite to calcium triphosphate. In van der Hoeve syndrome the presence of magnesium in stapes suggests osteoclastic function stimulation. The osteoclasts secrete many protons, causing an acidified microenvironment. Brushite is formed, and Ca/P ratio decreases in comparison with that of control patients (2.0:1 vs. 2.6:1).
Vestibular and Cochlear Ototoxicity of Topical Antiseptics Assessed by Evoked Potentials
Authors: Perez Ronen , Freeman Sharon , Sohmer Haim , Sichel Jean‐Yves
Published: November 2003

Objectives/Hypothesis To evaluate and compare the effect of chlorhexidine gluconate, povidone‐iodine, and alcohol—three antiseptics used before ear surgery—on the function of the vestibular and cochlear parts of the sand rat's inner ear. The assessment of damage is based on the recording of vestibular evoked potentials (VsEPs) and auditory brainstem response (ABR).

Study Design Prospective controlled animal study.

Methods Fat sand rats were randomly assigned to five different groups, each receiving topical application of a different agent: saline (control), gentamicin (ototoxic control), chlorhexidine, povidone‐iodine, and alcohol. Right‐side total labyrinthectomy was performed, and a polyethylene tube was inserted into the left (contralateral) middle ear. After baseline recordings were taken of VsEPs and ABR, each animal received five consecutive daily applications of the specific agent into the left middle ear. Three days after the fifth application, evoked potential recordings (VsEPs and ABRs) were repeated and compared with baseline measurements.

Results Administration of saline affected neither VsEPs nor ABR. In contrast, as expected, neither of these responses could be recorded after gentamicin application. After application of chlorhexidine all waves disappeared in all sand rats. Alcohol caused the waves to disappear in some of the animals only. Povidone‐iodine did not affect VsEP recordings and had only a small effect on ABR.

Conclusions Chlorhexidine and alcohol had a clear toxic effect on the vestibular and cochlear function of the inner ear of the sand rat, whereas povidone‐iodine did not. Thus, taking into consideration that this is an animal study, it appears that povidone‐iodine might be preferable to the other agents tested in disinfecting ears with a perforated tympanic membrane.
Physical Therapy for Migraine‐Related Vestibulopathy and Vestibular Dysfunction With History of Migraine
Authors: Whitney Susan L. , Wrisley Diane M. , Brown Kathryn E. , Furman Joseph M.
Published: November 2003

Objectives/Hypothesis To assess the efficacy of physical therapy for patients with a diagnosis of migraine‐related vestibulopathy (MRV) or vestibular dysfunction with a history of migraine headache.

Study Design Retrospective case series

Methods Thirty‐nine patients were identified through a retrospective chart review, 14 with a diagnosis of MRV and 25 with migraine headache. The patients were treated with a custom‐designed physical therapy e‐ercise program for a mean of 4.9 visits over a mean duration of 4 months. Patients completed the Dizziness Handicap Inventory (DHI), the Activities‐Specific Balance Confidence Scale (ABC), and the Dynamic Gait Inde‐ (DGI), reported the number of falls they had e‐perienced in the past 4 weeks, and rated the severity of their dizziness on an analogue scale of 0 to 100 at initial evaluation and at discharge.

Results Significant differences were seen before and after therapy in each of the outcome measures used. The average decrease in DHI score was 12 points (P < .01). ABC scores increased an average of 14 points (P < .01). Subjects increased their DGI scores an average of 4 points (P < .01). The number of patients reporting more than one fall decreased by 78% at discharge. (P < .05). Baseline symptoms of dizziness decreased an average of 11 points (P < .05).

Conclusions Patients with MRV and migraine headache demonstrated improvement in physical performance measures and self‐perceived abilities after vestibular physical therapy.
Impact of Facial Paralysis on Patients With Acoustic Neuroma
Authors: Cross Teedah , E. Sheard Charlotte , Garrud Paul , Nikolopoulos Thomas P. , O'Donoghue Gerard M.
Published: November 2003

Objective To assess the psychological distress, the ways of coping with that stress, and the self‐esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored.

Study Design Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self‐esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis.

Patients One hundred three patients with facial paralysis after surgical removal of acoustic tumors.

Results Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = −0.28, P = .005). High levels of distress were associated with low levels of self‐esteem, as shown by the significant negative correlation between level of distress and self‐esteem (r = −0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self‐esteem was the most important contributing factor (standardized coefficient β −0.60, P = .0001), followed by age (β −0.24, P = .006) and sex (β −0.21, P = .04). This model explained 44% of the distress variance.

Conclusion Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self‐esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self‐esteem and decrease their distress, especially in these high‐risk groups.
Tonsillectomy As a Treatment of Obstructive Sleep Apnea in Adults With Tonsillar Hypertrophy
Authors: Verse Thomas , Kroker Béatrice A. , Pirsig Wolfgang , Brosch Sibylle
Published: November 2003

Objectives High surgical success rates for adenotonsillectomy in children with sleep‐related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy.

Study Design Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep‐related breathing disorders were evaluated based on the severity level of their preoperative apnea‐hypopnea index (AHI).

Material and Methods Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow‐up time was 3 to 6 months.

Results Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI ≥50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred.

Conclusions Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.
Treatments for Snoring: A Comparison of Somnoplasty and an Oral Appliance
Authors: Cartwright Rosalind , Venkatesan T. K. , Caldarelli David , Diaz Frank
Published: November 2003

Objectives Objectives of the study are 1) to test the effectiveness of somnoplasty (radiofrequency volumetric tissue reduction of the soft palate) for the control of loud, socially disruptive, snoring; 2) to test the long‐term efficacy of this treatment by spouse report; and 3) to compare the effectiveness of somnoplasty with another treatment.

Study Design Twenty patients with complaints of loud snoring and a respiratory disturbance index no greater than 15 respiratory events per hour with sleep‐related episodes of oxygen desaturation no lower than 80% were offered an experimental treatment. Ten were treated with somnoplasty, and a comparison group of 10 matched patients used an oral appliance. All were restudied in the laboratory wearing a device programmed to count minutes of sleep during which snoring was loud, soft, or absent.

Methods For the 10 somnoplasty patients, a spouse rating of snoring determined whether the patient received one or more treatments. Five patients had a single treatment to three sites, and five others had two such treatments. Ten patients wore an oral appliance of the tongue‐retaining type (Snore X, Fremont, CA).

Results Seven of the 10 somnoplasty patients met the improvement criteria set for reduced loud snoring (a spouse rating of 3 or less on a 10‐point scale, and 10% or less of sleep time in loud snoring in the laboratory). The comparison group also had a significant improvement in the percentage of sleep time in loud snoring while wearing the Snore X appliance.

Conclusion Since there was no significant difference between the two groups in percentage of sleep time spent in loud snoring while treated, the choice of method to control snoring must be based on factors other than efficacy.
Maxillomandibular Advancement for Persistent Obstructive Sleep Apnea After Phase I Surgery in Patients Without Maxillomandibular Deficiency
Authors: Li Kasey K. , Riley Robert W. , Powell Nelson B. , Guilleminault Christian
Published: November 2003

Objective To assess the outcomes of maxillomandibular advancement (MMA) for the treatment of persistent obstructive sleep apnea syndrome (OSA) after phase I reconstruction in patients who do not have maxillomandibular deficiency.

Methods From January 1997 to September 1998, 25 patients previously treated with phase I reconstruction (uvulopalatoplasty, genioglossus advancement, and/or hyoid suspension) who did not have maxillary and mandibular deficiencies underwent MMA for persistent OSA. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), and cephalometric data. In addition, a minimum of 6 months after surgery, questionnaires containing a 10‐cm visual analogue scale (0 = no change, 10 = drastic change) were mailed to the patients. The questionnaire subjectively assessed the patient's perception of the facial appearance after surgery, whether there was pain or discomfort of the temporomandibular joint, the overall satisfaction with the treatment outcomes, and whether the patient would recommend the operation to other patients.

Results Nineteen (76%) questionnaires were completed and returned by 15 men and 4 women. The mean age was 45.3 ± 6.6 years and the mean BMI was 33.1 ± 7.1 kg/m2. The mean RDI improved from 63.6 ± 20.8 to 8.1 ± 5.9 events per hour, and the mean LSAT improved from 73.3 ± 13.2% to 88.1 ± 4.1%. One patient was defined as an incomplete responder (RDI >20). One patient reported transient pain and discomfort of the temporomandibular joint. Although all of the patients felt that there were changes in their facial appearance after surgery, 18 of the 19 patients gave either a neutral or a favorable response to their facial esthetic results. All of these patients were satisfied with the overall outcomes and would recommend the treatment to others.

Conclusion MMA is a highly effective treatment for persistent OSA after phase I surgery in patients who otherwise do not have maxillomandibular deficiency. The patient satisfaction is extremely high. Furthermore, previous concerns of unfavorable postoperative facial esthetics and temporomandibular joint dysfunction do not appear to be significant.
Tumor Necrosis Factor Gene Polymorphism in Chronic Sinusitis
Authors: Takeuchi Kazuhiko , Majima Yuichi , Sakakura Yasuo
Published: November 2003

Objectives It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis.

Study Design Thirty‐eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films.

Methods Both tumor necrosis factor‐α (TNF‐α) and tumor necrosis factor‐β (TNF‐β) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects.

Results A significantly higher frequency (P < .05) of TNFB*2 allele of TNF‐β gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF‐α and chronic sinusitis.

Conclusion We concluded that TNF‐β gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.
Quantitative Analysis of Tympanic Membrane Disease Using Video‐Otoscopy
Authors: Jaisinghani Vikram J. , Hunter Lisa L. , Li Yaoli , Margolis Robert H.
Published: November 2003

Objective To perform quantitative analysis of pathological changes in the tympanic membrane using video‐otoscopic images.

Study Design Prospective case‐control study.

Methods Forty‐two ears of children with chronic otitis media with effusion (OME) and 15 ears of normal children were included in this study. Tympanic membrane images were captured and digitized using a Welch‐Allyn (Skaneatales Falls, NY) VDX‐300 Illumination and Imaging system with S‐VHS input to a MIRO DC 30 (Pinnacle Systems, Mountain View, CA) visual board in a Power PC–based computer. These images were visualized and recorded during static and pneumatic pressure changes. Quantitative analysis of tympanic membrane disease was performed using Image Pro Plus Imaging software (Media Cybernetics, Del Mar, CA). The measurements included area of the tympanic membrane and its quadrants, area of tympanic membrane involved by disease, angle formed at the umbo, and length of the malleus versus vertical length of the tympanic membrane.

Results Tympanosclerosis was present in 57% of ears and occurred most frequently in the anteroinferior quadrant, but the ma‐imum area of involvement was in the posteroinferior quadrant. The ratio of the angles formed at the umbo was significantly greater (P = .01) for the OME group compared with the control group. The ratio of the length of the umbo and the vertical length of the tympanic membrane was almost identical for the OME and the control groups (P = .4).

Conclusions Video‐otoscopic images can be used for quantitative analysis of tympanic membrane disease. The ratio of the posterior angle to the anterior angle formed at the umbo seems to be a more reliable indicator of post otitis media than is a reduced length of the long process of malleus.
Complement C3 Cleavage and Cytokines Interleukin‐1β and Tumor Necrosis Factor‐α in Otitis Media With Effusion
Authors: Närkiö‐Mäkelä Mervi , Teppo Anna‐Maija , Meri Seppo
Published: November 2003

Objectives To analyze whether complement C3a anaphylatoxin, other C3 fragments, interleukin‐1β (IL‐1β), or tumor necrosis factor‐α (TNF‐α) contributes to inflammation in chronic otitis media with effusion (OME).

Methods The amount of C3a was measured by enzyme‐linked immunoassay. Further breakdown of C3 was analyzed by Western blotting. IL‐1β and TNF‐α concentrations were measured by radioimmunoassay. Bacteria were analyzed by culture and polymerase chain reaction.

Results Highly elevated levels of C3a and other C3 cleavage fragments were found in all middle ear effusion (MEE) samples. The mean values (± SEM, n = 26) for C3a, IL‐1β, and TNF‐α were 5973 ± 1124 ng/mL, 1043 ± 490 pg/mL, and 79 ± 14.3 pg/mL, respectively. Comparison to an average C3 level of 555 (±108) μg/mL indicated that at least 40.5% ± 6% of total C3 had become activated within the MEE. C3a concentrations were higher in the group in which the effusion had been present in the middle ear for a prolonged period (≥4 mo) (P = .04). Children with multiple tube insertions had higher C3 (P = .006) and TNF‐α (P = .04) concentrations in their MEE samples than those receiving their first tubes. C3 and C3a concentrations in MEE correlated to each other (correlation coefficient [r] = 0.513, P = .0056), as did concentrations of IL‐1β and TNF‐α (r = 0.7016, P < .0001). No significant correlation was found between complement C3 or C3a levels and IL‐1β, TNF‐α, or bacterial growth.

Conclusions Highly elevated levels of C3a in MEE indicate ongoing complement activation, which is stronger than in almost any other disease demonstrated previously. Elevated C3a levels contribute to chemotactic and inflammatory potential in the MEE and correlate with the chronicity of the disease.