bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost and Cost‐effectiveness of Universal Screening for Hearing Loss in Newborns
Authors: Kezirian Eric J. , White Karl R. , Yueh Bevan , Sullivan Sean D.
Published: February 2003

OBJECTIVE

To estimate the cost and cost‐effectiveness of universal newborn hearing screening.

STUDY DESIGN AND SETTING

Decision analysis model utilizing the hospital perspective. This model evaluated 4 distinct protocols for screening a fixed and defined hypothetical cohort of newborn infants.

OUTCOME MEASURES

Cost of screening and the number of infants with hearing loss identified through universal screening.

RESULTS

Otoacoustic emissions testing at birth followed by repeat testing at follow up demonstrated the lowest cost ($13 per infant) and had the lowest cost‐effectiveness ratio ($5100 per infant with hearing loss identified). Screening auditory brainstem evoked response testing at birth with no screening test at follow‐up was the only protocol with greater effectiveness, but it also demonstrated the highest cost ($25 per infant) and highest cost‐effectiveness ratio ($9500 per infant with hearing loss identified). These findings were robust to sensitivity analysis, including best‐case and worst‐case estimation. The prevalence of hearing loss and the fraction of infants returned for follow‐up testing had a large impact on the absolute level, but not relative level of protocol cost and cost‐effectiveness.

CONCLUSION

The otoacoustic emissions testing protocol should be selected by screening programs concerned with cost and cost‐effectiveness, although there are certain caveats to consider.

SIGNIFICANCE

The most significant barriers to implementation of universal newborn hearing screening programs have been financial, and this study compares the most common protocols currently in use. This study can assist program directors not only in the decision to initiate universal screening but also in their choice of screening protocol.
Expression of Nitric Oxide Synthase Type 3 in Reflux‐Induced Esophageal Lesions
Authors: Chandra Rakesh , Haines G. Kenneth , Bentz Brandon G. , Shah Pinky , Robinson Alan M. , Radosevich James A.
Published: February 2003

BACKGROUND

The expression of endothelial constitutive nitric oxide synthase (NOS3) by squamous dysplasia and carcinomas of the head and neck has previously been described. We sought to compare NOS3 expression in squamous mucosa, glandular metaplasia, and adenocarcinoma of the esophagus.

METHODS

Forty paraffin‐embedded specimens from 20 patients with adenocarcinoma were stained with anti‐NOS3 monoclonal antibody. The percentage of cells stained and the intensity of staining were determined for squamous epithelium, metaplasia, and adenocarcinoma. Staining characteristics were statistically analyzed according to clinical variables.

RESULTS

NOS3 expression was significantly higher in adenocarcinoma and squamous epithelium compared with glandular metaplasia. Among the carcinomas, larger tumor size (T3/4), nodal positivity, and advanced TNM stage (III/IV) significantly correlated with increased NOS3 expression.

CONCLUSIONS

NOS3 is expressed in refluxinduced lesions of the esophagus. Glandular metaplasia shows basal levels of NOS3 that significantly increase with malignant transformation and tumor progression. The role of free radicals in carcinogenesis is being actively studied.
Safety and Efficacy of Topical Mitomycin C in Myringotomy Patency
Authors: Jassir David , Buchman Craig A. , Gomez‐Marin Orlando
Published: February 2003

OBJECTIVE

To develop an alternative method for prolonged middle ear ventilation using topical mitomycin C.

STUDY DESIGN AND SETTING

Twenty guinea pigs with normal ears had bilateral myringotomies performed using the argon laser. After myringotomy, either mitomycin C (0.4 mg/mL) or saline pledgets were applied topically. Monitoring consisted of otomicroscopy and distortion‐product otoacoustic emissions.

RESULTS

Before myringotomy, all tympanic membranes were intact, and distortion‐product otoacoustic emissions were measurable. After myringotomy, none (0%) of the saline‐treated myringotomies were patent at day 7 as compared with 100% of the mitomycin C‐treated myringotomies. At day 42, 10 (52.6%) of 19 mitomycin‐treated myringotomies remained patent and 4 (28.6%) of 14 were patent at 131 days. Five (13.1%) ears developed purulent otorrhea; 3 were mitomycin C‐treated and 2 were treated with saline solution. Distortion‐product otoacoustic emissions testing did not document any evidence of ototoxicity.

CONCLUSION

Topical mitomycin C appears to be safe and effective at prolonging the duration of myringotomy patency in the guinea pig.

SIGNIFICANCE

Mitomycin C may be useful as an adjunct for preventing myringotomy closure.
Occult Laryngeal Pathology in a Community‐Based Cohort
Authors: Reulbach Todd R. , Belafsky Peter C. , Blalock P. David , Koufman James A. , Postma Gregory N.
Published: February 2003

BACKGROUND

Little information is available regarding the prevalence of laryngeal pathology in adults.

PURPOSE

To estimate the prevalence of occult laryngeal pathology in a community‐based cohort of adults over 40 years of age.

METHODS

One hundred consecutive volunteers over age 40 with no history of voice disorders were enrolled. All completed a self‐administered laryngeal symptom questionnaire and underwent a comprehensive head and neck examination including transnasal fiberoptic laryngoscopy.

RESULTS

The mean age of the cohort was 61 years. Vocal fold bowing (presbylaryngis) was present in 72% of the patients, and findings of laryngopharyngeal reflux were present in 64% of the cohort. In addition, other laryngeal pathology were identified in 21%. Only 12% had a completely normal laryngeal examination.

CONCLUSIONS

Occult laryngeal pathology is very common in persons over 40. Findings suggestive of laryngopharyngeal reflux are present in 64%, and vocal fold bowing is present in 72% of persons over 40.
Dosage Regimens of Intranasal Aerosolized Surfactant on Otitis Media with Effusion in an Animal Model
Authors: Venkatayan Natarajan , Connelly Patricia E. , Mautone Alan J. , Troublefield Yolanda L. , Chandrasekhar Sujana S.
Published: February 2003

OBJECTIVE

To determine optimal dosage regimens of intranasal metered dose aerosolized surfactant with and without other medications in the treatment of otitis media with effusion (OME).

STUDY DESIGN

Resolution of experimental OME in gerbils was determined based on otomicroscopy and tympanometry. Experimental intranasal drugs were: surfactant, surfactant with betamethasone, surfactant with phenylephrine, and a normal saline solution placebo. Medications were administered once or twice daily via a metered dose inhaler.

RESULTS

For twice‐daily dosing, mean days to OME resolution were 8.5 for the aerosolized surfactant, 6.3 for the surfactant with betamethasone, 18.7 for the surfactant with phenylephrine, and 16 each for control and placebo. Resolution with the once‐daily dosage was longer for all conditions. Results were comparable using tympanometry.

CONCLUSION

OME resolved faster than the natural course when treated with intranasal surfactant with and without steroids. Twice‐daily dosing was statistically superior.

SIGNIFICANCE

This study reiterates the effectiveness of OME treatment with an aerosolized synthetic surfactant with and without steroids and establishes a superior twice‐daily dosage schedule.
Node Counts in Neck Dissection: Are they Useful in Outcomes Research?
Authors: Agrama Mark T. , Reiter David , Topham Allan K. , Keane William M.
Published: February 2003

OBJECTIVES

We studied the unilateral nodal yields for procedures reported as standard or modified radical neck dissection (RND) to determine their applicability in outcomes research.

METHODS

We analyzed the unilateral nodal yields for all procedures reported as RND for carcinoma of the oral cavity, pharynx, and larynx at our institution from 1985 to 1997 (n = 64, no prior treatment). These included both standard and modified techniques, encompassing levels I through V of the neck. Each side of a bilateral RND was treated as a separate case. This sample was compared with a similar population from the National Cancer Institute's Surveillance, Epidemiology, and End‐Results (SEER) registry. Nodal yield was obtained for RND alone and for unspecified neck dissection with primary excision for the same diseases and time period (n = 1499).

RESULTS

The mean nodal yield from 64 RND was 30 vs 27 in the SEER data. The standard deviation was 14.7 compared with 17.2 in the SEER data. Values ranged from 7 to 66 nodes whereas the SEER range was from 1 to 97 nodes. Although the SEER data contain nodal yields from regional or selective neck dissection, we corroborate our findings of large variance in nodal yield from our RND sample.

CONCLUSIONS

Large variance in nodal yields from RND may have undefined effects on quality of life, cure rate, and survival. Until correlation of nodal yields with outcomes is examined, we cannot know how to relate RND to outcomes.
Hemostatic Alterations in Patients with Acute, Unilateral Vestibular Paresis
Authors: Fattori Bruno , Nacci Andrea , Casani Augusto , Cristofani Renza , Sagripanti Andrea
Published: February 2003

OBJECTIVES

The etiopathogenesis of acute unilateral peripheral vestibulopathy (APV) still remains a matter of debate; ischemic changes in the circulation of the labyrinth may play a role. We consequently looked for possible hemostasis alterations in a group of patients with APV of an unknown nature.

METHODS

We evaluated blood parameters known to be involved in circulation disorders, including total and HDL cholesterol, tryglycerides, apolipoprotein A and B, lipoprotein(a), homocysteine, folate, prothrombin time, activated partial thromboplastin time, fibrinogen, D‐dimer, antithrombin III, protein C, protein S, activated protein C resistance, and anticardiolipin IgG and IgM antibodies. A series of 23 patients affected with APV were consecutively referred to our department, in the acute phase, before treatment, and in the follow‐up phase after 4 to 6 weeks of pharmacologic washout. The aforementioned blood parameters were also measured in a series of 15 patients with Menière's disease.

RESULTS

The patients with APV in the acute phase compared with the patients with Menière's disease in the acute phase exhibited increased plasma levels of fibrinogen (mean, 338.3 ± 135.9 SD vs 271.3 ± 69.8 SD mg/dL, P = 0.05), increased plasma levels of D‐dimer (mean, 320 ± 207.8 SD vs 226.7 ± 138.7 SD NG/mL), enhanced plasma levels of lipoprotein(a) (41.4 ± 38.6 SD vs 16 ± 18.2 SD mg/dL, F = 5.67, P = 0.02), high leukocyte count (9.1 ± 2.7 SD vs 6.5 ± 1.3 SD x 103/μL; F = 8.42, P < 0.006), and low serum folate concentration (5.3 ± 1.8 SD vs 7.1 ± 2.7 NG/mg; F = 4.34, P = 0.04). During follow‐up the prothrombin time was prolonged (F = 4.34, P = 0.04) and leukocyte count decreased (F = 7.39, P < 0.019) in the APV patients, whereas fibrinogen, D‐dimer, lipoprotein(a), and folate were unchanged.

CONCLUSION

Our results provide evidence suggesting an involvement of the hemostatic system in APV.
Revision Myringoplasty with Solvent‐Dehydrated Human Dura Mater (Tutoplast)
Authors: Sertaç Yetişer , Tosun Fuat , Bülent Satar
Published: February 2003

OBJECTIVES

Several grafting materials have been used in the reconstruction of the perforations of the tympanic membrane. The use of dehydrated dura homografts as a substitute for the tympanic membrane has not been fully documented. On the other hand, revision surgery is more critical in terms of patients' expectations. The aim of this study is to determine the tissue stiffness, the compliance, and the wound healing rate of dura homografts in revision surgery of perforations of the tympanic membrane.

STUDY DESIGN AND SETTING

The charts of 45 patients who have received dura grafts because of re‐perforation or failure of the myringoplasty have been reviewed retrospectively. The healing process of the myringoplasty, graft take rate, pure‐tone hearing level, and tympanogram were reviewed.

RESULTS AND CONCLUSION

It has been concluded that dura homografts, which have excellent tissue‐compability, stability, and an 86.7% graft success rate, are preferred in patients in whom their own temporalis fascia cannot be used because of previous operations. It has been demonstrated by tympanometric analysis that the compliance of the graft during various pressure applications is as good as the normal eardrum.
Surgical Treatment for Hypopharynx Carcinoma: Feasibility, Mortality, and Results
Authors: Eckel Hans Edmund , Staar Susanne , Volling Peter , Sittel Christian , Damm Michael , Jungehuelsing Markus
Published: February 2003

This study seeks to evaluate treatment modalities, mortality after surgery, survival, and local control rates for a consecutive cohort of patients with cancer of the hypopharynx treated according to a prospective protocol that favors surgery as an initial approach to the disease. The charts of 228 consecutive patients with previously untreated hypopharyngeal squamous cell carcinoma were reviewed. Outcome measures (overall survival, disease specific survival, and local control) were calculated using the Kaplan‐Meier estimator. Of 228 consecutive patients, 136 (59.6%) were found suitable for initial surgical treatment. Of the remaining 92 patients, 18 (7.9%) had nonresectable lymph node metastases, 16 (7.0%) had unresectable primary tumors, 13 (5.7%) refused surgery, and 13 (5.7%) presented distant metastases during initial diagnostic evaluation. Of those who had surgery, 46 had larynx‐sparing procedures, 54 had total laryngectomy, and 36 had total laryngo‐pharyngectomy. None of the patients who had surgery died postoperatively. Actuarial 5‐year overall survival was 27.2% for all 228 patients, 39.5% for the 136 patients with surgical treatment, and 61.1% for the 46 patients who were treated with larynx‐sparing procedures.
Free Radical Damage in Nasal Polyp Tissue
Authors: Doğru Harun , DeliBaş Namik , Döner Fehmi , Tüz Mustafa , Uygur Kemal
Published: February 2003

OBJECTIVE

To investigate whether the free radical injury in nasal polyp tissue exists or not.

STUDY DESIGN

A prospective study in patients with nasal polyps.

METHODS

Polyp specimens were obtained from 19 patients. Control specimens were acquired from 16 patients who underwent partial turbinectomy with concha bullosa free of rhinitis, sinusitis, and allergy, confirmed by endoscopic nasal examination, coronal paranasal sinus CT scan, and prick test. MDA levels of nasal polyps and control specimens were measured by using the method of Knudsen et al.

RESULTS

The mean MDA levels of nasal polyps and control specimens were 38.2 ± 5.1 (33.3–52.2) and 33.9 ± 1.6 (32.6–37.4), respectively. MDA levels in NP were significantly higher compared with control specimens (P < 0.01).

CONCLUSION

High level of MDA in nasal polyp tissue that represents FR increase supports the existence of cell injury in nasal polyp tissue. FRs should be considered in the development and life cycles of NP which is thought to have multifactorial pathogenesis.
Cerebrospinal Fluid Fistula after Transtemporal Skull Base Surgery
Authors: Leonetti John , Anderson Douglas , Marzo Sam , Moynihan George
Published: February 2003

OBJECTIVES

The purpose of this article is to outline our methods for the prevention and management of cerebrospinal fluid (CSF) leak after transtemporal skull base surgery.

METHODS

A total of 589 patients underwent a variety of transtemporal surgical approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999. The medical records were retrospectively reviewed to identify the tumor histology, size, and location as well as the surgical approach, defect reconstruction technique, and the incidence of postoperative CSF leak.

RESULTS

The risk of CSF fistulae was greatest in utilizing the restrosigmoid approach (8%) and least in those who underwent a translabyrinthine approach (4%). Tumor size had no bearing on the incidence of the CSF leak and the overall incidence of meningitis was 1.0%.

CONCLUSION

The proper surgical technique will minimize the risk of CSF leak after transtemporal skull base surgery. Immediate management of CSF fistulae helped prevent meningitis in the majority of these patients.
Hearing Loss in Progressive Systemic Sclerosis Patients: A Comparative Study
Authors: Kastanioudakis Ioannis , Ziavra Nausicaa , Politi Eudokia N. , Exarchakos Georgios , Drosos Alexandros A. , Skevas Antonios
Published: February 2003

OBJECTIVE

To investigate the middle and inner ear involvement in patients with progressive systemic sclerosis (PSS).

STUDY DESIGN AND SETTINGS

We prospectively evaluated 34 PSS patients. All patients underwent a complete ear‐nose‐throat physical examination and audiological evaluation with pure tone, impedance, and speech audiometry. In addition, systemic manifestations of the disease and drug therapy were recorded. Finally, all patients were tested for the presence of autoantibodies. The results were compared with those of 45 age‐matched healthy subjects.

RESULTS

We found a sensorineural hearing loss in 20% and mixed type hearing loss in 3.3% of the patients. There was no correlation of hearing loss with age, systemic manifestations of the disease, presence of autoantibodies, and drug therapy. Ten percent of the patients had patulous eustachian tubes.

CONCLUSION

One fourth of PSS patients had a hearing loss affecting the middle and mainly the high frequencies. This is a lower percentage than that reported by other investigators. A significant prevalence of bilateral patulous eustachian tubes was noticed as well. Further investigation is needed for a better understanding of the mechanism of ear damage in PSS patients.
Portal Venous Ultraviolet B‐Irradiated Donor Alloantigen Prevents Rejection in Circumferential Rat Tracheal Allografts
Authors: Genden Eric M. , Mackinnon Susan E. , Yu Samuel , Hunter Daniel A. , Flye M. Wayne
Published: February 2003

BACKGROUND

Before tracheal transplantation can be considered as a method of reconstruction in patients with extensive circumferential tracheal defects, we must achieve a state of nontoxic, donor‐specific tolerance so that the risks of such a transplant do not outweigh the benefits.

OBJECTIVE

Our objective was to determine whether a single intraportal injection of modified donor alloantigen achieves donor‐specific immunosup‐pression for major histocompatibility complex‐mismatched rat tracheal allografts.

STUDY DESIGN

Buffalo (recipient) rats were pretreated with either a single portal‐vein administration of ultraviolet B (UVB)‐irradiated donor splenocytes (n = 4) or an intraportal inoculation of nonirradiated donor splenocytes (n = 4). Major histocompatibility complex‐mismatched Lewis (donor) tracheal allograft segments were then grafted into treatment groups 7 days after donor‐cell pretreatment. Tracheal rejection was assessed by histologic analysis, mucosal cilia motility, and in vitro immunologic assessment.

RESULTS

The UVB‐treated group demonstrated no acute or chronic rejection as well as complete functional recovery. In vitro immunologic assessment demonstrated a donor‐specific hyporesponsiveness and donor allospecificity. Untreated animals and those receiving nonirradiated donor splenocytes showed acute rejection of their tracheal allografts.

CONCLUSION

Recipient pretreatment with intraportally administered UVB‐irradiated donor splenocytes prevents rejection of circumferential rat tracheal allograft segments by inducing a donor‐specific immune hyporesponsiveness.
Injection Snoreplasty: How to Treat Snoring without All the Pain and Expense
Authors: Brietzke Scott E. , Mair Eric A.
Published: February 2003

OBJECTIVE

We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well‐described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring.

STUDY DESIGN AND SETTING

Twenty‐seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring.

RESULTS

Twenty‐five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening.

CONCLUSION/SIGNIFICANCE

Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence.
Lymphatic Malformation with Internal Jugular Phlebectasia
Authors: Yoon Patricia J. , Messner Anna H.
Published: February 2003

Lymphatic malformations are an uncommon but readily recognized congenital anomaly. Characteristic presentation is within the first year of life, as a soft compressible mass, often in the neck. Infection or trauma may precipitate rapid enlargement. A more obscure diagnosis is that of internal jugular phlebectasia, or isolated jugular vein aneurysm. The scant data available in the pediatric surgery literature seem to point toward a relationship between these 2 pathologic entities.1,2 We present a patient in whom diagnosis of internal jugular phlebectasia accompanied that of lymphatic malformation.
Transtympanic Stimulation of the Facial Nerve to Assess Nerve Integrity in Iatrogenic Facial Nerve Paralysis
Authors: Limb Charles J. , Niparko John K. , Tunkel David E.
Published: February 2003

Facial nerve paralysis is a well‐described complication of head and neck surgical procedures. When the nerve is purposefully transected, the clinical approach is often clear, involving nerve repair, grafting, or substitution. In cases where the extent of facial nerve injury is not obvious, the potential for recovery is often uncertain.1 We present a case of complete ipsilateral facial paralysis after resection of a parapharyngeal space tumor in a child. We used transtympanic stimulation of the tympanic segment of the facial nerve to assess anatomic integrity of the nerve. More experience with this technique may provide valuable information in guiding the management of postoperative facial nerve injury.
T3 Glottic Cancer: Oncologic Results and Prognostic Factors
Authors: Lassaletta Luis , García‐Pallarés Marta , Morera Eduardo , Ricardo Bernáldez , Gavilan Javier
Published: February 2003

OBJECTIVES

To analyze oncologic results, prognostic factors, and consideration of transglottic tumors as a separate entity in 73 patients with T3 glottic carcinoma treated by surgery ± radiation therapy at La Paz University Hospital from 1984 to 1994.

METHODS

Sixty‐four patients underwent a total laryngectomy; neck dissection was performed in 50 patients; 29 patients received postoperative radiotherapy.

RESULTS

The 5‐year overall survival, cause‐specific survival, and relapse‐free survival rates were 58.1%, 66.8%, and 63.7%. Univariate analysis revealed prognostic significance for age, dyspnea, initial tracheostomy, and pathologic lymph node status. No difference was found when comparing survival and relapse rates between transglottic and glottic tumors.

CONCLUSION

Surgery provides acceptable rates of cancer control and survival for patients with T3 glottic carcinoma. Older patients, patients with positive neck nodes, and those presenting with dyspnea have worse prognosis. The term transglottic is merely descriptive and has little impact on prognosis.
Value of Flow Cytometry in the Evaluation of Head and Neck Fine‐Needle Lymphoid Aspirates: A 3‐Year Retrospective Review of a Community‐Based Practice
Authors: Cannon C. Ron , Richardson L. Douglas
Published: February 2003

OBJECTIVE

To study the clinical efficacy of flow cytometry in patients suspected of having a lymphoma with head and neck pathology.

STUDY DESIGN

Retrospective review of 49 patients with lymphoid aspirates having concurrent flow cytometry studies.

SETTING

Private practice office‐based study.

CONCLUSION

Fine‐needle aspiration with concurrent flow cytometry is a useful, convenient adjunct to the diagnosis of head and neck non‐Hodgkins lymphomas.

SIGNIFICANCE

Flow cytometry is a significant improvement over fine‐needle aspiration derived cytologic diagnosis alone. Tissue open biopsy may be avoided altogether in some patients with non‐Hodgkins lymphoma.
Versatility and Donor Site Morbidity of the Lateral Upper Arm Flap in Intraoral Reconstruction
Authors: Gellrich Nils‐Claudius , Schramm Alexander , Hara Iwao , Gutwald Ralf , Jürgen Düker , Schmelzeisen Rainer
Published: February 2003

OBJECTIVE

The lateral upper arm flap is not widely used yet for intraoral defect reconstruction. Investigation of its morphologic and functional outcome was the objective of this study.

STUDY DESIGN

The morphologic and functional results of recipient (swallowing, flap survival, dehiscence of margins, cutaneous fistulas, intraoral hairs) and donor sites (wound healing, scar width and length, sensory and motor disturbance) (n = 44) were checked clinically. Postoperative swallowing was investigated via videofluorography (n = 11).

RESULTS

The lateral upper arm flap showed low donor site morbidity, primary closure was achieved in all but one case. Sensory deficit at the proximal forearm (n = 27) occurred without any case of compromise of radial nerve function. Videofluorography allows for objective evaluation of swallowing function.

CONCLUSIONS

The lateral upper arm flap is the reconstruction of first choice for intraoral defects due to its low donor site morbidity.
Nasal Irrigation for the Alleviation of Sinonasal Symptoms
Authors: Heatley Diane G. , McConnell Kari E. , Kille Tony L. , Leverson Glen E.
Published: February 2003

OBJECTIVE

To determine the effect of nasal irrigation on sinonasal symptoms.

STUDY DESIGN AND SETTING

A total of 150 adult subjects with chronic sinusitis symptoms were recruited from the community and assigned to 1 of 3 treatment groups: nasal irrigation with bulb syringe, nasal irrigation with nasal irrigation pot, or control treatment with reflexology massage. Groups 1 and 2 performed daily hypertonic saline irrigation with 1 device for 2 weeks and then with the other device for 2 weeks. Group 3 performed reflexology massage daily for 2 weeks. Prospective data collected included pretreatment Medical Outcomes Study Short Form, pretreatment and posttreatment Rhinosinusitis Outcomes Measure, daily medication use, subjective treatment efficacy, and preference of irrigation method.

RESULTS

There was a significant and equivalent improvement in Rhinosinusitis Outcomes Measure 31 score after 2 weeks of intervention in each treatment group; 35% of subjects reported decreased use of sinus medication.

CONCLUSION

Daily nasal irrigation using either a bulb syringe, nasal irrigation pot, and daily reflexology massage were equally efficacious and resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects. Medication usage was decreased in approximately one third of participants regardless of intervention.
Clinical Anatomy of the Nasal Process of the Frontal Bone (Spina Nasalis Interna)
Authors: Hosemann Werner , Gross Rudolf , Goede Ullrich , Kuehnel Thomas
Published: February 2003

OBJECTIVES

During endonasal frontal sinusotomy with the sharp spoon, a solid piece of bone is frequently encountered anterior to the neo‐ostium. This bone may be referred to as the nasal process of the frontal bone or internal nasal spine (spina nasalis interna). A prominent spina may render an extended sinusotomy difficult and may call for use of the drill. A series of anatomic measurements is presented to illustrate the 3‐dimensional anatomy of the spina nasalis and the regional anatomy.

METHODS

A maximum endonasal frontal sinusotomy (Draf type I‐II procedure, nasofrontal approach type II) was performed on 36 anatomic specimens by means of a sharp spoon. The dimensions of the remaining nasal spine were measured subsequently together with the anterior‐posterior diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neo‐ostium to the anterior ethmoidal artery.

RESULTS

The individual microanatomy of the medial floor of the frontal sinus showed a wide range of variation. The average height of the individual spine was 10 mm, the maximum depth 6 mm. A correlation was found between the nasofrontal angle of the specimen and the anterior‐posterior dimension of the spine: the more acute the angle, the thicker the spine. In three quarters of the cases, the neo‐ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery.

CONCLUSIONS

The presented investigations provide the surgeon with quantitative data on the individual anatomy of the nasal spine and offer additional information for selecting the appropriate surgical procedure in the individual patient.
Progression Difference between Cancers of the Larynx and Hypopharynx is Not Due to Tumor Size and Vascularization
Authors: Lukits J. , Timár J. , Juhász A. , Döme B. , Paku S. , Répássy G.
Published: February 2003

A recent survey of head and neck cancer indicated a sharp difference in survival between cancer of the hypopharyx and cancers formed in other head and neck sites. We have analyzed tumor size relative to clinical stage and vascularization as possible causes for such a difference in a series of 21 patients with cancer of the laryngopharynx (11 glottic and 10 hypopharyngeal). We found that the volume of the smallest cancers of the larynx at stage 2 is significantly larger than the volume of the cancers of the hypopharynx at stage 4 (P < 0.05). Next, we have determined by immunohistochemistry and morphometry the microvessel density, microvessel perimeter, and vascular endothelial growth factor (VEGF) expression of laryngo‐hypopharyngeal cancers. Analysis of these data indicates that there is no difference in vascularization and VEGF expression between these two tumor types. These data strongly suggest that the invasive but not the angiogenic phenotype of hypopharyngeal cancer cells could be responsible for the more aggressive biologic behavior of this head and neck cancer subtype.
Elective Neck Dissection versus Observation in Stage I Squamous Cell Carcinomas of the Tongue and Floor of the Mouth
Authors: Dias Fernando L. , Kligerman Jacob , De Sá Geraldo Matos , Arcuri Roberto A. , Freitas Emilson Q. , Farias Terence , Matos FáTima , Lima Roberto A.
Published: February 2003

A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, recurrence in the neck, treatment failure, results of salvage treatment, and disease‐free survival. Forty‐nine patients underwent surgical treatment: 25 resection of primary and 24 resection plus neck dissection. Overall incidence of regional metastases was 24.5%. Eight patients (16%) developed recurrence of the disease. Seven (14%) had regional recurrences (including 1 with distant metastases) and 1(2%) had local recurrence. Twenty‐four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05). Overall salvage rate was 37.5%. Second primary tumors developed in 16% of patients. Patients who underwent elective neck dissection had a 23% higher disease‐free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importance of control of the neck in early oral cancer. Elective neck dissection significantly improved regional control of the disease.
Osseointegrated Implants in Children: Experience from Our First 100 Patients
Authors: Granström Gösta , Bergström Kerstin , Odersjö Marie , Tjellström Anders
Published: February 2003

This study was undertaken on 100 children aged 16 years or under intended for installation of osseointegrated implants. Of these, 76 had implants installed for bone‐anchored hearing aids or prostheses. The main indication for implant installation was a bilateral ear malformation. Surgery was generally performed as a two‐stage procedure with a healing time of 3 to 4 months in between. Available bone thickness was on average 2.5 mm, and lack of bone necessitated bone augmentation in 12 patients. Thirty‐nine percent of implants were installed in contact with the dura, sigmoid sinus, or an air cell. Implant failures were 5.8% of 170 inserted fixtures. Adverse skin reactions appeared in 9.1% of patients over a 21‐year follow‐up period. Revision surgery was undertaken in 22% of patients because of appositional growth of the temporal bone. Of the 24 children considered but not found suitable for osseointegration surgery, plastic surgery was considered a better option, or growth of the temporal bone was awaited. It is concluded that the rate of implant failure is lower in children; the frequency of skin reactions is the same as in adults, but revision surgery is more common in young patients because of new bone formation. Our clinical experience supported by the data presented in this article suggests that the concept could be used with good functional and aesthetic results in children.
Conservative Management of Infections in Cochlear Implant Recipients
Authors: Yu Kenneth C.Y. , Hegarty Joseph L. , Gantz Bruce J. , Lalwani Anil K.
Published: February 2003

OBJECTIVE

The goal of this study was to evaluate a conservative management strategy of postoperative infection after cochlear implantation.

METHODS

A retrospective review of the medical records of 108 cochlear implant patients operated on at the University of California, San Francisco between 1991 and 2000 and 133 cochlear implant patients from the University of Iowa between 1997 and 2000 showed 4 patients with evidence of postoperative infections. The clinical presentation, intervention, laboratory results, and outcome are analyzed in each case.

RESULTS

Minimal surgical intervention with limited incision and drainage with prolonged postoperative antibiotics was effective in treating postoperative cochlear implant infections without the need for device removal. Implant function remained unaffected after surgery.

CONCLUSION

Postoperative cochlear implant infections can be effectively controlled with limited surgical and prolonged medical management. Chronic implant infections may be explained by a primary immunodeficiency. With appropriate treatment leading to infection control, a conservative management strategy is advocated before consideration of device explantation.
Muscle Fiber and Satellite Cell Apoptosis in the Aging Human Thyroarytenoid Muscle: A Stereological Study with Confocal Laser Scanning Microscopy
Authors: Malmgren Leslie T. , Jones Christine E. , Bookman Linda M.
Published: February 2003

OBJECTIVE

This study determines the role of changes in numerical densities of apoptotic myonuclei and satellite cells in age‐related remodeling of the thyroarytenoid muscle (TA).

DESIGN

Changes in numerical densities of apoptotic myonuclei and satellite cells were estimated for the entire TA by using stereological techniques.

RESULTS

There was an increase in NV apoptotic myonucleus, fiber type (P < 0.05) and in the percentage of apoptotic myonuclei (P < 0.05) in type 1 but not in type 2 muscle fibers. There was also an increase in NV apoptotic satellite cell, fiber type (P < 0.05) and in the percentage of apoptotic satellite cells (P < 0.05) in type 1 fibers but not in type 2 fibers.

CONCLUSION

Apoptosis may contribute to age‐related fiber loss and atrophy in the TA.

SIGNIFICANCE

Therapeutic techniques based on decreasing the frequency of apoptosis may block age‐related fiber loss and atrophy in the TA.
Free Flap Reconstruction of the Head and Neck: Analysis of 241 Cases
Authors: Haughey Bruce H. , Wilson Ewain , Kluwe Lucia , Piccirillo Jay , Fredrickson John , Sessions Donald , Spector Gershon
Published: February 2003

OBJECTIVE

We undertook this study of free flap reconstruction of the head and neck to stratify patients and procedures, to determine how donor site preference changed over time, to assess medical and surgical outcomes, and to identify variables associated with complications.

METHODS

We analyzed computerized medical records from 236 patients who underwent a total of 241 reconstructions at a tertiary academic medical center in St. Louis between 1989 and 1998. We created a more detailed retrospective database of 141 of those patients by using 48 perioperative variables and 7 adverse outcome measures. Multivariate statistical models were used to analyze associations between variables and outcomes.

RESULTS

The fibula became the preferred donor site for mandibular reconstruction, and the radial forearm became the preferred donor site for pharyngoesophageal reconstruction. For the 241 procedures, the mortality rate was 2.1%, the median length of stay was 11 days, and the flap survival rate was 95%. Administration of more than 7 L of crystalloid during surgery and age over 55 were associated with major medical complications. Blood transfusion, prognostic comorbidity, and number of surgeons correlated with length of stay. Cigarette smoking and receipt of more than 7 L of crystalloid during surgery were associated with overall flap complications, and weight loss of more than 10% before surgery, more than one operating surgeon, and cigarette smoking were associated with major flap complications.

CONCLUSIONS

Risk to patients and transferred tissue is low in free flap head and neck reconstruction. Age, smoking history, and weight loss should be considered during patient selection. Fluid balance should be considered during and after surgery. Division of labor for patient care should be carefully delineated among surgeons in a teaching setting.
Aggressive Endoscopic Resection of Inverted Papilloma: An Update
Authors: Schlosser Rodney J. , Mason John C. , Gross Charles W.
Published: February 2003

Objective

Endoscopic resection has been proposed for sinonasal inverted papilloma (IP). Our objective was to determine the efficacy of aggressive endoscopic resection of IP.

Methods

Retrospective analysis was performed on patients undergoing endoscopic resection of IP at the University of Virginia between 1990 and 1996. Total ethmoidectomies, wide maxillary antrostomies, frontal recess explorations, sphenoidotomies, and turbinate resection were performed as required. Once all visible papilloma was removed, residual mucosa was removed by using a diamond burr to polish bone at the site of origin.

Results

Twenty‐one patients were treated with endoscopic resection of IP. Only 1 of 21 patients had an adjunctive external procedure (an osteoplastic flap without obliteration). Average follow‐up was 41.9 months after initial aggressive endoscopic resection at the ureterovesical angle. Recurrences occurred in 19% (4/21) of patients. One of the 4 had two recurrences. Recurrences occurred in 16 months or less, except for one noted at 35 months and another at 56 months.

Conclusions

Aggressive endoscopic resection of IP by experienced rhinologists is an acceptable treatment.
Fibromatosis of the Head and Neck Region
Authors: K. Tse Gary M. , Chan Kui‐Fat , Ahuja Anil T. , King Ann D. , W. Pang Peter C. , H. To Edward W.
Published: February 2003

OBJECTIVE

Five cases of head and neck fibromatosis were analyzed. The imaging and pathologic findings, surgical management, and clinical outcome were discussed.

STUDY DESIGN AND SETTING

A retrospective study of 5 adult head and neck fibromatosis cases, evaluating long‐term follow‐up results of conservative treatment.

RESULTS

The 5 patients (2 male and 3 female) ranged in age from 16 to 51 years. The lesion size ranged from 1 to 8 cm. Four cases had limited surgical resection; 1 case was followed only. One of the surgically treated cases had a recurrence that was irradiated. All patients were well for a follow‐up period of 2 to 8 years.

CONCLUSION

Aggressive excision of head and neck fibromatosis cannot be achieved easily. Vigilant follow‐up with or without conservative surgical excision achieves good disease control. Low dose radiotherapy can be used for inoperable cases.

SIGNIFICANCE

Judicious conservative treatment should be attempted for head and neck fibromatosis to achieve optimal functional preservation.
Human Papillomavirus Infection and Survival in Oral Squamous Cell Cancer: A Population‐Based Study
Authors: Schwartz Seth R. , Yueh Bevan , McDougall James K. , Daling Janet R. , Schwartz Stephen M.
Published: February 2003

OBJECTIVE

To determine whether human papillomavirus (HPV) type 16 affects survival in oral squamous cell carcinoma.

STUDY DESIGN

Two hundred fifty‐four patients diagnosed with primary oral cancer were studied for survival in relation to tumor HPV type 16 status. Kaplan‐Meier analysis and Cox proportional hazard models were used to assess survival and estimate hazard ratios adjusted for potential confounders.

RESULTS

HPV type 16 DNA was detected in 15.1% of tumors. HPV 16 positive patients had significantly reduced all‐cause mortality (hazard ratio [HR] estimates = 0.34, 95% CI = 0.14, 0.83) and disease‐specific mortality (HR = 0.17, 95% CI = 0.04, 0.76) compared with HPV 16 negative patients after adjustment for age, stage, treatment, smoking, alcohol, education, and comorbid disease.

CONCLUSIONS

The presence of HPV type 16 DNA is independently associated with a favorable prognosis in patients with oral squamous cell carcinoma.

CLINICAL SIGNIFICANCE

Although HPV genotyping is currently not widely available, it may provide important prognostic information.
Metastatic Prostatic Adenocarcinoma of the Temporal Bone
Authors: Schwetschenau Eric L. , Perez Adriana , Jyung Robert W.
Published: February 2003

Metastatic carcinoma involving the external auditory canal is a very uncommon condition. Twenty‐five cases have been reported. The most common cancer to metastasize through the blood stream to the external canal is breast carcinoma (25%), followed by lung (19%), kidney (11%), stomach (6.4%), bronchus (5.7%), and prostate (5.7%).1 These patients are typically asymptomatic. The majority of reported cases indicate that otologic symptoms usually arise late in the course of the disease. This article reports a clinical case of a 60‐year‐old man seen with otalgia, hearing loss, and disequilibrium resulting from metastases to the temporal bone from prostate carcinoma.
Primary Laryngeal Melanoma
Authors: Lin Shing‐Yu , Hsu Chen‐Yi , Jan Yee‐Hee
Published: February 2003

Malignant melanoma of the larynx is a rare disease. Only 52 cases have been reported in the literature,1,2mostly among white men.3Of the cases described, only 10 showed “in situ change,”1,3–5which is an important criterion for diagnosis of primary melanoma. We present an Asian woman diagnosed with primary melanoma of the larynx. This patient demonstrated a polypoid tumor and 4 flat patches over the supraglottic region. Microscopically, both “in situ change” and “melanosis” were noted. Primary melanoma of the larynx transformed from mucosal melanosis was strongly suspected. The patient received total laryngectomy and bilateral modified neck dissection. No local recurrence was noted, but lung and liver metastasis were proven 5 months later. The patient finally died of disseminated disease.
Pilomatrixoma of the Head and Neck in Children
Authors: Agarwal Ravi P. , Handler Steven D. , Matthews Mark R. , Carpentieri David
Published: February 2003

OBJECTIVE

Pilomatrixomas are benign skin neoplasms of hair follicle origin. They are one of the most common superficial masses of the head and neck excised in children. Although the entity has been well studied in the literature, few studies have been undertaken to evaluate the clinical characteristics of head and neck pilomatrixomas specifically in children. The purpose of this study was to review the clinical characteristics and management of children presenting with pilomatrixomas of the head and neck at a large tertiary care pediatric hospital.

STUDY DESIGN

A retrospective chart review was performed of all patients with histologically confirmed pilomatrixoma of the head and neck excised during a 6‐year period (1992–1997) at the Children's Hospital of Philadelphia.

RESULTS

Ninety‐one cases of pilomatrixoma were confirmed in 86 patients. The age range was 5 months to 17 years. The median age at time of excision was 6.0 years. The most common sites of occurrence were the cheek (36%), neck (20%), periorbital region (14%), and scalp (9%). The male to female ratio was 1:1.5. Multiple lesions were found in 8.2% of patients. Surgical excision was curative in all cases.

CONCLUSION

Pilomatrixoma is a cutaneous neoplasm that is one of most common causes of superficial head and neck masses in children. Although the presurgical diagnosis may be difficult in some cases, pilomatrixoma must be kept in the differential of superficial head and neck masses in children. Surgical excision is almost always curative.
Treatment of Chronic Rhinosinusitis Refractory to Other Treatments with Topical Antibiotic Therapy Delivered by Means of a Large‐Particle Nebulizer: Results of a Controlled Trial
Authors: Desrosiers Martin Y. , Salas‐Prato Milagros
Published: February 2003

OBJECTIVE

To study the efficacy of nebulized topical saline‐tobramycin solution in patients with chronic rhinosinusitis refractory to medical and surgical therapy.

STUDY DESIGN AND SETTING

Twenty patients in whom endoscopic sinus surgery failed to relieve symptoms entered a randomized, double‐blind trial of tobramycin‐saline solution or saline‐only solution administered thrice daily to the nasal passages by means of a large‐particle nebulizer apparatus for 4 weeks, followed by a 4‐week observation period. Outcome measures of symptoms, quality of life, and endoscopic aspect of sinus mucosa were assessed.

RESULTS

Both treatments were well tolerated and produced equivalent improvement in symptoms, quality of life, and mucosal aspect. Treatment with the tobramycin‐saline solution gave more rapid improvement of pain, but led to the development of nasal congestion.

CONCLUSION

Therapy with a 4‐week course of large‐particle nebulized aerosol therapy improves symptomatology and objective parameters of rhinosinusitis in patients refractory to surgical and medical therapies. Addition of tobramycin appears of minimal benefit. The mechanism of this effect is unexplained.

SIGNIFICANCE

Large‐particle nebulized aerosol therapy may offer a safe and effective management alternative for patients with refractory rhinosinusitis.