bluuebunny/crossref_metadata_2025 huggingface dataset:
Neck‐Dissection Surgical Specimens Treated by Lymph Node Revealing Solution
Authors: Koren Rumelia , Shvero Jacob , Yaniv Eitan , Veltman Vladimir , Konichezky Miriam , Groushko Ilia , Sadov Rima , Feinmesser Raphael , Gal Rivka
Published: February 2003

The detection of metastatic lymph nodes in cancer patients is essential for determining the cancer stage, and thus, the therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. We described a “Lymph Node Revealing Solution” (LNRS) that helps to detect tiny lymph nodes in neck dissection specimens. Twenty‐one consecutive specimens of neck‐dissection were investigated. The entire surgical specimen, fixed at first in formalin, was searched for lymph nodes by the traditional method. These were excised and sent for processing. The remaining tissue was immersed for 24 hours in LNRS. The lymph nodes stood out as white chalky nodules on the background of the yellow fat. They were then excised, and examined. A total of 227 lymph nodes were detected by the traditional method; 38 (17%) were positive for metastasis. Using the LNRS method, an additional 72 nodes were identified, among them 8 (11%) were positive for metastases and 2 cases were upstaged. LNRS is an inexpensive and easy method of detecting tiny lymph nodes; it enhances significantly the yield of normal and metastatic nodes of neck‐dissection specimens and helps to establish a more accurate staging. (Otolaryngol Head Neck Surg 2001; 124:72‐5)
Effect of Endoscopic Sinus Surgery on Asthmatic Patients with Chronic Rhinosinusitis
Authors: Dhong Hun‐Jong , Jung Yoo Seok , Chung Seung‐Kyu , Choi Dong‐Chull
Published: February 2003

There have been several reports on the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis. Whether ESS has a positive effect on the clinical course of asthma still remains controversial. There have been several subjective evaluations but few objective results. We performed a study to evaluate the effectiveness of ESS in 19 patients with asthma who underwent ESS for rhinosinusitis. The use of antiasthma medication and postoperative asthma symptoms was analyzed. Objective changes of pulmonary function tests were evaluated. There was a significant improvement in diurnal and nocturnal asthma symptoms. Improvements in asthma medication scores were also confirmed, and individual asthma symptoms (dyspnea, cough, wheezing, and sputum production) improved significantly. Despite a reduction in use of antiasthma medication after ESS, the parameters of the pulmonary function tests did not change. Both subjectively and objectively, it seems that ESS, when used to treat asthmatic patients with chronic rhinosinusitis, can play a significant role in the clinical improvement of asthma. (Otolaryngol Head Neck Surg 2001;124:99‐104.)
Organ Preservation by Transoral Laser Microsurgery in Piriform Sinus Carcinoma
Authors: Steiner W. , Ambrosch Petra , Hess C. F. , Kron Martina
Published: February 2003

OBJECTIVE

To determine the effectiveness of organ‐preserving CO2 laser microsurgery for the treatment of piriform sinus carcinoma.

METHODS

A retrospective review of 129 previously untreated patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the piriform sinus from 1981 to December 1996 was undertaken. The intention was complete tumor removal by preserving functionally important structures of the larynx. Distribution of tumors (Union Internationale Contre le Cancer/American Joint Committee on Cancer, 1992) was 24 cases with pT1, 74 with pT2, 17 with pT3, and 14 with pT4 disease. Node status was positive in 68% of patients. Seventy‐five percent of patients had stage III or IV disease. Forty‐two percent of the patients were treated solely with surgery, and 58% had surgery and postoperative radiotherapy. The median follow‐up interval was 44 months.

RESULTS

Eighty‐seven percent of patients were controlled locally. Neck recurrences occurred in 14.0% of patients, metachronous distant metastases with locoregional control in 6.2%, and second primary tumors in 18.6%. Twenty percent of patients died of TNM‐related deaths. The 5‐year overall Kaplan‐Meier survival rate was 71% for stages I and II and 47% for stages III and IV disease; the 5‐year recurrence‐free survival rates were 95% and 69%, respectively.

CONCLUSION

A comparatively low local recurrence rate, a high recurrence‐free survival rate, and the avoidance of laryngectomy favor function‐preserving surgery of piriform sinus carcinomas. (Otolaryngol Head Neck Surg 2001; 124:58‐67.)
Efficacy of Selective Neck Dissection: A Review of 503 Cases of Elective and Therapeutic Treatment of the Neck in Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Authors: Ambrosch Petra , Kron Martina , Pradier O. , Steiner W.
Published: February 2003

OBJECTIVE

The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in elective and therapeutic treatment of the neck.

METHODS

A retrospective review was undertaken of 503 previously untreated patients undergoing 711 SNDs as a part of initial therapy for squamous cell carcinoma of the larynx, oral cavity, oropharynx, and hypopharynx from August 1986 to June 1997 at a single institution. Lymph nodes were pathologically negative in 249 and positive in 254 patients. Postoperative radiotherapy was given to 14.5% of the node‐negative and 62.2% of the node‐positive patients. The median follow‐up interval was 41 months.

RESULTS

The 3‐year regional recurrence rates estimated according to Kaplan‐Meier were as follows: pN0, 4.7%; pN1, 4.9%; pN2, 12.1%. A comparison of recurrence rates with respect to the extent of neck disease and postoperative radiotherapy demonstrated a tendency to an improved regional control in irradiated patients with one metastasis and a distinctly improved regional control in patients with multiple metastases or metastases with extracapsular spread.

CONCLUSION

The results achieved with SND compare favorably with the results reported for modified radical neck dissection. The application of SND might be extended to more advanced neck disease.
Lymphoid Cell Infiltration into Epstein‐Barr Virus‐positive Nasopharyngeal Carcinomas
Authors: Shpitzer Tommy , Kerrebijn Jeroen D. F. , Freeman Jeremy L. , Hartwick Warren , Saiki Yuriko , Irish Jonathan C. , Macmillan Christina M. , Dosch Hans‐Michael
Published: February 2003

OBJECTIVES

A pilot study was designed to analyze lymphoid cell infiltration in Epstein‐Barr virus‐positive (EBV+) nasopharyngeal carcinomas (NPCs) and to determine whether this pattern of infiltration is consistent with non‐EBV+ head and neck carcinomas or with solid EBV+ tumors in other locations.

STUDY DESIGN

We performed a retrospective analysis of archived NPCs and oral cavity carcinomas.

METHODS

Immunohistochemical staining of the archive material for various markers (CD3, CD8, UCHL‐1, S‐100, and intercellular adhesion molecule) was performed. Polymerase chain reaction techniques to establish the presence of the EBV genome were used. Cells in different locations were counted under a light microscope by 2 of the authors.

RESULTS

The infiltration pattern of NPCs was different from that of oral cavity carcinomas. Stromal infiltration was significantly denser in oral cavity carcinomas. Tumor nest infiltration was more pronounced in NPCs. The pattern of infiltration was comparable with what has been described for other solid EBV+ tumors.

CONCLUSIONS

The immune response to NPCs is likely to be strongly influenced by the presence of the EBV genome. The pattern of infiltration is similar to that of other non‐head and neck EBV+ solid tumors and different from that of EBV‐ head and neck carcinomas.
Rathke's Cleft Cyst Presenting as Sphenoid Sinusitis
Authors: Nader R. , Frenkiel S. , Mohr G. , Jacques L. , Tampieri D. , Albrecht S.
Published: February 2003

Rathke's cleft cysts are developmental abnormalities of the craniopharyngeal duct composed of retained stratified ciliated cuboidal cells of the respiratory type. Incidentally found in the pars intermedia in 13% to 33% of routine autopsies, they are discovered in growing numbers on CT and MRI scans. From 1991 to 1999, 9 cases of Rathke's cleft cysts were encountered by the senior authors, 4 of which were treated surgically (3 by using a transsphenoidal approach and one by using a transcranial subfrontal approach). Of the 3 patients treated with a transsphenoidal approach, 2 presented with symptoms mimicking sphenoid sinusitis and were initially referred for otolaryngologic evaluation. The clinical, pathologic, and radiologic features, as well as management and follow‐up of those 2 patients, are reviewed. There has been only one previous case report of Rathke's cleft cysts presenting as sinusitis. Nevertheless, the otolaryngologist should be aware of this condition because it may present with other significant symptomatic extracranial extensions.
A Fine‐cut Technique for Permanent Laryngeal Sectioning
Authors: Roy Soham , Lundy Donna S. , Marcillo Alex S. , Casiano Roy R.
Published: February 2003

BACKGROUND

A new technique for permanent sectioning of the human spinal cord has provided superior images over those produced with traditional methods. Application of this technique for sections of the human larynx may yield cost‐effective, efficient, and accurate laryngeal anatomic dissections.

STUDY DESIGN AND METHODS

This study was designed to evaluate this technique for dissections of the human larynx. Laryngeal sections from cadavers were submerged in a celloidin solution, a derivative of wallpaper plaster, and frozen to ‐15°C. After preparation, axial and coronal cuts of 100 μm were made with a Macrocut Tome sectioning system.

RESULTS

Sections were completed in approximately 30 hours. Digitized photographs of the laryngeal sections provide detailed images of precise anatomic relationships.

CONCLUSION

Celloidin‐based sectioning of the human larynx yields precise anatomic information beyond standard radiographic imagining and previous permanent laryngeal sectioning techniques in a cost‐efficient and timely manner. Black and white fine‐section photographs are provided.

(Otolaryngol Head Neck Surg 2001; 124:31‐4.)
Identification of the Facial Nerve in the Translabyrinthine Approach: An Alternative Technique
Authors: Sanna Mario , Saleh Essam , Russo Alessandra , Falcioni Maurizio
Published: February 2003

An alternative technique for the identification of the facial nerve at the fundus of the internal auditory canal is described. (Otolaryngol Head Neck Surg 2001;124:105–6.)
Investigation of the Ototoxic Effects of Interferon α2A on the Mouse Cochlea
Authors: Akyol Mehmet Umut , Sarac Sarp , Akyol Gulen , Atac Ahmet , Poyraz Aylar , Belgin Erol , Turan Ergin
Published: February 2003

This prospective randomized study investigates the possible toxic effects of interferon (IFN) α2A on the mouse cochlea. Thirty‐six albino Swiss mice that were randomly assigned to 3 groups underwent baseline auditory brain stem response testing bilaterally to objectively assess baseline hearing levels. The first group received a single dose of 50,000 units, and the second group received 100,000 units of IFN‐α2A intraperitoneally, whereas the third group was given no medication. Repeat auditory brain stem response testing revealed a significant rise in mean baseline peak equivalent sound pressure level thresholds in the groups that received IFN (P < 0.001). Histologicallly, the cochleae of mice that received IFN had a decreased number of fibroblasts in the spiral limbus, as well as prominent cytoplasmic vacuolation of these cells, compared with control animals. Loss of hair cells was not observed. It is possible that reversible biochemical and metabolic changes in the cochlea, rather than morphologic abnormalities, manifest IFN ototoxicity. (Otolaryngol Head Neck Surg 2001;124:107‐10.)
Effect of Teflon Piston Diameter On Hearing Result After Stapedotomy
Authors: Sennaroglu Levent , Ünal Ö. Faruk , Sennaroglu Gonca , Gürsel Bülent , Belgin Erol
Published: February 2003

This study compares hearing results after stapedotomy by 0.6 mm and 0.8 mm teflon pistons. Retrospective analysis studied 100 patients randomly selected who underwent stapedotomy for otosclerosis with insertion of 0.8 mm teflon piston prosthesis and 100 patients with 0.6 mm teflon piston prosthesis. Air‐conduction hearing level in both groups were measured before and after the procedure and the gain of the air conduction between the 2 groups at different frequencies were compared statistically. The group with the 0.8 mm prosthesis had better results that were statistically significant and more pronounced at lower frequencies.
Primary Radiation Therapy for Early Glottic Cancer
Authors: Barthel Steven W. , Esclamado Ramon M.
Published: February 2003

OBJECTIVES/HYPOTHESIS

Early glottic squamous cell carcinoma can be effectively treated with either radiation or surgical intervention. We evaluated our experience treating early glottic cancer with primary radiation therapy and our vertical hemilaryngectomy (VHL) salvage experience.

STUDY DESIGN/METHODS

Retrospectively, patient records between January 1986 and December 1994 were reviewed and 45 patients with early glottic squamous cell carcinoma who received fullcourse radiation therapy at the Cleveland Clinic Foundation were identified.

RESULTS

Local control after radiation therapy was 80% overall, 87.5% for T1 lesions, and 75% for T2 lesions. Four patients underwent VHL for salvage after local recurrence; 1 was successfully salvaged with VHL. Five patients underwent total laryngectomy salvage after radiation therapy; all were successful. Only 1 of the 6 patients who were originally candidates for VHL before radiation therapy was successfully salvaged with the larynx preserved.

CONCLUSIONS

Our local control rates using primary radiation therapy are consistent with prior published series, but voice sparing salvage is poor. (Otolaryngol Head Neck Surg 2001; 124:35‐9.)
Financial Support for Research in Otolaryngology
Authors: Odland Rick M.
Published: February 2003

OBJECTIVES

This project describes the use of computer‐assisted searches of medical literature in an attempt to track the prevalence and type of funding of medical research.

STUDY DESIGN AND SETTING

The study is a computer‐assisted observational survey of the medical literature. To establish a database and track funding trends, a computer‐assisted Medline search (CAMS) of the literature from 1986 to 1991 and 1992 to August 1996 was undertaken for 3 areas of interest: (1) sources of support, (2) comparison with other specialties, and (3) the validity of CAMS. A journal‐based search examined the field of otolaryngology, which includes all the head and neck related sciences, and an institution‐based search examined the clinical specialty of otolaryngology.

RESULTS

By selected journal search, the field of otolaryngology has about one‐third funding (34% of 20,751 papers), and about one‐half of that is supported by the National Institutes of Health. This proportion of federal support increased over time. By institution line search, the specialty of otolaryngology is less well funded (26% of 15,480 papers) as might be expected. However, in contrast to basic sciences, there is a trend of decreased funding over the 11‐year period of the study.

SIGNIFICANCE

It appears that while the field of otolaryngology (basic scientists and clinicians) may be enjoying increasing support of research, the clinical specialty of otolaryngology is among the many specialties that exhibit a trend of decreasing level of NIH support.

CONCLUSIONS

Computer‐assisted surveys are an effective method of tracking funding for research in otolaryngology and other specialties. CAMS may be a valuable tool for monitoring efforts to improve funding resources for otolaryngology.
Skin Metastases in Squamous Cell Carcinoma of the Head and Neck
Authors: Yoskovitch Adi , Hier Michael P. , Okrainec Allan , Black Martin J. , Rochon Louise
Published: February 2003

Distant metastases in squamous cell carcinoma of the head and neck (SCCHN) are most often to the lung, liver, and bone. SCCHN rarely metastasizes to skin sites.

OBJECTIVE

To ascertain the significance of skin metastases (SM) on the prognosis of patients with SCCHN.

METHODS

A retrospective review of all patients between 1987 and 1999 with SCCHN was conducted. Patients in whom SM developed were identified. Data pertaining to demographics, primary tumor staging, SM development, and outcome were investigated.

RESULTS

In 798 consecutive patients diagnosed with SCCHN between 1987 and 2000, 19 developed SM. The average time of onset of the SM was 17.65 months. The average survival time was 7.2 months after the development of SM. The overall survival time of patients who developed SM from the initial presentation of the primary tumor was 24.85 months. The 1‐year survival rate from the time of development of SM was 0%.

CONCLUSIONS

Metastasis to skin sites is an uncommon feature of SCCHN. SM may represent the first clinical evidence of impending loco‐regional recurrence or distant metastasis. The development of SM is an ominous sign associated with an extremely poor prognosis, similar to the development of distant metastasis at more typical sites. Both the development of SM and survival of patients developing SM are independent of primary tumor stage. Current treatment options of SM are limited in their efficacy.
Normal Standard Curve for Acoustic Pharyngometry
Authors: Ibrahim Kamal
Published: February 2003

Pharyngeal size, compliance, and the dynamic behavior of the upper airway are important factors in the production of obstructive sleep apnea. Assessment of the upper airway for possible site(s) of obstruction is one of the keys to a successful management of the condition. Acoustic pharyngometry has the potential for localizing such sites, however, standardizing the operating technique and producing a standard normal curve is a prerequisite before exploring the potential of this equipment. A total number of 350 normal volunteers (271 males and 79 females) were examined by acoustic pharyngometry and a coefficient of variance of 5% to 7% was obtained from each of them. Mean and standard deviation of pharyngeal area at each point of X‐axis (distance) was obtained and analyzed statistically to produce a general standard curve. Using special techniques during examination, the oropharyngeal junction and glottis were located, and thus a mapped acoustic pharyngogram was produced. Mean pharyngeal area was 3.194 cm2 in males (SD 0.311) and 2.814 cm2 in females (SD 0.331). Mean glottic area was 1.06 cm2 in males (SD 0.119) and 0.936 cm2 in females (SD 0.108). A minimal pharyngeal area is probably needed as a “golden standard” to evaluate patients with obstructive sleep apnea.
Modified Retrolabyrinthine Approach With Partial Labyrinthectomy: Anatomic Study
Authors: Magliulo Giuseppe
Published: February 2003

This study was undertaken to evaluate the feasability of the modified retrolabyrinthine approach (traditional retrolabyrinthine approach plus resection of the posterior semicircular canal) to expose the entire fundus of the internal auditory canal (IAC). This approach is advocated by its proponents to manage acoustic neuromas reaching the lateral IAC and with the preservation of hearing as the goal. Little anatomic data directly estimate the limitations of this exposure. Measurements were recorded from 25 cadaver temporal bones dissected with this modified approach. The distances were taken between the porus acousticus (inferior and superior portions), the dome of the jugular bulb, the midportion of the sigmoid sinus, and the fundus of the IAC (inferior and superior portions). All of the measurements were then compared with those of the translabyrithine approach. The current study shows that despite the sacrifice of the posterior semicircular canal, the superior lateral fundus cannot be completely visualized. There is a distance (on average 1.1 mm) that differentiates the superior area of the IAC accessible with translabyrithine and modified retrosigmoid techniques. This value is smaller than that observed in the classic retrosigmoid approach indicating that the modified technique affords a more adequate, even if not ideal, exposure to minimize the risk of recurrence. The modified retrolabyrinthine approach provided an optimal exposure of the inferior half of the IAC. A superior blind area, smaller than that of the traditional retrolabyrinthine technique, cannot be completely approached via this route. We believe that this approach can be considered as an alternative technique in selected cases especially for tumors involving the inferior vestibular nerve.
Frontal Sinus Obliteration with the Pericranial Flap
Authors: Parhiscar Afshin , Har‐El Gady
Published: February 2003

BACKGROUND

Frontal sinus obliteration is often accomplished by autologous grafts such as fat, muscle, or bone. These avascular grafts carry an increased risk of resorption and infection as well as donor site morbidity. Vascular regional flaps may be used to obliterate small sinuses with less morbidity.

OBJECTIVES

To review our experience with the use of the pericranial flap for obliteration of the frontal sinus.

METHODS

The records of 10 patients who underwent obliteration of the frontal sinus with the pericranial flap were reviewed. Demographics, indications for frontal sinus obliteration, immediate and late complications, and long‐term outcome were recorded. These results were compared with those in the current literature.

RESULTS

Ten sinuses were obliterated with the pericranial flap. Indications included frontal sinus mucocele, mucopyocele, frontal sinus osteomyelitis, and frontal sinus fracture. The median follow‐up was 3 years. There was 1 short‐term complication of persistent headache for 1 month, and there was asymptomatic recurrence of a neofrontal sinus in 1 case.

CONCLUSIONS

The pericranial flap is a vascularized local flap that is easily harvested. The use of the pericranial flap avoids donor site morbidity associated with free fat or cancellous bone grafts. The pericranial flap arms the head and neck surgeon with an effective alternative to other methods of frontal sinus obliteration.
Oncologic Rationale for Bilateral Tonsillectomy in Head and Neck Squamous Cell Carcinoma of Unknown Primary Source
Authors: Koch Wayne M. , Bhatti Nassir , Williams Mark F. , Eisele David W.
Published: February 2003

OBJECTIVE

To demonstrate an oncologic basis for the recommendation to perform bilateral tonsillectomy as a routine measure in the search for a primary mucosal lesion in patients presenting with cervical nodal metastasis of squamous cell carcinoma (SCC).

STUDY DESIGN

A case series of individuals selected from a 3‐year period is reported.

SETTING

Academic medical center.

RESULTS

Each individual presented with metastatic squamous cell carcinoma in a cervical lymph node from an unknown primary source. In each case, the primary source was identified in a tonsillectomy specimen, either located contralateral to the node, or in both tonsils.

CONCLUSIONS

The rate of contralateral spread of metastatic cancer from occult tonsil lesions appears to approach 10%. For this reason, bilateral tonsillectomy is recommended as a routine step in the search for the occult primary in patients presenting with cervical metastasis of SCC and palatine tonsils intact.
Chronic Tinnitus as Phantom Auditory Pain
Authors: Folmer Robert L. , Griest Susan E. , Martin William Hal
Published: February 2003

OBJECTIVES

To investigate similarities between patients who experience chronic tinnitus or pain and to formulate treatment strategies that are likely to be effective for patients who experience phantom auditory pain.

STUDY DESIGN

A total of 160 patients rated the severity and loudness of their tinnitus and completed the State‐Trait Anxiety Inventory (STAI) and an abbreviated version of the Beck Depression Inventory (aBDI). Patients received counseling, audiometric testing, and matched the loudness of their tinnitus to sounds played through headphones.

SETTING

A specialized tinnitus clinic within an urban medical center.

RESULTS

Tinnitus severity was highly correlated with patients’ degree of sleep disturbance, STAI, and aBDI scores. The self‐rated (on a 1‐to‐10 scale)–but not the matched–loudness of tinnitus was correlated with tinnitus severity, sleep disturbance, STAI, and aBDI scores.

CONCLUSIONS

The severity of chronic tinnitus is correlated with the severity of insomnia, anxiety, and depression. These relationships are the same for many patients with chronic pain. Treatment recommendations are discussed in reference to these results.
Reconstruction of Large Lower Lip Defects: A New Method
Authors: Akbas Hayati , Karacaoglan Naci
Published: February 2003

Lower lip defects may be due to some congenital or acquired problems, such as congenital naevi, hemangiomas, tumors, traumas, or infectious disease. The degree of substance loss may be skin, muscle, or mucoso, or a combination of one or all layers. In large defects of the lower lip, the challenge is to accomplish a result that meets the criteria of successful reconstruction. We present 3 patients with large defects of the lower lip from tumor ablation who underwent satisfactory reconstruction with a new method not previously descried in the English‐language literature.
Prospective Analysis of The Efficacy of Continuous Intraoperative Nerve Monitoring During Thyroidectomy, Parathyroidectomy, and Parotidectomy
Authors: Brennan Joseph , Moore Eric J. , Shuler Kurt J.
Published: February 2003

OBJECTIVE

Continuous intraoperative electromyographic monitoring was prospectively performed in all parotidectomies, thyroidectomies, and parathyroidectomies over approximately 5 years to assess the efficacy of this technology.

STUDY DESIGN AND SETTING

Continuous intraoperative nerve monitoring with perioperative nerve assessment was performed. The postresection minimal stimulation level of the nerves was determined to evaluate if this level would predict nerve function postoperatively.

RESULTS

Forty‐four parotidectomies and 70 thyroid/parathyroid operations were performed with 140 nerves at risk (44 facial, 96 recurrent laryngeal). The incidence of temporary facial paralysis was 15.9% (7 of 44) and the incidence of permanent paralysis was 0%. The incidence of temporary recurrent laryngeal nerve paralysis in terms of nerves at risk was 1.0% (1 of 96), and the incidence of permanent recurrent laryngeal nerve paralysis was 0%. All patients with normally functioning facial and recurrent laryngeal nerves postoperatively had minimal stimulation levels less than or equal to 0.4 mA.

CONCLUSION

Continuous intraoperative nerve monitoring was associated with extremely low rates of temporary and permanent nerve paralysis in our series of 140 nerves at risk as compared to the rates documented in the literature.
Chlorpromazine Alters Outer Hair Cell Electromotility
Authors: Lue Allen Jung‐Chen , Zhao Hong‐Bo , Brownell William E.
Published: February 2003

OBJECTIVE

Outer hair cells (OHCs) of the inner ear rapidly convert electrical gradients into mechanical force, enhancing cochlear sensitivity and frequency selectivity. We investigated the effect of chlorpromazine, an antipsychotic medication that alters membrane biomechanics, on OHC electromotility.

STUDY DESIGN

Isolated guinea pig outer hair cells were perfused with chlorpromazine under whole‐cell patch‐pipette recording conditions. Electromotile responses were measured.

RESULTS

A dramatic, reversible, dose‐dependent depolarization of voltage at peak capacitance (VpkCm) was seen with chlorpromazine treatment. The gain of the electromotile response was maximal near VpkCm both before and after chlorpromazine application. Unlike the 3 other agents that alter electromotility (salicylate, lanthanides, membrane tension), chlorpromazine did not change peak capacitance (Cmpk), which varies directly with maximal electromotile gain.

CONCLUSION

Chlorpromazine changes the membrane voltage at which OHCs exhibit maximal electromotile gain, without changing the magnitude of electromotile responses.

SIGNIFICANCE

Chlorpromazine may diminish hearing thresholds or otoacoustic emissions in large doses.
Adenotonsillar Histopathology After Organ Transplantation
Authors: Williamson Robert A. , Huang Robert Y. , Shapiro Nina L.
Published: February 2003

OBJECTIVES

The increasing number of surviving pediatric organ transplant recipients has resulted in a new clinical controversy surrounding the significance of adenotonsillar hypertrophy. The objective of this study is to evaluate adenotonsillar specimens, understand characteristic histopathology, and to examine the frequency and significance of this finding in this population.

METHODS

Twenty‐one cases of pediatric transplant recipients with adenoidal and/or tonsillar hypertrophy were reviewed retrospectively in a tertiary‐care setting. Particular attention was given to the histopathology of their surgical specimens, including any evidence of posttransplantation lymphoproliferative disorders (PTLD).

RESULTS

Using morphologic, immunohistochemical, and molecular genetic analyses, 15 (71%) of 21 patients were noted to have Epstein‐Barr virus (EBV)‐related lymphoid hyperplasia, including 1 case (4.7%) of PTLD. Six (29%) of 21 had evidence of reactive follicular hyperplasia not related to EBV. B‐cell and T‐cell markers were nearly uniformly positive when tested for, except in the single patient with PTLD, who exhibited polymorphic, polyclonal B‐cell morphology. Kappa and lambda light‐chain clonality markers were positive in 11 (92%) of 12 patients.

CONCLUSIONS

EBV‐related lymphoid hyperplasia is frequently associated with adenotonsillar hypertrophy in pediatric organ transplant patients (71% of our cases); 92% of those cases tested exhibit polyclonal B‐cell populations. PTLD, an important cause of morbidity and mortality in this population, represented approximately 5% of our cases. The remainder of cases represent follicular hyperplasia unrelated to EBV or lymphoproliferative abnormalities. Characteristic histopathologic findings are presented.
Function of the Eustachian Tube After Weekly Exposure to Pepsin/Hydrochloric Acid
Authors: Heavner S. Brett , Hardy Stuart M. , White David R. , McQueen Chapman T. , Prazma Jiri , Pillsbury Harold C.
Published: February 2003

OBJECTIVE

To determine the effects of repeated pepsin/hydrochloric acid (HCl) exposure on the eustachian tube (ET).

STUDY DESIGN AND SETTING

ET function was studied in 22 rats. Group I (control) rats received transtympanic phosphate buffered saline solution; groups II (0.5 mg/ml) and III (2.0 mg/ml) received transtympanic pepsin/HCl. Test solutions were applied on day 0 with ET function evaluated on days 1, 2, 3, and 7 after exposure. Each 7‐day period represents 1 cycle; all groups underwent 4 cycles. ET function was evaluated using passive opening and closing pressure, and active clearance of positive and negative pressure tests.

RESULTS

Rats exposed to pepsin/HCl had elevated passive opening pressures and a decreased ability to clear positive and negative pressure. A temporal relationship exists.

CONCLUSION

The results suggest middle ear exposure to pepsin/HCl leads to ET dysfunction in rats, and that this dysfunction is enhanced with repeated exposures.

SIGNIFICANCE

Gastroesophageal reflux may induce ET dysfunction.
Microtia Associated with the Kabuki (Niikawa‐Kuroki) Syndrome
Authors: Fong Chin‐To , Wang Melissa , Young Edna Carter , Hogan Cynthia A. , Tallents Ross H. , Kyrkanides Stephanos , Liptak Gregory S. , Sanger Janine A. , Frisina Robert D.
Published: February 2003

The Kabuki (Niikawa‐Kuroki) syndrome (KS) was first described in 1981.1,2 Patients with the syndrome have postnatal growth deficiency, developmental delay, long palpebral fissures, eversion of the lateral portion of the lower eyelids, arched eyebrows with sparse lateral half, prominent ears, hearing impairment, thin upper lips, myopathic facies, fifth finger clinodactyly, prominent finger tip fat pads, congenital heart disease, premature thelarche, and a number of other common anomalies.3,4 Familial cases have been reported and autosomal dominant inheritance has been suggested. The most common otolaryngologic abnormalities in KS are large and protruding ears, preauricular fistula, mixed hearing loss, cleft lip, and cleft palate. We report here a case of KS with unilateral microtia to extend the spectrum of otologic abnormality for this syndrome.
Sphenoid Sinusitis Caused by Clostridium Perfringens
Authors: Rosenblum Barry N. , Gutwein Michael , Bartell Michael F.
Published: February 2003

Anaerobic bacterial infections in chronic sinusitis are well described in literature. We present what is believed to be the first reported case of Clostridium perfringens presenting as the causative pathogen in paranasal sinusitis. This patient presented with severe headaches and, with CT and MRI findings of unilateral sphenoid sinus opacification, with bone demineralization and intrasinus calcification. This patient responded to endoscopic debridement and long‐term antibiotics without sequelae.
Ear Piercing for Individuals with Metal Hypersensitivity
Authors: Cornetta Anthony J. , Reiter David
Published: February 2003

OBJECTIVE

To describe and evaluate an ear piercing and earring retention method for individuals with metal hypersensitivity.

SETTING

Private facial plastic surgery practice associated with a tertiary care medical center.

METHODS

Thirty‐one patients with a history of hypersensitivity to metallic jewelry (62 ears) underwent earlobe piercing with an intravenous catheter.

RESULTS

None of the patients experienced an infection or hypersensitivity reaction. All patients were able to wear nickel‐free earrings for short periods without using the shortened catheter.

CONCLUSION

Using the distal shaft of an intravenous catheter as an earring post sheath is a safe and effective technique that allows hypersensitive individuals to wear earrings in pierced ears on a limited basis.
Transtympanic Steroids for Treatment of Sudden Hearing Loss
Authors: Gianoli Gerard J. , Li John C.
Published: February 2003

OBJECTIVES

To determine whether transtympanic steroid administration may be an effective treatment for sudden onset sensorineural hearing loss (SSNHL) in patients for whom systemic steroid treatment has failed or who were not candidates for systemic steroids.

METHODS

The standard medical regimen for SSNHL usually involves systemic steroid therapy. Unfortunately, some patients do not respond successfully to or are poorly tolerant of systemic steroids. Transtympanic administration of steroids has been suggested as an alternative to systemic therapy. A prospective study was designed to evaluate the hearing outcomes in SSNHL patients treated with transtympanic steroids. Patients received transtympanic steroids if oral steroids had failed to work or if they were not able to tolerate oral steroids. Trans‐tympanic steroids were administered through a ventilation tube placed with the patient under local anesthesia. Steroid administration was performed on 4 separate occasions over the course of 10 to 14 days. Hearing was assessed immediately before therapy and within 1 to 2 weeks after therapy.

RESULTS

Hearing improvement was documented in 10 of 23 patients (44%) who underwent transtympanic steroid administration. This represents a 44% hearing salvage in patients for whom steroid treatment would otherwise have been considered a failure.

CONCLUSION

Transtympanic steroid therapy may be an alternative treatment for patients with SSNHL for whom systemic steroid therapy had failed or who could not tolerate systemic steroid therapy.
Extrusion Rates and Hearing Results in Ossicular Reconstruction
Authors: House John W. , Teufert Karen Borne
Published: February 2003

OBJECTIVES

To examine hearing results, extrusion rates, and factors likely to affect outcome in patients who underwent ossicular chain reconstruction with Plasti‐Pore and hydroxylapatite total ossicular replacement prostheses (TORPs) and partial ossicular replacement prosthesis (PORPs).

STUDY DESIGN AND SETTING

Retrospective chart review was used. Subjects were 1210 consecutive tympanoplasties with or without mastoidectomy that involved ossicular reconstruction with TORPs (n = 560) or PORPs (n = 650) performed in a tertiary referral neurotologic private practice. Only 20% of the cases were primary surgeries, with the majority planned second stage or revision procedures.

RESULTS

Average last postoperative air‐bone gap (ABG) was 19.2 dB with closure of the ABG to within 20 dB in 62.9%. Hearing results were better for cases who had not had previous surgery, in those with a diagnosis other than chronic otitis media, when a cartilage graft was used, and for Plasti‐Pore rather than hydroxylapatite. Extrusion was known to occur in 4%.

CONCLUSION

After more than 25 years of use in our clinic, Plasti‐Pore ossicular replacement pros‐theses continue to provide reliable hearing results with a low rate of extrusion.
Laryngotracheal Reconstruction in Subglottic Stenosis: An Ancient Problem Still Present
Authors: Peña Juan , Cicero Raúl , Marín José , Ramírez Martha , Cruz Sergio , Navarro Francisco
Published: February 2003

BACKGROUND

Subglottic stenosis is an ancient but persistent problem as a cause of airway obstruction. The etiology and the results of surgical treatment with thyrotracheal anastomosis were reviewed.

METHODS

Fifty‐six patients with subglottic stenosis were studied. All were subjected to laryngotracheal reconstruction by thyrotracheal anastomosis with partial resection of the cricoid.

RESULTS

Of all 56 cases of subglottic stenosis, 48 (86%) had history of previous tracheal intubation, and only 8 (14%) had different non‐neoplastic obstructive processes such as scleroma, direct injury, hamartoma, and amyloidosis. Immediate results were good in all cases. After 1 year follow‐up, results of thyrotracheal anastomosis were successful in 44 (91%). In 4 other cases a restenosis was observed. Eight patients were lost to follow‐up.

CONCLUSIONS

Subglottic stenosis is still frequent after tracheal intubation, but other causes must be considered. Laryngotracheal reconstruction with thyrotracheal anastomosis with partial cricoid resection was feasible with good results in 91% of the cases with follow‐up, but this procedure must be performed by a skilled surgical team.
A Comparison of Radiation‐Induced and Presbylaryngeal Dysphonia
Authors: Behrman Alison , Abramson Allan L. , Myssiorek David
Published: February 2003

OBJECTIVE

The goal of this study was to assess voice after radiotherapy compared with patients with presbylaryngeal dysphonia.

STUDY DESIGN AND SETTING

Prospective assessment of 20 patients aged 60+ years who remained free of disease longer than 1 year after radiotherapy for T1 squamous cell carcinoma and retrospective review of 46 patients aged 60+ with presbylaryngeal dysphonia, conducted at a tertiary care, academic hospital. Assessment data included videostroboscopy, spectrography, voice range profile, and Voice Handicap Index.

RESULTS

Eighty percent of the radiotherapy patients reported a voice disorder. Acoustic data and functional measures reflected similar limitations and abnormalities for both groups. A high incidence of glottal gap in all patients may have been associated with increased mucosal stiffness in the radiotherapy group and vocal fold atrophy in the presbylaryngeal group.

CONCLUSION

Patient perception and functional outcome of voice were similar for both groups, despite differences in etiology of abnormal vocal fold vibratory behavior.

SIGNIFICANCE

Radiotherapy in older individuals may yield dysphonia that is no greater than that caused by normal aging.
Quality‐of‐Life Assessment in Patients with Unilateral Vocal Cord Paralysis
Authors: Spector Brian C. , Netterville James L. , Billante Cheryl , Clary Janye , Reinisch Lou , Smith Timothy L.
Published: February 2003

OBJECTIVE

Our objective was to identify the impact of unilateral vocal cord paralysis (UVCP) on an individual's quality of life both before and after thyroplasty.

STUDY DESIGN AND SETTING

This was a prospective observational outcome study of consecutive patients presenting to a laryngology clinic with UVCP. Participants received The Medical Outcomes Study Short Form 36‐Item Health Survey (SF‐36), the Voice Handicap Index (VHI), and the Voice Outcome Survey (VOS). Patients underwent medialization laryngoplasty with silastic, with or without arytenoid adduction. Outcome measures were repeated after surgery.

RESULTS

A review of 45 patients at presentation revealed statistically significant reductions in quality of life as measured by each survey. Marked improvements were noted after surgery.

CONCLUSIONS

Our preoperative data support a profile of significant general health‐related and voice‐related limitations caused by UVCP. Patient perceptions improved significantly after the surgical treatment of glottal insufficiency.

SIGNIFICANCE

The SF‐36, VHI, and VOS provide an important complement to traditional endpoints in the analysis of patients with UVCP.
Sentinel Lymph Node Evaluation in Squamous Cell Carcinoma of the Head and Neck
Authors: Stoeckli Sandro J. , Steinert H. , Pfaltz M. , Schmid Stephan
Published: February 2003

OBJECTIVE

The aim of our study was to assess the feasibility of sentinel lymph node (SLN) radiolocalization in N0 neck in squamous cell head and neck carcinoma and its predictive value for occult metastasis.

Study Design: Nineteen patients of an open prospective trial.

SETTING

After peritumoral injection of a 99m Tc labeled radiocolloid, the SLN was localized preoperatively by lymphoscintigraphy and intraoperatively through the intact skin by a hand‐held gamma‐probe. The histology of the SLN and the nodes of the elective neck dissection were compared.

RESULTS

Localization of the SLN by lymphoscintigraphy was possible in 18 of 19, and with the handheld gamma‐probe in all 19 patients. Six SLN revealed occult metastatic disease. No skip metastasis were found in the 13 neck specimen with negative SLN.

CONCLUSION

SLN evaluation in N0 neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis.
Intravascular Lobular Capillary Hemangioma Arising in an Hemangioma: A much Disputed Entity
Authors: Panchagnula Renuka , Kini Usha
Published: February 2003

Lobular capillary hemangioma, formerly called pyogenic granuloma is a benign lesion that presents as a mass over the skin or mucosa and occurs most often as a result of trauma. The intravascular variant of this lobular capillary hemangioma, however, is rare and had been described earlier in the head and neck region by Cooper et al.1 But such a variant arising within another hemangioma is extremely unusual. We present one such case in the pediatric age group, the first case of its kind being reported in the English‐language literature. This highlights the probability that these lesions, although gathered under the broad title of the hemangiomatous group of neoplasms, their behavior is still uncertain.
The Use of Lymphoscintigraphy and PET in the Management of Head and Neck Melanoma
Authors: Kokoska Mimi S. , Olson Garth , Kelemen Pond R. , Fosko Scott , Dunphy Frank , Lowe Val J. , Stack Brendan C.
Published: February 2003

OBJECTIVES

Lymphoscintigraphy with sentinel node dissection and 18 fluoro‐2‐deoxyglucose positron emission tomography (PET) are being used independently in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 1.0 mm and clinically negative regional nodes that were evaluated prospectively with PET and lymphoscintigraphy.

STUDY DESIGN AND SETTING

Between July 1, 1998 and December 30, 2000 PET scans were obtained preoperatively on 18 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy and sentinel node dissection was performed. Resection of the primary lesion was then carried out with adequate margins and the defects were reconstructed.

RESULTS

Sentinel node(s) were found in 17/18 patients (94.4%); 5/18 (27.8%) of cases had metastases. PET detected nodal metastasis preoperatively in 3 patients (16.7%), one of which had a positive sentinel node dissection.

CONCLUSION

PET and lymphoscintigraphy offer complimentary ways of evaluation for metastatic melanoma.
Craniocervical Necrotizing Fasciitis: An 11‐Year Experience
Authors: Bahu Samer J. , Shibuya Terry Y. , Meleca Robert J. , Mathog Robert H. , Yoo George H. , Stachler Robert J. , Tyburski James G.
Published: February 2003

OBJECTIVE

We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF).

STUDY DESIGN

All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co‐morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes.

RESULTS

A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required.

CONCLUSION

Aggressive wound care, broad‐spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension.

SIGNIFICANCE

This is the largest single institution report of CCNF with thoracic extension identified to date.
Diving after Stapedectomy: Clinical Experience and Recommendations
Authors: House John W. , Toh Elizabeth H. , Perez Alejandro
Published: February 2003

OBJECTIVES

Much controversy exists concerning the risk of inner ear barotrauma after stapes surgery in scuba and sky divers. Uniform consensus has not been established regarding poststapedectomy barorestrictions. The purpose of this study was (1) to determine the prevalence of adverse auditory and/or vestibular sequelae in patients after stapedectomy related to scuba and sky diving, and (2) to offer recommendations on barometric exposure after stapes surgery.

STUDY DESIGN

Survey questionnaires were mailed to 2222 patients who had undergone stapedectomies at a single tertiary otologic referral center between 1987 and 1998. Two hundred eight of the initial 917 respondents (22.7%) had snorkeled, scuba, or sky dived after stapes surgery, and 140 of these responded to a second questionnaire detailing dive protocols, otologic symptoms, and their relationship to the diving activities. Of the 140, 28 had scuba or sky dived. Their survey data were analyzed and their medical records were reviewed.

RESULTS

Four of the 22 scuba divers (18.1%) experienced otologic symptoms at the time of diving. These included otalgia on descent (3/22; 13.6%), tinnitus (1/22; 4.5%), and transient vertigo on initial submersion (1/22; 4.5%). One patient had sudden sensorineural hearing loss and vertigo develop 3 months after scuba diving, which he related to noise exposure. He was subsequently found to have a perilymph fistula, which was successfully repaired. Of the 9 patients who sky dived, 2 patients (22.2%) reported otologic symptoms during the dive. No significant diving‐related long‐term effects indicative of labyrinthine injury were seen in any of the 28 patients.

CONCLUSIONS

Stapedectomy does not appear to increase the risk of inner ear barotrauma in scuba and sky divers. These activities may be pursued with relative safety after stapes surgery, provided adequate eustachian tube function has been established.