bluuebunny/crossref_metadata_2025 huggingface dataset:
Nocturnal Nasal Congestion and Nasal Resistance
Authors: Stroud Robert H. , Wright Steven T. , Calhoun Karen H.
Published: November 2003

Objectives: To compare total nasal resistance (TNR) in upright and supine positions in patients who did and did not complain of nocturnal (supine) nasal congestion symptoms without daytime (upright) congestion, and to determine what other conditions were associated with nocturnal nasal congestion (NNC) symptoms.

Study Design: A prospective study comparing objectively measured nasal airflow in different positions (upright and reclining) with subjective patient symptoms.

Methods: Subjects completed a questionnaire about nasal symptoms. Anterior rhinomanometry was performed with patients upright, reclined 45°, and supine. TNR in subject subsets was compared using the Student t test.

Results: TNR did not differ between upright patients with (n = 27) and without (n = 20) NNC. Supine TNR (P < .04) and increase in TNR (P < .02) between upright and supine was greater in patients with NNC. Smokers (n = 15, 10 with NNC, 5 without) had greater TNR increases when supine versus nonsmokers (P < .02). Patients with rhinitis symptoms (n = 29, 18 with NNC, 11 without) had greater TNR increases when supine than patients without rhinitis (P < .01). Patients who both smoked and had rhinitis (n = 11, 7 with NNC, 4 without) had a greater supine TNR than patients who smoked or had rhinitis alone (P < .02).

Conclusions: Some patients without daytime nasal congestion experience NNC. They have a significantly greater TNR increase when supine versus patients without NNC. Smokers and patients with rhinitis, with or without NNC, have a significantly greater TNR increase when supine versus nonsmokers or patients without rhinitis. Smoking cessation and treatment of rhinitis may improve the patients' NNC.
Prognostic Value of Ley and H Antigens in Oral Tongue Carcinomas
Authors: Xie Xin , Boysen Morten , Clausen Ole Petter F. , Bryne Magne A.
Published: November 2003

Objective: To investigate the prognostic significance of the carbohydrate epitopes H and Ley and their relationship with proliferation and apoptosis.

Study Design: Eighty randomly selected patients with T1‐T4 oral tongue squamous cell carcinoma (SCC) were studied. Serial sections were cut from diagnostic, formalin‐fixed, paraffin‐embedded specimens.

Methods: Sections were stained immunohistochemically for H antigen and Ley.

Results: Expression of H antigen was associated positively with Ley expression (P = .0001). Expressions of H antigen or Ley correlated with the proliferative markers Ki67 (P = .0442 and P = .0003, respectively) and pAgNOR >1 (P = .0674 and P = .0047, respectively), but not with apoptotic markers such as Bax expression or the apoptotic index (AI). Tumors that expressed H antigen and high levels of Ley (>50%) had a poor prognosis (P = .0006 and P = .0056, respectively). Combinations of expression of H antigen and Ley, and either proliferative or apoptotic markers revealed an enhanced prognostic potential (P < .0001). The combination of pAgNOR score greater than 1 and H‐antigen expression appeared to be the best combination to predict good prognosis.

Conclusion: The expression of H antigen and Ley, especially their combination with proliferative or apoptotic markers, has prognostic value in tongue SCC.
Measuring in Situ Central Airway Resistance in Patients With Laryngotracheal Stenosis
Authors: Wassermann Klaus , Koch Andrea , Warschkow André , Mathen Frank , Müller‐Ehmsen Jochen , Eckel Hans‐Edmund
Published: November 2003

Objectives: To evaluate a newly developed bronchoscopic technique for the assessment of intratracheal pressures.

Study Design: In situ measurement of central airway resistance in 20 consecutive spontaneously breathing subjects. Thirteen patients had benign glottic or subglottic stenosis. Seven patients without central airway disease served as normal control subjects.

Methods: A pressure catheter was introduced into the trachea via the working channel. The pressure swing was measured upstream and downstream of the stenosis. Central airflow was monitored simultaneously using a commercial pneumotachograph attached to a mouthpiece. Data acquisition frequency was 500 Hz. Prestenotic and poststenotic inspiratory and expiratory resistances could be calculated and displayed from the raw data off‐line.

Results: Inspiratory and expiratory resistances measured in mid‐trachea or below the stenosis (subglottic) were 0.36 ± 0.13 and 0.35 ± 0.13 kPa·s/L for the control subjects (C), 1.11 ± 0.47 and 0.65 ± 0.26 kPa·s/L for patients who did not need to be operated on (NOOP), 7.11 ± 7.19 and 3.35 ± 2.25 kPa·s/L respectively for those who required surgical correction (OP). Supraglottic inspiratory and expiratory resistances for C were 0.22 ± 0.09 and 0.25 ± 0.06 kPa·s/L, for NOOP 0.15 ± 0.10 and 0.14 ± 0.11 kPa·s/L, and for OP 0.26 ± 0.13 and 0.24 ± 0.07 kPa·s/L respectively. The cut‐off point for surgical correction was estimated to be >2.5 kPa·s/L of inspiratory resistance. Concurrent expiratory values showed a considerable overlap between OP and NOOP. No correlation could be established between local resistance values and dyspnea score.

Conclusions: In situ subglottic flow‐pressure tracing in spontaneously breathing patients who present with benign obstruction of the upper airways is well tolerated and may help to identify patients who need surgical correction.
Cochlear Fluid Space Dimensions for Six Species Derived From Reconstructions of Three‐Dimensional Magnetic Resonance Images
Authors: Thorne Marc , Salt Alec N. , DeMott John E. , Henson Miriam M. , Henson O. W. , Gewalt Sally L.
Published: November 2003

Objectives: To establish the dimensions and volumes of the cochlear fluid spaces.

Study Design: Fluid space volumes, lengths, and cross‐sectional areas were derived for the cochleas from six species: human, guinea pig, bat, rat, mouse, and gerbil.

Methods: Three‐dimensional reconstructions of the fluid spaces were made from magnetic resonance microscopy (MRM) images. Consecutive serial slices composed of isotropic voxels (25 μm3) representing the entire volume of fixed, isolated cochleas were obtained. The boundaries delineating the fluid spaces, including Reissner's membrane, were resolved for all specimens, except for the human, in which Reissner's membrane was not consistently resolved. Three‐dimensional reconstructions of the endolymphatic and perilymphatic fluid spaces were generated. Fluid space length and variation of cross‐sectional area with distance were derived by an algorithm that followed the midpoint of the space along the length of the spiral. The total volume of each fluid space was derived from a voxel count for each specimen.

Results: Length, volume, and cross‐sectional areas are provided for six species. In all cases, the length of the endolymphatic fluid space was consistently longer than that of either perilymphatic scala, primarily as a result of a greater radius of curvature. For guinea pig specimens, the measured volumes of the fluid spaces were considerably lower than those suggested by previous reports based on histological data.

Conclusions: The quantification of cochlear fluid spaces provided by this study will enable the more accurate calculation of drug and other solute movements in fluids of the inner ear during experimental or clinical manipulations.
Effects of Depletion of Complement in the Development of Labyrinthitis Ossificans
Authors: DeSautel M. Gregory , Brodie Hilary A.
Published: November 2003

Hypothesis: Labyrinthitis ossificans results in part from the intense inflammatory response to Streptococcus pneumoniae cell wall components. Depletion of complement in Mongolian gerbils following induction of meningitis will reduce the degree of inflammation and subsequent cochlear fibrosis.

Study Design: Random prospective study. Histological evaluations were performed with the researcher blinded to the experimental group

Methods: S pneumoniae meningitis was induced in 10 control and 18 experimental Mongolian gerbils with an intrathecal injection of the bacteria. Both groups of animals received treatment with penicillin. The experimental group was also treated with cobra venom factor to deplete complement in the animals. Three months after the induction of meningitis, the animals' temporal bones were harvested for histological evaluation.

Results: The decomplemented animals developed significantly less intracochlear fibrosis (P < .01). The mortality rate for the experimental group was 11% compared with 40% in the control group (P = .14).

Conclusions: Reduction of the intense inflammatory response to the S pneumoniae cell wall components in suppurative labyrinthitis secondary to bacterial meningitis reduced the degree of labyrinthitis ossificans.
Histopathological Changes of the Eustachian Tube Cartilage and the Tensor Veli Palatini Muscle With Aging
Authors: Takasaki Kenji , Sando Isamu , Balaban Carey D. , Haginomori Shin‐Ichi , Ishijima Ken , Kitagawa Miwa
Published: November 2003

Objectives: The eustachian tube (ET) and the tensor veli palatini muscle (TVPM) are thought to play an important role in ventilatory function. Calcification of the ET cartilage and the replacement of TVPM by fat tissue are often observed histologically in elderly patients. To our knowledge, however, there are no quantitative studies of these pathological findings in relation to age.

Study Design: The calcification of the ET cartilage and the atrophy of the TVPM in 36 normal human temporal bones obtained from 36 individuals with ages ranging from 2 days to 88 years were investigated.

Methods: The number of calcified chondrocytes in the midportion of the ET cartilage was quantified as the average number of cells per square millimeter. Atrophy of the TVPM was evaluated at the midportion of the site where the TVPM is attached to the tip of lateral lamina of ET cartilage. A grade of 0, 1, 2, 3, or 4 was assessed for each section, which indicated approximately 0% to 5%, 5% to 30%, 30% to 70%, 70% to 95%, or 95% to 100% of the TVPM replacement by fat tissue, respectively.

Results: A statistically significant correlation was found between the number of the calcified cells and aging (P < .001). A statistically significant correlation was also found between the degree of the atrophy of TVPM and aging (P < .001).

Conclusions: The calcification of the ET cartilage and the atrophy of the TVPM are closely associated with aging. Therefore, it is suggested that these two findings may be a predisposing factor for ET dysfunction in elderly adults.
Voice Acoustics After Autologous Fascia Injection for Vocal Fold Paralysis
Authors: Rihkanen Heikki , Lehikoinen‐Söderlund Sari , Reijonen Petri
Published: November 2003

Objectives: The present study was carried out to assess the impact of fascial injection on voice acoustics. Preliminary results had suggested that voice, as rated by a panel of listeners, was significantly improved after autologous fascia augmentation of a paralyzed vocal fold.

Study Design: A prospective study among patients with unilateral vocal fold paralysis was carried out. Eighteen subjects were analyzed 9 months (mean) after the procedure.

Methods: The preoperative and postoperative samples of vowel/a/ were analyzed by Key Elemetrics (Lincoln Park, NJ). Computerized Speech Lab.

Results: There was a significant improvement (P < .05) in all parameters measured, including jitter, shimmer, noise‐to‐harmonic ratio, and maximum phonation time. No laryngeal complications were seen.

Conclusions: According to these preliminary results, vocal fold augmentation by an injection of autologous fascia seems a simple, inexpensive, reliable and safe method to restore voice quality after unilateral vocal fold paralysis.
Advances and Refinements in Phonosurgery
Authors: Ford Charles N.
Published: November 2003

Scientific discovery, technological advances, and improved outcomes assessment have resulted in advances and refinements in phonosurgery. Three areas of substantial evolution are phonomicrosurgery, laryngeal framework surgery, and the use of implantable materials in vocal folds. Discovery of the importance of the superficial layers of the lamina propria has led to increased use of more limited medial microflap approaches and less frequent use of the classic lateral cordotomy flap approach. Alternative approaches to managing vocal fold scarring defects have addressed the separation of body and cover and provided suitable lamina propria replacement. Approaches to sulcus vocalis have been refined to address type II (linear vergeture) and type III (focal invasive pit) sulcus, where there is loss of lamina propria, while still recognizing the common nonpathological type I (physiological) sulcus. Technological advancements such as photodynamic therapy, tuned dye lasers, and laryngeal microdebridement have augmented the armamentarium for mechanical removal of laryngeal papillomata. Careful infusion‐assisted microexcision and adjunctive medical management have been refined and made more effective. Laryngeal framework surgery has embraced the development of Silastic, hydroxylapatite, expanded polytetrafluoroethylene, and titanium shims. Anatomical studies have helped to improve operative precision and safety, and have led to inventive variations in arytenoid repositioning that improve closure of the posterior subunit. Vocal fold augmentation by injection has been facilitated by innovative use of the rigid telescope and intraoperative videostroboscopy. Anatomical studies have focused on the infrafold region and rheological studies have attempted to match viscoelastic properties of injectable substances to those of vocal fold tissues. Alloplastic materials such as Teflon have been largely supplanted by newer bioimplantables such as fat, collagen, and fascia.
Inner Ear Barotrauma After Stapedectomy in the Guinea Pig
Authors: Antonelli Patrick J. , Adamczyk Melanie , Appleton Catherine M. , Parell G. Joseph
Published: November 2003

Objective: The safety of scuba diving after stapedectomy is controversial. Stapedectomy is thought to predispose to inner ear barotrauma (e.g., perilymph fistula); however, many individuals continue to scuba dive following stapedectomy without ill effects. The purpose of this study was to evaluate the cochlear effects of barotrauma, similar to that experienced with scuba diving, on inner ears previously treated with stapedectomy.

Study Design: Prospective, controlled.

Methods: Sixteen Hartley albino guinea pigs underwent unilateral total stapedectomy followed by hyperbaric dives on 5 consecutive days, beginning 3 weeks after stapedectomy. Cochlear effects were determined using click and tone‐pip evoked electrocochleographic thresholds and cochlear hair cell counts.

Results: Mean auditory thresholds increased by 29 dB after stapedectomy (P < .001), then remained stable thereafter. Mean thresholds in both the operated and control ears did not change with hyperbaric dives. Evidence of middle ear barotrauma (e.g., hemorrhage or tympanic membrane perforation) was observed in eight poststapedectomy ears and five control ears, but none demonstrated significant threshold elevation greater than or equal to 10 dB. Hair cell counts were not different between operated and control ears.

Conclusions: Stapedectomy does not appear to predispose to cochlear sequelae in the guinea pig model of diving‐related barotrauma.
Localization of Laminin Isoforms in the Guinea Pig Cochlea
Authors: Weinberger Debra G. , ten Cate Wouter‐Jan , Lautermann Juergen , Baethmann Martina
Published: November 2003

Objective: To elucidate the pathogenesis of inner ear disorders by examining the distribution of a major component of basement membranes, the glycoprotein laminin.

Study Design: Animal model.

Methods: Adult guinea pig cochleae were fixed with methanol and sectioned. Sections were examined for the presence of laminins α2, α5, β1, and γ1 using immunohistochemistry.

Results: Laminins α2, α5, and β1 were not detected. Laminin γ1 was found in the limbus, spiral ligament, and stria vascularis.

Conclusions: Anti‐laminin antibodies have been found in patients with inner ear disorders. Laminin γ1 demonstrates specific staining at multiple sites in the guinea pig cochlea. These structures may be targets of antibodies causing sensorineural hearing loss.
Dendritic Cells in Precancerous Lesions of the Larynx
Authors: Sprinzl Georg Mathias , Hussl Burkhard , Obrist Peter , Yoneda Kozo , Thumfart Walter Franz , Romani Nikolaus , Schrott‐Fischer Annelies
Published: November 2003

Objectives: Hyperplastic lesions of the laryngeal mucosa can eventually develop into squamous cell carcinoma. The relationship between dendritic cell infiltration of head and neck cancers and prognosis is well known. Surprisingly, data regarding dendritic cell infiltration in precancerous lesions are not available today. It was the purpose of our study to extend these observations and to investigate in more detail the density and distribution of dendritic cells in precancerous lesions.

Study Design: Retrospective survey by immunohistochemistry.

Methods: For this study we investigated paraffin‐embedded tissue sections of 41 specimens. Histological diagnosis disclosed precancerous lesions of the larynx in 34 cases and in 7 cases, squamous cell carcinoma. Immunohistochemical study was performed using antibodies against the cell surface markers S‐100, HLA‐DR, CD20, CD45 RO, CD45 RA, and Lag. Typical dendritic cell distributions of the immunostained specimens were photographed and measured on a quantitative basis. The medical histories of the patients were then analyzed retrospectively.

Results: HLA‐DR+ cells could be detected in 14 of 16 cases in mild dysplastic lesions. The infiltration of the dysplastic lesions was sparse compared to cases with higher‐graded dysplastic lesions. The distribution patterns of the dendritic cells in specimens with severe dysplastic lesions, but squamous cell carcinoma were extremely similar and markedly different from those in grades I and II specimens. Memory T lymphocytes (CD45 RO+) were detected more often in the group with severe dysplastic lesions (8 of 9 cases) than in the group with squamous cell carcinoma (3 of 8 cases). The inverse became evident for CD20 and CD45 RA immunolabeling.

Conclusions: Few dendritic cells were found in the precancerous lesions. This may suggest that these early lesions (grades I and II) are not efficiently monitored by the immune system. Therefore they may develop into carcinomas unimpaired by cytotoxic T cells. As the degree of malignancy rises (grade III), more dendritic cells infiltrate the tumor.
Compliance With Anti‐Reflux Therapy in Patients With Otolaryngologic Manifestations of Gastroesophageal Reflux Disease
Authors: Giacchi Renato J. , Sullivan Daniel , Rothstein Stephen G.
Published: November 2003

Objectives: The otolaryngologic manifestations of gastroesophageal reflux include sore throat, throat clearing, sensation of postnasal drip, hoarseness, and globus. This constellation of laryngeal and pharyngeal symptoms can be referred to as laryngopharyngeal reflux (LPR). Many patients with LPR are treated empirically and the results are often rewarding. The objective of this study is to evaluate compliance with antireflux therapy in this patient population.

Study Design: A prospective analysis of 30 patients referred to an otolaryngology clinic for the above symptoms.

Methods: The patients were treated for LPR using a standardized behavior modification form in combination with medical management. Patient compliance was followed with a patient questionnaire and evaluation of medication renewal from pharmacy records.

Results: The patients were followed for an average of 4 months and 80% reported an improvement of their symptoms. Evaluation of patient questionnaires revealed that 50% of patients reported taking their medications as prescribed. Compliance varied widely with regard to behavioral modifications. The degree of symptomatic improvement was significantly correlated with overall compliance with both medications and behavioral changes (Pearson correlation coefficient, P < .05). The individual behavioral changes that were significantly correlated with the reduction of symptoms were avoidance of food and liquid before sleep and elevation of the head of bed, but not food habits.

Conclusions: The treatment plan for gastroesophageal reflux disease requires behavioral modifications and prescription medications that many patients may find difficult to follow. However, those patients who comply with the treatment plan can be expected to have an improvement of their symptoms. Furthermore, simplifying the treatment regimen including those elements most correlated with symptomatic improvement may increase patient compliance.
Saccharin Test of Maxillary Sinus Mucociliary Function After Endoscopic Sinus Surgery
Authors: Asai Kazuyasu , Haruna Shin‐ichi , Otori Nobuyoshi , Yanagi Kiyoshi , Fukami Masaya , Moriyama Hiroshi
Published: November 2003

Objectives: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis.

Study Design: Methods: This study was conducted on 88 maxillary sinuses of 74 patients after ESS. The maxillary sinus fontanel was broadly opened via the middle meatus using an endoscope, and a saccharin granule was adhered to the bottom of the maxillary sinus mucosa. The time until the patient recognized the sweet taste was recorded. Before the ST test, the bilateral maxillary sinuses were classified into the following four groups on the basis of the post‐ESS severity of mucosal edema and swelling as revealed by endoscopic observation: normal (45 sinuses), mild mucosal edema and swelling (24), moderate mucosal finding (14), and severe mucosal finding or filling of the sinus with a polyp(s) (5).

Results: The mean ST values in the normal group and the groups with mild, moderate, and severe mucosal edema and swelling were 35.7, 38.1, 63.6, and 88.0 minutes, respectively. Thus the ST increased with the post‐ESS severity of the mucosal lesion. However, for the group with mild mucosal edema and swelling, scanning electron microscopic observation of three maxillary sinuses in which the ST exceeded 120 minutes and four sinuses in which the ST was 40 minutes revealed extensive cilia loss in the former sinuses, but not in the latter. A second post‐ESS endoscopic observation was performed in 17 patients, revealing improvement in 11 sinuses, no change in 5 sinuses, and aggravation in 1 sinus (compared with the initial test). The ST test was also repeated, revealing that the ST became shorter in most of the endoscopically improved sinus group. However, a few sinuses showed a discrepancy between the change in the endoscopic findings and the ciliary function (ST).

Conclusion: Measurement of the maxillary sinus ST is a simple, accurate, and useful technique for assessing the post‐ESS mucociliary function in conjunction with endoscopy, and the information gained can help in deciding subsequent therapy.
Effects of Clarithromycin on Cultured Human Nasal Epithelial Cells and Fibroblasts
Authors: Miyanohara Toshio , Ushikai Masato , Matsune Shoji , Ueno Kazuyoshi , Katahira Shoko , Kurono Yuichi
Published: November 2003

Objective/Methods: Long‐term administration of clarithromycin has been reported to be effective in the treatment of chronic sinusitis. To investigate the mechanism underlying the anti‐inflammatory activity of clarithromycin, the authors evaluated the effect of clarithromycin on the gene expression of proinflammatory cytokine and the DNA‐binding activity of nuclear factor (NF)‐κB in cultured human nasal epithelial cells and fibroblasts. Cells were incubated with endotoxin purified from nontypeable Haemophilus influenzae or interleukin (IL)‐1β in the presence of clarithromycin.

Results: Northern blot analysis revealed that clarithromycin suppressed IL‐1β gene expression in human nasal epithelial cells stimulated by H influenzae endotoxin (HIE). Intercellular adhesion molecule‐1 gene expression in nasal fibroblasts stimulated by IL‐1β was also suppressed by clarithromycin. Furthermore, electrophoretic mobility shift assay demonstrated that clarithromycin reduced DNA‐binding activity of NF‐κB in both human nasal epithelial cells and fibroblasts stimulated by HIE or IL‐1β, respectively.

Conclusion: The present results suggest that clarithromycin may reduce gene expression of proinflammatory cytokines and adhesion molecules from nasal mucosa at the transcriptional factor level and exert an anti‐inflammatory effect on nasal mucosa in chronic sinusitis.
Postoperative Quality of Life in Vestibular Schwannoma Patients Measured by the SF36 Health Questionnaire
Authors: da Cruz Melville J. , Moffat David A. , Hardy David G.
Published: November 2003

Objective: To quantify the postoperative quality of life in patients following surgical treatment for vestibular schwannoma.

Study Design: Patient self‐assessment using the short form 36 (SF36) multidimensional quality of life health questionnaire. Sex‐ and age‐matched normalized scores were calculated using a standardized process and accepted normative data.

Setting: Tertiary referral skull base unit.

Results: An 80% response rate (90 patients) was achieved. The postoperative quality of life in vestibular schwannoma patients, as quantified by seven of the eight SF36 health scales was less than the appropriate matched healthy standard. Comparison of a variety of preoperative patients and tumor factors‐different operative approaches (translabyrinthine and retrosigmoid), tumor size (group cut of points of tumor diameter 1.5 mm and 2.5 mm), patient sex, and ranking of patient age‐showed no statistically significant difference in measured quality of life outcomes for each of these traditional predictors.

Conclusion: Reduced quality of life in patients after surgical treatment for vestibular schwannoma, coupled with the low tumor growth rates and minimal preoperative symptoms, supports a conservative approach to patient management. The advantages and disadvantages of a variety of approaches used to measure the quality of life after surgical treatment of vestibular schwannoma and their impact on clinical decision making for patients, are discussed.
A Cost‐Utility Analysis of Pediatric Cochlear Implantation
Authors: O'Neill Ciaran , O'Donoghue Gerard M. , Archbold Susan M. , Normand Charles
Published: November 2003

Objective/Hypothesis: The aim of this study was to explore the cost‐utility of pediatric cochlear implantation, incorporating savings associated with education into the analysis.

Methods: The costs of pediatric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear implant program in the United Kingdom. After implantation, profoundly hearing‐impaired children have been found to develop hearing threshold levels equivalent to severely hearing‐impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing‐impaired and profoundly hearing‐impaired children. From this study, savings in educational costs that would result from enabling the profoundly hearing‐impaired to function as severely hearing‐impaired were determined. Cost‐utility was established conservatively by applying to children the known gains in utility reported by adults with cochlear implants.

Results: The discounted costs of creating a pediatric cochlear implant user and of maintaining the child over the first 12 years were £48,757 ($78,011). The discounted difference in education costs associated with a profoundly hearing‐impaired child (HL >95 dB) as compared with a severely hearing‐impaired child (HL 70‐95 dB) over the same period was £26,781 ($42,850). These represent the potential savings in educational costs associated with pediatric cochlear implantation. Assuming implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory school years (ages 4‐16) was £21,976 ($35,162). Cochlear implants have been shown to improve the quality of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children receiving implantation at age 4 years, and assuming a life expectancy of 74 years, the quality‐adjusted life‐year (QALY) gain is calculated to be 16.33. The cost per undiscounted QALY gain was estimated to be £1,345.70 ($2153.12) and per discounted QALY gain to be £10,341 ($16,545.60).

Conclusion: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost‐effective health care intervention in profoundly hearing‐impaired young children.
Sentinel Lymph Node Radiolocalization in Head and Neck Squamous Cell Carcinoma
Authors: Alex James C. , Sasaki Clarence T. , Krag David N. , Wenig Barry , Pyle Paula B.
Published: November 2003

Objectives: To determine the feasibility of sentinel node radiolocalization in stage N0 in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel node could be prognostic of regional micrometastatic disease.

Study Design: A prospective report on the application sentinel node radiolocalization in eight patients with N0 squamous cell carcinoma of the head and neck region.

Methods: For each patient a peritumoral submucosal injection of filtered technetium (99mTc) prepared with sulfur colloid was performed immediately following intubation. After at least 30 minutes, focal areas of accumulation corresponding to a sentinel node were marked on the skin surface. Complete neck dissections were performed, and the sentinel nodes were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen.

Results: Sentinel node radiolocalization accurately identified two or more sentinel lymph nodes in all eight cases. In one patient, two of the three lymph nodes containing micrometastatic disease were sentinel lymph nodes. There was no instance in which sentinel node was negative for micrometastatic disease while being positive in a nonsentinel lymph node.

Conclusions: Accurate localization of the sentinel lymph node using radiolabeled sulfur‐colloid is feasible in patients with squamous cell carcinoma of the head and neck region. Although sentinel node radiolocalization in head and neck squamous cell cancer may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.
Long‐Standing Lateral Neck Mass As the Initial Manifestation of Well‐Differentiated Thyroid Carcinoma
Authors: Coleman Sean C. , Smith Jonathan C. , Burkey Brian B. , Day Terrence A. , Page Robert N. , Netterville James L.
Published: November 2003

Objective: To analyze the presentation, evaluation, and treatment of a subset of patients with well‐differentiated thyroid carcinoma who present with a lateral neck mass and no palpable disease in the thyroid gland.

Study Design: A retrospective review of all patients undergoing thyroidectomy for malignancy.

Methods: A database of all thyroidectomies performed for malignancy by the Vanderbilt University Department of Otolaryngology—Head and Neck Surgery from 1992 to 1997 was created. Patients who presented with an isolated neck mass without evidence of palpable disease in the thyroid were selected for the study population.

Results: There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as isolated lateral neck mass. The characteristics of this group (compared with the population of all thyroid malignancies) include younger age at presentation (37.7 ± 15.2 y vs. 49.8 ± 15.6 y; Student t test:P = .019) and long‐standing presence of symptoms (27.4 ± 39.6 mo vs. 3.6 ± 3.9 mo;P = .023). These patients generally presented from a referring facility after having an excisional biopsy, which was 100% accurate. Fine‐needle aspiration is becoming more useful and was 66.7% accurate. Histological examination revealed cancer in the thyroid gland in all patients, 11 cases of papillary carcinoma, 2 follicular carcinomas, and one medullary carcinoma. The mean size of the primary focus was 10.9 ± 8.7 mm, with 29% demonstrating bilateral disease and 14% demonstrating multifocal disease in the ipsilateral gland. The neck specimens revealed an average of 5.3 ± 3.2 metastatic nodes in levels II–IV and 3.9 ± 4.6 metastatic nodes in the paratracheal region.

Conclusion: Based on this patient population, the long‐standing lateral neck mass in the young patient should raise the physician's index of suspicion for thyroid carcinoma. Fine‐needle aspiration should be used in conjunction with judicious excisional biopsy. The bilateral and multifocal nature of otherwise occult primary disease argues for total thyroidectomy in this setting.
Quantification of the Learning Curve for Percutaneous Dilatational Tracheotomy
Authors: Massick Douglas D. , Powell David M. , Price Phillip D. , Chang Susan L. , Squires Gregory , Forrest L. Arick , Young Donn C.
Published: November 2003

Objectives/Hypothesis: Although numerous investigators have reported a bedside percutaneous dilatational tracheotomy (PDT) complication incidence similar to that of standard operative tracheostomy, others have proposed a “learning curve” for PDT resulting in increased complications early in individual or institutional experience with this procedure. The objective of this investigation is to characterize and quantify the proposed learning curve for PDT.

Study Design: Prospective analysis of complication incidence for the first 100 PDT procedures performed in a local community hospital Department of General Surgery.

Methods: Demographic data, patient disease variables, and patient anatomic features, as well as perioperative, postoperative, and late complications, were recorded prospectively. Patients were divided into sequential cohorts of 20 and were evaluated for complications at regular intervals.

Results: Perioperative and late complication incidence was significantly higher in the first 20 patients who underwent PDT. However, postoperative complication incidence did not significantly vary with operator or institutional experience. In addition, patients with suboptimal anatomy were found to have a significantly increased complication incidence, independent of operator and institutional experience.

Conclusions: Percutaneous dilational tracheotomy has an identifiable learning curve that is most prominent in the first 20 patients treated. Early experience with PDT should be obtained under controlled circumstances, ideally the operating suite. Although most complications occur during acquisition of early experience with PDT, certain life‐threatening complications such as tube dislodgment or inability to complete procedure may occur even after extensive experience is obtained. Bedside PDT has an acceptable complication incidence, but any surgeon employing this technique must be prepared to perform immediate standard open tracheotomy to minimize potentially lethal complications of this elective procedure.
Redefining the Survival of the Fittest: Communication Disorders in the 21st Century
Authors: Ruben Robert J.
Published: November 2003

Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language.

Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language.

Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States.

Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product.

Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication‐based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.
Dynamic Asymmetry of the Vestibulo‐ocular Reflex in Unilateral Peripheral Vestibular and Cochleovestibular Loss
Authors: Maire Raphaël , van Melle Guy
Published: November 2003

Objective: Rotatory tests in the horizontal plane have shown various degrees of vestibulo‐ocular reflex (VOR) asymmetry in patients after surgical deafferentation of one labyrinth. The purpose of this work was to characterize dynamic horizontal VOR responses among patients presenting with a unilateral peripheral labyrinthine deficit of nonsurgical origin and to compare results in isolated vestibular loss versus cochleovestibular loss.

Study Design: This study included 40 patients who presented with an acute, spontaneous unilateral peripheral labyrinthine lesion. Twenty‐two patients had vestibular loss alone (without associated hearing impairment) and 18 presented with a cochleovestibular deficit (sudden hearing loss with vertigo). The majority of these patients were part of a long‐term protocol to evaluate vestibular compensation.

Methods: All patients underwent both the clockwise test and the counterclockwise rotatory test in the horizontal plane, using brief impulses of moderate intensity. Results were analyzed by a simplified model of vestibular function, allowing a parametric estimation of the response.

Results: A weak and transitory horizontal VOR asymmetry was observed in the 22 patients with vestibular loss. However, the 18 patients with cochleovestibular loss demonstrated a more severe and persistent asymmetry.

Conclusions: This study revealed a difference in the dynamic characteristics of the horizontal VOR between patients with vestibular loss and those with cochleovestibular loss. Our results support the presence of an extensive labyrinthine lesion in cochleovestibular deficit that involves the otolith organs. The implications of this involvement on the central mech‐ anisms of otolith‐canal interaction are discussed.
Assessing Olfactory Function in Laryngectomees Using the Sniffin'Sticks Test Battery and Chemosensory Evoked Potentials
Authors: Welge‐Luessen Antje , Kobal Gerd , Wolfensberger Markus
Published: November 2003

Objectives/Hypothesis: Laryngectomees are often considered to be completely anosmic. The aim of this study was to determine whether anosmia in laryngectomees reflects diminished transport of odorants to the olfactory epithelium or olfactory epithelial damage.

Study Design: Twenty‐five laryngectomees were examined psychophysically using the Sniffin'Sticks test battery. All patients rated the degree of their subjectively perceived deficit on a rating scale. Chemosensory evoked potentials were also recorded in 11 of 25 patients.

Results: Sixteen patients complained very little about their smell deficit, even though the psychophysical testing found 18 patients to be anosmic and 7 hyposmic. Olfactory potentials could be recorded in only 7 of the 11 patients who received this evaluation, despite the fact that all 11 perceived, at least vaguely, the olfactory stimulus, H2S, during the recording sessions. No meaningful correlation between the psychophysical and electrophysiological data was observed.

Conclusions: The psychophysical data revealed the laryngectomees to be either functionally anosmic or hyposmic. The olfactory evoked potential data suggested that at least in two thirds of the laryngectomized patients the olfactory system had some function, even up to 22 years after surgery. Because patients in everyday situations find ways to bring odorants to the olfactory mucosa, the low number of complaints about subjectively perceived deficits is reasonable.
Long‐Term Use of Preservatives on Rat Nasal Respiratory Mucosa: Effects of Benzalkonium Chloride and Potassium Sorbate
Authors: Cho Jin‐Hee , Kwun Yong‐Sig , Jang Han‐Sung , Kang Jun‐Myung , Won Yu‐Sung , Yoon He‐Ro
Published: November 2003

Objectives: The preservatives benzalkonium chloride (BZC) and potassium sorbate (PS) are widely used, not only for nasal drops, but also for eyedrops and cosmetics. However, there have been many case reports that consider lesions such as dermatitis or conjunctivitis to be the results of irritation induced by BZC or PS.

Methods: We evaluated the histological changes after the long‐term administration of BZC or PS on rat nasal respiratory mucosa. Forty rats were used for the BZC group and 40 rats for PS group. Animals in each group were divided into four subgroups. The first subgroup received a low‐concentration preservative solution that was commonly used for nasal sprays. The second subgroup received a high‐concentration preservative solution that was reported to induce dermatitis in humans. The third and fourth subgroups received a steroid mixed preservative solution of low and high concentrations, respectively. The control group was administrated normal saline. After each group received 1, 2, and 4 weeks of topical administration, the symptomatic and histological changes on H&E stain were observed.

Results: Sneezing and nasal rubbing with forelegs were observed in almost all subgroups by the seventh day of treatment. The preservatives induced nasal lesions, including intraepithelial glandular formation, inflammatory cell infiltration, vascular hyperplasia, and edematous change. The symptomatic and histological changes were pronounced with the prolonged duration of administration. Similar results were observed in the steroid mixed‐solution groups. In the PS steroid mixed‐solution group, however, symptoms and nasal lesions were reduced with the prolonged duration of administration.

Conclusion: It is our finding that even a low‐concentration solution of preservative can lead to nasal lesion. Hence there is a strong need to develop both a preservative that can be safely and widely used and a nasal spray without preservatives.
Postoperative Airway Findings After Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome
Authors: Li Kasey K. , Riley Robert W. , Powell Nelson B. , Zonato Adriana , Troell Robert , Guilleminault Christian
Published: November 2003

Objective: To evaluate the upper airway characteristics in the early postoperative period after maxillomandibular advancement for obstructive sleep apnea syndrome.

Methods: Nasopharyngolaryngoscopy was performed before and 48 hours after surgery on 70 consecutive patients who underwent maxillomandibular advancement for obstructive sleep apnea syndrome. The preoperative and the postoperative evaluations were performed by the same examiner for consistency.

Results: Mild to moderate lateral pharyngeal wall edema was identified in 70 consecutive patients. Fourteen patients (20%) had edema as well as ecchymosis involving the pyriform sinus and aryepiglottic fold. Four of these patients (6%) were also noted to have hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord that partially obstructed the airway. These four patients were closely monitored for 1 to 2 additional days for possible expanding hematoma leading to airway compromise. None of these patients were found to have airway difficulty, and the minimum oxygen saturation was more than 90% throughout the hospitalization. All four patients were discharged uneventfully, and the hematoma resolved completely within 10 days.

Conclusion: Although postoperative edema was expected after maxillomandibular advancement, hypopharyngeal hematoma was unexpected. Although none of our patients had evidence of airway difficulty, the possibility of an expanding hypopharyngeal hematoma should be considered in patients complaining of breathing difficulty after maxillomandibular advancement surgery.
A Pilot Study of Autofluorescent Endoscopy for the in Vivo Detection of Laryngeal Cancer
Authors: Delank Wolfgang , Khanavkar Barbara , Nakhosteen John A. , Stoll Wolfgang
Published: November 2003

Objectives To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer.

Study Design This is a prospective, multicenter clinical study. We investigated whether autofluorescent endoscopy using the Lung Imaging Fluorescent Endoscopy (LIFE)–Lung System (Xillix, Olympus) is capable of identifying early cancer of the larynx, especially in comparison with conventional white‐light endoscopy and microscopic laryngoscopy. Benign lesions as well as microinvasive and invasive squamous cell carcinoma of the larynx were investigated. For logistic reasons and because of the pilot character of this study, the number of patients was limited.

Methods Sixteen patients having 24 laryngeal lesions of both benign or malignant character were subsequently examined by autofluorescent endoscopy, white‐light endoscopy, and microscopic laryngoscopy. Based on optical appearance, and for each method separately, the lesions were classified as malignant or not. The visual results were documented and histologically verified.

Results The sensitivity of autofluorescent endoscopy for laryngeal cancer detection was more than 90% and therefore higher than that of white‐light endoscopy and microscopic laryngoscopy. However, as far as laryngeal cancer is concerned, the specificity of autofluorescent endoscopy was very low. Many of the false‐positive results were due to inflammation, hypervascularization, and edema.

Conclusion Autofluorescent endoscopy is advantageous only in the hands of an experienced ENT specialist. Although it does not replace the combination of white‐light endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Autofluorescent endoscopy can help in determining whether microscopic laryngoscopy performed with general anesthesia should be recommended urgently to the patient. Microscopic laryngoscopy remains the best method for the identification of malignant lesions, if it is combined with obtaining taking multiple biopsy specimens. Confirmation of the results of this pilot study with a larger series of patients is desirable.