bluuebunny/crossref_metadata_2025 huggingface dataset:
An in vivo canine model for testing treatment effects in laryngeal hyperadduction disorders
Authors: Green David C. , Berke Gerald S.
Published: October 2006

Adductor spastic dysphonia is a voice disorder characterized by a strained, squeezed, effortful voice produced by true and false cord hyperadduction. An in vivo canine model has been developed to simulate hyperadduction of the true cords. Using this model, the thyroarytenoid muscle was found to have a greater effect on intraglottic and subglottic pressure than cricothyroid muscle contraction. The intraglottic and subglottic pressure was reduced after simulated recurrent laryngeal paralysis. This model can be used in future studies to compare laryngeal treatment modalities for disorders that have a component of vocal cord hyperadduction, such as spastic dysphonia.
Otolaryngologic management of patients with subdural empyema
Authors: Hoyt David J. , Fisher Samuel R.
Published: October 2006

From 1979 to 1988,17 patients presented to Duke University Medical Center for treatment of subdural empyema. Empyemas were caused by sinusitis in 53% of the patients and by otitis media in 12%. None of those with otologic causes required mastoid drainage, while all patients with sinus infections required sinus drainage. External frontoethmoidectomies were associated with a lower incidence of fronto‐ethmoid re‐exploration (P = 0.048), and antrosto‐mies with a lower incidence of maxillary re‐exploration (P = 0.111), than were more limited drainage procedures. Sinus drainage performed simultaneously with neurosurgical drainage reduced the incidence of sinus re‐exploration (P = 0.167), neurosurgical re‐exploration (P = 0.048), and length of hospitalization (P = 0.020).
Hematoporphyrin photodynamic therapy: Is there truly a future in head and neck oncology? Reflections on a 5‐year experience
Authors: Gluckman Jack L.
Published: October 2006

Photodynamic therapy, which consists of the selective destruction of tumors using a combination of a photosensitizer administered systemically (dihe‐matoporphyrin ether) and an argon dye‐pumped laser, has provoked profound interest amongst oncologists and has particularly titillated head and neck oncologists with its potential. Unfortunately, no multi‐institutional trials for head and neck tumors have been introduced, and the literature is replete with anecdotal reports from individual researchers on the management of advanced cancers for palliation, superficial early cancers, and field cancerization of the mucosa (“condemned mucosa”)‐ A personal 5‐year experience with 41 head and neck cancers was reviewed, as was the current literature. An attempt was made to place in perspective the true role and future direction of this technology.
Monothermal differential caloric testing in patients with Meniere's disease
Authors: Wexler David B. , Harker Lee A. , Voots Richard J. , McCabe Brian F.
Published: October 2006

The monothermal differential caloric test allows determination of vestibular recruitment and de‐cruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Meniere's disease. This study examined patients having unilateral Meniere's disease. Nystagmus beat frequency (NBF) and slow‐component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmo‐graphic findings showing unilateral dysfunction were present in 54% of patients by slow‐component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lat‐eralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow‐component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow‐component velocity to determine unilateral hypofunction and relative vestibular recruitment.
Comparison of evoked electromyography of the larynx to electrical and magnetic stimulation of the motor cortex of the dog
Authors: Haghighi Siavash S. , Estrem Scott A.
Published: October 2006

The electromyographic and contractile properties of the laryngeal muscles upon stimulation of the laryngeal nerve have been described before. In the present investigation, we used electrical and magnetic stimulation to activate the vocalis muscle in dogs. Stimulation of the vagus nerve at the brain stem exit point resulted in evoked vocalis compound muscle action potential identical in onset latency and configuration to that obtained by the transcranial single‐shock magnetic stimulation at high intensity (>80%). Electrical stimulation of the laryngeal representation of the somatomotor cortex resulted in a contra‐lateral evoked vocalis compound muscle action potential. Central delay time for the 10th cranial nerve was calculated by subtracting the latency of the vocalis recorded by stimulation of the vagus nerve as it exited the brain stem from the latency obtained by direct cortical stimulation.
Sternocleidomastoid muscle transfer and superficial musculoaponeurotic system plication in the prevention of Frey's syndrome
Authors: Casler John D. , Conley John
Published: October 2006

Parotidectomy may be associated with a significant depression in the retromandibular region and a significant incidence of gustatory sweating (Frey's syndrome). Superiorly and inferiorly based sternocleidomastoid flaps and posterior plication of the superficial musculoaponeurotic system were evaluated for their ability to ameliorate both consequences. Sixteen patients with sternocleidomastoid flaps and 16 patients with superficial musculoaponeurotic system plication were compared to a control group of 104 patients. The incidence of Frey's syndrome was 47.1% in the control group, 12.5% (P = 0.025) in the sternocleidomastoid flap group, and 0% (P = 0.005) in the superficial musculoaponeurotic system plication group. The surgical techniques are described. The prevalence of Frey's syndrome is discussed with respect to age, sex, radiation therapy, and the type of parotidectomy performed. The indications and contraindications of the three surgical techniques are described.
Allergic fungal sinusitis: Problems in diagnosis and treatment
Authors: Allphin Allan L. , Strauss Melvin , Abdul‐Karim Fadi W.
Published: October 2006

Although first described in 1983, allergic Aspergillus sinusitis (AAS) has yet to gain wide recognition among otolaryngologists and pathologists. We have treated three patients with a history of asthma, nasal polyposis, and recurrent pansinusitis who fit the description of allergic Aspergillus sinusititis. Histopathologically, mucinous material with abundant eosinophils and Charcot‐Leyden crystals (“allergic mucin”) is interspersed with fungal hyphae. Immunologic characteristics include serum total immunoglobulin E (IgE) elevation, increased RAST classes, and cutaneous reactivity to molds.

A retrospective analysis of the histopathology of 82 patients with chronic sinusitis was also undertaken. Eleven additional patients with classic allergic mucin were identified, but were found to be without evidence of fungal elements. The clinical features of all 14 patients are reviewed revealing the spectrum of disease. The difficulties of diagnosis and a therapeutic protocol which includes wide local debridement and postoperative use of systemic steroids are discussed.
Ciprofloxacin: Drug of choice in the treatment of malignant external otitis (MEO)
Authors: Levenson Mark J. , Parisier Simon C. , Dolitsky Jay , Bindra Gurpaul
Published: October 2006

Ciprofloxacin, a fluorinated quinolone with high efficacy against Pseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant external otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow‐up of 18 months after completion of therapy. A new classification of malignant external otitis (MEO) is presented.
A new approach to serial monitoring of ultra—high frequency hearing
Authors: Feghali Joseph G. , Bernstein Richard S.
Published: October 2006

Early detection of drug‐induced hearing loss is best accomplished by monitoring hearing at the ultra‐high frequencies. Unfortunately, at these frequencies, sound pressure at the tympanic membrane (TM) critically depends on the placement of the sound source and on the size and shape of each individual external ear. Thus, presentation of the same sound may yield substantially different sound pressures in different ears. Moreover, only a slight change in the position of an earphone may yield large changes in sound pressure at the tympanic membrane. As a consequence of these characteristics, the reliability of ultra–high‐frequency audiometry is poorer than at conventional audiometric frequencies. However, for the early detection of ototoxicity, it is necessary only to monitor for increases in thresholds. Accordingly, a sound‐delivery system was developed which fixes the relative position of the sound source and the ear. This system ensures that sounds at the same level may be presented during different test sessions. To assess the stability of ultra–high‐frequency thresholds, normal hearing subjects were tested in sessions separated by several weeks. Thresholds were obtained between 1 and 16 kHz and were found to be reliable. It is concluded that this type of system can be used for monitoring the ototoxic effects of drug therapy.
Otoplasty: Critical review of clinical results
Authors: Adamson Peter A. , Mcgraw Becky L. , Tropper Guy J.
Published: October 2006

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow‐up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage‐sparing technique. This method of otoplasty relies on a conchal set‐back and suture transfixion technique to improve the antihelical contour.

Yuricular medialization averaged 10.3 mm. Overcorrection is required, particularly in the superior pole, as loss of correction with healing was approximately 40% of the initial medialization. Revision surgery due to loss of correction was necessary for 6.6% of the ears initially operated on by the senior author. Patients who presented following cartilagecutting procedures tended to have a higher rate of revision and persistent postoperative stigmata. Complications in general were few; however, mersilene suture extrusion occurred in 8% of ears. Only one of these required revision surgery for associated loss of correction. Despite these drawbacks, over 95% of patients achieved satisfactory results using cartilage‐sparing otoplasty techniques.
The lymphocyte transformation test with type II collagen as a diagnostic tool of autoimmune sensorineural hearing loss
Authors: Berger Peter , Hillman Matthias , Tabak Mehmet , Vollrath Michael
Published: October 2006

Immunological disorders of the cellular type can be diagnosed by the lymphocyte transformation test (LTT). An autoimmune mechanism of certain cases of sensorineural hearing loss (SNHL) can be evaluated by using human inner ear tissue as an antigen. Recent studies have shown that type II collagen plays an important role, not only in some autoimmune mediated rheumatoid diseases, but also as an antigenic substrate of inner ear tissue in autoimmune sensorineural hearing loss. This paper deals with results of the lymphocyte transformation test using type II collagen as antigen in 68 patients with progressive sensorineural hearing loss (PSNHL) and 68 healthy volunteers. Thirty‐four patients showed a strong stimulation in the lymphocyte transformation test, in contrast to only four volunteers in the control group, two of whom had a history of rheumatoid arthritis.
P300 response to tones and speech sounds after cochlear implant: A case report
Authors: Kaga Kimitaka , Kodera Kazuoki , Hirota Eiko , Tsuzuku Toshihiro
Published: October 2006

P300 potentials evoked by tones and spoken words were recorded from a 20‐year‐old man with a House‐3M® single‐channel cochlear implant. Three months after cochlear implantation, there was a slight appearance of P300 response to both pure‐tone stimuli and spoken‐word stimuli; 6 months later, clearly identifiable P300 response to both pure‐tone stimuli and spoken‐word stimuli were obtained. These results are consistent with an encoding improvement for re‐establishment of information processing after auditory rehabilitation.
The intraoperative management of the thyroid gland during laryngectomy
Authors: Brennan Joseph A. , Meyers Arlen D. , Jafek Bruce W.
Published: October 2006

The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intra‐operatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isth‐musectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.
Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: A comparative study of reconstructed and nonreconstructed patients
Authors: Urken Mark L. , Buchbinder Daniel , Weinberg Hubert , Vickery Carlin , Sheiner Alan , Parker Robin , Schaefer Jacqueline , Som Peter , Shapiro Arnold , Lawson William , Biller Hugh F.
Published: October 2006

Over the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well‐being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant‐borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discussed.
Computerized tomography and magnetic resonance imaging following cranial base surgery
Authors: Carrau Ricardo L. , Weissman Jane L. , Janecka Ivo P. , Snyderman Carl H. , Curtin Hugh D. , Sekhar Laligam , Lee Hyung Seok
Published: October 2006

The computed tomography scans and magnetic resonance imaging films of 57 patients who underwent anterior or anterolateral cranial base surgery from January 1987 to August 1989 were retrospectively reviewed to ascertain the significance of early and late postoperative intracranial imaging changes.

Extra‐axial changes (air, blood, cerebrospinal fluid collection) were found in 96% of patients; axial changes (brain edema, contusion) were seen in 30% of patients in the first postoperative period (72 hours). Subsequently, extra‐axial changes began to resolve but axial changes became more prevalent. After 6 months, only axial changes persisted (enceph‐alomalacia).

It was encouraging to find a low correlation of imaging abnormalities with clinically significant findings.
Quantifying the spread of botulinum toxin through muscle fascia
Authors: Shaari Christopher M. , George Elaina , Wu Bei‐Lian , Biller Hugh F. , Sanders Ira
Published: October 2006

Botulinum toxin was recently approved for treating several head and neck dystonias. Paralysis of neighboring muscles is the major complication of its use. Spread of toxin from the injected muscle has been suggested as an etiology. This study examines how botulinum toxin crosses muscle fascia by a novel method of quantifying muscular paralysis.

Botulinum toxin (0.2 to 10 U) was placed onto the fascia of rat tibialis anterior (TA) muscles (n = 6). Toxin was also placed on dose‐matched muscles that had their fascia surgically removed (n = 6). Twenty‐four hours later, the nerve to the tibialis anterior was electrically stimulated to deplete the muscle fibers of glycogen. Toxin‐paralyzed fibers retained their glycogen and appeared purple on periodic acid‐Schiff (PAS) stain.

Botulinum toxin easily passed through muscle fascia even at subclinical doses. The presence of fascia reduced the spread of botulinum toxin by 23%. These results suggest that spread of botulinum toxin can be prevented only by delivering small doses to the center of a target muscle.
Otoacoustic emissions in normal and hearing‐impaired children and normal adults
Authors: Spektor Zorik , Leonard Gerald , Kim D. O. , Jung Marjorie D. , Smurzynski Jacek
Published: October 2006

Although distortion‐product otoacoustic emissions (DPOEs) have been studied in adults recently, there is little information regarding them in young children. DPOEs and click‐evoked otoacoustic emissions (CEOEs) were measured from a same group of normal and hearing‐impaired children (age 4 through 10 years) and normal adults (age 22 through 29 years). Measurements of DPOEs in 13 children's ears with normal hearing showed higher levels of emissions in the 700‐ to 1400‐Hz and 5.7‐kHz regions relative to the data obtained in 10 normal adult ears. The 22 ears of children with sensorineural hearing loss demonstrated agreement between pure‐tone audiograms and “DPOE audiograms.” Measurements of CEOEs revealed that the average level of emission in 15 normal‐hearing children's ears was slightly lower than that previously obtained in newborns, but slightly higher than that of adults. In children, the CEOE spectral components in the 4‐ to 6‐kHz region were lower than in newborns, but higher than in adults. These results support the view that the DPOEs and CEOEs comprise a valuable tool in assessment of cochlear function in subjects of all ages.
The natural history of epistaxis in hereditary hemorrhagic telangiectasia
Authors: Aassar O. Sami , Friedman Craig M. , White Robert I.
Published: October 2006

The purpose of this retrospective study is to document the natural history of epistaxis in patients with hereditary hemorrhagic telangiectasia. A telephone questionnaire was administered to 73 patients who had been previously screened for pulmonary arteriovenous malformations (PAVMs). The incidence of epistaxis in this population was 93%, with a mean onset age of epistaxis of 12 years, a mean frequency of bleeding of 18 episodes per month, and a mean duration of bleeding of 7.5 minutes. More than 90% of patients experienced the onset of epistaxis before the age of 21 and symptoms were progressive with age. There were no differences in the age of onset, frequency of epistaxis, or duration of epistaxis between patients with PAVMs versus those without PAVMs. Although the natural history of epistaxis does not predict the presence or absence of pulmonary arteriovenous malformations, epistaxis is an early marker of the disease, hereditary hemorrhagic telangiectasia, and might guide screening for pulmonary and cerebral arteriovenous malformations in children of affected parents.
Cis‐platinum ototoxicity in children
Authors: Pasic Thomas R. , Dobie Robert A.
Published: October 2006

Cis‐platinum is an ototoxic antineoplastic drug. Evaluation of auditory thresholds in 33 children receiving cis‐platinum shows that a threshold shift at 6 and 8 kHz is first measurable after a cumulative dose of 201 to 300 mg/m2. A 35‐ to 40‐dB high‐frequency threshold shift is evident after a cumulative cis‐platinum dose of 301 to 400 mg/m2. Increasing cumulative doses of cis‐platinum are associated with a greater degree of hearing loss. Receiver‐operator characteristic curves were used to find a criterion value that effectively identified threshold shifts that were due to cis‐platinum ototoxicity. A 15‐dB or greater shift in the 6‐ and 8‐kHz threshold average identifies a high true‐positive (50%) and low false‐positive (0%) rate of cis‐platinum‐induced hearing loss. Using this criterion, cis‐platinum ototoxicity affected 77% of children who received cis‐platinum (median cumulative dose 360 mg/m2).
Anatomical correlates of functional recovery in the avian inner ear following aminoglycoside ototoxicity
Authors: Girod Douglas A. , Tucci Debara L. , Rubel Edwin W.
Published: October 2006

Tucci and Rubel have demonstrated functional recovery of the chick cochlea following aminoglycoside ototoxicity. The cochleae of these same animals were examined by scanning electron microscopy (SEM) in order to further understand this recovery process.

Hatchling chicks were given daily doses of gentamicin for 10 days. Auditory‐evoked potential measurements and examination of the cochlea by scanning electron microscopy were performed after survival periods of 5 days to 20 weeks.

After 5 days of gentamicin exposure, there was near complete basal hair cell loss associated with a high‐frequency hearing loss. Apical progression of damage with a broad‐band hearing loss occurred over 4 weeks. At 20‐weeks, hair cell counts were normal with a small high‐frequency hearing loss. Hair cell regeneration played a major role in the functional recovery of the cochlea.
Surgical pathology of cancer of the oral cavity and oropharynx
Authors: Brennan Clare T. , Sessions Donald G. , Spitznagel Edward L. , Harvey Joseph E.
Published: October 2006

A study was designed to determine the influence of certain surgical pathologic findings on tumor spread and survival in patients with cancer of the oral cavity and oropharynx. All patients with the histopathological diagnosis of carcinoma of the oral cavity or oropharynx from 1955 to 1983 were included in the study. Using the Head and Neck Tumor Registry of the department of otolaryngology of the Washington University School of Medicine, information was obtained regarding preoperative evaluation, staging, classification, diagnosis, treatment, surgical pathology parameters, and outcome results. The patient populations consisted of 545 patients with oral cavity cancer and 224 patients with oropharynx cancer, all of whom were eligible for 3‐year follow‐up.

Information from a retrospective analysis of the pretreatment examination records regarding site and size of the primary tumor and neck dissection, and specific treatment, and from surgical pathology reports regarding site, size, tumor spread and resection margins, was correlated with treatment outcome. The database file was analyzed using dbase III and its companion program Framework, and SAS PC (Statistical Analysis Systems for personal computers).
The rhinologic evaluation of alzheimer's disease
Authors: Feldman Jeffrey I. , Murphy Claire , Davidson Terence M. , Jalowayski Alfredo A. , De Jaime Gabriella Galindo
Published: October 2006

Olfactory dysfunction is currently not listed among the NINCDS‐ADRDA clinical criteria for the diagnosis of Alzheimer's disease. There is a large amount of psychophysical and neuropathologic evidence to suggest that patients with Alzheimer's type dementia have olfactory system abnormalities. The rhinologic status of this group has not been characterized. The authors examined 21 Alzheimer's patients and 21 age‐matched controls to determine whether 1. the Alzheimer's group, in fact, had a diminished sense of smell, and whether 2. rhinologic factors were responsible for this nasal dysfunction. The findings support a neurologically mediated phenomenon as the cause for significant impairment in olfactory function in patients with probable Alzheimer's disease.
A comparison of risk factors in juvenile‐onset and adult‐onset recurrent respiratory papillomatosis
Authors: Kashima Haskins K. , Shah Farida , Lyles Alan , Glackin Robert , Muhammad Nadayah , Turner Laurie , Van Zandt Shirley , Whitt Sheila , Shah Keerti
Published: October 2006

The clinical triad of a firstborn delivered vaginally to a young (teenage) mother has been previously noted among juvenile onset recurrent respiratory papillomatosis (JO‐RRP) patients. This study was based on a questionnaire survey of JO‐RRP patients, adult onset recurrent respiratory papillomatosis (AO‐RRP) patients, and juvenile and adult controls. The survey results revealed that the complete or partial triad was observed in 72% of JO‐RRP patients, 36% of AO‐RRP patients, 29% of juvenile controls, and 38% of adult controls. As compared with juvenile controls, JO‐RRP patients were more often firstborn (P <.05), delivered vaginally (P <.05), and born to a teenage mother (P <.01). Among adult participants, AO‐RRP patients reported more lifetime sex partners (P <.01) and a higher frequency of oral sex (P <.05) than reported by adult controls.

AO‐RRP and JO‐RRP appear to have distinguishable epidemiologic features indicating that the mode of human papillomavirus (HPV) transmission is different in these two disorders.
Metastatic head and neck malignancy treated using MRI guided interstitial laser phototherapy: An initial case report
Authors: Castro Dan J. , Lufkin Robert B. , Saxton Romaine E. , Nyerges Anthony , Soudant Jacques , Layfield Lester J. , Jabour Bradley A. , Ward Paul H. , Kangarloo Hooshang
Published: October 2006

Interstitial laser phototherapy (ILP) guided by magnetic resonance imaging (MRI) may become an attractive adjunctive modality for the treatment of deep and surgically inaccessible tumors of the head and neck when accurate methods of laser dosimetry and “real‐time” monitoring techniques with the MRI are introduced. We recently demonstrated in ex vivo and in vivo models, a linear relationship between levels of laser energies, thermal profiles, MR signal intensity changes, and histopathological tissue damage. Results of treatment in a patient with an unresectable large right jugulodigastric metastatic squamous carcinoma using new approach of MRI guided ILP are now reported. The patient complained of significant right‐sided neck pain and headaches secondary to a rapidly growing metastatic lymphadenopathy which recurred after previous surgery, radiation, and chemotherapy. Two treatment sessions were used at an interval of 2 weeks. Each treatment was performed in the MRI suite under heavy sedation. Using a 600‐μm bare fiber of the Nd:YAG laser implanted interstitially under MR guidance, the metastatic node was treated at three sites. T1‐ and T2‐weighted images were performed prior to, immediately after, 24 and 48 hours, and 4, 5, 7, 9, 16, and 25 days post‐treatment. Successful relief of pain and growth arrest of this node was observed after the second treatment and at the 3‐month follow‐up. These results demonstrate that this technique of ILP guided by MRI may be feasible in humans, and will become clinically practical when appropriate methods of dosimetry and instrumentation are developed.
The incidence and distribution of cupular deposits in the labyrinth
Authors: Moriarty Brian , Rutka John , Hawke Michael
Published: October 2006

Findings of large basophilic staining deposits on the cupula of the posterior semicircular canal ampulla have been used in part to explain the clinical phenomenon of benign positional vertigo (BPV). Although it is generally agreed that cupulolithiasis may involve other canal ampullae, the precise nature, distribution, and origin of these deposits remains unclear. In order to provide a better understanding of this finding, a series of 566 temporal bone specimens from the Ear Pathology Research Laboratory at the University of Toronto were reviewed. The results from this survey and speculations concerning the nature and formation of these deposits are discussed.
Contemporary management of cervical tuberculosis
Authors: Lee Kelvin C. , Tami Thomas A. , Lalwani Anil K. , Schecter Gisela
Published: October 2006

Although excisional biopsy has traditionally been required to diagnose cervical tuberculosis (TB), fine needle aspiration biopsy (FNAB) has also been found to be useful. The presentation and management of 47 patients diagnosed with cervical TB between 1984 and 1988 were retrospectively reviewed. Chest x‐rays were normal in 58% of the patients, and purified protein derivative (PPD) skin testing was positive in 96%. When FNAB was used, TB could be suspected in 83% of cases and definitively established in 62%. Open biopsy correctly diagnosed cervical TB in all masses excised. Medical therapy alone resulted in resolution of disease in 94% of patients diagnosed by FNAB, and subsequent excisional biopsy was necessary in only one patient. The results suggest that FNAB is a useful initial procedure in the diagnosis of cervical TB. Excisional biopsy should be reserved for cases where no diagnosis by FNAB can be made, or for persistent cervical disease despite full‐course antituberculous chemotherapy.
Changes in the microbial flora of airline headset devices after their use
Authors: Brook Itzhak , Jackson William E.
Published: October 2006

The bacterial flora of 20 headset devices were evaluated before and after they were worn for 1 hour. Bacteria were recovered from all headsets, and their number increased from a mean (± standard deviation) of 60 ± 5 organisms per device to 650 ± 51 organisms per device (P <.001). The predominant organisms recovered were Staphylococcus spp, Streptococcus spp, Propionibacterium spp, and Peptostreptococcus spp. This study demonstrates the presence of potential pathogens in headset devices, as well as the increase in the number of these pathogens after the headsets have been worn for 1 hour.
An analysis of prognostic factors in cutaneous neuroendocrine carcinoma
Authors: Pitale Michèle , Sessions Roy B. , Husain Shaista
Published: October 2006

Since the first report of cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) in 1972, knowledge of the biological behavior of this tumor has continued to increase. This study reviews three previously unreported cases in addition to reports on 429 patients collected from the literature. The presenting features of these 306 patients were analyzed for frequency and then were analyzed by the Cox proportional hazard model for the relationship of each to recurrence and outcome. This study confirms that cutaneous neuroendocrine carcinoma is an aggressive disease; that the most common cause of death in these patients is by distant metastasis; and that men have succumbed more frequently than women. As a result of this study, aggressive treatment of cutaneous neuroendocrine carcinoma is recommended, especially in the male patient.
Variations of the anterior cricoid split: The effect on airway cross‐sectional area in the rabbit
Authors: Macarthur Carol J. , Senders Craig W.
Published: October 2006

The anterior cricoid split (ACS) operation has been documented as a successful treatment for the difficult‐to‐extubate infant or child. The exact mechanism by which this operation is successful is still being investigated. In an effort to further elucidate the effect of the ACS procedure on the subglottic airway, four groups of rabbits were studied. Both size and shape of the subglottic area after surgical manipulation were evaluated, comparing control rabbits with ACS, anteroposterior cricoid split (A‐PCS), and partial cricoid split with sparing of soft‐tissue lining (partial ACS). The animals were sacrificed 4 weeks after surgery, and the larynxes were harvested. Analysis showed a significant enlargement of the subglottic lumen in all experimental groups as measured at the inner lamina of the cricoid cartilage. However, the true subglottic lumen was significantly enlarged only in the ACS group. Findings showed that true enlargement of the subglottic lumen was limited in all experimental groups to increased thickness in the soft‐tissue lining of the subglottic lumen, which was most marked in the A‐PCS group. A significant change in subglottic lumen shape occurred in the A‐PCS group as well. These results suggest the A‐PCS should be approached clinically with caution when a stent is not used.
Experimental applications of porous (coralline) hydroxylapatite in middle ear and mastoid reconstruction
Authors: Jahn Anthony E.
Published: October 2006

Hydroxylapatite is a ceramic implant material which has been extensively investigated in the orthopedic and oral surgical literature. A set of animal experiments was carried out to determine the feasibility of the use of porous (coralline) hydroxylapatite for middle ear and mastoid reconstruction. Coralline hydroxylapatite was placed in the mastoid bulla of dogs and was carved into struts which were placed into the middle ear and against the tympanic membrane.

Coralline hydroxylapatite is a highly biocompatible material which showed abundant ingrowth when in contact with host bone. There was also good soft‐tissue ingrowth and fibrous tissue fixation within the middle ear and against the tympanic membrane.

Hydroxylapatite is generally accepted to be osteoconductive, but not osteogenic. However, one of the specimens described with chronic inflammatory mucosal changes, shows de novo new bone formation within the pores of the graft. While normally the bone formed in coralline hydroxylapatite is secondary (lamellar), in this specimen primary (woven) bone was found.

Porous (coralline) hydroxylapatite appears to be an excellent otologic graft material. It biointegrates with the host, is osteoconductive, and under certain circumstances may be osteogenic.
Intraoperative versus interstitial radiotherapy: A comparison of morbidity in the head and neck
Authors: Close Lanny Garth , Morrish Thomas N. , Nguyen Phuc
Published: October 2006

Intraoperative radiation therapy (IORT) and interstitial radiotherapy (brachytherapy) are highly effective adjunctive treatments for head and neck cancer. The radiotolerance of the carotid artery, pharynx, and mandible to therapeutic doses of these modalities, however, has not been clearly established. To investigate the effects of IORT and interstitial iridium 192 (192Ir) on these structures in the canine, both sides of the neck of 12 mongrel dogs were operated on to expose 4‐cm segments of the common carotid artery, pharynx, and mandible. One side of the neck was irradiated in each animal with the opposite side serving as the unirradiated control. The animals were divided into 3 groups of 4 dogs each. The first group received 40‐Gy IORT and the second, 60‐Gy IORT. In the third group of animals, afterloading catheters were implanted followed by placement of 60‐Gy 192Ir. At 2 and 4 months after irradiation, 2 dogs in each treatment group were killed and histopathologic examination of the carotid artery, pharynx, and mandible was performed using hematoxylin‐eosin staining.

No statistically significant difference between treatment groups was found for carotid artery injury, but a trend for the proportion of fibrosis of the carotid on the irradiated side to increase with dose (P = .125) and time (P = .250) was noted. No apparent or statistically significant difference was found between treatment groups for pharyngeal injury. The greatest histologic changes noted following IORT and 192Ir brachytherapy were found in mandible specimens. The incidence of bone marrow suppression in irradiated mandible specimens versus controls approached statistical significance (P = .062). Osteoradionecrosis (ORN) was noted in the irradiated mandible specimens of two dogs, one of which received 60‐Gy IORT and the other 60‐Gy interstitial 102Ir.

This manuscript reviews animal and clinical investigations relevant to the use of IORT and interstitial radiotherapy to the head and neck. Recommendations are made regarding further animal and clinical research as well as methods of treatment.
Hyperparathyroidism induced by hypothyroidism
Authors: Walker Regina Paloyan , Oslapas Raymond , Ernst Kazuko , Hessel Patricia , Nayyar Rajinder , Lawrence Ann M. , Paloyan Edward
Published: October 2006

The coexistence of hyperparathyroidism and thyroid tumors and/or chronic thyroiditis has raised the possibility of an etiologic relationship. The present study was designed to test the hypothesis that the chronic elevation of thyroid‐stimulating hormone (TSH) is related to the development of hyperparathyroidism. Three groups of 24 rats each were treated for 12 weeks as follows: group 1 received propylthiouracil (PTU) in their deionized water; group 2 received PTU and thyroid hormone to suppress TSH and to serve as a control group for possible direct effects of PTU; and group 3 was not treated at all and served as another control group. At 12 weeks, 95% of group 1 rats (PTU only) showed hyperplasia of the parathyroids with a 30% mean increase in circulating parathormone.
Symptomatic versus asymptomatic endolymphatic hydrops: A histopathologic comparison
Authors: Sperling Neil M. , Paparella Michael M. , Yoon Tae H. , Zelterman Daniel
Published: October 2006

One of the unanswered questions in Meniere's disease research is the pathophysiology by which the classic symptoms are produced. A histopathological study was undertaken to identify the pathological features of symptomatic endolymphatic hydrops and their relationship to these symptoms. Two groups of temporal bones were examined, compared, and described. The first group was from patients with symptoms of Meniere's disease (n = 29). Temporal bones in the second group were chosen for the presence of endolymphatic hydrops and the absence of otologic symptoms (n = 13). Significant differences were noted in the severity of hydrops, the frequency of membrane ruptures, the endolymphatic duct, and coexistent pathologic conditions. Ruptures were seen in 38% of temporal bones from symptomatic patients and in only 8% of temporal bones from patients with asymptomatic endolymphatic hydrops. Based on this study and a review of the literature, the authors believe that the symptoms and findings of Meniere's disease are explained best on the basis of both chemical and physical mechanisms being operational intermittently and together.
Facial nerve management in cranial base surgery
Authors: Janecka Ivo P. , Sekhar Laligam N. , Sen Chandra N.
Published: October 2006

This study reviewed 124 patients who required facial nerve manipulation during cranial base surgery. Most of them underwent only nerve displacement or selective transection for improved surgical access to the cranial base (70 and 34, respectively). Fourteen patients had the facial nerve resected for oncologic reasons and repaired with primary nerve grafting. Most patients regained quite satisfactory facial function with quality correlating with the degree of nerve injury. Six patients had facial nerve resected as part of oncologic palliation and had the facial deficit rehabilitated with regional tissue.

A correlation between preoperative facial nerve weakness and the quality of nerve graft function was not found. An oncologic correlation, however, is suggested (patients with preoperative weakness had less favorable prognosis). Overall, patients who require facial nerve resection for oncologic reasons do not do as well as those with normal preoperative function.
Inner ear‐specific autoantibodies
Authors: Yamanobe Shigeharu , Harris Jeffrey P.
Published: October 2006

The sera of patients with idiopathic sensorineural hearing loss (SNHL) were examined, using qualitative immunoblotting (Western blotting), for the presence of inner ear (IE)‐specific autoantibodies. The water‐soluble extracts and the sodium dodecyl sulfate‐soluble extracts were prepared as the antigens from bovine IE tissues and several other organs in order to determine the specificity of autoantibodies in their sera to the IE. Some patients (n = 46) tested had autoantibodies that reacted with 68‐, 62‐, 55‐, 50‐, or 47‐kd antigenic determinants found in all tissues, while others (n = 13) showed IE‐specific autoantibodies which reacted with 220‐, 60‐, 58‐, 33–35‐, or 32‐kd determinants. The presence of these autoantibodies from patients with progressive SNHL may have important implications with regard to their etiology and possibly their sensitivity to therapeutic intervention. It is now necessary to purify these IE‐specific antigens and determine their clinical usefulness.
Determination of vocal fold mucosal wave velocity in an in vivo canine model
Authors: Sloan Steven H. , Berke Gerald S. , Gerratt Bruce R. , Kreiman Jody , Ye Ming
Published: October 2006

The vocal fold traveling wave is essential to normal voice production. The present investigation examined whether the velocity of the traveling wave (TWV) could be consistently determined in an in vivo canine model and if traveling wave velocity is affected by changes in the amplitude of recurrent laryngeal nerve stimulation (RLNS) and superior laryngeal nerve stimulation (SLNS). The results showed that traveling wave velocity increased with an increase in recurrent laryngeal nerve stimulation at low constant superior laryngeal nerve stimulation, but was poorly correlated with increases in recurrent laryngeal nerve stimulation at a high level of superior laryngeal nerve stimulation. Furthermore, traveling wave velocity was significantly correlated with superior laryngeal nerve stimulation at constant recurrent laryngeal nerve stimulation. This study demonstrated the feasibility of objectively measuring traveling wave velocity in vivo.
Revision stapedectomy
Authors: Langman Alan W. , Lindeman Roger C.
Published: October 2006

The need for revision stapedectomy surgery still exists despite the many changes that have occurred in the surgical technique for the treatment of stapedial otosclerosis over the past 30 years. Sixty‐six revision stapes operations were analyzed to determine the causes of failure of previously operated cases of stapedial otosclerosis, and to evaluate the hearing results following a revision stapedectomy. Failure was most often due to erosion of the incus (41%), displacement of the prosthesis from the incus (24%), or migration of the prosthesis from the center portion of the oval window (24%). Postoperative improvement of hearing was observed in 81% of ears operated on for a conductive hearing loss. Closure to within 10 dB, however, occurred in 61%. Two ears suffered a deterioration in the sensorineural hearing level following the revision surgery. Speech discrimination scores following revision surgery were improved in 5% of ears and unchanged in the remainder. Although the overall hearing results are less favorable than those seen in primary stapedectomy, revision stapedectomy surgery should continue to be offered to patients whose primary stapes surgery failed or whose initial good result declined over time.
Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery
Authors: Rodgers Grayson K. , Luxford William M.
Published: October 2006

Meningitis and cerebrospinal fluid (CSF) leak are serious complications of acoustic tumor surgery. Previous reports have varied in the incidence of and the predisposing factors to these complications. This study reviews a series of 723 acoustic tumors removed via the translabyrinthine approach at the House Ear Clinic in Los Angeles. The incidences of CSF leak and meningitis were 6.8% and 2.9%, respectively. The patients who developed these problems were compared to the remainder of the study population for differences in age at surgery, tumor size, operative time, and length of hospital stay. Meningitis occurred more frequently in larger tumors, and patients with either complication had a longer hospital stay. The presence of CSF leak did not predispose to meningitis. It is concluded that technical factors account for postoperative CSF leak and meningitis after translabyrinthine acoustic tumor removal.
Insertional trauma of multichannel cochlear implants
Authors: Welling D. Bradley , Hinojosa Raul , Gantz Bruce J. , Lee Jen‐Tin
Published: October 2006

Insertional trauma to the cochlea from three different multichannel cochlear implant electrodes was evaluated in a single‐blind controlled study in fresh human temporal bones. Sixteen fresh human temporal bones were implanted with one of three types of multichannel electrodes (Symbion/InnerAid, Cochlear/Nucleus®, or Storz/UCSF). Seven temporal bones were used as controls where a cochleostomy only was created. The temporal bones were evaluated histologically and cochlear histograms of the trauma were created.

Although the three electrode designs caused damage which was unlikely to hinder implant performance, a distinct pattern of trauma was seen with each of the three electrode types. The least traumatic of the three electrode designs in this study was the Nucleus type. The degree of insertional trauma may be relevant to changing indications for insertion of cochlear implants as well as for patients with device failure who require reimplantation.
A comparison of suture versus laser‐assisted microvascular anastomosis (LAMA) in the pig buttock flap model
Authors: Wenig Barry L.
Published: October 2006

Introduction of microvascular free‐tissue transfer to head and neck surgery has completely altered the current approach to extirpation and reconstruction. The increased flexibility now available offers multiple options for reconstruction and has essentially removed the limitations of size and geometry which existed with other types of repair. Despite these advantages, increased surgical time and potential flap failure loom as limiting factors.

Since the initial use of sutures to perform microvascular anastomoses, numerous experiments have been conducted in order to identify other options for vessel approximation. Laser‐assisted microvascular anastomosis (LAMA) was first attempted with the neodymium‐yttrium aluminum garnet (Nd:YAG) laser and, subsequently, other wavelengths were used in experimental models. Success with this technique has been repeatedly documented.

Although a comparable animal model to study skin flaps was initially described in 1979, little is currently available in the literature that describes the actual use of a microvascular free flap model. Certainly, nothing exists regarding the role of LAMA and microvascular free‐tissue transfer.

This study was designed to establish a reliable and reproducible animal model to study free‐tissue transfer. Through the use of laser Doppler flowmetry, values of blood perfusion of flaps can be determined. Anastomoses with standard suture and various laserassisted techniques could then be done and compared, analyzing the parameters of time and blood flow. Histologic evaluation could be correlated with clinical observations. In so doing, LAMA could be objectively evaluated as a potentially viable method of vascular reconstruction in microsurgical free‐tissue transfer.