bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial Nerve Monitoring in Middle Ear and Mastoid Surgery
Authors: Noss Roger S. , Lalwani Anil K. , Yingling Charles D.
Published: November 2003

Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery.

Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist.

Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence.

Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively.

Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.
Surgical Anatomy of the Anterior Ethmoidal Canal in Ethmoid Roof
Authors: Moon Hyoung‐Jin , Kim Hyun‐Ung , Lee Jeung‐Gweon , Chung In Hyuk , Yoon Joo‐Heon
Published: November 2003

Objectives/Hypothesis This study was undertaken to examine three main relationships. First, the distance and angle from the anterior ethmoidal canal to the limen nasi and the sill were measured. Second, the location of the anterior ethmoidal canal was examined in relation to the lamellas and the skull base. Third, the existence of bony defects in the canal and the course of the canal through the anterior cranial fossa were studied.

Study Design This study employed both sagittal computed tomography and cadaver dissection.

Methods Seventy sagittally divided heads from randomly chosen Korean adult cadavers were used. Sagittal computed tomography was performed on all specimens. Then they were meticulously dissected under a surgical microscope.

Results The mean distance and angle between the limen nasi and the anterior ethmoidal canal were 49.0 mm and 54.5°, respectively. The anterior ethmoidal canal was located between the second and third lamella in 61 of 70 cases. In 60 of 70 cases it was attached to the base of the skull, and in the remaining 10 cases it ran 2 to 3 mm below the skull base. When viewed from the superior side, the course of the anterior ethmoidal canal formed a diagonal line from the lateral to the medial side. Partial bony defects of the anterior ethmoidal canal were observed in eight cases, and complete bony defects in none.

Conclusion This study provides surgeons with a better understanding of the anatomy of the anterior ethmoidal canal.
Intraoperative Gamma Probe Localization of Parathyroid Adenomas
Authors: Sullivan Daniel P. , Scharf Stephen C. , Komisar Arnold
Published: November 2003

Objectives/Hypothesis In an effort to reduce operative time, improve diagnostic accuracy, and decrease perioperative morbidity, we combined preoperative technetium Tc 99m–sestamibi localization with the use of the gamma probe intraoperatively. This report examines our experience with the gamma probe for rapid intraoperative localization of parathyroid adenomas.

Study Design A retrospective chart review was performed to identify all patients who underwent parathyroid exploration with the aid of the gamma probe at Lenox Hill Hospital (New York, NY).

Methods Charts were reviewed for operative details, radiological findings, and pathological diagnoses.

Results Between November 1, 1998, and June 30, 2000, 35 parathyroid explorations were performed with the aid of the gamma probe. The preoperative localization study was accurate in 34 of 35 cases. The gamma probe successfully identified the parathyroid adenoma in 33 of 35 cases. There were two false‐positive cases in which the gamma probe mistakenly identified a thyroid adenoma rather than a parathyroid adenoma. In 11 of 35 cases, the gamma probe was judged essential for rapid localization of the parathyroid adenoma. These cases included patients with multiple or ectopic adenomas and patients who had previous parathyroid surgery. Average operative time to remove parathyroid disease was 80 minutes (range, 45–140 min), which included 20 to 40 minutes waiting for frozen‐section results. All patients became normocalcemic, and there were no major complications in this series.

Conclusion The gamma probe is a useful tool that complements a well‐performed localization study. It is most useful in patients who have multiple or ectopic adenomas or have had prior parathyroid surgery.
Osseous Tissue Engineering With Gene Therapy for Facial Bone Reconstruction
Authors: Lindsey William H.
Published: November 2003

Objective Facial osseous defects remain a major functional and esthetic challenge for the head and neck surgeon. Tissue engineering may provide advantageous alternatives to conventional therapies. The objective of the study was to evaluate the efficacy of gene therapy in the repair of osseous facial defects.

Study Design Blinded, controlled, prospective animal experiment.

Methods Thirty adult athymic nude rats were divided into five groups of six animals. Three groups were used as control subjects. Two groups were treated with 3.75 × 108 viral particles containing recombinant type 5 adenoviral vectors. One group received viruses that coded for β‐galactosidase production, another received viruses that coded for bone morphogenetic protein (BMP‐2) production. After 120 days rats were examined at necropsy with precise planimetry, histological analysis of new bone growth, and radio‐densitometric analysis of bone thickness.

Results Radio‐densitometric measurements showed that BMP‐2–treated nude athymic rats had significantly enhanced osseous repair compared with control subjects when evaluated by both radio‐densitometry and histological examination.

Conclusion Gene therapy–treated, immunosuppressed rodents had an enhanced osteoinductive repair of a dorsal osseous nasal defect.
Laryngeal Angiosarcoma: A Clinicopathologic Study of Five Cases With a Review of the Literature
Authors: Loos Benjamin M. , Wieneke Jacqueline A. , Thompson Lester D. R.
Published: November 2003

Objective Primary laryngeal angiosarcoma (LA) is rare without a reported series evaluating these tumors.

Study Design/Methods Five patients with LA were retrospectively retrieved from the Otorhinolaryngic Registry of the Armed Forces Institute of Pathology.

Results Three men and 2 women, aged 29 to 71 years, presented with hoarseness (n = 4) and hemoptysis (n = 1). Two patients had previous neck radiation. The tumors involved the supraglottis (n = 4) with a mean size of 3.1 cm. Histologically, all tumors had anastomosing vascular channels lined by remarkably atypical endothelial cells protruding into the lumen, frequent atypical mitotic figures, and hemorrhage. All cases tested (n = 4) demonstrated immunoreactivity with antibodies to Factor VIII‐RA and CD34. All patients had surgery followed by postoperative radiation (n = 3 patients). Three patients died with disease (mean, 17 mo), whereas one patient is alive with no evidence of disease at 18 years.

Conclusions LA is a rare tumor, frequently associated with previous radiation, usually involving the supraglottis with characteristic histomorphologic and immunophenotypic features. LA has a poor prognosis, making appropriate separation from other conditions important.
Benign Paroxysmal Positional Vertigo After Stapedectomy
Authors: Atacan Erbil , Sennaroglu Levent , Genc Aydan , Kaya Sefa
Published: November 2003

Objective To determine the incidence of benign paroxysmal positional vertigo (BPPV) following stapedectomy in a patient group and the efficacy of the Epley maneuver in this group.

Study Design Prospective study in a university‐based tertiary referral system.

Methods The patient group comprised 63 patients who had undergone stapedectomy; a control group consisted of normal healthy individuals with no otolaryngological complaints. All individuals underwent the Dix‐Hallpike maneuver for the diagnosis of BPPV. Patients who exhibited vertigo, torsional nystagmus (which reverses its direction on return to sitting position) preceded by a latent period, and the fatigability of these findings were considered to have BPPV. If the test result was positive, they underwent the Epley therapeutic maneuver.

Results Four of the patients who had undergone a stapedectomy showed characteristic findings of BPPV. No individual in the control group had BPPV. All patients responded well to the Epley maneuver.

Conclusions Stapedectomy may be regarded as an etiological factor in BPPV. Because the fenestra is located in the posterior part of the stapes footplate, the pathophysiology appears to be related to utricular rather than saccular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy. An Internet survey of the relevant literature in English shows a scarcity of publications on the incidence of BPPV following stapedectomy. In the present study, 63 patients who had undergone a stapedectomy were investigated for the presence of BPPV; all had Dix‐Hallpike maneuvers performed for the diagnosis. Sixty‐three individuals with no otolaryngological complaints made up the control group. Four of the patients who had undergone stapedectomy showed characteristic findings of BPPV, and no individual in the control group had BPPV; the difference between the two groups was statistically significant. All four of the patients diagnosed with BPPV responded well to the Epley maneuver. The pathophysiology appears to be related to utricular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy.
Surgical Treatment of Tracheostomal Stenosis
Authors: Giacomarra Vittorio , Russolo M. , Tirelli G. , Bonini P.
Published: November 2003

Hypothesis Stenosis of the tracheostome is a frequent complication following total laryngectomy; the problems created by tracheostomal stenosis are the result of reduced airflow and consequent turbulence. Many authors have studied etiological factors for the onset of stomal stenosis, and a number of procedures have been recommended for the surgical correction of such stenosis.

Study Design A prospective analysis of 12 patients who underwent surgical correction of stomal stenosis is presented.

Methods At the Institute of Clinical Otolaryngology we have recently defined a surgical technique for the correction of stomal stenosis that combines radial incisions, V‐shaped flaps, and interposing flaps. This technique enables us to correct all the types of stenosis, and we have treated 12 patients to date.

Results To date, the average follow‐up has been 17 months (range, 3–36 mo), and the results are encouraging. Early stenosis of the tracheostoma reappeared in one patient, who had successful repeat surgery with the same technique.

Conclusions Early results suggest the routine use of this surgical technique in the treatment of stomal stenosis.
Post‐Tonsillectomy Bleeding: A Meta‐Analysis
Authors: Krishna Priya , Lee Dennis
Published: November 2003

Objective/Hypothesis To reconcile conflicting reports and opinions of the value of preoperative coagulation studies for patients undergoing tonsillectomy.

Study Design Meta‐analysis: Articles were identified by MEDLINE search, references from review articles, textbook chapter, and retrieved reports. Independent observers selected prospective trials of patients undergoing tonsillectomy or adenoidectomy and tonsillectomy. Retrospective studies meeting other inclusion and exclusion criteria were included for sensitivity analyses of results.

Methods Data were abstracted from studies for an end point of bleeding with normal and abnormal coagulation tests. Four prospective studies met all inclusion and exclusion criteria. These four studies were used in the data synthesis. An additional eight retrospective studies met all other criteria and were used in the sensitivity analysis.

Results Pooled analysis of 3384 patients revealed a rate of 3.3% (95% confidence interval [CI], 2.5%–4.1%) for post‐tonsillectomy bleeding in patients with normal coagulation studies. A rate of 8.7% (95% CI, 1.5%–15.9%) was obtained for bleeding in patients with abnormal coagulation studies. No significant rate difference in post‐tonsillectomy bleeding was demonstrated.

Conclusion There is no difference in the rate of post‐tonsillectomy bleeding in patients with abnormal coagulation studies as compared with patients with normal coagulation studies obtained preoperatively.
Complementary and Alternative Medicine in Otolaryngology
Authors: Asher Benjamin F. , Seidman Michael , Snyderman Carl
Published: November 2003

The widespread interest in and use of complementary and alternative medicine (CAM) by patients in the United States has been established by multiple surveys. One‐third of the U.S. population uses some form of CAM, and an estimated 23 billion dollars is spent annually on these therapies. Because of prevalent usage of CAM among patients, it is important that physicians have some knowledge of this subject. With this purpose in mind, this report reviews the current research on CAM as it relates to common disorders of the head and neck: rhinitis, sinusitis, tinnitus, vertigo, and head and neck oncology.
Tonsillectomy With Argon Plasma Coagulation (APC): Evaluation of Pain and Hemorrhage
Authors: Bergler Wolfgang , Huber Kerstin , Hammerschmitt Nicolas , Hörmann Karl
Published: November 2003

Objective Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one‐step procedure. The aim of this prospective, randomized, single‐blinded study was the evaluation of pain and hemorrhage of the “hot” argon‐plasma‐coagulation tonsillectomy (TEAPC) compared with a conventional “cold” non‐electrosurgery tonsillectomy (TEConv).

Methods Two hundred one consecutive patients undergoing tonsillectomy were included in a single‐blinded, randomized, prospective study with stratification in two age groups.

Results There was no statistical significant difference between TEAPC and TEConv in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TEAPC group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TEAPC compared with the TEConv in both age groups (P <.01).

Conclusions The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.
Spectral Karyotyping Analysis of Head and Neck Squamous Cell Carcinoma
Authors: Singh Bhuvanesh , Gogineni Swarana , Goberdhan Andy , Sacks Peter , Shaha Ashok , Shah Jatin , Rao Pulivarti
Published: November 2003

Objectives/Hypothesis The genetic content of head and neck squamous cell carcinomas is ill defined. Spectral karyotyping (SKY) is a new technique that allows the simultaneous detection of all chromosomal translocations by labeling each individual chromosome with different fluorescent agents. In the current study we used SKY to analyze cell lines and a primary tumor derived from head and neck squamous cell carcinomas (HNSCC) to delineate recurrent translocations and breakpoints.

Study Design Spectral karyotyping analysis of head and neck cancer.

Methods Two cell lines (MDA886 and MSK922) and one primary tumor in short‐term culture were subjected to metaphase growth arrest with colcemide in their exponential growth phase and fixed onto glass slides. Painting probes for each of the autosomes and the sex chromosomes were generated from flow‐sorted human chromosomes using sequence‐independent DNA amplification. The probes were labeled using a polymerase chain reaction–based reaction and hybridized to metaphase preparations for 2 days at 37°C. Biotinylated probes were detected using avidin Cy5 and digoxigenin‐labeled probes with an anti‐mouse digoxigenin antibody followed by goat anti‐mouse antibody conjugated to Cy5.5. Chromosomes were counterstained with 4,6‐diamino‐2‐phenyliodole (DAPI), and a minimum of five metaphases were captured and analyzed for each case. Breakpoints on the SKY‐painted chromosomes were determined by comparison of corresponding DAPI banding.

Results Spectral karyotyping analysis revealed a complex pattern of chromosomal abnormalities. A total of 66 translocations were identified in the three cases, with one new recurrent translocation at (der(4)t(4;20)(q35;?)). Nine complex translocations, involving three or more chromosomes, were identified in these cases. Overall, 96 breakpoints were assigned to metaphase chromosomes and another 74 breakpoints could not be assigned. Breakpoints most commonly involved chromosomes in genetic rearrangements were 1, 3, 5, 8, 13, 16, and 17.

Conclusions Spectral karyotyping analysis reveals the true complexity of chromosomal aberrations in cell lines derived from head and neck squamous cell carcinomas. The use of SKY, in combination with other techniques, may allow for a more complete assessment of the genetic abnormalities of head and neck cancers and serve as a starting point for gene identification.
Tetracaine Topical Anesthesia for Myringotomy
Authors: Hoffman Ronald A. , Li Chun‐Lun J.
Published: November 2003

Objectives/Hypothesis To study the efficacy and safety of topical tetracaine anesthesia for office myringotomy and myringotomy with a tube.

Study Design Retrospective review of patients undergoing office myringotomy, with or without tube insertion, performed over a 4‐year period.

Methods A topical solution of 8% tetracaine base in 70% isopropyl alcohol was used in 381 ears. Five to 10 drops of the solution were applied to the tympanic membrane for 10 to 15 minutes and aspirated. Myringotomy was performed either with a myringotomy knife or with a CO2 laser (OtoLAM).

Results Topical tetracaine was used in all 231 ears (100%) undergoing myringotomy without a tube and 150 of 212 ears (71%) undergoing myringotomy with a tube. Tetracaine alone was effective in providing tympanic membrane anesthesia in 95% of myringotomy without a tube (220 ears) and in 93% of myringotomy with a tube (139 ears). There were six complications, including five cases of severe vertigo and one unusual prolonged, transient facial nerve weakness.

Conclusion Topical tetracaine is efficacious and safe for use in office myringotomy.
Cervicofacial Rhytidectomy After Head and Neck Tumor Removal
Authors: Lee Jonathan H. , Sherris David A.
Published: November 2003

Objective To compare intraoperative and postoperative complication rates of cervicofacial rhytidectomy after head and neck tumor removal with complication rates of rhytidectomy in the normal patient population.

Study Design Retrospective chart review and literature review.

Methods A sample of 11 patients treated by a single surgeon (D.A.S.) at an academic referral center who met the inclusion criteria was reviewed for previous head and neck surgical history, medical history, and surgical results and subsequent complications of the facial esthetic procedure. These rates were compared with the complication rates for cervicofacial rhytidectomy in normal patients as quoted in the general medical literature.

Results Patients ranged in age from 48 to 75 years (mean age, 58 y). Of the 11, no patient experienced a major complication of rhytidectomy, and two experienced a minor postoperative complication. Both patients had received postoperative radiation for the treatment of their previous tumor, and both noted a small (<1.5 cm) area of wound dehiscence before postoperative day 10, which required no revision and healed without sequelae. No other intraoperative or postoperative complications were found.

Conclusion Cervicofacial rhytidectomy may be safely and effectively performed on postoperative patients with head and neck tumors without increased incidence of major complications when compared with patients without a surgical tumor history. The increased incidence of minor wound dehiscence experienced by 2 of the 3 patients who received postoperative radiation in this study may indicate that small areas of skin incision dehiscence are more likely in patients who have been radiated. Surgeons performing rhytidectomy on patients with head and neck tumors who were previously radiated should consider more meticulous subdermal closure to avoid such dehiscence. Patients should be informed of the slightly higher risk of dehiscence before surgery.
Parathyroid Cysts: A Case Report and Review of the Literature
Authors: Fortson James K. , Patel Vijaykumar G. , Henderson Vernon J.
Published: November 2003

Objectives/Hypothesis Parathyroid cysts are rare clinical entities. They frequently present as a clinical diagnostic problem. They may mimic solitary thyroid nodules. The purpose of the study was to review the literature and present a case of a 22‐year‐old euthyroid woman presenting with recurrent swelling in the neck. Her complaints included choking and dysphagia. Fine‐needle aspiration of the mass revealed clear, watery fluid with an extremely high level of calcium and c‐terminal midmolecule parathyroid hormone assay in excess of 8000 pg/mL. Treatment consisted of neck exploration and removal of a 6 × 5‐cm cystic encapsulated mass. Pathological diagnosis revealed a benign parathyroid cyst. The role of needle aspiration in diagnosing thyroid masses and the importance of parathyroid hormone assay in diagnosing parathyroid cyst are emphasized.
Phonoscopy—A Valuable Tool for Otolaryngologists and Speech‐Language Pathologists in the Management of Dysphonic Patients
Authors: Leonard Rebecca , Kendall Katherine
Published: November 2003

Objectives To describe the phonoscopic evaluation, present a rationale for its use, and demonstrate its use in identifying laryngeal and vocal pathology.

Study Design Retrospective review.

Methods One hundred consecutive cases of new patients referred to our voice clinic team were reviewed. Findings on laryngeal examination as reported by the referring otolaryngologist were compared with our findings on “phonoscopic” examination. The phonoscopic examination combines the traditional voice evaluation performed by speech‐language pathologists with endoscopy, which is relatively new to the voice clinician, to visualize the larynx during a broad sample of phonatory tasks. Patients with spasmodic dysphonia or tremor were excluded from the study.

Results In 26 cases of the 100 reviewed, our observations were consistent with those of the referring otolaryngologist. In 32 cases, we agreed with the referral diagnosis, but found additional factor(s) related to pathology. In 42 cases, our findings differed from those of the referring physician.

Conclusions Results support our contention that phonoscopic evaluation can be of value to both the otolaryngologist and speech‐language pathologist. It is particularly recommended in those patients whose dysphonia is unexplained following diagnostic laryngeal examination by the otolaryngologist, in cases in which voice use is a suspected factor in the pathology, and when voice therapy is a recommended treatment for a dysphonic patient.
Bilateral Lateral Rhinotomy Incisions for Medial Maxillectomies in the Management of Pediatric Invasive Fungal Sinusitis
Authors: Malhotra Pramit S. , Danahey Daniel , Sidman James
Published: November 2003

Objective To determine if simultaneous, bilateral lateral rhinotomies for medial maxillectomies would result in central skin or bone loss in pediatric patients with invasive fungal disease.

Study Design Retrospective chart review.

Setting Tertiary care children's hospital.

Patients Three children underwent surgery between April 1996 and June 1998. Ages at treatment ranged from 11 to 14 years. All had bilateral, biopsy‐proven invasive fungal disease of the lateral walls of the nose. All were undergoing chemotherapy for acute lymphocytic leukemia (ALL) or acute myelocytic leukemia (AML).

Intervention Bilateral lateral rhinotomies for medial maxillectomy. Two of 3 also had simultaneous total septectomy.

Main Outcome Measure Skin survival and patient survival.

Results All three patients had bilateral simultaneous medial maxillectomy for invasive fungal disease in the presence of profound pancytopenia secondary to treatment of leukemia. One patient had minor nasal edema postoperatively, but none showed any loss of the central nasal skin or facial skeleton. All patients survived the invasive fungal disease with follow‐up of at least 24 months. All patients underwent multiple debridements after the original surgery, and 3 of 6 eyes had permanent epiphora requiring dacryocystorhinostomies.

Conclusions Bilateral simultaneous lateral rhinotomies are safe in children and did not result in any central skin loss. Aggressive bilateral surgery for invasive fungal disease is compatible with a good esthetic outcome and long‐term survival.
Effects of Interferon‐α‐2b and Octreotide on Healing of Esophageal Corrosive Burns
Authors: Kaygusuz Įrfan , Çelįk Onur , Özkaya Özay , Yalçin Şinasi , Keleş Erol , Çetįnkaya Tufan
Published: November 2003

Objective The aim of this study was to investigate the effect of interferon‐α to 2b and octreotide on the treatment of esophagus corrosive burns.

Method The experimental study was performed on 63 rabbits. Burn was obtained by treating a segment, isolated in cervical esophagus, with NAOH. The rabbits were allocated into three groups (control, interferon, and octreotide). On the fourth, eighth, and 20th days, 7 rabbits randomly selected from each group were killed. Comparisons among the groups were made by taking histopathologic findings, stenosis index, and hydroxyproline production into consideration. Cross‐tabulation and analysis of variance tests were used for statistical analysis.

Results There were no statistically significant differences among the groups in terms of epithelial changes, extension of inflammation, and severity of fibrosis. In terms of severity of inflammation, there was a statistically significant difference between the control and the other two groups. Also, a significant difference was found between the control group and the other two groups in terms of extension of fibrosis on the 20th day. The difference between the control and the two treatment groups was significant on the eighth day and the 20th day measurements. Comparison of the hydroxyproline values showed a statistically significant difference between the octreotide group and the other two groups on the eighth and 20th days.

Conclusion Histopathologic and biochemical findings indicate that, by hindering fibrosis progress, octreotide (and interferon) might be new and promising alternatives in the treatment of corrosive burns of the esophagus.
Endoscopic Management of 108 Sinus Mucoceles
Authors: Har‐El Gady
Published: November 2003

Objectives/Background Traditional teaching has emphasized the need for complete removal of sinus mucoceles to achieve a cure. However, with the introduction of endoscopic sinus surgical instruments and techniques, there has been a trend toward transnasal endoscopic management of sinus mucoceles. The aim of this study is to establish the efficacy of endoscopic management of sinus mucoceles.

Study Design Retrospective review.

Patients and Methods Between 1988 and 2000, 103 patients with 108 paranasal sinus mucoceles were treated endoscopically. This series includes 66 frontal and frontoethmoid, 17 ethmoid, 7 sphenoethmoid, 12 sphenoid, and 6 maxillary mucoceles. Ninety patients (83.3%) had intraorbital extension and 85 of them presented with some degree of proptosis or eye displacement. Sixty patients (55.5%) had erosion of the skull base with varying degrees of intracranial extension of the mucocele. Follow‐ up ranged from 1 to 131/2 years with a median of 4.6 years.

Intervention All patients underwent endoscopic‐wide marsupialization of the mucocele cavity. Stents were used in frontal mucoceles only.

Results Recurrence of a frontal mucocele was seen in 1 patient (0.9%). In 5 patients, out of 23 patients who presented with massive pansinus polyposis in addition to the mucocele, recurrent polyposis required revision surgery. However, the mucoceles did not recur in those patients.

Conclusions There is increasing evidence in the literature that endoscopic management of sinus mucoceles results in long‐term control with recurrence rates at or close to 0%. Rhinologic surgeons should consider the endoscopic technique as the surgical treatment of choice.
Evaluation of Omeprazole in the Treatment of Reflux Laryngitis: A Prospective, Placebo‐Controlled, Randomized, Double‐Blind Study
Authors: Noordzij J. Pieter , Khidr Aliaa , Evans Brent A. , Desper Ellen , Mittal Ravinder K. , Reibel James F. , Levine Paul A.
Published: November 2003

Objectives Proton‐pump inhibitors are often recommended in the treatment of laryngitis secondary to gastric reflux. Despite prospective treatment studies reporting high efficacy, only one previous report has been placebo‐controlled and blinded. The objective of this study was to determine the efficacy of omeprazole in treating proven reflux laryngitis.

Study Design Prospective, placebo‐controlled, randomized, double‐blind clinical trial.

Methods Fifty‐three patients with one or more reflux laryngitis symptoms were recruited to undergo 24‐hour dual‐channel pH probe testing. Thirty patients with more than four episodes of laryngopharyngeal reflux were enrolled. By random assignment, 15 patients received 40 mg omeprazole twice a day and the other 15 received placebo for a period of 2 months. Symptoms (hoarseness, throat pain, lump in throat sensation, throat clearing, cough, excessive phlegm, dysphagia, odynophagia, and heartburn) and endoscopic laryngeal signs (erythema, edema, and mucus accumulation) were recorded initially, at 1 month, and 2 months.

Results In general, most symptom scores improved over time for both the omeprazole and placebo groups. Hoarseness, when patients begin with low hoarseness symptom scores, and throat clearing improved significantly more in patients on omeprazole than in those on placebo during the 2‐month study. Throat pain, lump in throat sensation, excessive phlegm, difficulty swallowing, pain with swallowing, and heartburn showed improvement in both treatment arms, signifying the possibility of a placebo effect. Endoscopic laryngeal signs did not change significantly over the course of the study for either treatment group.

Conclusions A placebo effect appears to exist in the treatment of reflux laryngitis. However, hoarseness, when initially scored low, and throat clearing resulting from reflux laryngitis are effectively treated by omeprazole.
A Cost–Benefit Analysis and Method of Creating High‐Quality Posters for a Low Cost
Authors: Karamzadeh Amir M. , Wong Brian J. F. , Crumley Roger L.
Published: November 2003

Objective To introduce the results of a cost–benefit analysis comparing an office‐based low‐cost technique for producing research posters versus conventional methods.

Study Design Cost–benefit analysis.

Methods The average cost for manufacturing a 4′ × 6′ poster using university‐based and commercial reprographic centers (from 10 different institutions and cities) was determined through a phone survey. The total number of posters (1248) presented at the American Academy of Otolaryngology–Head and Neck Surgery Annual Meeting from 1995 through 1999 was used to calculate and subsequently compare the total cost of generating posters using conventional versus our low‐cost method. A detailed description of this technique (low‐cost) is also offered.

Results The total printing costs for this meeting using the commercial or university‐based services was $294,000 and $268,000 versus approximately $11,000 with our method. Esthetically, our technique is satisfactory and difficult to distinguish from standard methods from the typical poster‐viewing distance.

Conclusions Given the current medical economic environment, the cost disparity between conventional and “low‐cost” poster production, the esthetic acceptability of both, and the relative (compared with oral presentations) lack of scientific impact, we propose that the present technique is an extremely pragmatic option for poster production.
The Intracranial Complications of Rhinosinusitis: Can They Be Prevented?
Authors: Jones N. S. , Walker J. L. , Bassi S. , Jones T. , Punt J.
Published: November 2003

Objectives/Hypothesis Reference textbooks on the intracranial complications of rhinosinusitis imply that many of the intracranial complications of rhinosinusitis can be prevented. We sought to examine whether or not this is true.

Study Design A retrospective case series.

Methods The study included 47 consecutive patients presenting with intracranial complications secondary to rhinosinusitis between 1992 to 1999 with a mean follow‐up of 5 years and 1 month.

Results The most common presenting symptoms of intracranial involvement were an altered mental state, headache, fever, seizure, vomiting, a unilateral weakness or hemiparesis, or a cranial nerve sign. These justify an urgent magnetic resonance imaging or computed tomography scan. The importance of imaging before a lumbar puncture cannot be overemphasized. Of particular note was the finding that 21 patients (45%) presented with a periorbital cellulitis or frontal swelling. Therefore, it does not follow that because a collection of pus presents anteriorly it precludes any intracranial involvement. More than half of our patients (55%) had visited their primary care physician with an upper respiratory tract infection and had been treated appropriately. Once any central symptoms or signs developed, there was little evidence of any significant delay in referral to our unit. Only six patients had a history of nasal disease, three having had recent sinus surgery and three having had nasal polyps. Nine patients had significant long‐term morbidity, seven patients had epilepsy, one patient had dysphasia, and one patient had right arm weakness. The single death in our series was associated with a cavernous sinus thrombosis.

Conclusions The report emphasizes the need for surgeons to be alert to the diagnosis, particularly in patients with a periorbital abscess or frontal swelling. Sinus surgery has a role in obtaining pus for culture, as well as draining the sinus if it is in continuity with an intracranial collection. Intracranial infections secondary to rhinosinusitis occur sporadically and, although it appears that this cannot be prevented, early recognition and treatment are essential to reduce any subsequent morbidity or mortality.
Powered Endoscopic Dacryocystorhinostomy
Authors: Wormald Peter John
Published: November 2003

Objectives To describe powered endoscopic dacryocystorhinostomy (DCR) with full sac exposure and primary mucosal anastomosis and report perioperative and follow‐up results achieved with this procedure.

Study Design Prospective, nonrandomized cohort study.

Methods Operative and postoperative data were prospectively collected on 36 unselected patients (15 men and 21women; mean age, 62.4 y; range 14–91 y) who presented to a lacrimal clinic with epiphora and obstruction of the drainage of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. A total of 47 procedures were performed; all were done by the same surgeon, who used a standardized surgical technique. Follow‐up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit.

Results The only surgical complication was one case of orbital fat exposure. Forty‐five of the 47 DCRs were patent after a mean follow‐up of 11 months (standard deviation = 5 mo), yielding a success rate of 95.7%. Patency was assessed by endoscopic visualization of the ostium and fluorescein (initially placed on the conjunctiva) in the ostium. One of the 47 DCRs was a failure and one patient had O'Donaghue tubes in place with symptoms. Two patients with a patent ostium and positive results on fluorescein testing continued to have some symptoms.

Conclusion Powered endoscopic DCR with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR.
Botulinum Toxin to Reduce Saliva Flow: Selected Indications for Ultrasound‐Guided Toxin Application Into Salivary Glands
Authors: Ellies Maik , Laskawi Rainer , Rohrbach‐Volland Saskia , Arglebe Christian , Beuche Wolfgang
Published: November 2003

Objectives/Hypothesis The study investigates the effect of local injections of botulinum toxin type A (Botox) into the major salivary glands of the head in various states of hypersalivation. In particular, we studied pathological states with permanent as well as passing hypersalivation disorders and present new indications for local application of botulinum toxin to the salivary glands.

Study Design Retrospective clinical investigation.

Methods A total of 55 to 65 units of Botox were injected under sonographic control into the left and right parotid and submandibular glands of four patients with hypersalivation resulting from head and neck carcinoma, tracheostomy, and “idiopathic” hypersalivation disorder. At defined time intervals following injection, flow rate, total protein and immunoglobulin A content, and the enzymatic activities of amylase, acid phosphatase, and kallikrein were determined in the saliva. The patients were clinically examined to assess the severity of their symptoms, including sonographic control of the major salivary glands.

Results All four patients reported distinct improvement of their symptoms within 1 week after injection. Salivary flow rate had considerably dropped, whereas the concentrations of the salivary components were much increased. Sonography did not reveal any changes of the salivary gland parenchyma. Therapeutic side effects were absent.

Conclusions Treatment of hypersalivation by local injections of Botox into the salivary glands of the head is a reliable and efficient therapy without side effects for certain otolaryngological diseases, especially if injections are performed under sonographic control. Extension of this therapeutic concept to other indications is suggested.
Evaluation of Paragangliomas Presenting as a Cervical Mass on Color‐Coded Doppler Sonography
Authors: Stoeckli Sandro J. , Schuknecht Bernhard , Alkadhi Hatem , Fisch Ugo
Published: November 2003

Objectives To assess the potential of color Doppler sonography to identify cervical mass lesions as paragangliomas.

Study Design Prospective evaluation.

Methods Fifteen patients with 18 paragangliomas (13 carotid body tumors, 3 vagal and 2 temporal) presenting as a mass in the neck were investigated using color Doppler sonography.

Results All paragangliomas presented in B‐mode sonography as solid, well‐defined, and hypoechoic tumors. Color Doppler imaging revealed hypervascularity in 15 (82%) tumors. No flow signal was detected in 3 carotid body tumors at standard velocity encoding (30 cm/s). Only carotid body tumors could be assessed in their full extent. Temporal and vagal paragangliomas were only partially visible. Carotid body tumors showed a splaying of the carotid bifurcation with displacement of the external carotid anteriorly and both the internal carotid and the internal jugular vein posteriorly. Anterior displacement of both carotid arteries and posterior displacement of the internal jugular vein was found in the 3 vagal paragangliomas. The caudal tumor extension of the 2 temporal paragangliomas was recognized within the expanded lumen of the internal jugular vein. According to the direction of tumor growth and vascular supply, the intratumoral flow signal was predominantly directed upward in carotid body tumors and downward in vagal and temporal paragangliomas.

Conclusions Based on the appearance in the B‐mode, the hypervascularity, the relationship toward the carotid arteries and the internal jugular vein, and the intratumoral flow direction, color Doppler sonography was able to establish the diagnosis and type of a paraganglioma.
The Incidence and Distribution of Cupular Deposits in the Pediatric Vestibular Labyrinth
Authors: Bachor Edgar , Wright Charles G. , Karmody Collin S.
Published: November 2003

Objectives Deposits of basophilic material on the cupulae of the semicircular ducts have been described in adult human temporal bones, and such deposits have been implicated in the clinical phenomenon of benign paroxysmal positional vertigo (BPPV). Although relatively rare, BPPV has been reported to occur in children. The goal of this study was to evaluate the occurrence of cupular deposits in pediatric material.

Study Design Basic science, two‐center histopathologic temporal bone study.

Methods We examined 186 temporal bones from 121 individuals between the ages of newborn and 10 years. The average age was 14.7 months. All temporal bones were acquired at autopsy, embedded in celloidin, and sectioned for light microscopic study. The cupulae of the semicircular ducts were identified and any deposits found were graded according to their size and position on the cupula.

Results A total of 276 cupulae were identified, and in 35 (12.7%) of these a basophilic deposit was found. In many cases the deposits contained recognizable otoconial crystals. Most deposits were small and they were almost equally distributed between the three semicircular ducts. However, the lateral and posterior cupulae were somewhat more involved than the superior cupula. Our data showed that cupular deposits are less frequently found in the pediatric labyrinth, compared with adults as reported in previous studies.

Conclusions The lower occurrence in children versus adults suggests that the deposits may be a phenomenon of the aging vestibular labyrinth.
Distance From Acoustic Neuroma to Fundus and a Postoperative Facial Palsy
Authors: Kobayashi Mari , Tsunoda Atsunobu , Komatsuzaki Atsushi , Yamada Ichiro
Published: November 2003

Objective/Hypothesis Generally, patients with small acoustic neuroma have less facial palsy after its removal. The middle cranial fossa approach is mainly applied to the small acoustic neuroma and tumor size does not influence the prognosis of facial palsy. The internal auditory canal cannot be fully opened in the middle cranial fossa approach, and the facial nerve is tightly attached in the fundus. According to these anatomical factors, we hypothesized that acoustic neuromas located away from the fundus might be removed with less facial nerve damage. We investigated the distance between the acoustic neuroma and fundus and its clinical relationship.

Study Design Retrospective study of 45 patients with acoustic neuroma who underwent a middle cranial fossa approach.

Methods The distance between the acoustic neuroma and fundus and the tumor diameter were measured on T2‐weighted and contrast‐enhanced magnetic resonance images, respectively. These data were compared with the postoperative facial nerve function.

Results The mean distance was 3.0 ± 1.8 mm (range, 0–10 mm), and the mean diameter was 11.3 ± 3.7 mm (means ± standard deviation; range, 4–20 mm). Neither the distance nor the diameter had any correlation to the degrees of postoperative facial palsy either immediately or at 3 months after surgery.

Conclusions As far as the nerve was anatomically preserved, postoperative facial nerve function seemed to be influenced by factors other than surgical manipulation among small acoustic neuromas. Although the tumor fills in the fundus, it may not influence postoperative facial nerve function and also may not interfere with indication of the middle cranial fossa approach for removal of the acoustic neuroma.
Neonatal Hearing Loss in the Indigent
Authors: Oghalai John S. , Chen Lei , Brennan Megan L. , Tonini Ross , Manolidis Spiros
Published: November 2003

Objective To compare the risk factor profile for neonatal hearing loss (HL), and the follow‐up rate of those identified with HL in an indigent population with those in an insured population.

Study Design Retrospective review.

Methods We studied 4526 neonates from the high‐risk nursery or neonatal intensive care unit from two adjacent hospitals in Houston, Texas. Ben Taub General Hospital (BTGH) is a county public hospital that serves mainly the indigent. Texas Children's Hospital (TCH) is a private tertiary care center that serves patients with private insurance and Medicaid.

Results Overall, 133 infants failed the screening test. Follow‐up diagnostic testing identified 48 patients with definite HL. Although nearly twice as many patients at BTGH failed screening compared with TCH (88 vs. 45), four times as many patients at BTGH did not return for diagnostic testing (43 vs. 10). When a hearing aid was needed, there was a delay in getting one at BTGH (P <.05). There was a higher prevalence of dysmorphic facial features and central nervous system disease and a lower prevalence of long‐term ventilatory support at BTGH (P <.05). There were no differences between BTGH and TCH in the prevalence of low birth weight, neonatal asphyxia, syndromic stigmata, neonatal infection, family history of HL, or neonatal transfusion (P >.1).

Conclusions Significant differences in the risk factor profile for neonatal HL exist between the indigent and the general population. A worrisome problem exists with the timely intervention in hearing‐impaired indigent neonates.