bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Middle Ear Cholesteatomas in Children: Our Experience in 34 Cases
Authors: Darrouzet Vincent , Duclos Jean‐Yves , Portmann Didier , Bebear Jean‐Pierre
Published: February 2003

OBJECTIVES

To evaluate clinical data, extensions, residual disease rate, and functional results in cases of congenital cholesteatoma in pediatric patients compared with cases of acquired forms.

STUDY DESIGN AND SETTING

In a retrospective study conducted at a single tertiary care center over a decade, 34 congenital cholesteatomas (mean patient age, 6.6 years) isolated from a series of 215 cholesteatomas in children were treated surgically and followed up for an average of 83 months. Surgical treatment consisted of the closed technique (CT), open technique tympanoplasty in CT [TOT], radical mastoidectomy (RM), or Rambo's technique. The main outcome measures were surgical findings, residual lesion rate, and hearing assessment.

RESULTS

The first surgical procedure was CT in 85.3%, TOT in 8.8%, RM in 2.9%, and Rambo's technique in 2.9% of patients. Two, 3, and 4 operations were necessary in 76.5%, 11.4%, and 11.4% of children, respectively. Residual lesions were observed in 34.6% of those multi‐operated patients (7 CT and 2 TOT), 24.1% in those treated with CT, and 29.2% in those treated with CT with a planned second look. Mean postoperative pure tone average and air‐bone gap were 26 and 21 dB, respectively. A speech reception threshold of less than 30 dB HL was achieved in 66% of patients. A total of 26 ossiculoplasties had to be performed (8 partial and 18 total); the mean postoperative air‐bone gap was lower after the former (15 dB) than after the latter (22 dB). A high‐frequency pure‐tone hearing loss of more than 10 dB was uncommon (5.8%). Unsurprisingly, the residual lesion rate seems to be higher for congenital than for acquired cholesteatomas, but hearing results are significantly better.

CONCLUSION

In most cases, staged CT appears to be the best technique to treat these lesions, which often develop in a well‐pneumatized mastoid.
Outcome Predictors for Endoscopic Sinus Surgery
Authors: Wang Pa‐Chun , Chu Chia‐Chen , Liang Shu‐Cheng , Tai Chih‐Jaan
Published: February 2003

OBJECTIVE

The outcomes management of endoscopic sinus surgery (ESS) is a major effort to improve the quality of chronic sinusitis treatment. The objective of this study was to investigate the factors that may predict a variety of outcomes of ESS.

STUDY DESIGN AND SETTING

Two hundred and thirty consecutive patients who underwent ESS were prospectively evaluated by computerized axial tomography scan of the sinus and a validated chronic sinusitis survey (CSS) before surgery. The effects of prognostic factors were then investigated.

RESULTS

Extent of disease was a consistent predictor (P < 0.05) for bleeding, complication occurrence, medical resource utilization, subjective sinus‐specific health status, and physicians' objective evaluation of surgical outcomes. The preoperative CSS total score and extent of disease significantly (P < 0.05) predicted the postoperative CSS total score. Subjective and objective outcomes were significantly correlated (r = 0.58, P = 0.0001). These findings suggested the necessity of disease severity stratification when reporting ESS outcomes.

CONCLUSION

Operation‐related events, medical resource utilization, physician evaluation, and sinus‐specific health status of patients are all integral parts of reporting outcomes of ESS. We have concluded that computerized axial tomography scan of the sinuses and CSS are efficient ways of providing reliable baseline information before ESS.
Tuberculous and Nontuberculous Cervical Lymphadenitis: A Clinical Review
Authors: Chao Siew Shuen , Loh Kwok Seng , Tan Kun Kiang , Chong Siew Meng
Published: February 2003

OBJECTIVES

The aim of the present study was to identify differences in clinical characteristics between patients with tuberculous cervical lymphadenitis and those with nontuberculous cervical lymphadenitis and to determine the diagnostic accuracy of fine needle aspiration (FNA) cytology.

STUDY DESIGN AND SETTING

Seventy‐two patients with inflammatory cervical lymphadenitis were studied retrospectively. They were divided into 2 groups: group 1 consisted of those with tuberculous lymphadenitis and group 2 consisted of those with non‐tuberculous lymphadenitis. The demographic characteristics, clinical parameters, and hematological and cytological results of the 2 groups were compared.

RESULTS

Other than there being a significantly higher proportion of foreign‐born patients in group 1, there were no differences in clinical characteristics between the 2 groups. The sensitivity and specificity of FNA cytology in the diagnosis of tuberculous lymphadenitis were 88% and 96%, respectively.

CONCLUSION

It is difficult to clinically differentiate tuberculous from nontuberculous lymphadenitis. FNA cytology is useful in the diagnosis of tuberculous lymphadenitis.

SIGNIFICANCE

In regions where tuberculosis is endemic, treatment can be instituted without the need for excisional biopsy if the FNA results show characteristic caseating granuloma.
Aspirin‐Sensitive versus Non‐Aspirin‐Sensitive Nasal Polyp Patients: Analysis of Leukotrienes/fas and Fas‐Ligand Expression
Authors: Ziroli Nancy E. , Na Hanjo , Chow James M. , Stankiewicz James A. , Samter Max , Young M. Rita I.
Published: February 2003

OBJECTIVE

The goal of the present study was to identify levels of leukotrienes released by leukocytes and nasal polyps from aspirin‐sensitive patients (ASPs) and non‐aspirin‐sensitive patients (NASPs) after exposure to various concentrations of aspirin. Eosinophil expressions of apoptosis regulators were also compared.

STUDY DESIGN AND SETTING

Leukotriene release from nasal polyps and leukocytes of ASPs and NASPs was measured after exposure to differing concentrations of aspirin. Eosinophils were analyzed for Fas and Fas ligand receptors using flow cytometry.

RESULTS

NASPs showed increased leukotriene release from nasal polyps on increased aspirin exposure. Polyps from ASPs did not show any change. ASPs showed greater leukotriene release from blood on increasing aspirin exposure compared with NASPs. Flow cytometric analysis showed eosinophils in the peripheral blood of ASPs have decreased Fas expression compared with those of NASPs.

CONCLUSIONS

This study showed differences in leukotriene release and eosinophil apoptosis between ASPs and NASPs.
Management of Sphenoid Sinus Cerebrospinal Fluid Rhinorrhea: Making Use of an Extended Approach to the Sphenoid Sinus
Authors: Mehendale Neelesh H. , Marple Bradley F. , Nussenbaum Brian
Published: February 2003

OBJECTIVES

Specific information addressing the management of cerebrospinal fluid (CSF) fistulas that originate from within the sphenoid sinus remains scant. The objective of this study was to review the cause and management of CSF rhinorrhea arising from the sphenoid sinus.

STUDY DESIGN AND SETTING

This is a retrospective chart review of 12 cases of CSF rhinorrhea arising from the sphenoid sinus that occurred in 11 patients. All patients were treated at a single institution between 1994 and 1999.

RESULTS

All patients were managed surgically with sphenoid sinus fat obliteration using an endoscopic sublabial, transseptal approach. This approach was successful for all 12 cases, with median duration of follow‐up of 18 months.

CONCLUSIONS

Endoscopically assisted transseptal repair of CSF fistulas that originate within the sphenoid sinus offers an alternate approach to previously described methods of repair in this region. Advantages include wide access to the entire sphenoid sinus, improved access to laterally pneumatized regions within the sphenoid sinus, and rostral mucosal closure over the repair within the sinus.
Lung Volume Dependence of Pharyngeal Cross‐Sectional Area by Acoustic Pharyngometry
Authors: Kamal Ibrahim
Published: February 2003

Pharyngeal size and the dynamic behavior of the pharynx may be important factors in the modulation of pharyngeal airflow. There are two measures of pharyngeal function: changes in pharyngeal area with lung volume and changes in pharyngeal area in response to externally applied positive pressure. Both measurements have been used for the assessment of pharyngeal function, and both reflect pharyngeal “floppiness.” The aim of the present study was to examine the relationship between pharyngeal cross‐sectional area, using acoustic reflection technique, and different lung volumes (tidal volume, inspiratory reserve volume, and expiratory reserve volume), to determine whether there are differences in mechanical properties of the pharynx of normal volunteers in response to changes in intrapharyngeal pressure. The acoustic technique was used to assess the pharyngeal cross‐sectional area of 40 healthy volunteers (29 men and 11 women) at tidal volume, inspiratory reserve volume, and expiratory reserve volume. In men, the mean pharyngeal area at tidal volume was 3.191 cm2, the mean pharyngeal area at inspiratory reserve volume was 2.976 cm2, and the mean pharyngeal area at expiratory reserve volume was 2.975 cm2. In women, the corresponding pharyngeal area measurements were 2.832, 2.484, and 2.492 cm2. statistical analysis of results showed that men have a larger pharyngeal cross‐sectional area and the pharyngeal airways of men and women act in a similar manner in response to changes in intrapharyngeal pressure, with men having a greater change. Examination of the pharyngeal compliance by acoustic pharyngometry adds to the potential of this technique as a tool for the evaluation of the pharyngeal airway in terms of area and dynamic behavior assessment. This may be of relevance in promotion of the development of upper airway assessment in patients with obstructive sleep apnea.
The Otologic Consequences of the Omagh Bomb Disaster
Authors: Miller Ian S. M. , McGahey David , Law Kathleen
Published: February 2003

OBJECTIVES

The goal of the study was to compare the spontaneous healing rate for traumatic perforation of the tympanic membrane sustained in the Omagh bomb disaster with that of previous reports in the literature.

DESIGN AND SETTING

A retrospective study was conducted at Tyrone County Hospital, Northern Ireland, 2 years after the incident.

PARTICIPANTS

One hundred thirty‐eight patients who sustained otologic injuries from the bomb blast were included in the study.

RESULTS

Only 47 of the 124 perforations healed spontaneously. The previously reported spontaneous healing rate for traumatic perforations of the tympanic membrane is 80% to 90%; in our study, the healing rate was unexpectedly low at 38%.

CONCLUSION

The massive explosion in a narrow street with hundreds of persons in close proximity to the bomb may account for the poor healing rate.
The Effects of an External Nasal Dilator and Nasal Dimensions in Asians
Authors: Ochi Kentaro , Ohashi Toru
Published: February 2003

OBJECTIVES

We examined the potential correlation between the effectiveness of an external nasal dilator for Asians and nasal dimensions.

STUDY DESIGN AND SETTINGS

The length, width, and height of the subjects' nose were measured. From these parameters, a nasal index (nasal width/nasal length) and a basal view index (columella height/nasal width) were calculated. Nasal airway resistances with and without an external nasal dilator were measured.

RESULTS

There was a significant correlation between both nasal index and basal view index and the changes in nasal resistance that resulted from wearing an external nasal dilator, whereas no significant correlation was detected between each of the 3 nasal dimensions and changes in nasal resistance.

CONCLUSIONS

Noses with a smaller nasal index or a larger basal view index receive greater benefits from the wearing of an external nasal dilator. The effects of external nasal dilators are influenced by nasal shape rather than by individual nasal dimensions in Asians.
Reassessment of CD62L as a Marker of Pre‐Effector T Cells in the Tumor Draining Lymph Nodes of Head and Neck Cancer Patients
Authors: Strome Scott E. , Martin Elizabeth , Flies Dallas , Khurana Dianne , Salomao Diva , Tamada Koji , Chapoval Andrei I. , Kasperbauer Jan L. , Olsen Kerry D. , Chen Lieping
Published: February 2003

OBJECTIVES

CD62L was evaluated as a determinant of human pre‐effector T cells.

STUDY DESIGN AND SETTING

Phenotype and cytokine secretion profiles of CD62L cells were determined based on activation status.

RESULTS

CD62LLow T cells demonstrated significantly higher secretion of interleukin (IL)‐10 and interferon (IFN)‐Γ than did CD62LHigh T cells. After activation, the majority of cells expressed high levels of the CD62L surface marker. Postactivation levels of IL‐10 production remained elevated or unchanged. In a murine B16 melanoma model, freshly isolated CD62LLow tumor draining lymph nodes (TDLN) T cells showed increased secretion of IL‐2 and IL‐4 but not of IL‐10 or IFN‐γ. The surface expression of CD62L and cytokine secretion patterns were maintained after activation with concomitant increases in IL‐10.

CONCLUSION

Our results provide evidence that CD62LLow T cells in TDLNs of progressively growing squamous cell carcinoma of the head and neck differ phenotypically and functionally from those of mouse origin.

SIGNIFICANCE

Characterization of this human CD62LLow T cell population provides initial insight regarding novel surface markers in TDLN T cells that might correlate with antitumor reactivity.
The Temporal Course of Adenovirus‐Mediated Gene Transfer in the Rat Larynx
Authors: Ian N. Jacobs , Ralph P. Tufano , Danielle S. Walsh , Timothy Crombleholme
Published: February 2003

OBJECTIVE

Polypeptide growth factors have important influences on wound‐healing and scar tissue formation. Specific growth factors or their inhibitors may potentially decrease scar tissue formation and prevent subglottic stenosis. Gene transfer using recombinant adenovirus may be an ideal method to mediate endogenous production of growth factors to inhibit fibrosis.

STUDY DESIGN

The study incorporated adenovirus‐mediated transduction of normal and stenotic rat larynges and histologic analysis of the sequential expression of a β‐galactosidase marker gene over time.

SETTING

The study was conducted at the animal care facility of an academic children's hospital.

RESULTS

We report successful transduction in normal and injured rat larynx with peak expression of β‐galactosidase at 2 days after transduction and almost complete disappearance by 7 days. There appeared to be an early inflammatory response to the viral injection, but at 7 and 14 days after injection (transduction) the uninjured rat larynges resumed a normal histologic appearance. All distant sites stained negative for β‐galactosidase.

CONCLUSION

Recombinant adenovirus‐mediated gene transfer is feasible in the rat larynx with transient duration and limited toxicity.

SIGNIFICANCE

Adenovirus‐mediated gene transfer has the potential to deliver growth factors that modulate wound healing and inflammation in the larynx by inhibiting fibrosis.
Final Validation of the Pediatric Tracheotomy Health Status Instrument (PTHSI)
Authors: Hartnick Christopher J. , Giambra Barbara K. , Bissell Cynthia , Fitton Cynthia M. , Cotton Robin T. , Parsons Susan K.
Published: February 2003

OBJECTIVE

We sought to describe the development and final testing of an instrument designed to evaluate the impact of tracheotomy on the health‐related quality of life of affected families in whom a child has had a tracheotomy (the Pediatric Tracheotomy Health Status Instrument [PTHSI]).

STUDY DESIGN

This cross‐sectional study designed to analyze a disease‐specific health status instrument to establish validity and reliability.

RESULTS

The PTHSI was initially pilot tested in 130 families during a 3‐month period from September through November 2000. After initial analysis and revision, from January 2001 through July 2001, 154 different families completed the revised instrument. The overall Cronbach's α coefficient for the instrument was 0.91, with domain‐specific coefficients ranging from 0.66 for physical symptoms to 0.87 for caregiver stress and coping. Specific criterion validity analysis produced a Pearson correlation coefficient of 0.8 (P < 0.0001). Construct validity testing via Wilcoxon matched sum testing suggested statistically significant differences between subpopulations (P < 0.001).

CONCLUSION

After initial testing and revision of the PTHSI, final instrument administration and analysis reveal the instrument to be valid and reliable. Future studies are planned to evaluate its responsiveness in longitudinal application.
Does Dexamethasone with Preemptive Analgesia Improve Pediatric Tonsillectomy Pain?
Authors: Giannoni Carla , White Sno , Enneking F. Kayser
Published: February 2003

OBJECTIVE

The study goal was to determine whether the combination of dexamethasone with preemptive analgesia has an additive effect in further improving recovery.

STUDY DESIGN

We conducted a prospective, randomized, double‐blinded trial of 50 children undergoing tonsillectomy at a university ambulatory surgery center. One study group received 1 intravenous dose of dexamethasone, and another group received 1 dose of saline solution. All patients received tonsillar fossa injections of ropivacaine plus clonidine before tonsil excision.

RESULTS

The 2 study groups were similar in main outcome measurements. Pain intensity and quality of life were not statistically different between the groups. There was a small trend to less trismus and less cumulative codeine use in the steroid group. Overall, there was a very low incidence of nausea and vomiting in both groups, which may have been due to the preemptive analgesia.

CONCLUSION

Dexamethasone does not significantly improve the morbidity of pediatric tonsillectomy when preemptive analgesia with ropivacaine and clonidine is used concurrently.
Speech Recognition in Background Noise of Cochlear Implant Patients
Authors: Fetterman Bruce L. , Domico Elizabeth H.
Published: February 2003

OBJECTIVES

The performances of adult patients using Spectral peak (Nucleus 22 or Nucleus 24 patients) or Continuous Interleaved Sampling or Advanced Combination Encoder (Clarion patients) were evaluated in their ability to perform in quiet and in 2 levels of background noise.

PATIENTS AND METHODS

Ninety‐six patients were tested with the City University of New York Sentences presented at 70 dB in quiet and at signal‐to‐noise ratios (SNR) of +10 and +5 dB. Patients were scored on the number of words perceived correctly.

RESULTS

Scores were different at each condition (P < 0.05): 88% words correct in quiet, 73% correct at an SNR of +10 dB, and 47% correct at an SNR of +5 dB. Linear regression analysis found no significant correlation between test score and age at implantation or time using the implant. A weak negative correlation was found between years of hearing loss and score.

CONCLUSION

Competing noise interferes with comprehension of connected speech for most cochlear implant patients.
Microsatellite Analyses of Loci at 7q31.3‐q36 Reveal a Minimum of Two Common Regions of Deletion in Nasopharyngeal Carcinoma
Authors: Tan Guolin , Xiao Jianyun , Tian Yongqian , Dong Longnwen , Jiang Nin , Zhan Fenfang , Li Guiyuan
Published: February 2003

OBJECTIVE

Our goal was to better define the extent and specificity of deletion in the 7q32‐qter chromosomal region in nasopharyngeal carcinoma (NPC).

DESIGN AND SETTING

Polymerase chain reaction‐based deletion analysis was performed on DNA samples from 24 paired NPCs and corresponding germlines using 13 microsatellite markers mapped to chromosome subbands 7q31.3‐q36.

RESULTS

Loss of heterozygosity of at least 1 marker in this interval was found in 18 (75%) of 24 tumor specimens. Particularly frequent allelic losses were identified at 5 loci: D7S495 (46%), D7S509 (42%), D7S500 (45%), D7S631 (30%), and D7S514 (35%). Two shortest regions of overlap could be identified in this interval, although the most common shortest region of overlap appeared to lie around D7S500 between but not including D7S631 and D7S495, on chromosome subband 7q32.

CONCLUSION

These results suggest that at least 2 putative tumor suppressor genes important in the pathogenesis of NPC are present in the examined interval, an interval that has also been found to harbor deletions in breast and prostate carcinomas.
Expression of the Proto‐Oncogene eIF4E in Inflammation of the Oral Cavity
Authors: Chandy Binoy , Abreo Fleurette , Nassar Raja , Stucker Fred J. , Nathan Cherie‐Ann
Published: February 2003

OBJECTIVE

eIF4E (4E) is elevated in 100% of head and neck squamous cell carcinoma (HNSCC) and in premalignant lesions of the larynx. However, it is not elevated in normal mucosa. In this study, we hypothesize that 4E is not significantly elevated in inflammation unlike its expression in premalignant lesions of the oral cavity.

STUDY DESIGN

Biopsies from the oral cavity were divided into 5 groups: (1) normal mucosa, (2) chronic inflammation, (3) mild dysplasia from leukoplakic lesions, (4) mild dysplasia in surgical margins of patients with HNSCC, and (5) HNSCC. Immunohistochemical qualitative analysis was then performed.

RESULTS

None of the 15 specimens in group 1 and 100% of the 15 specimens in group 5 expressed 4E. Of the 29 specimens in group 2 only 4/29 (13%) overexpressed 4E compared with 10/31 (32%) in group 3 and 9/21 (42%) in group 4. There was a significant difference between groups 2 and 3 and groups 2 and 4 (P < 0.0001 and P < 0.003 respectively) but no significant difference between groups 1 and 2 (P = 0.13) and between groups 3 and 4 (P = 0.30).

CONCLUSION

4E is not significantly elevated in inflammation of the oral cavity thus fulfilling one of the criteria that biomarkers require to be useful in a clinical setting.
Middle meatal vs antral lavage cultures in intensive care unit patients
Authors: Kountakis Stilianos E. , Skoulas Ioannis G.
Published: February 2003

OBJECTIVE

The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis.

METHODS

Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center.

RESULTS

Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, χ2‐1.52, P = 0.218).

CONCLUSION

Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.
Management of common voice problems: Committee report
Authors: Zeitels Steven M. , Casiano Roy R. , Gardner Glendon M. , Hogikyan Norman D. , Koufman James A. , Rosen Clark A.
Published: February 2003

OBJECTIVE

This report provides the reader with a state‐of‐the‐art update on a number of common voice problems that require phonosurgical intervention.

STUDY DESIGN AND SETTING

This multiauthor review is not a position statement of the American Academy of Otolaryngology–Head and Neck Surgery (AAOHNS) and may reflect institutional preference and/or bias. It arose from a panel discussion at the AAOHNS meeting in 2000.

RESULTS

We provide a review of the genesis and management of papillomatosis, dysplastic glottal epithelium, arytenoid granulomas, Reinke's edema, and vocal‐fold paralysis.

CONCLUSIONS AND SIGNIFICANCE

In the past decade, there has been a dramatic expansion of knowledge regarding a variety of voice disorders and associated treatment. There has been a convergence of basic science investigations in anatomy, physiology, and pathology with clinical trials of treatment, both surgical and nonsurgical. This information should provide the reader with current insight into critical management issues of the aforementioned disorders.
Inhibition of matrix metalloproteinases in gerbil cholesteatoma: Preliminary findings
Authors: Lehman David A. , Wilmoth Jason G. , Prevatt Angela R. , Schultz Gregory S. , Antonelli Patrick J.
Published: February 2003

OBJECTIVES

This study was conducted to examine the role of matrix metalloproteinases (MMPs) and the impact of a topical MMP inhibitor, ilomostat, on the development of tympanic membrane (TM) atelectasis in the gerbil model.

METHODS

Eustachian tubes were cauterized bilaterally in 19 gerbils. Thereafter, both TMs received once‐daily topical treatment for 8 weeks with ilo‐mostat or vehicle or no treatment (n = 6 or 7 per group). TM atelectasis was serially graded, and TMs were harvested at 8 weeks. Gelatin zymograms were performed to determine MMP activity.

RESULTS

The mean activity levels of proenzyme and active MMP‐9 and MMP‐2 and degree of atelectasis did not differ between groups. TM atelectasis did not correlate to levels of enzymes across individual samples.

CONCLUSIONS

Topical application of an MMP inhibitor did not significantly prevent the development of TM atelectasis. It remains to be determined whether the use of MMP inhibitors may prevent the progression of atelectasis in humans.
Role of the tongue base suspension suture with The Repose System bone screw in the multilevel surgical management of obstructive sleep apnea
Authors: Miller Frank R. , Watson Daniel , Malis David
Published: February 2003

OBJECTIVE

The Repose System (tongue base suspension) is a new, minimally invasive technique for tongue base suspension in the treatment of obstructive sleep apnea. The purpose of this project was to describe our preliminary experience using this tongue base suspension system in conjunction with uvulopalatopharyngoplasty (UPPP) in the multilevel surgical approach to the management of obstructive sleep apnea (OSA).

STUDY DESIGN

We conducted a retrospective analysis of 19 consecutive patients undergoing UPPP and The Repose System tongue base suspension for the management of obstructive sleep apnea during a 1‐year period (1998 through 1999).

RESULTS

Fifteen patients (11 men and 4 women) had complete preoperative and postoperative polysomnographic data. A 46% reduction in the preoperative respiratory disturbance index (RDI) (38.7 ± 12.3) versus the postoperative RDI (21.0 ± 7.4, P < 0.05) was demonstrated at a mean of 3.8 months after surgery. The apnea index demonstrated a 39% reduction. The surgical cure rate was 20% (3 of 15 patients).

CONCLUSIONS

The Repose System in conjunction with UPPP has been shown to produce significant reductions in the RDI and apnea index as well as a significant increase in O2 saturation. Despite the improvement in these objective parameters, the overall surgical cure rate was only 20% (3 of 15 patients) in this retrospective series. Further research is warranted to define the role of The Repose System in the management of obstructive sleep apnea patients with multilevel airway obstruction.
Management and outcome of early glottic carcinoma
Authors: Smith Jonathan C. , Johnson Jonas T. , Myers Eugene N.
Published: February 2003

OBJECTIVE AND STUDY DESIGN

We designed a retrospective study to analyze treatment methods and outcomes for patients with lesions ranging from carcinoma in situ to invasive T1 glottic squamous cell carcinoma. Patients with nonsquamous cell carcinoma, verrucous variant of squamous cell carcinoma, anterior commissure involvement, and T2 lesions were excluded.

SETTING

University of Pittsburgh School of Medicine, a tertiary referral center.

RESULTS

Fifty‐four patients met the inclusion criteria. Mean follow‐up was 49 months (range 24 to 96 months). Forty‐eight of 54 (89%) were treated with endoscopic excision. Forty of these 48 patients (83%) were successfully treated with endoscopic excision(s) as the only treatment modality. Four patients had persistence of disease despite multiple endoscopic excisions. Two of these patients underwent hemilaryngectomy, 1 received radiation treatment, and 1 received radiation therapy followed by a hemilaryngectomy. Four patients had recurrence of disease. Two patients with recurrence required radiation therapy and 2 patients required a total laryngectomy. With the selective application of multiple endoscopic excisions, radiation therapy, and more invasive operation, 100% of patients are without evidence of disease with a laryngeal preservation rate of 96%.

CONCLUSIONS

This study supports the use of endoscopic excisional biopsy as the primary treatment modality for lesions ranging from carcinoma in situ to invasive T1 glottic carcinoma. This study also highlights the importance of close clinical follow‐up and the potential need for further treatment. By reserving open operation and radiation therapy to selective cases, we successfully treated all patients while limiting the disadvantages of radiation therapy and more invasive operation to the minority of patients.
Oncocytic Neoplasms of the Parotid Gland: A 16‐Year Institutional Review
Authors: Capone Randolph B. , Ha Patrick K. , Westra William H. , Pilkington Thomas M. , Sciubba James J. , Koch Wayne M. , Cummings Charles W.
Published: February 2003

BACKGROUND

Oncocytic neoplasms of the parotid gland are a rare collection of salivary gland tumors that include oncocytosis, oncocytoma, and oncocytic carcinoma. Mounting evidence has linked the presence of oncocytes to acquired mitochondrial dysfunction.

OBJECTIVES

The study goals were to further delineate this poorly understood group of salivary gland tumors and to search for genetic alterations indicative of mitochondrial dysfunction.

METHODS

Cases were identified by search of the surgical pathology archival files from 1984 through 2000. Corresponding medical records were reviewed. Tumor mitochondrial DNA (mtDNA) was evaluated for mtDNA mutations within the control region (C‐tract).

RESULTS

Twenty‐one parotid oncocytic neoplasms were identified. Oncocytoma was the most frequent morphology (62%), followed by oncocytosis (28.5%) and oncocytic carcinoma (9.5%). One specimen displayed synchronous oncocytic morphologies (oncocytoma, oncocytosis, and oncocytic metaplasia). One oncocytoma specimen displayed the mtDNA C‐tract alteration.

CONCLUSIONS

Oncocytic neoplasia of the parotid gland is a rare form of salivary gland disease with obscure etiology. The presence of multiple oncocytic morphologies in a single specimen is suggestive of transition between forms. Although oncocytic tumorigenesis secondary to acquired mitochondrial dysfunction is a plausible mechanism, few of these tumors actually harbor mtDNA alterations within the control region.
Long‐Term Effects of Cochlear Implants in Children
Authors: Waltzman Susan B. , Cohen Noel L. , Green Janet , Roland J. Thomas
Published: February 2003

OBJECTIVE

Since 1987, when the use of multichannel cochlear implants was initiated in children, candidacy has expanded; many thousands of children have received these devices, and results have revealed a wide range of performance. However, few long‐term studies exist on a large population of these children. There have been concerns expressed that cochlear implant function might degrade over time, that devices and electrodes might migrate and extrude in the growing child, or that there might even be a deleterious effect of long‐term stimulation of the cochlear nerve. The purpose of this study was to explore the long‐term effects of implantation as a function of performance over time, reimplantation, and educational factors.

STUDY DESIGN AND SETTING

We studied 81 children who received implants at a major academic medical center and were followed for 5 to 13 years.

RESULTS

Results revealed significant gains in speech perception, use of oral language, and ability to function in a mainstream environment. There was no decrease in performance over time and no significant incidence of device or electrode migration or extrusion, and device failure did not cause a deterioration in long‐term outcome.

CONCLUSIONS

Multichannel cochlear implants in children provide perception, linguistic, and educational advantages, which are not adversely affected by long‐term electrical stimulation.
Factors Predictive of Poor Functional Outcome after Chemoradiation for Advanced Laryngeal Cancer
Authors: Staton Jonathan , Robbins K. Thomas , Newman Lisa , Samant Sandeep , Sebelik Merry , Vieira Francisco
Published: February 2003

OBJECTIVE

The study goal was to determine whether pretreatment parameters can be used to predict poor outcomes related to laryngeal function among survivors after organ preservation therapy for advanced laryngeal cancer.

DESIGN

A retrospective analysis of patients treated in an ongoing chemoradiation trial.

SETTING

Academic tertiary care referral medical center.

PATIENTS AND METHODS

Among the 65 patients receiving concomitant intra‐arterial cisplatin and radiation therapy for stage III and IV laryngeal cancer between 1993 and 1999, we identified 45 who were available for follow‐up and were disease free 6 months after the completion of therapy. A nominal logistic regression analysis was performed to study the effect of age, gender, T and N classification, vocal cord fixation, massive cartilage destruction, and neck dissection on the likelihood of requiring a tracheostomy tube for breathing and/or a gastrostomy tube for feeding at 6 months after the completion of therapy.

MAIN OUTCOME MEASURE

Persistent use of gastrostomy tube feedings and/or tracheostomy at 6 months after the completion of therapy.

RESULTS

Sixteen patients (36%) required a feeding tube and/or a tracheostomy (tracheostomy 13, gastrostomy 13, both 10). Regression analysis of all pretreatment factors indicated vocal cord fixation as being the strongest predictor of a poor functional outcome (defined as the persistent need for a feeding tube and/or tracheostomy at 6 months after therapy). Among the 27 patients in this subset, 15 (56%) had a poor functional outcome. In contrast, only 1 (6%) of 18 patients without vocal cord fixation had poor laryngeal function. Although the history of pulmonary disease was not a significant parameter by itself, when combined with vocal cord fixation, 6 of 8 patients had a poor functional outcome.

CONCLUSION

Pretreatment parameters may be used to predict a poor functional outcome after chemoradiation. Because of the high likelihood of poor function, laryngeal cancer patients seeking organ preservation therapy with chemoradiation should be cautioned if they present with a fixed vocal cord.
Comparison of Thinprep versus Conventional Smear Cytopreparatory Techniques for Fine‐Needle Aspiration Specimens of Head and Neck Masses
Authors: Ford Lloyd , Rasgon Barry M. , Hilsinger Raymond L. , Cruz Raul M. , Axelsson Karen , Rumore Gregory J. , Schmidtknecht Thomas M. , Puligandla Balaram , Sawicki John , Pshea William
Published: February 2003

OBJECTIVES

Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine‐needle aspiration (FNA) of head and neck masses.

METHODS

In a prospective, randomized, single‐blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques.

RESULTS

ThinPrep produced less air‐drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses.

CONCLUSIONS

For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood‐borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.
Acoustic Rhinometry Findings in Patients with Mild Sleep Apnea
Authors: Houser Steven M. , Mamikoglu Bulent , Aquino Benjamin F. , Moinuddin Rizwan , Corey Jacquelynne P.
Published: February 2003

BACKGROUND

Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR.

OBJECTIVE

This study was undertaken to assess the degree of nasal obstruction seen in allergic patients with and without OSA.

STUDY DESIGN AND SETTING

This study was a retrospective data analysis from a tertiary referral center. The AR data from 10 patients with and 40 patients without mild OSA were compared.

RESULTS

The mean congestion factors at the first cross‐sectional area (CSA1) on the AR graph were found to be significantly higher in the OSA group than in the non‐OSA group (P= 0.03). The classification of change in congestion factors demonstrated significant differences at CSA1, CSA2, and CSA3 and in volume (tdistributions <0.001, 0.0312, <0.001, and <0.001, respectively). The non‐OSA patients noted a significant subjective improvement in nasal congestion after topical nasal decongestion, whereas the OSA patients did not (P< 0.0001 and 0.064, respectively).

CONCLUSION

Although the role of nasal obstruction in OSA is controversial, our study lends evidence to the thought that the nasal obstruction associated with allergic rhinitis is associated with the presence of mild OSA.

SIGNIFICANCE

Whether allergic rhinitis is a direct cause of OSA is debatable, but we have shown that greater nasal congestion is related to the presence of OSA in a population of patients with allergic rhinitis.
Tympanoplasty Results in Patients with Cleft Palate: An Age‐ and Procedure‐Matched Comparison of Preliminary Results with Patients without Cleft Palate
Authors: Gardner Edward , Dornhoffer John L.
Published: February 2003

OBJECTIVE

Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age‐ and procedure‐matched controls.

METHODS

Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure‐equalizing tubes were compared.

RESULTS

No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air‐bone gap (P = 0.6805), graft survival rate (P = 1.00), and need for postoperative intubation (P = 0.457).

CONCLUSION

Results in patients with cleft palate appear to be similar to those in patients without cleft palate.
Promoter Hypermethylation: An Important Epigenetic Mechanism for hMLH1 Gene Inactivation in Head and Neck Squamous Cell Carcinoma
Authors: Liu Kela , Huang Huaiyun , Mukunyadzi Perkins , Suen James Y. , Hanna Ehab , Fan Chun‐Yang
Published: February 2003

OBJECTIVE

The hMLH1 gene is one of the mismatch DNA repair genes. Inactivation of the hMLH1 gene has been implicated in the tumorigenesis of many types of human cancers. In most sporadic forms of human cancers, promoter hypermethylation is responsible for hMLH1 gene inactivation. Lack of hMLH1 protein expression has been found in a subset of head and neck squamous cell carcinomas (HNSCCs). The purpose of this study was to investigate whether promoter hypermethylation causes hMLH1 gene inactivation in HNSCCs.

STUDY DESIGN

hMLH1 protein expression was determined by immunohistochemical staining in 62 cases, whereas hMLH1 gene promoter methylation was analyzed by methylation‐sensitive restriction enzyme digestion, followed by polymerase chain reaction, in 35 cases of HNSCCs.

RESULTS

Sixteen (26%) of 62 cases of HNSCCs showed near‐complete loss of hMLH1 protein expression on immunohistochemical staining. Twelve (92%) of 13 cases that were negative for the hMLH1 protein displayed promoter hypermethylation, whereas 17 (77%) of 22 cases positive for the protein were free of promoter methylation.

CONCLUSIONS

Promoter hypermethylation may be an important mechanism for hMLH1 gene inactivation in a subset of HNSCCs.
Biomechanical Effects of Hydration in Vocal Fold Tissues
Authors: Chan Roger W. , Tayama Niro
Published: February 2003

OBJECTIVE

It has often been hypothesized, with little empirical support, that vocal fold hydration affects voice production by mediating changes in vocal fold tissue rheology. To test this hypothesis, we attempted in this study to quantify the effects of hydration on the viscoelastic shear properties of vocal fold tissues in vitro.

STUDY DESIGN

Osmotic changes in hydration (dehydration and rehydration) of 5 excised canine larynges were induced by sequential incubation of the tissues in isotonic, hypertonic, and hypotonic solutions. Elastic shear modulus (G'), dynamic viscosity η' and the damping ratio ζ of the vocal fold mucosa (lamina propria) were measured as a function of frequency (0.01 to 15 Hz) with a torsional rheometer.

RESULTS

Vocal fold tissue stiffness (G') and viscosity increased significantly (by 4 to 7 times) with the osmotically induced dehydration, whereas they decreased by 22% to 38% on the induced rehydration. Damping ratio (ζ) also increased with dehydration and decreased with rehydration, but the detected differences were not statistically significant at all frequencies.

CONCLUSION

These findings support the longstanding hypothesis that hydration affects vocal fold vibration by altering tissue rheologic (or viscoelastic) properties.

SIGNIFICANCE

Our results demonstrated the biomechanical importance of hydration in vocal fold tissues and suggested that hydration approaches may potentially improve the biomechanics of phonation in vocal fold lesions involving disordered fluid balance.
The Effects of Age on Auditory Speech Perception Development in Cochlear‐Implanted Prelingually Deaf Children
Authors: Hassanzadeh Saeid , Farhadi Mohammad , Daneshi Ahmad , Emamdjomeh Hessam
Published: February 2003

One of the most important factors in auditory speech perception of cochlear‐implanted children is age. The goal of this study was to compare auditory speech perception among children implanted from 6 different age groups: 0 to 3, 4 to 5, 6 to 7, 8 to 9, 10 to 11, and >12 years. The subjects of this study were matched based on socioeconomic status, residual hearing before cochlear implantation, the kinds of cochlear implant device, speech processing strategy, communication mode after implantation, and primary language in family. All of them have used the device minimally for 2 years. The subjects were tested with a range of closed and open‐set auditory speech perception tests, and the levels of auditory speech perception in different age groups were compared. Results showed that the children who received an implant at 0 to 3 years of age had maximum auditory speech perception.
The Pedicled Superficial Temporalis Fascial Flap: A New Method for Reconstruction in Otologic Surgery
Authors: Olson Krista L. , Manolidis Spiros
Published: February 2003

OBJECTIVES

Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery.

METHODS

The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures.

RESULTS

No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow‐up ranges from 2 to 25 months.

CONCLUSIONS

This fascial flap provides a wide surface area of tissue on a narrow‐based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.
Prevalence of Heat Shock Protein in Patients with Meniere's Disease and Allergy
Authors: Derebery M. Jennifer
Published: February 2003

OBJECTIVE

The study purpose was to investigate the prevalence of elevated heat shock protein 70 (HSP‐70) in patients with Meniere's disease who have milk allergy compared with those who are not allergic to milk.

METHODS

Fifty‐five patients with Meniere's disease and allergy in whom milk allergy had been confirmed by intradermal progressive dilutional food testing or skin testing to milk antigen were included. Blood serum was tested for HSP‐70 elevation with a Western blot assay using bovine renal extract. The 29 women and 26 men ranged in age from 29 to 76 years (mean age 52.8 years). Forty percent of the patients had bilateral Meniere's disease.

RESULTS

Overall prevalence of HSP‐70 elevation was 29.1%. This was higher in bilateral patients (50%) than unilateral patients (15%) (P ≤ 0.007). The effect was based primarily on elevated HSP‐70 in bilateral (62.5%) and unilateral (7.7%) patients in those with no milk allergy (P ≤ 0.006). The prevalence of HSP‐70 elevation was actually lower in those with milk allergy (19.2%) than in those with no milk allergy (37.9%). This difference was statistically significant only in the subset of patients who were <50 years old (0% vs 33.3%, respectively; P ≤ 0.04).

CONCLUSIONS

We found no relationship between the presence of antibodies to HSP‐70 and allergy to milk. The significance of elevated HSP‐70 in patients with Meniere's disease has yet to be defined.
The Effect of Optical Design on Micromanipulator Spot Size Using CO2 Laser Irradiation
Authors: Chao Kenneth K. H. , Cheung Eric , Armstrong William B. , Wong Brian J. F.
Published: February 2003

OBJECTIVE

The study goal was to compare the laser spot size created using reflective and refractive micromanipulators with a CO2 laser and to determine the sensitivity of spot size to laser power.

STUDY DESIGN AND SETTING

A CO2 laser and operating microscope (400‐mm focal length) was coupled to either a reflective (Cassegrain‐like) or refractive micromanipulator. Laser spot size was determined by measuring the region of ablation created by laser irradiation of wood (dry tongue depressors), exposed photographic film, and agar gel using optical micrometry. Laser power varied from 0.5 to 20 W with pulse durations of 0.1 and 0.5 second.

RESULTS

The reflective micromanipulator demonstrated overall smaller spot sizes for a given laser power and lower incremental change in spot size with increasing power. The reflective design demonstrated less sensitivity to increases in laser power.

CONCLUSIONS

Micromanipulator optical design can result in significant differences in laser spot size. The reflective device used in this study demonstrated less sensitivity to increasing laser power.