bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric orbital floor fractures: Nausea/vomiting as signs of entrapment
Authors: Cohen Seth M. , Garrett C. GAELYN
Published: September 2022

OBJECTIVE

We sought to explore whether nausea and vomiting are predictive of entrapment.

STUDY DESIGN AND SETTING

We retrospectively evaluated the data regarding orbital floor fractures in children younger than 19 years old presenting at a tertiary care center from 1990 to 2001. Zygomatic, naso‐orbital ethmoid, and displaced orbital rim fractures were excluded from our analysis. Data on the fracture type, signs and symptoms, ocular motility, surgical repair, and resolution of diplopia were also collected.

RESULTS

Twenty‐nine orbital floor fractures were identified. One fourth of the children had nausea/ vomiting, and half had trapdoor fractures. Seventeen percent of patients had entrapment of the inferior rectus. The positive predictive value of nausea/vomiting with a trapdoor fracture for entrapment was 83.3% (P = 0.002, Fisher exact test). Half the patients required surgical intervention, most commonly for diplopia or gaze restriction. Gaze impairment did not resolve in 2 patients.

CONCLUSION

Patients with trapdoor fractures who present with nausea/vomiting are at a high risk of inferior rectus entrapment and poor outcome. (Otolaryngol Head Neck Surg 21003;129:000‐000)
Hearing Preservation with the Retrosigmoid Approach for Vestibular Schwannoma: Myth or Reality?
Authors: Lassaletta Luis , Fontes Leonardo , Melcon Enrique , Sarria Maria Jose , Gavilan Javier
Published: September 2022

OBJECTIVE

The purpose of this study is to present our experience with the retrosigmoid approach for vestibular schwannoma resection, emphasizing our hearing results, discussing selection and reporting results criteria.

STUDY DESIGN AND SETTING

The notes of 65 consecutive cases of vestibular schwannoma undergoing the retrosigmoid approach were reviewed. Hearing data were reported according to the recommendations of the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS). In addition, the terms normal, serviceable, useful, and measurable hearing were considered.

RESULTS

Tumor size ranged from 8 to 50 mm (mean, 24.1 mm). Of the 29 patients with preoperative serviceable hearing (AAO‐HNS classes A and B), 5 patients (17%) had postoperative serviceable hearing, and 6 patients (20%) had postoperative useful hearing (AAO‐HNS classes A, B, and C).

CONCLUSION

The retrosigmoid approach is a reliable surgical procedure for most vestibular schwannoma tumors. However, hearing preservation results show wide differences depending on selection and reporting results criteria. Hearing preservation, although possible, may not be the main reason to choose this approach. (Otolaryngol Head Neck Surg 2003;129:397–401.)
Use of 3‐Dimensional Computed Tomography Scan to Evaluate Upper Airway Patency for Patients Undergoing Sleep‐Disordered Breathing Surgery
Authors: Li Hseuh‐Yu , Chen Ning‐Hung , Wang Chao‐Ran , Shu Yu‐Hsiang , Wang Pa‐Chun
Published: September 2022

OBJECTIVE

Our goal was to investigate the correlation between upper airway 3‐dimensional computed tomography (3‐D CT) measurements and polysomnography data of patients with sleep‐disordered breathing (SDB).

STUDY DESIGN AND SETTING

The 3‐D CT scan measurements of the retropalatal space (RP), lateral and anteroposterior diameters of RP, retroglossal space, uvular thickness, and volume of upper airway were taken prospectively from 194 consecutive SDB patients. These were correlated with patients' respective Respiratory Distress Index (RDI), snoring index, and lowest arterial oxygen saturation gathered from polysomnographic data.

RESULTS

RP (r = −0.27, P = 0.0001) and lateral diameter (P = 0.0073) were significantly correlated with RDI. Multivariate regression model (R 2 = 0.286) demonstrates RP (P = 0.0036) and retroglossal space (P = 0.027) to be predictive of RDI. No 3‐D CT parameters correlated with snoring index and lowest arterial oxygen saturation attained statistical significant.

CONCLUSION

The 3‐D CT scan measurements can be valuable in evaluating upper airway patency in patients with SDB. The RP was the most relevant upper airway anatomic structure identified in these patients.

SIGNIFICANCE

Modification of palatal surgery to increase the lateral dimension of the RP may be a breakthrough in increasing its success rate.
Voice and Deglutition Functions after the Supracricoid and Total Laryngectomy Procedures for Advanced Stage Laryngeal Carcinoma
Authors: Dworkin James Paul , Meleca Robert J. , Zacharek Mark A. , Stachler Robert J. , Pasha Raza , Abkarian G. G. , Culatta Richard A. , Jacobs John R.
Published: September 2022

OBJECTIVES

The investigation compared speech and deglutition functions after alternative surgical treatments for advanced stage laryngeal carcinoma: the supracricoid laryngectomy (SCL) versus the total laryngectomy (TL).

STUDY DESIGN AND SETTING

Cohort investigation at Wayne State University School of Medicine.

METHODS

Quantitative studies of laryngeal biomechanics, acoustic and speech aerodynamic features, and deglutition skills of these individuals were coupled to listener and patient self‐impressions of speech and voice characteristics for group comparative analyses.

RESULTS

Results revealed that patients from each subgroup performed comparably relative to speech intelligibility and voice quality disturbances. Videostroboscopy of the neoglottal mechanisms in these two populations helped to explain these outcomes. Acoustic and speech aerodynamic testing demonstrated variably abnormal features in both surgical subgroups. Whereas the SCL patients eventually achieved full oral diets, they required many sessions of swallowing therapy to obtain this objective and eliminate tube feeding supplementation. The TL patients did not evidence protracted swallowing difficulties or the need for specific exercises in order to remove their feeding tubes postoperatively. References to organ preservation strategies in lieu of surgical management are included for completeness purposes.

CONCLUSIONS

The SCL and TL surgical procedures for advanced stage laryngeal carcinoma resulted in equivalent speech and swallowing functional outcomes. (Otolaryngol Head Neck Surg 2003;129:311–20.)
β‐Trace Protein Test: New Guidelines for the Reliable Diagnosis of Cerebrospinal Fluid Fistula
Authors: Meco Cem , Oberascher Gerhard , Arrer Erich , Moser Gerhard , Albegger Klaus
Published: September 2022

OBJECTIVE

Cerebrospinal fluid (CSF) fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to β2‐transferrin, another CSF protein, β‐trace protein (βTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new βTP test for use in routine CSF fistula diagnosis.

METHODS

Nephelometric detection of βTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed.

RESULTS

The βTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the β2‐transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF βTP values, respectively.

CONCLUSION

Quantitative measurement of βTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with β2‐transferrin test or sodium‐fluorescein test.
Microscopic Anatomy of the Infraorbital Canal, Nerve, and Foramen
Authors: Kazkayasi Mustafa , Ergin Ahmet , Ersoy Mehmet , Tekdemir Ibrahim , Elhan Alaittin
Published: September 2022

OBJECTIVE

We performed this study to investigate the morphologic and topographic anatomy, and variations of the infraorbital canal (IOC), infraorbital nerve (ION), and infraorbital foramen (IOF).

STUDY DESIGN AND SETTING

This study was performed at the Anatomy Department of Ankara University School of Medicine between 1999 and 2000. The morphometry of these anatomic areas on cadaver heads were studied microscopically. The morphologic and topograpic anatomies of IOC, ION, and IOF were carried out microscopically with x25 to x40 magnification on 10 cadaver heads (20 sides).

RESULTS

We found the shape of the IOF as oval in 30% (6 sides), round in 40% (8 sides), and semilunar in 30% (6 sides) of the cadaver heads. We detected the IOF as single in 90% (18 sides), double in 5% (1 side), and triple in 5% (1 side) of the cases. We determined a complete roof (we called it as “canal”) in 50% of cases and groove plus canal in 50% of the heads. The mediolateral relationship of the vessels to the nerve while emerging from the IOF was investigated, and the artery was always found in a mediosuperior position and the vein was inferior to it. In all specimens, the ION was found to be consisting of 3 to 8 fascicles interwoven with the artery and the vein in the loose connective tissue sheath.

CONCLUSION

A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon while performing maxillofacial surgery and regional block anesthesia. Anatomic variations on this area may take place and a surgeon must take this into consideration so as to increase the surgical success. (Otolaryngol Head Neck Surg 2003;129: 692‐7.)
Age‐Related Changes in the Vestibular‐Evoked Myogenic Potentials
Authors: Ochi Kentaro , Ohashi Toru
Published: September 2022

OBJECTIVE

We sought to investigate the effects of gender and age on the vestibular‐evoked myogenic potential (VEMP).

STUDY DESIGN AND SETTINGS

Sixty healthy adult volunteers (28 male and 32 female) were investigated in this study. The subject age was distributed between 20 and 77 years old.

RESULTS

No gender‐related differences were detected in the VEMP. There was a significant correlation between age and both the evoking threshold and the pInII amplitude of the VEMP, whereas no significant correlation was observed between age and left‐right differences of the VEMP.

CONCLUSIONS

The correlation between age and the parameters of the VEMP is presumably secondary to age‐related functional changes in the sensory and neural elements of the VEMP. It is safe to evaluate the VEMP using the value of the non‐affected side when assessing unilateral lesions. However, it may be necessary to take age into account in evaluating the VEMP when bilateral lesions are suspected.
Effects of Resveratrol on Acoustic Trauma
Authors: Seidman Michael , Babu Seilesh , Tang Wenxue , Naem Emad , Quirk Wayne S.
Published: September 2022

OBJECTIVE

The purpose of the study is to test the ability of resveratrol to protect the auditory system from reactive oxygen species (ROS)‐mediated noise damage. Oxidative stress is mediated by ROS, which are known to cause cellular and molecular damage. Interfering with this process, using ROS inhibitors/scavengers such as antioxidants has shown promise in protecting specific systems from oxidative damage. Among the antioxidants receiving recent attention is resveratrol, an active component in red wine.

STUDY DESIGN AND SETTING

Ten Fischer rats were used for this study. The experimental group (n = 5) received 7 weeks of resveratrol treatment (430/μg/kg/day), by gavage, and the control group (n = 5) received normal saline solution by gavage. Baseline auditory brainstem responses (3, 6, 9, 12 and 18 kHz) were determined for both groups. After 21 days, animals were exposed to noise (105 dB, 4500 to 9000 Hz for 24 hours). Postnoise auditory brainstem responses were assessed at 4 recovery time points: immediate, at 3 days, 7 days, and 4 weeks after noise exposure.

RESULTS

Results demonstrate that the resveratrol group showed reduced threshold shifts compared with the control group after noise exposure. These shifts were significantly different between groups at 6 and 9 kHz (P < 0.05), corresponding to the region most represented by the frequency of the traumatic noise.

CONCLUSION/SIGNIFICANCE

Initial studies in our laboratory as well as other investigators have shown the importance of specific antioxidant therapy in the prevention of ischemic, noise, and age related hearing loss. The current study demonstrates a protective effect of resveratrol on noise‐induced hearing loss.
Multicenter Study Assessing Effects of Heat and Moisture Exchanger Use on Respiratory Symptoms and Voice Quality in Laryngectomized Individuals
Authors: Ackerstaff Annemieke H. , Fuller D. , Irvin M. , MacCracken E. , Gaziano J. , Stachowiak L.
Published: September 2022

OBJECTIVE

A multicenter study based in the United States assessed the heat‐moisture exchanger effect on respiratory symptoms and “voice quality” of laryngectomees.

PATIENTS AND MEASURES

The study group consisted of 81 consecutive laryngectomees (62 men and 19 women; mean age, 66 years; age range, 45 to 89 years), with a median follow‐up of 3.5 years (range, 0.5 to 24 years). A structured questionnaire was used to assess 3‐month results, and tally sheets recorded the frequency of cough‐expectoration during first and last trial weeks.

RESULTS

Compliance was 73% (n = 59); decrease in coughing, 68%; sputum production, 73%; forced expectoration, 60%; and need for stoma cleaning, 52% of these 59 patients. Regarding daily cough‐expectoration frequency, a statistically significant decrease (P < 0.0001) was found between the first and last trial weeks. Regarding influence on voice quality, 46% of regular users reported improvement in intelligibility, 30% in loudness, 37% in fluency, and 40% in telephone intelligibility. Fourteen patients (19%) reported skin irritation, with discontinuation of 7 patients.

CONCLUSION

The observed decrease in pulmonary symptoms and improvement in voice quality confirm earlier reports from the Netherlands, United Kingdom, and Spain indicating improvement in postlaryngectomy quality of life. (Otolaryngol Head Neck Surg 2003;129:705‐12.)
Laryngeal Complications after Type I Thyroplasty
Authors: Cotter Cheryl S. , Avidano Michael A. , Crary Michael A. , Cassisi Nicholas J. , Gorham Mary M.
Published: September 2022

Type I thyroplasty has become a primary surgical choice for voice restoration in patients with glottal incompetence. This study examines factors associated with laryngeal complications after type I thyroplasty. Ten laryngoscopic variables were analyzed from preoperative, intraoperative, and postoperative videolaryngoscopies of 51 patients undergoing 58 medialization procedures. Ten patient and operative variables were examined by medical record review. Major complications were defined as wound hemorrhage, airway obstruction, or prosthesis extrusion. Minor complications were defined as vocal fold hematoma without airway obstruction or prosthesis movement. The major complication rate was 8.6%, and the minor complication rate was 29%. No delayed hemorrhage or airway obstruction occurred. Prosthesis extrusion occurred in five (8.6%) patients 1 week to 5 months after surgery. Extrusion was associated with suboptimal prosthesis placement in 80% of cases. Two patients retained excellent glottal closure despite extrusion. Vocal fold hematoma was identified in 14 (24%) cases and resolved within 1 week. Prosthesis movement occurred in three (5%) patients 1 week to 6 months after surgery and resulted in poor glottal closure. All patients with prosthesis extrusion or movement were female. Type I thyroplasty remains a safe outpatient procedure with few major complications. Prosthesis extrusion was associated with suboptimal prosthesis placement and may or may not result in poor glottal closure. Minor vocal fold hematomas were relatively frequent, resolved rapidly, and were not associated with airway obstruction. Female patients may be more prone to complications because of their small laryngeal size.
Diagnosis and Treatment of Unilateral Cricothyroid Muscle Paralysis with a Modified Isshiki Type 4 Thyroplasty
Authors: Shaw Gary Y. , Searl Jeff P. , Hoover Larry A.
Published: September 2022

Cricothyroid adduction increases tension to the vocal folds, thus increasing fundamental frequency and upper pitch range. We treated 10 patients with cricothyroid muscle dysfunction using this technique. Preoperative electromyographic, acoustic, and perceptual analysis was performed. Intraoperatively the effect of increasing tension on the fundamental, falsetto, and basal frequencies was measured by using a strain gauge to the adducting suture at several tensions and a cervical microphone connected to a pitch meter. Postoperative acoustic and perceptual analysis was then performed up to 18 months later. Analysis of pitch vs. tension curves indicates a near‐linear relationship until very high tensions are applied. Statistically significant improvement was achieved in both acoustic and perceptual analysis, although some deterioration was noted between early and late results. Cricothyroid adduction is indicated for a large range of vocal fold tension problems.
Microanalytic Acoustical Voice Characteristics of Near‐Total Laryngectomy
Authors: Keith Robert L. , Leeper H. A. , Doyle Philip C.
Published: September 2022

Limited acoustic data are available describing vocal characteristics of individuals after near‐total laryngectomy. Computer‐based acoustic analyses (Fo, jitter, shimmer, signal‐to‐noise ratio) were performed on vowel samples produced by 20 speakers who underwent near‐total laryngectomy. On the basis of data obtained, the subjects who had undergone near‐total laryngectomy demonstrated (1) higher than normal and more variable modal fundamental frequency values for sustained vowels; (2) increased frequency (jitter) and amplitude (shimmer) perturbation; and (3) decreased spectral noise (signal‐to‐noise) components. In addition, speakers who had undergone near‐total laryngectomy showed an increased percentage of unvoiced sound production during their vowel productions. The large variability and general aperiodicity of the phonatory signal during vowel production suggests an ineffective laryngeal valving system with overcompensation in attempts to generate effective voice. These findings have implications for designing behavioral therapy programs to improve voice quality in speakers who receive conservation laryngectomy procedures for treatment of laryngeal carcinoma.
Forehead Flap in Nasal Reconstruction
Authors: Friduss Michael , Dagum Paul , Mandych Alexander , Reppucci Angelo
Published: September 2022

We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and 10 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short‐term pincushioning in all patients, scar contracture that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two‐dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two‐dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction.
Papillary Carcinoma of the Thyroid
Authors: Segal Karl , Fridental Ran , Lubin Ernesto , Shvero Jacob , Sulkes Jaqueline , Feinmesser Raphael
Published: September 2022

Between 1954 and 1993 503 patients with papillary carcinoma of the thyroid were treated at the Department of Otolaryngology‐Head and Neck Surgery of the Beilinson Medical Center. Two thirds of these patients were women. The median follow‐up period was 10.3 years. In more than 30% of cases the tumor was discovered because of the presence of an enlarged lymph node and/or invasion to adjacent structures. Total or near‐total thyroidectomy was performed in 381 patients. The 48 patients in whom it was necessary to perform a reoperation had a significantly higher complication rate. Multicentricity was found in 65% of those cases in which both thyroid lobes were available for histologic examination. Nineteen patients were found to have a “tail” cell variant, 223 had a pure papillary variant, and 261 a follicular variant. The mortality rate was 6.2% 15 years after Initial therapy. A number of factors‐age, size of tumor, presence of distant metastases, “tall” cell variant, and type of surgery‐were found to be significant predictors of survival. After almost 40 years of experience in treating more than 500 cases of papillary cancer, we have come to the conclusion that the surgical approach should be aggressive.
Pediatric tympanoplasty: The role of adenoidectomy
Authors: Gianoli Gerard J. , Worley N. Knight , Guarisco J. Lindhe
Published: September 2022

A chronic dry perforation in a child presents a dilemma with regard to timing of intervention or whether intervention is appropriate at all. Many studies have looked at elements associated with eustachian tube function in hopes of finding prognostic factors. Adenoidectomy has been shown to be very effective in the treatment of chronic and recurrent otitis media. Intuitively, it would seem to play a role in pediatric tympanoplasty; however, no study has thoroughly investigated this issue to date. To evaluate the role of adenoidectomy in pediatric tympanoplasty, we performed a retrospective review of all patients younger than 18 years who had a simple dry perforation and underwent a Wullstein's type I tympanoplasty. Thirty‐six patients were identified for review during the 7‐year study period. The patients were grouped into those who had previous adenotonsillectomy (n = 12), those who had prior adenoidectomy alone (n = 10), and those who had neither (n = 14). Initial success of tympanoplasty was noted to be high in all three groups. However, at 6‐month follow‐up, the success for the group who had not had prior adenoidectomy or tonsillectomy dropped dramatically (14.3%), whereas the other two groups maintained success rates in excess of 75% (p = 0.002). This relationship remained fairly constant throughout the 2 years of follow‐up. Although our population under study is somewhat small, the results support a potentially advantageous role of adenoidectomy for pediatric tympanoplasty. These results and their implications will be discussed.
Overexpression of p53 predicts organ preservation using induction chemotherapy and radiation in patients with advanced laryngeal cancer
Authors: Bradford Carol R. , Zhu Shaobo , Wolf Gregory T. , Poore Judy , Fisher Susan G. , Beals Theodore , McClatchey Kenneth D. , Carey Thomas E.
Published: September 2022

A critical research frontier in head and neck oncology involves defining the use of induction chemotherapy regimens to allow organ preservation and to avoid functionally debilitating surgical resections. Completed clinical trials in laryngeal cancer indicate that such an approach is feasible, but progress thus far has been limited by our inability to predict which patients are likely to respond to chemotherapy and preserve their larynx. Mutation of the p53 tumor‐suppressor gene is the most common genetic alteration identified thus far in human cancers, and it may be important in regulation of cell proliferation and chemosensitivity. To determine whether p53 overexpression predicts chemotherapy response, organ preservation, and survival in patients with advanced laryngeal cancer, we analyzed immunohistologic expression of p53 in tissue sections from 178 patients with advanced laryngeal cancer who were entered in the Department of Veterans Affairs Laryngeal Cancer Cooperative Study, a multiinstitutional clinical trial comparing induction chemotherapy (c/s‐platinum and 5‐fluo‐rouracil) plus radiation therapy (94 patients) to surgery plus postoperative radiation therapy (84 patients). Larynx preservation was significantly higher in the group of patients whose tumors overexpressed p53 (74% vs. 52.5%; p = 0.03). The presence of p53 overexpression did not predict survival in either the surgery or the chemotherapy groups (p = 0.82 and p = 0.53).
Effect of partial middle turbinectomy on nasal airflow and resistance
Authors: Cook Paul R. , Begegni Ali , Bryant W. Cullen , Davis William E.
Published: September 2022

We report the first prospective study of the effect of partial middle turbinectomy on nasal airflow and resistance as measured objectively by active anterior rhinomanometry. Our study group consisted of 31 consecutive patients who underwent functional endoscopic sinus surgery with simultaneous partial middle turbinate resections. We found that all patients had significant improvement in nasal airflow (p < 0.001) and significant decrease in nasal resistance (p < 0.001). Thus we found no deleterious effect on nasal function. Additionally, we reviewed the literature on retrospective series in which patients had received partial middle turbinectomies and found no evidence that nasal function was impaired after surgery. We conclude that partial middle turbinectomy may be performed without adversely altering nasal function, as measured by active anterior rhinomanometry.
Brain abscess: With special reference to otolaryngologic sources of infection
Authors: Yen Pen‐Tung , Chan Shu‐Toa , Huang Tsun‐Sheng
Published: September 2022

The number of brain abscesses has been reduced since the preantibiotic era. This was accomplished by judicious use of antibiotics, by the advent of computed tomography, and by improvements in patient care and surgical techniques. Analysis from 122 patients with brain abscess demonstrated this trend of progress. Our series had a 3.2‐to‐1 male predominance. The underlying conditions included otolaryngologic infections (26 cases), cyanotic heart diseases (27 cases), implantation abscess (25 cases), lung infections (5 cases), meningitis (4 cases), osteomyelitis (2 cases), decreased immunity from chronic systemic diseases (12 cases), and unknown causes (21 cases). Otolaryngologic subgroups can be detailed as chronic otitis media with cholesteatoma (15 cases), chronic otitis media with mastoiditis (4 cases), sinusitis (2 cases), esophageal stenosis (3 cases), cheek cellulitis (1 case), and nasopharyngeal carcinoma (1 case). The initial symptoms and signs were headache (46 cases), fever (36 cases), altered consciousness (30 cases), neurologic deficits (33 cases), vomiting (11 cases), and seizure (17 cases). Of the brain abscesses treated, multiple brain abscess represented 16.4% of all cases. The overall percentage of patients with full recovery was 52.5%, whereas 84.8% of otolaryngologic subgroup recovered fully. The overall mortality was 19.7%. The mortality rate of brain abscess from otolaryngologic sources was 3.8%, whereas that from nonotolaryngologic sources was 24%.
Evaluation of temporal and facial osteomyelitis by simultaneous In‐WBC/Tc‐99m‐MDP bone SPECT scintigraphy and computed tomography scan
Authors: Weber Peter C. , Seabold James E. , Graham Scott M. , Hoffmann Henry H. , Simonson Teresa M. , Thompson Brad H.
Published: September 2022

A reliable imaging technique is needed for follow‐up of patients with temporal and facial osteomyelitis. Clinical outcome in 20 patients with suspected osteomyelitis of the temporal/mastoid, calvarium, and mandible facial bones was evaluated with 30 combined In‐WBC/Tc‐99m MDP bone single photon emission computed tomographic (SPECT) scans and 27 computed tomographic scans. Simultaneous dual‐tracer 25‐minute SPECT scans were acquired 18 to 20 hours after radiotracer injection by use of a three‐detector system. Diagnosis of the 20 patients (age range, 3 to 74 years) included 8 with facial osteomyelitis, 6 with malignant otitis externa, 3 with mandibular osteomyelitis, and 3 with calvarial osteomyelitis. Diagnosis was confirmed by biopsy/culture results in 18 patients and by endoscopic and clinical evaluation in 2 patients with initial negative scans. Of the 30 In‐WBC/MDP scans, 15 were true‐positive, 13 true‐negative, 1 false‐negative, and 1 equivocal. Of a total of 27 CT scans, 9 were true‐positive, 5 false‐negative, and 1 equivocal in patients with biopsy‐proven osteomyelitis. Three computed tomographic scans were false‐positive and 1 was equivocal in patients without osteomyelitis, because of concurrent postoperative bone abnormalities. Additionally, 8 computed tomographic scans were true‐negative. These results suggest that dual In‐WBC/Tc‐99m MDP bone SPECT scintigraphy provides an accurate imaging modality for diagnosis and follow‐up of temporal and facial osteomyelitis when existing clinical or postoperative bone changes make it difficult to detect active osteomyelitis by computed tomographic scan.
Management of the recurrent laryngeal nerve in suspected and proven thyroid cancer
Authors: Falk Stephen A. , Mccaffrey Thomas V.
Published: September 2022

Vocal cord paralysis occurs with and without infiltration of the recurrent laryngeal nerve. Patients with no paralysis may have recurrent laryngeal nerve infiltration. We studied 262 patients with invasive thyroid carcinoma and an additional 480 patients that we operated on, and we offer an approach to the management of the recurrent laryngeal nerve during surgery for suspected or proven thyroid cancer. Because complete excision of papillary carcinoma with resection of the recurrent laryngeal nerve did not improve survival over incomplete excision, we recommend incomplete excision of papillary carcinoma infiltrating a functioning recurrent laryngeal nerve with postoperative I‐131 and thyroid‐stimulating hormone suppression. We observed (1) lymphoma and Reidel's thyroiditis causing paralysis with infiltration of the recurrent laryngeal nerve with recovery of function, (2) benign and malignant nodules causing paralysis without infiltration of the recurrent laryngeal nerve with recovery of function, and (3) infiltration of the recurrent laryngeal nerve without paralysis in lymphoma, Graves' disease, and thyroiditis. In surgery for a suspicious nodule with paralysis, identify the recurrent laryngeal nerve, resect it if it is infiltrated by carcinoma, and preserve it if not infiltrated or if infiltrated by any pathology besides carcinoma.
Olfactory disturbance in pediatric tracheotomy
Authors: Rothschild Michael A. , Myer Charles M. , Duncan Heather J.
Published: September 2022

Several studies have described hyposmia after laryngectomy. The most common mechanism invoked is a reduction in nasal airflow, leading to elevated olfactory detection thresholds. Children with nasal obstruction have been shown to also have elevated olfactory detection thresholds linked to reduced nasal airflow. A child with a tracheotomy is in some degree similar to a laryngectomee. These patients will have variable amounts of nasal airflow reduction proportional to the degree of suprastomal obstruction. Our concern was that this alteration in nasal airflow may cause hyposmia. Furthermore, if the olfactory system requires adequate early stimulation for normal development (as is the case with vision and hearing), tracheotomy would be suspected to cause persistent hyposmia even after decannulation. Thus decreased olfactory sensitivity, delayed olfactory experience, or both could interfere with a child's ability to recognize and identify odor stimuli. We studied children aged 4 to 16 years with upper airway obstruction requiring tracheotomy and compared their abilities to identify familiar odorants with those of a large group of normal control children. None of the children had intrinsic mucosal or olfactory pathology. Statistical analysis of the early data shows a significant reduction in olfactory identification scores in the patients with tracheotomies, both by Student's t test and by the Wilcoxon rank sum test. Analysis of covariance confirmed age as an independent prognostic variable for identification ability. We therefore conclude that tracheotomy can reduce a child's ability to identify familiar odorants.
Comparison of Modified PhadezymRAST,* ImmunoCAP,* and serial dilution titration skin testing by receiver operating curve analysis
Authors: Corey Jacquelynne P. , Nelson Rita S. , Lai Vincent
Published: September 2022

Improved technology in in vitro tests for allergen‐specific immunoglobulin E has led to increased efficiency and faster turnaround times. ImmunoCAP (Pharmacia Diagnostics, Clayton, N.C.) is an in vitro‐specific immunoglobulin E test that uses a three‐dimensional cellulose solid allergen phase, which allows quick results in 6 hours. In comparison, modified PhadezymRAST (Pharmacia Diagnostics) uses a two‐dimensional solid phase, and results take 3 days to obtain. This study compares the sensitivity and specificity of CAP with that of modified RAST in the detection of specific immunoglobulin E, and it assesses the correlation of the individual class scores of CAP and modified RAST with end points obtained from skin‐dilutional end‐point titration. The reproducibility of CAP was also assessed. Patients evaluated at the University of Chicago Allergy Clinic who had a history and physical examination consistent with immunoglobulin E‐mediated allergy and in whom skin testing was clinically indicated as part of their allergy management, were asked to donate some blood for simultaneous in vitro testing by PhadezymRAST and ImmunoCAP. Testing was performed in batches. Random samples from the CAP batches were chosen for duplicate runs under conditions blinded to the technician. Receiver operating curve analysis was used for comparison of the sensitivity and specificity of RAST vs. that of CAP. We used Pearson product‐moment correlation coefficients to compare the correlation of RAST and CAP classes with the end points from skin testing. Our results indicate that the sensitivity and specificity of RAST and CAP are similar, that the classes of these two tests correlate well with the end points from skin testing, and that duplicate samples of CAP also correlate well.
Mastoid oscillation: A critical factor for success in the canalith repositioning procedure
Authors: LI John C.
Published: September 2022

The canalith repositioning procedure has recently gained controversial recognition as a treatment for benign paroxysmal positional vertigo. Some authors contend that the canalith repositioning maneuver is no more effective than no treatment at all. Unfortunately, its technique has not been uniformly applied and its outcomes have not been uniformly assessed. I have found the use of mastoid oscillation to be critical in the success of this procedure. Another important factor is the time interval between diagnosis and relief of symptoms. Because it is well known that benign paroxysmal positional vertigo can spontaneously resolve after many months, the time frame for comparison should be short. A 1‐week time interval was chosen for study purposes. Sixty patients were randomly assigned to three initial groups. The control group (n = 23) was not given any treatment. A second group (n = 27) was given treatment with the canalith repositioning maneuver with mastoid vibration. A third group (n = 10) was assigned to receive the canalith repositioning maneuver without mastoid vibration. Resolution was defined as no symptoms and negative Dix‐Hallpike test results. The results showed that none of the control group's symptoms resolved completely in 1 week. Although 60% of those who received the canalith repositioning maneuver without mastoid vibration felt improved, none was free of nystagmus. An overwhelming 92% of those who received the canalith repositioning maneuver with mastoid vibration felt improved, and 70% were free of rotatory nystagmus after only one treatment. A review of all patients diagnosed with benign paroxysmal positional vertigo and treated with the canalith repositioning maneuver with mastoid vibration was also undertaken. In a series of 67 patients with a minimum of four weeks of follow‐up, only two have not responded to the canalith repositioning maneuver, yielding a 97% rate of symptom control.
Adjuvant drug strategies in the treatment of recurrent respiratory papillomatosis
Authors: Avidano Michael A. , Singleton George T.
Published: September 2022

The purpose of this study was to evaluate adjuvant drug therapies combined with standard laser excision in the treatment of recurrent respiratory papillomatosis. Previous studies have presented conflicting data on the efficacy of various treatments, including interferon and isotretinoin. A retrospective study of 34 patients with moderate to severe papillomatosis who underwent both laser surgery and adjuvant therapy was therefore performed. All patients were treated with interferon. Five interferon failures received isotretinoin, and three with recalcitrant disease received methotrexate. Interferon produced a complete response in 16 patients and partial response in 12 patients. Juvenile‐onset disease had a slightly higher response to interferon than adult‐onset disease. Isotretinoin produced no response in all five patients. Methotrexate demonstrated a marked improvement in both severity of disease and treatment interval in all three patients. Serious side effects were limited to one interferon patient with febrile seizures, which resolved with discontinuation of therapy. We conclude that adjuvant therapy including interferon and methotrexate is clearly of benefit in the treatment of patients with respiratory papillomatosis. A detailed approach to surgery combined with an interferon dosing regimen is presented. Further study of methotrexate appears warranted.
Sarcoidosis of the sinonasal tract: A new staging system
Authors: Krespi Yosef P. , Kuriloff Daniel B. , Aner Musa
Published: September 2022

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.
Radiation exposure in paranasal sinus imaging
Authors: Sillers Michael J. , Kuhn Frederick A. , Vickery Christopher L.
Published: September 2022

Plain films of the paranasal sinus were the imaging technique most frequently used before the advent of computed tomography. With improved resolution, computed tomography imaging has become the standard for evaluating patients with disease of the paranasal sinuses. With the widespread availability of computed tomography scanning, patients are likely to undergo multiple examinations during the treatment of their disease. Concern has been raised over the radiation exposure to the patient, in particular, with regard to radiation‐induced cataracts. The purpose of this study is to measure the radiation dose associated with a variety of techniques for imaging the paranasal sinuses. A cadaveric specimen with thermoluminescent dosimeters placed over the orbits was used to measure radiation exposure during plain‐film imaging, limited computed tomography, standard axial and coronal computed tomography, thin‐cut axial computed tomography, and thin‐cut coronal computed tomography. The measured dose in all these techniques is less than 4% of the acute dose associated with cataract formation.
Treatment of cervical necrotizing fasciitis with hyperbaric oxygen therapy
Authors: Langford F. P. Johns , Moon Richard E. , Stolp Bryant W. , Scher Richard L.
Published: September 2022

Hyperbaric oxygen therapy has significantly improved the management of necrotizing fasciitis of the extremities and trunk. Its role in cervical necrotizing fasciitis has not been fully evaluated. Historically, necrotizing fasciitis has been associated with considerable morbidity and mortality. This report discusses our experience with cervical necrotizing fasciitis in six patients treated from 1986 to 1993 who received hyperbaric oxygen therapy. All patients survived. In all cases infection was of probable odontogenic origin. Most patients in whom necrotizing fasciitis develops have identifiable risk factors; however, two patients in this series were previously healthy, and there was no relationship between hospital course and identified risk factors. Clinical presentation and microbiology are reviewed together with the rationale for hyperbaric oxygen therapy as an adjunct to broad‐spectrum antibiotics and aggressive early surgical debridement.
Nystagmus and postural instability after headshake in patients with vestibular dysfunction
Authors: Michael S. Panosian Maj , Paige Gary D.
Published: September 2022

Nystagmus after rapid head‐shaking (post‐headshake nystagmus) is often seen in patients with vestibulopathy. Post‐headshake nystagmus is transient and is frequently associated with symptoms of dizziness, dysequilibrium, or vertigo. The phenomenon presumably reflects headshake‐induced asymmetry in vestibulo‐ocular reflex pathways, which persists after head‐shaking stops. We postulated that the same vestibular imbalance that underlies post‐headshake nystagmus might produce an equivalent in postural instability. To test this hypothesis, we investigated the effect of headshake on postural control and eye movements in patients who exhibited post‐headshake nystagmus, vestibulopathy, or both. Postural instability was quantified with a dynamic platform device, whereas eye movements were recorded with electrooculography. Ten normal controls and 21 patients with a history of post‐headshake nystagmus or unilateral vestibulopathy were evaluated. Subjects were tested for 20 seconds before and immediately after passive horizontal headshake (±30‐degree amplitude) at 2 Hz for 20 seconds. Postural stability was assessed while subjects stood with eyes closed, and the floor was modulated proportionally with sway. The difference in normalized peak‐to‐peak sway (equilibrium score) before and after headshake was assessed in all subjects and compared between groups. Post‐headshake nystagmus was documented by electro‐oculography recorded during posturography. Results for normal controls and vestibulopathic subjects without post‐headshake nystagmus showed only a small transient decline in postural stability after headshake. Those with post‐headshake nystagmus (regardless of caloric asymmetry) showed a robust decline in postural stability. The most dramatic decline, together with an increased number of “falls” (step‐out responses), occurred in those patients with both a vestibulopathy (caloric response asymmetry) and post‐headshake nystagmus. These findings illustrate that the vestibular imbalance underlying post‐headshake nystagmus shares a counterpart in the form of headshake‐induced postural instability.
New approaches to the evaluation of the auditory system and a current analysis of otoacoustic emissions
Authors: Lonsbury‐Martin Brenda L. , Martin Glen K. , McCoy Marcy J. , Whitehead Martin L.
Published: September 2022

Healthy ears generate low‐level sounds known as otoacoustic emissions that are produced by the normal workings of the inner ear. By placing a specially constructed probe containing an assembly of miniature microphones in the ear canal, hearing investigators can listen to these sounds. Before emissions were discovered, the only methods available to explore the ordinarily inaccessible structures of the cochlea involved invasive and, thus damaging, experiments, which could only be performed on animals. With the discovery of otoacoustic emissions, noninvasive research on the inner ear became possible, thus allowing study of the fundamental processes that determine the excellent sensitivity and fine frequency tuning that are uniquely associated with human hearing. The results of these basic experiments have made it possible to develop a number of useful clinical applications based on emissions testing. One noteworthy benefit is the use of emissions as a screening test that objectively assesses the functional integrity of peripheral processing in patients who are difficult to examine, such as infants and young children. Other applications take advantage of the test's diagnostic strength as an indicator of the sensory component of a sensorineural hearing loss. Finally, because emissions testing can be conducted rapidly and accurately under computer control, it has proved useful in the serial monitoring of ear performance in instances where a progressive hearing impairment is suspected.
Metabolic disorders of the vestibular system
Authors: Rybak Leonard P.
Published: September 2022

This article reviews the impact of metabolic disorders on vestibular function. Diabetes mellitus is a disorder of glucose metabolism that can be associated with vestibular dysfunction. Vertigo can be alleviated by diet management in many cases. Elevated levels of blood lipids have been implicated in cochleovestibular disorders. Treatment with a lipid‐lowering drug has resulted in improved auditory and vestibular function in a placebo‐controlled trial. Hypothyroidism may affect different parts of the vestibular system depending on the severity and duration of thyroid deficiency. Severe congenital hypothyroidism can cause central vestibular disorders affecting the cerebellum, whereas mild hypothyroidism may result in peripheral vestibulopathy. Endogenous alterations in concentrations of estrogen and progesterone in the premenstrual syndrome or with the use of exogenous hormones such as oral contraceptives may trigger vertigo. Metabolic evaluations for unexplained vertigo should include a lipoprotein profile, with cholesterol and triglyceride levels, glucose tolerance test, and thyroid hormone measurements. Nutritional and drug therapy may be useful to reverse the vestibular dysfunction.
Perilymph fistula pathophysiology
Authors: Wall Conrad , Rauch Steven D.
Published: September 2022

A great deal of the controversy associated with perilymph fistula is due to the lack of a sensitive, specific way of detecting and thus diagnosing one. The existing subjective, clinical observations need to be replaced with an objective, scientific methodology having higher specificity and sensitivity for the detection of perilymph fistula. Three detection methods presently under development are presented here. One uses a miniendoscope to observe the middle ear. This procedure is less traumatic than inspection with tympanotomy. Thus it is less likely to create artifacts that can be mistaken for a fistula leakage. The “yes‐no” observation decision is to be replaced with a graded quantitative measure. The second method concentrates on detected leakage from inner to middle ear. β2‐Transferrin, a unique endogenous substance found in perilymph and cerebrospinal fluid, can be detected with one‐ or two‐dimensional gel electrophoresis and immunoblotting. The third method is a system identification fistula test. It measures a change in a physiologic response that is caused by the presence of the fistula. Classic biophysical models of the vestibular end organs can be used to predict the dynamics of responses to systems identification stimuli.