bluuebunny/crossref_metadata_2025 huggingface dataset:
HLA‐DRB1, ‐DQA1, and ‐DQB1 Genotypes in Patients With Nasal Polyposis
Authors: Molnar‐Gabor Etelka , Endreffy Emöke , Rozsasi Ajnacska
Published: November 2003

Objectives/Hypothesis Genetic etiology is suspected in the development of nasal polyposis on the basis of familial aggregation. This study investigated whether there is an association between HLA‐DRB1, ‐DQA1, and ‐DQB1 alleles and developing nasal polyposis.

Study Design Data from 50 polypectomized patients were compared with data from 50 healthy randomly selected controls. Polyp score, possible asthma, aspirin sensitivity, and ASA triad were also recorded.

Methods Genotyping of HLA‐DRB1 alleles was carried out with the Dynal RELI SSO HLA‐DRB, a direct DNA probe test that utilizes a polymerase chain reaction (PCR) and nucleic acid hybridization for the differentiation of 70 HLA‐DRB alleles and 9 supertypes. For DQA1* genotyping PCR‐RFLP (restriction fragment length polymorphism) was used, differentiating eight alleles. The DQB1* typing was carried out using a INNO‐LiPA DQB PCR‐reverse hybridization kit, allowing the discrimination of 30 alleles.

Results People carrying the HLA‐DR7‐DQA1*0201, and ‐DQB1*0202 haplotype were found to have a two to three times higher odds ratios (ORs) for developing the disease, compared with controls. Patients with ASA triad carried the above‐mentioned DR7 allele with the linked alleles significantly more often (P < .001). Subjects carrying HLA‐DR5 allele and the linked alleles had lower odds ratio values.

Conclusion These results underline that allergy is not conditional for the formation of nasal polyps as thought before. Nasal polyposis associated with asthma and aspirin sensitivity is probably a unique form of nasal polyps. The authors plan further investigations in this field.
Characterization of an Experimentally Induced Inner Ear Immune Response
Authors: Ma Chun‐lei , Billings Peter , Harris Jeffrey P. , Keithley Elizabeth M.
Published: November 2003

Objective To determine the effects of a sterile immune response on the structure and function of the cochlea.

Methods An immune response was created in guinea pigs by systemically sensitizing the animals to keyhole limpet hemocyanin and subsequently challenging the inner ear with the protein. Animals were allowed to survive for 1 to 5 weeks, after which the cochlea was evaluated histologically. Hearing was measured by auditory brainstem response before the inner ear challenge, during the survival period, and prior to sacrifice.

Results Inflammatory cells infiltrated the cochlea from the circulation. Surface preparations and plastic sections of the organ of Corti 1 and 2 weeks after the initiation of the inflammation demonstrated degeneration of the sensory and supporting cells in cochlear turns containing inflammatory cells. Good preservation of structures was seen in the more apical cochlear turns with little or no inflammatory cells. In cochleas from animals that survived 5 weeks, most of the infiltrated cells were cleared after undergoing apoptosis and the inflammatory matrix in the scala tympani began to calcify. Hearing loss was moderate to severe depending on the amount of inflammation.

Conclusion Although in general the immune response serves to protect an organism from infection, these results demonstrate that bystander injury associated with local immune responses in the cochlea, an organ incapable of regeneration, causes permanent cochlear destruction and hearing loss.
Outcomes Research and Obstructive Sleep Apnea
Authors: Piccirillo Jay F.
Published: November 2003

Sleep disorders in general and obstructive sleep apnea syndrome in particular are prevalent health problems. This report describe the methodology and findings from a prospective multicenter outcomes research study on obstructive sleep apnea syndrome that was conducted by the American Academy of Otolaryngology—Head and Neck Surgery. Other outcome measures available for outcomes research in obstructive sleep apnea syndrome are also summarized.
Outcomes Assessment for Chronic Otitis Media: The Chronic Ear Survey
Authors: Nadol Joseph B. , Staecker Hinrich , Gliklich Richard E.
Published: November 2003

Analysis of outcomes in chronic otitis media has in the past been limited to audiological measurement or physical examination. The Chronic Ear Survey (CES) is an instrument to measure the impact of chronic otitis media and its treatment. The survey provides information regarding total ear‐specific health, as well as subscore information regarding activity restriction, symptoms, and medical resource usage attributable to chronic otitis media. Application of the CES to a prospective, nonrandomized series of 147 patients revealed that patients with chronic otitis media have significantly decreased CES scores compared with unaffected controls and that surgical intervention provides a significant improvement in ear‐specific outcomes.
Prospective, Randomized Outcome Study of Endoscopy Versus Modified Barium Swallow in Patients With Dysphagia
Authors: Aviv Jonathan E.
Published: November 2003

Objective Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long‐term care settings. While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia. The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve.

Study Design Randomized, prospective cohort outcome study in a hospital‐based outpatient setting.

Methods One hundred twenty‐six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia‐free interval. The patients were enrolled for 1 year and followed for 1 year.

Results Seventy‐eight MBS examinations were performed in 76 patients with 14 patients (18.4%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia. These differences were not statistically significant (ξ2 = 0.93, P = .33). In the MBS group the median pneumonia‐free interval was 47 days; in the FEESST group the median pneumonia‐free interval was 39 days. Based on Wilcoxon's signed‐rank test, this difference was not statistically significant (z = 0.04, P = .96).

Conclusion Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia‐free interval are essentially the same.
Effects of Thermal Conducting Media on the Skin Surface During Laser Irradiation
Authors: Ries William Russell , Speyer Matthew T. , Reinisch Lou
Published: November 2003

ObjectivesTo investigate the effects of thermally conductive, optically transparent media placed on skin during treatment with the flashlamp excited dye laser (FEDL). The use of higher energy densities to treat persistent cutaneous vascular lesions may result in a decrease in the number of treatment sessions. However, increased fluences can cause complications of scarring, hyperpigmentation, infection, skin texture changes, or hypopigmentation. The thermally conductive media should assist in dissipating surface thermal energy and thereby protect the skin from the complications.

Study DesignThis was a prospective laboratory study using an animal model. The results were verified in a prospective, pilot, human‐use trial.

MethodsThe threshold for acute skin damage and measurements of the thermal transients were made using a rabbit model. The threshold for purpura was noted with and without the use of a sapphire as a thermal conductor. The thermal transients were measured with small thermocouples placed subcutaneously. On a human subject, purpura intensities were photographed and measured using computer morphometrics after treatment with the FEDL and skin surface protection with air, glass, sapphire, and diamond as conductive media.

ResultsWith the interposition of the sapphire thermal conductor during the FEDL treatment, excessive temperature increases of the epidermis were prevented during the laser pulse compared with glass and controls. Both sapphire and diamond resulted in decreased purpuric intensities with the applications of equivalent fluences. Wound recovery time for the purpura was decreased by approximately half a day when any of the surface conductors were used.

ConclusionsThe decreased transient temperature and decrease in purpura seen with the use of sapphire and diamond protecting the epidermis during treatment with the FEDL should result in fewer untoward effects during treatment of vascular lesions and facilitate their management.
Patterns of Maxillofacial Injuries As a Function of Automobile Restraint Use
Authors: Major M. Scott , MacGregor Allison , Bumpous Jeffrey M.
Published: November 2003

Objective To determine the pattern and severity of maxillofacial injuries sustained in a motor vehicle accident (MVA) resulting from automobile restraint use.

Design Retrospective database review of patients injured in a MVA who were admitted to the level I trauma center at the University of Louisville Hospital in Louisville, Kentucky.

Methods Demographic data, drug and alcohol impairment screening, and comorbidity data were obtained from database searches of trauma records. Forty‐four patients had an airbag deployed, 34 patients wore seat belts, and 94 patients were unrestrained. All maxillofacial Abbreviated Injury Scale (AIS) ratings were compared among the three groups.

Results Twenty‐two of the 44 patients (50%) in the airbag group sustained only facial injuries. Fifteen of them had lacerations; four others had only facial abrasions. Three of the airbag patients had moderate facial injuries (AIS = 2); none required operative management. The airbag group had a mean AIS rating of 1.13, the seat belt group a mean AIS of 1.29, and the unrestrained group a mean AIS of 1.46. Patients using either seat belts (mean age, 40.5 y) or airbags (mean age, 44.9 y) were older than the unrestrained group (mean age, 39.6 y). Drug and/or alcohol impairment was significantly greater in the unrestrained group (mean, 38%) compared with the seat belt group (mean, 26%) and the airbag group (mean 11%).

Conclusions Use of airbags is associated with less severe maxillofacial injuries compared with either a seat belt alone or no restraint. There is an inherent risk of minor maxillofacial injuries with airbag usage, but the severity of injury is distinctly reduced.
Increased Expression of Transforming Growth Factor‐β1, Acidic Fibroblast Growth Factor, and Basic Fibroblast Growth Factor in Fetal Versus Adult Fibroblast Cell Lines
Authors: Lee Nina J. , Wang Steven J. , KayDurairaj K. , Srivatsan Eri S. , Wang Marilene B.
Published: November 2003

Objectives Fetal wound healing occurs without scar tissue formation. Differences in growth factor expression between fetal and adult fibroblasts have been explored. Recently we used RNA expression studies to demonstrate that transforming growth factor (TGF)‐β1, acidic fibroblast growth factor (α‐FGF), and basic fibroblast growth factor (β‐FGF) could be detected in both fetal and adult fibroblast cell lines. In addition, adult fibroblasts showed greater relative expression of these growth factors than fetal fibroblasts. The aim of this study was to identify the level of protein expression in fetal and adult fibroblasts.

Study Design/Methods Fetal and adult fibroblasts were grown in culture using standard and serum‐free media. After protein extraction, Western blot studies were performed to detect the presence and amount of TGFβ‐1, α‐FGF, and β‐FGF growth factor proteins. β‐Tubulin was used as a control.

Results TGFβ‐1, α‐FGF, and β‐FGF proteins were detected in fetal and adult fibroblasts grown in standard and serum‐free media. The fetal fibroblasts showed higher levels of all three growth factor proteins compared with the adult fibroblasts.

Conclusions Western blot studies suggest higher levels of TGFβ‐1, α‐FGF, and β‐FGF expression in fetal fibroblasts. It is clear that significant differences exist in the expression/production of these growth factors and it seems likely that further study of these differences will help elucidate the unique healing capabilities of fetal fibroblasts.
Supracricoid Partial Laryngectomy With Cricohyoidoepiglottopexy and Cricohyoidopexy for Glottic and Supraglottic Carcinomas
Authors: Bron Luc , Brossard Edgar , Monnier Philippe , Pasche Philippe
Published: November 2003

ObjectivesTo review the patients operated in our department with supracricoid partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) (59 cases) or cricohyoidopexy (CHP) (10 cases) technique, for primary or recurrent glottosupraglottic squamous cell carcinoma and compare the technique with other surgical or conservative approaches for treatment of laryngeal carcinoma.

MethodsFrom hospital charts, we retrospectively reviewed 69 patients who had undergone supracricoid partial laryngectomy with the CHEP or CHP technique between 1983 and 1996 for primary or recurrent glottosupraglottic squamous cell carcinoma in our department. Statistical evaluation of oncological and functional results were conducted. Results were compared with other surgical and conservative treatment for glottosupraglottic carcinoma of the larynx that were published previously in the literature.

ResultsSixty‐nine patients had CHEP or CHP for glottosupraglottic carcinoma of the larynx. Thirteen percent of the patients received adjuvant radiotherapy. Minimum follow‐up was 2 years or until death. Five‐year actuarial survival (Kaplan‐Meier method) was 68%. Global local control was achieved in 84% of cases. Among previously untreated patients (n = 54), local control rate was 94.5%. After 1 year, 92.7% of patients achieved normal swallowing and respiration. Salvage total laryngectomy had to be performed in four patients (5.7%) for persistent aspiration and in five patients (7.2%), who were previously treated with radiotherapy, for local recurrence. No permanent tracheostomy or gastrostomy was required.

ConclusionsOur experience with supracricoid partial laryngectomy with either CHP or CHEP suggests that this technique is a valuable alternative to radiotherapy for T2–T4 glottosupraglottic carcinomas, particularly those with extension and invasion of the anterior commissure. It allows for preservation of a good laryngeal function without altering the long‐term survival, keeping total laryngectomy as a salvage procedure.
Identification of MUC5B Mucin Gene in Human Middle Ear With Chronic Otitis Media
Authors: Kawano Hirokazu , Paparella Michael M. , Ho Samuel B. , Schachern Patricia A. , Morizono Noriko , Le Chap T. , Lin Jizhen
Published: November 2003

Objectives To identify the mucin gene and its expressing cells in the middle ear mucosa with chronic otitis media (COM), and to study the correlation between infiltration of inflammatory cells in the submucosa and expression of the mucin gene in the mucosal epithelium with COM.

Study Design Middle ear mucosal specimens removed from the inferior promontory area of 19 patients undergoing middle ear surgery for COM were studied.

Methods Sections were stained with H&E, Alcian blue‐periodic acid Schiff (AB‐PAS), polyclonal MUC5B antibody, and specific MUC5B riboprobe for histological, histochemical, immunohistochemical, and mucin mRNA analyses.

Results H&E staining revealed pseudostratified epithelia in 18 of the middle ear specimens with COM and cuboidal secretory epithelia in one. AB‐PAS staining of epithelia revealed abundant secretory cells and their products (glycoconjugates). In situ hybridization and immunohistochemistry studies demonstrated that the secretory cells of the middle ear mucosa with COM expressed MUC5B mucin mRNA and its product MUC5B mucin.

Conclusions The MUC5B mucin gene and its product were identified in the middle ear secretory cells of patients with COM. Its e‐pression was e‐tensive in pseudostratified mucosal epithelia and related to infiltration of inflammatory cells in the submucosa of the middle ear cleft with COM, suggestive that inflammatory cell products are involved in the production of MUC5B.
Hearing Preservation With Labyrinthine Ablation in Otitis Media
Authors: Antonelli Patrick J. , Briggs Russell D. , Gerhardt Kenneth J.
Published: November 2003

Objectives Iatrogenic fenestration of the inner ear in the presence of otitis media is commonly associated with permanent hearing loss. Hearing can generally be preserved when the vestibular labyrinth is ablated in a controlled manner in noninflamed ears. The purpose of this study was to examine the feasibility of hearing preservation with violation of the inner ear in the presence of middle ear inflammation.

Study Design Prospective and controlled animal model.

Methods Otitis media was induced bilaterally in pigmented guinea pigs with transtympanic injection of Streptococcus pneumoniae, nontypeable Haemophilus influenzae, or formalin‐killed nontypeable H influenzae. Two to 4 days after injection, the horizontal canal of one ear was transected and sealed. Hearing was tested before and after labyrinthine ablation.

Results Otitis media was induced in all ears. Bacterial cultures were positive in 19 of 20 S pneumoniae–injected ears, and in 10 of 16 nontypeable H influenzae–injected ears. One week after surgery, elevation of click thresholds (> 15 dB) was encountered in none of the fenestrated or unfenestrated S pneumoniae–infected ears, in two of six unfenestrated and three of six fenestrated nontypeable H influenzae–infected ears, and in one of five killed‐nontypeable H influenzae– injected ears both with and without fenestration.

Conclusions These data suggest that ablation of a semicircular canal in the presence of middle ear inflammation or infection does not necessarily lead to profound sensorineural hearing loss. Hearing loss associated with iatrogenic violation of the semicircular canals may be more dependent on factors other than the presence of nonspecific middle ear inflammation.
Partial Parotidectomies: Morbidity and Benign Tumor Recurrence Rates in a Series of 94 Cases
Authors: Lee Rea J.
Published: November 2003

Objectives Review the methods available for parotidectomy. Describe the technique of partial parotidectomy assisted by evoked electromyographic nerve location and the expected morbidity and benign and low‐grade cancer tumor recurrence rates from this modified procedure.

Study Design From 1983 to 1999 the author performed or assisted in 94 parotidectomies (79 partial), all done by a single specialty group and all using evoked electromyographic nerve location. The cases were surveyed by reviewing all the hospital and office records on these cases and tabulating the type and extent of surgery, pathology, postoperative problems recorded, and long‐term follow‐up.

Methods Partial parotidectomy was elected in those cases of benign and low‐grade malignant disease in which adequate tumor removal required a less than complete lobectomy or total parotidectomy. Heavy reliance was placed on proactive nerve location by an evoked electromyographic device with dissecting/stimulating hemostat. A retrospective review focusing on these cases was performed based on the patient charts and their continued documentation by the practice.

Results In 79 partial parotidectomies there were no documented facial nerve injuries and one incidence of recurrence of a benign mixed tumor and an acinic cell carcinoma, respectively.

Conclusion Partial parotidectomy has the advantages of reduced risk to the facial nerve, reduced operating time, possible outpatient surgery, and no apparent risk of increased recurrence of benign tumors.
Bacteriology of Nontraumatic Maxillary Sinus Mucoceles Versus Chronic Sinusitis
Authors: Busaba Nicolas Y. , Siegel Noah , Salman Salah D.
Published: November 2003

Objective To compare the bacteriology of maxillary sinus mucoceles to chronic sinusitis and understand the pathogenesis of nontraumatic maxillary sinus mucoceles (NTMSM).

Study Design Retrospective review.

Methods Review of intraoperative bacteriology culture results obtained in patients with NTMSM. Patients with history of facial trauma or previous paranasal sinus surgery were not included in the study. The results were compared to intraoperative cultures obtained from patients with chronic sinusitis (CS).

Results The study groups consisted of 16 patients with NTMSM (9 male and 7 female patients) and 211 patients with CS (86 male and 125 female patients). Cultures in the NTMSM group were positive in 7 of 16 patients (44%) (four cultures had more than one isolate). There was no growth in cultures of 9 patients (56%). On the other hand, cultures in 176 patients with CS (83%) grew organisms (42 cultures had more than one isolate); there was no growth in 35 of 211 patients (17%) (P = .0007). The cultures grew aerobic bacteria in 7 of 16 (44%) and 160 of 211 (76%) patients of the NTMSM and CS groups, respectively. Anaerobic bacteria were detected in cultures of 2 of 16 patients (12.5%) with NTMSM compared with 13 of 211 patients (6.2%) in the CS group (P = .286). The most common pathogenic aerobe in the NTMSM group was α‐hemolytic Streptococcus, while Staphylococcus aureus was the most common in the CS group.

Conclusion The bacteriology of maxillary sinus mucoceles is different from that of CS. The majority of patients with mucoceles have sterile intraoperative cultures. The data do not support infection as the main origin of NTMSM.
High Incidence of Laryngopharyngeal Reflux in Patients With Head and Neck Cancer
Authors: Copper Marcel P. , Smit Conrad F. , Stanojcic Laki D. , Devriese Pieter P. , Schouwenburg Paul F. , Mathus‐Vliegen Lisbeth M.H.
Published: November 2003

Objectives Laryngopharyngeal reflux may play a role in the etiology of squamous cell cancer of the head and neck and contribute to complications in head and neck cancer patients after surgery or during radiotherapy.

Study Design Prospective study.

Methods To investigate the incidence of laryngopharyngeal and gastroesophageal reflux in patients with head and neck cancer, ambulatory 24‐hour double‐probe pH monitoring was performed in 24 untreated patients with laryngeal or pharyngeal squamous cell carcinoma. In addition, 10 patients who had been irradiated in the head and neck area were analyzed for reflux to study the effect of radiotherapy on reflux.

Results Only 4 of the 24 head and neck cancer patients (17%) had neither pathological laryngopharyngeal nor gastroesophageal reflux. Esophageal acid exposure was abnormal in five patients and acid exposure at the level of the upper esophageal sphincter was abnormal in four patients. Eleven patients had pathological reflux in both areas. Irradiated patients did not differ from the untreated patients considering the incidence of pathological laryngopharyngeal or gastroesophageal reflux.

Conclusions The data obtained in this study indicate that reflux is a common event in head and neck cancer patients.
Ki‐67 (MIB1), p53, and Lewis‐X (LeuM1) as Prognostic Factors of Recurrence in T1 and T2 Laryngeal Carcinoma
Authors: Sittel Christian , Eckel Hans E. , Damm Michael , von Pritzbuer Ekkehard , Martin Kvasnicka Hans
Published: November 2003

Objectives Recently published data suggest a prognostic value of immunohistochemical proliferation markers for limited laryngeal carcinoma. Previous studies have reported contrasting findings on this issue. In this context, different treatment modalities may be responsible for contradictory findings. To study the relationship between proliferative activity—expressed by the immunohistochemical labeling index of proliferation‐associated markers Ki‐67 (MIB1), Lewis‐X (LeuM1), and proliferating cell nuclear antigen (PCNA) and by p53 status—and treatment failure in a matched‐pair study on recurrent and nonrecurrent T1 and T2 glottic carcinoma having received primary transoral laser surgery.

Methods Twenty‐one patients with tumor recurrence were randomly selected and matched with 26 patients with nonrecurrent disease regarding histopathological grading and age. MIB1 staining was used to determine the Ki‐67 labeling inde‐, and LeuM1 staining for detecting the Lewis‐X antigen; immunohistochemistry determined the p53 status and PCNA labeling inde‐.

Results The Ki‐67 labeling index was significantly (P = .001) higher in tumors from patients who had treatment failure (mean = 20.02%) than in patients who did not fail treatment (“nonfailures”) (mean = 9.95%). Carcinoma with a Ki‐67 (MIB1) labeling index above the median (15%) of the general study population showed a mean time to relapse of 23 months (n = 21), compared with 50 months for cases (n = 26) below the median (P = .016). PCNA labeling index correlated less impressively with tumor recurrence (mean = 28.59% for treatment failures, mean = 21.75% for nonfailures, P = .022). Positive detection of the Lewis‐X antigen was significantly associated with recurrence (P = .015) and time to relapse (P = .006). Status of p53 was not a significant prognostic factor.

Conclusion The Ki‐67 (MIB1) labeling index may be associated with early relapse of limited laryngeal carcinoma treated with transoral laser surgery. Since the prognostic relevance of Ki‐67 seems to be different for radiological and surgical concepts of treatment, Ki‐67 might become useful as criterion of therapy selection. The Lewis‐X antigen, for the first time used on laryngeal carcinoma, seems to be a strong prognostic marker deserving further investigations.
Wedge Turbinectomy: A New Combined Photocoagulative Nd:YAG Laser Technique
Authors: Vagnetti Alessandro , Gobbi Emanuele , Maria Algieri Giuseppe , D'Ambrosio Luciano
Published: November 2003

Objectives To demonstrate that Nd:YAG laser photocoagulation using a combination of interstitial and contact approaches in the surgical treatment of inferior turbinate hypertrophy yields improved results in terms of postoperative nasal patency, complications, and relapse.

Study Design A group of 121 patients with symptoms of nasal obstruction due to hypertrophied inferior turbinates were treated between January 1994 and December 1997 at the Otolaryngology—Head and Neck Surgery Unit of the Main Military Hospital of Rome using the wedge turbinectomy, a new endonasal laser technique.

Methods This is a combined photocoagulative procedure performed under local anesthesia. In the first surgical step we perform interstitial photocoagulation using Nd:YAG laser and in the second step we use a contact approach, making two strips of photocoagulated mucosa running side by side from the tail to the head of turbinate.

Results At 1‐year follow‐up, the complication rate in all our patients treated with this laser technique was very low and we achieved a steady improvement in nasal patency in 104 patients (85.9%). The relapse rate was approximately14%, but we observed that 65% of the patients who experienced long‐term failure were affected by allergic rhinitis.

Conclusions An accurate preoperative evaluation of the cause of the turbinate hypertrophy is fundamental to achieving better results after laser turbinectomy and reducing the risk of relapse.
Candidate's Thesis: Chronic Sinusitis and Anosmia: Pathologic Changes in the Olfactory Mucosa
Authors: Kern Robert C.
Published: November 2003

Objectives To evaluate histological changes in the olfactory mucosa of patients with chronic rhinosinusitis. These results are analyzed in light of current understanding of the pathophysiology of anosmia secondary to nasal and sinus disease.

Study Design Prospective study of olfaction on patients undergoing sinus surgery for the management of chronic rhinosinusitis.

Methods Thirty patients, aged 22 to 39 years, underwent olfactory biopsy at the time of surgery with evaluation by a pathologist. Inflammatory changes were graded as mild (normal), moderate, or severe. Clinical olfactory function was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT). The results correlated with the degree of olfactory dysfunction.

Results Of the 30 patients 19 had unequivocal olfactory mucosa in the biopsy specimen. Eleven had only respiratory or indeterminate mucosa. Nine patients demonstrated normal olfactory mucosa and normal olfactory function (UPSIT >35). Ten patients demonstrated pathological changes in the olfactory mucosa with an influx of lymphocytes, macrophages, and eosinophils. Of these 10 patients, 7 had olfactory deficits as determined by UPSIT. The remaining three patients had normal olfactory function despite moderate chronic inflammation. These studies indicate that the olfactory mucosa is capable of mounting an inflammatory response similar to that seen in the respiratory mucosa of patients with chronic sinusitis. These data suggest that the olfactory deficits in these patients may be the result of inflammatory changes within the olfactory mucosa in addition to any alteration in airflow to the olfactory cleft.
Acoustic Characteristics of Voice After Severe Traumatic Brain Injury
Authors: McHenry Monica
Published: November 2003

Objectives/Hypothesis To describe the acoustic characteristics of voice in individuals with motor speech disorders after traumatic brain injury (TBI).

Study Design Prospective study of 100 individuals with TBI based on consecutive referrals for motor speech evaluations.

Methods Subjects were audio tape‐recorded while producing sustained vowels and single word and sentence intelligibility tests. Laryngeal airway resistance was estimated, and voice quality was rated perceptually.

Results None of the subjects evidenced vocal parameters within normal limits. The most frequently occurring abnormal parameter across subjects was amplitude perturbation, followed by voice turbulence index. Twenty‐three percent of subjects evidenced deviation in all five parameters measured. The perceptual ratings of breathiness were significantly correlated with both the amplitude perturbation quotient and the noise‐to‐harmonics ratio.

Conclusions Vocal quality deviation is common in motor speech disorders after TBI and may impact intelligibility.
Application of the Vestibular Disorders Activities of Daily Living Scale
Authors: Cohen Helen S. , Kimball Kay T. , Adams Angela S.
Published: November 2003

Objective Existing scales of functional performance are either insufficiently sensitive or omit some important daily life tasks. This paper demonstrates that a new scale of self‐perceived disablement in the vestibularly impaired population—the Vestibular Disorders Activities of Daily Living Scale (VADL)—differentiates between disabled and healthy persons and evaluates the associations of this assessment with other measures of vestibular disorders.

Study Design Prospective.

Methods Subjects were 1) asymptomatic, healthy adults, 2) patients with benign paroxysmal positional vertigo, 3) patients with chronic vestibulopathy excluding Meniere's disease, postsurgical vertigo, and postconcussion vertigo, and 4) family members. Patient were assessed on the VADL, the Dizziness Handicap Inventory, level of vertigo, and computerized dynamic posturography. Healthy subjects and family members completed the VADL.

Results The VADL differentiates healthy persons from patients but does not differentiate between patient groups. Patients perceived themselves as more independent than their spouses perceived them to be. Scores are weakly correlated with vertigo frequency and posturography scores for conditions with unreliable kinesthesia and absent or unreliable vision. The VADL is more responsive to higher levels of impairment than the Dizziness Handicap Inventory.

Conclusions This well‐normed, self‐administered scale of self‐perceived disablement is useful for evaluating the functional status of patients with peripheral vestibular disorders. Perceptions of patients and significant others vary, but scores are moderately correlated with some standard measures of vestibular function. As it assesses a different domain of function than do standard diagnostic tests, the VADL will augment these tests during initial evaluation and may be useful for assessing posttreatment change.
Genome‐Wide Screening for Radiation Response Factors in Head and Neck Cancer
Authors: Singh Bhuvanesh , Kim Se‐Heon , Carew John F. , Yu Irene , Shaha Ashok R. , Wolden Suzanne , Boyle Jay , Shah Jatin P. , Rao Pulivarti H.
Published: November 2003

Introduction Radiation therapy is an integral part of the treatment of head and neck cancer. Factors predicting radiation response are ill defined. The aim of this study was to identify genetic aberrations associated with radiation response in cell lines derived from head and neck squamous cell carcinomas (HNSCC) using comparative genomic hybridization (CGH) for genome‐wide screening.

Methods Five cell lines derived from HNSCC were subjected to a single course of radiation (400 cGy) in parallel with a similarly handled, untreated control. Cellular response to radiation was determined on posttreatment days 1, 2, 3, 4, and 5 using a cell viability assay (MTT assay). Radiation response was defined as 35% or greater decrease in cell survival relative to control. Tumor doubling time was determined by cell counts performed at day 0 and 1 for each cell line. All experiments were done in quadruplicate. CGH analysis was performed by differentially labeling DNA from tumor and normal tissue with fluorescent agents. The labeled DNAs were simultaneously hybridized to normal metaphase chromosomes. Image analysis for fluorescence intensity along the entire length of each metaphase chromosome allowed generation of a color ratio, which was used to detect copy number changes.

Results Radioresistance was identified in two of five cell lines. The tumor doubling time was not a predictor of radiation response. CGH identified a complex pattern of aberrations, with gain of 3q common to all cell lines. The number of genetic aberration was higher in radiation‐sensitive cell lines than in radiation‐resistant ones. No recurrent aberrations were unique to the radiation‐resistant cell lines. Recurrent gains at 7p and 17q and losses at 5q, 7q, and 18q were unique to the radiation‐sensitive cell lines.

Conclusions The number of aberrations identified by CGH analysis may be a predictor of radiation response. A large study of primary tumors is warranted to confirm this association and identify specific genetic aberrations associated with radiation response.
Efficacy of Computed Tomographic Image–Guided Endoscopic Sinus Surgery in Residency Training Programs
Authors: Casiano Roy R. , Numa William A.
Published: November 2003

Objective To determine the efficacy of computed tomographic image‐guided endoscopic surgery in the hands of inexperienced surgeons.

Study Design Four second‐year otolaryngology residents, with no prior experience performing ethmoidectomies, performed endoscopic sinus surgery (ESS) on formalin‐fixed human cadaveric specimens with and without the aid of computer‐assisted surgery (CAS).

Methods Each resident was asked to identify critical sinus, orbital, and skull base structures while performing a total ethmoidectomy and multiple sinusotomies. Their surgical accuracy (percentage of correctly identified structures), total operative time, and incidence of major complications were recorded for each side. A total of 16 sides were evaluated (8 with and 8 without CAS). Statistical significance between groups was determined by means of Pearson's χ2 analysis.

Results Statistical analysis showed a significant difference (P = .001) in the mean accuracy of identifying critical anatomical landmarks between the CAS (97%) and non‐CAS (76.8%) groups. Although not statistically significant, operative time appeared to be longer in the group using CAS (average of 67 vs. 80 min). Three major intracranial complications were documented only in the group not using CAS.

Conclusions Although, unquestionably, a thorough knowledge of the anatomy remains essential for performing ESS, CAS improves surgical accuracy and reduces the risk of major intracranial or intraorbital complications for residents. In additional, our data suggest that this technology may enhance surgical efficiency and improve the learning curve by reducing operative time (below one's normal baseline) while maintaining a greater than 90% accuracy in identifying critical anatomical landmarks.
Arytenoid Adduction Combined With Gore‐Tex Medialization Thyroplasty
Authors: McCulloch Timothy M. , Hoffman Henry T. , Andrews Brian T. , Karnell Michael P.
Published: November 2003

Objective To describe the technique of combined Gore‐Tex medialization thyroplasty with arytenoid adduction and to determine the long‐term vocal outcome of patients treated for unilateral vocal cord paralysis with this procedure.

Study Design A retrospective chart review and patient reevaluation for patients treated at The University of Iowa Hospitals and Clinics between May 1995 and June 1999.

Methods The review addressed patient demographics, perioperative and long‐term complications, and voice outcomes. Details of the surgical technique are provided within the manuscript.

Results Seventy‐two Gore‐Tex medialization procedures were completed. Arytenoid adduction was included in 22 of these procedures. This subset of patients was compared with the patients treated with Gore‐Tex alone. No major postoperative complications occurred in either group. Preoperative and postoperative voice and videostroboscopy data were available for 19 arytenoid adduction patients and 25 Gore‐Tex alone patients. On a seven‐point scale (6 [severely abnormal] → 0 [normal voice]), the average patient rating of voice dysfunction improved from 4.2 to 1.6 (arytenoid adduction) and 4.5 to 2.8 (Gore‐Tex alone). Maximum phonation time improved from 6.9 seconds to 16.7 seconds in the arytenoid adduction group. Subjective voice assessment employing the four‐point GRBAS scale (3 [severely abnormal] → 0 [normal]) identified average improvement from an overall grade of 2.1 to 0.8 arytenoid adduction and 2.2 to 1.5 in the Gore‐Tex alone group. Improvement was identified in the vocal quality of breathiness from 1.9 to 0.2 (arytenoid adduction) and 1.9 to 0.9 (Gore‐Tex alone).

Conclusions The combined technique of Gore‐Tex medialization thyroplasty and arytenoid adduction provide functional results that appear to exceed the improvement attained with medialization alone.
Quantitative Analysis of Eotaxin and RANTES Messenger RNA in Nasal Polyps: Association of Tissue and Nasal Eosinophils
Authors: Shin Seung‐Heon , Park Jae‐Yul , Jeon Chang‐Ho , Choi Jin‐Kyo , Lee Sang‐Heon
Published: November 2003

Objectives/Hypothesis Nasal polyps develop in the ethmoidal and middle turbinate area, often in relation to inflammatory conditions. Their exact etiology and pathogenesis are still under debate. Histologically, the polyps are infiltrated by a number of inflammatory cells, with eosinophil predominating in most specimens. This finding suggests that the nasal polyp is an inflammatory growth that is controlled by the local environment. The chemokines eotaxin and RANTES (r egulated on a ctivation n ormal T cell e xpressed and s ecreted) have been postulated to be involved in the recruitment and activation of eosinophils to certain inflamed tissues. The purpose of this study was to investigate eotaxin and RANTES mRNA expression in nasal polyps and its effect on tissue and nasal eosinophils.

Methods Nasal polyps (917 allergic and 30 nonallergic cases) were obtained from endoscopic sinus surgery, and 15 normal inferior turbinates also were taken. Immunohistochemical staining for eosinophils and quantitative reverse transcriptase–polymerase chain reaction (RT‐PCR) tests for eotaxin and RANTES mRNA expression were performed, and the concentration of nasal eosinophil cationic protein (ECP) was measured.

Results The amounts of eotaxin mRNA in the allergic nasal polyps were 11.4 times higher and the levels in the nonallergic polyps were 6.4 times higher than in the normal inferior turbinate. However, the RANTES mRNA expression did not show any differences among the three groups. Tissue eosinophilia and nasal ECP levels were significantly correlated with eotaxin mRNA level but not with RANTES mRNA expression.

Conclusion Nasal polyp eosinophilic infiltration and activation correlate mainly with increased eotaxin gene expression rather than with RANTES expression.
Variability of Eustachian Tube Function: Comparison of Ears With Retraction Disease and Normal Middle Ears
Authors: Bunne Marie , Falk Bernt , Magnuson Bengt , Hellström Sten
Published: November 2003

Objective To explore the short‐term and long‐term variability of tubal opening and closing in ears with advanced retractions and in healthy ears.

Study Design/Methods Twenty ears with retraction type middle ear disease (R‐MED) and 20 normal ears underwent direct recording of the middle ear pressure during repeated forced openings, equalization of +100 daPa and −100 daPa by swallowing, Valsalva inflation, and forceful sniffing. Tests were performed twice (separated by 30 min) on each of 2 days separated by 3 to 4 months.

Results There was considerable intraindividual variability of the forced opening pressure and the closing pressure in both groups, within as well as between sessions and test days. Although the variability was 1.5 to 2 times higher in ears with retraction than in the normal group, mean Po and Pc did not differ between the groups. Compared with normal ears, ears with retraction changed more frequently from a positive to negative test response, or vice versa, when re‐tested after 30 minutes. Rates of positive response in the equalization and Valsalva tests were significantly lower in diseased ears compared with normal ears.

Conclusions Eustachian tube opening and closing functions vary more in ears with retraction disease than in normal ears, which is consistent with the variable clinical course of R‐MED and implies that single tubal function tests have little prognostic value on the individual level.
Safety of Neck Rotation for Ear Surgery in Children With Down Syndrome
Authors: Wendell Todd N. , Holt Philip J. , Thomas Allen A.
Published: November 2003

Objective Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery.

Study Design Prospective consecutive patients, each serving as his or her own control.

Methods Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal.

Results When the anesthetized children had their necks placed in either right or left 60° rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60° neck rotation during surgery.

Conclusion Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.
Fluorescent In Situ Hybridization Evaluation of p53 Gene Deletions at a Tumor Interface of Lingual Carcinoma
Authors: Hartig Gregory , Zhang Jianhua , Marta Voytovich G. , Newton Michael , Chen Alice , Collins Savita P. , Wu Shi‐Qi
Published: November 2003

Objective/Hypothesis To evaluate the ability of fluorescent in situ hybridization (FISH) to detect malignant cells missed by standard histological assessment at an interface between malignant and normal tissue in lingual squamous cell carcinoma (SCC) and to correlate findings of FISH assessment with patients' clinical stages.

Study Design Retrospective assessment of archival tissue from 31 patients with lingual SCC treated at University of Wisconsin Hospital and Clinics in Madison.

Methods An assay combining standard histological and FISH techniques was used to assess a tumor interface tissue section and allow identification of each tumor's ploidy characteristics and p53 gene deletions and the presence or absence of malignant cells within tissue viewed as “normal” on histological review.

Results Forty‐five percent of tumors (14 of 31) demonstrated ploidy changes and 84% (26 of 31) showed p53 deletions. Of these 26 tumors with p53 deletions, 14 were found to have “microfoci” with p53 deletions within tissue that appeared normal on histological e‐amination. These microfoci were found in 75% of late‐stage tumors and in only 35% of early‐stage tumors.

Conclusions FISH allowed identification of malignant cells in tissue viewed as normal on standard histological assessment, and this finding occurred more frequently in late‐stage tumors.
A Prospective Population‐Based Study of Cutaneous Malignant Melanoma of the Head and Neck
Authors: Gillgren Peter , Månsson‐Brahme Eva , Frisell Jan , Johansson Hemming , Larsson Olle , Ringborg Ulrik
Published: November 2003

Objectives/HypothesisFor cutaneous malignant melanoma (CMM) of the head and neck, neither prognostic factors in population‐based groups, nor outcome with respect to surgical resection margins is clear. Therefore, we analyzed data in a regional registry to align treatment results for CMM of the head and neck with prognosis and survival times.

Study DesignPatient material collected prospectively for an 18‐year period in a Swedish cancer registry underwent statistical analyses to establish the most reliable prognostic factors and the influence of surgical treatment on the survival of patients with CMM of the head and neck.

MethodsData originated from the CMM database of the Stockholm‐Gotland area of Sweden. Tumor thickness or invasiveness (Breslow or Clark's levels), extent of surgical margin, sex, histogenetic type, anatomic site, and ulceration were compared statistically for 469 patients.

ResultsMale patients with head and neck CMM had a 68% 10‐year survival rate; the 10‐year survival rate for female patients was 87%. The corresponding figures for CMM at other sites were 83% and 90%, respectively. Tumor thickness (or Clark level of invasion) was the only statistically significant prognostic factor in a multivariate analysis (P< .001). The surgical resection margin seemed to be of no importance to outcome.

ConclusionsLong‐term survival after treatment for CMM of the head and neck is better than reported in most earlier publications, presumably because our evaluation used population‐based materials, an important factor in accurate reporting of this kind. Tumor thickness is the main prognostic factor in estimating outcome.