bluuebunny/crossref_metadata_2025_split huggingface dataset:
Possible participation of acidic pH in bone resorption in middle ear cholesteatoma
Authors: Nguyen Khac‐Hung , Suzuki Hideaki , Ohbuchi Toyoaki , Wakasugi Tetsuro , Koizumi Hiroki , Hashida Koichi , Baba Ryoko , Morimoto Hiroyuki , Doi Yoshiaki 
Published: October 2013

Objectives/HypothesisThe etiopathology of bone resorption in cholesteatoma is unclear. We studied pH in middle ear cholesteatoma tissue and the permeability of the cholesteatoma epithelium in an attempt to elucidate the mechanism of bone resorption in this disease.Study DesignLaboratorial study.MethodsCholesteatoma tissue was collected from patients with primary acquired middle ear cholesteatoma. The pH of the keratin debris of cholesteatoma was measured using a pH meter. The cholesteatoma epithelium was examined under a confocal laser scanning microscope, and under a transmission electron microscope. Expression of filaggrin in the cholesteatoma tissue was explored by fluorescence immunohistochemistry and by quantitative reverse transcription‐polymerase chain reaction.ResultsThe pH of the keratin debris of cholesteatoma was acidic. The pH of the basal layer of the cholesteatoma epithelium was significantly lower than that of the antrum mucosa. Transmission electron microscope showed distinct penetration of lanthanum in the intercellular space of the basal, spinous, and granular layers of the cholesteatoma epithelium, but only a small amount of lanthanum in the granular layer in the normal skin. The expression of filaggrin mRNA was significantly lower in the cholesteatoma tissue than in the normal skin.ConclusionsThese results indicate that acid leakage through the cholesteatoma epithelium probably participates in the resorption of the underlying bone structure. The increased permeability of the cholesteatoma epithelium may be explained by a decrease in filaggrin expression.Level of EvidenceN/A. Laryngoscope, 124:245–250, 2014
Hyaluronic acid gel weight: A nonsurgical option for the management of paralytic lagophthalmos
Authors: Martín‐Oviedo Carlos , García Irene , Lowy Alex , Scola Esteban , Aristegui Miguel , Scola Bartolome 
Published: October 2013

Objectives/HypothesisManagement of lagophthalmos should be a priority in the treatment of patients with facial palsy. The aim of the study was to evaluate the safety and efficacy of injecting hyaluronic acid gel into the upper eyelid as a nonsurgical alternative for patients with temporary facial palsy.Method/Study DesignRetrospective study of 26 patients treated with hyaluronic acid gel injected into the pretarsal region of the upper eyelid. Measurements taken before and after treatment were standardized and compared using digitized photographs. Patients were followed up for 1 year, and overall outcomes were assessed.ResultsAll patients initially demonstrated improvement in lagophthalmos, which decreased to 0.0 mm. After 1 month, a significant increase in lagophthalmos was observed in two patients (initial fissure of 8 and 9 mm), and a platinum weight was implanted to control keratopathy. The remaining patients (initial lagophthalmos below 6.5 mm) maintained the improvement until facial restoration. Only three patients had recurrent lagophthalmos (2 mm) due to resorption, which was resolved by injecting an additional 0.3 cc. The mean improvement in lagophthalmos was 4.6 mm (range, 3.5–6.5 mm). Complications included transient ecchymosis and minimal blepharoptosis due to nonreabsorption in five patients. These patients were successfully treated with hyaluronidase.ConclusionsHyaluronic acid gel has proven effective in reducing paralytic lagophthalmos and controlling keratopathy in patients with temporary facial palsy, especially those with palpebral fissure with attempted closure no greater than 6.5 mm. Injection of hyaluronic acid gel is safe, quick, and easily performed. In addition, it is more cost‐effective than surgery.Level of Evidence4. Laryngoscope, 123:E91–E96, 2013
Acceptability and reliability of multiple mini interviews for admission to otolaryngology residency
Authors: Campagna‐Vaillancourt Maude , Manoukian John , Razack Saleem , Nguyen Lily H. P. 
Published: October 2013

Objectives/HypothesisTo evaluate the acceptability and reliability of the Multiple Mini Interview (MMI) for the selection of applicants to an Otolaryngology–Head and Neck (OTL–HNS) residency program.Study DesignProspective observational study.MethodsCanadian medical graduates applying to the OTL–HNS residency program at McGill University in 2011 and 2012 underwent a 7‐station MMI. Upon completion, the major stakeholders commented on and rated various aspects of the MMI using a 7‐point Likert scale. Descriptive statistics were used to analyze the quantitative portion of the exit survey, while content analysis and thematic description was applied to qualitative data. Interrater reliability was examined with intraclass correlation coefficients.ResultsData was collected from 45 applicants and 18 evaluators. The majority of applicants (>80%) felt that the MMI helped them present their strengths and was free of any gender, cultural, or age bias. Assessors (>85%) agreed the MMI evaluated a valid range of competencies, and that it tested more aspects of an applicant than did traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred it over the traditional interview. Overall, interrater reliability of the MMI was good.ConclusionThis is the first study to examine how the MMI interview process can be adapted for admission to an OTL–HNS residency program, while showing both good acceptability for all major stakeholders and good reliability.Level of EvidenceN/A Laryngoscope, 124:91–96, 2014
Down syndrome: An electrophysiological and radiological profile
Authors: Saliba Issam , Sbeity Samer , El‐Zir Elie , Yammine Fady G. , Noun Carla T. , Haddad Antoine 
Published: October 2013

Objectives/HypothesisTo assess the hearing status of trisomy 21 patients by analyzing electrophysiological and radiological findings of any correlation between hearing impairment and major or minor inner ear malformations.Study DesignProspective radiological and electrophysiological study.MethodsA group of 34 ears of Down syndrome subjects and 20 ears of a volunteer age‐ and sex‐matched control group of 10 normal subjects were studied electrophysiologically by means of otoacoustic emissions and auditory brainstem response. Temporal bone computed tomography (CT) scans were carried out in both groups; radiological findings were compared. Inner ear structure measurements were applied attempting to disclose subtle bony labyrinthine anomalies. The findings from both groups were statistically analyzed employing the t test.ResultsThe rate of sensorineural hearing loss (SNHL) in Down syndrome group was 41%. Temporal bone CT scans showed no ossicular malformation in all Down syndrome cases. Major inner ear abnormalities were disclosed in 5.8%; they corresponded to two cases of lateral semicircular canal dysplasia detected on CT images by visual inspection. The application of various inner ear structure measurements increased the overall detection rate of common inner ear malformations to 47%. A statistically significant correlation was found between hearing level and vestibule length (P = .009) and internal auditory canal length (P = .028). Vestibular aqueduct width was correlated to different otic abnormalities.ConclusionsSNHL is mainly secondary to the underestimated subtle inner ear malformations that are adequately demonstrated by adopting standardized inner ear structure measurements on petrous bone imaging. Vestibular height and internal auditory canal length were correlated to SNHL.Level of Evidence3b. Laryngoscope, 124:E141–E147, 2014
Septal perforation repair without intraoperative mucosal closure
Authors: Flavill Eric , Gilmore Jim E. 
Published: October 2013

Objectives/HypothesisTo report a technique for septal perforation repair that does not rely on intraoperative mucosal closure of the perforation defect.Study DesignCase series with prospective and retrospective data collection.MethodsNine patients received multilayer interposition grafts and no attempt at intraoperative mucosal closure for repair of septal perforations. Eight patients received multilayer interposition grafts consisting of temporoparietal fascia on one side, polydioxanone plate in the middle, and deep temporal fascia on the other side. One patient received a variant graft consisting of acellular dermal matrix, polydioxanone plate, and full‐thickness temporal fascia. Silastic or silicone sheets were placed bilaterally for at least 12 weeks to protect the septum during healing. This technique was applied to a variety of challenging surgical candidates.ResultsThe eight patients who received interposition grafts with bilateral temporal fascia had complete repair of septal perforation sites. The variant interposition graft had complete loss on the acellular dermal matrix side but good integration of temporal fascia on the contralateral side.ConclusionsThis tension‐free technique does not rely on intraoperative mucosal closure of the septal perforation. It has been used to successfully obtain complete repair in a variety of challenging surgical candidates when combined with temporal fascia autografts.Level of Evidence4. Laryngoscope, 124:1112–1117, 2014
Ten‐year health‐related quality of life in cochlear implant recipients
Authors: Arnoldner Christoph , Lin Vincent Y. , Honeder Clemens , Shipp David , Nedzelski Julian , Chen Joseph 
Published: October 2013

Objectives/HypothesisTo evaluate the long‐term impact of cochlear implantation on quality of life measured by the Medical Outcomes Study 36‐Item Short‐Form Health Survey (SF‐36). Scores were also converted to the SF‐6D to derive health utility scores.Study DesignProspective cohort study.MethodsThirty‐two patients undergoing cochlear implantation completed the SF‐36 preoperatively, 1 year, and 10 years after cochlear implantation.ResultsSF‐36 results showed improvements in seven of the eight attributes when preoperative scores where compared with 1‐ and 10‐year results. Between 1 and 10 years postoperatively, six of eight domains deteriorated in scores. When converted to the SF‐6D, the mean preoperative utility scores were 0.592 for standard gamble, 0.636 using the ordinal health state paradigm, and 0.579 using the Bayesian technique. Ten years postoperatively, health utility scores were 0.643 (standard gamble), 0.684 (ordinal health state), and 0.6 (Bayesian). Between preoperatively and 10‐year postoperatively, improvements were therefore 0.051, 0.048, and 0.021 for standard gamble, ordinal health state, and Bayesian paradigm, respectively.ConclusionsThis study establishes the long‐term sustained benefits of cochlear implantation on quality of life. Nevertheless, both the SF‐36 and SF‐6D seem to underestimate the benefit accrued through this intervention. Our data are consistent with others regarding the unsuitability of the SF‐36 in benefit assessment, notwithstanding that conversion to the SF‐6D is feasible, and the SF‐6D seemed to better depict possible benefits from cochlear implantation as compared to the SF‐36.Level of Evidence4. Laryngoscope, 124:278–282, 2014
Frontal sinus drillout (modified Lothrop procedure): Long‐term results in 204 patients
Authors: Ting Jonathan Y. , Wu Arthur , Metson Ralph 
Published: October 2013

Objectives/HypothesisTo determine the long‐term results of frontal sinus drillout (also known as modified Lothrop procedure) for the treatment of advanced frontal sinus disease.Study DesignRetrospective review.MethodsThe records of patients who underwent frontal sinus drillout by a single surgeon at an academic medical center from June 1995 through November 2011 were reviewed. Patient demographics and perioperative clinical findings were analyzed for their impact on surgical outcome. Failure was defined as restenosis of the frontal drainage pathways, necessitating additional frontal sinus surgery.ResultsA total of 204 patients underwent frontal drillout surgery (143 bilateral procedures) over the 16‐year period. Mean follow‐up was 10.2 years (range 0.9–17 years). Symptomatic re‐obstruction of the frontal sinus requiring revision surgery occurred in 61 (29.9%) patients. Drillouts performed for a diagnosis of mucocele or tumor had significantly higher failure rate (38.9%, odds ratio [OR] = 2.9, P = 0.022 and 58.3%, OR = 5.3, P = 0.020, respectively). The majority of surgical failures (61%) occurred within 2 years of surgery, but delayed failures were observed up to 12 years after drillout. Clinical outcome did not correlate with a history of smoking, asthma, nasal allergy, aspirin sensitivity, prior sinus surgery, nasal polyposis, or the presence of eosinophilic mucin.ConclusionFor the majority of patients who undergo frontal sinus drillout, patency of the frontal sinus outflow tract appears to be maintained for more than a decade; nevertheless, almost one‐third of patients who undergo this procedure will ultimately require additional frontal sinus surgery.Level of Evidence4. Laryngoscope, 124:1066–1070, 2014
Correlation between bacterial biofilms and osteitis in patients with chronic rhinosinusitis
Authors: Dong Dong , Yulin Zhao , Xiao Wang , Hongyan Zhang , Jia Liu , Yan Xie , Jia Wang 
Published: October 2013

Objectives/HypothesisBacterial biofilms (BBF) and osteitis are potential contributors to the local inflammatory load in chronic rhinosinusitis (CRS). This study investigated the relationship between BBF and osteitis status in CRS patients.Study DesignProspective cohort study.MethodsEighty‐four CRS patients undergoing endoscopic sinus surgery and 22 control patients were enrolled in this study. Mucosal and bony samples from ethmoid sinus were obtained for confocal scanning laser microscopy and microscopic examination. Biofilm volume (BV), biofilm score (BS), histopathologic bony grade, Global Osteitis Scoring Scale (GOSS) score, and Hounsfield unit (HU) value on computed tomography were recorded. Associations between these parameters describing BBF and osteitis were assessed.ResultsThe histopathologic bony grade 2 (0–3) versus 0 (0–3) (P < 0.001), GOSS score 4.5 (0–31) versus 0 (0–26) (P = 0.014) and HU value 431.5 (310–509) versus 354 (288–499) (P < 0.001) in patients with BBF were greater than those without BBF. The bony grade (r = 0.683, P < 0.001 and r = 0.664, P < 0.001), GOSS score (r = 0.314, P = 0.004 and r = 0.312, P = 0.004), and HU value (r = 0.539, P < 0.001 and r = 0.520, P < 0.001) were significantly increased with higher BV and BS.ConclusionA total of 84.8% of the bone underlying mucosa with BBF had some form of osteitis in ethmoid sinus, and approximately 46.4% of CRS patients were from a subgroup with both BBF and osteitis. The volume of BBF correlated well with severity of osteitis in CRS patients.Level of Evidence3b. Laryngoscope, 124:1071–1077, 2014
Volumetric analysis of endoscopic and traditional surgical approaches to the infratemporal fossa
Authors: Fahmy Carol E. , Carrau Ricardo , Kirsch Claudia , Meeks Darlene , de Lara Danielle , Solares C. Arturo , Otto Bradley A. , Prevedello Daniel M. 
Published: October 2013

Objectives/HypothesisIn an effort to decrease morbidity, skull base surgeons have explored less invasive approaches to the infratemporal fossa, including endonasal‐endoscopy, minicraniotomies, and transantral endoscopic and microscopic corridors. This project presents quantitative data that assesses the practicality, and volumetric exposure afforded by endonasal and open approaches to the infratemporal fossa.Study DesignFirst, the study defines the anatomy of endoscopic‐endonasal and preauricular approaches to the infratemporal fossa. Subsequently, the study involved the calculation of anatomical volumes using cadaveric and virtual models.MethodsComputed tomography (CT) scanning of two anatomical specimens served to recreate computer simulations of the endonasal and preauricular approaches, allowing for the assessment of the infratemporal fossae volumes. In addition, the dissections served to identify and mark critical surgical landmarks and boundaries. A second CT scan, after the surgical dissection, allowed for a reanalysis of the data for a volumetric comparison of the surgical approaches.ResultsPre‐ and postdissection CT scans and computer simulations revealed that volumes in the open and endonasal approaches to the infratemporal fossa are strikingly similar, suggesting that volumes of surgical instrumentation and visualization may also be comparable. However, the entry gate for instrumentation differed significantly for each approach.ConclusionThis study suggests that, although the entry gate for instrumentation is greater during an open approach, contrary to intuition, an open approach does not create a substantially larger working space or visual field. Analysis of volumetric measurements facilitates a better understanding of the indications for each procedure.Level of EvidenceN/A. Laryngoscope, 124:1090–1096, 2014
Hypocalcemia after total laryngectomy
Authors: Basheeth Naveed , O'Cathain Eadaoin , O'Leary Gerard , Sheahan Patrick 
Published: October 2013

Objectives/HypothesisHypocalcemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for postlaryngectomy hypocalcemia at our institution.Study DesignRetrospective review of 65 consecutive total laryngectomies.MethodsClinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcemia. Risk factors for hypocalcemia were studied.ResultsFive cases were excluded due to concomitant abdominal surgery (3), preoperative hypocalcemia (1), and no postoperative calcium levels (1). A total of 43% of patients had postoperative biochemical hypocalcemia. On univariate analysis, bilateral neck dissection was significant for hypocalcemia (P = 0.02), with pT4 classification having borderline significance (P = 0.07). On multivariate analysis, bilateral neck dissection (P = 0.02) and salvage surgery were significant (P = 0.03), with pT4 stage again having borderline significance (P = 0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcemia. There were no significant risk factors for severe hypocalcemia identified.ConclusionsHypocalcemia is common after total laryngectomy, particularly in the postradiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.Level of Evidence4. Laryngoscope, 124:1128–1133, 2014
Metastatic melanoma to the upper aerodigestive tract
Authors: Mifsud Matthew , Padhya Tapan A. 
Published: October 2013

This study is a systematic review of the literature that was performed to clarify the natural history and treatment outcomes of upper aerodigestive tract metastases from cutaneous melanoma. A search of the MEDLINE database was undertaken from 1950 to 2013 to identify relevant manuscripts for this review. Article inclusion required cases with documentation of previous cutaneous melanoma primary lesions, adequate survival data, and description of metastatic treatment. Individual patient data were extracted from source articles for analysis of survival outcomes. A systematic search revealed 34 relevant articles with 37 cases for inclusion. Metastases were identified throughout the upper aerodigestive tract with a predilection for the oropharynx, larynx, and oral cavity. Treatment outcomes were estimated with the Kaplan‐Meier method, with survival of 37% and 16% at 1 and 5 years, respectively. As expected from previous reports, 73% presented with disseminated disease burden with almost universally poor prognosis despite locoregional or systemic therapy. Conversely, a group of patients with limited metastatic burden had improved treatment response with a 1‐year survival of 90%, denoting a hazard ratio of 9.7332 (95% confidence interval, 4.5–21.1) for disseminated disease in comparison. Upper aerodigestive tract metastases of melanoma thus are rare clinical entities that in general present in the setting of disseminated disease and evidently necessitate a focus on palliation. In contrast, for those with a limited metastatic burden, aggressive multimodality therapy including complete metastectomy can produce a significant survival advantage.Level of EvidenceNA Laryngoscope, 124:1143–1149, 2014
Unravelling Robin sequence
Authors: van Lieshout Manouk J. S. , Joosten Koen F. M. , Hoeve Hans L. J. , Mathijssen Irene M. J. , Koudstaal Maarten J. , Wolvius Eppo B. 
Published: October 2013

Objectives/HypothesisThe airway management of children with Robin sequence is controversial. This study provides an overview of a single‐center experience with the diagnosis and treatment of 59 children with Robin sequence.Study DesignRetrospective cohort study.MethodsWe conducted a retrospective cohort study of 59 children (<1 year old) with Robin sequence managed between 2000 and 2010. Robin sequence was defined as the presence of mandibular hypoplasia and clinical signs of airway obstruction. Data were collected on demographic characteristics, the presence of a syndrome, the perinatal period, and the management of airway and nutritional problems.ResultsEighteen children (31%) needed respiratory support because of severe respiratory distress, and a sleep study found obstructive apneas in another eight children who had been managed by prone positioning and/or monitoring. In the isolated group significantly fewer children needed respiratory support compared to the nonisolated group. After the age of 1 year, 10% of the Robin sequence cohort was still in need of treatment for obstructive symptoms. Almost half (47%) needed temporary nutritional support.ConclusionsThe prevalence of respiratory distress in children with Robin sequence is high. In most children, treatment with prone positioning was sufficient to relieve the airway obstruction. Successful treatment with prone positioning was significantly more often seen in children with an isolated Robin sequence. About one‐third of all Robin sequence children needed respiratory support in the neonatal and/or infant period. However, in childhood, only 10% of the total Robin sequence cohort was still dependent on respiratory support.Level of Evidence4 Laryngoscope, 124:E203–E209, 2014