bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standard Bipolar Diathermy Vessel Ligation for Thyroidectomy
Authors: Tysome James Russell , Hassan Rudaina , Davis Jeremy 
Published: August 2008

ObjectiveAssess the safety and possible advantages of using bipolar diathermy with standard forceps, compared to clamp‐and‐tie for vessel ligation in thyroidectomy.MethodsRetrospective case‐control study of 153 patients undergoing thyroid surgery at our unit using the clamp‐and‐tie technique (January 2000‐December 2002), compared to bipolar diathermy with standard bipolar forceps (January 2003‐January 2006) for vessel ligation. Patient demographics, operating time, length of hospital stay, need for drain insertion, and complications (recurrent laryngeal nerve palsies, reactionary haemorrhage requiring re‐exploration or late (>24h post‐op) haematomas, hypocalcaemia) were compared between the two groups. Outcomes were compared using Prism (GraphPad Software, CA, USA). Data sets were initially tested for normal distribution using the D'Agostino and Pearson test of normality before comparison using two‐tailed, unpaired t‐tests, Mann‐Whitney U test, Chi‐squared or Fisher exact tests as appropriate, with p<0.05 considered significant.ResultsSignificantly fewer drains were inserted and patients were discharged significantly earlier when standard bipolar diathermy was used for vessel ligation in hemithyroidectomies (p<0.001). The complication rates were similar for thyroidectomy using either technique, comparable to rates in large published series.ConclusionsThe use of bipolar diathermy with standard forceps for vessel ligation in thyroid surgery has been shown to be as safe and effective as the clamp‐and‐tie technique, while providing the advantage of the use of fewer drains, resulting in earlier patient discharge. This is a cost‐efficient technique as it gives the advantage of reduced inpatient stay seen by others using bipolar vessel sealing devices or the harmonic scalpel, but without the expense.
Transoral Laser Excision of Base of Tongue Cancer
Authors: Camp April A. , Petruzzelli Guy J , Fundakowski Christopher 
Published: August 2008

ObjectiveRecently, the use of laser in head and neck surgery has increased, consequent to technical advances in laser technology and visualization techniques. The objective of this study was to determine survival and qualitative results in patients who have undergone transoral laser excision of base of tongue (BOT) squamous cell carcinoma (SCCA).MethodsA retrospective chart review was performed of patients with previously untreated, biopsy proven SCCA of the BOT treated with transoral laser excision at a tertiary care facility. All patients had follow‐up for at least 24 months. Disease specific and overall survival data was determined using Kaplan‐Meier approximations. Quality of life (QOL) data was obtained via interview using a well established questionnaire.ResultsBetween 1995 and 2005, 71 patients, ages 38–85, were treated with transoral laser excision for BOT SCCA; 1.4, 12.7, 9.9, and 75% were stage I, II, III, and IV, respectively, at diagnosis. At 24 months, overall survival was 90%, while disease‐specific survival was 94%. No correlation was found between survival and gender, overall stage, tumor size, nodal status, or adjuvant therapy. Local‐regional recurrence occurred in 10% of patients. QOL data was obtained for 46 patients and yielded acceptable results, with 52% of patients reporting mild or no pain, 98% reporting minimal impairment to normal swallowing, and 70% reporting normal speech.ConclusionsTransoral laser excision is an innovative method for excision of BOT SCCA and offers an improved approach in terms of survival and quality of life for treatment of these lesions.
Tumour Size and Bilateral Thyroid Cancer after Thyroidectomy
Authors: Hwang Euna , Pakdaman Michael Navid , Black Martin J , Payne Richard J 
Published: August 2008

Objective1) Determine the incidence of bilateral papillary thyroid cancer (PTC) after total thyroidectomy (TT). 2) Compare tumour size, demographic and prognostic factors between bilaterality and non‐bilaterality (unilateral and/or isthmian involvement).MethodsPathology reports of 491 patients who underwent TT between 2002 and 2007 and had a definite diagnosis of PTC were reviewed. Statistical significance was obtained using chi‐square analysis.Results66 patients (13.4%) had bilateral PTC, of whom 4 also had isthmian involvement; 26 (5.3%) had PTC in the isthmus only; and 399 (81.3%) had unilateral PTC, of whom 15 also had isthmian involvement. Bilaterality was present in 12.1% of women and 19.5% of men; and in 14.9% of patients aged below 45 and 12.4% of patients aged 45 and above (all p‐values non‐significant). Among bilateral PTC patients, 69.7% had a primary tumour greater than 2 cm, 48.5% had extracapsular extension, and 37.8% had lymph node (LN) metastasis; as compared to 66.1%, 21.9%, and 16.1%, respectively, in non‐bilateral PTC patients (p‐values non‐significant, <0.001, and <0.01). Incidence of bilaterality was 25.8% and 23.7% in presence of extracapsular extension and LN metastasis, correspondingly; as opposed to 9.4% and 8.9% in their absence.ConclusionsIn our study, 13.4% of patients had bilateral PTC at TT. No significant correlation was established between bilaterality and gender, age, and tumour size. Bilateral PTC patients were more commonly found to have extracapsular extension and LN metastasis. Both these prognostic factors were associated with a higher incidence of bilaterality. These findings elucidate that bilateral involvement may constitute a poor prognostic indicator.
Ultrasound‐Guided Mechanical Fragmentation of Sialoliths
Authors: Geisthoff Urban , Maune Steffen 
Published: August 2008

ObjectiveAssess the efficacy of ultrasound‐guided mechanical intraductal stone fragmentation and removal of sialoliths (SonoFragmentation). SonoFragmentation has been described recently as a new technique for the treatment of sialolithiasis (Surg Endosc 2006;20(4):690–4).MethodsRetrospective analysis of cases treated within the last 3 years.ResultsSonoFragmentation was used as a 2nd line treatment in 22/28 cases. 10 patients were free of stones (parotid gland [PG]: 2x, submandibular gland [SMG]: 7x, sublingual gland: 1x; in 2 cases sialendoscopy was additionally used). Residual stones persisted in 12 patients (PG: 2x, SMG: 10x). 6 patients with sialolithiasis of the GP were primarily treated with the technique. 4 of those patients were cured. Reasons for failure were lacking accessibility of the stone by the forceps (9x), impossibility to grasp the stone (5x) and/or the concomitant grabbing of soft tissue together with the stone (3x).ConclusionsThe efficacy of SonoFragmentation as a secondary treatment after failure of other minimally invasive methods is about 50% (10/22). Additionally, it is a promising primary therapeutic option (cure: 4/6 patients).
Use and Misuse of IOPTH Levels During Parathyroidectomy
Authors: Seybt Melanie Wilson , Loftus Kelly , Rader Kendall , Mulloy Anthony , Terris David J 
Published: August 2008

ObjectiveThe combined use of localization and intraoperative parathyroid hormone assay (IOPTH) has facilitated the performance of targeted or minimally invasive parathyroidectomy. The precise algorithm of the use of IOPTH has been debated. We sought to clarify the optimal sequence of testing.MethodsAfter IRB approval was obtained, demographic data and intraoperative laboratory and surgical findings from patients undergoing parathyroidectomy were prospectively gathered and analyzed. Specific attention was paid to the value of pre‐excision (P‐E) values and the 5‐minute postoperative (5‐min) levels and their impact on intraoperative decision‐making. In the first 49 consecutive patients, a P‐E baseline value was sought; in all cases a 5‐min value was obtained when possible.Results112 patients underwent parathyroidectomy during the study period. 30 of these were for secondary or tertiary hyperparathyroidism and were excluded. 78 (95.1%) of the patients were eucalcemic. In 4 cases (4.9%), the incorporation of the pre‐excision baseline value represented a false positive, and surgery was aborted prematurely. In no case did the P‐E value change what was otherwise destined to be a successful result based on pre‐incision value. In 47 cases (57.3%), operative time was conserved as the procedure was correctly stopped after the 5‐min level.ConclusionsPre‐excision baseline levels, while logical in their original proposal, appear to play virtually no role in determining the completeness of an exploration, and may in fact be misleading. A 5‐minute postoperative level adds value in over one‐half of cases by allowing earlier termination of the operation.
Dosage Changes in Long‐Term Botox Use for Laryngeal Dystonia
Authors: Birkent Hakan , Maronian Nicole C , Waugh Patricia F. , Merati Albert L , Perkel David , Hillel Allen D 
Published: August 2008

ObjectiveBotulinum toxin (BTX) injections continue to be the mainstay of treatment for laryngeal dystonia (LD). Many patients are entering their 2nd and 3rd decade of treatment. In this study, the dosage consistency of BTX injections over time was examined in patients with long‐term BTX use for LD.MethodsRetrospective chart review, 1990–2007. Patients with adductor‐type LD who had received at least 20 injections to the thyroarytenoid (TA) muscles were included in the study. The change of total dose and patient‐reported effective weeks were investigated; data of the first 5 injections were excluded to eliminate initial dose searching.Results55 patients (11 male, 44 female, mean age 60.6) with a mean follow‐up period of 149.9 ± 43.7 months (range 44 to 211 months) were identified. Total number of treatment episodes was 1825 with a mean of 33.18 ± 10.37 (range 20 to 58) and a mean interval of 19.1 ± 1.3 (range 2 to 118) weeks. The average total dose of BTX for each treatment episode was 2.15 ± 0.37 U (range 0.125 to 10.00 U). The total dose trended downward over time; this trend became statistically significant at 13th injection. The overall mean duration of effect was 15.5 ± 1.1 (range 1 to 58) weeks and did not show a significant change over time.ConclusionsThe BTX dose needed for a constant response in the treatment of LD decreases over time, raising the concern that neural recovery from repeated BTX is not infinite.
Endoscopic Supraglottic Laryngectomies. Results on 45 Cases
Authors: Remacle Marc J , Lawson Georges , Jamart Jacques 
Published: August 2008

ObjectiveThe aim of this study was to evaluate long‐term results of transoral CO2 laser‐assisted surgery for supraglottic carcinoma.MethodsFrom 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent different types of endoscopic partial supraglottic laryngectomies according to the European Laryngological Society (ELS) proposal of classification (3 limited excision‐type I; 29 medial without resection of the pre‐epiglottic space‐type II; 4 medial with resection of the pre‐epiglottic space‐type III; 11 lateral‐type IV) in combination with neck dissection performed during the same session. Frozen sections were performed on the laryngeal margins after tumoral resection. No patient had tracheostomy perioperatively.ResultsOverall survival was 93 ± 4% after 3 years and 89 ± 6% after 5 years. The minimum follow‐up was 3 years. Frozen sections were negative in 40 cases and presented only dysplasia in 5 cases. N0 nodes were positive in 8 cases (18%). Two postoperative bleedings were controlled by electrocautery. All of them relearned undisturbed deglutition within 5 days to 3 weeks from surgery. Two patients presented aspiration pneumonia. Mean duration of hospitalization was 12.5 days.ConclusionsEndoscopic partial laryngectomies according to the ELS proposal of classification for selected supraglottic SCC prove to be an excellent alternative to radiotherapy and open neck surgery for selected supraglottic carcinoma.
Transnasal Esophagoscopy Findings: Interspecialty Comparison
Authors: Falcone Michael T , Garrett C Gaelyn , Vaezi Michael Fredrick , Ossoff Robert H , Slaughter James Christopher , Ekbom Dale C. , Mau I‐Fan Theodore 
Published: August 2008

ObjectiveOtolaryngologists implement transnasal esophagoscopy (TNE) to assess esophageal pathology. Previous studies using TNE to evaluate esophageal pathology have been limited in various ways. These are largely retrospective and deal with select patient populations. There are currently no data on the prevalence of esophageal pathology in “all comers” to an otolaryngology voice center. The objectives are to assess the prevalence of esophageal pathology in this population and determine the inter‐observer variability of the findings reviewed by an otolaryngologist and a gastroenterologist.MethodsConsecutive patients with throat symptoms presenting to the voice center were asked to undergo TNE. The findings were videotaped and reviewed by an otolaryngologist and a gastroesophagologist blinded to the patients’ presenting complaint.Results50 patients were selected prospectively to undergo TNE. Hoarseness was the most common presenting symptom (68%). According to the gastroesophagologist, the prevalence of esophageal findings was: Barrett's esophagus (12%), esophagitis (10%), hiatal hernia (32%), and esophageal stricture (10%). The percent agreement for a normal study was 72% (kappa 0.44). The percent agreement (kappa value) for various pathologic findings are as follows: Barrett's esophagus, 86% (0.45); esophagitis, 88% (0.43); hiatal hernia, 76% (0.39); and esophageal stricture, 96% (0.73). The frequency of an exact agreement between raters was 54%. For an abnormal study, the percent agreement was 80%. The reviewers were 7.11 times more likely to agree than disagree (p = 0.002).ConclusionsEsophageal abnormalities are common in patients presenting to a voice subspecialty clinic. An interdisciplinary approach can provide this population with complementary patient care.
Cochlear Implantation in Autoimmune Inner Ear Disease
Authors: Stidham Katrina R , Roberson Joseph B 
Published: August 2008

Objective1) Evaluate the success of cochlear implantation (CI) in patients with autoimmune inner ear disease (AIED). 2) Discuss the impact of CI on consideration of immunosuppressive therapy for patients with fluctuating hearing loss due to AIED.MethodsRetrospective chart review was conducted of patients undergoing CI with diagnosis of AIED between 6/02 and 6/07. Patients’ autoimmune and immunotherapy treatment history was explored. Non‐operative ear hearing thresholds and speech discrimination scores (SDS) were documented pre‐ and postoperatively. Objective and subjective implant success in setting of fluctuating hearing in non‐implant ear was evaluated.ResultsFour patients with AIED, aged 5–55, underwent CI. Two had isolated otologic symptoms and 2 had other systemic autoimmune diagnoses. All had been previously treated with steroids. Three had received other immunosuppressive therapy. One declined other treatment due to potential risks. At the time of implantation, 3 patients had functional hearing in the non‐implant ear and received benefit from a hearing aid. Each continued to have usable hearing, with fluctuating improvements post‐implant at times to much better SDS than would normally meet candidacy requirements for CI. All patients found the implant provided better hearing than the hearing‐aid ear.ConclusionsCI is a viable option for patients with AIED. Implanting a profoundly deafened ear where opposite ear has fluctuating but usable hearing does not negatively impact outcomes. With the success of CI for AIED, the potential risks of long‐term immunosuppressive therapy may not warrant its use in patients with isolated hearing loss symptoms.
Delayed Facial Nerve Palsy after Middle Ear Surgery
Authors: Papanikolaou Panagiotis N , Xenelis John E , Bibas Thanos , Sengas John V 
Published: August 2008

Objective1) Report the incidence and outcome of delayed facial nerve palsy following middle ear surgery in our department, and 2) review the medical literature.MethodsThis is a retrospective chart review study of 833 patients who were operated for chronic otitis media with cholesteatoma (572 patients), otosclerosis (192 patients), and profound hearing loss who received a cochlear implant (68 patients) since 1993.ResultsDelayed facial nerve palsy was observed in 10 patients (1.2%). In all cases, immediate postoperative facial nerve function was normal and the palsy occurred 5 to 8 days postoperatively. Facial nerve function recovered in all patients within 6 months. Assessment and management issues are discussed.ConclusionsDelayed facial nerve palsy may rarely occur following middle ear surgery and has an excellent recovery rate.
DPOAEs in High Altitude Disease at Mount Everest
Authors: Behnisch Axel Rolf , Rasp Gerd , Mees Klaus 
Published: August 2008

ObjectiveThe aim of this study was to measure DPOAEs in climbers on Mount Everest as a criterion for differential diagnosis of high altitude disease. The levels of distortion product otoacoustic emissions (DPOAEs) change at frequencies between 0,75 kHz and 1,5 kH along with intracranial pressure (ICP). DPOAEs are suggested for monitoring ICP changes.MethodsIn order to determine the etiology of DPOAE‐level changes obtained in 6 climbers with severe acute mountain sickness, blood oxygen saturation was measured simultaneously, and a standard request form of Lake‐Louis symptoms of high altitude disease was filled in with every DPOAE measurement. Data are presented from DPOAE measurements at frequencies of 1, 1.5, 2, 3 and 4 kHz during an ascent to Mount Everest (8848 m) up to an altitude of 7800 m.ResultsIn all climbers, DPOA levels decreased at 4 kHz and 3 kHz with declining oxygen saturation (SaO2) at high altitude. That has been described in many prior animal studies. On the other hand, DPOAE at 1 kHz showed decreasing levels only with symptoms of high altitude disease (AMS). In one climber with severe symptoms of intracranial hypertension after the ascent to the high camp at 7800 m, decreasing DPOAE levels at 1 kHz were measured in the absence of declining blood oxygen saturation. The most pronounced decline of DPOAEs at 1 kHz was also seen on that occasion.ConclusionsDPOAEs are suggested for detection of intracranial hypertension and early detection of high‐altitude cerebral edema.
Electronystagmography in Migraine Equivalent Syndrome
Authors: Dellepiane Massimo , Mora Renzo , Barettini Luciano , Crippa Barbara , Salami Angelo 
Published: August 2008

ObjectiveThe aim of the study was to determine the efficacy of electronystagmography testing in the diagnosis of vertigo in children with migraine equivalent syndrome.MethodsThe investigation included 20 patients, aged between 5 and 14 years and affected with an “migraine equivalent syndrome” (group A). The patients, head blocked, sat on a “Tönnies rotatory chair” which was placed in the middle of a rotatory cylindrical chamber (2 metres in diameter and 1.9 metres in height). The rotatory cylinder was driven by a direct current engine which turned it clockwise and counterclockwise, up to 200 degrees/sec., and its internal area was covered with 32 black vertical contrasts. As a control group, 50 healthy children were identified. All the subjects underwent the rotatory vestibular stimulation by Stop test, to optokinetic stimulation and to contemporary rotatory vestibular and optokinetic stimulation (VVOR).ResultsFor the analysis of the results, we have considered nystagmus mean gain and direction of visual‐vestibular‐ocular‐reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular‐ocular‐reflex (VOR). In the control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus.ConclusionsIn the healthy patients, VVOR nystagmus is always homodirectional to OKN and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. Our data highlight a possible correlation between CNS disorders and migraine equivalent syndrome.
Endaural Atticotomy for pars flaccida Cholesteatoma
Authors: Leonetti John P , Marzo Sam J , Kircher Matthew L 
Published: August 2008

ObjectiveTo present our long‐term results using an endaural atticotomy approach for the management of 361 cases of pars flaccida cholesteatoma.MethodsThis is a retrospective chart review of 361 cases of attic cholesteatoma that were surgically managed at our tertiary care, academic medical center between 7/88 – 7/07.Results361 of the 2068 cholesteatomas treated at our institution were surgically managed with an endaural atticotomy approach. There were 201 females and 160 males who ranged in age from 17–77 years. The most common clinical symptoms were aural fullness, hearing loss, and otorrhea. Ossiculoplasty was necessary in 170 of 361 or 47% of the patients. Hearing levels were maintained or improved in 297 patients or 82%. Cholesteatoma recurred in 29 of 361 patients (8%) and 24 of these 29 patients failed to return for otoscopic evaluation and PE tube replacement. The mean follow‐up was 7.7 years.ConclusionsThe endaural approach for pars flaccida cholesteatoma is an option for limited retraction cholesteatomas in patients who will reliably be seen for ventilation tube replacement.
Global vs Regional HB Score: Reporting Facial Nerve Function
Authors: Reitzen Shari D. , Lalwani Anil K 
Published: August 2008

ObjectiveTo determine the reliability of the House‐Brackmann facial nerve grading scale in the setting of differential function across its branches.Methods14 physicians of different levels were provided with digital video clips of 11 patients with differential facial nerve functioning, and asked to report facial nerve function as a traditional global score and as a regional score based on the House‐Brackmann scale for the forehead, eye, nose, and mouth. Agreements between the traditional global score and the regional scores, as well as inter‐rater agreement, were analyzed.ResultsIn patients with variable facial weakness, a single House‐Brackmann score did not fully communicate their facial function. The single House‐Brackmann score most strongly correlated with the regional scoring of the nose/midface (59%), followed by the mouth (51%), eye (48%), and forehead (35%). Overall inter‐reader reliability was relatively strong for the midface (kappa=0.503) and global scores (kappa=0.541), followed by the mouth (k=0.419), the forehead (k=0.330), and the eye (k=0.302). There was a marked tendency for reader agreement to increase among those with more clinical experience. Reader agreement of the forehead (k=0.597) and eye (k=0.469) were strong only among experienced readers.ConclusionsIn patients with differential facial function, a single global score is inadequate to describe facial function, and in this study, most directly correlated with the function of the midface. Regional assessment using the House‐Brackmann grading scale more fully communicates facial function and increases in reliability with experience.