bluuebunny/crossref_metadata_2025_split huggingface dataset:
S169 – Radiation‐Associated Dysphagia with Nasopharyngeal Carcinoma
Authors: Meier Jeremy D. , Leonard Rebecca , Farwell D Gregory , Belafsky Peter C 
Published: August 2008

ObjectivesWe have observed that patients with dysphagia after radiotherapy (RT) for nasopharyngeal carcinoma (NPC) have substantially worse swallowing function than patients treated with RT of other sub‐sites. The purpose of this investigation was to describe swallowing dysfunction after RT for NPC and compare swallowing parameters to patients receiving RT for cancer from another site.MethodsFluoroscopic swallowing data of persons with dysphagia after RT for NPC was abstracted from a clinical database. Objective swallowing parameters were compared to age‐ and gender‐matched normal controls and to cancer stage‐matched patients treated with RT for oropharyngeal cancer (OPC).Results13 patients with NPC were compared to 13 controls and 13 patients with OPC. The average duration from RT to fluoroscopic study was 74 months for NPC and 24 months for OPC (p=.06). 62% of NPC and 47% of OPC were gastrostomy tube‐dependent. 92% of NPC patients aspirated or penetrated compared to 62% of OPC patients. The maximal average tolerated bolus was 10.6cc for NPC and 22.2cc for OPC (p<.02). Mean hyolaryngeal elevation was 4.02 (±1.27) for normals, 2.96 (±0.86) for OPC, and 2.45 (± 1.17) for NPC (p<.01). Opening of the pharyngoesophageal segment was lower than normal in both NPC and OPC. Pharyngeal constriction was 0.08 (±0.09) for normals, 0.40 (±0.24) for OPC and 0.45 (±0.27) for NPC (p<.001).ConclusionsThe data suggest that patients with dysphagia after radiotherapy for NPC present at a later date, have significantly less hyolaryngeal elevation, have weaker pharyngeal constriction, and cannot tolerate as large a bolus as patients treated with radiotherapy for OPC.
S171 – Head and Neck Microvascular Reconstruction: Changing Trends
Authors: Pena Rene M , Kim Paul Dae‐Gwon , Rowe Mark R 
Published: August 2008

ObjectivesThe practice of head and neck reconstruction has been evolving over the past 15 years with the introduction of new surgical techniques, and increasing options for tissue harvest. We sought to investigate corresponding trends in the disciplines performing head and neck microvascular reconstruction.Methods2 specialties for the proportion of head and neck microvascular reconstruction were compared: those performed by otolaryngologists and those done by plastics surgery. A 3‐part study was performed to evaluate these trends: 1) Total case number of microvascular cases of otolaryngology residents and plastic surgery residents over the last 4 years was evaluated through the ACGME national data; 2) A poll of the percentage of otolaryngology residency programs that have their own microvascular reconstructive surgeon, and if that surgeon was hired within the last 5 years; and 3) The number of scientific articles published relating to microvascular head and neck reconstruction were systematically queried for 2 timeframes, (1995–2000) and (2002–2007).ResultsThe national number of cases has steadily increased in the last 5 years. It has slowly increased compared to plastic surgery, but when all flaps are evaluated, it is not significant. We also found that the number of peer‐reviewed articles relating to microvascular free flaps authored by otolaryngologists has increased. The data from the polls are still pending.ConclusionsThere is an increasing trend emerging in the practice of head and neck microvascular reconstruction, with an increase number of articles being authored and increased number of surgeries being performed by otolaryngolo‐gists, compared to plastic surgeons.
S172 – Primary TE Puncture in Stapler‐Assisted Total Laryngectomy
Authors: Leahy Kevin , Tufano Ralph P 
Published: August 2008

Objectives1) To present a novel method for placement of a primary tracheoesophageal puncture (TEP) following stapler assisted laryngectomy. 2) To discuss the challenges and pitfalls of TEP placement following stapler‐assisted laryngectomy.MethodsA case series of 10 consecutive patients treated with stapler‐assisted laryngectomy who underwent primary tracheoesophageal puncture at the time the initial surgery was conducted. Because stapler‐assisted total laryngectomy poses a unique challenge for the placement of concurrent TEP, we developed a novel technique whereby flexible esophagoscopy was performed and under direct visualization, a modified Seldinger technique was employed with a Russel percutaneous gastrostomy placement kit to allow creation of a TEP. This series was performed at a single academic institution. The primary outcome measured was ability of alaryngeal speech.Results10 consecutive cases of primary tracheoesophageal puncture in stapler‐assisted laryngectomy achieved alaryngeal speech.ConclusionsThe method described provides simple, safe, and repeatable results that facilitate alaryngeal speech in patients undergoing primary tracheoesophageal puncture and stapler‐assisted laryngectomy.
S174 – Therapeutic Selective Neck Dissection Outcomes
Authors: Shepard Peter M , Jordan Olson , Leverson Glen E , Harari Paul M , Hartig Gregory K 
Published: August 2008

ObjectivesTo examine the efficacy of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma.MethodsA retrospective chart review was performed on a cohort of 156 subjects with clinically positive regional nodal metastases, whose initial management included neck dissection by a single surgeon from 1994–2007. 69 subjects underwent selective neck dissection (SND), while 87 underwent radical or modified radical neck dissection (R/MRND). The majority of subjects (81%) received postoperative radiotherapy. Primary outcomes included 3‐year regional recurrence and 5‐year overall survival, using Kaplan‐Meier analysis.ResultsFollowing exclusion of subjects with local recurrence before or concurrent with regional recurrence, there were 4 (8.6%) regional recurrences in the SND group and 15 (22%) in the R/MRND group. 2 and 6 of these recurrences involved the contralateral neck in each group, respectively. Using multivariate analysis we adjusted for differences in nodal and primary tumor stage, primary tumor site, year of surgery, extracapsular spread, and postoperative radiotherapy rates. The lower regional recurrence rate in the SND group remained statistically significant (p=0.02). Overall 5‐year survival was 46% in the SND group vs. 34% in the R/MRND group (p=0.23).ConclusionsThese results demonstrate excellent regional disease control following SND in patients with neck node metastases. SND with adjunctive radiotherapy remains our preferred approach for most patients undergoing therapeutic neck dissection.
S176 – Level II‐B and V‐A Lateral Neck Dissection in PTC
Authors: Farrag Tarik Y , Lin Frank , Brownlee Noel , Kim Matthew , Sheth Shiela , Tufano Ralph 
Published: August 2008

Objectives1) Patterns of cervical metastasis in PTC. 2) Importance of elective dissection of levels II‐B & V‐A.MethodsCharts were reviewed of 53 consecutive patients (February 2002‐December 2007) with PTC who underwent lateral neck dissection that included at least levels II (A and B), and V (A and B).Results53 patients underwent lateral neck dissection for FNA‐confirmed nodal metastasis of PTC. 46 patients underwent unilateral neck dissection, while 7 had bilateral neck dissection, resulting in a total of 60 neck dissection specimens which were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 out of 59 specimens (33/59–%60) positive for metastasis. Level II‐B was positive 5 times (5/59, 8.5%–95% CI: 2.4, 20.4); and each time level II‐B was positive, level II‐A was also positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58–66%). Level IV was excised 58 times and was positive in 29 specimens (29/58–50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16‐40‐40%). Level V‐A did not account for any of the positive level V results.ConclusionsPatients with PTC undergoing lateral neck dissection for FNA‐confirmed nodal metastases might harbor disease in level II‐B, especially if level II‐A is involved. Elective dissection of level V‐B should also be considered in this scenario, while routine level V‐A dissection is not necessary.
S178 – Utility of CT‐Sestamibi Fusion in Parathyroid Exploration
Authors: Clark Michael J , Pellitteri Phillip 
Published: August 2008

Objectives1) Delineate the role of CT‐technetium 99m sestamibi (CT‐MIBI) fusion in directed parathyroidectomy. 2) Determine the clinical situations where CT‐MIBI fusion would be strongly recommended.MethodsCharts from 190 patients with primary hyperparathyroidism who underwent CT‐MIBI mage fusion as a part of a scan directed, minimally invasive parathyroid exploration protocol were reviewed. The results of conventional sestamibi imaging and CT‐MIBI image fusion were compared with operative findings.ResultsCT‐MIBI image fusion accurately localized solitary hyperfunctional parathyroid glands in 70% of patients imaged; 55% of patients were localized with conventional sestamibi imaging. CT‐MIBI fusion imaging was most accurate and predictive when conventional images suggested that the solitary gland was separated from the thyroid or when the adenoma was located in the retro‐thyroidal/ retro‐esophageal plane or mediastinum.ConclusionsCT‐MIBI image fusion is not superior to conventional sestamibi imaging when utilized for routine localization of hyperfunctional parathyroid glands. CT‐MIBI fusion is of greatest benefit in guiding the directed approach to solitary glands, which are separate from the thyroid or ectopically located, regions where conventional imaging has proven to be less accurate. This imaging technique will augment the minimally invasive surgical approach in selected patients with primary hyperparathyroidism in order to further refine the focused technique. Its utility as the standard preoperative localization modality is not yet established and requires further investigation. Evaluation of differences in facility utilization with CT‐MIBI image fusion and conventional sestamibi imaging may be helpful in determining its role in preoperative localization for hyperparathyroidism.
S188 – Development of Laryngoscope with a Built‐in Laser Ruler
Authors: Lee Jin‐Choon , Wang Soo‐Geun , Goh Eui‐Kyung , Kim Yong‐Wan , Lee Jin‐Woo , Lee Young‐Ok , Lee Jong‐Kil 
Published: August 2008

ObjectivesThe endoscope for inspection of body cavities has improved the accuracy of diagnosis. However, the magnification changes as the distance between the scope and object is varied. Changes in magnification make it impossible to measure surface distances for staging of lesion or to determine the displacement of structures. The objective of this invention is to develop a new device that provides a simple and noninvasive method of measuring accurate lesion size through an endoscope.MethodsThe invention incorporates a built‐in laser diode that projects auto‐parallel beams into the optical path of the rigid laryngoscope to form 2 spots in the field of view.ResultsThe interspot distance is constant despite changes in focal plane, magnification, or viewing angle of laryngoscope. The interspot distance of being projected to even surface is constantly 4 mm.ConclusionsThis device enables the laryngologist to easily measure the distance between landmarks, or the size of vocal fold lesions in the outpatient setting.
S190 – Voice Spectral Analysis After Surface Electrical Stimulation
Authors: Hapner Edie Renee , Gorham‐Rowan Mary , Morris Richard J. , Fowler Linda P 
Published: August 2008

ObjectivesThe purpose of this study was to measure changes in vocal fold closure associated with surface electrical stimulation (VitalStim®).Methods30 participants, 15 male and 15 female, ages 20–56 years, were included in the study. Participants underwent 1 hour of surface electrical stimulation, per guidelines reported in the VitalStim® manual. 3 trials of the vowel /ae/ were analyzed pre‐ and post‐stimulation. Indirect estimates of glottal closure were obtained from the recorded vowels, as follows: 1) H1–H2: the amplitude of the first harmonic to the second harmonic (open quotient); 2) H1–A1: the ratio of the amplitude of the first harmonic to the amplitude of the first formant (glottal width); and 3) H1–A3: the ratio of the amplitude of the first harmonic to the amplitude of the third formant (spectral tilt).ResultsThe direction and magnitude of change for all 3 parameters varied widely across participants. No significant difference occurred pre‐ vs. post‐stimulation for any of the parameters.ConclusionsVitalStim® did not systematically affect open quotient, glottal width, or spectral tilt. These results do not support the concept that VitalStim® has a direct effect upon vocal fold closure.
S195 – Laryngeal Observation of Early Cancer with NBI System
Authors: Higashikawa Masahiko 
Published: August 2008

ObjectivesThe Narrow Band Imaging (NBI) is an illumination method for medical endoscopes that can visualize the micro‐vascular structure of the organ surface. The effectiveness of NBI has been reported in detecting the oropharyngeal and hypopharyngeal neoplasm lesion. The aim of this study is to identify the usefulness of NBI in laryngeal lesion, especially in observing cases of post‐operated or post‐irradiated early laryngeal cancers.Methods16 patients of early laryngeal cancer after treatment for at least 6 months were entered in this study: 1 case of T1s, 8 cases of T1a, 3 cases of T1b, and 4 cases of T2. 3 cases of T1a underwent cordectomy under direct laryngoscope using KTP laser. 13 cases were treated with irradiation.ResultsThe cases for which NBI was suggested to be useful were: T1b, undergoing laser surgery, supra‐glottic carcinoma, appearing hyper‐adduction of the false vocal fold during phonating, and causing severe mucosal edema after irradiation.ConclusionsNBI system may play an important role in the observation of post‐therapy of early laryngeal cancer.
S198 – Muscle Pedicle Thyroplasty for Difficult or Revision Cases
Authors: Christenson Thomas , Goyal Neerav , Spiegel Joseph R 
Published: August 2008

Objectives1) Describe a modification of the type I thyroplasty procedure of Isshiki, incorporating a pedicled muscle flap which is rotated through the thyroid cartilage window into a pocket lateral to the thyroarytenoid muscle. The muscle flap is used to replace or augment an alloplastic implant. 2) Be able to understand the applications and indications for this procedure.MethodsOur series describes 6 patients undergoing primary or revision thyroplasty since January 2006. In primary cases, the muscle pedicle was utilized after initial dissection resulted in an injury to the endolaryngeal mucosa, or to augment an implant that did not produce adequate medialization. In the revision cases, the muscle pedicle was utilized to replace a Silastic implant at the time of removal. Pre‐operative and postoperative videostroboscopy was performed on all patients.ResultsPostoperative videostroboscopy revealed satisfactory glottic closure in all 6 patients between 1 and 3 months after their operations.ConclusionsThe procedure of muscle pedicle thyroplasty provides adequate glottic closure in cases of revision thyroplasty and in cases where it was used to augment another implant. It represents an alternative medialization technique in difficult and unusual cases, or when an alloplastic implant is contraindicated. Long‐term durability of the medialization is not assessed in this series.
S202 – Patterns of Dysphagia in Hospital Inpatients
Authors: Lotfizadeh Ali , Chhetri Dinesh K 
Published: August 2008

ObjectivesTo evaluate the patterns of dysphagia, aspiration, and vocal cord motion abnormality (VCMA) among inpatients at a tertiary care referral hospital.MethodsThe medical records of all patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES) between July 2005 and June 2007 were reviewed retrospectively. Demographic information, and presence of aspiration or VCMA was documented. Patients were categorized according to indication for hospitalization as well as into surgical and non‐surgical categories. Dysphagia severity was assessed and variations in the prevalence of aspiration and VCMA were ascertained using correlation analysis.Results418 inpatients underwent FEES. Commonly observed patient categories included: 1) neurological/neurosurgical, 2) liver disease/transplant, 3) cardiac surgery, 4) medicine, 5) other surgical. The overall prevalence of aspiration and VCMA were 51% and 21% respectively. VCMA was observed twice as frequently in surgical patients (p = 0.0005), while aspiration was seen at similar rates (p = 0.85) among surgical and non‐surgical patients. Dysphagia was most severe in neurological/neurosurgical patients. The prevalence of VCMA was highest in cardiac surgery patients (p = 0.007), but the incidence of aspiration did not differ markedly among the groups (p = 0.18).ConclusionsSwallowing dysfunction is associated with a multitude of medical and surgical conditions. The severity of dysphagia, and the prevalence of associated VCMA vary among different patient categories, while aspiration occurs at similar rates. Understanding these patterns is crucial in guiding the diagnosis and management of inpatients with dysphagia.
S203 – The STAMP Registration for Image‐guided Otologic Surgery
Authors: Matsumoto Nozomu , Hong Jaesung , Makoto Hashizume , Komune Shizuo 
Published: August 2008

Objectives1) Develop a less invasive but accurate enough registration strategy for otological surgical navigation. 2) Evaluate the new system in phantom study. 3) Evaluate the new system in cochlear implant surgeries.MethodsA new registration method was developed for otologic surgery. Previously, the registration for accurate image‐guided surgery often required invasive fiducial markers attached on patient's bone. We utilized the template of the bone surface to transfer the pre‐made virtual bone‐anchored markers to the patient's bone intraoperatively and eliminated the necessity for preoperative marker positioning or preoperative additional CT scan.ResultsWe tested this Surface Template‐Assisted Marker Positioning (STAMP) method using 5 temporal bone replicas, and in 5 ear surgeries (2 cochlear implants, 3 translabyrinthine acoustic neuroma surgeries) to investigate whether this method improves, or at least retains, the accuracy of image‐ guided surgery (IGS). The fiducial registration errors and target registration errors in the phantom study was ∼0.7 mm and ∼1.5 mm, respectively. The target registration errors in replicas were always less than 2 mm. In actual ear surgeries the fiducial registration errors were ∼0.6 mm and the target registration errors were less than 2 mm in 4 of 5 surgeries. All patients received successful cochlear implantation or tumor removal.ConclusionsThe new method reduced the preoperative procedures for patients but did not reduce the accuracy of the surgical navigation. Our method would be a useful IGS method in the field of otology where both accuracy and non‐invasiveness are required.
S206 – Efficacy of MRI for Management of Labyrinthine Fistulae
Authors: Sone Michihiko , Mizuno Terukazu , Otake Hironao , Nakashima Tsutomu 
Published: August 2008

ObjectivesSurgical management of cholesteatomas with labyrinthine fistulae has been reported and several techniques have also been advocated, however, no uniform surgical technique can be adopted in all cases with fistulae. We examined the efficacy of MRI evaluation for surgical management of cholesteatoma with a labyrinthine fistula.MethodsThe case histories of 23 patients who had undergone surgery for middle ear cholesteatoma with a labyrinthine fistula were examined. Imaging analysis was performed using a 3‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging (MRI) sequence. Clinical symptoms, presence of fistulae, surgical management, and postoperative outcomes were compared between groups who had or had not undergone preoperative 3D‐FLAIR MRI.ResultsSafe surgical management was achieved in the group without MRI evaluation. The group with MRI evaluation contained cases with larger fistulae and more severe clinical symptoms; however, MRI provided precise information concerning the degree of labyrinthitis, which enabled adequate surgical management and successful outcomes including improvement of sensorineural hearing loss in some cases.ConclusionsInformation provided by 3D‐FLAIR images is valuable in the surgical management of cholesteatoma with a labyrinthine fistula, especially in cases with large fistulae and severe symptoms related to inner ear disturbances.
S207 – Split Light Reflex in Retraction of the Tympanic Membrane
Authors: Grant David G , Pothier David Douglas , Canter Richard J , Jardine Annette Hillegonda 
Published: August 2008

ObjectivesIt is difficult to reliably diagnose the early stages of retraction on a purely clinical basis. This is of particular importance where a diagnosis needs to be made in a setting, such as in primary care or a clinical dataset, where tympanometry is not always available. Although a split light reflex is sometimes used clinically, it has not been shown to be of definite diagnostic value.MethodsDigital photographs were taken of the tympanic membrane of 50 sequential ears for which a type C tympanogram had been recorded and 50 ears for which a type A tympanogram had been recorded. Each photograph was cropped to an area that incorporated the light reflex only. 3 otologists examined each image and recorded the status of the light reflex as split, not split, or ‘unable to determine.’ResultsThe sensitivity of the split light reflex in diagnosing mild retraction of the tympanic membrane ranged from 83% to 87% with a ‘majority value’ sensitivity of 91%. The specificity ranged from 84% to 98%. The positive predictive value ranged from 84% to 90%. The Krippendorff's alpha statistic for inter‐rater reliability between all three raters was 0.61.ConclusionsThe split light reflex is a sensitive and specific sign in the diagnosis of a mildly retracted tympanic membrane. This finding has important implications in the construction of a reliable system for the staging of retractions of the pars tensa.
S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?
Authors: Heman‐Ackah Selena E. , Ryan Dunn , Huang Tina C. 
Published: August 2008

ObjectivesA number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost‐effectiveness of the diagnostic screening for ASSNHL.MethodsThe study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work‐up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed.ResultsAll patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA‐ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA‐ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low.ConclusionsThe utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.