bluuebunny/crossref_metadata_2025_split huggingface dataset:
How we do it: Evaluation of nurse‐led ENT services in the UK: a preliminary descriptive postal questionnaire survey
Authors: Duvvi S , Gollapalli R , Sankar V , Walker T , Kumar B.N , Reddy K.T.V. 
Published: December 2006

Keypoints• There has been a steady growth in the volume and range of nurse led services in ENT practise in the UK.• There was very little consistency in the titles of the nurses providing nurse led services but those nurses working in advanced practice roles now require courses, diplomas, degrees and study days related to ENT.• Locally or nationally agreed practice guidelines can define nursing practice boundaries and ensure accountability.• Monitoring and evaluation of nurse led services also requires attention.
How we do it: Switching from mechanical perforation to the CO2 laser; audit results of primary small‐fenestra stapedotomy in a district general hospital
Authors: Badran K. , Gosh S. , Farag A. , Timms M.S. 
Published: December 2006

Keypoints• The use of laser for stapedotomy was introduced in our department in the year 2002, and since then has taken over the mechanical technique.• A total of 85 patients who had undergone primary stapedotomy with either technique are reported with regards to effectiveness and rate of side effects.• Although footplate complications were reduced with the laser, short‐term hearing outcomes were similar between the two techniques.• In four occasions, the surgeon had to switch back to the mechanical technique unexpectedly.• Stapedotomy will continue to be performed with the laser in our department, bearing in mind the occasional need for the older technique.
Prospective randomised single‐blind controlled trial of glacial acetic acid versus glacial acetic acid, neomycin sulphate and dexamethasone spray in otitis externa and infected mastoid cavities
Authors: Johnston M.N. , Flook E.P. , Mehta D. , Mortimore S. 
Published: December 2006

Objectives:  The literature reports the merits of antibacterial, antibiotic and steroid agents in treating otological infections but no controlled clinical trial has directly compared 2% glacial acetic acid (EarCalm; Stafford‐Miller Ltd, Brentford, UK) against 2% glacial acetic acid, 0.1% dexamethasone and 3250 U/ml of neomycin sulphate (Otomize; Stafford‐Miller Ltd) in the treatment of otitis externa and infected mastoid cavities.Design:  Prospective, single‐blind randomised controlled trial.Setting:  Outpatients, Derby Royal Infirmary, Derby, UK.Patients:   Emergency and GP referrals with acute otitis externa (n = 53) and infected mastoid cavities (n = 56).Main outcome measures:  Otoscopy was performed at initial randomisation and then at 2 and 4 weeks, the ear assessed for active and inactive disease.Results:  Patients with active otitis externa, 71% (15/21) resolved with glacial acetic acid, dexamethasone and of neomycin sulphate after 2 weeks, increasing to 86% (18/21) after 4 weeks treatment. Patients on glacial acetic acid had only 38% (12/32) resolution after 4 weeks (P < 0.0005). Two per cent glacial acetic acid, dexamethasone and neomycin sulphate resolved only 30% (8/27) of infected mastoid cavities compared to only 10% (3/29) on glacial acetic acid (P < 0.07). A further 2 weeks treatment this increased to 67%, (18/27) with glacial acetic acid, dexamethasone and neomycin sulphate and 48% (14/29) with glacial acetic acid. These results are not statistically significant.Conclusion:  Glacial acetic acid, dexamethasone and neomycin sulphate is significantly more effective in treating otitis externa when compared with glacial acetic acid. This effect failed to be significant in the infected mastoid cavities group. We therefore recommend that in conjunction with aural toilet, antibiotic/steroid combination is more effective than an antibacterial agent for otitis externa. Larger numbers of infected mastoid cavities are required to be studied.
Can objective parameters derived from videofluoroscopic assessment of post‐laryngectomy valved speech replace current subjective measures? An e‐tool‐based analysis
Authors: Kazi R. , Singh A. , Mullan G.P.J. , Venkitaraman R. , Nutting C.M. , Clarke P. , Rhys‐Evans P. , Harrington K.J. 
Published: December 2006

Objectives:  The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e‐tool.Study design:  Cross‐sectional study.Setting:   Head and Neck Oncology Unit, Tertiary Referral Centre.Patients:  Forty‐two patients following total laryngectomy.Intervention:  Videofluoroscopy using an e‐tool (JRuler).Main outcome measures:  Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables.Results:  Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub‐neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub‐neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters.Conclusions:  Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
Safe magnetic resonance scanning of patients with metallic middle ear implants
Authors: Wild D.C. , Head K. , Hall D.A. 
Published: December 2006

Objective:  To determine the MR scanning risk to patients with otologic implants.Design:  We used a repeated‐measures study with an additional control measure to assess two aspects of risk; (i) movement of the device in the magnetic field, and (ii) absorption of energy leading to local heating. We used an ex vivo test method that met with international standards. We measured the effects in a Philips Intera Achieva 3 Tesla (T) MR scanner using a Sense Head 8 channel RF coil.Setting:  University‐based magnetic resonance research facility.Main outcome measures:  Heating or displacement of the stapedectomy pistons.Results:  No evidence of displacement or heating was found.Conclusion:  Complying with the ex vivo standard testing protocols, the Schuknecht and McGee wire pistons (device product numbers 140106 and 140108, respectively) were found to be safe in a 3 T MR scanner. These conclusions can be extrapolated to the in vivo case.
Epidermal hyperplasia of the tympanic membrane and deep external ear canal: novel histo‐pathological features, embryological and clinical correlates
Authors: Upile T. , Michaels L. , Jerjes W. , Howard D. , Hopper C. , Wright A. 
Published: December 2006

Objectives.  To study the histology and developmental biology of epidermis of tympanic membrane and deep ear canal and to correlate the histo‐pathological features with clinical conditions.Method.  Histo‐pathological and electron microscopic examination was performed of deep meatal skin, keratosis, keratosis obturans, external canal cholesteatoma, retraction pockets, acquired cholesteatoma and tympanic membrane perforations.Results.  In some mature ears, a marked change in the normal flat thin epidermis to one resembling that of the fetus is seen in the presence of local inflammation. This hyperplastic epidermis is present in varying lengths on the tympanic membrane and deep ear canal and displayed as hyperplastic bands growing down into sub‐epidermal tissue and sometimes penetrated the collagen layer of the tympanic membrane to enter the middle ear. Keratosis was frequent on the surfaces of the tympanic membrane and deep ear canal, which may also be found in the invading bands, where they produced small keratin cysts.Conclusions.  Severe chronic otitis media, with inflammatory exudates, glandular metaplasia or tympanosclerosis, may be associated with hyperplasia. This type of epidermal hyperplasia appeared to be pathogenic and was observed in several structurally distinct entities such as keratosis, keratosis obturans, retraction pockets, and cholesteatoma of the deep external canal. Invading epidermis in the middle ear, in some cases, is indistinguishable from acquired cholesteatoma. This reverse differentiation highlights a primordial property of auditory epithelium, which was not previously recognised. Furthermore, hyperplastic epidermis appears to be pathogenic and may be the cause of some specific conditions or their complications.References 1 Johnson A., Hawke M., Berger G. (1984) Hodge memorial Award‐surface wrinkles, cell ridges, and desquamation in the external auditory canal. J Otolaryngol.13, 345–3542 Johnson A., Hawke M. (1985) Cell shape in the migratory epidermis of the external auditory canal. J Otolaryngol.14, 273–281
Is there an association between blood group O and epistaxis?
Authors: Reddy V.M. , Broad S. , Daniel M. , Moir A.A. 
Published: December 2006

Objectives.  Blood group O is associated with lower expression of von Willebrand factor 2, although the clinical significance of this is unclear. Earlier work demonstrated lower admission rate for epistaxis among Asians compared with Caucasians in our unit (P < 0.01) 1, with one of the possible explanations being higher prevalence of blood group O among Caucasians. This study investigates whether blood group O is over‐represented in patients admitted with epistaxis.Method.  Retrospective comparison of blood groups of Caucasian patients admitted at our institution (HISS data) with epistaxis during a six‐year period (2000–2005) with blood groups of the UK Caucasian population in general, determined from National Blood Service data.Results.  A total of 1,261 Caucasians admitted with epistaxis were identified (readmissions excluded). Among epistaxis patients, 50% were blood group O (636/1261), but among the general population this was 46% (chi‐square test P < 0.05).Conclusions.  Blood group O appears over‐represented in Caucasian patients admitted with epistaxis, compared with the Caucasian population in general. Although a causal relationship cannot be confirmed in this study, the possibility that blood group O is a risk factor for epistaxis warrants further investigation.References 1 Daniel M., Jaberoo M.C., Stead R.E., Reddy V.M., Moir A.A. Is admission for epistaxis more common in Caucasian than in Asian people? A preliminary study. Clin Otolaryngol Allied Sci. (in press)2 Miller C.H., Haff E., Platt S.J., Rawlins P., Drews C.D., Dilley A.B., et al. (2003) Measurement of von Willebrand factor activity: relative effects of ABO blood type and race. J Thromb Haemost. 1, 2191–2197
Oral Sub‐mucous fibrosis (OSMF): a study of associated habits and their impact
Authors: Supriya M. , Patel S. , Vishwakarma R. 
Published: December 2006

Objective.  To determine the incidence of associated habits in patients with OSMF. The relationship between the different habits and the severity of the disease.Design.  Cross‐sectional Survey.Setting.  Tertiary Referral Centre.Participants.  Adult patients with OSMF.Outcomes Measured.  (1) Association of different habits with OSMF. (2) Duration of chewing before onset of symptoms related to OSMF. (3) Severity of OSMF with respect to different chewing habits.Results. A total of 500 patients with OSMF were included in this study over 2‐year period. Except 3 patients (0.6%) rest all gave history of one of these chewing habits–(Pan‐Masala is a mixture of Arecnuts, Lime, Catechu and undisclosed sweetening and Flavouring agents). 432 (86.4%) of Pan‐Masala with Tobacco, 56 (11.2%) of only Tobacco, 8 (1.6%) of only Betel Nut, 1 (0.2%) of pan‐Masala without Tobacco. Smoking Tobacco had no statistically significant effect on the incidence of OSMF in any of these groups. In the above mentioned order the other associated factors were respectively. The mean duration of chewing before onset of symptoms in years 3.28, 3.95, 8.37 and 10. The proportion of patients with <2 finger mouth opening was 249/432 (57.63%), 28/56 (50%), 3/8 (37.5%), 0 (0%).Conclusion.  The occurrence of OSMF is strongly associated with the habit of chewing Pan‐Masala with Tobacco and less so with only Tobacco or Betel Nut. Patients consuming Pan‐Masala with Tobacco develop this disease earlier then chewers of Tobacco and Betel Nut. Restriction of mouth opening is worst with Pan‐Masala with Tobacco.References 1 Ariyawardana A., Athukorala A.D., Arulanandam A. (2006) Effect of betel chewing, tobacco smoking and alcohol consumption on oral sub‐mucous fibrosis: a case‐control study in Sri Lanka. J Oral Path & Med35, 197–2012 Ranganathan K., Devi M.U., Joshua E., Kirankumar K., Saraswathi T.R. (2004) Oral sub‐mucous fibrosis: a case‐control study in Chennai, South India. J Oral Path & Med33, 274–277
Oncolytic virotherapy for nasopharyngeal cancer
Authors: Bapat U. , Wang Y. , Alusi G. , Chisholm E. , Francis J. , Hallden G. , Lemoine N. 
Published: December 2006

Objectives.  To evaluate the oncolytic potential of a replication‐selective mutant adenovirus (VAI‐deleted adenovirus) in an established EBV‐positive cancer cell line and to develop a new regime to enhance the potency of the virus by combination with additional agents.Methods.  In vitro (cytotoxicity) assays to determine cell survival were performed to assess the viral potency of replicating adenovirus (wild‐type and the VAI‐deleted mutant) in established EBV‐negative and EBV‐positive cancer cell lines. Various drugs including a histone deacetylase inhibitor (HDACi), phenylbutyrate and standard chemotherapeutic agents used in nasopharyngeal cancer (cisplatin, 5‐fluorouracil and paclitaxel) were evaluated for their cytotoxic effect on these tumour cells. Subsequent experiments were performed to determine whether addition of these increased the anti‐tumour efficacy of the VAI‐deleted adenovirus and/or lowered the required viral dose. Sequencing studies with the virus and drugs were carried out to determine the most synergistic combination causing cytotoxicity. Viral infectivity and replication studies with and without HDACi were also undertaken.Results.  The mutant adenovirus was found to be more potent than the wild‐type virus against the EBV‐positive cells. Combination with various therapeutic agents (phenylbutyrate, cisplatin, 5‐fluorouracil and paclitaxel) results in lowering of the virus dose and a synergistic effect. Sequencing of drug followed by virus achieves the best results. There was no significant change in infectivity or replication with addition of the HDACi.Conclusion.  Combination of the VAI‐deleted adenovirus with agents already in clinical use results in synergy. In vivo and thereafter translational studies would enable the clinical application of such treatment for EBV‐associated tumours.Reference 1 Wang, Y., et al. (2005) Virus‐associated RNA I‐deleted adenovirus, a potential oncolytic agent targeting EBV‐associated tumors. Cancer Res. 65, 523–531
Elastic scattering spectroscopy in the head & neck
Authors: Upile T. , Jerjes W. , Howard D. , Michaels L. , Hopper C. , Wright A. 
Published: December 2006

Objectives.  To develop the a technique of optical biopsy of oral dysplastic lesions that will provide real‐time diagnosis, allow in situ monitoring, and which will be feasible in the clinical environment especially for patient follow‐up.Method.  Ethics approval was granted. Ex‐vivo specimens were evaluated to determine the optimal protocol before use in vivo. 75 spectra were obtained from 25 patients with oral leukoplakia. The spectral readings were mapped, and the area was then biopsied. Photographic images were co‐registered with the histological specimen. The sensitivity and specificity of the technique was determined compared to the gold standard of histo‐pathological examination of paraffin sections.Results.  The sensitivity and specificity in determining dysplastic from benign conditions were 70% and 78.6% respectively at 580 nm.Conclusions.  The use of Elastic Scattering Spectroscopy may aid the differentiation of normal and dysplastic mucosal lesions in the head & neck.References 1 Chung, A., Karlan, S., Lindsley, E., et al. (2006) In vivo cytometry: a spectrum of possibilities. Cytometry A. 69, 142–1462 Dhar, A., Johnson, KS., Novelli, MR., et al. (2006) Elastic scattering spectroscopy for the diagnosis of colonic lesions: initial results of a novel optical biopsy technique. Gastrointest Endosc.63, 257–261
The effect of co‐morbidity on quality of life in patients treated with radiotherapy for head and neck squamous cell cancer
Authors: Oozeer N.B. , Paleri V. , Benbow J. , Downs C. , Kelly C. 
Published: December 2006

Objective:  To identify the impact of co‐morbidity on the quality of life (QoL) of patients suffering from head and neck squamous cell cancer (HNSCC) during radiation treatment.Methods:  A total of 250 patients diagnosed with HNSCC between August 2001 and February 2003 underwent QoL and psychological profile assessment using the University of Washington QoL instrument (UWQoL) and the Hospital Anxiety and Depression Scale (HADS) respectively. The assessment was performed prospectively at the beginning and at two time points during radiation therapy. Co‐morbidity burden was assessed retrospectively by case note analysis of 112 patients using the Adult Co‐morbidity Evaluation 27 (ACE‐27) index, which is a previously described and validated instrument. Demographic and tumour data were obtained from prospective databases. Co‐morbidity burden and impact of co‐morbidity on QoL were the main outcome measures estimated.Results:  All data was analysed using SPSS for Windows V 10. Mean co‐morbidity burden in this group was 1.10. Fifty eight percent of patients had some form of co‐morbid illness. Co‐morbidity grades did not influence the QoL and HADS scores before treatment (one way anova). QoL and HADS scores deteriorated during radiation treatment. The change in scores after treatment was not influenced by co‐morbidity in this population (one way anova).Conclusions:  This study shows that the co‐morbidity burden seen in HNSCC bears no influence on the treatment related QoL and psychological profile during radiation therapy. Severe co‐morbidity may have a greater effect on patients QoL and HADS score, but small sample size does not make this statistically significant.
Dissection of level IIb in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature
Authors: Paleri V. , Subramaniam S. , Oozeer N. , Rees G. , Krishnan S. 
Published: December 2006

Objectives.  Selective neck dissection is commonly used to clear occult metastases in the N0 neck. The aim of this study is to identify the incidence of micrometastases in level IIb nodes in patients with upper aerodigestive tract squamous cell carcinoma with clinically and radiologically staged N0 necks and to perform a systematic review of the literature on the incidence of metastases in this setting.Methods.  Thirty‐eight patients were selected and 50 neck dissection (ND) specimens were examined prospectively. Tissue dissected from level IIb was sent separately for histo‐pathological analysis. All the relevant literature in the English language was systematically reviewed.Results.  On average, 2.9 ± 0.4 nodes (range 0–10) were harvested. One patient had a metastatic node in level IIb with extracapsular spread in the ipsilateral neck. No other positive nodes were detected. There was an incidental finding of a deposit of papillary thyroid carcinoma. Sixteen of the 50 NDs showed micrometastases at other levels, predominantly in level IIa (75%). The systematic review identified 11 papers with 704 patients suitable for inclusion. The overall incidence of metastatic disease at level IIb in the context of an N0 neck from any site is 2.3% (16/704). 3.5% (11/312) of oral cavity cancer metastasise to level IIb and none of the 244 patients with laryngeal cancer had level IIb metastatic nodes.Conclusions.  Nodal metastasis is rare in the level IIb even in the presence of positive nodes in adjacent level IIa. There appears to be no advantage in performing contralateral level IIb dissection in N0 necks.
The role of platelet‐derived lysophospholipids in the progression of head and neck cancer
Authors: Lucey D. , Walsh M.A. , Costello R. 
Published: December 2006

Objectives.  Platelets are known to have an important role in cancer progression but their function remains to be fully elucidated. In this study, we tested the hypothesis that platelet derived lysophospholipids are important in the spread and survival of head and neck cancer cells. Lysophospholipids are known to promote many of the hallmarks of cancer, including adhesion, proliferation, invasion and angiogenesis.Methods.  In our study we utilised ‘paired’ primary and metastatic cell lines isolated from a primary tongue cancer lesion and a metastatic lymph node, respectively, from the same patient. This facilitates the study of the nature of head and neck cancer metastasis by comparing the local and metastatic neoplastic population from the same cancer. To investigate the role of lysophospholipids in squamous cell carcinoma of the tongue we compared the receptor profile of these cell lines at the RNA and protein level using PCR and flow cytometry. In addition, we analysed the functional significance of these findings using cell migration and chemoresistance assays.Results.  We demonstrated for the first time that lysophospholipid receptors known to be critical in white blood cell migration are present in metastasising but not localised cancer cells. In addition, we proved that lysophospholipids are important in HNSCC migration and delineated many of the molecular pathways involved. Finally, we demonstrated that the presence of lysophospholipids protects cancer cells from chemotherapy‐induced apoptosis.Conclusions.  Platelet derived lysophospholipids appear to be important in HNSCC metastasis. They may also explain why HNSCC nearly always metastasise to lymph nodes.
The symmetry of paediatric tympanograms
Authors: Cruise A. , Georgalas C. , Wareing M. 
Published: December 2006

Objectives.  The poorer outcome of myringoplasty in children in comparison with adults is commonly attributed to poor Eustachian tube function. The only routine test giving an indication of Eustachian tube function is tympanometry. It is common practice to look at the contralateral tympanogram as a predictor of the child's Eustachian tube function when deciding whether to proceed with myringoplasty. This relies on the assumption that Eustachian tube function is symmetrical. This study seeks to assess whether this assumption is correct.Method.  We collected copies of 297 pairs of tympanograms carried out in a paediatric ENT clinic over a ten‐month period. We compared the symmetry of tympanograms of children aged from 5 to 16 years.Results.  We looked at the association between normal Eustachian tube functions (type A) or abnormal Eustachian tube function (type B, C1 or C2) in one ear and Eustachian tube function in the other ear. A type‐A tympanogram in one ear predicted a type‐A tympanogram in the other ear with a sensitivity of 0.81 (95% CI 0.74–0.86) and specificity of 0.75 (0.66–0.82). The positive predictive value of a type‐A tympanogram was 0.82 (0.75–0.87) and the negative predictive value was 0.73 (0.65–0.81).Conclusions.  There is a good correlation of Eustachian tube function, as demonstrated by tympanometry, between the ears of a child. If Eustachian tube function does have an impact on myringoplasty outcome then the contralateral tympanogram should provide some help in the decision on timing of myringoplasty.