bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery
Authors: Farrag Tarik Y. , Samlan Robin A. , Lin Frank R. , Tufano Ralph P. 
Published: February 2006

AbstractObjective: The objective of this study was to evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery.Methods: The authors conducted a retrospective chart review of 340 patients who have undergone thyroid surgery from January 1998 to June 2005 and had preoperative laryngoscopy by mirror, fiberoptic, or videostroboscopic examination. Reports of preoperative voice change or complaint and reports of preoperative VF examination, including the method of examination, were recorded. For patients with VF motion impairment, reports of the intraoperative condition of the recurrent laryngeal nerve (RLN), preoperative diagnosis based on fine needle aspiration, and final postoperative histopathologic examination results were recorded.Results: Twenty‐two patients were found to have preoperative VF motion impairment, of which seven (32%) patients were asymptomatic with no detectable subjective or objective voice problems. This differs significantly from the hypothesis that patients with VF motion impairment are always symptomatic (P = .009). Using voice symptoms as a screening test to predict VF motion impairment in 340 patients reveals that the sensitivity was 68%, specificity was 91%, positive predictive value (PPV) was 31%, and negative predictive value (NPV) was 98%. Among the 22 patients with preoperative VF motion impairment, five (72%) of the seven asymptomatic patients had benign, slowly progressive disease on their final histopathology reports. Six of these asymptomatic patients had their preoperative VF evaluation by fiberoptic examination, whereas one patient had indirect mirror laryngoscopy. Of 22 patients with preoperative VF motion impairment, five (22.5%) patients had abnormal VF mobility contralateral to the thyroid lesion on their preoperative evaluation, and only two of them had nerve injury reported after a previous thyroid surgery. This result differs significantly from the hypothesis that impaired mobility is ipsilateral to the side of the lesion (P = .05).Conclusions: Patients without voice complaints can have VF motion impairment. Patients can also have VF motion impairment contralateral to the thyroid lesion. Preoperative VF examination helps counsel patients appropriately about the risks of surgery and helps outline a plan for the extent of surgery while minimizing the medicolegal ramifications of iatrogenic RLN injury.
Immunoglobulins and Inflammatory Cytokines in Nasal Secretions in Humoral Immunodeficiencies
Authors: Rose Markus A. , Schubert Ralf , Schmitt‐Grohe Sabina , Reichenbach Janine , Zielen Stefan 
Published: February 2006

AbstractObjective: Chronic respiratory tract infections are a common problem in patients with severe humoral immunodeficiency despite intravenous immunoglobulin therapy (IVIG), often presenting as rhinosinusitis.Methods: Because it is unclear whether IVIG is a good substitute at the mucosal surface, we analyzed immunoglobulin levels and inflammatory cytokines (ECP, IL‐8, and TNF‐α) in nasal secretions of 13 patients with common variable immunodeficiency (CVID) and in 10 patients with IgA deficiency.Results: In patients with CVID, median IgG and IgM levels did not differ significantly from controls, whereas inflammatory cytokines were markedly elevated, reflecting persistent inflammation at the mucosal site. In contrast, patients with IgA deficiency showed significantly raised IgG and IgM levels, whereas ECP and TNF‐α were only slightly increased.Conclusion: Low levels of SIgA might be compensated locally at the mucosal site by high levels of IgM and IgG. Our findings implicate that adequate IVIG is not sufficient to prevent chronic inflammation of the sinuses in patients with severe humoral immunodeficiency.
A Double‐Blind, Randomized, Placebo‐Controlled Trial of Macrolide in the Treatment of Chronic Rhinosinusitis
Authors: Wallwork Ben , Coman William , Mackay‐Sim Alan , Greiff Lennart , Cervin Anders 
Published: February 2006

AbstractObjectives: The antiinflammatory effect of macrolide antibiotics has been well‐established, as has their role in the treatment of certain disorders of chronic airway inflammation. Several studies have suggested that long‐term, low‐dose macrolides may be efficacious in the treatment of chronic rhinosinusitis; however, these studies have lacked a control group. To date, this effect has not been tested in a randomized, placebo‐controlled study.Method: The authors conducted a double‐blind, randomized, placebo‐controlled clinical trial on 64 patients with chronic rhinosinusitis. Subjects received either 150 mg roxithromycin daily for 3 months or placebo. Outcome measures included the Sinonasal Outcome Test‐20 (SNOT‐20), measurements of peak nasal inspiratory flow, saccharine transit time, olfactory function, nasal endoscopic scoring, and nasal lavage assays for interleukin‐8, fucose, and a2‐macroglobulin.Results: There were statistically significant improvements in SNOT‐20 score, nasal endoscopy, saccharine transit time, and IL‐8 levels in lavage fluid (P < .05) in the macrolide group. A correlation was noted between improved outcome measures and low IgE levels. No significant improvements were noted for olfactory function, peak nasal inspiratory flow, or lavage levels for fucose and a2‐macroglobulin. No improvement in any outcome was noted in the placebo‐treated patients.Conclusion: These findings suggest that macrolides may have a beneficial role in the treatment of chronic rhinosinusitis, particularly in patients with low levels of IgE, and supports the in vitro evidence of their antiinflammatory activity. Additional studies are required to assess their place in clinical practice.
Epiglottic and Base‐of‐Tongue Prolapse in Children: Grading and Management
Authors: Yellon Robert F. 
Published: February 2006

AbstractObjectives: A distinct entity of airway obstruction from epiglottic and base‐of‐tongue (EBT) prolapse in the pediatric population is defined. Laryngopharyngeal findings, swallowing dysfunction, and gastroesophageal reflux disease are described in a group of children with EBT prolapse. A new grading system is also presented.Study Design: A prospective study was conducted of laryngopharyngeal findings in children with EBT prolapse, a description of a new grading system, and review of the pediatric literature.Methods: Fourteen children with EBT prolapse were prospectively studied with flexible fiberoptic nasopharyngolaryngoscopy. A new grading system for EBT prolapse was developed. Grade 0 is a normal airway. Grade 1 is prolapse of the epiglottis against the posterior pharyngeal wall but with normal position of the tongue. Grade 2 is prolapse of the epiglottis and base of tongue with only the epiglottic tip visible. Grade 3 is glossoptosis with no portion of the epiglottis visible. The diagnostic modalities and treatments for EBT prolapse are reviewed.Results: Of the 14 children studied, seven (50%) had grade 1, four (29%) had grade 2, and three (21%) had grade 3 EBT prolapse. Swallowing dysfunction (five of 14, 38%) and gastroesophageal reflux disease (13 of 14, 93%) were also prevalent.Conclusion: The new grading system was applied successfully to describe the severity and sites of airway obstruction in 14 children with EBT prolapse. Swallowing dysfunction and gastroesophageal reflux disease occur in this population. Although surgical therapies are sometimes effective, lack of consistent success and the risk of aspiration with procedures other than tracheotomy may lead some to conclude that continuous positive airway pressure or tracheotomy are the safest options.
Polyester Wax: A New Embedding Medium for the Histopathologic Study of Human Temporal Bones
Authors: Merchant Saumil N. , Burgess Barbara , O'Malley Jennifer , Jones Diane , Adams Joe C. 
Published: February 2006

AbstractBackground: Celloidin and paraffin are the two common embedding mediums used for histopathologic study of the human temporal bone by light microscopy. Although celloidin embedding permits excellent morphologic assessment, celloidin is difficult to remove, and there are significant restrictions on success with immunostaining. Embedding in paraffin allows immunostaining to be performed, but preservation of cellular detail within the membranous labyrinth is relatively poor.Objectives/Hypothesis: Polyester wax is an embedding medium that has a low melting point (37°C), is soluble in most organic solvents, is water tolerant, and sections easily. We hypothesized that embedding in polyester wax would permit good preservation of the morphology of the membranous labyrinth and, at the same time, allow the study of proteins by immunostaining.Methods: Nine temporal bones from individuals aged 1 to 94 years removed 2 to 31 hours postmortem, from subjects who had no history of otologic disease, were used. The bones were fixed using 10% formalin, decalcified using EDTA, embedded in polyester wax, and serially sectioned at a thickness of 8 to 12 μm on a rotary microtome. The block and knife were cooled with frozen CO2 (dry ice) held in a funnel above the block. Sections were placed on glass slides coated with a solution of 1% fish gelatin and 1% bovine albumin, followed by staining of selected sections with hematoxylin and eosin (H&E). Immunostaining was also performed on selected sections using antibodies to 200 kD neurofilament and Na‐K‐ATPase.Results: Polyester wax–embedded sections demonstrated good preservation of cellular detail of the organ of Corti and other structures of the membranous labyrinth, as well as the surrounding otic capsule. The protocol described in this paper was reliable and consistently yielded sections of good quality. Immunostaining was successful with both antibodies.Conclusion: The use of polyester wax as an embedding medium for human temporal bones offers the advantage of good preservation of morphology and ease of immunostaining. We anticipate that in the future, polyester wax embedding will also permit other molecular biologic assays on temporal bone sections such as the retrieval of nucleic acids and the study of proteins using mass spectrometry–based proteomic analysis.
Three‐Week Thyroxine Withdrawal: A Thyroid‐Specific Quality of Life Study
Authors: Davids Taryn , Witterick Ian J. , Eski Spiro , Walfish Paul G. , Freeman Jeremy L. 
Published: February 2006

AbstractObjectives/Hypothesis: The purpose of this study is to determine the impact of a 3‐week T4 withdrawal test on the quality of life (QOL) of patients undergoing investigation for residual/recurrent well‐differentiated thyroid cancer.Study Design: Prospective survey study.Methods: 181 patients with well‐differentiated thyroid cancer were surveyed using a thyroid‐specific QOL‐thyroid survey at three times throughout the study: prior to T4 withdrawal, after the 3‐week withdrawal period, and 4 weeks after resuming T3/T4 combination therapy.Results: A very small, though statistically significant, reduction was observed in the four domains of QOL defined by the QOL‐thyroid survey from baseline values to 3 weeks after T4 withdrawal. The maximal difference was 2.04 (fatigue), out of a possible 10 point score, in the physical well‐being category.Conclusions: The thyroid‐specific QOL questionnaire demonstrates a statistically significant though very small and probably not clinically significant reduction in the QOL of thyroid cancer patients undergoing an induced 3‐week hypothyroid state. Three‐week T4 withdrawal is a simple, cost‐effective, and readily available test.
Treatment of Chronic Posterior Laryngitis With Esomeprazole
Authors: Vaezi Michael F. , Richter Joel E. , Stasney C Richard , Spiegel Joseph R. , Iannuzzi Ralph A. , Crawley Joseph A. , Hwang Clara , Sostek Mark B. , Shaker Reza 
Published: February 2006

AbstractObjective: To evaluate the efficacy of acid‐suppressive therapy with the proton pump inhibitor esomeprazole on the signs and symptoms of chronic posterior laryngitis (CPL) in patients with suspected reflux laryngitis.Study Design: Prospective, multicenter, randomized, parallel‐group trial that compared twice‐daily esomeprazole 40 mg with placebo for 16 weeks.Methods: Eligible patients had a history of one or more CPL symptoms (throat clearing, cough, globus, sore throat, or hoarseness) and laryngoscopic signs indicating reflux laryngitis based on CPL index (CPLI) scores measured during a screening laryngoscopy. Patients were randomized to treatment if their 7‐day screening diary‐card recordings showed a cumulative primary symptom score of 9 or higher and they had 3 or more days with moderately severe symptoms based on a 7‐point scale. Efficacy was assessed by changes in symptoms as recorded by patients and investigators and by changes in CPLI scores based on laryngoscopic examinations.Results: The patients' primary CPL symptom at final visit (primary efficacy end point) was resolved in 14.7% (14/95) and 16.0% (8/50) of patients in the esomeprazole and placebo groups, respectively (P = .799). Esomeprazole and placebo were not significantly different for change from baseline to the final visit in mean total CPLI (–1.66 ± 2.13 vs. –2.0 ± 2.55, respectively; P = .446) or any other secondary efficacy end points based on patient diary card or investigator assessments.Conclusion: This study provides no evidence of a therapeutic benefit of treatment with esomeprazole 40 mg twice daily for 16 weeks compared with placebo for signs and symptoms associated with CPL.
Safety and Efficacy of Nasal Application of CpG Oligodeoxynucleotide as a Mucosal Adjuvant
Authors: Kodama Satoru , Abe Nobuyuki , Hirano Takashi , Suzuki Masashi 
Published: February 2006

AbstractObjectives: Nasal vaccination is an effective regimen to prevent upper respiratory infections. An appropriate adjuvant is required for the development of a nasal vaccine. The safety and efficacy of CpG oligodeoxynucleotide (ODN) as a mucosal adjuvant was examined.Methods: Mice were nasally administered various doses of CpG ODN weekly, a total of three times. Histologic changes in the spleen and the nasal mucosa were examined, and the alterations in cell subpopulations were analyzed by flow cytometry. In addition, the mice were nasally immunized with P6 outer membrane protein of nontypeable Haemophilus influenzae (NTHi) and CpG ODN, and P6‐specific immune responses were examined.Results: No inflammation or tissue damage was observed locally or systemically after nasal administration, even with a high dose of CpG ODN. A high dose of CpG ODN induced an increase in CD8+ T cells in the nasal mucosa and B cells in the spleen. When CpG ODN was coadministered with P6, P6‐specific mucosal and systemic immune responses were effectively induced, since high levels of the specific IgA and IgG were detected in the nasal wash and serum, respectively.Conclusions: These findings suggest that CpG ODN is a safe and effective mucosal adjuvant. Further, nasal vaccination with P6 and CpG ODN might be an effective regimen to prevent upper respiratory infections.
Upregulation of Surfactant Protein A in Chronic Rhinosinusitis
Authors: Lee Heung‐Man , Kang Hee Joon , Woo Jeong‐Soo , Chae Sung Won , Lee Sang Hag , Hwang Soon Jae 
Published: February 2006

AbstractObjectives: Surfactant protein A (SP‐A) is protein that appears to play an important role in mammalian first‐line host defense. However, the presence of SP‐A in the human paranasal sinus mucosa is not well known. The purpose of this study was to investigate the expression of SP‐A protein in human paranasal sinus mucosa and to compare the expression of SP‐A mRNA between normal paranasal sinus mucosa and paranasal sinus mucosa with chronic rhinosinusitis.Methods: Paranasal sinus mucosa samples from 10 patients who underwent surgery for chronic rhinosinusitis without polyps and 10 normal control subjects were used. Reverse transcriptase polymerase chain reaction was done to detect SP‐A mRNA. The expression level of SP‐A transcripts was semiquantified with desitometry. Cellular localization of SP‐A was sought by using immunohistochemistry.Results:
SP‐A mRNA and protein were expressed in the human paranasal sinus mucosa. SP‐A/GAPDH mRNA ratio in the paranasal sinus mucosa with chronic rhinosinusitis was greater compared with that in normal paranasal sinus mucosa (P < .05). Immunohistochemical staining revealed SP‐A immunoreactivity in the epithelial cells and submucosal glands of paranasal sinus mucosa in both control subjects and chronic sinusitis patients. Stronger immunoreactivity was observed in chronic rhinosinusitis mucosa as compared with normal paranasal sinus mucosa.Conclusion: SP‐A mRNA and protein are present in both normal and diseased human paranasal sinus mucosa. These results may provide potential targets for novel therapy of chronic rhinosinusitis.
Level IIb Lymph Node Metastasis in Laryngeal Squamous Cell Carcinoma
Authors: Lim Young Chang , Lee Jin Seok , Koo Bon Seok , Choi Eun Chang 
Published: February 2006

AbstractObjectives: Selective neck dissection, despite preservation of the spinal accessory nerve, can lead to some degree of postoperative shoulder dysfunction as a result of removal of level IIb lymph nodes. The aim of this study was to determine whether level IIb lymph nodes can be preserved in elective or therapeutic neck dissection as a treatment for patients with laryngeal squamous cell carcinoma (SCC).Study Design: This was a prospective analysis of a case series.Methods: A prospective analysis of 65 patients with laryngeal SCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection from January 1999 to December 2002 was performed. During the neck dissection, the contents of the level IIb lymph nodes were dissected, labeled, and processed separately from the remainder of level II nodes and the main neck dissection specimen. The incidence of pathologic metastasis to level IIb lymph nodes and the regional recurrence within this area were evaluated. In addition, several potential risk factors for metastatic disease in the level IIb lymph nodes such as sex, age, cT stage, cN stage, and the presence of other positive lymph nodes were also evaluated.Results: A total of 125 neck dissections were performed in this series. Of these dissections, 102 (82%) were elective and 23 (18%) were therapeutic. The prevalence of metastases in the level IIb lymph nodes was 1% (one of 46) and 0% (zero of 56) in clinically node‐negative (N0) ipsilateral and contralateral necks, respectively, and 37% (seven of 19) and 0% (zero of four) in clinically node‐positive ipsilateral and contralateral necks, respectively. There was a statistically significant association between level IIb metastases and clinically positive N stage (P < .001). The presence of other positive lymph nodes was also shown to have a statistically significant association with metastasis in the level IIb lymph nodes (P = .001). Only two of 46 patients (4%) with clinically N0 necks developed a regional recurrence. However, three of eight cases (38%) with positive pathologic level IIb lymph nodes developed regional recurrence.Conclusion: Level IIb lymph node pads may be preserved in elective neck dissection in patients with laryngeal SCC. However, this area should be removed thoroughly during therapeutic neck dissection in the treatment of clinically node‐positive necks.
Methicillin‐Resistant Staphylococcus aureus Infections in Acute Rhinosinusitis
Authors: Huang Wei‐Hsiung , Hung Pei‐Kai 
Published: February 2006

AbstractObjective/Hypothesis: Methicillin‐resistant Staphylococcus aureus (MRSA) has recently become a serious problem in various fields of medicine. However, it has rarely been studied in acute rhinosinusitis. The aim of this study was to identify the clinical manifestations and treatment outcome of community‐acquired methicillin‐resistant S. aureus in acute rhinosinusitis.Study Design: This was a prospectively collected case series.Methods: Since 2000, we have launched a prospective long‐term study for bacteriology, drug susceptibility, and their changing trend in acute rhinosinusitis. Patients with the diagnosis of acute rhinosinusitis were enrolled from October 2000 through March 2003. Their middle meatus discharge was taken for aerobic culture. Antibiotic sensitivity test was performed for each isolate.Results: A total of 601 patients with the diagnosis of acute rhinosinusitis were included in this study. MRSA was isolated in 16 specimens. Its prevalence rate in acute rhinosinusitis was 2.7% (16 of 601). Multiple pathogens were more frequently found in children with MRSA infection. Five of seven adults had previous nasal procedures. Eight of nine children had a history of antibiotic use. Except for two patients without follow up, the remaining 14 patients resolved after receiving oral antibiotics according to culture results.Conclusions: The incidence of MRSA infection in acute rhinosinusitis was 2.7% in our study. The most important risk factor was nasal surgeries in adults and previous antibiotic use in children. The treatment outcome of community‐acquired MRSA was excellent with oral antibiotics.
Stridor and Dysphagia in Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Authors: Castellano Dominic M. , Sinacori John T. , Karakla Daniel W. 
Published: February 2006

AbstractAs otolaryngologists, we are the first consulted for stridor and dysphagia. One must consider both extrinsic and intrinsic etiologies in the differential diagnosis of these symptoms. We report a series of patients with diffuse idiopathic skeletal hyperostosis (DISH) who presented with stridor or dysphagia. We describe the initial presenting symptoms, physical examination/radiographic findings, and discuss the management options. Traditional teaching is that surgery is rarely indicated for DISH of the cervical spine. Recommendations regarding the role of surgery as well as a review of our surgical experience are discussed.