bluuebunny/crossref_metadata_2025_split huggingface dataset:
Auditory Brainstem Implant in a Child with Severely Ossified Cochlea
Authors: Sanna Mario , Khrais Tarek , Guida Maurizio , Falcioni Maurizio 
Published: September 2006

AbstractObjective: The hearing outcome after implanting a severely ossified cochlea has always been less satisfactory than implanting a patent one. The aim of our study is to present a case where brainstem implantation was successfully performed as an alternative to cochlear implantation in a child with bilateral severe ossification of the cochlea.Study Design: Case presentation. This study was conducted at Gruppo Otologico, Rome, Italy, a private referral center for neurotology and skull base surgery.Methods: The subject of our study was a 12‐year‐old female child with postmeningitic deafness and bilaterally ossified cochleae. This case is the first brainstem implantation performed at our center with the indication of severe ossification of the cochlea.Results: Successful brainstem implantation of a device was carried out, and the hearing of the patient was restored to the degree that she can freely use the telephone after 8 months of implantation.Conclusion: Although more cases are needed before establishing the exact outcome of brainstem implantation in cases of deafness in the presence of severe bilateral cochlear ossification, preliminary results show the superiority of brainstem implants to conventional or even customized cochlear implants.
Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology Patient
Authors: Mehta Vishvesh M. , Har‐El Gady , Goldstein Nira A. 
Published: September 2006

AbstractContext: Post‐obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II).Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea.Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003.Setting: Tertiary care teaching hospital and its affiliates.Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years.Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities.Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery.
In Vivo Detection of Head and Neck Cancer Orthotopic Xenografts by Immunofluorescence
Authors: Rosenthal Eben L. , Kulbersh Brian D. , Duncan Ryan D. , Zhang Wenyue , Magnuson J Scott , Carroll William R. , Zinn Kurt 
Published: September 2006

AbstractPurpose: To determine whether Cy5.5‐labeled antiepidermal growth factor (EGFR) antibody could be used to detect head and neck squamous cell carcinoma (HNSCC) xenografts in vivo.Methods: AntiEGFR antibody (cetuximab) was labeled with Cy5.5, a fluorophore with emission in the near infrared range. The cetuximab‐Cy5.5 conjugate was systemically administered in subtherapeutic doses (50 μg) to mice bearing orthotopically xenografted HNSCC cell lines (SCC1, CAL27, and FaDu). As a control, isotype‐matched human immunoglobulin (Ig)G1k antibody labeled with Cy5.5 was systemically injected in parallel experiments. All tumor regions (n = 6) were imaged by fluorescent stereomicroscopy at 0, 6, 24, 48, or 72 hours. Tumor size was measured by high‐frequency ultrasonography at 72 hours. Transcervical partial and near‐total resections were then performed with stereomicroscopic imaging after each resection. The mandible and associated structures were then resected, paraffin embedded, and then serial sectioned for analysis.Results: Tumors could be clearly visualized by near infrared fluorescent stereomicroscopy at 48 and 72 hours after systemic administration of cetuximab‐Cy5.5 but not after administration with the labeled isotype control antibody, IgG1k‐Cy5.5. Ultrasound measurement of tumors (n = 5) correlated with fluorescent measurements of tumor (Spearman's coefficient, 0.92, P ≤ .01). When fluorescent stereomicroscopic findings were correlated with histologic findings in near‐total resections, this technique could accurately identify residual tumor less than 1 mm in size.Conclusion: Fluorescent immunoguided neoplasm detection may be used as a diagnostic tool and to guide surgical therapy by providing real‐time imaging information about the extent of disease or the presence of residual disease.
Frontal Sinus Cranialization Using the Pericranial Flap: An Added Layer of Protection
Authors: Donath Alexander , Sindwani Raj 
Published: September 2006

AbstractObjectives: Extensive fractures involving the anterior and posterior tables of the frontal sinus are treated by frontal sinus cranialization. During this procedure, the disrupted posterior wall of the frontal sinus is removed, the sinus mucosa is drilled away, and the brain and dura are permitted to rest against the repaired anterior wall and sinus floor. Conventionally, the area originally occupied by the frontal sinus is left as dead space or filled with free adipose tissue. We describe a method of cranialization using a pericranial flap and report our experience with this technique.Study Design: Retrospective study.Methods: The medical records of patients who underwent frontal sinus cranialization using the pericranial flap at our institution were reviewed. Demographics, indications for cranialization, complications, and perioperative outcomes were examined.Results: A total of 19 patients underwent (bilateral) frontal sinus cranialization with the pericranial flap between 2000 and 2005. Indications included extensive frontal sinus fractures involving the posterior table (78.9%), mucocele (10.5%), arteriovenous malformation (5.3%), and frontal bone osteomyelitis (5.3%). There were no intraoperative complications. A postoperative cerebrospinal fluid leak occurred in one patient with extensive skull base injuries. This was repaired endoscopically. Follow‐up ranged from 9 to 55 months.Conclusions: The pericranial flap is easily harvested and versatile. Using this vascularized tissue during cranialization affords added protection by providing an extra barrier between the intracranial cavity and the frontal bone and sinonasal tract. This technique is inexpensive, safe, and effective and should be considered when cranialization of the frontal sinus is performed.
Quality of Life in Advanced Oropharyngeal Carcinoma After Chemoradiation Versus Surgery and Radiation
Authors: Mowry Sarah E. , Ho Allen , LoTempio Maria M. , Sadeghi Ahmad , Blackwell Keith E. , Wang Marilene B. 
Published: September 2006

AbstractObjective: The objective of this cohort study from a tertiary academic university practice was to identify differences in patients' perceived quality of life after either chemoradiation or surgery and radiation for advanced‐stage oropharyngeal carcinoma.Methods: From institutional databases, thirty‐five patients were identified who had undergone either primary chemoradiation or primary surgery and postoperative radiation for advanced oropharyngeal cancer (stage II‐IV). Patients voluntarily responded by mail using the University of Washington quality‐of‐life instrument version 4 (UW‐QOL). Data were analyzed using χ2 and Wilcoxon tests.Results: There were 17 patients who underwent chemoradiation and 18 patients who underwent surgery and postoperative radiation. All surgical patients had undergone free‐flap reconstruction. Patients completed the UW‐QOL an average of 25 months after treatment. There was no statistically significant difference between the two groups with regard to any specific domain, including pain, appearance, swallowing, chewing, speech, saliva, or mood. There was a trend toward significance for taste (P = .07) with chemoradiation patients reporting poorer taste function. The lack of difference in the patients' perception of appearance and swallowing was rather surprising given the vastly different treatment modalities. Respondents reported equivalent overall quality of life in response to global quality‐of‐life questions.Conclusion: Most patients with advanced oropharyngeal carcinoma report good quality of life after treatment, regardless of treatment modality. Although the short‐term side effects of treatment may be different between the groups, long‐term quality of life is remarkably similar whether the patients choose primary chemoradiation or surgery with postoperative radiation.
Immediate Recurrent Laryngeal Nerve Reconstruction and Vocal Outcome
Authors: Yumoto Eiji , Sanuki Tetsuji , Kumai Yoshihiko 
Published: September 2006

AbstractObjective: The objective of this prospective study was to assess the long‐term effects of immediate reconstruction of the recurrent laryngeal nerve (RLN) during thyroid cancer extirpation on postoperative phonatory function.Subjects and Methods: The subjects were 22 patients with advanced thyroid cancer who underwent resection of the primary lesion and involved RLN. RLN paralysis was seen in 12 patients preoperatively and involvement of the RLN was noted intraoperatively in 10. Immediate reconstruction of the RLN was performed on eight patients using the great auricular nerve and one underwent direct anastomosis of the RLN stumps (group I). Nine patients opted not to have phonosurgical procedures (group II). The remaining four had arytenoid adduction immediately after cancer extirpation (group III). Phonatory function (stroboscopy, maximum phonation time [MPT], mean airflow rate [MFR], harmonics‐to‐noise ratio [HNR], jitter, and shimmer) was followed for at least 9 months.Results: Minimal or no glottal gap during phonation was observed in six patients in group I, whereas the patients in group II had a large gap along the entire fold. HNR, MPT, and MFR were significantly better in group I (17.7 ± 3.6 dB, 15.1 ± 6.3 s, and 100 ± 32 mL/s, respectively) than in group II (12.1 ± 2.9 dB, 5.4 ± 3.1 s, and 430 ± 207 mL/s, respectively). Patients in group III had a gap of varying degrees along the membranous fold. Although HNR, shimmer, and MPT in group III were comparable to group I, the other parameters were less f/vorable than in group I.Conclusion: Immediate RLN reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function.
Surgical Treatment of Pediatric Cholesteatomas
Authors: Shirazi Mobeen A. , Muzaffar Kamil , Leonetti John P. , Marzo Sam 
Published: September 2006

AbstractObjective: Management of pediatric cholesteatomas remains controversial. We reviewed our 16‐year experience in the surgical treatment of cholesteatomas in children and describe a treatment paradigm.Study Design: The authors conducted a retrospective review.Methods: A total of 106 mastoidectomies (86 for an acquired cholesteatoma and 20 for a congenital cholesteatoma) were performed in children 16 years old and younger from 1988 to 2003. Follow up ranged from 2 years to 12 years with a mean follow‐up period of 6 years. Hearing outcomes, cholesteatoma recidivism, and dry mastoid cavity were the main outcomes measured.Results: Seven (7%) patients had revision surgery for cholesteatoma recidivism. Rates of cholesteatoma recurrence for canal all up (CWU) and canal wall down (CWD) mastoidectomy groups were similar (8% vs. 6%). The percentage of patient with good serviceable hearing (pure‐tone average ≤25 dB) was higher in those with a CWU mastoidectomy as compared with the CWD mastoidectomy group (81% vs. 47%) (P < .05). Extent of disease and stapes superstructure erosion on presentation were significant (P < .05) predictors of both cholesteatoma recidivism and poor hearing. All 106 subjects studied had a dry mastoid and 78 patients (74%) had a maintenance‐free cavity at the time the study was completed.Conclusion: The treatment of pediatric cholesteatomas should be individualized with CWD mastoidectomy chosen for patients with recurrent or more extensive disease. We conclude that the CWU procedure is an adequate surgical option for treating most acquired and congenital cholesteatomas, preventing disease recurrence, and maintaining good hearing outcomes.
Reconstruction of Dorsal and/or Caudal Nasal Septum Deformities With Septal Battens or by Septal Replacement: An Overview and Comparison of Techniques
Authors: André Robert F. , Vuyk Hadé D. 
Published: September 2006

AbstractObjectives: The objectives of this study were to describe and compare two techniques used to correct nasal septum deviations located in the dorsal and/or caudal septum.Study Design: The authors conducted a retrospective clinical chart review.Methods: The authors conducted a comparison of functional and technical results between surgery in the L‐strut of the septum in 114 patients with septal battens or by septal replacement by subjective self‐evaluation and by examination of the position of the septum during follow up.Results: There was subjective improvement in nasal breathing in 86% of the septal batten group and in 94% of the septal replacement group. This difference was not statistically significant. The technical result was judged by examining the position of the septum during follow up as midline, slightly deviated, or severely deviated. The septum was significantly more often located in the midline during follow up in the septal replacement group than in the septal batten group.Conclusion: Treatment of deformities located in the structurally important L‐strut of the septum may be technically challenging and many functional, structural, and esthetic considerations must be taken into account. On the basis of this series, both septal battens and septal replacement techniques may be considered for correction of deviations in this area. The functional improvement rates were not significantly different between the techniques, although during follow up, the septum appeared to be significantly more often located in the midline in the septal replacement group. The techniques are described and their respective advantages and potential drawbacks are discussed.
Development and Validation of the Vocal Tremor Scoring System
Authors: Bové Michiel , Daamen Nicole , Rosen Clark , Wang Chen‐Chi , Sulica Lucian , Gartner‐Schmidt Jackie 
Published: September 2006

AbstractBackground: Essential tremor (ET) occurs in approximately 4% of the population, and 25% of patients with ET have vocal tract involvement referred to as essential tremor of voice (ETV). Treatment of vocal tremor has a variable success rate most likely as a result of inaccurate identification of the affected area(s). A vocal tremor assessment system was developed to standardize the evaluation and scaling of vocal tremor. Applying this system clinically can help determine who will benefit most from botulinum toxin injection treatment. The Vocal Tremor Scoring System (VTSS) can also be used as a tool to determine treatment efficiency for all treatment modalities of ETV, including surgery, medications, and implantable devices.Study Design: The authors studied instrument development and validation.Methods: A clinical consensus conference was conducted to develop an assessment tool for standardized rating of vocal tremor location and severity. The assessment tool was then tested for reliability using video‐perceptual analysis. Once validated, the assessment tool was applied to 10 examinations of patients with vocal tremor who had been treated with botulinum toxin A (BtxA) injections of the thyroarytenoid muscle(s) to determine the ability of the scoring instrument to predict treatment outcome.Results: The VTSS is based on severity scores for different anatomic sites within the vocal tract. The assessment areas of the VTSS are the palate, base of tongue, pharyngeal walls, larynx, supraglottis, and true vocal cords. Statistical analysis of the video‐perceptual analysis results showed that the anatomic sites with the best interrater agreement were the true vocal folds, palate, base of tongue, and supraglottis. Overall, the VTSS demonstrated a level of interrater reliability of at least 0.914 at all sites. Intrarater reliability was excellent. The consensus group also analyzed 10 standardized examinations and the scores from both reviewer groups were then compared and found to have a reliability of at least 0.6 at each site. Pretreatment VTSS scores of 10 patients with ETV who underwent BtxA therapy were then compared with treatment response. The VTSS predicted the favorable treatment outcome 100% of the time when the score given to the true vocal folds was equal or greater to the mean of the scores given to the other sites.Conclusion: The VTSS represents the first standardized system for rating anatomic site(s) and severity of vocal tremor. This tool will allow improved communication between otolaryngologists, facilitate research in vocal tremor treatments, and establish a descriptive system for assessing vocal tremor. Using this assessment tool for patients with vocal tremor increases optimal patient selection and success rate for intralaryngeal botulinum toxin treatment.
The Endoscopic Management of Zenker Diverticulum: CO2 Laser versus Endoscopic Stapling
Authors: Miller Frank R. , Bartley Jess , Otto Randal A. 
Published: September 2006

AbstractObjective: The purpose of this project was to analyze the endoscopic management of Zenker diverticulum (ZD) using both the CO2 laser and endoscopic stapling techniques. This study compares the two techniques in terms of diverticulum size, onset to oral intake, hospital stay, resolution of symptoms (dysphagia and regurgitation), and complications.Study Design: A retrospective consecutive case series was performed at an academic medical center.Methods: Forty patients underwent an attempted endoscopic resection of the ZD using either the CO2 laser or the endoscopic stapling technique. The two techniques were compared on a variety of parameters, including diverticulum size, hospital stay, onset to oral intake, resolution of symptoms, and complications. Symptom scores were obtained before and after surgery with a patient self‐reported scoring report (scale 0–3 for both dysphagia and regurgitation with 0 indicating asymptomatic and 3 severe symptoms).Results: Forty patients underwent an attempted endoscopic management of ZD. Five patients (12.5%) failed endoscopic exposure (four converted to open, one observed). Sixteen patients underwent CO2 laser management and 19 underwent endoscopic stapling. The mean diverticulum size (3.8 cm CO2 laser versus 4.4 cm stapling) was not significantly different for the two groups. Both groups demonstrated a significant decrease in preoperative versus postoperative dysphagia and regurgitation symptoms scores, respectively, CO2 laser dysphagia scores decreasing from 2.75 to 1.38 and the regurgitation score dropping from 1.51 to 0.68, whereas endoscopic stapling dysphagia score decreased from 2.74 to 1.21 and the regurgitation score dropped from 1.37 to 0.53. Overall, 86% of patients demonstrated an onset of liquid intake on postoperative day 1 and the average length of stay was 3.4 days in the CO2 laser group and 1.5 days in the endoscopic stapling (P < .0015). Complications included dental trauma in four patients (two CO2 laser and two stapling) and subcutaneous air in three patients (all three CO2 laser). There were no cases of mediastinitis, recurrent laryngeal nerve injury, fistula, or perioperative death.Conclusions: The endoscopic management of ZD is a safe and effective technique. The endoscopic stapling technique appears to have an improved efficacy and safety when compared with the CO2 laser technique. The two techniques are compared and contrasted.
How Can an Underlaid Fascia Graft Form the Middle Layer of a Reconstructed Tympanic Membrane?
Authors: Szabó László Z. 
Published: September 2006

AbstractObjective/Hypothesis: Autogenous f/scia is a material popularly applied as a connective tissue graft for reconstruction of the tympanic membrane. The objective was to establish how an underlaid fascia graft can form the middle layer of a reconstructed tympanic membrane.Study design: In the underlaid technique, the graft is laid on the medial surface of the tympanic remnant without removal of the mucous membrane, which is covered with entodermal epithelium. Interestingly earlier authors have regarded this fact as natural, though, if it is really so, it must be a result of an unexpected, special mechanism that apparently contradicts the general rules of transplantation.Methods: Experimental operations were performed on one ear of 114 adult, male guinea pigs. The posterior quadrants of the tympanic membrane were removed, and the perforation was closed with an underlaid temporal fascia graft. Examinations were made after different survival times. The temporal bones were removed immediately, and specimens were processed histologically.Results: The graft proved to be well adapted to the margin of the tympanic membrane. The epithelium of the outer surface grew both from the meatal skin and from the margin of the tympanic remnant. In connection with the regeneration of the mucous membrane of the inner surface, unexpected, special events were observed. The originally intact epithelium of the mucous membrane was annihilated, and disappeared completely. Consequently, the fibrous layer of the tympanic remnant and the graft came into direct contact and grew together. The regeneration of the mucous membrane started at the margin of the graft.Conclusions: The histologic observations described have clarified the problem of the underlaid technique.