bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consequences to Hearing During the Conservative Management of Vestibular Schwannomas
Authors: Walsh Rory M. , Bath Andrew P. , Bance Manohar L. , Keller Anne , Rutka John A. 
Published: November 2003

AbstractObjective:To estimate the risk of loss of serviceable hearing during the conservative management of vestibular schwannomas.Study Design:Retrospective case review.Methods:Twenty‐five patients with a radiological diagnosis of unilateral vestibular schwannoma were managed conservatively for a mean duration of 43.8 months (range, 12–194 mo). The pure‐tone average (PTA) (0.5, 1, 2, and 3 kHz) and speech discrimination scores (SDS) were measured at regular intervals throughout the entire duration of follow‐up. Serviceable hearing was defined using two criteria: 70% SDS/30 dB PTA (the 70/30 rule) and 50% SDS/50 dB PTA (the 50/50 rule). The size and growth rate of tumors were determined according to the American Academy of Otolaryngology—Head and Neck Surgery guidelines (1995). Intervention was recommended if there was evidence of continuous or rapid radiological tumor growth, and/or increasing symptoms or signs suggestive of tumor growth.Results:The risk of loss of serviceable hearing for the total group was 43% using the 70/30 rule and 42% using the 50/50 rule. Tumor growth was considered significant (> 1 mm) in 8 tumors (32%) and nonsignificant in 17 (68%). The risk of loss of serviceable hearing for the tumor‐growth group was 67% using the 70/30 rule and 80% using the 50/50 rule. In contrast, the risk of loss of serviceable hearing for the no tumor–growth group was 25% using the 70/30 rule and 14% using the 50/50 rule. No audiological factors predictive of tumor growth were identified.Conclusions:There is a significant risk of loss of serviceable hearing during the conservative management of vestibular schwannomas. This risk appears to be greater in tumors that demonstrate significant growth.
Pressure Transfer Between Intracranial and Cochlear Fluids in Patients With Meniere's Disease
Authors: Konrádsson Konrád S. , Nielsen Lars Holme , Carlborg Björn I. R. , Borgkvist Britt 
Published: November 2003

AbstractObjectives: To elucidate the pressure transfer between intracranial and labyrinthine fluids in patients with well‐defined unilateral Meniere's disease.Study Design: Eleven patients previously exposed to hypobaric pressure agreed to be investigated further with the tympanic membrane displacement (TMD) technique. TMD was used to indirectly analyze perilymph pressure changes as the result of changes in body position.Methods: Repeated measurements for both the diseased and the healthy ears were made with the patients supine and then in a sitting position. The TMD parameters for the maximum inward displacement, the Vi, and the mean volume displacement, the Vm, were calculated and compared.Results: The paired comparison showed statistically significant larger Vi values for both ears in the supine position. A similar tendency was observed for the Vm value. This difference of the Vi was significantly larger for the diseased ear compared with the currently healthy ear. The results were compared to the audiometric and electrocochleographic results previously obtained on the same patients when they were subjected to hypobaric pressure. Patients who experienced the largest differences in hearing level thresholds in the lower frequencies also showed the greatest differences in TMD values as the result of postural changes.Conclusions: Despite the limited number, the statistically supported results suggest a relation between the efficiency of the routes of pressure transfer and the observed effect of hypobaric exposure. The results also indicate that for the patients tested, the routes of communication are more effective in the diseased ear than in the healthy ear—a condition that may relate to the pathogeneses of Meniere's disease.
Temporal Bone Histopathology in Connexin 26–Related Hearing Loss
Authors: Jun Andrew I. , McGuirt Wyman T. , Hinojosa Raul , Green Glenn E. , Fischel‐Ghodsian Nathan , Smith Richard J. H. 
Published: November 2003

AbstractObjective: Mutations in GJB2, a gene that encodes a gap junction protein, Connexin 26 (Cx26), are responsible for approximately one third of sporadic severe‐to‐profound or profound congenital deafness and half of severe‐to‐profound or profound autosomal recessive nonsyndromic hearing loss (ARNSHL). Mouse mutants homozygous for knockouts of this gene are nonviable, precluding histopathologic studies of the associated inner ear pathology in this animal model. Therefore, we studied archival temporal bone sections to identify temporal bone donors with Cx26‐related deafness.Study Design: Temporal bone donors with a history of congenital severe‐to‐profound or profound deafness were identified in the registry of the Temporal Bone Library at the University of Iowa. Histological findings were interpreted in a blinded fashion. DNA extracted from two celloidin‐embedded mid‐modiolar sections from each temporal bone was screened for the 35delG Cx26 mutation. The entire coding region of Cx26 was screened for other deafness‐causing mutations if the 35delG mutation was detected.Results: Of five temporal bone donors with congenital severe‐to‐profound deafness, one donor was found to have Cx26‐related deafness. This individual was a Cx26 compound heterozygote, carrying the 35delG mutation and a noncomplementary Cx26 missense mutation on the opposing allele. Microscopic evaluation of this temporal bone showed no neural degeneration, a good population of spiral ganglion cells, near‐total degeneration of hair cells in the organ of Corti, a detached and rolled‐up tectorial membrane, agenesis of the stria vascularis, and a large cyst in the scala media in the region of the stria vascularis.Conclusion: This study is the first to report the temporal bone histopathology associated with Cx26‐related deafness. Preservation of neurons in the spiral ganglion suggests that long‐term successful habilitation with cochlear implants may be possible in persons with severe‐to‐profound or profound Cx26‐related deafness.
Role of Vascular Reflex in Nasal Mucosal Swelling in Nasal Allergy
Authors: Numata Tsutomu , Konno Akiyoshi , Terada Nobuhisa , Hanazawa Toyoyuki , Nagata Hiroshi , Tanikawa Hirokazu 
Published: November 2003

AbstractObjective: In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy.Methods: Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy.Results: Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa.Conclusions: Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.
Arterial Supply of the Nasal Tip in Asians
Authors: Jung Dong Hak , Kim Hee Jin , Koh Ki Seok , Oh Chang Seok , Kim Kyung‐Su , Yoon Joo‐Heon , Chung In‐Hyuk 
Published: November 2003

AbstractObjectives:The blood supply to the nasal tip and columella was examined to determine whether it could be damaged as a result of transcolumellar incision during an external rhinoplasty approach in Asians.Methods:The blood vessels that supply the nasal tip were examined by dissecting 51 cadavers, and their corresponding 102 nasal sections were injected with red latex before dissection. The size and distribution of the vessels were measured with the unaided eye and the primary supply vessels were determined. The subdermal layer in which the vessels lie and the course of the vessels were also investigated.Results:The main blood supply source of the nasal tip proved to be the lateral nasal artery in 78% (80/102) of the cases examined, while the remaining cases (22%) received their blood supply via the dorsal nasal artery. Columellar branches were narrow in diameter and varied in size and appearance, and were therefore appeared insufficient as a main blood supply. These arteries passed through the musculoaponeurotic layer, but they were also in close proximity to the main surgical plane in the dome of the lower lateral cartilage.Conclusions:The authors speculate that the nasal tip blood supply in Asians is primarily derived from the lateral nasal or dorsal nasal arteries, with a variable contribution from the columella arteries. Therefore, it is important to correctly determine the surgical plane below the musculoaponeurotic layer in order to prevent skin flap necrosis or nasal tip deformity that may occur from damage to the main vessel during an external rhinoplasty approach.
Influence of Tobacco and Alcohol on the Stage of Laryngeal Cancer at Diagnosis
Authors: Trigg Dean J. , Lait Marci , Wenig Barry L. 
Published: November 2003

AbstractObjective This study sought to examine the influence of cigarette smoking and alcohol consumption on the stage of laryngeal cancer at diagnosis.Study Design A retrospective review of 499 laryngeal cancer patients diagnosed between 1978 and 1997 was conducted.Methods Parameters that included smoking history, history of alcohol consumption, and the tumor stage and location at diagnosis were analyzed using the proportional odds model, correlation coefficient, and Student t test.Results Three hundred sixteen patients met the inclusion criteria, and 180 (56%) had advanced‐stage disease at the time of presentation. The statistical model demonstrated a small but significant relationship between tobacco and alcohol on the stage of laryngeal cancer at diagnosis. Patients diagnosed with an advanced‐stage tumor (stage III or IV) smoked a significantly greater amount and were more likely to be heavy drinkers than those diagnosed with a localized laryngeal cancer.Conclusions Our results demonstrate that for every incremental increase in pack years of smoking, there is a small but measurable increase in the odds that a patient's laryngeal cancer will be stage III or IV at diagnosis. Likewise, being a “heavy” drinker as opposed to a “social” drinker raises the likelihood of an advanced tumor. Given the preventable nature of these risk factors, the moderation of alcohol consumption and cessation of smoking is prudent advice that should be conveyed to all patients.
The Nose As Bacterial Reservoir: Important Differences Between the Vestibule and Cavity
Authors: Glück Ulrich , Gebbers Jan‐Olaf 
Published: November 2003

AbstractThe difference between the spectra of potential bacterial pathogens (PBPs) in the nasal vestibule and cavity has not been taken into account in clinical studies.Purpose Since one can anticipate different flora in different kinds of mucosae, the authors compared bacterial species in the vestibule with those of the cavity.Subjects and Method A total of 534 healthy male clerical workers in a downtown Lucerne office building were examined with fractionated swabs.Results PBPs, notably Staphylococcus aureus, were found in 412 subjects and surprisingly, differences in flora of the two sites were noted in 130 of them: PBPs were observed in the vestibule and not in the cavity in 85 of the subjects, and in 45 of them, the reverse was true.Conclusion The practical implications of these findings are considerable regarding infection control in patients at increased infection risk.
Modified Particle Repositioning Procedure
Authors: Tirelli Giancarlo , D'Orlando Elena , Zarcone Oscar , Giacomarra Vittorio , Russolo Mario 
Published: November 2003

AbstractObjectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo.Study Design Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal‐repositioning techniques.Methods Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360° along their longitudinal axis and head shaking on reaching each single position were evaluated.Results Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360° along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head‐shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P = .00011).Conclusions The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head‐shaking.
Pediatric Outcomes Research: Development of an Outcomes Instrument for Tonsil and Adenoid Disease
Authors: Stewart Michael G. 
Published: November 2003

AbstractWe describe the design and validation process of a disease‐specific health status instrument for use in children with tonsil and adenoid disease. This instrument is reliable and valid and should be useful in future outcomes research on tonsil and adenoid disease. Some of the unique issues and challenges regarding outcomes research in pediatric patients are also discussed.
Pain, Quality of Life, and Spinal Accessory Nerve Status After Neck Dissection
Authors: Terrell Jeffrey E. , Welsh Deborah E. , Bradford Carol R. , Chepeha Douglas B. , Esclamado Ramon M. , Hogikyan Norman D. , Wolf Gregory T. 
Published: November 2003

AbstractObjective To assess quality of life (QOL) in patients with head and neck cancer who underwent neck dissection and to compare QOL scores for patients in whom the spinal accessory nerve (CN XI) was resected or preserved.Setting and Design and Outcomes Measures Three hundred ninety‐seven patients who had undergone treatment for head and neck cancer completed the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, the Medical Outcomes Study SF‐12 General Health Survey, and questions on “pain despite pain medications” and headaches.Results Of the 397 patients, 222 had no neck dissection, 46 had neck dissections resecting CN XI, and 129 had dissection sparing CN XI. Of the latter group, 68 patients had dissections sparing level V and 61 dissections included level V. Age, sex, primary site distribution, and T stage were not different between the groups. Patients who had neck dissections sparing CN XI had better scores on the HNQOL pain domain (P = .002), had less shoulder or neck pain (P = .003), and took pain medications less frequently (P = .0004) compared with patients who had neck dissections sacrificing CN XI. When CN XI was preserved, patients who had no level V dissection had better pain domain scores (P = .03) and eating domain scores (P = .007) on the HNQOL, had less shoulder or neck pain (P = .006), and had less physical problems (P = .03) than patients who had level V dissected. On multivariate analysis, pain‐related QOL scores after neck dissection were significantly better (P < .01) if patients had dissections with preservation of CN XI and if level V was not dissected.Conclusion Neck dissections sparing CN XI are associated with better pain scores on the HNQOL, less shoulder and neck pain, and less need for medications. When CN XI is spared, not dissecting level V of the neck is associated with better HNQOL pain scores, less shoulder or neck pain, and fewer physical problems.
Effect of High Laryngeal Mask Airway Intracuff Pressure on the Laryngopharyngeal Mucosa of Dogs
Authors: Martins Regina Helena Garcia , Braz José Reinaldo Cerqueira , Defaveri Júlio , Gregório Elisa Aparecida , Abud Tânia Mara Vilela 
Published: November 2003

AbstractObjectives To evaluate the effect of increased of laryngeal mask airway (LMA) intracuff pressures on the laryngopharyngeal mucosa.Study Design Animal model.Methods Sixteen mixed‐breed dogs were randomly allocated to two groups, G1 (intracuff volume, 30 mL; n = 8) and G2 (intracuff volume, 54 mL; n = 8), to produce, respectively, high or very high intracuff pressures. Anesthesia was induced and maintained with pentobarbital. Intracuff pressures were measured immediately after insertion and inflation of a No. 4 laryngeal mask airway (LMA) and 30, 60, 90, and 120 minutes thereafter. The dogs were euthanized, and biopsy specimens from eight predetermined areas of the laryngopharynx in contact with LMA cuff were collected for light microscopic (LM) and scanning electron microscopic (SEM) examination.Results Initial LMA cuff inflation in G1 and G2 resulted in intracuff pressures of 119 mm Hg ± 4 mm Hg and 235 mm Hg ± 13 mm Hg, respectively. Over a 2‐hour period, the intracuff pressure decreased significantly in G1 (P < .001) and G2 (P < .01), and there was a significant difference between the groups over time (P < .001). The LM study of laryngopharyngeal mucosa in both groups showed mild congestion in the subepithelial layer. There were no differences between the groups (P > .10) or among the areas sampled (P > .10). In some areas of G2, the SEM study showed epithelial desquamation that was more intense than that in G1.Conclusions The increase in LMA intracuff pressure caused only mild alterations in the laryngopharyngeal mucosa of the dog.
Unaided Speech in Long‐Term Tube‐Free Tracheostomy
Authors: Eliachar Isaac 
Published: November 2003

AbstractObjectives/Hypothesis Objectives of the current study were as follows: 1) to determine whether a self‐sustaining, tube‐free tracheostomy with unaided speech capability can be achieved, 2) to propose new surgical techniques to enhance voluntary constriction of a tube‐free tracheostoma to improve cough and speech production, and 3) to explain the mechanism involved in unaided speech after long‐term tracheostomy. The hypotheses were that long‐term, tube‐free tracheostomy could minimize the unwanted effects of conventional tube‐dependent tracheotomy; that surgical shunting of the trachea to the skin surface can be established through a short, skin‐lined, self‐supporting, nostril‐like opening; and that patients could generate speech and cough without the need to occlude the stoma or use stents and/or one‐way valves if such a long‐term tube‐free tracheostoma were established.Study Design A prospective study of tube‐free tracheostomy intended to establish unaided cough and speech.Methods Thirty‐five patients who underwent long‐term flap tracheostomies between 1992 and 1999 with the prospective intent of establishing a self‐sustaining stoma without the need for tubes or stents were reviewed. The patients were trained to intentionally constrict the stoma for production of unaided speech and cough. The pertinent techniques developed for successful achievement of these characteristics are presented and reviewed. A new surgical technique using a local tendinous muscular sling was designed to further improve the efficacy of stomal constriction.Results A tube‐free stoma was successfully established in all 35 patients. Eighteen patients achieved effective intentional constriction of the stoma and thereby were capable of unaided speech production. Four patients required an additional new surgical sling procedure to optimize unaided cough and speech production. Thirteen patients achieved only limited unaided speech production, but were satisfied to do nothing further.Conclusions New surgical techniques and postoperative management to create a modified tube‐free tracheostomy with self‐constricting capabilities can enable production of effective cough and near‐normal generation of unaided speech. In this manner, the airway can be secured with little or no voice compromise.
A Novel Approach to Laryngeal Suspension After Partial Laryngectomy
Authors: Giacchi Renato J. , Abraham Kuriakose M. , Kaufman David , DeLacure Mark D. 
Published: November 2003

AbstractObjectives Supraglottic laryngectomy is a well‐established surgical therapy for selected carcinomas of the larynx and hypopharynx. Most compromised by this procedure and its variations is the laryngeal mechanism that protects the lower respiratory tract from aspiration. Laryngeal suspension serves to compensate for the loss of the resected laryngeal elevator muscles by pulling the larynx upward and forward beneath the tongue base. In this study we describe a method of laryngeal suspension in supraglottic laryngectomy using a cartilage‐anchored suture carrier device.Study Design Report of this novel approach to laryngeal suspension using seven suture anchors in two patients undergoing supraglottic laryngectomy.Methods Seven Mitek Micro anchors (Mitek, Westwood, MA) were used to perform laryngeal suspension in two patients undergoing supraglottic laryngectomy. Our technique is compared with traditional methods. Operative data as well as postoperative functional results are reviewed.Results Laryngeal suspension using suture anchors was successful, with failure of only one anchor. Oral alimentation was quickly re‐established in both patients. There were no perioperative or postoperative complications.Conclusions We describe a novel approach to laryngeal suspension that overcomes some of the technical challenges inherent in traditional suturing techniques. This novel approach is technically easier and more efficient than traditional methods and accomplishes distribution of stress forces on the thyroid cartilage remnant.