bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chest Radiographs after Dilatational Percutaneous Tracheotomy: Are they Necessary?
Authors: Donaldson David R. , Emami A. J. , Wax Mark K. 
Published: February 2003

BACKGROUNDThe efficacy of routinely obtaining chest radiographs after standard open tracheotomy has been questioned. Recent literature would suggest that after a routine, uncomplicated tracheotomy, chest radiography is a low‐yield procedure that incurs unnecessary expense. Percutaneous dilatational tracheotomy (PDT) is rapidly replacing open tracheotomy as the intensive care unit procedure of choice for airway management. Complication rates are equivalent between the two procedures.OBJECTIVEWe examined the value and cost‐effectiveness of routine postoperative chest radiographs in patients undergoing PDT.STUDY DESIGN AND SETTINGThe study was a prospective analysis of 54 consecutive PDTs performed at a tertiary care academic institution.RESULTSEighteen (33%) patients had chest radiographs obtained within 1 hour of PDT (6 at the request of the otolaryngology service); 35 (66%) underwent radiography more than 2 hours later at the request of the intensive care unit for reasons other than PDT. There were no incidents of pneumothorax, pneumomediastinum, or tracheotomy tube malposition in any patient. Patients undergoing chest radiography within 1 hour of the PDT also had chest radiographs within 12 hours at the request of ICU staff for their underlying disease.CONCLUSIONSRoutine chest radiography after PDT is of low yield. Because most of these patients require chest radiographs for their underlying disease within 12 hours, a cost savings of approximately $13,500 would be realized in this patient population.SIGNIFICANCERoutine chest radiography after PDT is unwarranted in most cases.
Temporal Bone Necrosis: Diagnosis, Classification, and Management
Authors: Pathak Irvin , Bryce Graham 
Published: February 2003

OBJECTIVEThe goal of this study was to analyze temporal bone necrosis and classify its diagnosis and treatment according to extent of necrosis and cause.METHODS AND MATERIALTwenty‐six cases of temporal bone necrosis were retrospectively reviewed between 1988 and 1997 at the University of British Columbia.RESULTSPatients were classified on the basis of disease extent restricted to the tympanic bone or extension beyond the tympanic bone, as well as on the basis of the cause of disease; treatment based on classification. Patients with localized disease of the tympanic bone had minimal symptoms. Those with radiation‐induced localized necrosis were less likely to respond to conservative medical management. Patients with diffuse disease were more likely to require surgical intervention.CONCLUSIONSTemporal bone necrosis comprises a spectrum of disease from idiopathic tympanic bone necrosis, which rarely requires surgery, to the more severe forms of radiation‐induced diffuse temporal bone necrosis that may cause life‐threatening complications requiring surgical intervention.
Predictors of Airway Intervention in Angioedema of the Head and Neck
Authors: Zirkle Molly , Bhattacharyya Neil 
Published: February 2003

OBJECTIVERecords of patients presenting with angioedema of the head and neck were analyzed to determine clinical factors that predict the need for airway intervention.METHODSA review of patients with angioedema of the head and neck over a 10‐year period was conducted. Data were collected regarding demographics, cause of edema, and sites of involvement. A logistic regression model was used to ascertain whether any clinical variables were significant in predicting the need for airway intervention.RESULTSReview of 138 charts with an admitting diagnosis of angioedema yielded 66 cases of angioedema of the head and neck in 48 patients. Twenty‐three (34.8%) patients required airway intervention. Logistic regression identified increasing age and angioedema involving the oral cavity/ oropharynx as predictors of airway intervention; involvement of other sites, cause, and sex were not predictive.CONCLUSIONLocation of edema and patient age predict which patients with angioedema of the head and neck are likely to require airway intervention.
Risk Factors Associated with Hypothyroidism after Laryngectomy
Authors: Gal Robin L. , Gal Thomas J. , Klotch Douglas W. , Cantor Alan B. 
Published: February 2003

Hypothyroidism is a well‐documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy. The Cox proportional hazards model was used to identify factors significantly related to an increased risk for development of hypothyroidism. The actuarial method was used to estimate the period of greatest risk for the development of hypothyroidism. Increased risks were found for patients who were female (P = 0.0049), received preoperative radiation therapy (P = 0.0022), had invasion of the thyroid gland by tumor (P = 0.0003), had presence of cervical metastases (P = 0.0022), and had postoperative fistula (P = 0.0095). From the actuarial method, we estimated that the period of time when patients were at greatest risk for development of hypothyroidism was between 0 and 14 months after surgical intervention. Wound complications were twice as frequent in hypothyroid patients. Perioperative awareness of risk factors associated with the development of hypothyroidism in patients undergoing laryngectomy allows for early recognition and management of hypothyroidism and may reduce the number of complications related to wound healing and fistula.
Development and application of a health‐related quality‐of‐life instrument for adults with cochlear implants: The Nijmegen Cochlear Implant Questionnaire
Authors: Hinderink Johannes B. , Krabbe Paul F. M. , Van Den Broek Paul 
Published: February 2003

OBJECTIVE:The goal was to develop a quantifiable, self‐assessment health‐related quality of life (QoL) instrument for use in cochlear implant (CI) users.DESIGN:Three principal domains were distinguished: physical, psychological, and social. Forty‐five postlingually deaf adult multichannel CI users and 46 deaf candidates on the waiting list for CIs (control group) participated in the study.RESULTS:Retrospective scores for the CI group corresponded very well with the scores for the control group. Current QoL scores were substantially higher for all 6 subdomains. Internal consistency and test‐retest reliability coefficients proved to be satisfactory, and the ability to detect clinical changes with the Nijmegen Cochlear Implantation Questionnaire (NCIQ) proved to be good.CONCLUSIONS:The psychometric characteristics of the NCIQ proved to be reliable and probably valid and sensitive to clinical changes. The data obtained with the NCIQ reflected that the instrument was able to detect that a CI had significant effects on several health‐related QoL aspects, including the social and psychological domains.
Analysis of Aerobic Bacterial Strains Found in Chronic Rhinosinusitis Using the Polymerase Chain Reaction
Authors: Keech Daniel R. , Ramadan Hassan , Mathers Peter 
Published: February 2003

INTRODUCTIONRhinosinusitis is a common disease affecting an estimated 14% of the population. Although there is general agreement in the literature regarding acute rhinosinusitis, chronic rhinosinusitis is not as well studied, and no consensus has been reached regarding the bacterial etiology. The goal of this study was to test chronic rhinosinusitis mucosal specimens using the polymerase chain reaction (PCR) for aerobic bacterial content and to compare the results with standard culture data.RESULTSRoutine culture samples grew 50% aerobic bacteria, whereas PCR detected 62% aerobic bacteria contamination.CONCLUSIONPCR detected more bacteria in mucosal samples than in standard culture, but standard culture of this mucosa reflects the general aerobic bacteria found in chronic rhinosinusitis, with no predominant species of aerobic bacteria.SIGNIFICANCEThe analysis of chronic rhinosinusitis mucosa with the PCR method should give a more accurate picture of the bacteria found in chronic rhinosinusitis so that proper therapy can be instituted.
Single‐Stage Laryngotracheal Reconstruction in Children: A Review of 200 Cases
Authors: Gustafson L. Mark , Hartley Benjamin E. J. , Liu James H. , Link Dana T. , Chadwell Jon , Koebbe Chris , Myer Charles M. , Cotton Robin T. 
Published: February 2003

OBJECTIVEWe reviewed our experience with pediatric single‐stage laryngotracheal reconstruction (SSLTR) to identify factors that affect postoperative outcomes, including the need for reintubation and tracheostomy.STUDY DESIGNRetrospective chart review was done.RESULTSIn total, 190 children underwent 200 SSLTRs; 29% were reintubated, and 15% required postoperative tracheostomy. Currently, 96% are decannulated. The use of anterior and posterior costal cartilage grafting, age less than 4 years, sedation for more than 48 hours, a leak pressure around the endotracheal tube at greater than 20 cm H2O, and moderate/severe tracheomalacia significantly increased the rate of reintubation. The duration of stenting did not affect outcomes. Children with anterior and posterior grafts and those with moderate or severe tracheomalacia were more likely to need a postoperative tracheostomy.CONCLUSIONSSLTR can be effective for the treatment of pediatric laryngotracheal stenosis. Diligent preoperative assessment of the patient and the patient's airway and close postoperative care are important to the success of this operation.
Evaluation of Hydroxyapatite Ossicular Chain Prostheses
Authors: Pasha Raza , Hill Samuel L. , Burgio Don L. 
Published: February 2003

Hydroxyapatite (HA) middle ear prostheses have gained popularity as an alternative to human autografts and homografts. This study reports on 3 HA prostheses types: total ossicular chain prostheses, used for grafting the stapes footplate to the tympanic membrane; partial ossicular chain prostheses, used for grafting the stapes superstructure to the tympanic membrane; and Kartush incus struts (Smith & Nephew Richards Inc), used for grafting the stapes superstructure to the undersurface of the malleus. This single‐surgeon study of 33 consecutive cases revealed a statistically significant difference in mean postoperative air‐bone gap and air‐bone gap closure between incus struts (14/26 dB) or partial (22/11 dB) or total (25/10 dB) ossicular chain prostheses (ttest:P< 0.05). Prognostic risk factors graded by the Middle Ear Risk Index indicate a tendency for worse postoperative hearing with increasing Middle Ear Risk Index. This study supports the use of HA ossicular prostheses and, in particular, the use of the malleus for ossicular chain construction. (Otolaryngol Head Neck Surg 2000;123:425‐9.)
Pilot Study to Evaluate the Efficacy of Hyperbaric Oxygen Therapy in Improving the Survival of Reattached Auricular Composite Grafts in the New Zealand White Rabbit
Authors: McClane Stacie , Renner Gregory , Bell Patricia L. , Early Elizabeth K. , Shaw Bharat 
Published: February 2003

OBJECTIVEThis investigation is a prospective, randomized, blinded study seeking to evaluate the efficacy of hyperbaric oxygen (HBO) therapy in improving the survival of the reattached auricular composite graft.STUDY DESIGNTwenty New Zealand White rabbits were randomly assigned to control (10) and treatment (10) groups in a prospective fashion. After amputation and reattachment of measured segments of each ear, the treatment group received 14 HBO treatments for 10 days. The control group received only standard postoperative care. On postoperative day 18, the surviving composite grafts were measured, recorded, and statistically analyzed.RESULTSThe mean percentage of graft survival for the control group was 0.31% (range 0%‐2.5%), and the mean for the group receiving HBO was 15.94% (range 0%‐38%). A median test was used to evaluate this difference, which was found to be statistically significant (P = 0057).CONCLUSIONOur study appears to indicate a possible survival benefit for the composite grafts in those rabbits that received HBO treatments. We believe that there are several significant difficulties with the rabbit as a model for this study, but we are encouraged at this point that a limited measurable benefit was observed. Further investigations with HBO appear to be warranted at this time.
Tumors and Tumorous Masses Presenting as Temporomandibular Joint Syndrome
Authors: Mostafapour Sam P. , Futran Neal D. 
Published: February 2003

OBJECTIVENeoplasms of the temporomandibular joint (TMJ) usually mimic common causes of TMJ syndrome, leading to delay in diagnosis. To increase awareness of TMJ neoplasms and establish guidelines for early intervention, we performed a retrospective analysis of a series of patients with neoplasms of the TMJ.STUDY DESIGN AND SETTINGA retrospective review of the records of patients with neoplasms of the TMJ from 1990 to 1997 was done.RESULTSSix patients were identified. The neoplasms included benign and malignant neoplasms. The time from initial presentation to final diagnosis was in most cases prolonged, ranging from 3 months to 8 years. Patients typically showed advanced lesions radiographically. All patients required surgical extirpation. Postoperative radiation therapy was used for malignant lesions. Patient outcomes were delineated.CONCLUSIONS AND SIGNIFICANCENeoplasms, both benign and malignant, of the TMJ are rare but represent a challenging diagnostic problem. In patients with 1 month or more of recalcitrant TMJ swelling or pain, radiographic imaging may be considered to rule out these rare neoplasms. This may lead to earlier intervention and improved outcome.
Penetrating Neck Trauma in Children: An Urban Hospital's Experience
Authors: Kim Michael K. , Buckman Robert , Szeremeta Wasyl 
Published: February 2003

OBJECTIVEAs the incidence of violent crime increases in our society, the rate of penetrating head and neck trauma in children also rises. The methods of management of pediatric penetrating neck wounds are addressed.METHODSAll clinical records of children younger than 18 years admitted with penetrating neck injuries between 1990 and 1997 were reviewed. The injuries were classified according to type and location of the neck wound. Demographic data, clinical presentation, diagnostic studies, and management techniques were evaluated.RESULTSThirty‐five children aged 6 to 18 years old were evaluated for 31 missile wounds and 4 stab wounds. There were 30 boys and 5 girls. Fourteen percent of injuries were in zone 1, 60% in zone II, and 26% in zone III. Of the 33% of children with zone II penetrating neck traumas who underwent selective neck explorations, 86% had significant intraoperative findings. The mortality rates for zones I, II, and III were 60%, 29%, and 56%, respectively. The overall mortality rate was 40%.CONCLUSIONSPenetrating neck trauma in children may lead to potentially life‐threatening injuries. Selective management of penetrating head and neck injuries in children can be a safe and effective policy in an experienced trauma center.
The Workforce in Otolaryngology‐Head and Neck Surgery: Moving into the Next Millennium
Authors: Pillsbury Harold C. , Cannon C. Ron , Holzer Susan E. Sedory , Jacoby Itzhak , Nielsen David R. , Benninger Michael S. , Denneny James C. , Smith Richard V. , Cheng Eme Y. , Hagner Alison P. , Meyer Gregg S. 
Published: February 2003

OBJECTIVEThe goal was to examine the current scope of otolaryngologists’ practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck.STUDY DESIGNA large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios.RESULTSThe current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted.CONCLUSIONSThis study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology.
Glabellar Frown Lines as a Reliable Landmark for the Supratrochlear Artery
Authors: Vural Emre , Batay Funda , Key J. Michael 
Published: February 2003

OBJECTIVEPreservation of the supratrochlear vascular pedicle (SVP) during use of the paramedian forehead flap can be accomplished by the aid of Doppler imaging; however, a reliable surface landmark may be invaluable in cases where Doppler examination fails. Our observations showed that the most prominent glabellar frown lines (GFLs) are very close to the SVP; however, the actual relationship of these structures remains unclear.STUDY DESIGNThe relationship between GFLs and the SVP was investigated in 19 volunteers by the aid of Doppler imaging and in 8 cadaver heads by dissection. The distance between the GFLs and the SVP was measured.SETTINGThe study took place at an academic tertiary‐care facility.RESULTSThe SVP was located just at the GFLs in almost 50% of the cases and an average of 3.2 mm lateral to GFLs in the remaining cases.CONCLUSIONGFLs may serve as reliable surface landmarks in the use of the paramedian forehead flap where Doppler imaging was not helpful.
Calvarial Bone Graft Harvest: A New Technique
Authors: Strong E. Bradley , Moulthrop Thomas 
Published: February 2003

OBJECTIVEThis study evaluates the use of a new calvarial bone graft‐harvesting device (BHD).STUDY DESIGNA total of 18 calvarial bone grafts (CBGs) were harvested from 9 cadavers with the BHD. The recorded parameters included drilling time, graft harvest time, graft size, graft integrity, and violation of the calvarial inner table. Five CBGs were subsequently harvested in vivo and used for 2 nasal reconstructions and 3 orbital reconstructions.RESULTSThe CBG dimensions ranged from 1.25 to 2.5 cm in width and 3.0 to 16.0 cm in length. Graft harvest time ranged from 5 minutes, 55 seconds to 25 minutes, 30 seconds (mean 13 minutes, 7 seconds). There were no fractured grafts. The cadaveric inner table was violated twice with a cutting burr, and 1 dural exposure occurred in the clinical study.CONCLUSIONAlthough caution must be used with all CBGs, the BHD appears to be safe and more efficient than osteotomes or oscillating saws.
Fine‐Needle Aspiration: Survey of Clinical Utility
Authors: Cannon C. Ron , Replogle William H. 
Published: February 2003

OBJECTIVESThe goal was to determine the features of clinical usage of fine‐needle aspiration (FNA) in this country in terms of utilization, indications, and practice and demographic characteristics of those who use FNA.STUDY DESIGNA survey was mailed to otolaryngologist‐head and neck surgeons (OTO‐HNSs) in the United States. The results were totaled and analyzed for indications for FNA performance, practice setting, age, and geographic location of practitioners.RESULTSThe most common indications for use of FNA were in the diagnoses of neck, thyroid, salivary, and other masses in the head and neck. In the survey group the average number of FNAs performed per month was 4.7 per respondent practitioner. FNA was statistically related to age (older physicians performed it less) and region of the country. FNAs are performed at a lower rate in the West.CONCLUSIONSFNA is a commonly performed procedure. Certain groups of OTO‐HNSs (older, located in western states) do not perform FNA as commonly as other OTO‐HNSs. Further education regarding the merits of FNA is needed.
Preoperative Evaluation of the Radial Forearm Free Flap Patient with the Objective Allen's Test
Authors: Nuckols Douglas A. , Tsue Terance T. , Toby E. Bruce , Girod Douglas A. 
Published: February 2003

OBJECTIVEThe conventional subjective Allen's test (SAT) can be problematic because of its subjective nature. The objective Allen's test (OAT) was used before surgery to reliably and objectively assess forearm vascular flow in anticipation of harvesting a radial forearm free flap (RFFF) for use in head and neck reconstruction.STUDY DESIGN AND SETTINGRetrospective analysis of 65 patients undergoing both preoperative SAT and OAT was completed at the University of Kansas Medical Center between December 1994 and March 1998.RESULTSThe sensitivity and specificity of the SAT compared with the sensitivity and specificity of the OAT were only 65% and 76%, respectively. In 40 patients with at least 1 forearm with a positive SAT, only 1 (2.5%) patient was found by OAT to have vasculature that would not have allowed safe RFFF harvest in either forearm. In contrast, of the 25 patients with equivocal or negative SAT results in both arms, 18 (72%) were found by OAT to be safe candidates for RFFF harvests.CONCLUSIONSThe OAT is an objective measure of forearm vascular flow and is superior to conventional SAT in RFFF donor‐site selection.
Management of nasopharyngeal stenosis after uvulopalatoplasty
Authors: Krespi Yusef P. , Kacker Ashutosh 
Published: February 2003

OBJECTIVE:The objective of this study is to evaluate the management of nasopharyngeal stenosis (NPS) with the CO2 laser and a customized nasopharyngeal obturator.STUDY DESIGN:An 8‐year retrospective study based at a tertiary care teaching hospital consisting of 18 patients with NPS after uvulopalatoplasty treated over an 8‐year period with the CO2 laser and a nasopharyngeal obturator. Patients with grade I stenosis were treated in the office and did not require a nasopharyngeal obturator. More severe cases (grades II and III) were treated in the operating room and required a nasopharyngeal obturator.RESULTS:Eighteen patients with NPS, stages I to III, were treated with a CO2 laser with or without a nasopharyngeal obturator with good results.CONCLUSION:The repair of NPS with a CO2 laser and a nasopharyngeal obturator in severe cases helps in restoring nasopharyngeal patency.SIGNIFICANCE:This technique provided a reliable method of correcting postuvulopalatoplasty NPS.
Revision stapedectomy
Authors: De La Cruz Antonio , Fayad Jose N. 
Published: February 2003

OBJECTIVE:To evaluate results of revision stapedectomy with and without use of the laser and determine factors predictive of hearing outcome.STUDY DESIGN AND SETTING:Retrospective review of 356 revision stapedectomy operations performed at the House Ear Clinic, a tertiary neurotologic private practice, between 1983 and 1995.RESULTS:A postoperative gap of <10 dB was obtained in 60% of cases. Results were similar with and without the use of a laser. Sensorineural hearing loss of >10 dB occurred in 7.7%, with 3 (1.4%) ears with profound hearing loss. A poorer outcome was related to incus necrosis, multiple revisions, and indications for surgery other than conductive hearing loss.CONCLUSION:Revision stapedectomy can provide good gap closure in 60% of cases, with small risk of sensorineural hearing loss.SIGNIFICANCE:Although not as satisfactory as primary stapedectomy, revision stapedectomy can be offered to patients with reasonable expectations for good gap closure.