bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tympanic membrane/middle ear pathologic correlates in chronic otitis media
Authors: Jaisinghani Vikram J. , Paparella Michael M. , Schachern Patricia A. , Le Chap T. 
Published: November 2003

AbstractObjective: To correlate pathologic findings of the tympanic membrane with pathologic changes in the middle ear cleft in chronic otitis media. Study Design: Retrospective. Material and Methods: One hundred‐fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear pathologic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correlate the presence of these middle ear pathologies with histopathologic changes of the tympanic membrane. The tympanic membrane pathologies included perforation, myringosclerosis, retraction, hemorrhage, fluid‐filled cystic spaces, or dilated vessels. Temporal bones were also assessed for atelectasis. Fifty‐six normal temporal bones were taken as controls for measurements. Results: Significant correlations between tympanic membrane and middle ear pathology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossicular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying multiple pathologic changes in the middle ear. Conclusion: When tympanic membrane pathology is detected otoscopically, its presence, alone or in combination, can be a strong indicator of underlying middle ear pathology. However, a normal‐appearing tympanic membrane does not exclude the possibility of middle ear pathology. These findings suggest the need for other diagnostic tools such as multifrequency tympanometry and otoacoustic emissions to complement otoscopy for diagnosis of middle ear pathology, especially in a tympanic membrane that appears “normal.”
Efficacy of endoscopic static pressure/area assessment of the passive pharynx in predicting uvulopalatopharyngoplasty outcomes
Authors: Isono Shiroh , Shimada Akiko , Tanaka Atsuko , Tagaito Yugo , Utsugi Makoto , Konno Akiyoshi , Nishino Takashi 
Published: November 2003

AbstractObjectives/Hypothesis: Although uvulopalatopharyngoplasty (UPPP) is an attractive surgical treatment for obstructive sleep apnea (OSA), the unpredictable outcome limits application of the procedure. Since UPPP corrects only retropalatal airway (RP) patency, we hypothesized that response to UPPP is determined by collapsibility of the retroglossal airway (RG), where UPPP does not correct. Methods: We estimated closing pressure (Pclose) for each pharyngeal segment by endoscopically obtaining the static pressure/area relationship of the passive pharynx in completely paralyzed and anesthetized patients with sleep‐disordered breathing (n = 41) before UPPP. Preferable response to UPPP was defined as the number of oxygen dips (ODI), obtained by nocturnal oximetry, less than 10 h−1 after UPPP. Results: Patients with negative Pclose at RG responded to UPPP significantly better than those with positive Pclose at RG (22/30 [73%] vs. 3/11 [27%], P < .05). ODI after UPPP was significantly correlated with age, Pclose at RP, and Pclose at RG. Conclusions: Endoscopic assessment of anatomic abnormality of the pharynx in paralyzed patients with sleep‐disordered breathing under general anesthesia has clinical value for the improvement of UPPP outcome.
Comparison of the sensitivity of lateral neck radiographs and computed tomography scanning in pediatric deep‐neck infections
Authors: Nagy Mark , Backstrom James 
Published: November 2003

AbstractObjective: To compare the sensitivity of lateral neck films and computed tomography (CT) scanning with contrast in evaluating children with a high index of suspicion for a deep‐neck infection, either retropharyngeal, parapharyngeal, or combined based in clinical presentation. Study Design: A retrospective chart review of children presenting to the Children's Hospital of Buffalo, New York, with the diagnosis of a deep‐neck infection between January 1991 and November 1997 was conducted. In total, 57 children were included in the study, ranging in age from 12 to 119 months (1–10 y). Methods: Charts were reviewed for presenting signs, symptoms, and laboratory values and included only those children with the presence of fever, limited neck range of motion, a lateral neck mass, dysphagia, and a leukocyte count greater than 15,000 cells/mm3. Results of lateral neck radiographs and CT scanning with contrast were evaluated and compared when available. Results: Lateral neck radiographs were found to have a sensitivity of 83% for determining the presence of a pediatric deep‐neck infection, whereas CT scanning with contrast had a sensitivity of 100%. Conclusion: Lateral neck radiographs were found to offer no benefit in the workup of children strongly suspected of having a deep‐neck infection based on clinical presentation. Despite the higher cost, CT scanning with contrast is the recommended radiologic test in such cases. This single study allows the determination of size, type, and location of the infectious process and is invaluable in treatment planning for pediatric patients with infection in deep‐neck spaces.
Nasal dilator strips increase maximum inspiratory flow via nasal wall stabilization
Authors: Di Somma Emily M. , West Stephen N. , Wheatley John R. , Amis Terence C. 
Published: November 2003

AbstractObjective: Inspiratory flow limitation associated with collapse of the nasal vestibular walls is a feature of nasal breathing at high ventilatory levels. We examined whether an external nasal dilator strip (ENDS) device (Breathe Right, CNS Inc., Chanhassen, MN) influences maximum inspiratory and expiratory flow rates. Study Design: Prospective, randomized. Methods: We studied 20 Caucasian subjects (13 female, 7 male; age range, 16–49 y) performing maximum‐effort nasal flow‐volume loop studies with (ENDS) and without ENDS (control) and following topical nasal decongestant (oxymetazoline hydrochloride, 0.2 mg per nostril). Results: ENDS increased peak inspiratory flow from 2.55 ± 0.24 L/s (mean ± standard error [SE]) to 2.86 ± 0.25 L/s and forced inspiratory flow at 50% of vital capacity from 2.23 ± 0.24 L/s to 2.53 ± 0.24 L/s (both, P < .0001), but had no effect on maximum expiratory flows. Nasal decongestant increased the forced expiratory volume in 1 second from 3.39 ± 0.22 L/s to 3.59 ± 0.22 L/s and the average forced expiratory flow over 25% to 75% of vital capacity from 3.31 ± 0.31 L/s to 3.61 ± 0.28 L/s (both, P ⩽ .008), but had no effect on maximum inspiratory flows. The combination of decongestant and ENDS increased both inspiratory and expiratory maximum flows. Conclusion: Since ENDS selectively increases maximum nasal inspiratory flow rates, we conclude that ENDS increases inspiratory nasal patency during maximum inspiratory efforts through the nose by supporting the lateral nasal vestibular walls and making them more resistant to collapse.
Approaches to the sellar and parasellar region: Anatomic comparison of the microscope versus endoscope
Authors: Spencer William R. , Das Kaushik , Nwagu Chedioze , Wenk Eugene , Schaefer Steven D. , Moscatello Augustine , Couldwell William T. 
Published: November 2003

AbstractObjective: Traditionally, surgical approaches to the sellar region require the use of the operating microscope. Over the past decade endoscopic surgery has gained much popularity because of advances in optics and illumination. Endoscopic surgery of the sellar region has been performed successfully. The goal of the present study was to quantify the amount of exposure to the sellar and suprasellar region that the endoscope provides versus the microscope, with three different anterior approaches to the sellar region. Methods: The transethmoidal, endonasal‐transsphenoidal, and sublabial‐transsphenoidal approaches were performed on 14 formalin‐fixed cadaver heads with a 0° endoscope and repeated with the operative microscope. The distances of relevant surgical landmarks and the amount of exposure superior and anterior to the dorsum sella, as well as the lateral exposure, were measured. The mean distances were then used to calculate the volume of exposure for each of the approaches. Results: It was found that the endoscope provided greater view than the operating microscope in all three approaches. The difference was statistically significant using a paired Student t test and a signed‐rank test (P < .001). Conclusion: The authors believe that endoscopic surgery of the sellar region can be performed safely and effectively, while providing the surgeon with a view that is superior to that afforded by the operating microscope
A retrospective comparison of the morbidity and cost of different reconstructive strategies in oral and oropharyngeal carcinoma
Authors: Smeele Ludwig E. , Irish Jonathan C. , Gullane Patrick J. , Neligan Peter , Brown Dale H. , Rotstein Lorne E. 
Published: November 2003

AbstractPurpose: Evaluate and compare the morbidity and costs of different reconstructive strategies in oral and oropharyngeal carcinoma. Study Design: Retrospective cross‐sectional. Patients and Methods: One hundred twenty‐seven consecutive patients treated surgically for oral and oropharyngeal carcinoma between 1990 and 1996 were evaluated. Sixty‐three patients had segmental mandibulectomies with 30 plate–soft tissue reconstructions and 33 bone–soft tissue flaps. Sixty‐four patients had soft‐tissue‐only reconstructions. The following outcome parameters were analyzed: operative time, intraoperative blood loss, postoperative admission length, ICU and coronary care unit admission length, surgical interventions for complications, re‐admissions, and prolonged (> 6 mo) gastrostomy tube feeding, and all costs within the disease‐free interval. Means and standard deviations were calculated for continuous parameters. Differences among the three groups were analyzed using one‐way analysis of variance. For discontinuous parameters, the chi‐square test was applied. Results: Longer operative time (1.8 h) and more blood loss (150 mL) for bone‐soft tissue flaps were the only statistically significant findings (P < .05) between the three groups. Conclusion: There is no rationale for allowing presumed factors of morbidity or cost select for type of reconstruction in patients with oral and oropharyngeal carcinoma.
Detection of recurrent head and neck squamous cell carcinomas after radiation therapy with 2‐18f‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography
Authors: Farber Leonard A. , Benard Francois , Machtay Mitchell , Smith Robin J. , Weber Randal S. , Weinstein Gregory S. , Chalian Ara A. , Alavi Abass , Rosenthal David I. 
Published: November 2003

AbstractObjectives/Hypothesis: Fluorodeoxyglucose positron emission tomography (FDG‐PET) has been proposed as a sensitive method to diagnose and stage various malignancies. We assessed the efficacy of FDG‐PET imaging in distinguishing tumor persistence/recurrence from posttreatment changes following radiation therapy for squamous carcinomas of the head and neck. Study Design: Retrospective analysis of IDG‐PET results compared with biopsy results or outcome, or both. Methods: Twenty‐eight patients who had undergone radiation therapy with or without surgery for treatment of squamous cell carcinoma were studied with FDG‐PET imaging. There was clinical suspicion for recurrence in each patient, but no obvious mass or lesion to biopsy was found on physical examination or anatomic imaging. The results of FDG‐PET imaging were compared with those of biopsy or clinical follow‐up of at least 6 months, or both. Results: FDG‐PET imaging was positive in 13 patients, and the presence of active disease was confirmed in 12. Two thirds of the 12 received further cancer treatment. There were 15 negative FDG‐PET images. Thirteen of these were confirmed true‐negative images, but two studies were false‐negative images. The sensitivity and specificity of FDG‐PET were 86% and 93%, respectively, with positive and negative predictive values of 92% and 87%, respectively. The overall accuracy was 89%. Conclusion: FDG‐PET imaging is a useful modality to distinguish tumor persistence/recurrence from radiation‐induced tissue changes in the neck following treatment for head and neck cancer. FDG‐PET can identify patients who may benefit from further treatment, and may lead to improved outcome for individual patients. Key Words: Fluorodeoxyglucose; head and neck cancer: positron emission tomography; squamous cell carcinoma.
What Your Colleagues Think of Tympanostomy Tubes—28 Years Later
Authors: Todd N. Wendell 
Published: November 2003

AbstractObjective: Assess the changing opinions of otolaryngologists about tympanostomy tubes, including indications, tube material and shape and size, placement sites, and complications. Study Design: Crosssectional survey, compared to the same survey done 28 years earlier. Method: Questionnaires mailed to the 441 active fellows and 86 candidates of the Triological Society. Response rate 69.3%. Results: The preference for polyethylene has decreased from 75% to 13% of respondents. Preferred insertion sites are more anterior. The proportion of respondents who have seen a permanent perforation as a consequence has increased from 26% to 93%. The proportion of respondents who have seen a tube‐attributable cholesteatoma has increased from 8% to 38%. The average tube duration has increased from 4 months to 18 months. Teflon and Silastic are now the materials most often used. As 28 years earlier, about 19% of patients get a subsequent tympanostomy tube. Anesthetics most commonly used now are general or topical phenol. Conclusion: The consensus on several aspects of tympanostomy tubes has changed during 28 years. Controversy continues about the indications for using tubes. Although not a not cure‐all for otitis media, tympanostomy tubes have proved useful.
Ototoxicity of Topical Gentamicin Preparations
Authors: Bath Andrew P. , Walsh Rory M. , Bance Manohar L. , Rutka John A. 
Published: November 2003

AbstractObjective: To document that commercially available topical gentamicin‐containing eardrops carry a risk of ototoxicity if they reach the middle ear through a tympanic membrane defect. Study Design: Clinical study, retrospective case‐note review. Setting: Department of Otolaryngology, The Toronto Hospital, University of Toronto. Patients: Sixteen patients were identified with well‐documented histories, physical findings and laboratory investigations consistent with topical gentamicin‐induced ototoxicity. One patient with incapacitating unilateral Meniere's disease underwent successful intentional vestibular ablation using topical gentamicin/steroid drops. Results: In all cases of inadvertent ototoxicity, patients had used the drops for longer than 7 days (average 20.7 d) prior to symptoms developing. All patients developed vestibulotoxicity that was confirmed on ENG testing. Only 1 patient had a noticeable worsening of cochlear reserve. Deliberate and successful therapeutic ablation of vestibular function in a patient with unilateral Meniere's disease confirms the vestibulotoxic nature of commercially available topical gentamicin preparations. Conclusions: Physicians should consider the potential for ototoxicity if gentamicin‐containing eardrops (and by extrapolation all topical aminoglycoside drops) are used for longer than 7 days in patients with a tympanic membrane defect. These preparations should not be used in the presence of healthy middle ear mucosa and should be discontinued shortly after the discharge has stopped. It is important to recognize that toxicity is primarily vestibular rather than cochlear.
Facial Nerve Function After Petrosectomy
Authors: Häusler Rudolf , Caversaccio Marco , Zbären Peter 
Published: November 2003

AbstractObjectives: Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation‐decompression, forward or backward rerouting, and facial nerve suture and grafting. Study Design: Fifty‐six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy. Methods: The treatment of the facial nerve included 15 denudation‐compressions, 23 denudation‐compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House‐Brackmann grading system was used for facial nerve evaluation. Results: Normal or nearly normal facial nerve function was obtained in facial nerve denudation‐decompression with and without rerouting (House‐Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). Conclusions: Our results show that petrosectomy with denudation‐decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.
Transmucosal Fine‐Needle Aspiration Diagnosis of Intraoral and Intrapharyngeal Lesions
Authors: Shah Saurabh B. , Singer Mark I. , Liberman Eva , Ljung Britt‐Marie 
Published: November 2003

AbstractObjectives: The effectiveness of fine‐needle aspiration biopsy (FNAB) for the diagnosis of neck, thyroid, and salivary gland masses is well documented. Very few reports explore the potential of an intraoral FNAB approach for the diagnosis of submucosal lesions. We describe our technique and present case examples of pertinent differential diagnostic entities. We recommend an expanded role for FNAB of the oral cavity and oropharynx.Study Design: Retrospective review.Methods: A uniform technique was employed for transmucosal FNAB of 76 patients with intraoral masses. In applicable cases, cytology results were compared with traditional biopsy methods and permanent histopathologic specimens for accuracy.Results: Our experience demonstrates the high sensitivity (93%) and specificity (86%) of intraoral FNAB when compared with biopsy by conventional means. FNAB provides distinct advantages for the cytologic diagnosis of submucosal lesions, which may be difficult to reach and adequately sample through conventional biopsy. FNAB of the tonsil and tonsillar fossa provides a safe and effective means of diagnosing both lymphoma and squamous cell cancer. Transmucosal FNAB via the mouth led to rapid diagnosis of a number of benign and malignant lesions. Applying this uniform FNAB technique, we had no significant complications.Conclusion: We recommend transmucosal FNAB as an effective means for highly accurate diagnosis of submucosal lesions of the oral cavity and oropharynx.Clinical Relevance: Traditional biopsy techniques in the oral cavity may require anesthesia and may have diagnostic difficulties, particularly for submucosal lesions. Transmucosal FNAB overcomes these shortcomings by providing a minimally invasive means to rapid diagnosis of intraoral lesions.
Expression of eIF4E During Head and Neck Tumorigenesis: Possible Role in Angiogenesis
Authors: Nathan Cherie‐Ann O. , Franklin Scott , Abreo Fleurette W. , Nassar Raja , de Benedetti Arrigo , Williams J. , Stucker Fred J. 
Published: November 2003

AbstractObjective: The translation initiation factor eIF4E (4E) when overexpressed in mammalian cells results in their oncogenic transformation. 4E facilitates the synthesis of two powerful tumor angiogenic factors (VEGF and FGF‐2) by selectively enhancing their translation. 4E is overexpressed not only in all head and neck squamous cell cancers but also in some dysplastic margins. Tumorigenesis in the head and neck is proposed to be a multistep process preceded by clinically evident precancerous lesions. Molecular events underlie the histological changes that herald transformation. We wanted to study the role of 4E in tumorigenesis and further elucidate its causal role in angiogenesis.Methods: An immunohistochemical analysis with antibodies to 4E, VEGF, and basic (b)‐FGF was performed on 115 specimens of the head and neck representing various stages of histological progression of malignancy. This was correlated with mean vessel density (MVD) using factor VIII.Results: There were 41 cases of hyperplasia and low‐grade dysplasia, 40 cases of high‐grade dysplasia and 34 cases of cancer. There was a significant increase in the percent of cases expressing 4E from low‐grade dysplasia through tumor. However, for VEGF and b‐FGF the significant increase was only seen between the tumor group and dysplastic groups and no significant increase was noted between low‐grade and high‐grade dysplasia. There was a significant increase in MVD from low‐ (10.7 ± 1) to high‐grade grade dysplasia (18.0 ± 2.3). This increase was even more striking for the 4E positive cases.Conclusion: 4E elevation is correlated with progressive cell transformation in the head and neck. Its correlation with VEGF, b‐FGF, and MVD potentates its possible role in angiogenesis.
Extracranial Drainage of Cerebrospinal Fluid: A Study of Beta‐Transferrins in Nasal and Lymphatic Tissues
Authors: Solomon Philip , Chen Joseph , D'Costa Mario , Gilbert Ralph , Davidson Jean , Johnston Miles 
Published: November 2003

AbstractObjective: To determine whether an alternative route of cerebrospinal fluid (CSF) drainage exists through the nasal mucosa and the cervical lymphatic system.Study Design: A prospective study was carried out on 18 patients at a university teaching hospital.Methods: Ten patients undergoing routine endoscopic sinus surgeries and eight patients undergoing neck dissections were recruited for this study. Tissues were sampled from the middle turbinate, nasopharynx, and upper septum in the first group; jugulodigastric lymph nodes and nasopharyngeal tissues were obtained from the second group. Specimens were subjected to immunofixation electrophoresis in an attempt to identify the presence of beta‐1 and beta‐2 transferrins. Serum samples were obtained from each subject to serve as controls.Results: All tissue specimens contained beta‐1 transferrin; none showed evidence of beta‐2 transferrin.Conclusion: Using this technique, an alternate route of CSF drainage through the nose and the cervical lymphatic system could not be confirmed. Nevertheless, a new technique of performing immunofixation in solid tissues for the purpose of beta‐transferrin identification is described.