bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Impairment of the Vestibular End Organ Resulting From Impulse Noise Exposure
Authors: Perez Ronen , Freeman Sharon , Cohen David , Sohmer Haim 
Published: November 2003

AbstractObjectives/Hypothesis To assess the effect of exposure to impulse noise, known to cause damage to the cochlea, on the vestibular part of the inner ear using short latency vestibular evoked potentials (VsEPs), which is a direct and objective test for evaluating the function of the vestibular end organs.Study Design Prospective animal study.Methods Sand rats (Psammomys obesus) underwent baseline measurements of VsEPs in response to linear and angular acceleration stimuli and measurement of the auditory nerve and brainstem evoked response (ABR). The animals were then exposed to 10 gunshots generating impulse noise at an intensity of approximately 160 dB sound pressure level (SPL). Repeat measurements of the evoked potentials were conducted 2 to 4 hours, 1 week, and 6 weeks after the exposure. The amplitude and latency of the first wave of VsEPs in response to linear and angular acceleration stimuli, reflecting the function of the otolith organs and semicircular canals respectively, were compared between baseline and post‐exposure measurements, as were ABR thresholds.Results The amplitude of the first wave of the VsEPs in response to linear acceleration was significantly (P <.001) reduced and the latency significantly (P <.005) prolonged 2 to 4 hours after the exposure in comparison to baseline measurements. The latency prolongation persisted in follow‐up measurements, whereas the amplitude showed partial recovery. The first wave of VsEPs in response to angular acceleration was unchanged long‐term. ABR thresholds were elevated in the long‐term by 60 dB.Conclusion It seems that impulse noise not only damages the cochlea, but also causes clear functional impairment to the vestibular end organs, mainly the otolith organs.
Impact of the Endoscopic Sinus Surgical Simulator on Operating Room Performance
Authors: Edmond Charles V. 
Published: November 2003

AbstractObjectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance.Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer.Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating.Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation‐trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times.Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.
Microbiology of Acute Otitis Externa
Authors: Roland Peter S. , Stroman David W. 
Published: November 2003

AbstractObjective To isolate and characterize bacteria and fungi from acute otitis externa (AOE) and to obtain susceptibility profiles on each bacterial isolate.Study Design Prospective core series.Methods Specimens were collected from the external canals of subjects with clinically diagnosed acute otitis externa. Species‐level identification for each bacterial isolate recovered was obtained by combining phenotypic and genotypic data. End point mean inhibitory concentration (MIC) testing was performed using National Committee for Clinical Laboratory Standards (NCCLS) recommended methods.Results In Alcon‐sponsored clinical studies conducted in 1998 to 2000, microbiology specimens were collected from 2039 subjects (2240 diseased ears) by 101 investigators throughout the United States. A total of 2838 bacteria, 32 yeast, and 17 molds were recovered from 2048 ears clinically diagnosed as acute otitis externa. Of the 202 bacterial species recovered, the species most frequently isolated was Pseudomonas aeruginosa (38%). The next 10 species most frequently isolated were:Staphylococcus epidermidis, 9.1%;Staphylococcus aureus, 7.8%;Microbacterium otitidis, 6.6%;Microbacterium alconae, 2.9%;Staphylococcus caprae, 2.6%;Staphylococcus auricularis, 2.0%;Enterococcus faecalis, 1.9%;Enterobacter cloacae, 1.6%;Staphylococcus capitis subsp. Ureolyticus,1.4%; and Staphylococcus haemolyticus, 1.3%. Susceptibility profiles of S. epidermidis isolates revealed the greatest frequency of high‐level resistance to selected antibiotics (≥8 μg/mL): 23%, neomycin‐resistant; 11%, oxacillin‐resistant; and 12%, ofloxacin‐resistant. Susceptibility profiles of S. aureus isolates revealed a lower frequency of high‐level resistance: 6.3%, neomycin‐resistant; 2.7%, oxacillin‐resistant; and 4.5%, ofloxacin‐resistant. P. aeruginosa with high‐level resistance to quinolones (≥128 mcg/mL for ofloxacin) was recovered from only 1 subject. Likewise, resistance of P. aeruginosa to aminoglycosides was rare. Twenty isolates had neomycin MICs ≥64 mcg/mL and 10 isolates had gentamicin MICs ≥16 mcg/mL. The coryneform isolates identified as Microbacterium otitidis had an intrinsic lack of susceptibility to quinolones (ofloxacin MICs ≥16 mcg/mL) and aminoglycosides (tobramycin MICs ≥32 mcg/mL and gentamicin MICs ≥8 mcg/mL).Conclusions Bacterial infections of the external ear canal are most often caused by P. aeruginosa. However, there are a great number of other gram‐positive and gram‐negative bacterial species that are recovered from patients with acute otitis externa. Because of this diverse etiology, the best topical therapeutic choice for topical therapy is for the most potent, broad‐spectrum (especially anti‐P. aeruginosa) antibiotic available.
The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction
Authors: Koch Wayne M. 
Published: November 2003

AbstractObjectives The use, advantages, and disadvantages of the platysma flap were assessed.Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001.Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the χ2 test.Results Thirty‐four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions.Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects.
The Role of Radiation in the Treatment of Advanced Juvenile Angiofibroma
Authors: Lee Jivianne T. , Chen Peter , Safa Afshin , Juillard Guy , Calcaterra Thomas C. 
Published: November 2003

AbstractObjectives/Hypothesis To demonstrate the efficacy of external beam radiation therapy as a primary treatment modality for the management of patients with advanced juvenile nasopharyngeal angiofibroma (JNA).Study Design Retrospective chart review.Methods The medical records of 130 patients with the diagnosis of JNA seen at UCLA Medical Center over a 41‐year period (1960–2000) were retrospectively reviewed.Results One hundred thirty cases of JNA have been seen at UCLA Medical Center from 1960 to 2000. One hundred two were treated with surgical resection, 1 refused therapy, and the remaining 27 received radiation (3000–5500 cGy) as their primary mode of treatment. Fifteen percent (4 of 27) of the irradiated patients developed recurrent tumor 2 to 5 years later. Long‐term complications occurred in 4 patients (15%) and consisted of growth retardation, panhypopituitarism, temporal lobe necrosis, cataracts, and radiation keratopathy.Conclusions External beam radiation therapy represents an effective mode of treatment for patients with advanced JNA. Although the latency period may be long, we think the likelihood of potentially fatal complications developing at the radiation dosages we recommend is less than the risk of significant morbidity and mortality associated with surgical intervention in these cases.
Esophageal Pressure Monitoring in Detection of Sleep‐Disordered Breathing
Authors: Virkkula Paula , Silvola Juha , Maasilta Paula , Malmberg Henrik , Salmi Tapani 
Published: November 2003

AbstractObjective The aim was to study the value of esophageal pressure monitoring combined with limited polygraphic recording (oxygen saturation, respiratory and leg movements, airflow, body position, and snoring sound) in diagnosis of sleep‐disordered breathing.Study Design A prospective study of consecutive patients with snoring was carried out.Methods Sixty‐seven patients underwent an overnight study on ward. Patients with normal oxygen desaturation index and any periodic breathing disturbances combined with elevated esophageal pressure were further studied with complete polysomnography.Results The patient compliance with esophageal catheter was 87%. Esophageal pressure monitoring increased effectively the detection of sleep‐disordered breathing with limited polygraphic recording. Sixty‐seven percent of the patients with normal oxygen desaturation index and respiratory‐related esophageal pressure variation had sleep‐disordered breathing on complete polysomnography. Increased esophageal pressure variation was significantly related with oxygen desaturation index and obstructive sleep apnea diagnosis (P <.001). All together, 48% of the mainly nonobese snorers had objective findings of sleep‐disordered breathing. Patients with upper airway resistance syndrome were few. Fifteen percent of the patients had periodic leg movements. Neither subjective or objective sleepiness nor snoring or obesity adequately exposed sleep‐disordered breathing in this material.Conclusion Esophageal pressure monitoring increases markedly the diagnostic value of limited polygraphic recording as a screening study for sleep‐disordered breathing.
Obstructive Sleep Apnea: A Comparison of Black and White Subjects
Authors: Meetze Keith , Gillespie M. Boyd , Lee Fu‐Shing 
Published: November 2003

AbstractObjective To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group.Study Design Cross‐sectional retrospective review.Setting University‐based sleep disorders laboratory.Methods The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level.Results Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P = .005). Black males with OSA have significantly lower oxygen saturations than white males (P = .025).Conclusion Black males who present to the otolaryngologist‐head and neck surgeon for evaluation of sleep‐disordered breathing may be at increased risk of severe OSA.
Functional Analysis After Supracricoid Partial Laryngectomy With Cricohyoidoepiglottopexy
Authors: Bron Luc , Pasche Philippe , Brossard Edgar , Monnier Philippe , Schweizer Velérie 
Published: November 2003

AbstractObjectives To assess prospectively speech and swallowing function in a series of 17 patients after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.Study Design Retrospective study.Methods From 1983 to 1996, 69 patients at Department of Otolaryngology—Head and Neck Surgery, CHUV (Lausanne, Switzerland) underwent a supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Seventeen of them (25%) could be contacted and accepted participation in a functional evaluation that included a questionnaire to document their present nutritional status and diet. A formal voice evaluation was also performed, which included psychoacoustic evaluation of vocal qualities, fundamental frequency parameters, phonation intensity range, phonatory quotient (vital capacity divided by maximum phonation time), and a laryngeal video laryngoscopy performed with a rigid endoscope.Results Median postoperative follow‐up was 66 months (range, 12–152 mo). Nine of 17 patients (53%) recovered a normal diet with no increased incidence of aspirations. Seven of 17 had minor limitations such as no peanuts, dry bread, or rice. Two of 17 patients were restricted to pureed food. Assessment of voice showed a clearly decreased mean fundamental frequency at 70.1 Hz (normal range, 121–211 Hz) and a narrowed frequency range of phonation with a mean value of 8.8 semitones (normal value, 27). Forty‐two percent of the patients went back to their normal professional life after the operation. Among the 10 who did not, 3 (16%) retired and 7 actually had to give up their profession, because of the modification of their voice or general asthenia and age close to retirement.Conclusion Restoration of laryngeal function after supracricoid partial laryngectomy with cricohyoidoepiglottopexy is satisfactory. Although most of the patients seem to recover normal swallowing function, severe voice alterations appear to be inevitable.
Long‐Term Results of Small Fenestra Stapedectomy Compared With Large Fenestra Technique
Authors: Esquivel Carlos R. , Mamikoglu Bulent , Wiet Richard J. 
Published: November 2003

AbstractObjectives/Hypothesis A comparison is made of the postoperative long‐term hearing results of small fenestra stapedectomy versus large fenestra techniques. Several reports in the literature favor improved hearing results in small fenestra stapedectomy compared with large fenestration and/or total stapedectomy.Methods A retrospective review of 34 patients who had stapedectomy performed by the same surgeon between 1982 and 1992. All patients have been followed for up to 10 years postoperatively.Results In 18 ears of 17 patients, surgery was performed with small fenestra technique, and 17 ears of 17 patients had total stapedectomy or posterior‐half fenestration. After small fenestra stapedectomy, initial average air–bone gap at 500, 1000, and 2000 Hz was 9 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated to 4% over the study period. Speech reception thresholds declined 15%. After total or posterior‐half stapedectomy the average air–bone gap at 500, 1000, and 2000 Hz was 5 dB hearing loss. Hearing thresholds at 4000 Hz deteriorated 8% and 18% for the small fenestra and large fenestra groups, respectively, over time. Statistically, there was no difference in hearing deterioration rate between these two groups.Conclusions An experienced surgeon can obtain excellent results using either large or small fenestra technique for otosclerosis. After initial successful closure of the air–bone gaps at all measured frequencies, hearing thresholds over the study period were stable for both groups.
Opening Plugged Tympanostomy Tubes
Authors: Westine John G. , Giannoni Carla M. , Gajewski Byron , Antonelli Patrick J. 
Published: November 2003

AbstractObjective To determine the most effective solvents for dissolving plugged tympanostomy tubes.Study Design In vitro laboratory study.Methods Twelve solvents (including ototopical antibiotics and water) were applied to fluoroplastic tympanostomy tubes (n = 260) plugged with dried mucoid middle ear effusion in an ear canal–tympanic membrane model. Time to clearance of the tympanostomy tubes was both visually and tympanometrically determined.Results Vinegar (P = .0030) and hyaluronidase solutions (P = .0030) were significantly better solvents than water.Conclusion Vinegar and hyaluronidase solutions are more likely to clear plugged tympanostomy tubes than water and ototopical antibiotics, but vinegar is the preferred solution because of its known relative safety for use in the ear.
Endoscopic Sinus Surgery for Inflammatory Maxillary Sinus Disease
Authors: Busaba Nicolas Y. , Kieff David 
Published: November 2003

AbstractObjective/Hypothesis The role of endoscopic sinus surgery for treating chronic maxillary sinusitis is well established. The purpose of the study is to determine the efficacy of endoscopic sinus surgery in the treatment of maxillary sinus inflammatory disease that includes mucoceles, retention cysts, and antrochoanal polyps.Study Design This is a retrospective review of 32 consecutive patients who underwent endoscopic sinus surgery for mucoceles (n = 21), retention cysts (n = 5), or antrochoanal polyps (n = 6).Methods The medical records were reviewed for patient demographics, presenting symptoms, and type of operation. Surgical outcome was determined by resolution of symptoms, recurrence of disease, and need for revision or additional surgery.Results Ethmoidectomy with middle meatal antrostomy was performed in all patients; 28 patients had additional middle turbinectomy. Postoperative follow‐up ranged from 6 months to 4 years. The operation resulted in resolution of symptoms and a patent antrostomy on long‐term follow‐up in all cases of mucoceles. No case required revision surgery. On the other hand, the disease recurred in three patients (60%) with retention cysts and three patients (50%) with antrochoanal polyps despite patent antrostomies. The recurrences occurred 3 to 6 months after the surgery. The recurrent cases of antrochoanal polyps required Caldwell Luc procedures. The three failures in cases of retention cysts were successfully managed with repeated office endoscopic marsupialization through a patent antrostomy.Conclusions Endoscopic sinus surgery is an effective treatment for mucoceles, with favorable long‐term outcome. Maxillary retention cysts commonly recur after endoscopic sinus surgery. However, the recurrence can be managed in the office through a patent antrostomy. Endoscopic sinus surgery may be offered as initial surgical treatment for antrochoanal polyps, but a Caldwell Luc operation may be needed for recurrent disease.
Autologous Transplantation of Fascia Into the Vocal Fold as a Treatment for Recurrent Nerve Paralysis
Authors: Nishiyama Koichiro , Hirose Hajime , Iguchi Yoshiaki , Nagai Hiromi , Yamanaka Jun , Okamoto Makito 
Published: November 2003

AbstractObjectives To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure.Study Design Technical modifications were made in transplantation of the temporal fascia into the paralyzed vocal fold. Eight patients underwent the surgery, and their phonatory function was examined preoperatively and postoperatively.Methods The following surgical techniques were applied to prevent the falling‐off of the graft: 1) a roll‐shaped fascia graft was prepared before the transplantation and 2) a pocket was made within the lamina propria mucosa using a newly devised special elevator. The maximum phonation time and airflow rate during sustained phonation (in four cases) were measured, and perceptual evaluation of voice quality was made using the GRBAS scale by speech pathologists before and after the surgery.Results All the cases showed no evidence of falling‐off of the graft. Elongation of the maximum phonation time and improvement in voice quality were obtained in all cases postoperatively.Conclusion The method proved to be useful for the treatment of glottal insufficiency due to recurrent nerve paralysis.
Monopolar Electrocautery in Adenoidectomy as a Possible Risk Factor for Grisel's Syndrome
Authors: Tschopp Kurt 
Published: November 2003

AbstractObjectives/Hypothesis Grisel syndrome is a nontraumatic atlantoaxial subluxation after an inflammatory process in the upper cervical region. It results from a peripharyngeal infection as well as a rare complication following adenotonsillectomy. After the introduction of monopolar suction electrocautery in adenoidectomy, an increased incidence of Grisel's syndrome has been observed. The purpose of the study was to evaluate monopolar suction electrocautery as a possible risk factor.Study Design Retrospective chart review along with current measurements of monopolar and bipolar electrocautery during adenoidectomy.Methods The charts of 1431 consecutive cases of adenoidectomy were reviewed before (n = 710) and after (n = 721) the introduction of monopolar suction electrocautery for intraoperative hemostasis. Moreover, energy of delivered current of electrocautery was measured in 30 pediatric patients during adenoidectomy.Results Three cases of Grisel's syndrome occurred as a postoperative complication in 721 adenoidectomies (0.4%) after the introduction of monopolar suction electrocautery. In contrast, no Grisel's syndrome was observed in 710 procedures before the use of monopolar electrocautery. Current measurements demonstrate an almost fourfold higher level of electrical energy using monopolar electrocautery compared with bipolar coagulation for bleeding control in adenoidectomy.Conclusion Monopolar suction cautery in adenoidectomy may be considered as a risk factor for Grisel's syndrome.
Sinonasal Undifferentiated Carcinoma: The Search for a Better Outcome
Authors: Musy Pierre Y. , Reibel James F. , Levine Paul A. 
Published: November 2003

AbstractObjective To evaluate the clinical outcomes of a standardized treatment approach for sinonasal undifferentiated carcinoma (SNUC).Study Design Single‐center, retrospective case series.Methods Fifteen patients with newly diagnosed SNUC were seen in the Department of Otolaryngology‐Head and Neck Surgery at the University of Virginia from 1991 to 2000. Long‐term follow‐up on five additional patients diagnosed between 1986 and 1991 was also analyzed.Results Overall, 10 patients were treated with curative intent with neoadjuvant chemoradiotherapy followed by craniofacial resection (CFR). The majority of the remainder was treated with palliative radiotherapy or chemoradiotherapy alone. Four patients who underwent CFR are currently free of disease at 4, 36, 49, and 164 months postoperatively. The 2‐year survival of all evaluable patients, regardless of treatment, was 47%. Two‐year survival was 64% in the group treated by CFR and 25% in the group treated with chemo‐ and/or radiotherapy (P = .076).Conclusion For patients with good performance status and limited intracranial or intraorbital disease, we continue to advocate initial chemoradiotherapy followed by craniofacial resection. Patients who are deemed inoperable as a result of advanced disease may nevertheless experience significant palliation with chemoradiotherapy only.