bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Age on Vestibular Rehabilitation Outcomes
Authors: Whitney Susan L. , Wrisley Diane M. , Marchetti Gregory F. , Furman Joseph M. 
Published: November 2003

AbstractObjectiveThe purpose of the retrospective chart review was to compare vestibular rehabilitation outcomes in young versus older adults.Study DesignRetrospective matched design.MethodsTwenty‐three persons with vestibular disorders aged 20 to 40 years were matched by gender, vestibular diagnosis, and vestibular function test results to 23 older adults aged 60 to 80 years. The patients were treated with a custom‐designed physical therapy exercise program. Patients completed the Dizziness Handicap Inventory, the Activities‐Specific Balance Confidence (ABC) scale, and the Dynamic Gait Index; number of falls; and rated the severity of their dizziness. The two‐samplettest, the Mann‐WhitneyUtest, and McNemar's test for correlated proportions were used to determine whether there was a difference in scores between the two age groups at the beginning and end of physical therapy.ResultsDuring the initial evaluation, older adults reported having statistically greater space and motion discomfort and more severe symptoms on a scale of 0 to 100. Younger adults had more impaired DGI scores and a higher proportion of caloric testing abnormalities. After rehabilitation, overall improvement was seen in both the younger and older populations. There were no statistical differences between the two groups on the DHI, the DGI, reported symptoms at discharge, or number of falls. When only the complete matched‐pair data were analyzed, there were no statistically significant differences between the age groups in the proportion of patients demonstrating clinical improvement.ConclusionAge does not significantly influence the beneficial effects of vestibular rehabilitation for persons with vestibular disorders.
The Muscular Compliance of the Auditory Tube: A Model‐Based Survey
Authors: Leuwer Rudolf , Schubert Rainer , Kucinski Thomas , Liebig Thomas , Maier Hannes 
Published: November 2003

AbstractObjectives The role of the paratubal muscles, especially the medial pterygoid muscle, still is unclear. The aim of this study was to define the function of the medial pterygoid muscle concerning the muscular compliance of the auditory tube.Methods High‐resolution cross‐sectional T1 magnetic resonance imaging data of one of the authors' paratubal structures were used, a new functional 3‐D model of the auditory tube and its related structures visualized by the Hamburg VOXEL‐MAN digital image system.Results Functional 3‐D reconstructions of the paratubal structures reveal that the medial pterygoid muscle is acting as a movable hypomochlion of the tensor veli palatini muscle. Contraction of the medial pterygoid muscle increases and relaxation decreases the force of the tensor veli palatini muscle on the distal part of the auditory tube. Hence, the opening pressure of the auditory tube is moderated by the action of the medial pterygoid muscle.Conclusion The influence of the medial pterygoid muscle on the opening pressure of the auditory tube may have an impact on the diagnosis and therapy in patients with patent auditory tube as well as the middle ear pathology in patients with cleft palate.
Hearing Results With a Hydroxylapatite/Titanium Bell Partial Ossicular Replacement Prosthesis
Authors: Smith Jason , Gardner Edward , Dornhoffer John L. 
Published: November 2003

AbstractObjectives/Hypothesis To study the preliminary hearing results in patients receiving a hybrid hydroxylapatite/titanium bell partial ossicular replacement prosthesis (PORP) and compare these with a cohort of patients receiving a HAPEX PORP. We hypothesized that the design of the hybrid PORP would enhance its acoustic properties. In particular, the titanium bell, which allows the prosthesis to be freestanding, would obviate the need for Gelfoam, preventing fibrosis.Study Design A retrospective study was made of two cohorts of patients.Methods A computerized otologic database was used to identify all patients implanted with either PORP. The four‐frequency (500, 1000, 2000, and 3000 Hz) pure‐tone average air–bone gap (PTA‐ABG) and ABG values for individual frequencies were compared using the Student t test.Results The PTA‐ABG for the titanium bell prosthesis was 9.8 ± 5.7 dB, compared with 13.2 ± 8.3 dB for the HAPEX PORP, which was statistically significant (P <.05). The average ABG values at 500 and 1000 Hz were also statistically significantly improved with the titanium bell PORP (P <.05).Conclusions The titanium bell PORP showed improved postoperative results for the PTA‐ABG and at 500 Hz and 1000 Hz. The prosthesis is freestanding and may provide better coupling with the capitulum, factors which may lead to improved hearing results in the lower frequencies.
Surgical Anatomy of the Sphenopalatine Artery in Lateral Nasal Wall
Authors: Lee Hye Yeon , Kim Hyun‐Ung , Kim Sung‐Shik , Son Eun Jin , Kim Ji Woo , Cho Nam Hoon , Kim Kyung‐Su , Lee Jeung‐Gweon , Chung In Hyuk , Yoon Joo‐Heon 
Published: November 2003

AbstractObjective We investigated the surgical anatomy of the sphenopalatine artery. First, the location of the sphenopalatine foramen on the lateral nasal wall and the pattern of the main branches of the sphenopalatine artery from the sphenopalatine artery were studied. Second, the course of the posterior lateral nasal artery with respect to the posterior wall of the maxillary sinus, the perpendicular plate of the palatine bone, and the pattern of distribution of its branches on the fontanelle was determined. Third, the distribution pattern on the inferior turbinate was analyzed.Study Design Fifty midsagittal sections of randomly selected Korean adult cadaver heads with intact sphenoid sinus and surrounding structures were used in the study.Methods The mucosa on the sphenopalatine foramen and its surrounding mucosa were removed with a microscissors, a fine forceps, and a pick to expose the sphenopalatine artery under an operating microscope (original magnification ×6).Results The feeding vessels of the superior turbinate were from the septal artery in 36 cases (72%). The feeding vessels to the middle turbinate branch originated from the proximal portion of the posterior lateral nasal artery just after exiting the sphenopalatine foramen in 44 cases (88%). Some portion of the posterior lateral nasal artery ran anterior to the posterior wall of the maxillary sinus in 38%. The major feeding arteries to the fontanelle were from the inferior turbinate branch in 25 cases (50%). In most cases, the inferior turbinate branch was the end artery of the posterior lateral nasal artery (98%).Conclusions The study provides detailed information concerning the sphenopalatine artery, which we hope will help explain the arterial bleeding that may occur during ethmoidectomy, middle meatal antrostomy, conchotomy, and endoscopic ligation of the sphenopalatine artery.
Clarithromycin and Prednisolone Inhibit Cytokine Production in Chronic Rhinosinusitis
Authors: Wallwork Ben , Coman William , Feron Francois , Mackay‐Sim Alan , Cervin Anders 
Published: November 2003

AbstractObjectives Long‐term, low‐dose macrolide therapy is effective in the treatment of chronic rhinosinusitis. The mechanism of its anti‐inflammatory effect and how this differs from corticosteroids remains unclear. The effect of clarithromycin and prednisolone on interleukin‐5, interleukin‐8, and granulocyte‐macrophage colony‐stimulating factor production by cultured chronic sinusitis nasal mucosa was examined in the study.Study Design and Methods Nasal mucosa was obtained from 11 patients with chronic sinusitis. This tissue was cultured for 24 hours in the presence of clarithromycin or prednisolone at a variety of concentrations. Cytokine levels were determined by enzyme‐linked immunoassay.Results Clarithromycin and prednisolone each produced significant reductions in interleukin‐5, interleukin‐8, and granulocyte‐macrophage colony‐stimulating factor production. There was no significant difference between the effects of clarithromycin and prednisolone.Conclusion Macrolide antibiotics are capable of inhibiting pro‐inflammatory cytokine production in vitro and are as potent as prednisolone. This mechanism is likely to be at least partly responsible for the clinical efficacy of macrolide antibiotics in chronic rhinosinusitis.
Patterns of Swallowing Failure Following Medialization in Unilateral Vocal Fold Immobility
Authors: Nayak Vijay K. , Bhattacharyya Neil , Kotz Tamar , Shapiro Jo 
Published: November 2003

AbstractObjective To quantify the incidence of penetration and aspiration following medialization for unilateral vocal cord immobility (UVCI) and determine patterns of failure.Study Design Blinded analysis consecutive case series.Methods Prospective blinded analysis of videofluoroscopic swallowing studies of patients who had received a medialization procedure was conducted, determining the incidence of penetration and aspiration by using the Penetration‐Aspiration Scale. Pharyngeal transport measures were also assessed. Associations between clinical factors and penetration‐aspiration were statistically determined.Results Sixty‐seven videofluoroscopic swallowing studies were reviewed in patients (mean age, 63.3 y) who had undergone vocal fold medialization (14 laryngoplasties and 53 vocal cord injections) for UVCI. Unilateral vocal cord immobility was left‐sided in 56 patients (83.6%), and 50 patients (74.6%) had a postsurgical etiologic factor for their immobility. Thirty (44.8%) and 16 (23.9%) patients demonstrated penetration and aspiration, respectively. Penetration most often occurred during the swallow, but aspiration was equally likely to occur during or after the swallow. No differences in the incidence of penetration or aspiration were noted according to the side of vocal fold paralysis (P = .20, χ2 test) or etiologic factor (P = .69). Further analysis found that swallow factors significantly associated with penetration and aspiration were swallow delay (P = .001, Wilcoxon ranked pairs test) and reduced laryngeal elevation (P = .001), as well as bolus residues in the valleculae (P = .002), piriform sinus (P = .001), or posterior pharynx (P = .008).Conclusions Many patients demonstrate significant radiographic aspiration even after medialization procedures for UVCI. Although glottal incompetence is a known risk factor for aspiration, other factors including pharyngeal bolus transport are important in determining an effective swallow in UVCI.
Myocardial Infarction After Microvascular Head and Neck Reconstruction
Authors: Chiang Scott , Cohen Benjamin , Blackwell Keith 
Published: November 2003

AbstractObjective/Hypothesis Microvascular flap transfer is a popular method for immediate reconstruction of defects in the head and neck resulting after the treatment of head and neck cancer. Head and neck cancer occurs most commonly in elderly patients with a high prevalence of heavy smoking. Surgery in this patient population is frequently prolonged and is associated with significant intraoperative blood loss. The present study seeks to identify factors contributing to perioperative myocardial infarction and to determine the best course of management.Study Design Retrospective analysis of 193 consecutive free flap surgeries.Methods A series of 193 microvascular free flaps performed over a 5‐year period for reconstruction of defects in the head and neck was retrospectively analyzed to identify the incidence, management, and outcome of perioperative myocardial infarction in this patient population.Results Myocardial infarctions occurred in seven patients, for an overall incidence of 3.6%. Statistical analysis using logistic regression failed to demonstrate any significant relationship between age, sex, total operative time, operative blood loss, net intraoperative fluid shifts, tumor stage, American Society of Anesthesiology (ASA) preoperative classification, type of free flap, and the occurrence of perioperative myocardial infarction. Hemodynamic instability manifested by hypotension occurred in four patients who had perioperative myocardial infarction. Three of these patients underwent urgent coronary artery bypass surgery, whereas one patient underwent urgent endovascular therapy with subsequent stabilization of the hemodynamic instability. All free flaps survived despite myocardial infarction and hemodynamic instability. Two patients (29%) died after postoperative intervals of 74 and 99 days, never having left the hospital.Conclusions Systemic hypotension is a well‐recognized risk factor for free flap failure. Our experience suggests that aggressive intervention to reverse coronary ischemia associated with hemodynamic instability has a favorable outcome on free flap survival, and free flap thrombosis is not an inevitable outcome of the low‐flow state associated with perioperative cardiopulmonary bypass. Although the overall incidence of perioperative myocardial infarction in patients undergoing microvascular head and neck reconstruction is low, patient mortality is high, so emphasis should be placed on preoperative identification of patients with coronary artery disease.
Laryngopharyngeal Reflux and Laryngeal Web Formation in Patients With Pediatric Recurrent Respiratory Papillomas
Authors: Holland Bradford W. , Koufman James A. , Postma Gregory N. , McGuirt William F. 
Published: November 2003

AbstractObjective To determine whether treatment of laryngopharyngeal reflux reduces the laryngeal soft tissue complications encountered in surgery for recurrent respiratory papillomas.Study Design Retrospective chart review.Methods Retrospective chart review of all pediatric patients treated for laryngeal recurrent respiratory papillomas between 1984 and 1999 was performed. Thirty‐one such patients were identified. Twenty‐four were at “high risk” for developing complications based on the number of operating suite visits and the presence of disease at the anterior commissure. Twelve patients underwent 24‐hour double pH probe testing.Results Overall, 13 of 31 patients (42%) developed laryngeal webs. No other soft tissue complications were encountered. Of the patients who had pH probe testing, 12 of 12 (100%) had at least one pharyngeal episode of acid exposure. Of the “high‐risk” patients, 10 were treated for reflux and only 2 of 10 (20%) developed webs. Eleven of 14 (79%) of the “high‐risk” patients who were not treated for reflux developed webs. The difference in rate of web formation between patients treated for reflux and those not treated for reflux was statistically significant (P = .011).Conclusions Antireflux treatments for patients undergoing surgery for laryngeal recurrent respiratory papillomas may reduce the soft tissue complications, especially scarring and web formation. Prophylactic antireflux therapy may be warranted in any patient undergoing surgery during which laryngeal mucosal disruption is anticipated.
Is Gastric Reflux a Cause of Otitis Media With Effusion in Children?
Authors: Tasker Andrea , Dettmar Peter W. , Panetti Marguerite , Koufman James A. , P. Birchall John , Pearson Jeffrey P. 
Published: November 2003

AbstractObjectives/Hypothesis Otitis media with effusion is the most common cause of childhood deafness. Gastroesophageal reflux has been implicated in the disease pathogenesis; therefore, it is necessary to identify the presence or absence of gastric juice in the middle ear.Study Design Middle ear effusions were collected from children undergoing myringotomy. If gastric reflux has occurred, effusions should contain pepsin protein.Methods Total pepsin/pepsinogen protein, fibrinogen, and albumin content of effusions were measured in enzyme‐linked immunosorbent assays using antibodies to porcine pepsin, human albumin, and human fibrinogen. Proteolytic activity of each effusion was measured at pH 2. The pH of effusions was measured.Results Fifty‐nine of 65 effusion samples gave a positive result with the antipepsin antibody, which also recognized pepsinogen. Pepsin/pepsinogen levels ranged from 0.8 to 213.9 μg/mL (serum reference levels, 49.8–86.6 ng/mL). All effusions contained albumin and fibrinogen with respective ranges of 1.77 to 95.75 and 0.30 to 2.30 mg/mL (serum reference levels, 35–45 and 2.2 to 4.6 mg/mL, respectively). Acidic protease activity occurred in 19 of 65 effusion samples. The pH of effusion samples was 7 to 9.Conclusions The majority of effusion samples contained pepsin/pepsinogen protein; only 29% were active. The pepsin level in effusion samples based on activity is substantially lower than levels based on antibody detection; however, the pH present would irreversibly inhibit pepsin, which would explain the low levels of active enzyme. Pepsin/pepsinogen levels in the effusion samples were up to 1000 times higher than serum levels, whereas albumin and fibrinogen levels were of the same magnitude. The pepsin in middle ear effusions is almost certainly due to reflux of gastric contents, and there may be a role for antireflux therapy in the treatment of otitis media with effusion.
Paranasal Sinus Malignancies: An 18‐Year Single Institution Experience
Authors: Myers Larry L. , Nussenbaum Brian , Bradford Carol R. , Teknos Theodoros N. , Esclamado Ramon M. , Wolf Gregory T. 
Published: November 2003

AbstractObjectives To characterize a single institution experience with management of paranasal sinus malignancies during an 18‐year time period, report long‐term survival rates, and identify prognostic factors.Study Design Retrospective chart review.Methods Studied were 141 patients treated for a paranasal sinus malignancy at a single institution from 1980 to 1997 with a minimum 3‐year follow‐up. Gender, age, TNM stage, anatomic site, pathology, treatment, and recurrence rates were reviewed. Multivariate analysis was performed to determine factors affecting survival.Results The male to female ratio was 1.6:1, and the median patient age was 60 years. Most patients presented with T3/T4 or locally advanced disease (88%), N0 status (96%), and M0 status (96%). The maxillary sinus was the most commonly affected site (70%), followed by the ethmoid sinus (26%). The most common malignancy was squamous cell carcinoma (51%), followed by adenoid cystic carcinoma (12%) and adenocarcinoma (11%). Sixty‐two percent of this study group underwent surgery as part of a multimodality curative treatment plan or alone as curative treatment. Eighteen patients (13%) had unresectable local disease and received non‐surgical palliative treatment. Kaplan‐Meier analysis revealed the 5‐year and 10‐year disease‐specific survival was 52% and 35%, respectively. Multivariate analysis revealed T4 stage (P = .005), N‐positive stage (P = .009), and M‐positive stage (P = .018) negatively impacted survival. Seventy‐two patients (51%) developed recurrent disease at a median time of 336 days after initial treatment.Conclusions Most patients with paranasal sinus malignancies presented with locally advanced disease. Advanced T stage, regional, and distant metastasis are highly predictive of poor survival. Recurrence rate is high and typically occurs within the first year after treatment.
External Auditory Canal Stenosis After Radiation Therapy
Authors: Carls J. Lauren , Mendenhall William M. , Morris Chris G. , Antonelli Patrick J. 
Published: November 2003

AbstractObjectives To determine whether the risk of external auditory canal stenosis from external‐beam radiation therapy is dose dependent.Study Design Retrospective chart review.Methods The presence of external auditory canal disease was recorded for patients who received low‐dose (e.g., lymphoma [20–40 Gy]), medium‐dose (e.g., chemodectoma [40–55 Gy]), or high‐dose (e.g., parotid and nasopharyngeal neoplasms [55–75 Gy]) external‐beam radiation therapy from 6 months to over 8 years following treatment. The incidence of external auditory canal disease was compared between groups.Results None of 13 low‐dose, none of 19 medium‐dose, and 8 of 91 (8.7%) high‐dose external‐beam radiation therapy subjects developed ipsilateral external auditory canal stenosis. No external auditory canal stenosis developed in patients treated with high‐dose external‐beam radiation therapy in the absence of parotid surgery. External auditory canal stenosis developed only in patients treated with parotidectomy and high‐dose external‐beam radiation therapy (P = .0059), and all of these cases of external auditory canal stenosis developed within 3 years of radiation therapy.Conclusions High dose external‐beam radiation therapy alone does not significantly predispose patients to external auditory canal stenosis. However, combined high‐dose external‐beam radiation therapy and surgery around the external auditory canal do significantly increase the risk of external auditory canal stenosis.
Measuring Comorbidity in Patients With Head and Neck Cancer
Authors: Hall Stephen F. , Rochon Paula A. , Streiner David L. , Paszat Lawrence F. , Groome Patti A. , Rohland Susan L. 
Published: November 2003

AbstractBackground Comorbidities are diseases or conditions that coexist with a disease of interest. The importance of comorbidities is that they can alter treatment decisions, change resource utilization, and confound the results of survival analysis.Objective The objective of this study was to determine the best comorbidity index to use in survival analysis of patients with squamous cell carcinoma of the head and neck.Method Four validated indexes, with very different methodologies (i.e., the Charlson Index, the Cumulative Illness Rating Scale, the Kaplan‐Feinstein Classification, the Index of Co‐existent Disease), were tested using data from 379 unselected consecutive patients with complete 3‐year follow‐up from the Kingston Regional Cancer Center. Kaplan‐Meier analysis and Cox Proportional Hazards Regression were used to stratify patients into three levels of increasing severity of comorbidity for each index. The Proportion of Variance Explained and Receiver Operating Characteristics curves were used to compare the performance of the indexes.Conclusion The Kaplan‐Feinstein Classification was the most successful in stratifying patients in this population.
Pseudocyst of the Auricle
Authors: Lim C. M. , Goh Y. H. , Chao S. S. , Lynne Lim 
Published: November 2003

AbstractObjective To study the epidemiological profile of patients with pseudocyst of the auricle and to review the effectiveness of surgical excision of the anterior cartilage with compression buttoning in this condition.Study Design Medical records of patients with pseudocyst of the auricle treated in the Department of Otolaryngology of the Singapore General Hospital were reviewed retrospectively during the period from March 1, 2000, to November 30, 2001.Methods A retrospective descriptive analysis of the epidemiological profile of patients with pseudocyst of the auricle was done. Surgical excision with compression buttoning was evaluated as the definitive treatment in this condition.Results Eighty‐seven percent of our patients were male and the mean age was 38.9 years old. There was no racial predisposition. All 9 patients who had simple aspiration of the cyst had prompt re‐accumulation of the pseudocyst. None of the patients had recurrence following excision and compression buttoning of the pseudocyst. The complication rate in our study was 2.4%. Only one patient developed initial perichondritis with a resultant cauliflower deformity following surgical excision.Conclusion Pseudocyst of the auricle typically presents as a painless unilateral swelling of the auricle in young adult males. Treatment options are varied. Excision of the anterior cartilage with compression buttoning yielded excellent results with no recurrence.