bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adjunctive Use of Endoscopy During Acoustic Neuroma Surgery
Authors: Wackym Phillip A. , King Wesley A. , Poe Dennis S. , Meyer Glenn A. , Ojemann Robert G. , Barker Fred G. , Walsh Patrick R. , Staecker Heinrich 
Published: November 2003

AbstractObjective/Hypothesis: In specific clinical situations, endoscopes offer better visualization than the microscope during acoustic neuroma (vestibular schwannoma) surgery and can therefore decrease the incidence of the postoperative complications of cerebrospinal fluid (CSF) leakage and recurrence of tumor. This study was undertaken to determine if the use of adjunctive endoscopy provides complementary information to the operating surgeon during surgery for acoustic neuromas.Method: Seventy‐eight patients with acoustic neuromas underwent tumor excision by two neurotologists (P.A.W., D.S.P.), together with their respective neurosurgical partners, via a retrosigmoid (suboccipital) approach (n=68), translabyrinthine approach (n=7), or middle cranial fossa approach (n=3). Endoscopy with a rigid glass lens endoscope was used during tumor removal to examine posterior fossa neurovascular structures, and after tumor excision to inspect the internal auditory canal (IAC), inner ear, and middle ear, depending on the approach used. One of the authors (D.S.P.) has not used adjunctive endoscopy during resections via the translabyrinthine and middle cranial fossa approaches, and therefore, these cases were excluded from the data collection and analysis.Results: Complete tumor excision was achieved in 73 patients. Endoscopy allowed improved identification of tumor and adjacent neurovascular relationships in all cases. In addition, residual tumor at the fundus of the IAC (n=11) and exposed air cells (n=24) not seen with the microscope during retrosigmoid approaches were identified endoscopically. In one of the translabyrinthine cases, the endoscope allowed identification of open air cells not visualized with the microscope. None of the 78 patients developed CSF rhinorrhea. Incorporating the endoscope did not significantly increase operative time.Conclusions: Endoscopy can be performed safely during surgery to remove acoustic neuromas. The adjunctive use of endoscopy may offer some advantages including improved visualization, more complete tumor removal, and a lowered risk of CSF leakage.
A Review of Randomized Clinical Trials in Tinnitus
Authors: Dobie Robert A. 
Published: November 2003

AbstractObjectives:Review reports of randomized clinical trials (RCTs) in tinnitus to identify well‐established treatments, promising developments, and opportunities for improvement in this area of clinical research.Study Design:Literature review of RCTs (1964‐1998) identified by MEDLINE and OLD MEDLINE searches and personal files.Methods:Studies were compared with the RCT criteria of Guyatt et al.5for quality of design, performance, and analysis; “positive” results were critically examined for potential clinical relevance.Results:Sixty‐nine RCTs evaluated tocainide and related drugs, carbamazepine, benzodiazepines, tricyclic antidepressants, 16 miscellaneous drugs, psychotherapy, electrical/magnetic stimulation, acupuncture, masking, biofeedback, hypnosis, and miscellaneous other nondrug treatments. No treatment can yet be considered well established in terms of providing replicable long‐term reduction of tinnitus impact, in excess of placebo effects.Conclusions:Nonspecific support and counseling are probably helpful, as are tricyclic antidepressants in severe cases. Benzodiazepines, newer antidepressants, and electrical stimulation deserve further study. Future tinnitus therapeutic research should emphasize adequate sample size, open trials before RCTs, careful choice of outcome measures, and long‐term follow‐up.
Unintentional Parathyroidectomy During Thyroidectomy
Authors: Lee Nina J. , Blakey John D. , Bhuta Sunita , Calcaterra Thomas C. 
Published: November 2003

AbstractObjectives: In the United States thyroidectomy is a frequently performed surgery by both general and head and neck surgeons. Even the most experienced thyroid surgeon, however, has probably received a pathology report stating that an incidental parathyroid gland or parathyroid tissue was found in the submitted thyroidectomy specimen. The aim of this report is to explore some of the pathologic and clinical characteristics of unintentional parathyroidectomy during thyroidectomy.Study Design: A retrospective review was performed of thyroidectomies performed at the University of California, Los Angeles, Center for the Health Sciences between 1989 and June 1998 which had pathology reports showing parathyroid tissue contained within the thyroidectomy specimen. This excluded any tissue submitted separately to be evaluated for parathyroid tissue and parathyroid tissue removed unintentionally during a thyroidectomy for a different procedure such as a laryngectomy or surgery for parathyroid disease.Methods: The pathology slides were reviewed to determine the incidence of unintentional parathyroid tissue removal, the size of the parathyroid tissue found within the thyroid specimen, the location of the parathyroid tissue (extracapsular, intracapsular, intrathyroidal), and whether this unintentional parathyroidectomy during thyroidectomy caused clinical consequences.Results: Four hundred fourteen applicable thyroidectomies were performed during this time with 45 (11%) discovered cases of unintentional parathyroidectomy during thyroidectomy. Twenty‐five (56%) cases were discovered during thyroidectomy for benign disease, and 20 (44%) during thyroidectomy for malignant thyroid disease. All the parathyroid tissue was normal and was found in extracapsular (58%), intracapsular (20%), or intrathyroidal (22%) locations. Of these 45 cases, recurrent laryngeal nerve paralysis was found only in two patients who had the nerve resected intentionally during the thyroidectomy, and none of the patients developed permanent hypocalcemia.Conclusions: Incidental parathyroid gland tissue was reported in 11% of the thyroidectomies performed in our series, without the clinical consequence of hypocalcemia. The majority (78%) of this parathyroid tissue was found in the extracapsular and intracapsular locations; therefore it is possible that these parathyroid glands may be identified and preserved with more meticulous inspection of the thyroid capsule during and after thyroidectomy to decrease the incidence of unintentional parathyroidectomy during thyroidectomy in the future.
Glottographic Measures Before and After Levodopa Treatment in Parkinson's Disease
Authors: Jiang Jack , Lin Emily , Wang Jian , Hanson David G. 
Published: November 2003

AbstractObjectives: Investigate the usefulness of acoustic and glottographic measures for detecting effects of levodopa (L‐dopa) treatment on vocal function of individuals with idiopathic Parkinson's disease.Study Design: Compare recordings of vowels sustained at a target comfortable loudness level obtained before and after L‐dopa treatment from 15 individuals with idiopathic Parkinson's disease showing signs of tremor.Methods: A simultaneous acoustic, airflow, and electroglottographic recording technique was employed to record vowels phonated by subjects before and after L‐dopa treatment. Algorithms were developed to derive from the recorded signal measures of fundamental frequency, SPL, airflow rate, speed quotient (ratio of glottal opening to closing time time), and short‐ and long‐term phonatory instability. A series of paired Student t tests or signed rank tests were performed to compare the pretreatment and posttreatment groups on these measures.Results: Measures of speed quotient, acoustic shimmer (cycle‐to‐cycle amplitude perturbation), and the extent of tremor derived from acoustic intensity contours were found to significantly decrease after medication. Sound pressure level tended to increase after medication. The acoustic jitter (cycle‐to‐cycle frequency perturbation) and the extent of tremor derived from airflow signals did not significantly differentiate between premedication and postmedication voices.Conclusions: Objective measures of acoustic and electroglottographic signals are useful in monitoring the pharmacologic response of Parkinson's disease, reflecting decrease of laryngeal rigidity and short‐ and long‐term acoustic amplitude fluctuation after L‐dopa treatment.
Otosclerosis in the 1960s, 1970s, 1980s, and 1990s
Authors: Lippy William H. , Berenholz Leonard P. , Burkey John M. 
Published: November 2003

AbstractEducational Objective:The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years.Study Design:Retrospective chart review.Setting:Private otology practice.Patients:Randomized selection of 400 patients (100 per decade) from 15,372 who underwent stapedectomy over the past four decades.Outcome Measures:Extent of cochlear involvement, bilaterality of disease, length of history, degree of hearing loss, and pathological findings are noted.Results:The decreasing incidence of footplates necessitating drillouts is discussed. Changing audiometric patterns at presentation such as decreased pure‐tone average hearing thresholds and smaller air‐bone gaps are also reviewed.Conclusion:This review demonstrates the changing patterns of presentation of otosclerosis over the past 37 years and will help guide the stapes surgeon into the year 2000.
A Patient‐Benefit Evaluation of Unilateral Congenital Conductive Hearing Loss Presenting in Adulthood: Should It Be Repaired?
Authors: Sperling Neil M. , Patel Nilesh 
Published: November 2003

AbstractObjective: To evaluate subjective and objective outcomes of surgical therapy in congenital conductive hearing loss (HL) presenting in adulthood. The impact of hearing restoration on quality of life (QOL) for these patients may differ from those with acquired HL.Study Design: Retrospective review of five patients treated surgically.Methods: Standard audiometry was completed. Patients completed a subjective questionnaire as well as subjective (open‐set) questions. A seven‐point Likert scale was used for closed‐set responses with 1 representing the worst possible outcome and 7 being best.Results: The average four‐frequency improvements in pure‐tone average and air‐bone gap were 18 dB (range, 7‐29 dB) and 16 dB (range, 2‐30 dB), respectively. An average score was obtained for each closed‐set question. The highest‐scoring items were for overall improvement of QOL (average score, 6), followed by perceived improvement in hearing (average score, 5.6). Other positive responses were improved ability to use the telephone (four of five patients) and improved localization of sound (four of five patients). Negative subjective responses included prolonged dysequilibrium in two of five, prolonged adjustment period in three, and dysgeusia in one patient.Conclusion: Important components of outcome are likely to escape our review if only objective measures are used to evaluate surgical outcomes. These results suggest that improved hearing in this population provides specific improvements in lifestyle and is perceived as a significant improvement in overall QOL.
Cortical Representation of Swallowing in Normal Adults: Functional Implications
Authors: Mosier Kristine , Patel Rakesh , Liu Wen‐Ching , Kalnin Andrew , Maldjian Joseph , Baredes Soly 
Published: November 2003

AbstractObjective: Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects.Study Design: Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques.Methods: Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross‐correlation analysis. One‐way and two‐way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence.Results: Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks.Conclusions: Activation of the primary motor and somatosensory cortices, as well as other sensory‐motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.
Histologic Findings of Silastic Medialization in the Canine Model
Authors: Simpson C. Blake , Seshul Merritt , Lennington Wayne , Juliao Saul , Netterville James L. 
Published: November 2003

AbstractObjectives: Examine the long‐term histological effects of Silastic medialization using a canine model.Study Design: Prospective study evaluating the effects of Silastic medialization in six canine larynges.Methods: Two subject groups were evaluated. The first group of four dogs underwent recurrent laryngeal section followed by Silastic medialization on the paralyzed side and placement of a smaller implant on the mobile side. Two of the dogs were sacrificed at 9 months and two at 2 years. The second subject group consisted of two additional dogs who underwent Silastic medialization followed by removal of the implants at 7 months and were sacrificed 18 months later. The larynges were then processed, sectioned in the axial plane, and examined microscopically.Results: Histological findings of both the mobile and paralyzed sides showed a thin (<0.5 mm) fibrous capsule surrounding the implant and minimal inflammatory response. Vocal fold mobility was maintained in all cases in which the recurrent laryngeal nerve was left intact. Capsule formation and inflammatory response were similar in all cases.Conclusions: Minimal tissue reactivity over a prolonged period of time suggests that long‐term results of Silastic medialization remain stable in paralyzed and mobile vocal folds for up to 2 years. Similar tissue response in the subjects in which the Silastic block was removed also suggests that Silastic medialization is a reversible procedure.
Overview of Telemedicine Applications for Otolaryngology
Authors: Burgess Lawrence P.A. , Holtel Michael R. , Syms Mark J. , Birkmire‐Peters Deborah P. , Peters Leslie J. , Mashima Pauline A. 
Published: November 2003

AbstractObjective/Hypothesis: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on‐line.Study Design: Prospective.Methods: The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in‐house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral.Results: Video‐otoscopy captures the image of an eardrum that can be sent from a remote site in a store‐forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in‐house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology.Conclusion: These efforts performed in a stepwise approach will lead to an otolaryngology‐head and neck surgery service that is on‐line for the next millennium, with telemedicine advances normalized to the standard of care.
Balance and Aging
Authors: Konrad Horst R. , Girardi Marian , Helfert Robert 
Published: November 2003

AbstractObjectives/Hypothesis: To provide a basic science and clinical review of normal balance changes with age, and to provide a current review for the evaluation and treatment of elderly patients with balance disorders. As we age, we lose balance function through loss of sensory elements, the ability to integrate information and issue motor commands, and because we lose musculoskeletal function. Diseases common in aging populations lead to further deterioration in balance function in some patients. Treatment of balance dysfunction in aging populations is based on the knowledge of normal aging processes and on an evaluation of the individual's balance loss and remaining balance elements. Prevention and rehabilitation play a major role in treatment; medical and surgical therapy also have a place.Study Design and Methods: Review of literature, personal research and observations.Results and Conclusions: Although older patients may be subject to most of the common balance disorders of younger patients, they have more problems with chronic disequilibrium and falls. Prevention and rehabilitation play an important role in treating these patients.
Frey Syndrome Before Frey: The Correct History
Authors: Dulguerov Pavel , Marchal Francis , Gysin Claudine 
Published: November 2003

AbstractObjective: To review the chronology of publications on gustatory sweating before Frey's landmark publication.Methods: Reports on Frey syndrome were reviewed, and all references given to publications before 1950 were obtained and examined. References to prior publications in the obtained articles were similarly reviewed. The cases described in these publications were analyzed for their compatibility with the accepted clinical symptoms of Frey syndrome.Results: Despite numerous references, the case described by Duphenix in 1757 is most probably a traumatic parotid fistula. The first reported case of Frey syndrome should be attributed to Baillarger in 1853.
Computer‐Aided Three‐Dimensional Reconstruction and Measurement of the Optic Canal and Intracanalicular Structures
Authors: Tao Hai , Ma Zhizhong , Dai Pu , Jiang Li 
Published: November 2003

AbstractObjective: To reconstruct the human optic canal and its inner structures and to provide detailed knowledge of this region for optic nerve decompression.Methods: Six optic canals and their inner structures were reconstructed using a computer‐aided three‐dimensional reconstruction system. Quantitative measurement of the canal wall thickness, bony canal transverse area, optic nerve transverse area, dural sheath transverse area, subarachnoid space transverse area, and subarachnoid space volume was done using the computer morphometric analysis system. The detailed spatial relationship among intracanalicular structures was also carefully identified on the three‐dimensional models.Results: The thinnest portion of the canal was the middle part of the medial wall (0.45 ± 0.14 mm) and the narrowest space was in the middle part of the optic canal (the transverse area was 18.21 ± 1.20 mm2). The volume of subarachnoid space that can be considered the compensatory space for distention incurred by the hemorrhage, optic nerve edema, or hematoma was 21.16 ± 4.31 mm3. At the cranial opening, the middle part, and the orbital opening, its transverse area was 4.45 ± 0.46 mm2, 2.68 ± 0.54 mm2, and 1.23 ± 0.34 mm2 respectively.Conclusions: Because the compensatory space was limited, even a tiny amount of blood or swelling of the nerve may cause optic nerve compression. Because the compensatory space for distention gradually decreases from cranial end to orbital end, the middle part and the anterior part of the optic canal and dural sheath are critical in optic nerve decompression.
Increased Expression of Keratinocyte Growth Factor Represents a Stereotypic Response to Tracheal Lumenal Insult Independent of Injury Mechanism
Authors: Hicks Wesley L. 
Published: November 2003

AbstractHypothesis: The author hypothesized that keratinocyte growth factor may play a role in mucosal epithelial repair in large conducting airway, and that the nature of the injury, denudation with disruption of the basement membrane by either mechanical or chemical means, versus exfoliation (loss of suprabasal cells only), would be reflected in the growth factor response.Study Design: This study evaluated the interdependent relationship between respiratory epithelial cells and the surrounding extracellular matrix in response to injury. In human cutaneous models, both keratinocyte growth factor and basic fibroblast growth factor are important in repair process.Method: A sterile tracheal explant culture system was developed that allows for controlled wounding of the epithelial surface using either 1) NaOH, 2) mechanical debridement, or 3) suprabasal exfoliation. Control and injured bovine tracheas were studied by immunohistochemistry up to 24 hours after injury.Results: Keratinocyte growth factor expression was strongly upregulated in epithelium and submucosa of denuded, but not exfoliation cultures, irrespective of means of injury. Disruption of the basement membrane by any means triggers a stereotypic growth factor response paradigm. This growth factor response has a consistent spatial, but variable, temporal relationship that is influenced by the type of injury‐mechanical versus chemical.Conclusion: This work demonstrates that the type of injury (denudation vs. exfoliation) affects the expression patterns of growth factors that may be important for airways repair.