bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Techniques to Facilitate Endoscopic Second‐Look Mastoidectomy
Authors: Haberkamp Thomas J. , Tanyeri Hasan 
Published: November 2003

AbstractObjectives/Hypothesis: Mastoidoscopy has shown to be a safe, effective alternative to traditional second‐look mastoidectomy. This study was undertaken to review surgical modifications to facilitate successful mastoidoscopy. Study Design: Retrospective database review of all surgical procedures performed by the senior author (t.j.h.) since January 1995. All surgeries were performed in a tertiary hospital setting. Results: Fifteen second‐look procedures were performed in this series. Five were performed endoscopically, 10 with traditional techniques. In the traditional surgeries five were prior to the use of endoscopy, five had contraindications to endoscopic mastoidectomy. There were six residual cholesteatomas in the series, one in the endoscopic cases (20%), and five in the traditional cases (50%). No cholesteatomas were identified with microscopic examination performed after endoscopy. There were no complications in the series. Mastoidoscopy gives limited access to the mesotympanum, eustachian tube and, in particular, the sinus tympani. The creation of a wide extended facial recess with removal of the buttress at the fossa incudis and removal of the incus and head of the maleus will facilitate inspection of the middle ear. Additional techniques are necessary to view the sinus tympani. The fallopian bridge technique, and the infratympanic extended facial recess technique may allow better visualization of the middle ear. Conclusion: Mastoidoscopy offers a safe alternative to traditional techniques for second‐look surgery. The morbidity appears similar to traditional techniques.
Use of the Laryngeal Mask Airway in Otologic Surgery
Authors: Duff Brian E. 
Published: November 2003

AbstractObjective/Hypothesis: The combination of intravenous sedation and local infiltration anesthesia is routinely utilized in otologic surgery. Advantages over general anesthesia with endotracheal intubation include ease and speed of induction and emergence, safety, and decreased postoperative discomfort. Anatomic and physiological patient constraints may preclude the use of intravenous sedation and anesthetists inexperienced in this technique may find it difficult to achieve a consistent level of anesthesia appropriate for major otologic surgery. Administration of anesthesia using the laryngeal mask airway (LMA) has been proposed to offer many of the advantages of intravenous sedation with less risk of oversedation and obstructive apnea. Study Design: A retrospective chart review. Methods: A review of 100 consecutive adult and pediatric patients undergoing major otologic procedures in which the LMA was utilized. Results: All laryngeal masks were introduced without a laryngoscope and successful placement was accomplished on the first attempt in 98%. Procedures were performed under spontaneous ventilation and in only one instance was surgery temporarily interrupted because of patient movement. No major complications occurred and no patients required endotracheal intubation. Only three patients complained of mild throat discomfort in the immediate postoperative period. Conclusions: The laryngeal mask airway is a safe and effective means of providing anesthesia during major otologic surgery.
Glutamate‐like Immunoreactivity During Hair Cell Recovery After Gentamicin Exposure in the Chinchilla Vestibular Sensory Periphery
Authors: Chin Kenley W. , Lopez Ivan , Lee Seung‐Chul , Honrubia Vicente 
Published: November 2003

AbstractObjective: Determine the expression of glutamate by immunohistochemistry in normal and recovering vestibular hair cells in the chinchilla crista ampullaris after gentamicin ototoxicity. Study Design: In five groups of three animals each, ototoxicity was produced by placing gentamicin (50 μg)‐impregnated Gelfoam pellets within the perilymphatic space of the superior semicircular canal. Animals were sacrificed at 1, 2, 4, 8, and 16 weeks after treatment. A group of normal (n=3) animals was also processed. Methods: For the detection of glutamate the inner ears of these animals were dissected, and the horizontal cristae ampullaris embedded in plastic. Two‐micron‐thick tissue sections were obtained and incubated with monoclonal antibodies against glutamate. The immunoreaction was detected using the avidinbiotiny‐lated‐complex technique and diaminobenzidine was the chromogen. Results: Normal sensory epithelia demonstrated type I and type II hair cells with moderate glutamate‐like immunoreactivity. Supporting cells demonstrated no glutamate‐like immunoreactivity. Afferent nerve fibers and calyxes surrounding type I hair cells demonstrated strong glutamate‐like immunoreactivity. At 1 and 2 weeks after treatment the few type II hair cells surviving ototoxic treatment (15%–18%) contained moderate glutamate‐like immunoreactivity, supporting cells showed no immunoreactivity, and nerve terminals and fibers displayed strong immunoreactivity. At 4 and 8 weeks after treatment, recovered hair cells (80%) had greater glutamate‐like immunoreactivity when compared with normal hair cells, supporting cells displayed no glutamate‐like immunoreactivity, and afferent fibers contained strong glutamate‐like immunoreactivity. At 16 weeks, glutamate‐like immunoreactivity in hair cells returned to normal level. Conclusion: Glutamate may be used as an indicator of hair cell differentiation and as an index of the molecular recovery of hair cells after ototoxicity.
Test‐Retest Reliability of Computed Tomography in the Assessment of Chronic Rhinosinusitis
Authors: Bhattacharyya Neil 
Published: November 2003

AbstractObjective: Computed tomography (CT) of the paranasal sinuses has emerged as the standard test for the assessment of chronic rhinosinusitis, as evidenced by the emergence of several CT‐based staging systems. Despite its central role in the diagnosis and treatment planning for chronic rhinosinusitis, the sinus CT represents a “snapshot in time.” This study was conducted to determine the reliability of the CT scan for chronic sinus disease: are the CT findings in chronic rhinosinusitis stable over time? Methods: A prospective series of patients scheduled for endoscopic sinus surgery was evaluated. A total of 45 patients received two CT scans: an initial scan obtained during routine diagnostic evaluation, and a second scan performed for use as part of an image‐guided sinus surgery protocol. No surgical intervention occurred between scans. The patients' scans were staged according to the Lund system by a blinded observer. The correlation between scans for each patient was determined using the matched pairs t test and the Pearson correlation coefficient. Results: The mean time interval between scans was 122.6 days (range, 5–364 d). The average Lund scores for the initial and second scans were 13.56 and 13.27, respectively. The Lund score for 5 patients remained the same, increased in 22 patients, and decreased in 18 patients. Overall, 75.6% of patients' second scans were within ±2 points of the first scan Lund score. The mean change in score between scans of —0.29 was not significant (P = .606, paired samples t test). The Pearson correlation coefficient between scans was 0.796 (P > .0001). Conclusions: CT scan assessment of chronic rhinosinusitis is a reliable test. The CT findings in patients with chronic rhinosinusitis remain consistent over time.
The Rhinology Laboratory
Authors: Bent John P. , Porubsky Edward S. 
Published: November 2003

AbstractObjectives: This study seeks to develop a rhinology lab model and to assess its effectiveness for physicians‐in‐training. Study Design: We established a rhinology lab at our institution with simple and affordable modifications to our temporal bone lab. Residents attended a seven‐part lecture series and received a list of endoscopic and open procedures to perform on computed tomography (CT)‐scanned, vessel‐injected cadaver heads. Methods: After 2 years we asked participating residents to rate their lab experience on a 1‐to‐10 (disagree‐agree) scale. Results: Cumulative scores indicated that residents enthusiastically perceived this additional training as worth while (μ=10), while increasing their efficiency (μ=9.5), safety (μ=9.875), and anatomic knowledge (μ=9.875). The lab has opened opportunities for rhinology research, as evidence by one resident publication and another project in progress. Survey feedback has helped develop guidelines for instructor participation in the lab as well as for assigned reading and independent study. Conclusions: Based on our preliminary experience, we recommend the rhinology lab to all residency programs as an important yet cost‐effective means of maintaining education in step with rapidly changing technologies.
Experimental Nasal Intubation: A Study of Changes in Nasoantral Mucosa and Bacterial Flora
Authors: Westergren Viveka , Otori Nobuyoshi , Stierna Pontus 
Published: November 2003

AbstractObjectives: To investigate the local effects in a nasal cavity and its adjacent sinuses of long‐term detention of an endonasal tube, with special attention to inflammatory pathology and microbiology. Study Design: Experimental rabbit study. Methods: Four groups of 4 rabbits, in all 16, were unilaterally nasally intubated and evaluated macroscopically, histopathologically, and bacteriologically after 1, 2, 4, and 8 weeks, respectively. Results: At first, in the 1‐ and 2‐week groups to the 4‐week group, histopathology, such as degeneration of olfactory mucosa, squamous cell metaplasia, and polyp formations, was observed together with frequent opportunistic bacterial findings in the nasal cavity. Later, in the 4‐ and 8‐week groups, inflammatory mucosal changes, such as septal increase of connective tissue, goblet cell hyperplasia, and epithelial invaginations, were found in the nasal cavity containing a tube. A concomitant increase was found of commensal bacteria adjacent to the tube and the similar bacterial findings in the ipsilateral maxillary sinuses. However, there were no signs of inflammatory reactions in the sinuses. Conclusions: Our investigation points to the tube as the cause of local goblet cell hyperplasia with an increased mucus production, and as a food source for the commensals with a marked increase of the amount of bacteria. The positive bacterial cultures from the maxillary sinuses might be considered to be colonization. However, because of the possibility of contamination, improved sampling techniques are required, as are further studies.
Repeated Inflation Does Not Prevent Otitis Media With Effusion in a Monkey Model
Authors: Alper Cuneyt M. , Doyle William J. 
Published: November 2003

AbstractObjective: Investigate the efficacy of repeated middle ear inflation with an inert gas (argon) for preventing the development of middle ear effusion in monkeys with functional eustachian tube obstruction.Study Design: Prospective controlled trial of daily middle ear inflation with five monkeys assigned to the inflation group and four to the control group.Methods: The right tensor veli palatini muscle of nine monkeys was paralyzed with botulinum toxin. Tympanometry was done before the procedure and then daily for 21 days. Presence and distribution of effusion were assessed before paralysis and on day 15 using magnetic resonance imaging (MRI). In five right ears inflation was done beginning at the first observation of negative middle ear pressure of ≤−200 mm H2O and repeated on all days with pressures ≤−100 mm H2O. Four right ears served as uninflated controls.Results: Right middle ear pressure decreased in all animals over the course of the study. Pressure returned to near‐ambient levels immediately following the argon inflation but was decreased to control levels at the subsequent observation on the following day. MRI at day 15 documented effusion in all right ears with no quantifiable differences in amount or distribution between ears that were and were not inflated with argon.Conclusions: Repeated inflation with an inert gas does not prevent middle ear effusion in monkeys with functional eustachian tube obstruction.
Surgical Management of Bell's Palsy
Authors: Gantz Bruce J. , Rubinstein Jay T. , Gidley Paul , Woodworth George G. 
Published: November 2003

AbstractObjectives: Incomplete return of facial motor function and synkinesis continue to be long‐term sequelae in some patients with Bell's palsy. The aim of this report is to describe a prospective study in which a well‐defined surgical decompression of the facial nerve was performed in a population of patients with Bell's palsy who exhibit the electrophysiologic features associated with poor outcomes. In addition, management issues related to Bell's palsy including herpes simplex virus type1 etiology, the natural history, electrodiagnostic testing, and efficacy of surgical strategies are reviewed.Study Design and Methods: A multicenter prospective clinical trial was designed utilizing electroneurography (ENOG) and voluntary electromyography (EMG) to identify patients with Bell's palsy who would most likely develop poor return of facial function, as suggested by Fisch and Esslen. Patients who displayed electrodiagnostic features of poor outcome, >90% degeneration on ENOG testing and no voluntary motor unit EMG potentials within 14 days of onset of total paralysis, were offered a surgical decompression of the facial nerve through a middle cranial fossa surgical exposure, including the tympanic segment, geniculate ganglion, labyrinthine segment, and meatal foramen. Control subjects were those who displayed similar electrodiagnostic features and time course.Results: Subjects who did not reach 90% degeneration on ENOG within 14 days of paralysis all returned to House‐Brackmann grade I (n=48) or II (n=6) at 7 months after onset of the paralysis. Control subjects self‐selecting not to undergo surgical decompression when >90% degeneration on ENOG and no motor unit potentials on EMG were identified had a 58% chance of developing a poor outcome at 7 months after onset of paralysis (House‐Brackmann grade III or IV [n=19]). A group with similar ENOG and EMG findings undergoing middle fossa facial nerve decompression exhibited House‐Brackmann grade I (n=14) or II (n=17) in 91% of the cases. An exact permutation test confirmed that the surgical group had a significantly higher proportion of patients with a good outcome (House‐Brackmann grade I or II) (P = .0002).Conclusion: Electroneurography in combination with voluntary EMG successfully identified patients who will most likely return to normal from those who had a greater chance of long‐term sequelae from Bell's palsy. Surgical decompression medial to the geniculate ganglion significantly improves the chances of normal or near‐normal return of facial function in the group that has a high probability of a poor result. Surgical decompression must be performed within 2 weeks of onset of total paralysis for it to be effective.
Analysis of a Critical Pathway in Osteoplastic Flap for Frontal Sinus Obliteration
Authors: Correa Alex J. , Reinisch Lou , Paty Victoria A. , Sanders David L. , Duncavage James A. 
Published: November 2003

AbstractObjectives: A critical pathway was applied to patients undergoing osteoplastic flap (OPF) for frontal sinus obliteration to determine whether efficiency could be improved.Study Design: A retrospective review of consecutive OPF procedures (n = 51) performed between 1992 and July 1997 was conducted.Methods: The patient groups were subdivided into those who underwent OPF alone and those who had endoscopic sinus procedures performed in addition to OPF. Comparisons were made between the precritical pathway and post‐critical pathway groups, specifically noting operative time, total operating room (OR) time, estimated blood loss (EBL), length of hospital stay, and costs. We used a critical pathway that was developed for endoscopic sinus procedures at our institution through a multidisciplinary team approach. Preoperative evaluation and testing, intraoperative equipment and medications, and postoperative care including follow‐up clinic visits were all standardized. An unpaired, two‐tailed Student t test was used to evaluate the data.Results: Statistically significant (P < .05) reductions in operative times, total OR time, EBL, and length of hospital stay were observed in the post‐critical pathway group who underwent endoscopic sinus procedures as well as OPF. Costs to the OR were reduced 29% and 15% for OPF and for OPF with endoscopic surgery, respectively. Patient costs were reduced 5% and 4% in these groups, respectively.Conclusions: With implementation of effective critical pathways, significant decreases in length of stay are seen, and cost reductions can be realized through the improved efficiency, shortened OR times, and decreases in redundancy of ordering materials.
Course of Proptosis in Patients With Graves' Disease After Endoscopic Orbital Decompression
Authors: Ulualp Seckin O. , Massaro Bruce M. , Toohill Robert J. 
Published: November 2003

AbstractAim: To evaluate the results of follow‐up and postoperative course of proptosis in patients with Graves' disease who underwent combined transconjunctival and transnasal endoscopic orbital decompression.Methods: Charts of patients with Graves' disease who underwent orbital decompression using combined transconjunctival and transnasal endoscopic technique were reviewed. The surgical technique involved preservation of the strut of bone between the lamina papyracea of the ethmoid and floor of the orbit of the maxilla. Data pertaining to patient demographics, previous treatments for orbital manifestations of Graves' disease, and preoperative and postoperative otolaryngologic and ophthalmologic examination findings were obtained. Postoperative course of reduction in proptosis was evaluated based on Hertel exophthalmometry measurements obtained in four intervals: 1) 0 to 1 month, 2) 1 month to 3 months, 3) 3 to 6 months, 4) 6 to 12 months.Results: Twenty‐eight orbital decompressions were performed on 15 patients. All patients were unresponsive to corticosteroids and orbital irradiation. Ten orbits exhibited preoperative and postoperative visual acuity of 20/20. Vision improved in nine orbits and did not change in six orbits. Proptosis was reduced in 25 orbits. Postoperative course of reduction in proptosis varied within year 1, with the smallest proptosis measurements documented between 6 and 12 months.Conclusions: Combined transconjunctival and transnasal endoscopic orbital decompression with preservation of the strut resulted in regression of proptosis, marked reduction in postoperative diplopia development, and improvement of visual acuity in patients with Graves' disease. Course of reduction in proptosis varied within postoperative 1 year, with the biggest reduction occurring between 6 and 12 months.
Peripheral Nerve Regeneration in CNTF Knockout Mice
Authors: Yao Mike , Moir Melinda S. , Wang Michelle Z. , To Michael P. , Terris David J. 
Published: November 2003

AbstractObjectives: To determine the role of ciliary neurotrophic factor (CNTF) in the regeneration of the mouse sciatic nerve following injury by studying the CNTF knockout mouse in a blinded, randomized and controlled evaluation.Study Design: Fifty‐eight wild‐type and 57 CNTF knockout mice were randomly assigned to one of four treatment groups: sham surgery (sciatic nerve exposure), sciatic nerve crush, nerve transection without repair, and nerve transection followed by epineurial suture repair using 10‐0 monofilament suture. Walking track analysis was performed before and after surgery at weekly intervals for 7 weeks, using a previously described formula. At the completion of walking track analysis, morphometric histological analysis of axon number and axon diameter in the distal sciatic nerves was performed.Results: The wild‐type and knockout mice that underwent only sham surgery had no change in their walking tracks during the study interval (P = .30 on postoperative day 49). The wild‐type mice that underwent sciatic nerve crush showed complete functional recovery (P = .66 on postoperative day 28), but the CNTF knockout mice whose sciatic nerves were crushed did not fully recover (P = .05 on postoperative day 49). The CNTF knockout and wild‐type mice showed similar levels of recovery after transection without repair (P = .78), and the rate of contracture formation was not significantly different (P = .40). The CNTF knockout and wild‐type mice showed similar levels of recovery after epineurial repair (P > .31), however the rate of severe contractures was greater in the CNTF knockout mice (6 of 13) than in the wild‐type mice (2 of 12) (P = .11).Conclusion: The absence of CNTF impairs the ability of mice to recover from a sciatic nerve crush injury. There is also a trend toward a greater rate of contracture formation after sciatic nerve transection and epineurial suture repair when CNTF is unavailable. These findings suggest that CNTF is important for recovery of neuronal function following crush and transection nerve injuries.
Normal Cochlear Function in mdx and mdxCv3 Duchenne Muscular Dystrophy Mouse Models
Authors: Pillers De‐Ann M. , Duncan Nancy M. , Dwinnell Shannon J. , Rash Sean M. , Kempton J. Beth , Trune Dennis R. 
Published: November 2003

AbstractObjectives/Hypothesis: Sensorineural hearing loss has been found in association with inherited muscular dystrophies in humans and in mouse models. An increased brainstem auditory evoked response threshold has been previously reported in the dystrophin‐deficient mdx mouse model for Duchenne muscular dystrophy, suggesting that full‐length dystrophin (Dp427) is involved in hearing. The objective of the present study was to confirm cochlear dysfunction with this gene defect and determine whether the shorter carboxyl terminus isoforms of dystrophin are also critical in maintaining normal hearing.Study Design: Case controlled. Animal model.Methods: Auditory brainstem response (ABR) audiometry to pure tones was used to evaluate cochlear function. Fourteen mdx, 4 mdxCv3, and 13 age‐matched control (C57BL/6J and C57BL/10ScSn) male mice were tested at 5 weeks and 11 weeks of age. The ABR thresholds to tone‐burst stimuli at 4, 8, 16, and 32 kHz were obtained for each ear and statistically compared (ANOVA) for potential group differences.Results: Both mdx and mdxCv3 mice demonstrated normal ABR thresholds when compared with controls.Conclusions: Both mdx and mdxCv3 mouse models have normal hearing by ABR. The authors' data suggest that dystrophin and its carboxyl terminus isoforms do not play a critical role in hearing in the mouse. This was unexpected, as previous studies using the brainstem auditory evoked response method suggested that the mdx mouse has an increased threshold for hearing.