bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stomal Recurrence after Total Laryngectomy for Squamous Cell Carcinoma of the Larynx
Authors: Imauchi Yutaka , Ito Ken , Takasago Esao , Nibu Ken‐Ichi , Sugasawa Masashi , Ichimura Keiichi 
Published: February 2003

OBJECTIVEStomal recurrence after total laryngectomy is one of the most serious issues in the management of laryngeal carcinoma. The management of stomal recurrence, including chemotherapy, radiotherapy, and surgery, has been reported as unsatisfactory.STUDY DESIGN AND SETTINGFrom 1985 to 1995, 69 patients underwent total laryngectomy for the treatment of laryngeal cancer at the University of Tokyo Hospital. To identify the risk factors for stomal recurrence, we analyzed these patients according to various clinicopathological factors.RESULTSStomal recurrence developed in 6 of 69 patients who underwent total laryngectomy for laryngeal carcinoma. Statistical analysis reveals that primary site, preoperative tracheotomy, and paratracheal lymph node metastasis are significant risk factors for stomal recurrence.CONCLUSIONIntensive follow‐up should be performed for patients with glottic carcinoma who had preoperative tracheotomy, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.
The Learning Curve Revisited: Stapedotomy
Authors: Sargent Eric W. 
Published: February 2003

OBJECTIVETo determine whether the outcome of stapedotomy changes with experience.STUDY DESIGN AND SETTINGRetrospective case review of an academic otologic practice of a fellowship‐trained otologist that consisted of 50 consecutive patients who underwent primary stapedotomy. The main outcome measures were preoperative and postoperative audiograms for both the operated ear and the opposite ear (control).RESULTSThere were no major complications or loss of hearing among the 50 patients. Minor complications included 1 middle ear infection, 2 torn flaps, and 1 tympanic membrane perforation. One patient had worse conductive hearing loss after surgery. The hearing of 2 patients was unchanged. Hearing for the entire group improved (P > 0.001) from a speech reception threshold of 55 dB (SD, 17 dB) to 30 dB (SD, 19 dB). Complete closure of the air‐bone gap was achieved in 20% of the first 10 patients and 30% of the last 10 patients.CONCLUSIONSThe results of stapedotomy improve with experience, although the learning curve seems less steep than has been reported for total or near‐total footplate removal.SIGNIFICANCEStapedotomy can be successfully performed early in surgical experience, but the learning curve should be acknowledged and discussed with the patient.
Objective and Early Diagnosis of Chylous Fistula in the Postoperative Period
Authors: Erisen Levent , Coskun Hakan , Basut Oguz 
Published: February 2003

OBJECTIVEThe study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period.STUDY DESIGN AND SETTINGWe prospectively evaluated 103 consecutive neck dissections during a 2‐year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF.RESULTSA statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001).CONCLUSIONSSerum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.
Facial Nerve Monitoring in Chronic Ear Surgery: Us Practice Patterns
Authors: Greenberg Jayson S. , Manolidis Spiros , Michael G. Stewart , Kahn Jeffrey B. 
Published: February 2003

OBJECTIVEThe use of intraoperative facial nerve monitoring (IOFNM) improves facial nerve outcomes in acoustic neuroma surgery, but the role of IOFNM in chronic ear surgery (CES) is poorly defined. This study was performed to identify IOFNM practice patterns in the United States for CES.METHODSA 10‐item survey was mailed to a random sample of 500 active members of the American Academy of Otolaryngology‐Head and Neck Surgery.RESULTSThe overall response rate was 45.2%. Of the respondents, 75% had access to IOFNM, and of this group, 66% used IOFNM at least some of the time. Otolaryngologists trained in the 1990s (P < 0.0001), those in an academic setting (P = 0.02), and those who perform more otologic than other types of surgery (P = 0.004) were more likely to use IOFNM. Although most respondents had access to IOFNM, only 32% thought that IOFNM should be required for CES.CONCLUSIONSThe majority of otolaryngologists who perform CES have access to IOFNM and will use it at least some of the time. IOFNM use is especially prevalent in otolaryngologists who have trained recently and in more experienced otologic surgeons. However, there are strong feelings against requiring IOFNM for CES.
Tympanosclerosis: Long‐Term Hearing Results after Ossicular Reconstruction
Authors: Teufert Karen Borne , De La Cruz Antonio 
Published: February 2003

OBJECTIVEThe study goal was to analyze long‐term hearing results and factors likely to affect outcome after ossicular reconstruction in patients with tympanosclerosis, particularly tympanosclerotic stapes fixation.METHODSWe conducted a retrospective chart review of the past 10 years. The short‐ and long‐term (up to 9 1/2 years) hearing results of first‐stage and second‐stage operations for middle ear tympanosclerosis in 203 consecutive patients, performed in a tertiary referral otologic private practice, are presented. There were 160 tympanoplasties and 43 tympanoplasties with mastoidectomy performed, with ossicular fixation secondary to tympanosclerosis in 135 cases. Of these 203, 42.9% were primary cases, with the majority being planned second‐stage or revision procedures.RESULTSThe average preoperative air‐bone gap (ABG) was 30.9 dB. The average short‐term postoperative ABG was 17.4 dB with closure of the ABG within 20 dB in 64.6%. The success rate (ABG ≤ 20 dB) for patients with ossicular fixation was 65.3%. Partial sensorineural hearing loss occurred in 1.0% of the patients, and none experienced profound sensorineural hearing loss (dead ears). There was no statistically significant change from short‐term to long‐term follow‐up in either ABG or air PTA, with mean differences of only 0.3 and 2.0 dB, respectively. The mean time to the last follow‐up was 1.6 years.CONCLUSIONOssicular reconstruction in individuals with tympanosclerosis can yield satisfactory, lasting hearing results with a low incidence of complications and no dead ears.
Sympathetic Cochleolabyrinthitis in Revision Stapedectomy Surgery
Authors: Richards Michele L. , Moorhead Jacquelyn E. , Antonelli Patrick J. 
Published: February 2003

OBJECTIVEThe purpose of this study was to determine whether revision stapedectomy could precipitate sensorineural hearing loss in the contralateral ear.METHODSWe conducted a retrospective review of 148 patients undergoing primary or revision stapedectomy at an academic, tertiary care facility.RESULTSStapedectomy resulted in significant improvements in mean air conduction thresholds in the ipsilateral ear. Overall, there were no significant changes in either the air or bone conduction values of the contralateral ear. Two patients demonstrated a >20‐dB decline in speech reception threshold and/or >20% decrease word recognition in the contralateral ear. Both of these patients demonstrated the decline only after revision surgery.CONCLUSIONRevision stapedectomy is on rare occasions associated with hearing loss in the contralateral ear. Contralateral hearing loss after revision stapedectomy may be due to sympathetic cochleolabyrinthitis.
Tracheal Bronchus: Classification, Endoscopic Analysis, and Airway Management
Authors: Doolittle Andrew M. , Mair Eric A. 
Published: February 2003

OBJECTIVETracheal bronchus (bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum.STUDY DESIGN/METHODSRetrospective case series.RESULTSThe tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12‐year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right‐sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy.CONCLUSIONSOtolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options.Tracheal bronchus is a congenital anomaly in which a right upper lobe bronchus has its origin in the trachea rather than at the carina. Bronchus suis, or “pig bronchus,” is an alternate name that is used because a tracheal bronchus is normal in swine and other ruminant animals. In approximately 1000 pediatric bronchoscopy procedures performed by the senior author during a 12‐year period, only 5 children (approximately 0.5%) were identified with a tracheal bronchus. We present 3 representative cases to highlight salient features of each variant of the tracheal bronchus. A newly described “tracheal diverticulum” variant is presented. Tracheal bronchus classification based on endoscopic analysis assists with airway management for this uncommon anomaly.
Continuous Gentamicin Therapy Using an IntraEAR Microcatheter for Meniere's Disease: A Retrospective Study
Authors: Seidman Michael 
Published: February 2003

OBJECTIVESThe study goals were to evaluate the safety and effectiveness of continuous gentamicin therapy (CGT) in the treatment of Meniere's disease and to evaluate the effect of flow rate.STUDY DESIGNIn a retrospective study, physicians who were known to have used CGT in the treatment of Meniere's disease were asked to report patient information on a standardized data collection form.RESULTSIn patients treated with low‐flow CGT, vertigo was eliminated or substantially controlled in 90%, tinnitus was improved in 69%, pressure was improved in 77%, hearing was worse in 23%, and vestibular function was ablated in only 14% of patients.CONCLUSIONOn the basis of an average 10‐month follow‐up period, of the methods currently available to treat Meniere's patients with gentamicin, low‐flow CGT seems to provide an excellent combination of vertigo control and tinnitus and pressure improvement, with a relatively low risk to hearing and vestibular function.SIGNIFICANCEThe clinical use of low‐flow CGT appears to be justified based on these data.
Congenital cholesteatoma: 20 years' experience at The Children's Hospital of Philadelphia
Authors: Potsic William P. , Korman S. Bruce , Samadi Daniel S. , Wetmore Ralph F. 
Published: February 2003

OBJECTIVEWe report our experience with congenital cholesteatoma over a span of 20 years with an emphasis on presenting characteristics and predictors of outcome.METHODSWe conducted a retrospective review from 1981 through 2000.RESULTSOne hundred seventy‐two congenital cases were identified in 167 patients. Five patients had bilateral disease. The majority (72%) were found in boys, with an average age of 5.0 years. Hearing loss was slight to moderate. When confined to 1 quadrant, cholesteatoma was anterosuperior in 82% of cases; 47% had cholesteatoma in 2 or more quadrants. Ossicular chain involvement was found in 43% of all cases, and mastoid extension was evident in 23%. The rate of recurrent disease was directly related to the extent and number of quadrants involved.CONCLUSIONTo our knowledge, this is the largest series of congenital cholesteatomas to be reported. This review confirms the male predominance and predilection for the anterosuperior quadrant. The extent of cholesteatoma and its relation to residual disease should be used as a guide for planning a second‐look procedure.
Surgery for pediatric vocal cord paralysis: A meta‐analysis
Authors: Brigger Matthew T. , Hartnick Christopher J. 
Published: February 2003

OBJECTIVEThe study goal was to determine the impact of various surgical procedures for bilateral vocal cord paralysis in children by using established principles of meta‐analysis.STUDY DESIGN AND SETTINGWe conducted a retrospective review of the literature in which a predetermined protocol was used to identify articles for meta‐analysis. Six articles met inclusion criteria, and pertinent data were extracted.RESULTSPooled data analysis demonstrated primary procedure‐specific decannulation rates for external arytenoidopexy for 19 of 24 (79%), external arytenoidectomy for 14 of 19 (74%), CO2 laser arytenoidectomy for 4 of 10 (40%), and costal cartilage graft procedures for 2 of 2 (100%). External arytenoid procedures are more efficacious than CO2 laser procedures in terms of primary decannulation (P = 0.02).CONCLUSIONMeta‐analysis of the existing literature reveals that external arytenoidopexy and external arytenoidectomy are equivalently effective procedures and that the two combined are significantly more effective than CO2 ablative procedures.SIGNIFICANCEExternal procedures appear to be more effective as a first‐line treatment in pediatric vocal cord paralysis, with arytenoidopexy with or without partial arytenoidectomy offering an attractive first‐line surgical option.
Same‐stage nasal and palatopharyngeal surgery for obstructive sleep apnea: Is it safe?
Authors: Busaba Nicolas Y. 
Published: February 2003

OBJECTIVEThe study goal was to determine the safety of performing same‐stage nasal and palatopharyngeal surgery for the treatment of obstructive sleep apnea syndrome (OSAS).STUDY DESIGN AND SETTINGWe conducted a retrospective review of 91 consecutive patients who underwent surgery for OSAS at tertiary care facilities. METHODS: Patients were divided into 2 groups: group 1 had same‐stage nasal and palatopharyngeal surgery (n = 63), whereas group 2 had palatopharyngeal surgery at a stage separate from the nasal surgery (n = 28). Patient demographics, severity of OSAS, type of surgery, perioperative care, and postoperative complications were reviewed.RESULTSThere were 55 men and 8 women in group 1, with an average age of 48 years. Group 2 consisted of 20 men and 8 women, with an average age of 45 years. The mean respiratory disturbance index was 36.5 and 33.5 for group 1 and 2, respectively. The mean lowest arterial Oxygen saturation for group 1 was 82%, whereas that of group 2 was 81%. Patients in both groups were observed in a hospital setting for a minimum of 1 day. They were admitted to a room close to the nurse's station, with continuous pulse oximeter monitoring. There were 3 complications reported for group 1: pneumonia (1 patient, postoperative day 4), tonsil bleed (1 patient, postoperative day 6), and septal hematoma (1 patient). One patient in group 2 had a tonsil bleed (postoperative day 8). There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period.CONCLUSIONSame‐stage nasal and palatopharyngeal surgery for OSAS is safe. Patients could be monitored with continuous pulse oximetry and managed outside of an intensive care unit setting in the immediate postoperative period.
Tumor necrosis factor‐α and interleukin‐1 β levels in recurrent and persistent otitis media with effusion
Authors: Yetiser Sertac , Satar Bulent , Gumusgun Atilla , Unal Faruk , Ozkaptan Yalcin 
Published: February 2003

OBJECTIVEBased on interleukin (IL)‐1β and tumor necrosis factor (TNF)‐α levels in effusions, our goals were to specify either recurrent or persistent otitis media with effusion (OME) is a mid stage in the development of chronic disease and to identify the factors that have an influence on cytokine levels.STUDY DESIGNSamples from groups with recurrent (n = 15) and persistent (n = 39) OME were essayed for IL‐1 β and TNF‐α. Children were also grouped with respect to age, sex, quality of effusion, and the presence of pharyngeal adenoid tissue.SETTINGTertiary referral center.RESULTSIn recurrent and persistent OME groups, IL‐1β was higher than TNF‐α (P < 0.01). IL‐β was higher in recurrent OME than in persistent OME (P < 0.05).CONCLUSIONRecurrent OME seems to be closer to the chronic stage of the disease relative to persistent OME in terms of higher IL‐1 β levels. Each exacerbation of acute disease in recurrent otitis media is likely to be mediated by IL‐1 β.SIGNIFICANCEWe were able to clarify that recurrent OME is a stage that occurs before chronic OME. Therefore, the prevention of acute attacks in recurrent disease would also impede long‐term damage to the middle ear.
Mitomycin C for the Prevention of Adhesion Formation after Endoscopic Sinus Surgery: A Randomized, Controlled Study
Authors: Chung Jeannie H. , Cosenza Mathew J. , Rahbar Reza , Metson Ralph B. 
Published: February 2003

OBJECTIVEMitomycin C (MMC) is an antineoplastic agent that has been shown to decrease scar tissue after ophthalmologic surgery. Our goal was to determine whether the application of MMC at the conclusion of sinus surgery decreases the incidence of postoperative adhesion formation.METHODSAt the completion of endoscopic sinus surgery in 55 patients, a cotton pledget saturated with 1 mL of 0.4 mg/mL MMC was placed for 4 minutes in the right or left middle meatus and a similar saline‐soaked pledget was placed on the opposite side. Patients were examined postoperatively by a masked observer for the presence of synechiae and mucosal changes.RESULTSPostoperative adhesions were observed in 16 patients (29%) with a mean follow‐up of 4.1 months. These adhesions were bilateral in 6 patients (10.9%) and unilateral in 10 patients (18%). Unilateral adhesions were observed on only 2 sides (3.6%) treated with MMC and 8 controls (14.5%) (P = 0.058). No adverse effects were observed.CONCLUSIONSMMC was found to be safe to use during sinus surgery, and it may reduce the incidence of postoperative adhesions at the dosage used in this study.SIGNIFICANCEBecause of the observed trend toward decreased synechiae formation with MMC application, further trials using higher concentrations and application times are warranted.
Botulinum Toxin Type B (MyoBloc) in the Management of Hyperkinetic Facial Lines
Authors: Ramirez Alexander L. , Reeck Jay , Maas Corey S. 
Published: February 2003

OBJECTIVEOur goal was to evaluate the safety and efficacy of botulinum toxin type B (BTX‐B) in the management of hyperfunctional facial lines.STUDY DESIGN AND SETTINGTwenty‐four patients from an academic faculty practice were treated with 400 to 800 units BTX‐B in the corrugator, orbicularis oculi, or frontalis. Patients were evaluated with the Wrinkle Improvement Score (WIS) and Rated Numeric Kinetic Line Scale (RNKLS) and questioned about side effects and pain. Evaluations were made at 1, 2, 4, 8, and 12 weeks.RESULTSOnset of effect was within 72 hours. WIS and RNKLS for all sites were statistically better after treatment, with the effect lasting 8 weeks. In general, patients noted a moderate improvement (grade 2) on WIS and a 2‐point improvement on RNKLS. Injection was more painful than that of BTX‐A. There were no complications.CONCLUSIONBTX‐B is a safe and effective technique to eliminate wrinkles. Further studies are needed to elucidate dosage and duration.SIGNIFICANCEBTX‐B is stable for prolonged periods of time, requires no preparation before use, and is antigenetically distinct from BTX‐A.
One‐Year Low‐Dose Erythromycin Treatment of Persistent Chronic Sinusitis after Sinus Surgery: Clinical Outcome and Effects on Mucociliary Parameters and Nasal Nitric Oxide
Authors: Cervin Anders , Kalm Olof , Sandkull Per , Lindberg Sven 
Published: February 2003

OBJECTIVEIn 17 patients with chronic sinusitis persistent after sinus surgery, long‐term, low‐dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time).STUDY DESIGN AND SETTINGWe conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment.RESULTSOf 17 patients, 12 responded to treatment. The 12‐month follow‐up showed an improvement in saccharine transit time (P< 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P= 0.12). Endoscopic nasal examination scoring improved significantly (P< 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P< 0.01). Improvements were also seen in headache (P< 0.05).CONCLUSIONThe present study suggests that long‐term, low‐dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment.SIGNIFICANCELong‐term, low‐dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo‐controlled studies are needed to validate the potential of this treatment.
World Wide Web‐Based Temporal Bone Anatomic Sections
Authors: Kavanagh Kevin T. 
Published: February 2003

The study goal was to post a complete set of temporal bone anatomy slides on the World Wide Web for anatomic study. Magnification of the width of the sections varied from 2.4 to 33.6 inches. Good representation of gross and tissue anatomy was obtained, but cellular detail was lacking. The website used approximately 37 megs of disk space. The resultant website provides a cost‐effective method of presenting large color photographs of temporal bone anatomy. Thumbnails allow comparison between sections, which aids in learning 3‐dimensional anatomy. A method for measuring distance on digitized images is also described. The sections may be viewed at www.ear‐anatomy.com, and continuing medical education credits may be earned at www.cme‐usa.org.