bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Tinnitus Resulting From Head or Neck Injuries
Authors: Folmer Robert L. , Griest Susan E. 
Published: November 2003

AbstractObjectives The main objectives were 1) to determine the percentage of cases of chronic tinnitus in a specialized clinic that resulted from head or neck injuries; 2) to describe the characteristics of this population; and 3) to compare patients with head or neck trauma with patients whose tinnitus onset was not associated with head or neck injuries.Study Design Retrospective analysis of tinnitus clinic patient data.Methods Detailed questionnaires were mailed to 2400 patients before their initial appointment at the Oregon Health and Science University Tinnitus Clinic (Portland, OR). All of the patients experienced and received treatment for chronic tinnitus. Patient data were entered into a database and later analyzed.Results Two hundred ninety‐seven patients (214 male and 83 female patients) reported that their chronic tinnitus started as a result of head or neck injuries. Compared with patients whose tinnitus onset was not associated with trauma, patients with tinnitus associated with head or neck trauma were younger; had better hearing thresholds; experienced headaches more frequently; reported greater difficulties with concentration, memory, and thinking clearly; were more likely to experience current depression, but not lifetime depression; rated their tinnitus as louder on a 1‐to‐10 scale; matched their tinnitus to louder sounds on the right side; and had higher Tinnitus Severity Index scores.Conclusions Tinnitus is a significant symptom that commonly occurs as a result of head or neck trauma. The fact that tinnitus resulting from head or neck injuries tends to be more severe (and is often accompanied by a greater number of co‐symptoms) than tinnitus resulting from other causes should be taken into account by clinicians treating these patients.
Orbital Complications in Endoscopic Sinus Surgery Using Powered Instrumentation
Authors: Graham Scott M. , Nerad Jeffrey A. 
Published: November 2003

AbstractObjectives/Hypothesis Powered dissection is increasingly used in endoscopic sinus surgery. Although it has certain clear advantages over conventional instrumentation, powered dissection also presents special liabilities. The objectives of the report are to highlight the special dangers of powered instrumentation near the orbit, to suggest techniques that might minimize these risks, and to review the management of orbital injuries.Study Design Case series.Methods A retrospective review was performed of patients who were referred to our institution with orbital injury complicating endoscopic sinus surgery in which powered instrumentation had been used. Patient demographics, status as revision or primary surgery, degree of intraoperative blood loss, indications for surgery, intraoperative findings, the complication sustained, time of recognition of the complication, immediate and delayed treatment, and clinical course were obtained from the clinical records.Results Three patients had medial rectus muscle injuries. In addition to the medial rectus injury, one patient also had blindness, probably from an orbital hemorrhage. One patient underwent orbital exploration in an unsuccessful attempt to reattach the ends of the medial rectus muscle. One patient had continuing diplopia, but declined orbital exploration or strabismus surgery.Conclusions Intraoperative orbital complications that might be of minor consequence with conventional instrumentation can have dramatic sequelae when powered dissection is used. Special care must be exercised in using powered instrumentation.
Analysis of the Relations Between the Shape of the Reconstructed Tongue and Postoperative Functions After Subtotal or Total Glossectomy
Authors: Kimata Yoshihiro , Sakuraba Minoru , Hishinuma Shigeyuki , Ebihara Satoshi , Hayashi Ryuichi , Asakage Takahiro , Nakatsuka Takashi , Harii Kiyonori 
Published: November 2003

AbstractObjectives/Hypothesis For reconstruction after subtotal or total glossectomy, both preserving the larynx and maintaining postoperative swallowing and speech functions can greatly improve quality of life; however, postoperative functional results are often unstable. Our experiences suggest that insufficient flap volume in the oral area and postoperative prolapse of the preserved larynx affect postoperative function. The objective was to investigate the relations of the shape of the reconstructed tongue to postoperative swallowing and speech functions.Study Design The shape of the reconstructed tongue was classified on the basis of magnetic resonance and intraoral inspection as protuberant, semi‐protuberant, flat, or depressed. Speech intelligibility was evaluated, and body weight, which might affect the shape of the transferred flap, was measured before and after surgery.Methods Thirty patients who had undergone subtotal or total glossectomy and subsequent reconstruction were reviewed.Results We found that speech intelligibility (P <.001), food (P <.01), and deglutition (P <.003) scores were significantly lower in patients with flat or depressed tongues than in patients with semi‐protuberant or protuberant tongues. Weight loss after surgery was significantly greater in patients with depressed tongues than in other patients (P <.013). Our results indicate that postoperative function is related to the shape of the reconstructed tongue.Conclusions We suggest that 1) wider and thicker flaps, such as rectus abdominis musculocutaneous flaps, be used; 2) flaps be designed to be approximately 30% wider than the defect; 3) laryngeal suspension be used to prevent prolapse of the transferred flap; and 4) careful general management and sufficient nutrition are important in the early postoperative period.
Palatal Reconstruction With the Palatal Island Flap
Authors: Moore Brian A. , Magdy Emad , Netterville James L. , Burkey Brian B. 
Published: November 2003

AbstractObjectives/Hypothesis The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects.Methods All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral‐based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function.Results Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow‐up ranged from 3 months to 6 years, with an average follow‐up of 18.5 months. Delayed donor site re‐epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae.Conclusion The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.
Vestibular Evoked Myogenic Potentials in Brainstem Stroke
Authors: Chen Chia‐Hung , Young Yi‐Ho 
Published: November 2003

AbstractObjectives/Hypothesis Despite its widespread application in the posterior fossa tumor, the study of vestibular evoked myogenic potential (VEMP) in cases of posterior fossa stroke remains scarce. The purpose of the study was to establish the role of VEMP in patients with brainstem stroke.Study Design Retrospective study.Methods Patients with acute vertigo were admitted and underwent a battery of auditory vestibular tests including caloric and VEMP tests; then they were surveyed by magnetic resonance imaging scan. Seven patients (two men and five women) were demonstrated as having brainstem stroke, including infarction in five patients and hemorrhage in two.Results Clinical manifestations consisted of dizziness/vertigo in all patients, spontaneous nystagmus in five (71%), and ataxia in three. No patients had experienced conscious change or conventional neurological deficits (eg, long tract signs). Electronystagmography revealed abnormal findings on eye tracking test in 100% of patients, on optokinetic nystagmus test in 71% of the patients, and on caloric testing in 10 ears (71%), including absent ice‐water caloric test response in 7 ears and canal paresis in 3 ears. Vestibular evoked myogenic potential testing displayed normal response in 3 ears and abnormal response in 11 ears (79%), including absent vestibular evoked myogenic potentials in 8 ears and delayed vestibular evoked myogenic potentials in 3 ears. When results of both caloric testing and VEMP test were combined, the abnormal rate increased to 93% (13 of 14 patients).Conclusions Caloric testing assesses the vestibulo‐ocular reflex, which passes upward through the upper brainstem, whereas VEMP testing evaluates the sacculocollic reflex, which travels downward through the lower brainstem. Hence, in evaluating the extension of brainstem stroke, both caloric and VEMP testing should be performed.
Reversible Canal Wall Down Mastoidectomy for Acquired Cholesteatomas: Preliminary Results
Authors: McElveen John T. , Chung Andy T. A. 
Published: November 2003

AbstractObjectives The educational objectives were to discuss a new technique to manage acquired cholesteatomas and to compare this with standard approaches used for cholesteatoma removal. The study objective was to determine the feasibility of using a new approach, the reversible canal wall down approach, in conjunction with bone cement to remove acquired cholesteatomas and, potentially, preserve the ossicular chain.Study Design Retrospective review of five patients who underwent resection of their acquired cholesteatomas using a technique that maximizes exposure, yet preserves the posterior canal wall and, potentially, the ossicular chain.Methods In the setting of a tertiary otological referral center, five consecutive patients with acquired cholesteatomas underwent reversible canal wall down surgery. Four patients were male (ages, 41, 53, 26, and 10 y), and one patient was a woman [age, 51 y]). A reversible canal wall down mastoidectomy approach was used in the patients. Main outcome measures were intraoperative findings with respect to cholesteatoma removal and postoperative clinical examination, including postoperative audiograms.Results Five patients had dry ears postoperatively. One patient initially had granulation tissue forming on the posterior ear canal. This eventually resolved. The patients who had a postoperative audiogram after cholesteatoma resection with ossicular chain preservation noted an improvement or stabilization in their hearing.Conclusions Using the reversible canal wall down approach in conjunction with bone cement, one is able to obtain excellent exposure of the cholesteatoma and, potentially, preserve the ossicular chain. This approach may be particularly useful in revision cholesteatoma surgery or in cases of acquired cholesteatoma in which the surgeon may be able to preserve the ossicular chain.
Nontraumatic Atlantoaxial Subluxation (Grisel Syndrome): A Rare Complication of Otolaryngological Procedures
Authors: Yu Kathy K. , White David R. , Weissler Mark C. , Pillsbury Harold C. 
Published: November 2003

AbstractObjective At the conclusion of the report, the readers should be able to recognize the rare complication of adenotonsillectomy of Grisel syndrome, discuss its pathogenesis, and provide early, effective treatment.Study Design Analysis of the clinical presentation, plain radiographs, computed tomography scans, and magnetic resonance imaging scans of a child with Grisel syndrome after adenotonsillectomy.Methods Retrospective study of the case record and a review of the literature regarding the pathogenesis, treatment modalities, outcome, and prognosis after early and delayed treatment of Grisel syndrome.Results Pathophysiology of atlantoaxial subluxation revolves around the periodontoid vascular plexus that drains the posterosuperior pharyngeal region. Infectious and inflammatory emboli cause synovial engorgement, weakening paraspinal ligaments. Radiological studies play an important role in diagnosis. Treatment consists of cervical immobilization, muscle relaxants, analgesics, and antibiotics. Full resolution is expected with early conservative management. Failure to recognize the syndrome can lead to catastrophic results.Conclusions Recognition of Grisel syndrome in addition to other rare complications of adenotonsillectomy requires a high index of suspicion. Early intervention is the critical factor for a positive outcome. However, delayed diagnosis is common and can result in catastrophic consequences, including neurological deficits, cosmetic deformity and, in rare instances, paralysis and death in the short term.
Results of Orbital Preservation for Advanced Malignant Maxillary Sinus Tumors
Authors: Nishino Hiroshi , Ichimura Keiichi , Tanaka Hidetaka , Ishikawa Kazuhiro , Abe Kouichi , Fujisawa Yoshiro , Shinozaki Takeshi 
Published: November 2003

AbstractObjective The purpose of the study was to examine the oncological and functional outcomes of multimodality therapy for patients with advanced malignant maxillary sinus tumors that invaded the orbit.Study Design Retrospective study.Methods The medical records of 26 patients with orbital invasion were retrospectively analyzed. The patient group consisted of 16 men and 10 women, with a median age of 58 years. The mean follow‐up period was 73 months. The most common disease was squamous cell carcinoma. Seven patients had nodal disease. All patients underwent simultaneous combined therapy consisting of conservative surgery through a sublabial incision, radiotherapy, and regional chemotherapy. Patients with nodal disease were treated with either irradiation or selective neck dissection.Results The 5‐ and 10‐year overall survival rates were 68% and 51%, respectively. The 5‐ and 10‐year local control rates were 66% and 51%, respectively. Overall survival rates and local control rates were significantly worse in patients with disease other than squamous cell carcinoma. Local control rates were significantly worse in patients with orbital apex disease than in patients without orbital apex disease. All 26 patients, despite orbital involvement, retained their orbital contents. Nineteen of these patients demonstrated adequate ocular function.Conclusions Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy is an effective method for local control and preservation of ocular function. However, performing orbital conservation procedure in patients with disease other than squamous cell carcinoma and with orbital apex disease must be considered carefully.
Myospherulosis Following Sinus Surgery: Pathological Curiosity or Important Clinical Entity?
Authors: Sindwani Raj , Cohen Jacob T. , Pilch Ben Z. , Metson Ralph B. 
Published: November 2003

AbstractObjectives/Hypothesis Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery.Study Design Case‐control study at an academic medical center.Methods Thirty‐two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period.Results Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P = .023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P = .009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 ± 2.1 vs. 4.5 ± 7.1 y, respectively [P = .086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis.Conclusions Patients who develop myospherulosis from lipid‐based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.
Serum Antidiuretic Hormone Levels in Patients With Unilateral Meniere's Disease
Authors: Lim Jin S. , Lange Mary E. , Megerian Cliff A. 
Published: November 2003

AbstractObjectives/Hypothesis Prior studies have indicated a possible role of antidiuretic hormone (ADH) in the pathogenesis of Meniere's disease. Animal studies have shown presence of ADH receptors in the inner ear, and chronic vasopressin administration has been shown to induce endolymphatic hydrops. Furthermore, elevation of serum ADH levels in human has been noted in patients with Meniere's disease. The goal of the study report was to analyze ADH levels in a series of patients with definite unilateral Meniere's disease to further investigate this relationship.Study Design Retrospective analysisMethods Antidiuretic hormone levels were obtained from 26 consecutive patients with a diagnosis of definite Meniere's disease as defined by the 1995 guidelines from the Committee of Hearing and Equilibrium (American Academy of Otolaryngology—Head and Neck Surgery). The ADH levels were drawn for each patient within one week of an acute episode of vertigo. These values were compared to ADH levels from 31 healthy volunteers. Statistical analysis was performed using a two‐tailed t test.Results Mean ADH level for patients with Meniere's disease was 4.07 pg/mL (SD = 2.82 pg/mL) and for the control group, 3.37 pg/mL (SD = 1.48 pg/mL). The difference in ADH levels was not statistically significant (P >.05).Conclusions Although previous reports have demonstrated a possible role of ADH in the pathogenesis of Meniere's disease, the study did not show a statistically significant elevation of ADH levels in patients with unilateral Meniere's disease. Before excluding an ADH‐inner ear pathogenic relationship, ADH levels in patients with bilateral Meniere's disease should be investigated.
Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider Caseload
Authors: Barker Fred G. , Carter Bob S. , Ojemann Robert G. , Jyung Robert W. , Poe Dennis S. , McKenna Michael J. 
Published: November 2003

AbstractObjectives/HypothesisFor many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume–outcome relationship for surgical excision of acoustic neuromas.Study DesignRetrospective cohort study.MethodsThe Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status.ResultsAt 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four‐level scale at hospital discharge: death (0.5%) and discharge to long‐term care (1.2%), to short‐term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher‐volume hospitals (OR 0.47 for fivefold‐larger caseload,P<.001) or by higher‐volume surgeons (OR 0.46,P<.001). Of patients who had surgery at lowest‐volume‐quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest‐volume‐quartile hospitals. There was a trend toward lower mortality for higher‐volume hospitals (P= .1) and surgeons (P= .06). Of patients who had surgery at lowest‐caseload‐quartile hospitals, 1.1% died, compared with 0.6% at highest‐volume‐quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high‐volume hospitals and surgeons. Length of stay was significantly shorter with high‐volume hospitals (P= .01) and surgeons (P= .009). Hospital charges were lower for high‐volume hospitals (by 6% [P= .006]) and surgeons (by 6% [P= .09]).ConclusionFor acoustic neuroma excision, higher‐volume hospitals and surgeons provided superior short‐term outcomes with shorter lengths of stay and lower charges.
Fiberoptic Endoscopic Evaluation of Swallowing
Authors: Hiss Susan G. , Postma Gregory N. 
Published: November 2003

AbstractObjectives/Hypothesis Approximately 8 million people in the United States report some degree of dysphagia annually; as the population continues to age, this will become a greater problem. A comprehensibly performed and interpreted fiberoptic endoscopic evaluation of swallowing provides invaluable information for the evaluation and management of individuals with dysphagia or aspiration, or both.Study Design Review.Methods The state‐of‐the‐art technique, interpretation, predictive value, and safety of fiberoptic endoscopic evaluation of swallowing was reviewed.
Bacteria and Granulation Tissue Associated With Montgomery T‐Tubes
Authors: Schmäl Frank , Fegeler Wolfgang , Terpe Hans Joachim , Hermann Wolfgang , Stoll Wolfgang , Becker Karsten 
Published: November 2003

AbstractObjectives Although complications (infection, development of granulation tissue) of silicone Montgomery T‐tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated.Study Design A prospective trial.Methods Twenty‐three Montgomery T‐tubes from 10 patients were analyzed with regard to the development of granulation tissue, bacterial growth (including genotyping with polymerase chain reaction), and results of sensitivity testing. Furthermore, stent sterilization (n = 6) was investigated.Results Granulation tissue occurred with 74% of the stents, and all specimens showed signs of infection but no foreign body reaction. The predominant organisms were Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%). The differences between groups with and without granulation tissue were significant for P aeruginosa. Polymerase chain reaction fingerprinting of the S aureus obtained from 15 stents (n = 3 patients) revealed a total of seven different genotypes. Whereas two of these patients harbored six different genotypes of S aureus, the third patient was persistently colonized by S aureus over a 15‐month period with the identical genotype. Susceptibility testing showed most commonly (65%) sensitivity to a combination of amoxicillin‐clavulanate and ofloxacin. After sterilization, 92% of analyzed stent segments showed no bacterial growth.Conclusions Granulation tissue commonly occurred next to the silicone (subglottic area, stoma) where S aureus and P aeruginosa were commonly isolated. A combination of mechanical irritation and bacterial infection seems to account for the development of granulation tissue. Polymerase chain reaction fingerprinting showed both prolonged persistence and a change of colonizing strains after multiple stent replacements. A combination of amoxicillin‐clavulanate and ofloxacin is the most effective antibiotic therapy. Sterilization of the cost‐intensive silicone stents is feasible, and reuse in the same patient is justifiable from economic aspects.