bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real‐Time, Cine Magnetic Resonance Imaging for Evaluation of the Pediatric Airway
Authors: Faust Russell A. , Remley Kent B. , Rimell Frank L. 
Published: November 2003

AbstractBackground Standard magnetic resonance imaging (MRI) and computed tomographic (CT) modalities are limited in their ability to image dynamic organs. New real‐time, dynamic, cine magnetic resonance imaging (CMRI) techniques have the potential to image moving structures.Objective We therefore investigated the feasibility of using CMRI techniques to dynamically image the human airway, to assess laryngeal and tracheal patency and function.Methods A cohort of 10 pediatric patients, 10 adult patients, and 10 normal volunteers underwent routine static MRI, as well as CMRI using a Siemens 1.5 T Vision system (Siemens, Erlangen, Germany). Patients also underwent endoscopic evaluation. Cine axial, coronal, and sagittal sequences of the larynx and trachea were obtained during quiet respiration, as well as during a variety of provocative maneuvers.Results CMRI readily demonstrated normal vocal cord mobility and tracheal stability in normal volunteers. Abnormal vocal mobility was easily appreciated using the CMRI imaging system. Similarly, dynamic effects of tracheomalacia were clearly demonstrated using CMRI. Dynamic extrinsic tracheal compression resulting from mass lesions or anomalous vasculature was also visualized using CMRI.Conclusions Cine MRI of the airway has the potential to provide novel data regarding laryngeal and tracheal patency and function. This evolving modality may serve as a valuable adjunct to static MR and CT imaging, as well as endoscopy, in the assessment of the airway.
The Sternocleidomastoid Flap—Its Indications and Limitations
Authors: Kierner A. C. , Zelenka I. , Gstoettner W. 
Published: November 2003

AbstractHypothesis The sternocleidomastoid (SCM) flap seems to be a practicable but underestimated flap for reconstructive and plastic surgery of the head and neck.Objectives To determine in which situations the SCM flap may represent a reliable alternative to other flaps used in head and neck surgery.Study Design Meta‐analysis of the complete literature on the SCM flap.Setting All literature found dealing with the SCM flap was reviewed, with special emphasis placed on the indications and success rates reported. The data presented are compared with our own morphologic findings and their putative clinical implications.Results Four types of SCM flap have been described: the muscle flap, the myocutaneous flap, the myoperiosteal flap, and the myosseus or osteomuscular flap. The SCM flap was either superiorly or inferiorly based. The SCM muscle flap was used in a total of 72 patients with only 1 major complication and 7 minor complications. The complication rate, therefore, is 11%. The applications of the muscle flap involved prevention of Frey's syndrome, closure of orocutaneous fistulae and soft tissue deficiencies, closure of pharyngocutaneous and cervical esophageal fistulae, and reconstruction of the tongue. Furthermore, Conley reported on the use of the SCM muscle flap in a group of 30 patients to reanimate the face, reconstruct oral cavity defects, protect the carotid and innominate artery, and even to aid shoulder elevation after poliomyelitis. The SCM myocutaneous flap seems to be the most common application, with a total of 138 patients. All in all, a total of 29 complications (21%) was reported, with partial skin necrosis by far the most frequent. Total failure of the flap has been described in 10 patients (7%). The SCM myocutaneous flap was used for closure of defects of the mouth as well as oro‐, pharyngo‐, and tracheocutaneous fistulae, facial reconstruction, reconstruction of mastoid defects, and reconstruction of the laryngotracheal complex in children. The SCM myosseus or osteomuscular flap was reported in 23 patients. Flap necrosis is reported in 1 case (4%). The SCM osteomuscular flap was used to reconstruct defects of the lower jaw in all patients. The SCM myoperiosteal flap was used in a total of 49 patients. The complication rate reported is 6% (3 cases). The myoperiosteal flap was used for reconstruction of the laryngotracheal complex in adults and for esophagopharyngeal reconstruction and fistula repair.Conclusions The data presented in previous literature is well correlated with our own morphologic findings. In comparison of the different techniques applied with the assumptions drawn on the basis of our own anatomic findings, it becomes evident that the SCM flap is only a useful tool in limited indications and under certain precautions.
Clinical Study of Botulinum‐A Toxin in the Treatment of Sialorrhea in Children With Cerebral Palsy
Authors: Suskind Dana L. , Tilton Ann 
Published: November 2003

AbstractObjective To assess the safety and efficacy of intraglandular (parotid and submandibular) botulinum‐A toxin (BTX‐A) in the treatment of sialorrhea in children with cerebral palsy (CP).Study Design Prospective, open‐label, dose‐escalation study.Setting Tertiary care Children's Hospital.Patients Twenty‐two subjects between 8 and 21 years of age with CP and significant sialorrhea.Intervention/Technique The first 12 subjects were injected in only the submandibular gland and the second 10 in the submandibular and parotid glands. Injections were performed under ultrasound localization. The first group (divided into 3) received a total of 10, 20, or 30 units of BTX‐A. The second group (divided into 3) received a standard of 30 units in the submandibular gland and 20, 30, or 40 units in the parotid glands.Main Outcome Measure(s) Drool quantification using a pre‐ and postinjection “drool rating scale,” dental roll weights, and “drool quotient.” Swallowing was evaluated pre‐ and postinjection with a formal speech therapy evaluation.Results All subjects successfully underwent BTX‐A injections without local or systemic complications. There were no adverse effects on swallowing. Objective “drool quantification” with dental rolls was extremely difficult in this population. Most indicative of results was the “drool rating” questionnaire and the “drool quotient.”Conclusions BTX‐A is a potentially safe and promising, minimally invasive treatment for sialorrhea in children with cerebral palsy.
Efficacy of Single‐Dose Dexamethasone as Adjuvant Therapy for Acute Pharyngitis
Authors: Wei Julie L. , Kasperbauer Jan L. , Weaver Amy L. , Boggust Andrew J. 
Published: November 2003

AbstractHypothesis Pharyngeal inflammatory pain is reduced by a single dose of dexamethasone.Study Design Prospective, randomized, double‐blinded, placebo‐controlled study.Methods From August 1998 to July 2000, a total of 118 patients were enrolled. We compared placebo (n = 37), a 10‐mg single dose of intramuscular injection of dexamethasone (n = 39), and a 10‐mg single dose of oral dexamethasone (n = 42). All patients were given oral antibiotics and had bacterial throat cultures.Results Complete telephone follow‐up 12 hours after treatment was available in 111 patients, and 24‐hour follow‐up data were available in 116. The change in pain visual analogue scale scores (pretreatment score minus 12‐h follow‐up score) reported by patients who were given either intramuscular (median score, 4; mean score ± SD, 4.2 ± 2.3) or oral dexamethasone (median score, 3; mean score ± SD, 3.8 ± 2.3) was significantly greater than that of the patients who were given placebo (median score, 2; mean score ± SD, 2.1 ± 2.0) (P <.001 and P = .002, respectively). This difference in improvement was also evident when the percentage of change was compared in the three treatment arms at 12‐hour and 24‐hour follow‐up. Patients who were given dexamethasone had the onset of pain relief a median of 4 hours earlier than those who were given oral and intramuscular placebo (P = .029). Statistically significant differences among the three treatment arms were confirmed when a bacterial pathogen was identified (n = 47) but not in a subset that did not have a pathogen identified.Conclusions Single‐dose dexamethasone appears to be a safe, effective, and inexpensive adjunctive treatment for acute pharyngitis in patients 15 years of age and older. Patients treated with intramuscular or oral dexamethasone had significant relief of pain (relative to baseline) compared with patients who were given placebo. Identification of a bacterial pathogen had a significant impact on the response to dexamethasone.
Recovery After Tonsillectomy in Adults: A Three‐Week Follow‐up Study
Authors: Salonen Aarre , Kokki Hannu , Nuutinen Juhani 
Published: November 2003

AbstractObjective To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge.Study Design A prospective, longitudinal study of 102 patients undergoing tonsillectomy.Methods All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3‐mg/kg continuous infusion over 24 hours, and oxy‐codone for rescue analgesia. Twenty‐five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol–codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities.Results No pre‐emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3–24 days) and the median of analgesic treatment was 12 days (range, 5–25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2–24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred.Conclusions The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol–codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.
Advantages of Recurrent Laryngeal Nerve Identification in Thyroidectomy and Parathyroidectomy and the Importance of Preoperative and Postoperative Laryngoscopic Examination in More Than 1000 Nerves at Risk
Authors: Steurer Martin , Passler Christian , Denk Doris M. , Schneider Berit , Niederle Bruno , Bigenzahn Wolfgang 
Published: November 2003

AbstractObjectives/Hypothesis Recurrent laryngeal nerve palsy (RLNP) is a major obstacle in thyroid and parathyroid surgery. Therefore, methods that reduce the number of temporary and, especially, permanent recurrent laryngeal nerve palsies are of great interest. One promising way to ensure the integrity of the recurrent laryngeal nerve (RLN) is to identify the nerve always. The first question raised in the present study was whether RLN preparation reduces the number of recurrent laryngeal nerve palsies or whether it introduces additional risks. Second, from former cases we know that the absence of postoperative hoarseness does not exclude RLNP, nor does postoperative hoarseness exclusively imply RLNP. Besides, misdiagnosis is not uncommon. Therefore, preoperative and postoperative laryngoscopic examination was given attention.Study Design Patients were investigated 1 to 7 days before and 3 to 7 days after surgery. When an RLNP was identified, patients were followed up in a 2‐week rhythm the first few times and every 6 to 8 weeks thereafter until RLNP resolved or it was considered premanent after 2 years.Methods We prospectively investigated 608 surgical patients with 1080 nerves at risk. Because different diseases might have different rates of postoperative RLNP, we analyzed benign thyroid disease (680 nerves at risk), thyroid malignoma (321 nerves at risk), and hyperparathyroidism (79 nerves at risk) separately. Patients undergoing primary surgery (no prior thyroid surgery) and secondary interventions (there were one or more thyroid operations before this intervention) were evaluated separately.Results We found 3.4%, 7.2%, and 2.5% of temporary recurrent laryngeal nerve palsies per nerve in the benign thyroid disease, thyroid malignoma, and hyperparathyroidism groups, respectively. The prevalence of recurrent laryngeal nerve palsies in these groups was 0.3%, 1.2%, and 0%, respectively. Conforming with other studies, the total number of recurrent laryngeal nerve palsies (temporary and permanent) was not increased compared with cases with no RLN preparation, whereas the number of permanent recurrent laryngeal nerve palsies was markedly reduced. An RLN was always identifiable. Astonishingly, the restitution of an RLNP was up to 2 years in duration; however, most restitutions occurred within the first 6 months. Thirty cases of hoarseness appeared or were intensified after surgery and were not caused by RLNP. Eleven cases of postoperative RLNP had no detectable hoarseness.Conclusions Besides indirect laryngoscopy, videostroboscopy should be performed in all cases with no evident bilateral normal laryngeal function or normal voice. Otherwise, the incidence of false‐positive or false‐negative diagnosis of RLNP is likely to be increased.
Inverting Papilloma of the Temporal Bone
Authors: Pou Anna M. , Vrabec Jeffrey T. 
Published: November 2003

AbstractObjectives Inverting papilloma of the temporal bone is exceedingly rare. The objective is to familiarize the clinician with the clinical presentation and prognosis of this entity.Study Design Retrospective case study and literature review.Methods Published reports of inverting papillomas originating in the temporal bone were reviewed in conjunction with two cases presenting at the University of Texas Medical Branch (Galveston, TX).Results Inverting papillomas of the temporal bone are frequently associated with persistent middle ear effusion and ipsilateral sinonasal tumors and display a higher incidence of malignancy.Conclusions Successful management of these tumors requires an aggressive surgical resection. Adjuvant radiation therapy is recommended in patients with malignant changes.
Risk Factors and Demographics in Patients With Spasmodic Dysphonia
Authors: Schweinfurth John M. , Billante Mark , Courey Mark S. 
Published: November 2003

AbstractObjectives Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia.Study Design Retrospective patient survey of 168 patients with a known diagnosis of spasmodic dysphonia who completed questionnaires at the time of interval botulinum toxin injection.Methods Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first‐degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of χ2 values.Results In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty‐five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P = .0001). Thirty percent of patients directly associated onset of spasmodic dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic dysphonia. Twenty‐six percent of patients had an essential tremor compared with 4% of first‐degree relatives (P = .0001), and 11% had associated writer's cramp compared with 2% of relatives (P = .02). Less than 1% of patients described a history of toxic exposure or electrical injury.Conclusions The majority of patients with spasmodic dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic dysphonia. Patients with spasmodic dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.
Successful Cochlear Implantation in Prelingual Profound Deafness Resulting From the Common 233delC Mutation of the GJB2 Gene in the Japanese
Authors: Matsushiro Naoki , Doi Katsumi , Fuse Yuka , Nagai Kenichi , Yamamoto Koichi , Iwaki Takako , Kawashima Takayuki , Sawada Ayako , Hibino Hiroshi , Kubo Takeshi 
Published: November 2003

AbstractObjectives Recently, we identified three novel mutations of the GJB2 gene in Japanese families with autosomal‐recessive non‐syndromic deafness. 1 Seven of 11 mutated chromosomes (63.6%) contained a 233delC allele, suggesting that the 233delC mutation is the most common mutation of the GJB2 gene in the Japanese population. After it was recognized that cochlear implantation (CI) is of benefit to children with prelingual deafness, we have had a number of prelingual pediatric CI patients. Because children carrying the homozygous 233delC mutation show bilateral prelingual profound deafness, they could be enrolled in the CI program at Osaka University Graduate School of Medicine. The purposes of this study were 1) to analyze the occurrence of the GJB2 mutations in our 15 prelingual pediatric CI patients in whom the cause of non‐syndromic deafness was unknown, and 2) to evaluate the auditory function and postoperative speech perception with CI of those GJB2‐related deaf subjects.Study Design Retrospective analysis.Methods Mutation analysis of the GJB2 gene by direct sequencing was performed with genomic DNA from 15 children born profoundly deaf as a result of unknown causes and implanted with CI. Intraoperative electrically evoked auditory brainstem response (EABR) and intra‐/postoperative EAP were measured. The speech perception was evaluated with Infants and Toddlers Meaningful Auditory Integration Scale (IT‐MAIS).Results and Conclusions We identified 4 CI patients (26.7%) out of 15 children carrying the homozygous 233delC mutation. Intra‐ and postoperative evaluation of the auditory system revealed almost intact cochlear and retrocochlear auditory function in these 4 patients. Postoperative auditory testing indicates that their speech perception had become significantly higher in comparison with that of other prelingual CI patients. These results suggest that prelingual deaf children carrying the homozygous 233delC mutation of the GJB2 gene can benefit from CI.
Relationship Between Mastoid Pneumatization and Middle Ear Barotrauma in Divers
Authors: Uzun Cem , Adali Mustafa K. , Koten Muhsin , Yagiz Recep , Aydin Salih , Cakir Bilge , Karasalihoglu Ahmet R. 
Published: November 2003

AbstractObjectives/Hypothesis Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (s elf‐c ontained u nderwater b reathing a pparatus) divers.Study Design Prospective, blinded.Material and Methods Twenty‐four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x‐ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization.Results ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2.Conclusion Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.
Impact of Functional Endoscopic Sinus Surgery on Symptoms and Quality of Life in Chronic Rhinosinusitis
Authors: Damm Michael , Quante Gero , Jungehuelsing Markus , Stennert Eberhard 
Published: November 2003

AbstractObjectives Chronic rhinosinusitis restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery modifies patients symptom profiles and quality of life.Study Design Open prospective clinical trial.Methods Questionnaires were given to 279 patients included in the series, who underwent sinus surgery at the Department of Otorhinolaryngology—Head and Neck Surgery, University of Cologne (Cologne, Germany) from 1995 to 1999. Patients assessed typical chronic rhinosinusitis–associated symptoms and restricted quality of life preoperatively and postoperatively using ranking scales (scales ranging from no to intolerable complaints). Statistical analyses were performed with the Wilcoxon test and Spearman rank correlation coefficient.Results Quality of life was restricted by chronic rhinosinusitis in 94% of all patients preoperatively and ranked as severe or intolerable in 74%. Leading symptoms of chronic rhinosinusitis were nasal obstruction in 92% and postnasal drip in 87%. Furthermore, patients reported dry upper respiratory tract syndrome in 68%, hyposmia in 66%, headache in 64%, and asthmatic complaints in 34%. After a mean postoperative follow‐up of 31.7 months, an amelioration of quality of life was achieved in 85%, no change in 12%, and a deterioration in 3%. The ranking of restricted quality of life improved from “severe” to “mild” (P <.01) in the mean. Mainly responsible for this improvement was the postoperative decrease of nasal obstruction (84%), headache (82%), and postnasal drip (78%) (all P <.01), which correlated significantly with nasal obstruction (r = 0.59), headache (r = 0.39), and postnasal drip (r = 0.55), respectively (all P <.01) with better quality of life.Conclusions The leading complaints within the symptom profile of patients with chronic rhinosinusitis are airway obstruction and postnasal drip. The restriction of quality of life in patients with chronic rhinosinusitis is mainly caused by these symptoms, which can be improved in excellent fashion by functional endoscopic sinus surgery in the majority of patients, achieving better quality of life in the long term.