bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood pseudohypacusis in patients with high risk for actual hearing loss
Authors: Radkowski Diana , Cleveland Sandra , Friedman Ellen M. 
Published: November 2003

AbstractObjective:While pseudohypacusis or nonorganic hearing loss is a well‐recognized phenomenon in adults, it is the aim of this report to heighten the physician' awareness of the occurrence of nonorganic hearing loss in pediatric patients. The medical and otologic histories of 18 cases identified consecutively between 1983 and 1991 at The Children' Hospital, Boston, Massachusetts, were retrospectively reviewed. In these selected cases an analysis of the audiometric configuration, age range, and sex distribution is undertaken. This review highlights the need to rule out pseudohypacusis even in pediatric cases where suspicion is low. A precedent trauma was the presenting complaint in a high percentage of our patient population. This association has not been previously reported in the pediatric literature. While the severity of the traumatic incident was often minor, extensive medical and surgical investigations had been considered before the identification of nonorganic hearing loss.Study Design:A retrospective chart analysis of patients identified with pseudohypacusis over a 7‐year period. Methods: A tertiary care children' hospital in an urban community. Eighteen consecutively identified patients examined by a staff audiologists at a tertiary care children' hospital. A specific battery of standard audiologic testing with the goal of detecting pseudohypacusis in children.Results:Successful if additional interventions such as exploratory tympanotomy were avoided.Conclusions:Pseudohypacusis was identified in 18 patients with a majority having an antecedent history of trauma. Additional interventions were canceled upon the detection of true threshold values. A high index of suspicion of pseudohypacusis in children and an organized standardized battery of audiologic testing will facilitate early identification of these patients and will avert inappropriate interventions.Laryngoscope, 108:1534–1538, 1998
Genotypic analysis of tumor suppressor genes PTEN/MMAC1 and p53 in head and neck squamous cell carcinomas
Authors: Henderson Ying C. , Wang Eric , Clayman Gary L. 
Published: November 2003

AbstractObjectives: Tumor suppressor gene mutations in both p53 and PTEN/MMAC1 genomic DNA have been detected in many types of cancer. The purpose of this study was to investigate the presence and importance of PTEN/MMAC1 mutations in squamous cell carcinomas. Methods: Exons of each gene were amplified after polymerase chain reaction (PCR) using genomic DNA derived from cell lines of squamous cell carcinoma of the head and neck (SCCHN) and snap‐frozen biopsy specimens from primary established head and neck tumors. The amplified and purified DNA was then sequenced directly. Result: As anticipated, point mutations of the p53 gene were found in 80% of cell lines examined. A single base mutation in codon 151 was found in six of 10 cell lines studied. PTEN/MMAC1 gene mutations were found in neither the cell lines tested nor the tumor biopsy samples. Conclusion: This study, as well as a large volume of data, confirms that mutations of the p53 gene are frequent events in head and neck cancer cell lines. Although PTEN/MMAC1 gene mutations have been found in a variety of carcinomas, this gene was not found to be mutated in SCCHN cell lines or in primary squamous cell carcinomas of the head and neck. This information is useful for further studies of mutations in these cell lines. Laryngoscope, 108:1553–1556, 1998
Quality of life and voice in patients with laryngeal carcinoma: A posttreatment comparison of laryngectomy (salvage surgery) versus radiotherapy
Authors: Finizia Caterina , Hammerlid Eva , Westin Thomas , Lindström Jörgen 
Published: November 2003

AbstractObjectives: This study was designed to compare the voice and the quality of life (QOL) of laryngeal cancer patients receiving treatment with radical radiotherapy with or without laryngectomy as salvage surgery. We also compared the patients' own perceptual ratings of their voice to the perceptual ratings of a group of listeners. Study Design: Two groups of laryngeal cancer patients were studied. Methods: Fourteen irradiated laryngeal speakers with preserved larynx were matched with 14 salvage surgery laryngectomized patients speaking with tracheoesophageal prosthesis (TEP). To measure patients' QOL, we used the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ‐C30), the EORTC Head and Neck module (EORTC QLQ‐H&N35), the Hospital Anxiety and Depression scale (HAD) and a study‐specific questionnaire. For the perceptual speech evaluation we used visual analog scales. Results: The perceptual ratings of speech intelligibility, voice quality, and speech acceptability showed a significant difference between the treatment groups. Both the patients who received treatment with radiotherapy and the listeners rated the irradiated laryngeal voices higher than the tracheoesophageal speech. The laryngectomized patients scored significantly better than the patients treated with radical radiotherapy on the question about hoarseness. No other significant difference was found for the QOL functions and symptoms. Conclusion: When patients treated with radiotherapy were compared with patients treated with laryngectomy as salvage surgery, QOL was similar, only small differences being found in the perceptual speech evaluation. Laryngoscope, 108:1566–1573, 1998
18FDG‐PET for the assessment of primary head and neck tumors: Clinical, computed tomography, and histopathological correlation in 38 patients
Authors: Paulus P. , Sambon A. , Vivegnis D. , Hustinx R. , Moreau P. , Collignon J. , Deneufbourg J. M. , Rigo P. 
Published: November 2003

AbstractObjectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer. Study Design: Retrospective review of 38 patients with biopsy‐proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG‐PET examinations. Twenty‐five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence. Methods: All patients were operated and clinical data, CT, and FDG‐PET results were correlated with histopathological findings. Results: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG‐PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal. Five false‐negative results (microscopic lymph node involvement) and two false positives were noted. Twelve of 13 patients with recurrent disease were correctly identified with FDG‐PET. FDG‐PET was the only imaging technique to identify local recurrence in two patients and lymph node involvement in two others. One false‐positive result occurred in a patient with a foreign body granuloma. Conclusions: FDG‐PET is a useful diagnostic modality for the detection of recurrent tumors and, in selected cases, precise lymph node involvement. The best way to further investigate the utility of clinical FDG‐PET is in the follow‐up of treated patients. Key Words: FDG‐PET, head and neck cancer, lymph node metastases, recurrent disease. Laryngoscope, 108:1578–1583, 1998
Surgical salvage after failed radiation for paranasal sinus malignancy
Authors: Curran Aongus J. , Gullane Patrick J. , Waldron John , Irish Jonathan , Brown Dale , O'Sullivan Brian , Cummings Bernard 
Published: November 2003

AbstractObjective: To comment on the role of surgical salvage following failed initial treatment for paranasal sinus malignancy. Design: A retrospective analysis of one hundred eighty patients treated at The Princess Margaret Hospital, Toronto, from 1976 to 1993. Materials and Methods: Thirty‐four of 95 patients (36%) who failed initial treatment underwent surgical salvage. Initial therapy in this group was radiation only (n = 27) and combined therapy (n = 7). Patient, tumor, and surgical data were recorded. There were 23 T4, three T3, six T2, and two T1 carcinomas. Survival, recurrence rates, and the influence of a variety of variables on outcome were analyzed. Results: Two‐ and 5‐year overall actuarial survival calculated from the date of diagnosis was 54% and 35%, respectively. Two‐ and 5‐year overall actuarial survival calculated from the date of salvage surgery was 44% and 22%, respectively. Advanced age (P <.004), patients with T4 category disease (P <.04), and squamous cell carcinomas (P <.049) correlated with poorer outcome on univariate analysis. Local failure was the most common cause of death (n = 13; 65%). Conclusion: Salvage surgery has a limited role in the management of persistent or progressive disease following failure of initial treatment. Careful postradiation surveillance with endoscopic biopsy under general anesthesia and immediate surgical resection when appropriate may improve the salvage rate. Laryngoscope, 108:1618–1622, 1998
Treatment of allergic fungal sinusitis: A comparison trial of postoperative immunotherapy with specific fungal antigens
Authors: Folker Randy J. , Marple Bradley F. , Mabry Richard L. , Mabry Cynthia S. 
Published: November 2003

AbstractObjective: To determine the effect of immunotherapy (IT) with fungal antigens on clinical outcome in patients with allergic fungal sinusitis (AFS). Study Design: Prospective case control. Methods: In this comparison study, 22 patients meeting the diagnostic criteria of allergic fungal sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent sinusitis. Eleven patients received postoperative immunotherapy (IT) with fungal and nonfungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy. Results: The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P < .001) and a sinusitis‐specific quality‐of‐life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P < .001) and topical nasal (P = .043) corticosteroid therapy to control disease. Follow‐up was similar in the two groups and was not a determinant of differences in outcome (P = .7). Conclusions: Results from this study indicate that specific IT with fungal antigens improves patient outcome in AFS. Laryngoscope, 108:1623–1627, 1998
An anatomic approach to endoscopic intranasal ethmoidectomy
Authors: Schaefer Steven D. 
Published: November 2003

AbstractObjectives: To develop an anatomic and functionally based approach to endoscopic intranasal ethmoidectomy. To develop such an approach using the salient features of the anterior to posterior (AP) and posterior to anterior (PA) intranasal sinus operations. To assess the safety of this form of ethmoidectomy in a patient population. Study Design: Retrospective chart review of patients undergoing ethmoidectomy by author or by residents under his direct supervision. Setting: University teaching hospital. In the 509 patients meeting study criteria, 168 anterior ethmoidectomies, 586 total ethmoidectomies, 264 sphenoidotomies, 290 frontal sinusotomies, and 838 antrostomies were performed between April 1992 and August 1997. Results: A complication rate of 0.98% and revision rate 2.9% were observed. Conclusions: Combining an AP approach to conserve sinus anatomy with a PA approach to avoid surgery directed toward the skull base provides a functional and safe procedure as demonstrated by the reported results. Laryngoscope, 108:1628–1634, 1998
Changes in nasal epithelium in patients with severe chronic sinusitis: A clinicopathologic and electron microscopic study
Authors: Al‐Rawi Mouwafak M. , Edelstein David R. , Erlandson Robert A. 
Published: November 2003

AbstractObjective: Defective ciliary ultrastructure and impaired mucociliary clearance play an important role in the development of respiratory disease and sinusitis. Changes in the ciliary ultrastructure of the sinonasal epithelium have been documented in patients with primary ciliary dyskinesia. However, secondary ciliary dyskinesias and epithelial cytopathologic changes have been underappreciated as a consequence of respiratory dysfunction and chronic sinusitis. Study Design: Thirty‐two patients with severe chronic sinusitis were evaluated for ciliary and epithelial abnormalities. Materials and Methods: Fourteen patients (44%) were children who underwent full allergy, sweat, and immunologic workups. Eighteen patients (56%) were adults who had severe refractory sinusitis and had failed previous sinus surgery. All patients underwent nasal epithelium biopsies of the middle turbinate and evaluation by light and transmission electron microscopy. Results: Ciliated cells were found in 23 patients (72%) with 9 patients (28%) having no cilia. Foci of normal ciliated epithelium were found in only 19% of the patients, often in epithelial invaginations. Variable numbers (usually a minor population) of cilia in 20 cases (87%) exhibited ultrastructural defects including compound cilia and microtubule and dynein arm defects. All of the patients showed variable loss of differentiated epithelial cells ranging from denuded epithelium to basal cell hyperplasia often associated with squamous metaplasia, secondary to chronic sinonasal disease. The lamina propria was often edematous with dilated capillaries, plasma cells, lymphocytes, and hyperplastic seromucous glands. Conclusions: This study demonstrates that ciliary dyskinesias are primarily the result rather than the cause of chronic sinusitis. Patients with chronic sinusitis of uncertain origin exhibit a prominent loss of differentiated epithelial cells, as well as ciliary defects, most of which are likely to be secondary to the chronic disease process. These changes slow down mucociliary clearance and lead to a vicious cycle leading to chronicity.
Noise‐induced hearing loss in young adults: The role of personal listening devices and other sources of leisure noise
Authors: Mostafapour Sam P. , Lahargoue Kelli , Gates George A. 
Published: November 2003

AbstractConcept: No consensus exists regarding the magnitude of the risk of noise‐induced hearing loss (NIHL) associated with leisure noise, in particular, personal listening devices in young adults. Objective: Examine the magnitude of hearing loss associated with personal listening devices and other sources of leisure noise in causing NIHL in young adults. Study Design: Prospective auditory testing of college student volunteers with retrospective history exposure to home stereos, personal listening devices, firearms, and other sources of recreational noise. Methods: Subjects underwent audiologic examination consisting of estimation of pure‐tone thresholds, speech reception thresholds, and word recognition at 45 dB HL. Results: Fifty subjects aged 18 to 30 years were tested. All hearing thresholds of all subjects (save one—a unilateral 30 dB HL threshold at 6 kHz) were normal, (i.e., 25 dB HL or better). A 10 dB threshold elevation (notch) in either ear at 3 to 6 kHz as compared with neighboring frequencies was noted in 11 (22%) subjects and an unequivocal notch (15 dB or greater) in either ear was noted in 14 (28%) of subjects. The presence or absence of any notch (small or large) did not correlate with any single or cumulative source of noise exposure. No difference in pure‐tone threshold, speech reception threshold, or speech discrimination was found among subjects when segregated by noise exposure level. Conclusion: The majority of young users of personal listening devices are at low risk for substantive NIHL. Interpretation of the significance of these findings in relation to noise exposure must be made with caution. NIHL is an additive process and even subtle deficits may contribute to unequivocal hearing loss with continued exposure. The low prevalence of measurable deficits in this study group may not exclude more substantive deficits in other popu lations with greater exposures. Continued education of young people about the risk to hearing from recreational noise exposure is warranted.
Effect of Steroids on Nasal Inflammatory Cells and Cytokine Profile
Authors: Kondo Hiroko , Nachtigal Dan , Frenkiel Saul , Schotman Elsa , Hamid Qutayba 
Published: November 2003

AbstractObjectives: To assess the cellular and humoral effects of unilateral topical steroid application on the nasal mucosa of chronic sinusitis patients. Study Design: Cohort study with randomized grouping. Methods: Chronic sinusitis patients awaiting endonasal sinus surgery were randomly divided into a study group and a control group. All patients underwent allergy studies and categorized as allergic or nonallergic. Patients in the study group were exposed unilaterally to fluticasone propionate nasal spray, 100 μg/day for 4 to 6 weeks before the planned surgery. The control group was not exposed to steroids. At the time of surgery, anterior ethmoid mucosa specimens were obtained. The samples were immunostained for CD3, MBP, CD68, elastase, and tryptase. In situ hybridization was used for the detection of interleukin (IL)‐4, IL‐5, and interferon gamma (IFN‐γ) mRNA. The results were compared between the treated and untreated sides of exposed patients, as well as with non‐treated controls. Results: Twenty‐one patients consented to participate in the study. The number of CD3‐, MBP‐, and tryptase‐positive cells was significantly less in the treated and untreated sides of exposed patients, compared with unexposed controls. IL‐4 and IL‐5 mRNA were significantly downregulated in the treated side of allergic patients, as compared with nontreated patients. This effect could not be shown for IL‐4 in nonallergic patients. Conclusions: Topical steroid therapy had an anti‐inflammatory effect on both allergic and nonallergic chronic sinusitis patients. The unilateral application of the steroid spray affected the contralateral side as well.
A Preliminary Study of Cocaine Absorption From the Nasal Mucosa
Authors: Liao Been S. , Hilsinger Raymond L. , Rasgon Barry M. , Matsuoka Keith , Adour Kedar K. 
Published: November 2003

AbstractObjective/Hypothesis: To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery. Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty. Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets. Group I received 4 mL of a 4% solution (160 mg) of cocaine for 10 min, Group II received 4 mL of a 4% solution (160 mg) of cocaine for 20 min, and Group III received 4 mL of a 10% solution (400 mg) of cocaine for 20 min. Absorption rate was determined by measuring serum cocaine concentration at intervals of 5,10,15, and 20 min. Residual cocaine was extracted from the pledgets and was analyzed quantitatively by using gas chromatography and mass spectroscopy. Results: Of total cocaine applied, 35% was absorbed systemically: 17% was absorbed within 5 min, 25% within 10 min, and 32% within 15 min. Of the cocaine absorbed, 47% was absorbed within the first 5 min, 70% within 10 min, and 90% within 15 min. Two patients (16.6%), both in Group III, had intraoperative hypertension; one of these patients also had transient ventricular tachycardia. Conclusions: Although a 4% solution of cocaine applied to the nasal mucosa on cottonoid pledgets for 20 min is safe, we observed an idiosyncratic absorption rate four times greater than expected; therefore, we advise against topical use of a 10% cocaine solution for anesthesia and vasoconstriction during rhinologic surgery.
Early outcome and complications of the extended subcranial approach to the anterior skull base
Authors: Fliss Dan M. , Zucker Gideon , Cohen Avi , Amir Aharon , Sagi Amiram , Rosenberg Lior , Leiberman Alberto , Gatot Albert , Reichenthal Eli 
Published: November 2003

AbstractObjectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Methods: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. Results: Twenty‐six patients underwent oncologic resections, 22 patients had reduction of complex fronto‐naso‐orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontensisn pneumocephalus. The most common late complication in all three groups was anosmia. Conclusions: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.
Evaluation of Surgical Approaches to Endoscopic Auditory Brainstem Implantation
Authors: Friedland David R. , Wackym Phillip A. 
Published: November 2003

AbstractObjectives: This study investigates the use of endoscopy for the placement of an auditory brainstem implant by translabyrinthine, retrosigmoid (suboccipital), and middle cranial fossa approaches. Study Design: Cadaver dissection and endoscope‐assisted placement of the auditory brainstem implant. Methods: Translabyrinthine, retrosigmoid, and middle cranial fossa dissections were performed bilaterally in five cadaveric heads. An auditory brainstem implant was placed within the lateral recess of the fourth ventricle under endoscopic visualization. The implantation was performed with all approaches and documented by digital image capture followed by production of dye‐sublimation photographic prints. Results: The lateral recess was visualized with the endoscope in all three approaches to the brainstem. The 30° endoscope provided the best visualization by translabyrinthine and retrosigmoid dissection and was essential for the middle cranial fossa approach. Refinement of implant position was readily achieved, as even the deepest portion of the recess could be seen with all three approaches. Conclusions: This study finds that endoscopy provides superior visualization of the lateral recess of the fourth ventricle than the operating microscope with all approaches. The retrosigmoid approach is recommended, as it provides the best view of the implantation site and the easiest angle for placement of the prosthesis. The use of the endoscope may allow for a smaller craniotomy than with conventional microscopic techniques, depending on tumor size. The translabyrinthine approach provides a good view of the lateral recess but had no advantage over other approaches. The middle cranial fossa approach is only possible with angled endoscopes; however, it is technically the most difficult and places the facial nerve at greatest risk.