bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult Epiglottitis in a Canadian Setting
Authors: Hébert Paul C. , Ducic Yadranko , Boisvert Denis , Lamothe André 
Published: November 2003

AbstractThe objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested casecontrol study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/105 population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (
P
< 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.
The Facial Ridge and the Discharging Mastoid Cavity
Authors: Wormald Peter John , Nilssen Erik L.K. 
Published: November 2003

AbstractThis study evaluates the causes for a persistently discharging mastoid cavity and attempts to weight the importance of each identified factor. It consists of a temporal bone dissection to evaluate the anatomy of the facial nerve and a clinical prospective study measuring the factors that contribute to a wet cavity. The factors measured were height of the facial ridge, the size of the meatus, state of the tympanic membrane, and size of the mastoid cavity. The height of the facial ridge and the kidney shape of the cavity were found to be the most significant factors contributing to the state of the cavity. The tympanic membrane and size of the meatus were also found to significantly influence the state of the cavity, whereas the size of the cavity was not significant. These results illustrate the importance of the facial ridge in mastoid surgery and that most poor results in mastoid surgery are due to the surgeon, not the disease.
Osteologic Classification of the Sphenopalatine Foramen
Authors: Wareing Michael J. , Padgham Nigel D. 
Published: November 2003

AbstractTextbook descriptions and illustrations of the opening of the sphenopalatine foramen (SPF) into the nasal cavity place it above and behind the posterior end of the middle turbinate (i.e., within the superior meatus). Although true for some skulls, this is not the situation for the majority and may be of importance, because the major blood supply to the nasal cavity enters via this route. Having studied 238 lateral nasal walls, the authors propose a classification of the osteology of the sphenopalatine foramen. In class I (35%) the opening of the SPF is purely into the superior meatus with a notch or foramen in the middle turbinate/ethmoidal crest of the palatine bone. In class II (56%) the SPF spans the ethmoidal crest (i.e., opens into both the superior and middle meati). In class III (9%) there are two separate openings into the superior and middle meati. These findings may explain the route of the artery to the inferior turbinate and indicate the need for care in dealing with the posterior end of the middle turbinate. They may also suggest a potential site for dealing with “difficult” epistaxis via an intranasal route.
Medical Management of Migraine‐Related Dizziness and Vertigo
Authors: Johnson Glenn D. 
Published: November 2003

AbstractHistorically, review of migraine‐related vestibular symptoms has focused on the various clinical presentations that occur and the results of diagnostic studies of vestibular function. Treatment of vestibular symptoms related to migraine has been proposed similar to that used for headache control, but few examples of the effectiveness of this therapy have been published. The purpose of this study is to present the various approaches that can be used to manage vestibular symptoms related to migraine, and to evaluate the overall effectiveness of these treatment approaches. This was a retrospective review of 89 patients diagnosed with migraine‐related dizziness and vertigo. The character of vestibular symptoms, pattern of cochlear symptoms, results of auditory and vestibular tests, and comorbidity factors are presented. Treatment was individualized according to symptoms and comorbidity factors, and analyzed regarding effectiveness in control of the major vestibular symptoms of episodic vertigo, positional vertigo, and nonvertiginous dizziness. Medical management included dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture. Complete or substantial control of vestibular symptoms was achieved in 68 (92%) of 74 patients complaining of episodic vertigo; in 56 (89%) of 63 patients with positional vertigo; and 56 (86%) of 65 patients with non‐vertiginous dizziness. Similarly, aural fullness was completely resolved or substantially improved in 34 (85%) of 40 patients; ear pain in 10 (63%) of 16 patients; and phonophobia in 17 (89%) of 19 patients. No patient reported worsened symptoms following medical management. The conflicting concept of a central disorder (migraine) as the cause of cochlear and vestibular dysfunction that often has peripheral features is discussed.
Clinical Manifestations of Mutations in the Neurofibromatosis Type 2 Gene in Vestibular Schwannomas (Acoustic Neuromas)
Authors: Welling D. Bradley 
Published: November 2003

AbstractVestibular schwannomas (acoustic neuromas) continue to cause significant facial nerve and hearing morbidity, despite marked improvement in diagnosis and treatment. Mutation of a tumor‐suppressor gene on human chromosome 22 has been found to be associated with vestibular schwannoma formation. The central hypothesis of this study is that specific mutations in the neurofibromatosis type 2 (NF2) gene may produce specific clinical characteristics or phenotypic expressions. The purposes of this investigation are: 1. to determine what proportion of vestibular schwannomas from patients with spontaneous unilateral and familial bilateral schwannomas have mutations present within the NF2 gene; 2. to determine whether specific types of mutations are associated with a specific clinical manifestation of this disease; and 3. to further define the relationship between newly discovered mutations within the NF2 tumor‐suppressor gene and possible clinical applications of this knowledge to advance diagnosis and treatment of patients with NF2 and spontaneous vestibular schwannomas. DNA from 61 schwannomas (29 unilateral vestibular schwannomas and 32 from patients with bilateral vestibular schwannomas[NF2]) were examined, and 33 unique mutations were identified. Significant differences were found in the frequency, distribution, and type of mutation between the NF2 schwannomas and the spontaneous vestibular schwannomas. Three clinical subtypes of NF2 were identified. In tumors from 28 patients, no mutations were identified. Of the 33 mutations identified in the NF2 gene, 30 were likely to result in loss of tumor‐suppressor function from protein truncation; however, three milder mutations termed missense mutations were associated with milder clinical manifestations of the disease and had a slower estimated growth rate. Variable clinical presentation in patients whose tumors had severe or truncating types of mutations suggest that factors in addition to the mutation class are likely to be responsible for a portion of the clinical expression of disease. New diagnostic options are now available for NF2 that will improve the likelihood of hearing and facial nerve preservation and ultimately have significant impact on the management of vestibular schwannomas.
Treatment of External Auditory Canal Exostoses
Authors: Whitaker Samuel R. , Cordier Aldo , Kosjakov Serge , Charbonneau Ronald 
Published: November 2003

AbstractExostoses of the external auditory canal can occur in patients living in coastal, southern California communities with a history of cold‐water aquatic activities such as ocean surfing and swimming. Although most canal exostoses are asymptomatic, patients with canal obstruction greater than 80% can have recurrent episodes of external otitis and a related conductive hearing loss. In most cases, medical treatment resolves the symptomatic external otitis and related hearing loss. Patients recalcitrant to medical treatment are candidates for surgical removal of the exostoses. This report reviews the authors' surgical experience with 18 patients (27 ears) who have undergone surgical removal of exostoses. Their preferred surgical technique of transmeatal removal of exostoses with a specialized mallet and thin chisel under local anesthesia is described.
Malignant Melanoma of the Head and Neck
Authors: Peralta Elizabeth A. , Yarington C. Thomas , Glenn Michael G. 
Published: November 2003

AbstractThis study compared outcomes for intermediate‐thickness(1.5 to 3.99 mm) head and neck melanomas treated with or without elective lymph node dissection (ELND). The records of all head and neck melanomas treated at Virginia Mason Medical Center from 1974 through 1995 were reviewed and analyzed for outcome by stage and elective or therapeutic lymph node dissection. One hundred seventy‐four patients with head and neck melanomas were treated in the study period, of which only 25% had intermediate‐thickness lesions. Of 38 clinically node‐negative patients with intermediate‐thickness lesions followed more than 3 years, 10 underwent ELND, yielding two positive dissections (20%). The rate of distant metastases and the mortality rate were 44% and 35% lower in patients undergoing ELND compared with stage II patients who did not undergo ELND, but the difference did not achieve statistical significance(P = 0.12 and 0.21, respectively). The role of ELND in head and neck melanoma is uncertain. This retrospective study is limited by the small number of intermediate‐thickness lesions, yet there appears to be a survival advantage to ELND in head and neck melanoma, even in negative dissections. Conventional histologic stains miss micrometastases detected by immunohistological and polymerase chain techniques. Removal of such micrometastases may explain the improved outcome. A multicenter prospective trial in head and neck melanomas, incorporating the latest techniques of sentinel node biopsy and immunohistological staining of node specimens, is needed to clarify definitive therapy for this increasingly common diagnosis.
Alloplastic and Microvascular Restoration of the Mandible
Authors: Mandpe Aditi H. , Singer Mark I. , Kaplan Michael J. , Greene David 
Published: November 2003

AbstractThe evolution of mandibular reconstruction following composite resection is advanced by improved alloplastic prosthesis and reliable microvascular free tissue transfers. A 42‐case, 6‐year experience is presented using both methods at the University of California, San Francisco. The advantages and complications of both are discussed. The authors conclude that the success rate for lateral defect restoration is equivalent with either technique, and that the anterior defects are more reliably reconstructed with free tissue transfer. The advantage of microvascular flaps in the anterior defect must be gauged against the physical status of the patient, disease extent, and likelihood of dental rehabilitation by interosseous fixation.
Effect of Melatonin on Tinnitus
Authors: Rosenberg Seth I. , Silverstein Herbert , Rowan P. Todd , Olds Michael J. 
Published: November 2003

AbstractObjective: Evaluate melatonin as a treatment for subjective tinnitus.Study Design: Randomized, prospective, double‐blind, placebo‐controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7‐day washout period between medications.Setting: Outpatient, private, neurotology practice.Patients: Thirty patients with subjective tinnitus.Main Outcome Measures: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview.Results: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02).Conclusion: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus.
Evaluation of Clinical Measures of Equilibrium
Authors: El‐Kashlan Hussam K. , Shepard Neil T. , Asher Anna Marie , Smith‐Wheelock Michael , Telian Steven A. 
Published: November 2003

AbstractObjective: Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities.Study Design: Cross‐sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients.Setting: Academic tertiary care referral center.Participants: Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction.Results: Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction.Conclusion: Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.
Surgical Management of the Substernal Thyroid Gland
Authors: Pulli Ronald S. , Coniglio John U. 
Published: November 2003

AbstractFrom 1992 to 1996, 19 patients had surgical resection of a substernal thyroid gland at the University of Rochester Medical Center, Rochester, New York. Based on a retrospective review of the 21 procedures performed, an algorithm for evaluation and surgical intervention is proposed. A limited medical workup is indicated and consists of a chest x‐ray, thyroid function tests, computed tomography scan, and, possibly, fine‐needle aspiration. Given a modestly high malignancy rate (16%) and a 37% reoperative rate, total thyroidectomy should be performed. When extensive mediastinal disease is encountered, a median sternotomy affords excellent access to the substernal thyroid gland.
Motor Innervation of the Guinea Pig Interarytenoid Muscle: Reinnervation Process Following Unilateral Denervation
Authors: Kawakita Seiji , Aibara Ryuichi , Kawamura Yuji , Yumoto Eiji , Desaki Junzo 
Published: November 2003

AbstractThe authors investigated the process of denervation and reinnervation of the interarytenoid (IA) muscle in the guinea pig using transmission electron microscopy and glycogen depletion technique after unilateral transection of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve to clarify the innervation pattern of the unpaired IA muscle. Anastomosis between the bilateral arytenoid branches was confirmed in the belly of the IA muscle. Five weeks after transection, all of the IA muscle fibers appeared to have been reinnervated by the contralateral RLN. As the arytenoid branch of the RLN runs together with that of the contralateral RLN in a single intramuscular nerve funiculus, it is possible that collateral sprouting branches grow and extend into the adjacent denervated Schwann's sheaths. The authors conclude that the unpaired IA muscle, as a whole, receives specific motor nerve supply from the bilateral RLNs, although each muscle fiber is innervated unilaterally.
Type I Posterior Laryngeal Clefts
Authors: Parsons David S. , Stivers F. Edward , Giovanetto Donald R. , Phillips Scott E. 
Published: November 2003

AbstractPosterior laryngeal clefts (PLCs) are described in the literature as rare laryngeal abnormalities. The authors believe type I clefts are much more common than previously reported. In two busy pediatric tertiary care centers, such clefts are the second most common congenital laryngeal finding at rigid endoscopy, second only to laryngomalacia. PLCs frequently present with symptomatology that can be attributed to other common disease processes and are often undiagnosed unless the surgeon maintains a high index of suspicion and specifically examines the posterior glottis by palpation during microlaryngoscopy. This report presents a series of 41 patients with type I PLCs, reviews their subtle and often confusing presenting signs and symptoms, and describes a simple yet reliable method of diagnosis.
Habitual Snorers and Sleep Apnoics Have Abnormal Vascular Reactions of the Soft Palatal Mucosa on Afferent Nerve Stimulation
Authors: Friberg Danielle , Gazelius Bertil , Lindblad Lars Erik , Nordlander Britt 
Published: November 2003

AbstractA local disturbance in the afferent nerves involved in the reflexogenic dilation of the upper airways (UAs) could contribute to the increased collapsibility seen in patients with obstructive sleep apnea (OSA). Laser Doppler perfusion monitoring, combined with electrical stimulation, is a method for investigating the afferent nerve regulation of the microcirculation. It was used in the mucosa of the soft palate in 35 patients with various degrees of UA obstruction and in 13 control subjects, all nonsmoking men. In a majority of snorers and patients with mild OSA, stimulation induced an exaggerated vasodilation, compared with controls. In contrast, in patients with severe OSA, the vasodilation was significantly reduced, compared with controls. These signs of disturbances in the microcirculation support the hypothesis of a local progressive afferent nerve lesion in heavy snorers with or without OSA.
Idiopathic Facial Paralysis: A Randomized, Prospective, and Controlled Study Using Single‐Dose Prednisone Versus Acyclovir Three Times Daily
Authors: De Diego Juan I. , Prim Maria P. , De Sarriá Maria J. , Madero Rosario , Gavilá Javier 
Published: November 2003

AbstractIn a prospective, controlled, and randomized study, we compared the outcome of 101 Bell's palsy patients treated with acyclovir (54 patients) or prednisone (47 patients). The acyclovir dosage was 2400 mg (800 mg three times a day) for 10 days, and prednisone was given as a single daily dose of 1 mg/kg of body weight for 10 days and tapered to 0 over the next 6 days. Minimum follow‐up was 3 months in all patients. Patients in the prednisone group had better clinical recovery than those treated with acyclovir. Less degree of neural degeneration was observed in the prednisone group compared with acyclovir patients. The incidence of sequelae was the same in both groups. According to these results, in a 10‐day treatment cycle acyclovir given 800 mg three times is not as useful as prednisone given 1 mg/kg of body weight once a day in patients with idiopathic facial nerve paralysis.
Changes in Immunostaining of Inner Ears After Antigen Challenge Into the Scala Tympani
Authors: Ichimiya Issei , Kurono Yuichi , Hirano Takashi , Mogi Goro 
Published: November 2003

AbstractTo study the mechanisms of immune responses and immune injuries in inner ears, labyrinthitis was induced by inoculation of keyhole limpet hemocyanin (KLH) into the scala tympani of systemically sensitized guinea pigs. Inner ears were then immunostained for KLH, immunoglobulin G (IgG), albumin, connexin26 (Cx26), and sodium‐potassium adenosine triphosphate (Na,K‐ATPase). Inflammatory cells containing KLH were observed in the scala tympani and in the collecting venule of the spiral modiolar vein (SMV). Spiral ligament, spiral limbus, and blood vessels including the SMV were diffusely positive for IgG and albumin. Immunoreactivity for Cx26 and Na,K‐ATPase was decreased compared with the normal ears in the fibrocytes of the spiral ligament. These results suggest that inflammatory cells and blood constituents could extravasate into the cochlea from blood vessels and that fibrocyte damage in the spiral ligament could cause cochlear dysfunction.
Three‐Dimensional Analysis of Cricoarytenoid Joint Motion
Authors: Wang Robert C. 
Published: November 2003

AbstractThe normal motion of the cricoarytenoid joint was characterized and analyzed in this study using seven fresh cadaver larynges mounted rigidly in an external fixator apparatus after radiopaque markers were attached to laryngeal landmarks. Fluoroscopic imaging and recording was performed of top, front, and side views while the arytenoid cartilages of each larynx were manipulated through the full range of motion from adduction to abduction. Computer video capture was performed of the recordings and editing of still frames accomplished to generate three‐dimensional plots of cricoarytenoid joint motion, which are shown in the manuscript.Selective and varying sequential disconnection of muscular and ligamentous structures to the arytenoid cartilage was achieved to determine their contributions to cricoarytenoid joint motion limitations and stability. The vocalis ligament, cricoarytenoid ligament, and conus elasticus are most important in controlling abduction, whereas the posterior cricoarytenoid muscle and conus elasticus are crucial in limiting adduction. The vocalis ligament prevents posterior displacement of the vocal process, while the cricoarytenoid ligament and a newly described ligament, the posterior capsular ligament, restricts anterior vocal process migration. Another ligament, the anterior capsular ligament, is described, which limits backward arytenoid cartilage tilting and lateral movement of the arytenoid cartilage on the cricoid cartilage facet. Section of the vocalis ligament with underlying conus elasticus produced reducible lateral arytenoid cartilage subluxation.Confirmation of cricoarytenoid joint facet relationships in full adduction and abduction was accomplished by fixation of the cricoarytenoid joints of one larynx in the two positions with adhesive, and subsequent exposure of the joint surfaces.Review of literature detailing human laryngeal embryological development shows that the glottis and arytenoid cartilages are formed in adduction, which explains how cricoarytenoid joint ligaments collaborate to achieve accurate vocal process approximation in adduction despite side‐to‐side asymmetries of the cricoarytenoid joint structures in the same larynges.