bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children
Authors: Dodson Edward E. , Hashisaki George T. , Hobgood Todd C. , Lambert Paul R. 
Published: November 2003

AbstractObjective/Hypothesis: Cases of cholesteatoma in pediatric patients were reviewed to determine which factors influence the outcome of surgical treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed, as comparisons of different surgical technique. Study Design: A retrospective analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years was conducted. Methods: Patient information was collected from an otology database, patient records, and audiology files. Results: Sixty‐six patients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12. 5 y). ICW mastoidectomy with tympanoplasty was the primary surgical treatment in 41 patients. Nineteen percent had residual disease at a planned second stage surgery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%. A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with tympanoplasty initially. Two patients (12%) had residual cholesteatoma found at a planned second state procedure, and no recurrent cholesteatoma was encountered. Seventy‐two percent maintained a SRT of less than 30 dB HL. Conclusions: These results support the continued use of ICW mastoidectomy with tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long‐term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with tympanoplasty provides a safe ear and good hearing results. Mastoid cavity care must be maintained indefinitely in many cases.
Surgical technique for implantation of the totally ossified cochlea
Authors: Balkany Thomas , Bird Philip A. , Hodges Annelle V. , Luntz Michal , Telischi Fred F. , Buchman Craig 
Published: November 2003

AbstractObjectives: Among the technical challenges of cochlear implant surgery is electrode insertion into the fully ossified cochlea. Earlier drill‐out techniques have two significant drawbacks: 1. up to one half fail when the electrode pulls away from the cochlea; and 2. extended radical mastoidectomy, abdominal fat graft for obliteration, and closure of the external auditory meatus are required. A simplified technique is described that allows positive fixation of the cochlear implant electrode and in selected cases avoids a radical cavity with obliteration. Study Design: Technical description with case reports and hearing outcomes. Methods: Ten cadaver temporal bones were dissected to determine middle ear landmarks that overlie the basal turn of the cochlea from the transcanal approach and to establish the feasibility of the intact canal wall procedure. Surgery was performed on four patients who had preoperative imaging evidence of full ossification, two with the canal wall down, and two with canal wall up. Standard measures of speech recognition were used to evaluate hearing. Results: Critical surgical landmarks are the round window, carotid artery, cochleariform process, and oval window. The procedure was successfully performed on four patients and open‐set speech recognition is present in each. Conclusions: This canal wall up procedure allows long electrode insertion without radical cavity/obliteration in patients with fully ossified cochleas and prevents distraction of the electrode from the cochlea. While open‐set word recognition was achieved by all subjects, results are poorer than expected for patients with limited or no ossification.
Dysphagia in patients with inclusion body myositis
Authors: Houser Steven M. , Calabrese Leonard H. , Strome Marshall 
Published: November 2003

AbstractObjectives: Inclusion body myositis (IBM) is an inflammatory myopathy with a 40% reported incidence of dysphagia. A protracted course, refractory to medical therapy, frequently leads to consultation with an otolaryngologist for dysphagia management. We studied the incidence, symptoms, and mechanisms of dysphagia in patients with IBM. Study Design: Retrospective study of medical records and self‐reported follow‐up survey; dysphagia is defined as difficulty in swallowing. Materials: Twenty‐two patients with biopsy‐proven IBM. Results: The rate of dysphagia was more than 80% (16 of 19), twice as high as previously reported. Progressive dysphagia was associated with a significantly worse functional class. Relevant management guidelines are established, including the timing for appropriate surgical intervention. Conclusion: Progressive dysphagia may signify more aggressive IBM or an episodic worsening in status. Recognition of the disease manifestations will afford proper patient management. Informed otolaryngologists can have a favorable impact on the dysphagia associated with IBM.
Expected neurologic outcomes for surgical treatment of cervical neurilemomas
Authors: Valentino Joseph , Boggess Michael A. , Ellis Jeffrey L. , Hester T. Oma , Jones Raleigh O. 
Published: November 2003

AbstractObjective: Neurilemomas are classically described as fusiform tumors that eccentrically displace the undisturbed neural fascicles. The authors seek to clarify the relationship of cervical neurilemomas to their nerve of origin and assess the functional outcome of surgical extirpation. Study Design: A retrospective review of clinical, intraoperative, and histopathologic data of six patients with cervical extracranial neurilemomas. Methods: Additional histochemical staining of the pathologic specimens was performed to evaluate the tumor for neurites. A comprehensive literature review of cervical neurilemoma cases and meta‐analysis of clinical outcomes in these cases were performed. Results: In the series of five consecutive cervical neurilemomas, only one was an eccentric mass pushing the undisturbed nerve aside. In the five other cases, excision of the neurilemoma required complete nerve excision. Neural elements traveling through the central portions of the tumor were clearly demonstrated histologically. Collective analysis of the literature on cervical neurilemomas revealed that although some cases allow nerve preservation, preservation of function is frequently poor. Conclusions: This experience and that reported in the literature suggest that it is frequently impossible to preserve the function of the nerve of origin with surgical treatment of cervical neurilemomas.
Surgery versus radiation therapy as single‐modality treatment of tonsillar fossa carcinoma: The roswell park cancer institute experience (1971–1991)
Authors: Hicks Wesley L. , Kuriakose M. Abraham , Loree Thorn R. , Orner James B. , Schwartz Gary , Mullins Alan , Donaldson Craig , Winston Janet M. , Bakamjian Vahram Y. 
Published: November 2003

AbstractObjective: To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single modality therapy. Methods: From 1971 to 1991 239 patients with oral pharyngeal cancer were treated at Roswell Park Cancer Institute. Of these patients 90 had tonsillar carcinoma. Seventy‐six of these patients received either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single‐modality therapy and are the subject of this review. All patients in the radiation arm of this review were surgical candidates who declined primary surgical therapy. Results: Sixty‐three percent of the SA and 80% of the RA treatment groups presented with either stage III or stage IV disease (P ⩽ .05). Forty‐seven percent of the SA group and 52% of the RA patients had clinically positive regional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved region. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA group was 75%, compared with 60% in the RA group (P value was not significant). The disease‐specific survival (all stages) was 61% in the SA group and 37% in the RA group (P ⩽ .05). The disease‐free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P ⩽ .05). Survival measured against clinical response to radiation therapy, in complete responders (all stages) was 83%; by contrast there were no survivors past 24 months in the partial response group (P ⩽ .001). Conclusion: The results from this study suggest that for early disease (stage I/II), surgery or radiation therapy as single‐modality treatment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single‐modality treatment, as measured by ultimate survival and the local control of disease. There is, however, a subset of patients with advanced disease who respond to radiation therapy and whose survival is equivalent to our surgical cohort of patients.
Increased acute and chronic mitotic activity in rat laryngeal muscles after botulinum toxin injection
Authors: Inagi Katsuhide , Connor Nadine P. , Schultz Edward , Ford Charles N. , Cook Crist H. , Bless Diane M. , Heisey Dennis M. 
Published: November 2003

AbstractObjectives: To characterize the acute and chronic cellular effects of botulinum toxin (BT) injection into rat laryngeal muscles. A complete characterization of these effects is important because patients with focal dystonias of the head and neck are commonly treated with BT injection. Further, potential muscular changes in the larynx must be carefully delineated owing to the critical phonatory and airway protective functions of these muscles. Study Design: The acute and chronic cellular effects of BT injection were studied using 5′‐bromo 2′‐deoxyuridine (BrdU) following single and repeated BT injection into rat laryngeal muscles. BrdU is incorporated into mitotically active nuclei such that changes in cell proliferative behavior following BT injection can be monitored. Results: Increased mitotic activity was detected in the tissue samples studied following BT injection. Differences in the times of the peak distribution of BrdU‐labeled cells in each laryngeal muscle were observed. This may be related to the diffusion effects of BT. Prolonged muscle fiber changes, including splitting, were also observed as the result of repeated BT injection. Conclusions: The results of this study suggest that BT may induce a proliferative response in muscle tissue.
Transforming growth factor‐β expression in otitis media with effusion
Authors: Cooter Michael S. , Eisma Roselle J. , Burleson Joseph A. , Leonard Gerald , Lafreniere Denis , Kreutzer Donald L. 
Published: November 2003

AbstractObjective: To characterize the existence and role of transforming growth factor‐β (TGF‐β) in otitis media with effusion (OME). Study Design: Retrospective. Methods: The levels of two major TGF‐β isoforms, TGF‐β1 and TGF‐β2, in the middle ear effusions (MEEs) of 44 children were evaluated using enzyme‐linked immunospecific assays (ELISAs). Forty‐eight MEEs were separated into three clinically relevant groups (i.e., serous, mucoid, and purulent), and TGF‐β levels were correlated with clinical parameters of disease for these MEEs. Results: Both TGF‐β1 and TGF‐β2 were present in the samples. Mean levels of TGF‐β1 (920.36 ± 437.75 pg/mg total protein) were generally 100‐fold greater than those of TGF‐β2 (9.65 ± 11.19 pg/mg total protein). TGF‐β1 levels were elevated in association with a history of previous tympanostomy tube placements (TTPs) (P = .029) and mucoid effusions (P = .042). TGF‐β2 levels were elevated in association with a history of previous TTPs (P = .100) and chronic (i.e., serous or mucoid) effusions (P = .003). Conclusions: TGF‐β1 is present in the MEEs of children with OME. Furthermore, TGF‐β1 and TGF‐β2 levels were elevated differentially in the presence of chronic disease indicators in OME, suggesting that these isoforms may have differing roles in the inflammatory processes that characterize OME.
Short‐term tympanostomy in conjunction with hyperbaric oxygen therapy
Authors: Vrabec Jeffrey T. , Clements Kelly S. , Mader Jon T. 
Published: November 2003

AbstractObjective: To determine the most effective method of short‐term middle ear aeration in patients unable to tolerate hyperbaric oxygen (HBO) therapy. Study Design: Prospective study comparing two methods of short‐term tympanostomy in each patient. Methods: Seventeen adult patients were referred for management of barotitis and inability to tolerate hyperbaric oxygen therapy (HBO). Each patient underwent CO2 laser tympanostomy on the right ear and tympanostomy with T‐tube placement in the left ear. The tube was removed on completion of HBO. Patients were asked to rate pain and their satisfaction with each method of tympanostomy using a visual analog scale. Otorrhea, persistent perforation, recurrent barotitis, hearing loss, and otalgia occurring during the study period were documented. Results: Laser tympanostomy was associated with a significantly lower incidence of otorrhea but was attended by recurrent barotitis in four of 16 patients. Laser tympanostomy was perceived as being less painful and was rated higher in overall satisfaction. Conclusions: Laser tympanostomy is an effective method for management of barotitis in patients unable to tolerate HBO. Otorrhea is significantly reduced, although a risk of recurrent barotitis exists if the laser perforation closes prior to completion of HBO. Both methods of short‐term tympanostomy reduce complications when compared with a retrospective cohort.
Neck dissection with simultaneous carotid endarterectomy
Authors: Rechtweg Jay , Wax Mark K. , Shah Rasesh , Granke Kenneth , Jarmuz Theresa 
Published: November 2003

AbstractBackground: Patients with metastatic neck disease from upper aerodigestive tract carcinomas have an extensive history of tobacco and alcohol abuse. These patients are predisposed to develop atherosclerotic vascular disease. Objective: An increased incidence and severity of carotid stenosis in patients receiving radiotherapy for head and neck cancers is known. Management of patients with severe carotid stenosis who require surgical treatment of their neck disease has not been described. The authors describe our experience with simultaneous carotid endarterectomy and neck dissection. Study Design: Prospective data collection. Methods: From 1991 to 1997 at West Virginia University Hospitals, Morgantown, West Virginia, and State University of New York (SUNY) at Buffalo, three patients with severe carotid stenosis required surgery for metastatic neck disease. Preoperative evaluation revealed a bilateral carotid stenosis greater than 90% in all patients. All patients underwent modified radical neck dissections and simultaneous carotid endarterectomies with saphenous vein grafting. Two patients, one undergoing partial pharyngectomy and laryngectomy and the other a laryngectomy and neck dissection, had coverage of the carotid artery with the myogenous component of a pectoral major graft. One patient had only a neck dissection. Results: Two patients healed with no local morbidity, no neck recurrence, and a patent carotid artery by Doppler. No strokes were encountered. One patient died of a myocardial infarction. Conclusion: Severe carotid stenosis that requires revascularization may have endarterectomy performed simultaneously with treatment of head and neck primary with no increase in morbidity.
Thyroglossal duct carcinoma: A rational approach to management
Authors: Kennedy Thomas L. , Whitaker Mark , Wadih George 
Published: November 2003

AbstractObjective: To discuss the authors' experience with thyroglossal duct carcinoma and present a rational approach to the management of this entity. Study Design and Methods: A retrospective review of the cytopathology and pathology records of all patients with the diagnosis of a thyroglossal duct remnant from 1965 to 1997 was performed. Results: Three cases of papillary thyroglossal duct carcinoma were identified, with one suspected squamous cell carcinoma by needle aspiration. The papillary carcinomas are discussed in detail to illustrate the difficulty encountered in managing the thyroid gland in the setting of a thyroglossal duct carcinoma. Fine‐needle aspiration proved effective in making the diagnosis preoperatively. Conclusions: The authors recommend that a thyroglossal duct cyst with a microscopic focus of papillary carcinoma, without cyst wall invasion, be managed with a Sistrunk procedure. Treatment of all other thyroglossal duct papillary carcinomas should include removal of all thyroid tissue followed by radioactive iodine treatment.
Persistent otitis media with effusion: A new experimental model
Authors: Russell John D. , Giles Shay J. 
Published: November 2003

AbstractObjectives/Hypothesis: Numerous mechanical animal models for the creation of otitis media with effusion (OME) have been described since the 1920s. However, there are many problems associated with these models, including high infection rates, unreliability, and high resolution rates. The aim of the current study was to create a suitable mechanical animal model that would produce a sterile and long‐lasting effusion. Study Design: A new technique using an external surgical approach on specific pathogen–free rats is described. Method: The eustachian tubes of 56 rats were obstructed in the mid portion along the skull base with gutta percha. Results: All animals developed an effusion within 1 week of the procedure. The resolution rate was 8%, with 80% maintaining sterile effusions for up to 1 year. Conclusions: This new procedure for an OME model has proved consistently reliable in creating a persistent and long‐lasting effusion. It has a low infection rate and should benefit future studies on the prolonged effects of OME on the tympanic membrane and middle ear.
Posttransplant lymphoproliferative disorder presenting in the head and neck
Authors: Lattyak Bruce V. , Rosenthal Philip , Mudge Christine , Roberts John P. , Renze John F. , Osorio Robert W. , Emond Jean C. , Lalwani Anil K. 
Published: November 2003

AbstractObjective: To determine the incidence of focal head and neck posttransplant lymphoproliferative disorder (PTLD) in children, its clinical presentation, associated risk factors, and outcome following treatment.Study Design: Retrospective.Methods: The authors conducted a 5‐year retrospective study of 61 children with liver transplants at the University of California, San Francisco. Suspected head and neck lesions were evaluated and biopsies were performed by an otolaryngologist. Diagnosis was made via histologic and immunohistochemical features and in situ Epstein‐Barr virus (EBV) localization.Results: Eight patients (13.1%) developed PTLD, five (8.2%) in the head and neck. Four patients had large tonsils, and one presented with airway obstruction from a supraglottic mass. Negative pretransplant EBV serology was a risk factor for PTLD. Treatment consisted of antiviral therapy and decreased immunosuppression. All patients with head and neck PTLD are disease free with excellent liver function.Conclusions: A high incidence of PTLD was found, with 63% presenting in the head and neck. While Waldeyer's ring is most commonly involved, PTLD may also present in the supraglottis. Adjunctive antiviral therapy and decreased immunosuppression are effective forms of treatment. Given the increasing number of pediatric liver transplants being performed, otolaryngologists should be familiar with PTLD and have a high index of suspicion in this at‐risk population.
Myosin heavy chain composition in rat laryngeal muscles after denervation
Authors: Shiotani Akihiro , Flint Paul W. 
Published: November 2003

AbstractObjectives: The effects of denervation on myosin heavy chain (MHC) expression in specific laryngeal muscles are characterized using gel electrophoresis. Observed temporal changes in MHC composition will then be used as a biologic marker in studies designed to develop strategies for laryngeal reinnervation and gene therapy. Study Design: Animal study using an adult rat model for laryngeal paralysis. Methods: In anesthetized rats the left recurrent and superior laryngeal nerve were divided. Animals were survived for 7, 14, 28, 90, and 180 days. Animals were euthanized and the thyroarytenoid (TA), vocalis (VOC), posterior cricoarytenoid (PCA), lateral cricoarytenoid (LCA), and cricothyroid (CT) muscle excised. Each muscle was processed for sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS‐PAGE) and densitometric measurements were obtained to determine composition of MHC fiber types. Results: The changes in relative MHC composition are described for each specific laryngeal muscle. In general, a decrease in type IIB and an increase in HA and IIX are seen after denervation. Expression of IIL in the denervated condition is variable and the relative change in type I is minimal. Conclusion: This study supports previous work using rat soleus muscle in which IIA/IIX expression is favored in conditions with decreased neuromuscular activity, and conversely, IIB expression is activity dependent. Expression of type I appears to be independent of neural activity. Further study will be undertaken to quantify expression of MHC components and to study factors modulating expression.
Nasal polyps in the olfactory cleft
Authors: Masaki Masami , Tanaka Yasuhiro 
Published: November 2003

AbstractObjectives: Nasal polyps frequently arise from the middle meatus in patients with nasal polyposis, but caution is required when polyps are seen protruding from the olfactory cleft. The purpose of this study was to evaluate a method to achieve effective and safe access to the olfactory cleft, and to determine the actual incidence of polyps arising from the olfactory cleft in patients with nasal polyposis. Patients: Eighty‐four patients with bilateral or unilateral nasal polyps (n = 143) ranging in age from 16 to 72 years underwent endoscopic sinus surgery in the period from January 1994 to December 1996. Methods: To observe and gain access to the olfactory cleft, septoplasty combined with endoscopic sinus surgery was needed in patients with nasal polyposis. Results: The endoscopy during the combined septoplasty and endoscopic sinus surgery revealed that 36.4% (n = 52) of bilateral or unilateral nasal polyps (n = 143) arose from the olfactory cleft. Of 52 polyps of olfactory cleft origin, 45 (86.5%) arose from the superior turbinate and/or superior meatus, 32 (67.3%) from the medial side of the middle turbinate, 24 (46.2%) from the anterior face of the sphenoid sinus, and 17 (32.7%) from the mucosa of the nasal septum. Conclusions: These findings suggest that for surgeries of nasal polyposis an approach to the olfactory cleft as well as to the middle meatus is required.
The agony of nasal polyps and the terror of their removal 200 years ago: One surgeon's description
Authors: Cohen Jack 
Published: November 2003

AbstractIn previous times, nasal polyps could grow to enormous size, especially in cases of incomplete removal. Many patients suffered a lingering death from the disease or a faster one from surgical attempts at removal. John Bell's operative procedure for this condition is reviewed, showing how terrifying it must have been for the patient.