bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distortion‐Product Otoacoustic Emissions and Glycerol Testing in Endolymphatic Hydrops
Authors: Magliulo Giuseppe , Cianfrone Giancarlo , Triches Lorena , Altissimi Giancarlo , D'Amico Raffaello 
Published: November 2003

AbstractObjectives/Hypothesis Aural fullness is a frequent symptom of endolymphatic hydrops. Its evaluation may provide valuable information on the initial stage of development of endolymphatic hydrops.Study Design The present investigation was specifically designed to ascertain the ability of the glycerol test, combined with pure tone audiometry and distortion product otoacoustic emissions (DPOAEs) testing, to diagnose endolymphatic hydrops early and to identify patients who may evolve toward Meniere's disease. For these purposes, patients who complained about aural fullness as their only audiologic symptom were selected.Methods This investigation consisted of 19 consecutive patients with unilateral or bilateral aural fullness who received no treatment. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with both DPOAEs. For the traditional pure‐tone glycerol test, a hearing improvement of at least 10 dB, at the lower two or three frequencies (125, 250, and 500 Hz), was judged as a positive result. For the DPOAE glycerol test, a smaller positive difference (5 dB) for at least three frequencies was interpreted as an ameliorative fluctuation.Results The outcomes of the glycerol tests (24 ears examined) showed variable patterns. Seven ears showed no significant changes of either the pure‐tone audiogram or DPOAE. In seven other ears, the comparison of the traditional glycerol test and the DPOAE glycerol test indicated an improvement in both measures. Another seven ears showed negative glycerol tests, whereas DPOAE responses gradually recovered reaching levels significantly higher than those recorded before glycerol administration. The three remaining ears showed contrasting results.Conclusions Patients with aural fullness in the absence of other associated symptoms may potentially be in the initial stages of Meniere's disease. This notion is confirmed by the present findings showing a high rate (58%) of positive glycerol tests in the selected patients. The importance of DPOAE testing is supported by their ability to detect minimal dysfunction, possibly representing endolymphatic hydrops that goes undetected by routine pure‐tone audiometry.
Steroid‐Dependent Anosmia
Authors: Stevens Michael H. 
Published: November 2003

AbstractObjective To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy.Study Design A prospective study of 24 patients with nasal and sinus polyps who were anosmic prior to endoscopic nasal and sinus surgery. Those who remained anosmic after surgery were treated with steroids. Most patients had asthma, allergic rhinitis, or both. A few had aspirin sensitivity.Methods All 24 patients had testing of their sense of smell before and after surgery. Those who remained anosmic postoperatively were first treated with topical nasal and then oral steroids and then tested again.Results Twelve of the 24 remained anosmic after surgery and were found to be unresponsive to nasal steroids, but oral steroids were found to restore the sense of smell to normal in most patients. Few patients continued to take the medication for long periods of time mainly because of a fear of side effects. Recent studies have suggested the role of systemic steroids in olfactory secretion, which may explain the mechanism for this response.Conclusion Patients who remain anosmic after the removal of nasal and sinus polyps can be treated with oral steroids resulting in improvement of their sense of smell. Further research is needed on a molecular level to determine the reason for this and also why oral but not nasal steroids are helpful in these patients.
A Comparison of Monopolar Electrosurgery to a New Multipolar Electrosurgical System in a Rat Model
Authors: Chinpairoj Suchet , Feldman Michael D. , Saunders James C. , Thaler Erica R. 
Published: November 2003

AbstractObjectives/Hypothesis The purpose of this study is to compare collateral tissue damage and wound healing in incisions created by electro‐dissociation and conventional electrosurgery. Conventional electrosurgery has been used as an alternative to the scalpel to improve hemostasis. However, the heat generated by this instrument can cause tissue damage surrounding the incision, limiting its use around nerves and large blood vessels. A new technology, Coblation (Arthrocare Corp., Sunnyvale, CA), uses “electro‐dissociation” to achieve similar results by creating charged particles from a conductive medium to make an incision while simultaneously achieving hemostasis. This new approach to electrosurgery may reduce soft tissue damage.Study Design: Methods Two prospective, matched design experiments were performed. In experiment I, both devices were set at the same electrical power in watts and then used to create an incision on the tongue of rats. In experiment II, the electrical power settings of both devices were adjusted until they created incisions of the same size. Epithelial destruction and collateral tissue damage were measured in histologically prepared tissue in both experiments, and the wound healing process was observed in experiment II at 0, 3, 7, and 14 days after surgery.Results The results showed that the electro‐dissociation method created significantly less epithelial destruction and collateral tissue damage in both experiments. Granulation tissue formation was also significantly less extensive in the electro‐dissociation–induced incision after 7 and 14 days of recovery.Conclusions Wound healing may be faster than with conventional electrosurgery if the Coblation device is used.
Arytenoid Appearance and Vertical Level Difference Between the Paralyzed and Innervated Vocal Cords
Authors: Hong Ki Hwan , Jung Kyung Soo 
Published: November 2003

AbstractObjectives/Hypothesis In unilateral vocal fold paralysis, it has been generally accepted that the paralyzed vocal fold presents at a higher level than a normally innervated vocal fold. In this study, we correlate the appearances of the paralyzed arytenoid and the differences in level between the paralyzed and innervated vocal folds.Study Design Retrospective review using video‐recorded images of larynx.Methods A total of 38 patients were selected for this study who reported symptoms of voice change attributable to a paralyzed vocal fold unilaterally. Video recordings were obtained using the laryngeal telescope. The heights were assessed according to the paralyzed positions, status (inspiration or phonation), and appearances of the paralyzed arytenoid. The appearances of paralyzed arytenoid were further clarified as the portions of the medial surface of the arytenoid that were visualized.Results In medial paralysis, the paralyzed vocal fold appeared mainly as being at an equal vertical level or as having no distinct difference from normal vocal fold during phonation. However, a few cases of medial paralysis showed a lower than normal or higher than normal vocal fold during phonation, depending on the appearance of the paralyzed arytenoid. In lateral paralysis, most of the paralyzed vocal folds were not higher than the innervated vocal folds during phonation.Conclusions The heights of paralyzed vocal folds were variable depending on the paralyzed positions, the status of the larynx, and appearances of the paralyzed arytenoid. The fact that the paralyzed vocal fold is at a higher level than the normal vocal fold should be reconsidered.
Autologous Fibrin Sealant Reduces Pain After Tonsillectomy
Authors: Gross Charles W. , Gallagher Richard , Schlosser Rodney J. , Burks Sandra G. , Flanagan Heidi L. , Mintz Paul D. , Avery Nancy L. , Mayers S. Lynne , Spotnitz William D. 
Published: November 2003

AbstractObjectives/Hypothesis Pain is a major cause of morbidity after tonsillectomy. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of care. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain after this operation.Study Design A prospective, randomized, blinded study was performed on 20 children aged 5 to 17 years who were undergoing tonsillectomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain.Methods All patients pre‐donated 40 mL of blood from which autologous concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. The 10 patients in the control group (C) received no fibrin sealant. Patients rated their level of pain immediately after surgery and at regular intervals for 3 days after surgery using the Wong‐Baker Faces Pain Rating Scale (1–6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated.Results At 7:00 p.m. on postoperative day (POD) 0, the mean ± SD fibrin sealant group pain score (2.9 ± 0.41 units) was significantly lower than for the C group (4.1 ± 0.43 units;P ≤ .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 p.m. on POD 1, with a mean of 3.5 ± 0.43 units versus 2.4 ± 0.48 units for C (P = .15). The odds of a patient in C experiencing emesis were 8.16 times higher, (P ≤ .05) than for patients in the fibrin sealant group.Conclusions Fibrin sealant significantly reduced pain the evening after pediatric tonsillectomy and also decreased the chance of e‐periencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.
The Relationship Between Dental Overbite and Eustachian Tube Dysfunction
Authors: McDonnell James P. , Needleman Howard L. , Charchut Steven , Allred Elizabeth N. , Roberson David W. , Kenna Margaret A. , Jones Dwight 
Published: November 2003

AbstractObjective The purpose of this study was to investigate the association between deep dental overbite and eustachian tube dysfunction (ETD).Design Case‐control studySetting Tertiary care pediatric otolaryngology outpatient clinic at the Children's Hospital, Boston, Massachusetts.Patients 105 patients between the ages of 2 and 6 years.Study Measurements Dental overbite, overjet, and occlusal relationships were measured by an observer who was unaware of ETD status. ETD was defined as having ventilation tubes in place or having the recommendation for ventilation tube placement by an attending pediatric otolaryngologist. In addition, demographic information and medical and social histories were prospectively recorded.Results In a multivariate logistic regression model, children with deep bites were 2.8 times more likely to have ETD than those without deep bites (P = .03). Other independent risk factors for ETD identified in this model were family history of otitis media (OM) and age less than 3 years.Conclusions Children with deep dental overbites are at a significantly increased risk for developing ETD.
The Role of Topical Antibiotic Prophylaxis in Patients Undergoing Contaminated Head and Neck Surgery With Flap Reconstruction
Authors: Simons Jeffrey P. , Johnson Jonas T. , Yu Victor L. , Vickers Richard M. , Gooding William E. , Myers Eugene N. , Pou Anna M. , Wagner Robin L. , Grandis Jennifer Rubin 
Published: November 2003

AbstractObjectives/Hypothesis Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high‐risk patients.Study Design We performed a randomized, prospective clinical trial.Methods Patients received either 1) parenteral piperacillin/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively, with piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria.Results Sixty‐two patients met inclusion criteria and were enrolled in the study. The overall wound infection rate was 8.1% (95% confidence interval [CI], 2.7%–17.8%). Two of 31 patients (6.4%) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients (9.7%) randomly assigned to receive topical plus parenteral antibiotics. This difference was not statistically significant (P = >.05). Infection rate was not associated with flap type (rotational vs. free tissue transfer), mandibular reconstruction, age, gender, tumor site, stage, surgical duration, or blood loss.Conclusions These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery. However, the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone.
Bedside Tracheostomy in the Intensive Care Unit: A Prospective Randomized Trial Comparing Open Surgical Tracheostomy With Endoscopically Guided Percutaneous Dilational Tracheotomy
Authors: Massick Douglas D. , Yao Shonan , Powell David M. , Griesen Dawn , Hobgood Todd , Allen James N. , Schuller David E. 
Published: November 2003

AbstractObjectives Objectives of the study were 1) to analyze the complication incidence and resource utilization of two methods of bedside tracheostomy and 2) to define selection criteria for bedside tracheostomy.Study Design Prospective randomized trial in the setting of a tertiary care center at a university hospital.Methods One hundred sixty‐four consecutive intubated patients selected for elective tracheostomy were enrolled. One hundred patients met selection criteria for bedside tracheostomy and were randomly assigned to either open surgical tracheostomy (50) or endoscopically guided percutaneous dilational tracheotomy(50). The remaining 64 patients received open surgical tracheostomies in the operating room. Main outcome measures were 1) perioperative and postoperative complication incidence and 2) resource utilization.Results Patients meeting our selection criteria for bedside tracheostomy had a significantly reduced perioperative complication rate compared with those who failed to meet these criteria, and subsequently underwent tracheostomy placement in the operating room (5% vs. 20%, P less than or equal to .01). No statistically significant difference was found in the perioperative complication incidence between the two methods of bedside tracheostomy. However, percutaneous tracheostomy placement at the bedside resulted in a significant increase in postoperative complication incidence (16% vs. 2%, P <.05) and incurred an additional patient charge of $436 per bedside procedure.Conclusions This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidence and resource utilization are defined for two methods of bedside tracheostomy. The results of this study confirm that open surgical tracheostomy represents the standard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge. These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost‐effective, high‐quality care.
Variance of Vestibular‐Evoked Myogenic Potentials
Authors: Ochi Kentaro , Ohashi Toru , Nishino Hirohito 
Published: November 2003

AbstractObjectives/Hypothesis Vestibular‐evoked myogenic potential (VEMP) has been thought to originate from sacculus. The variance of this potential and the effectiveness of the adjustments of pInII amplitudes using average muscle tonus of ipsilateral sternocleidomastoid muscle were evaluated. In addition, clinical application of VEMP was examined in patients with acoustic tumors (ATs) and vestibular neurolabyrinthitis (VNL).Study Design Prospective evaluation of the VEMP in 18 normal volunteers and 6 patients.Methods Variance and left–right difference of each parameter, including pI latency, nII latency, pInII amplitude, and threshold, was analyzed. Input– output function of pInII amplitude was evaluated. Average muscle tonus was calculated in 20 ears and applied for adjustment of pInII amplitude. Sensitivity of each parameter of VEMP was examined in 3 patients with ATs and 3 patients with VNL.Results VEMP was present in all 36 ears of 18 control subjects. Thresholds of VEMP for normal subjects were 80 to 95 dB normal hearing level (nHL). The muscle tonus affected pInII amplitude significantly; however, no statistically significant improvement was observed in test–retest investigation after adjustment using muscle tonus. The threshold of the affected side was elevated compared with the non‐affected side in all patients with ATs, whereas 2 of 3 patients showed normal pInII‐ratio. One patient with VNL presented normal VEMP, whereas 2 patients presented no VEMP to the highest stimulus intensity.Conclusions Interaural difference of thresholds might be the most useful parameters. Adjustment using average muscle tonus is not necessary when the subject is able to get sufficient muscle tonus.
Cochlear Implants in Five Cases of Auditory Neuropathy: Postoperative Findings and Progress
Authors: Shallop Jon K. , Peterson Ann , Facer George W. , Fabry Lee B. , Driscoll Colin L. W. 
Published: November 2003

AbstractObjectives To review our experiences with some of the preoperative and postoperative findings in five children who were diagnosed with auditory neuropathy and were provided with cochlear implants. We describe changes in auditory function, which enabled these children to have significant improvement in their hearing and communication skills.Study Design Pre‐ and postoperatively, these children received complete medical examinations at Mayo Clinic, including related consultations in audiology, pediatrics, neurology, medical genetics, otolaryngology, psychology, speech pathology, and radiology.Methods These children typically had additional medical and audiological examinations at more than one medical center. The hearing assessments of these children included appropriate behavioral audiometric techniques, objective measures of middle ear function, acoustic reflex studies, transient (TOAE) or distortion product (DPOAE) otoacoustic emissions, auditory brainstem responses (ABR), and, in some cases, transtympanic electrocochleography (ECoG). After placement of the internal cochlear implant devices (Nucleus CI24), intraoperatively we measured electrode impedances, visually detected electrical stapedius reflexes (VESR) and neural response telemetry (NRT). These intraoperative objective measures were used to help program the speech processor for each child. Postoperatively, each child has had regular follow‐up to assure complete healing of the surgical incision, to assess their general medical conditions, and for speech processor programming. Their hearing and communication skills have been assessed on a regular basis. Postoperatively, we have also repeated electrode impedance measurements, NRT measurements, otoacoustic emissions, and electrical auditory brainstem responses (EABR). We now have 1 year or more follow‐up information on the five children.Results The five children implanted at Mayo Clinic Rochester have not had any postoperative medical or cochlear implant device complications. All of the children have shown significant improvements in their sound detection, speech perception abilities and communication skills. All of the children have shown evidence of good NRT results. All but case D (who was not tested) showed evidence of good postoperative EABR results. Otoacoustic emissions typically remained in the non‐operated ear but, as expected, they are now absent in the operated ear.Conclusion Our experiences with cochlear implantation for children diagnosed with auditory neuropathy have been very positive. The five children we have implanted have not had any complications postoperatively, and each child has shown improved listening and communication skills that have enabled each child to take advantage of different communication and educational options.
Accuracy of Acoustic Rhinometry Measurements
Authors: Cakmak Ozcan , Çelik Hüseyin , Ergin Tan , Sennaroglu Levent 
Published: November 2003

AbstractObjectives To identify the factors that influence the accuracy of acoustic rhinometry measurements recorded with commercially available equipment.Study Design A simple model was used which consisted of a metal pipe and cylindrical inserts. These inserts comprised various lengths, and aperture dimensions were comparable to, or smaller than, the nasal valve areas of both adults and children.Methods Accuracy of the acoustic rhinometry technique was evaluated by comparing the measured and actual cross‐sectional areas. The results were discussed in terms of the calculated acoustic transmission, reflection, and attenuation coefficients of the pipe model variations.Results Reducing the inner diameter of the insert increased the degree of measurement error. As the length of the insert was increased, the measured cross‐sectional area gradually decreased, approaching the actual area of the experimental passageway. For larger inserts, level of error was not highly dependent on passageway length compared with the narrower inserts.Conclusion Our results show that both the cross‐sectional area and passageway length of the narrow segment are the most significant factors that influence the accuracy in acoustic rhinometry measurements.
Relief of Post‐Tonsillectomy Pain by Release of Lidocaine From Fibrin Glue
Authors: Kitajiri Shin‐ichiro , Tabuchi Keisaku , Hiraumi Harukazu , Kaetsu Hiroshi 
Published: November 2003

AbstractObjectives Pain inevitably develops after resection of the palatine tonsil (tonsillectomy). Therefore, we applied a mixture of lidocaine and fibrin glue to the tonsillar fossae immediately after tonsillectomy and evaluated its analgesic effects.Study Design A prospective randomized trial.Methods Seventy‐four consecutive patients who had undergone tonsillectomy by the same surgeon (S.K.) were allocated by the sealed envelope method into three groups. After routine tonsillectomy, the operation was terminated in group A (control group), but the bilateral tonsillar fossae were covered with 1 mL fibrin glue using CaCl2 as solution to dissolve thrombin in group B and using 4% lidocaine chloride instead of CaCl2 in group C. No significant difference was observed in age or sex among the three groups. Analgesic effects were evaluated in terms of the postoperative days required until the patient began to eat normally and the postoperative days on which the patient desired analgesic administration.Results The mean postoperative days until the patient began to eat normally were 4.22 in group A and 3.78 in group B, showing no significant difference, but 2.83 in group C, being significantly shorter (P <.05). The mean postoperative days on which analgesic administration was necessary were 4.56 in group A and 4.91 in group B, showing no significant difference, but 2.88 in group C, being significantly shorter (P <.05).Conclusion This method can be readily performed, requires no special treatment, and appears to have adequate pain‐relieving effects.