bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extrusion Rates and Hearing Results in Ossicular Reconstruction
Authors: House John W. , Teufert Karen Borne 
Published: February 2003

OBJECTIVESTo examine hearing results, extrusion rates, and factors likely to affect outcome in patients who underwent ossicular chain reconstruction with Plasti‐Pore and hydroxylapatite total ossicular replacement prostheses (TORPs) and partial ossicular replacement prosthesis (PORPs).STUDY DESIGN AND SETTINGRetrospective chart review was used. Subjects were 1210 consecutive tympanoplasties with or without mastoidectomy that involved ossicular reconstruction with TORPs (n = 560) or PORPs (n = 650) performed in a tertiary referral neurotologic private practice. Only 20% of the cases were primary surgeries, with the majority planned second stage or revision procedures.RESULTSAverage last postoperative air‐bone gap (ABG) was 19.2 dB with closure of the ABG to within 20 dB in 62.9%. Hearing results were better for cases who had not had previous surgery, in those with a diagnosis other than chronic otitis media, when a cartilage graft was used, and for Plasti‐Pore rather than hydroxylapatite. Extrusion was known to occur in 4%.CONCLUSIONAfter more than 25 years of use in our clinic, Plasti‐Pore ossicular replacement pros‐theses continue to provide reliable hearing results with a low rate of extrusion.
Laryngotracheal Reconstruction in Subglottic Stenosis: An Ancient Problem Still Present
Authors: Peña Juan , Cicero Raúl , Marín José , Ramírez Martha , Cruz Sergio , Navarro Francisco 
Published: February 2003

BACKGROUNDSubglottic stenosis is an ancient but persistent problem as a cause of airway obstruction. The etiology and the results of surgical treatment with thyrotracheal anastomosis were reviewed.METHODSFifty‐six patients with subglottic stenosis were studied. All were subjected to laryngotracheal reconstruction by thyrotracheal anastomosis with partial resection of the cricoid.RESULTSOf all 56 cases of subglottic stenosis, 48 (86%) had history of previous tracheal intubation, and only 8 (14%) had different non‐neoplastic obstructive processes such as scleroma, direct injury, hamartoma, and amyloidosis. Immediate results were good in all cases. After 1 year follow‐up, results of thyrotracheal anastomosis were successful in 44 (91%). In 4 other cases a restenosis was observed. Eight patients were lost to follow‐up.CONCLUSIONSSubglottic stenosis is still frequent after tracheal intubation, but other causes must be considered. Laryngotracheal reconstruction with thyrotracheal anastomosis with partial cricoid resection was feasible with good results in 91% of the cases with follow‐up, but this procedure must be performed by a skilled surgical team.
A Comparison of Radiation‐Induced and Presbylaryngeal Dysphonia
Authors: Behrman Alison , Abramson Allan L. , Myssiorek David 
Published: February 2003

OBJECTIVEThe goal of this study was to assess voice after radiotherapy compared with patients with presbylaryngeal dysphonia.STUDY DESIGN AND SETTINGProspective assessment of 20 patients aged 60+ years who remained free of disease longer than 1 year after radiotherapy for T1 squamous cell carcinoma and retrospective review of 46 patients aged 60+ with presbylaryngeal dysphonia, conducted at a tertiary care, academic hospital. Assessment data included videostroboscopy, spectrography, voice range profile, and Voice Handicap Index.RESULTSEighty percent of the radiotherapy patients reported a voice disorder. Acoustic data and functional measures reflected similar limitations and abnormalities for both groups. A high incidence of glottal gap in all patients may have been associated with increased mucosal stiffness in the radiotherapy group and vocal fold atrophy in the presbylaryngeal group.CONCLUSIONPatient perception and functional outcome of voice were similar for both groups, despite differences in etiology of abnormal vocal fold vibratory behavior.SIGNIFICANCERadiotherapy in older individuals may yield dysphonia that is no greater than that caused by normal aging.
Quality‐of‐Life Assessment in Patients with Unilateral Vocal Cord Paralysis
Authors: Spector Brian C. , Netterville James L. , Billante Cheryl , Clary Janye , Reinisch Lou , Smith Timothy L. 
Published: February 2003

OBJECTIVEOur objective was to identify the impact of unilateral vocal cord paralysis (UVCP) on an individual's quality of life both before and after thyroplasty.STUDY DESIGN AND SETTINGThis was a prospective observational outcome study of consecutive patients presenting to a laryngology clinic with UVCP. Participants received The Medical Outcomes Study Short Form 36‐Item Health Survey (SF‐36), the Voice Handicap Index (VHI), and the Voice Outcome Survey (VOS). Patients underwent medialization laryngoplasty with silastic, with or without arytenoid adduction. Outcome measures were repeated after surgery.RESULTSA review of 45 patients at presentation revealed statistically significant reductions in quality of life as measured by each survey. Marked improvements were noted after surgery.CONCLUSIONSOur preoperative data support a profile of significant general health‐related and voice‐related limitations caused by UVCP. Patient perceptions improved significantly after the surgical treatment of glottal insufficiency.SIGNIFICANCEThe SF‐36, VHI, and VOS provide an important complement to traditional endpoints in the analysis of patients with UVCP.
Sentinel Lymph Node Evaluation in Squamous Cell Carcinoma of the Head and Neck
Authors: Stoeckli Sandro J. , Steinert H. , Pfaltz M. , Schmid Stephan 
Published: February 2003

OBJECTIVEThe aim of our study was to assess the feasibility of sentinel lymph node (SLN) radiolocalization in N0 neck in squamous cell head and neck carcinoma and its predictive value for occult metastasis.Study Design: Nineteen patients of an open prospective trial.SETTINGAfter peritumoral injection of a 99m Tc labeled radiocolloid, the SLN was localized preoperatively by lymphoscintigraphy and intraoperatively through the intact skin by a hand‐held gamma‐probe. The histology of the SLN and the nodes of the elective neck dissection were compared.RESULTSLocalization of the SLN by lymphoscintigraphy was possible in 18 of 19, and with the handheld gamma‐probe in all 19 patients. Six SLN revealed occult metastatic disease. No skip metastasis were found in the 13 neck specimen with negative SLN.CONCLUSIONSLN evaluation in N0 neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis.
The Use of Lymphoscintigraphy and PET in the Management of Head and Neck Melanoma
Authors: Kokoska Mimi S. , Olson Garth , Kelemen Pond R. , Fosko Scott , Dunphy Frank , Lowe Val J. , Stack Brendan C. 
Published: February 2003

OBJECTIVESLymphoscintigraphy with sentinel node dissection and 18 fluoro‐2‐deoxyglucose positron emission tomography (PET) are being used independently in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 1.0 mm and clinically negative regional nodes that were evaluated prospectively with PET and lymphoscintigraphy.STUDY DESIGN AND SETTINGBetween July 1, 1998 and December 30, 2000 PET scans were obtained preoperatively on 18 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy and sentinel node dissection was performed. Resection of the primary lesion was then carried out with adequate margins and the defects were reconstructed.RESULTSSentinel node(s) were found in 17/18 patients (94.4%); 5/18 (27.8%) of cases had metastases. PET detected nodal metastasis preoperatively in 3 patients (16.7%), one of which had a positive sentinel node dissection.CONCLUSIONPET and lymphoscintigraphy offer complimentary ways of evaluation for metastatic melanoma.
Craniocervical Necrotizing Fasciitis: An 11‐Year Experience
Authors: Bahu Samer J. , Shibuya Terry Y. , Meleca Robert J. , Mathog Robert H. , Yoo George H. , Stachler Robert J. , Tyburski James G. 
Published: February 2003

OBJECTIVEWe review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF).STUDY DESIGNAll cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co‐morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes.RESULTSA review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required.CONCLUSIONAggressive wound care, broad‐spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension.SIGNIFICANCEThis is the largest single institution report of CCNF with thoracic extension identified to date.
Diving after Stapedectomy: Clinical Experience and Recommendations
Authors: House John W. , Toh Elizabeth H. , Perez Alejandro 
Published: February 2003

OBJECTIVESMuch controversy exists concerning the risk of inner ear barotrauma after stapes surgery in scuba and sky divers. Uniform consensus has not been established regarding poststapedectomy barorestrictions. The purpose of this study was (1) to determine the prevalence of adverse auditory and/or vestibular sequelae in patients after stapedectomy related to scuba and sky diving, and (2) to offer recommendations on barometric exposure after stapes surgery.STUDY DESIGNSurvey questionnaires were mailed to 2222 patients who had undergone stapedectomies at a single tertiary otologic referral center between 1987 and 1998. Two hundred eight of the initial 917 respondents (22.7%) had snorkeled, scuba, or sky dived after stapes surgery, and 140 of these responded to a second questionnaire detailing dive protocols, otologic symptoms, and their relationship to the diving activities. Of the 140, 28 had scuba or sky dived. Their survey data were analyzed and their medical records were reviewed.RESULTSFour of the 22 scuba divers (18.1%) experienced otologic symptoms at the time of diving. These included otalgia on descent (3/22; 13.6%), tinnitus (1/22; 4.5%), and transient vertigo on initial submersion (1/22; 4.5%). One patient had sudden sensorineural hearing loss and vertigo develop 3 months after scuba diving, which he related to noise exposure. He was subsequently found to have a perilymph fistula, which was successfully repaired. Of the 9 patients who sky dived, 2 patients (22.2%) reported otologic symptoms during the dive. No significant diving‐related long‐term effects indicative of labyrinthine injury were seen in any of the 28 patients.CONCLUSIONSStapedectomy does not appear to increase the risk of inner ear barotrauma in scuba and sky divers. These activities may be pursued with relative safety after stapes surgery, provided adequate eustachian tube function has been established.
Determination of the Optimal Conditions for Laryngeal Pacing with the Itrel Ii Implantable Stimulator
Authors: Zealear David L. , Swelstad Matthew R. , Sant'Anna Geraldo D. , Bannister Roger A. , Billante Cheryl R. , Rodriguez Ricardo J. , Garren Kurt C. , Billante Mark J. , Champney Michael S. 
Published: February 2003

OBJECTIVETo determine the optimal stimulus paradigm, electrode orientation, and configuration of an implantable stimulator used to reanimate the posterior‐cricoarytenoid (PCA) muscle in case of bilateral vocal fold paralysis (BVFP).STUDY DESIGNAcute studies were conducted on 13 canines implanted with Itrel II systems with or without PCA innervation. PCA stimulus‐response characteristics were obtained by measuring stimulated vocal fold displacement endoscopically.RESULTSThe denervated PCA was only 10% to 25% as responsive to stimulation as the innervated PCA. However, the response could be increased to 38% and 61% if the Itrel was modified to deliver 1 and 2 msec pulses, respectively. Stimuli delivered centrally to the muscle 5 mm from the median raphe improved performance.CONCLUSION AND SIGNIFICANCEThe optimal stimulus paradigm identified in this study (1 msec pulses delivered at 30 to 40 Hz and 2 to 8.5 mA) has been applied to implanted BVFP patients and improved outcome. Information regarding optimal electrode orientation could also be important to future clinical trials.
Intrinsic Nasal Muscles and their Electromyographic Evaluation after External Septorhinoplasty
Authors: Ozturan Orhan , Ozcan Cemal , Miman Murat Cem 
Published: February 2003

OBJECTIVESRhinoplastic surgery is performed for the improvement in the appearance of the nose, but it should not cause any detrimental effect on the intrinsic muscles. This study was conducted to evaluate the influence of the external rhinoplasty on intrinsic nasal muscles.METHODSTwenty‐one patients were operated on by external septorhinoplasty. Functions of the nasal muscles were assessed by electromyography in response to voluntary nasal movements in patients before and after surgery.RESULTSPostoperative electromyographic activities of the muscles were significantly less than pre‐operative measurements for all movements.CONCLUSIONInfluence of the surgical incisions, alterations of the sites of origin and/or insertion of the muscles, and the postoperative healing process can be incriminated for the decreased muscular activity. Nasal muscle function requires a better appreciation and respect for the achievement of the best aesthetic and functional results. The nasal valve reconstructive procedures should be applied routinely to compensate for this inevitable muscular involvement.
Determination of the “Incidental” Lund Score for the Staging of Chronic Rhinosinusitis
Authors: Ashraf Nomaan , Bhattacharyya Neil 
Published: February 2003

OBJECTIVEDetermine normative values for the Lund score for computed tomographic (CT) scans of the paranasal sinuses.METHODSPatients undergoing CT of the paranasal sinus region for nonsinusitis causes were evaluated and staged according to the Lund‐MacKay system. Complete and near complete Lund scores were computed from these scans and the frequencies of incidental paranasal abnormalities were tabulated.RESULTSA total of 199 patients who underwent CT scans of the internal auditory canals, pituitary, or orbits demonstrated adequate visualization of the paranasal sinuses. In 91 patients, the imaging was sufficient to compute a complete Lund score with a mean of 4.26 (95% CI, 3.43 to 5.10). In 130 patients, all sinuses were adequately imaged except for the ostiomeatal complex. For this near complete group, the mean prorated Lund score was 4.26 (95% CI, 3.55 to 4.97). Both of these scores differed significantly from an expected score of zero (P < 0.001).CONCLUSIONSThe Lund score in the general population is not 0. A Lund score ranging from 0 to 5 may be considered within an incidentally “normal” range, and should be factored into clinical decision‐making.
Harmonic Scalpel Tonsillectomy versus Electrocautery Tonsillectomy: A Comparative Pilot Study
Authors: Walker Renee A. , Syed Zubair A. 
Published: February 2003

OBJECTIVEUsing quality of life criteria, this pilot study prospectively evaluates if the ultrasonic dissector coagulator's (Harmonic Scalpel [HS], Ethicon Endo‐Surgery, Inc, Cincinnati, OH) unique properties offer advantages over traditional electrocautery (EC) tonsillectomies with respect to return to regular diet, activity, and complications such as bleeding and dehydration.METHODSOver a 13‐month period, 316 tonsillectomies (161 EC and 155 HS) were evaluated. Return to regular diet, regular activity, and the use of postoperative pain medications were monitored via a brief questionnaire. Complications, such as increased perioperative and postoperative bleeding, were monitored by chart review. Statistical analysis of the questionnaire data was performed.RESULTSSeventy‐five (46.6%) of the patients in the EC group responded versus 97 (62.6%) in the HS group. The ages ranged from 1 to 19 years old. Return to regular diet in 24 hours was statistically significant when comparing HS and EC questionnaire responders, 44.3% versus 22.7%, respectively; as was 72 hours, HS (74.2%) and EC (46.7%). Twenty‐eight percent of the HS questionnaire responders versus 12% of EC resumed normal activity within 24 hours. The perioperative blood loss was equal in the 2 groups. There were 14 late bleeds; 9 were EC patients and 5 HS patients. Two HS patients and 4 EC patients had readmissions for dehydration.CONCLUSIONSIt appears from this early pilot study that the Harmonic Scalpel tonsillectomy offers advantages of early return to diet and activity over standard electrocautery tonsillectomies. We report no difference in perioperative or postoperative bleeding.
The Basic Symptom Inventory–‐53 and its Use in the Management of Patients with Psychogenic Dizziness
Authors: Ruckenstein Michael J. , Staab Jeffrey P. 
Published: February 2003

OBJECTIVETo identify an accurate psychological screening questionnaire to assist in the management of patients with psychogenic dizziness.STUDY DESIGNPatients referred to the Balance Center of the University of Pennsylvania with a presumptive diagnosis of psychogenic dizziness based on neurotologic assessment were administered a Basic Symptom Inventory–‐53 (BSI–‐53) psychological screening questionnaire and were referred for psychiatric assessment. Neither the patients nor the psychiatrist were aware of the results of the BSI–‐53. The results of the neurotologic assessment, the BSI–‐53, and the psychiatric assessment were then compared for their degree of association.RESULTSStrong associations were demonstrated between the results of the BSI–−53 questionnaire and the results of the neurotologic and psychiatric assessments.CONCLUSIONSThe BSI–‐53 is an easily administered, objective, and accurate tool useful in identifying the presence of psychopathology in patients thought to have psychogenic dizziness. It is recommended as a valuable addition to the battery of tests performed when evaluating the dizzy patient.
Hearing Preservation in Patients with Vestibular Schwannomas with Sudden Sensorineural Hearing Loss
Authors: Friedman Rick A. , Kesser Bradley W. , Slattery William H. , Brackmann Derald E. , Hitselberger William E. 
Published: February 2003

OBJECTIVEWe evaluated hearing outcomes in patients with sudden hearing loss and vestibular schwannoma who underwent a hearing preservation operation for tumor resection in an effort to determine whether a history of sudden sensorineural hearing loss has an impact on subsequent hearing preservation surgery.METHODSRetrospective chart review of 45 patients operated between 1990 and 1998. Patients were divided into “Recovery” (n = 22) and “No Recovery” (n = 23) groups based on preoperative hearing recovery. Hearing preservation was assessed using the AAO‐HNS hearing classification system.RESULTSMeasurable hearing was preserved in 73% of patients, with 47% having good postoperative hearing (AAO‐HNS Classes A‐B). There was no significant difference in hearing outcome from patients presenting with progressive hearing loss (45% Classes A‐B). There was also no difference in postoperative hearing between the “Recovery” and “No Recovery” groups.CONCLUSIONSPatients with sudden hearing loss and vestibular schwannoma have the same chance of hearing preservation after tumor removal as those with progressive loss. Preoperative recovery of hearing is not predictive of hearing preservation. Available data support the nerve compression theory as the mechanism of sudden hearing loss in patients with vestibular schwannoma.
Extracranial Lower Cranial Nerve Sheath Tumors
Authors: Leonetti John P. , Wachter Bryan , Marzo Sam J. , Petruzzelli Guy 
Published: February 2003

OBJECTIVEThe purpose of this article is to review the clinicoradiographic features of lower cranial nerve sheath tumors and to outline surgical approaches that allow the safe and complete resection of these lesions.METHODSThirteen patients with lower cranial nerve sheath tumors of the infratemporal fossa were surgically treated between 7/88 and 10/99. A retrospective chart analysis provided details pertaining to clinical manifestations, radiographic assessment, intraoperative findings, tumor histology, and postoperative results.RESULTSThe most common presenting symptoms were neck pressure and voice change while sub‐mucosal palatal fullness and vocal cord paralysis were the most common presenting signs. All tumors were removed via lateral skull base approaches and the most common postoperative sequelae was dysphasia.CONCLUSIONLower cranial nerve sheath tumors of the infratemporal fossa usually reach considerable size before diagnosis because of a naturally slow growth rate in this relatively silent location. The safe surgical removal of these tumors, based on superior control of the internal carotid artery, can be achieved through the use of contemporary lateral skull base techniques.
Predictors of Weight Loss During Radiation Therapy
Authors: Beaver Mary Es , Matheny Keith E. , Roberts Dianna B. , Myers Jeffrey N. 
Published: February 2003

OBJECTIVETo define risk factors for weight loss or dehydration during radiation therapy (RT).STUDY DESIGN AND SETTINGRetrospective chart review, academic tertiary care center.RESULTSThe incidence of severe weight loss during RT was 32.7%, the incidence of dehydration was 10.9%, and the rate of prophylactic feeding gas‐trostomy tube placement was 32%. The patients most likely to suffer severe weight loss included patients with tumor sites of nasopharynx and base of tongue, those treated with chemoradiation, and patients with severe pretreatment weight loss. Prophylactic feeding gastrostomy tube placement before RT significantly reduced the incidence of severe weight loss and hospitalization during RT.CONCLUSIONSevere weight loss and dehydration during RT for head and neck cancer is common. Prophylactic feeding gastrostomy tubes significantly reduce the incidence of severe weight loss and hospitalization for dehydration during RT when placed before onset of RT. Patients at risk for severe weight loss include those with severe pretreatment weight loss, tumors of the nasopharynx and base of tongue, or treatment with chemoradiation.