bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Tumor Necrosis Factor‐α on Experimental Otitis Media With Effusion
Authors: Lee Dong‐Hee , Park Yong‐Soo , Jung Timothy T. K. , Yeo Sang‐Won , Choi Young‐Chul , Jeon Eun‐ju 
Published: November 2003

AbstractObjectives/Hypothesis Up to the present, many reports have demonstrated that local immune response is associated with maintenance and persistence of effusion in the middle ear cavity. Resulting retention of inflammatory cells and mediators in the middle ear results in ongoing effusion. The purpose of this study was to clarify the role of tumor necrosis factor in experimental otitis media with effusion, which was induced by transtympanic injection of tumor necrosis factor in the rats.Study Design Four groups were designed in two e‐periments. The purpose of e‐periment 1 was to confirm that transtympanic injection of TNF‐α produces the middle ear effusion. In experiment 2, TNFsolRI was used to evaluate the possibility as an inhibitor in otitis media with effusion.Methods The histopathological changes were observed under light microscope, and the changes in microvascular permeability were examined using Evans blue vital dye technique.Results Middle ear effusion was developed in 70% of specimens, and histopathological changes, such as subepithelial edema and marked infiltration of neutrophils, were present in 100% at 24 hours after administration of tumor necrosis factor‐α through transtympanic approach. Extravasation of Evans blue dye was found in all specimens injected by tumor necrosis factor‐α, which was qualified using a fluorescence microscope and quantified using a spectrophotometer. These histopathological findings and changes in microvascular permeability were significantly reduced by tumor necrosis factor soluble receptor type I.Conclusions Neutrophil infiltration, subepithelial edema, increased microvascular permeability, and resultant effusion were indirectly proved to be induced by tumor necrosis factor‐α. We hope that this study may contribute to understanding the role of tumor necrosis factor‐α in otitis media with effusion and clarifying the future role of tumor necrosis factor soluble receptor type I in preventing otitis media with effusion.
Functional Study of Four Neurotoxins as Inhibitors of Post‐traumatic Nerve Regeneration
Authors: Paydarfar Joseph A. , Paniello Randal C. 
Published: November 2003

AbstractObjectives/HypothesisChemical inhibition of nerve regeneration was studied as a potential adjunct in the treatment of injuries to the facial or recurrent laryngeal nerve. We propose that by treating selected muscles with an inhibitor of nerve regeneration shortly after injury, synkinesis may be controlled.Study DesignNerve regeneration after crush injury was studied in the rat posterior tibial and sciatic nerves, well‐established models for the study of peripheral nerve injuries.MethodsFour days after controlled crush injury to the posterior tibial nerve, the gastrocnemius muscle was injected with saline (control, n = 8), phenol (n = 6), doxorubicin (n = 6), or vincristine (n = 11). Injection without crush injury was performed using vincristine (n = 4) or botulinum toxin (n = 4). Four rats underwent crush injury to the sciatic nerve followed 4 days later by botulinum toxin injection to the gastrocnemius muscle. The percent of functional recovery (%FR) of the nerve was assessed using walking track analysis.ResultsVincristine significantly retarded nerve regeneration. Five weeks after injury, %FR returned to normal in controls, as well as in the phenol, doxorubicin, and botulinum toxin groups, while in the vincristine group %FR was less than 60% of baseline (P<.0001). Vincristine injections without crush injury showed no significant reduction in print length factor. Functional recovery in the botulinum/crush group was more rapid than the botulinum without crush group.ConclusionsApplication of vincristine to the gastrocnemius muscle significantly inhibits regeneration of the posterior tibial nerve after crush injury. Botulinum toxin does not prolong functional recovery after nerve injury; rather, crush injury protects against the prolonged chemodenervation seen with botulinum toxin. Doxorubicin and phenol injection did not prolong functional recovery at the doses tested.
Inner Ear Decompression Sickness in Sport Compressed‐Air Diving
Authors: Nachum Zohar , Shupak Avi , Spitzer Orna , Sharoni Zohara , Doweck Ilana , Gordon Carlos R. 
Published: November 2003

AbstractObjective We report our experience over the past 12 years with recreational diving‐related inner ear decompression sickness (IEDCS).Study Design Retrospective, consecutive case series.Methods Twenty‐four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow‐up.Results These 29 cases represent 26% of the severe decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the decompression schedule. The mean time from surfacing to appearance of symptoms was 47 ± 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo‐cochlear injury. Except for one patient who had central as well as peripheral vestibulo‐cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty‐six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05).Conclusions IEDCS related to compressed‐air recreational diving is more common than previously thought, and might occur even when no decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.
Can Eustachian Tube Ventilatory Function Impairment After Oxygen Diving Be Influenced by Application of Free Radical Scavenger Vitamins C and E?
Authors: Mutzbauer Till S. , Neubauer B. , Mueller P. H. J. , Sigg O. , Tetzlaff K. 
Published: November 2003

AbstractObjectives/Hypothesis To evaluate the influence of free radical scavenger vitamins C and E on eustachian tube ventilatory function changes related to oxygen dives.Study Design Prospective, randomized, double‐blind, placebo‐controlled study of middle ear impedance changes of oxygen divers being orally treated with free radical scavenger vitamins C and E.Methods Fifteen divers were allocated to two groups. Before diving on oxygen on consecutive days (days 1 and 2), divers in group 1 took a daily dose of 1 g ascorbic acid and 600 International Units d‐α‐tocopherol and divers in group 2 were given placebo. Before diving and 2 and 24 hours after diving on days 1 and 2, middle ear impedance was measured.Results Impedance decreased overnight after dive 1 (P = .04) but not after dive 2 (P = .31). No impedance differences were found between groups after the dive on day 1 (P = .83). Twenty‐four hours after the dive on day 1 and after the dive on day 2, impedance values in both groups were different (P = .02 vs. P = .07), emphasizing slightly more negative pressures in the vitamin group.Conclusion Vitamins C and E did not reduce eustachian tube ventilatory function impairment overnight after the dive on day 1, suggesting no evidence of free radical–mediated toxicity affecting the eustachian tube or middle ear mucosa. Repetitive oxygen dives may cause tissue adaptation suggesting other than antioxidant defense mechanisms.
Pediatric Laser‐Assisted Tympanostomy
Authors: Silverstein Herbert , Jackson Lance E. , Rosenberg Seth I. , Conlon W. Sean 
Published: November 2003

AbstractObjective To evaluate effectiveness of laser‐assisted tympanostomy in treatment of pediatric patients with chronic otitis media with effusion.Study Design Retrospective review of 23 pediatric patients who received office laser‐assisted tympanostomy.Methods A CO2 laser attached to an operating microscope with a microscope laser adaptor device or the handheld Oto‐LAM (Needham, MA) was used to perform all of the tympanostomies. The average diameter of tympanostomy was 2 mm; on average, 13.6 W was applied for 0.13 seconds.Results Laser‐assisted tympanostomy was performed on 37 pediatric ears (patient age range, 2–16 y) for the diagnosis of chronic otitis media with effusion. Average follow‐up time was 4.7 weeks. At the time of the follow‐up examination, 46% of the ears had no evidence of fluid and required no further intervention. Forty‐nine percent of the ears required placement of pressure equalization tubes. The average SRT improved from 30.8 dB preoperatively to 21.03 dB postoperatively.Conclusions Laser‐assisted tympanostomy appears to be an effective treatment for chronic otitis media with effusion in pediatric patients.
Gender‐Related Differences of Hyaluronic Acid Distribution in the Human Vocal Fold
Authors: Butler John E. , Hammond Thomas H. , Gray Steven D. 
Published: November 2003

AbstractObjective To quantify the distribution of hyaluronic acid (HA) within the normal human vocal fold and evaluate gender‐ and age‐related differences.Study Design Prospective, cross‐sectional study by age and gender groups using cadaveric vocal folds to study hyaluronic acid differences.Methods Twenty‐five vocal fold halves obtained at autopsy were evaluated from nine adult male (age range, 34–52 y), seven adult female (age range, 21–41 y), four geriatric male (age range, 65–77 y), and five geriatric female (age range 65–82 y) subjects. Midmembranous vocal fold sections were stained for HA using the Muller‐Mowry colloidal iron (acid mucopolysaccharide) stain with and without hyaluronidase. Digital imaging software was used to quantify the distribution of HA across the lamina propria at the vocal fold edge from superficial (subepithelial) to deep (vocalis muscle).Results A significant gender difference (P = .03) was noted in distribution when controlled for age. Combined, male subjects had a relatively constant distribution pattern throughout the depth of lamina propria. Female subjects showed relatively less HA in the first 15% of depth (most superficial) but showed more HA in the deeper 40% to 100% (toward vocalis muscle) than in male subjects.Conclusions Important clinical implications may be extrapolated from our findings. First, relatively less HA in the most superficial area implies less protection from vibratory trauma and overuse and may explain in part why more female than male patients have phonotrauma to phonotraumatic lesions. Second, evaluating the distribution of HA in the normal human vocal fold allows more direction in our application of HA as a therapeutic lamina propria substitute in patients with voice disorders.
Cost/Benefit Analysis of Open Tracheotomy, in the OR and at the Bedside, With Percutaneous Tracheotomy
Authors: Levin Roger , Trivikram Lalitha 
Published: November 2003

AbstractObjectives/Hypothesis (1) To determine whether percutaneous dilational tracheotomy (PDT), open tracheotomy in the operating room (OT/OR), and open tracheotomy at the bedside (OT/BS) are equally safe; and (2) to determine which procedure was most cost effective.Study Design Retrospective review of patient medical records and billing data.Methods Any adult patient (>20 y of age) on the medical or surgical services at Penn State Milton S. Hershey Medical Center who required a tracheotomy, elective or emergent, from September 1996 to July 1997 was included. The decision to perform OT in the OR, PDT, or OT at BS was made by the attending surgeon independent of this study. Each patient's course after tracheotomy was reviewed. All complications, perioperatively or postoperatively, for up to 10 days were documented. The complications were divided into two groups: major and minor. Determination of patient cost used surgical billing and OR materials staff records. The necessary equipment and staff for each procedure was determined, and an itemized cost list was retrospectively developed for a typical PDT, OT in OR, or OT at BS. The P values were calculated with the Cochran‐Mantel‐Haenszel (CMH) χ2 test of association.Results All procedures were equally safe, with PDT being the most cost effective.Conclusion This report confirms the results of several studies demonstrating that PDT, OT in the OR, and OT at the BS are equally safe; PDT appears to be most cost effective. Our analysis, however, does reveal several options for decreasing the cost of bedside tracheotomy to allow this procedure to be even more cost effective than PDT.
The Validity and Reliability of the Reflux Finding Score (RFS)
Authors: Belafsky Peter C. , Postma Gregory N. , Koufman James A. 
Published: November 2003

AbstractBackground The evaluation of medical and surgical outcomes relies on methods of accurately quantifying treatment results. Currently, there is no validated instrument whose purpose is to document the physical findings and severity of laryngopharyngeal reflux (LPR).Objective To evaluate the validity and reliability of the reflux finding score (RFS).Methods Forty patients with LPR confirmed by double‐probe pH monitoring were evaluated pretreatment and 2, 4, and 6 months after treatment. The RFS was documented for each patient at each visit. For test–retest intraobserver reliability assessment, a blinded laryngologist determined the RFS on two separate occasions. To evaluate interobserver reliability, the RFS was determined by two different blinded laryngologists.Results The mean age of the cohort was 50 years (± 12 standard deviation [SD]). Seventy‐three percent were women. The RFS at entry was 11.5 (± 5.2 SD). This score improved to 9.3 (± 4.7 SD) at 2 months, 7.3 (± 5.5 SD) at 4 months, and 6.1 (± 5.2 SD) at 6 months of treatment (P <.001 with trend). The mean RFS for laryngologist no. 1 was 10.8 (± 4.1 SD) at the initial screening and 10.8 (± 4.0 SD) at the repeat evaluation (r = 0.95, P <.001). The mean RFS for laryngologist no. 2 was 11.1 (± 3.8 SD) at the initial screening and 10.9 (± 3.7 SD) at the repeat evaluation (r = 0.95, P <.001). The correlation coefficient for interobserver variability was 0.90 (P <.001).Conclusions The RFS accurately documents treatment efficacy in patients with LPR. It demonstrates excellent inter‐ and intraobserver reproducibility.
Immediate Percutaneous Medialization for Acute Vocal Fold Immobility With Aspiration
Authors: Anderson Timothy D. , Mirza Natasha 
Published: November 2003

AbstractObjectives To determine the efficacy of immediate bedside or office percutaneous, trans‐thyroidal injections of a bioabsorbable gelatin material (Gelfoam, Upjohn Co., Kalamazoo, MI) to decrease the risk of aspiration resulting from acute vocal fold immobility.Study Design Retrospective review of patients presenting with acute vocal fold immobility and aspiration or high aspiration risk at an urban, tertiary care university hospital.Methods All patients were evaluated by videostroboscopy, functional endoscopic evaluation of swallowing (FEES), and objective voice measures. Patients with acute vocal fold immobility and evidence of aspiration on history or FEES were given the option of medialization by Gelfoam injection. Injections were performed percutaneously in the office or at the bedside under laryngoscopic guidance. FEES was repeated after injection to verify improvement in aspiration.Results Eleven patients underwent Gelfoam injection for treatment of aspiration and vocal fold immobility. All were significantly improved on post‐injection FEES study. All patients were returned to an oral diet, avoiding the need for long‐term enteral access.Conclusion Percutaneous Gelfoam injections is a rapid, temporary solution to the common problem of aspiration resulting from acute vocal fold immobility.
Microbiology of Chronic Frontal Sinusitis
Authors: Schlosser Rodney J. , London Scott D. , Gwaltney Jack M. , Gross Charles W. 
Published: November 2003

AbstractObjectives To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis.Study Design Retrospective, nonrandomized study.Methods Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis.Results Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase‐negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase‐negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery.Conclusions This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase‐negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.
Anterior and Posterior Medialization (APM) Thyroplasty
Authors: Hong Ki Hwan , Kim Joong Ho , Kim Hyun Ki 
Published: November 2003

AbstractObjective In unilateral vocal fold paralysis with dysphonia, most of the paralyzed vocal folds may be medialized effectively by medialization laryngoplasty. However, if the posterior glottal gap is wide, these procedures may sometimes have a limit to medialize the posterior glottis and cannot be effective for acceptable voice quality. The objective of this study is to introduce a new surgical technique for medializing the membranous and cartilaginous portions of the paralyzed vocal fold: anterior and posterior medialization (APM) thyroplasty.Method Six patients underwent APM thyroplasty. They completed preoperative and postoperative evaluation with acoustic analysis and video laryngoscopy.Results All patients satisfied their voice subjectively after surgery. The paralyzed vocal folds, membranous and cartilaginous parts, were medialized well, and the paralyzed arytenoid showed less anterior tipping postoperatively. On voice analysis all patients showed prolonged phonation times and decreased perturbations after surgery.Conclusion The advantages of this procedure are to medialize the membranous and cartilaginous portions of the paralyzed vocal fold directly and to correct vertical mismatch between two vocal folds. This procedure might be especially indicated in the lateralized position of the paralyzed vocal fold but not in the higher paralyzed vocal fold compared with the normal vocal fold.
Evaluation of Inlay Butterfly Cartilage Tympanoplasty: A Randomized Clinical Trial
Authors: Mauri Marcelo , Neto José Faibes Lubianca , Fuchs Sandra Costa 
Published: November 2003

AbstractObjectives/Hypothesis In 1998 Eavey described a new inlay technique for tympanoplasty in the pediatric age group using a cartilage graft through a transcanal approach. This technique was found to be effective and comfortable (no external canal incisions or ear packing). This study evaluated the efficacy of modified‐inlay cartilage tympanoplasty compared with the conventional underlay tympanoplasty.Study Design Randomized clinical trial.Methods Patients were enrolled from December 1998 to March 2000. Seventy tympanoplasties were done in adults with medium‐sized tympanic membrane (TM) perforations: 34 inlay tympanoplasties and 36 underlay tympanoplasties (control group). The main outcome measures were the “take rate” on the 30th postoperative day and the audiometric result at the second postoperative month. Secondary outcome measures include subjective postoperative hearing, postoperative pain, duration of surgery, and cost of the procedures.Results The “take rate” did not differ between groups on the 30th postoperative day (88.2% in the inlay tympanoplasty group vs 86.1% in the underlay tympanoplasty group;P = .8). After a mean follow‐up of 7.5 ± 3.8 months (range, 3–16 mo), the “take rate” was 85.3% in the inlay tympanoplasty group and 83.3% in the underlay tympanoplasty group (P = .8). In the inlay tympanoplasty group there was closure of the air–bone gap (ABG) to within 10 dB in 64.7% and to within 20 dB in 94.1%. The corresponding numbers to underlay tympanoplasty were 75% and 97.2%. In only 2 cases (5.9%) in the inlay tympanoplasty group and in 1 case (2.8%) in the underlay tympanoplasty group the ABG was greater than 20 dB. No audiometric difference was observed between groups (P = .6). Most patients in the inlay tympanoplasty group reported immediate improvement in their hearing (P <.0001). Pain was reported by 10 patients in the inlay tympanoplasty group and by 30 patients in the underlay tympanoplasty group on the first postoperative day (P <.0001). The duration of the surgery (mean ± standard deviation) was 33.6 ± 7.8 minutes for the inlay tympanoplasty group and 62.9 ± 12.7 minutes for the underlay tympanoplasty group (P <.0001). The estimated charge for inlay tympanoplasty at our institution was 65% less expensive than underlay tympanoplasty.Conclusion The “take rate” and audiometric results following inlay cartilage tympanoplasty or underlay tympanoplasty were similar. Inlay butterfly cartilage tympanoplasty did not require general anesthesia, was less expensive, and more comfortable to the patient.
Recurrence and Its Avoidance in Juvenile Angiofibroma
Authors: Howard David J. , Lloyd Glyn , Lund Valerie 
Published: November 2003

AbstractObjective Angiofibroma is a highly vascular lesion for which a wide range of surgical approaches has been recommended. Irrespective of the approach, a significant and often rapid recurrence rate is reported in all major series.Aim To consider the impact of lessons learned from imaging on the recurrence rate of angiofibroma.Material and Methods From a cohort of 90 male patients with histologically proven angiofibroma, 40 individuals were studied. The recurrence rate in 20 cases treated before March 1998 was compared with that in 19 cases treated thereafter. In the latter group, an additional exploration of the basisphenoid had been undertaken.Results The two cohorts were comparable in age range (7–27 y and 11–24 years, respectively), and all had been treated by midfacial degloving. In the first group, 8 recurrences occurred which were multiple in 1 patient. In the next 19 patients, the area of the pterygoid canal was meticulously explored and the basisphenoid drilled to remove all residual tumor. No recurrences have occurred in this group during a follow‐up of between 6 months to 3 years.Conclusion Meticulous removal of angiofibroma infiltrating the pterygoid canal and basisphenoid is paramount to avoid “recurrence.”