bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of Completion Thyroidectomy Following Unilateral Lobectomy for Well‐Differentiated Thyroid Cancer
Authors: Kupferman Michael E. , Mandel Susan J. , DiDonato Liesje , Wolf Pat , Weber Randal S. 
Published: November 2003

AbstractObjectives When a diagnosis of thyroid cancer is returned following unilateral lobectomy, removal of the contralateral lobe is frequently necessary. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer.Study Design Retrospective chart review.Methods Between 1997 and 2000, 36 consecutive patients, 32 females and 4 males, with a mean age of 43.6 years (range, 19–59 y), underwent completion thyroidectomy. Preoperative fine‐needle aspiration revealed follicular derived neoplasm in 32 patients (88.9%), indeterminate in 3 patients (8.3%), and Hürthle cell neoplasm in 1 patient (2.8%). The interval between the first and second operation was a mean of 43.3 days (range, 2–103 d).Results At the primary surgery, 29 patients (80.6%) had a follicular variant of papillary carcinoma, 6 (16.7%) had follicular carcinoma, and 1 (2.8%) had Hürthle cell carcinoma. Of these, 14 had multifocal disease. In the completion lobe, 20 patients (55.6%) had evidence of thyroid carcinoma. There was a 0% incidence of RLN injury, and the mean pre‐ and post‐completion thyroidectomy serum calcium was 8.9 mg/dL and 8.6 mg/dL, respectively. There was one postoperative hematoma, requiring re‐exploration. Five patients (13.9%) had a transient postoperative serum calcium (Ca) <8.0 mg/dL, with one being symptomatic. None required vitamin D or prolonged calcium supplementation.Conclusions When completion thyroidectomy is necessary for the treatment of thyroid malignancy, the procedure can be performed safely with low morbidity and is effective for diagnosing and removing occult disease in the remaining thyroid.
Laryngeal Electromyography in the Management of Vocal Cord Mobility Problems in Children
Authors: Jacobs Ian N. , Finkel Richard S. 
Published: November 2003

AbstractObjectives To evaluate the efficacy and clinical usefulness of laryngeal electromyography (EMG) in the evaluation and management of vocal cord mobility problems in children; and to determine the ability of laryngeal EMG to differentiate vocal fold fixation versus paralysis.Study Design Case‐series review of 8 children with vocal cord immobility who underwent laryngeal EMG.Methods Eight children with bilateral vocal fold immobility underwent microlaryngoscopy and electromyography. Bipolar concentric needle electrodes were used and implanted separately into both posterior cricoarytenoid (PCA) and both thyroarytenoid (TA) muscles. EMG activity was recorded during spontaneous ventilation under a light plane of anesthesia with propofol. EMG activity was correlated with the phases of the respiratory cycle.Results Three patients had evidence of normal EMG activity with PCA activity peaking during early inspiration. Maximal TA activity occurred expiration. These patients were assumed to have vocal fold fixation. Two of these 3 patients underwent laryngotracheoplasty (LTP) with posterior glottic expansion with costal cartilage. One is being considered for LTP in the future. Five patients had abnormal EMG activity and remain tracheotomy‐dependent. Four patients exhibited synkinetic activity with peak PCA activity during expiration and peak TA activity during expiration. Two patients had both fixation and unilateral vocal cord paralysis. One was successfully decannulated after posterior graft LTP and the other is planned for the future.Conclusions Electromyography, which differentiates paralysis from fixation, is a useful diagnostic tool in the evaluation of children with vocal cord immobility.
Orbital Preservation in Surgical Management of Sinonasal Malignancy
Authors: Imola Mario J. , Schramm Victor L. 
Published: November 2003

AbstractObjective To determine the oncological and functional outcome when applying defined criteria for orbital preservation during surgical treatment of sinonasal malignancy encroaching on the orbital structures.Study Design Retrospective consecutive review of patients in tertiary care center setting.Methods Analysis of 66 patients undergoing surgical treatment for sinonasal malignancy encroaching on the orbit. Orbital preservation was performed in all patients with tumor extension up to and including resectable periorbital involvement. Minimum follow‐up was 2 years. Detailed analysis of oncological and functional outcomes is included.Results Of 66 tumors abutting or invading into the orbit, 54 were amenable for surgical treatment with orbital preservation and the remaining 12 underwent orbital exenteration. Histopathological findings were divided into five subgroups: squamous cell carcinoma, adenomatous carcinomas, sinonasal undifferentiated carcinoma, sarcoma, and other. Squamous cell carcinoma represented the largest subgroup (24 patients), and 5‐year overall actuarial survival was not statistically different (P = 1.4; relative risk, 0.713) between patients treated with orbital preservation (53%) versus those undergoing exenteration (46%). Similarly, no difference in survival was found in the adenomatous carcinoma subgroup. Within the orbital preservation group as a whole, local recurrence occurred in 30% patients (16 of 54) compared with 33% patients (4 of 12) treated with orbital exenteration. Of note, eye‐sparing surgery was associated with local recurrence at the original site of orbital involvement in only 7.8% of cases (4 of 54). Overall eye function was graded as functional without impairment in 54% of patients (29 of 54), functional with impairment in 37% (20 of 54), and nonfunctional in 9% (5 of 54). The most common abnormality was globe malposition (enophthalmos or hypophthalmos) that was seen in 34 patients (63%) and was associated with the lack of adequate rigid reconstruction of subtotal or total orbital floor or multisegment orbital defects. However, enophthalmos was asymptomatic in the majority of cases, and persistent diplopia occurred in only five patients (9%). Various ocular sequelae were present in 20 of the 49 patients (41%) with functional eyes. Radiation therapy increased the risk of ocular complications, in particular, optic atrophy, cataract formation, excessive dryness, and ectropion.Conclusions Selective orbital preservation is oncologically safe and is a worthwhile undertaking in attempting to maintain a functionally useful eye with surgical management of sinonasal malignancy encroaching on the orbit. Consideration should be given to rigid orbital reconstruction in larger defects resulting from subtotal or total orbital floor resection or resections involving two or more orbital walls.
Perspectives in Laryngopharyngeal Reflux: An International Survey
Authors: Book David T. , Rhee John S. , Toohill Robert J. , Smith Timothy L. 
Published: November 2003

AbstractObjectives Although data exists to support the relationship between laryngopharyngeal reflux (LPR) and laryngitis, there is variability among otolaryngologists regarding the methods and criteria used to make the diagnosis. This study was undertaken to discern the current attitudes and practices of a select cohort of otolaryngologists in regards to LPR.Methods Four hundred fifteen surveys were mailed to members of the American Broncho‐Esophagological Association. Survey recipients were asked to rate patient symptomatology and physical examination findings in terms of their relationship to LPR and their preferred laryngeal visualization procedure in terms of clinical use and diagnostic accuracy. The role and validity of adjunctive diagnostic tests were also surveyed.Results Survey response rate was 38%. Symptoms felt to be most related to reflux were: throat clearing (98.3%), persistent cough (96.6%), heartburn/dyspepsia (95.7%), globus sensation (94.9%), and voice quality change (94.9%). The physical examination findings felt to be most related to reflux included: arytenoid erythema (97.5%), vocal cord erythema (95.7%) and edema (95.7%), posterior commissure hypertrophy (94.9%), and arytenoid edema (94.0%). Fiberoptic laryngoscopy was the most commonly performed diagnostic visualization procedure (75.7%) and was also considered to be most sensitive and specific (45.0%). The most commonly ordered adjunctive test was a double pH probe (37.2%), which was also felt to be the most sensitive and specific adjunctive test (75.9%).Conclusion A polling of a select group of otolaryngologists demonstrated agreement in the criteria used to diagnose reflux laryngitis, although some variability exists. The development of objective guidelines for the diagnosis of LPR is a critical initial step toward evaluating the manifestations and therapeutic interventions for this disease process.
Laryngeal Collagen Injection as an Adjunct to Medialization Laryngoplasty
Authors: Hoffman Henry , McCabe Daniel , McCulloch Timothy , Jin Sung M. , Karnell Michael 
Published: November 2003

AbstractObjectives/Hypothesis Dysphonia associated with laryngeal paralysis may be identified in the short term postoperatively or may develop years after successful medialization laryngoplasty. In selected cases, laryngeal collagen injection permits further medialization of one or both vocal folds by small increments to improve phonation after medialization thyroplasty. The study seeks to determine whether collagen injections result in measurable improvements in voice quality and vocal function when offered to select patients who have received medialization thyroplasty.Study Design Retrospective review of patient charts and voice database.Methods Seven patients were treated with Zyderm II collagen using indirect mirror laryngoscopy and a curved injection apparatus. Changes in voice quality and function were assessed by comparing measures obtained before treatment (mean period, 5.6 d), shortly after treatment (mean period, 38.1 d), and in the long term after treatment (mean period, 226 d).Results Mean self‐ratings of the patient, clinician's ratings, and objective measures demonstrated measurable improvement in vocal function after collagen injection.Conclusions The office‐based procedure offers a simple, efficient adjunct to open techniques of medialization laryngoplasty. Techniques of anesthesia, injection, and patient selection are discussed.
Endoscopic CO2 Laser Management of Laryngocele
Authors: Devesa Pablo Martinez , Ghufoor Khalid , Lloyd Simon , Howard David 
Published: November 2003

AbstractObjective To report on the management of laryngoceles by CO2 laser‐assisted endoscopic excision.Study Design A 15‐year retrospective study of 12 adult patients (7 men and 5 women) who presented with a laryngocele. Nine patients had an internal laryngocele, one patient had an external laryngocele, and two patients had combined internal‐external components. Two laryngoceles were right‐sided, six were left‐sided, and four were bilateral.Methods An endoscopic examination of the laryngocele was carried out for both diagnostic and therapeutic purposes. Once identified the air‐ or mucus‐filled cyst (extending from the laryngeal ventricle into the paraglottic space and beyond the thyrohyoid membrane in some cases), the laryngocele was excised in toto, with its surrounding capsule, via endoscopic approach using the CO2 laser.Results The main presenting symptom was dysphonia in seven patients, visible or palpable mass in the neck in three, and upper airway obstruction in the remaining two. All laryngoceles were treated with endoscopic laser excision of the internal and external components when required. The average postoperative stay in hospital was 1.8 days. Only two of the patients treated had a tracheotomy; both cases presented elsewhere with an emergency airway obstruction, which necessitated tracheotomy. In these two cases, decannulation was subsequently performed. There were no significant complications. The follow‐up ranged from 6 months to 5 years.Conclusion CO2 laser‐assisted endoscopic excision of a laryngocele is a quick, precise, and safe alternative to an external approach excision (lateral thyroidotomy, laryngofissure) with fewer complications than its external counterparts, resulting in speedier rehabilitation of both the patient and his or her voice.
Surgical Management of Posterior Epistaxis: A Changing Paradigm
Authors: Klotz Darrell A. , Winkle Mark R. , Richmon Jeremy , Hengerer Arthur S. 
Published: November 2003

AbstractObjective To demonstrate that surgery, as the initial treatment option for posterior epistaxis, can provide comparable success and complication rates to nonsurgical management with fewer associated costs.Study Design A retrospective chart review and cost analysis.Methods Two hundred three consecutive charts were reviewed for patient outcome, complications, and hospitalization time. Average costs were calculated from hospital department and physician fee schedules.Results Average success rate of all surgical procedures performed for posterior epistaxis was 90%, anterior–posterior packing success was 62%, and embolization success was 75%. The packing‐only group had a significantly greater mean hospitalization time (5.29 d) than patients who were treated either surgically (2.1 d) or with embolization (2.6 d). The average per‐patient admission charges were, for successful posterior packing, $5136 per patient; for surgical treatment, $3851 per patient; and for embolization, $5697 per patient. Surgery offered a cost savings of $1846 per patient over traditional packing. There was no significant difference in complication rates between the groups.Conclusion The review suggests that a better success rate, a comparable complication rate, and a cost savings can be achieved with surgical intervention as the first‐line treatment for intractable epistaxis when compared with traditional anterior–posterior packing and embolization.
Laryngeal Mask Anesthesia With Intraoperative Laryngoscopy for Identification of the Recurrent Laryngeal Nerve During Thyroidectomy
Authors: Scheuller Michael C. , Ellison David 
Published: November 2003

AbstractObjectives/Hypothesis A critical step in thyroidectomy involves definitive identification of the recurrent laryngeal nerve (RLN). Using the laryngeal mask airway, identification of the RLN can be facilitated by stimulation of the nerve while monitoring vocal cord movement with a fiberoptic laryngoscope. We present this technique as an effective and safe means to identify the RLN during thyroid surgery, with significant advantages over existing techniques in appropriately selected patients.Study Design Retrospective case series.Methods We performed thyroidectomy on 8 patients (13 RLN identifications) in which laryngeal mask airway anesthesia with fiberoptic laryngoscopy was used to identify the RLN. Results are reviewed with regard to postoperative vocal cord function, as well as intraoperative and postoperative courses with laryngeal mask airway anesthesia.Results In all 13 cases in which the RLN was sought, it was definitively identified by witnessing brisk vocal cord movement on a video screen with stimulation of the RLN. No patient had postoperative vocal cord paresis or paralysis. Overall recovery from laryngeal mask airway anesthesia was uneventful and had advantages when compared with general anesthesia with endotracheal intubation.Conclusions Laryngeal mask airway anesthesia with intraoperative fiberoptic laryngoscopy to identify the RLN is effective and safe in carefully selected patients. Advantages include decreased postoperative throat discomfort, absence of coughing during emergence from anesthesia, and elimination of the possibility of vocal cord mobility impairment secondary to RLN ischemia from the endotracheal tube balloon. In addition, this technique is applicable in operations besides thyroid surgery, in which definitive identification of the RLN is indicated.
Prevalence of Esophagitis in Patients With pH‐Documented Laryngopharyngeal Reflux
Authors: Koufman James A. , Belafsky Peter C. , Bach Kevin K. , Daniel Elena , Postma Gregory N. 
Published: November 2003

AbstractObjective To report the prevalence of esophagitis in patients with pH‐documented laryngopharyngeal reflux.Study Design Prospective study of 58 consecutive patients with documented laryngopharyngeal reflux, all of whom underwent transnasal esophagoscopy as part of their reflux evaluations.Methods All patients with a diagnosis of laryngopharyngeal reflux confirmed by abnormal pharyngeal pH monitoring over a 5‐month period were included, and all subjects completed a self‐administered reflux symptom index and underwent transnasal esophagoscopy with directed biopsy.Results Of the 58 study patients with pH‐documented laryngopharyngeal reflux, the mean age was 49 years (± 13 y), and 53% (31 of 58) were women. Of the study group, 40% (23 of 58) had heartburn and 48% (28 of 58) had abnormal esophageal reflux (by pH monitoring criteria); by transnasal esophagoscopy with biopsy, 12% (7 of 58) had esophagitis and another 7% (4 of 58) had Barrett's metaplasia. Thus, 60% of the study cohort had no heartburn, and 81% (47 of 58) had normal esophageal epithelium (i.e., no esophagitis or Barrett's metaplasia).Conclusions In the present series of patients with documented laryngopharyngeal reflux the prevalence of esophagitis and Barrett's metaplasia was only 19%. These data confirm the clinical impression that the patterns, mechanisms, and manifestations of laryngopharyngeal reflux differ from those of classic gastroesophageal reflux disease. Unlike gastroesophageal reflux disease, patients with laryngopharyngeal reflux uncommonly have esophagitis. Thus, although esophagoscopy may be an excellent method for screening the esophagus, it is not the method of choice for diagnosing laryngopharyngeal reflux.
Evolving Resistant Pseudomonas to Ciprofloxacin in Malignant Otitis Externa
Authors: Berenholz Leonard , Katzenell Udi , Harell Moshe 
Published: November 2003

AbstractObjectiveTo determine whether there has been an increase in ciprofloxacin‐resistant pseudomonas malignant otitis externa, and if this has increased the morbidity of the disease.Study DesignRetrospective.SettingTertiary referral center.PatientsTwenty‐eight patients over 13 years.ResultsThe records of a total of 28 patients who were admitted between 1988 and 2001 with the diagnosis of malignant otitis externa were reviewed. Seven patients had ciprofloxacin‐resistant pseudomonas on their hospital culture and sensitivity test. Five of the 7 resistant cases appeared in the last 3 years, as opposed to 2 of the 7 who appeared in the 10 years before that period. In our series, there is a significant trend developing over time of pseudomonas resistant to treatment with ciprofloxacin. No increased morbidity or mortality was found in the ciprofloxacin‐resistant pseudomonas group compared with the remaining patients who were sensitive to ciprofloxacin.ConclusionsIn our series, resistance to ciprofloxacin in patients with malignant otitis externa is increasing over time. This may have an impact on the relatively successful outpatient treatment of these patients in the past decade. A return to inpatient or outpatient intravenous treatment with third‐generation cephalosporins/antipseudomonal penicillins and more frequent debridement will be required in these patients.
Otologic Manifestations of Wegener's Granulomatosis
Authors: Takagi Dai , Nakamaru Yuji , Maguchi Shiroh , Furuta Yasushi , Fukuda Satoshi 
Published: November 2003

AbstractObjective/Hypothesis To evaluate the clinical features, treatment, and outcomes of otologic manifestations in Wegener's granulomatosis (WG) treated at Hokkaido University Graduate School of Medicine, Sapporo, Japan.Study Design We retrospectively reviewed 15 cases of WG with ear involvement.Methods Twenty‐five patients with WG were treated at Hokkaido University Graduate School of Medicine between 1992 and 2001. Fifteen of these patients had otologic symptoms. We evaluated the clinical course, method of therapy, and outcomes in all cases. Diagnosis of WG was made when the patients had clinical findings and a positive titer of cytoplasmic pattern antineutrophil cytoplasmic antibodies (c‐ANCA), or when there were clear histologic findings. We also present three case reports.Results In 15 cases, the most frequent finding was chronic otitis media. Sensorineural hearing loss was present in 2 patients. In 7 patients whose otologic manifestations were the primary involvement of WG, all were confirmed positive for c‐ANCA and were treated with glucocorticoids and immunosuppressive drugs. Three patients who could be treated within 1 month of symptom onset showed marked improvement.Conclusions In localized cases, biopsy specimens are often small, and it is frequently difficult to make a histologic diagnosis. The prognosis for hearing was poor when appropriate treatment was not given in the early stages of the disease. Therefore, WG should be included in the differential diagnosis in cases of atypical inflammatory states of the ear. Early diagnosis and appropriate treatment are important to prevent irreversible changes in the middle ear and inner ear.
Nissen Fundoplication Surgery for Extraesophageal Manifestations of Gastroesophageal Reflux (EER)
Authors: Lindstrom Dean R. , Wallace James , Loehrl Todd A. , Merati Albert L. , Toohill Robert J. 
Published: November 2003

AbstractObjective To determine the outcome of Nissen fundoplication surgery for the treatment of patients with chronic extraesophageal manifestations of reflux (EER).Methods A retrospective medical record analysis was performed. Patient demographics, extraesophageal disease secondary to gastroesophageal reflux (GER), methods of GER diagnosis, acid suppression therapy before antireflux surgery, and response to surgical intervention were evaluated.Results The charts of 29 patients who underwent Nissen fundoplication surgery for EER were included in the study. Hoarseness was present in 17 patients; laryngopharyngeal reflux (LPR) was the most common diagnosis (n = 20). Barium esophagram was done in all patients and revealed abnormalities indicative of GER in 26 patients. Twenty‐four‐hour ambulatory pH study was done in 27 patients and pharyngeal reflux was present in 19. Preoperative esophageal endoscopy was performed in 22 patients. This study revealed evidence of gastroesophageal reflux disease (GERD) in 14 patients with 8 having evidence of Barrett's esophagus. Sixteen of the 29 patients had symptoms or findings of GERD. Twenty‐eight patients had laparoscopic Nissen fundoplication (LNF) and 1 had an open procedure. Twenty‐five of the 29 patients (follow‐up ranging from 6–108 mo) had excellent results with near‐total freedom from symptoms and are taking no acid‐suppressive medications.Conclusions GER has an important role in the cause of many otolaryngologic and pulmonary disorders. Nissen fundoplication is an effective modality to treat EER in selected cases.