bluuebunny/crossref_metadata_2025_split huggingface dataset:
Videostroboscopy of the Pharyngoesophageal Segment in Laryngectomy Patients Treated With Botulinum Toxin
Authors: Meleca Robert J. , Dworkin James Paul , Zormeier Michele M. , Simpson Mark L. , Shibuya Terry , Mathog Robert H. 
Published: February 2003

OBJECTIVES:The purpose of this investigation was to use videostroboscopy to study the physiologic and biomechanical effects of botulinum toxin (Botox) injection on the pharyngoesophageal segment (PES) in total laryngectomy patients with poor‐quality tracheoesophageal puncture (TEP) voice caused by PES spasm.METHODS:The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were conducted before and after Botox injection of the PES. Ratings of videostroboscopic and speech samples were performed by 3 blinded judges with extensive experience with this patient population.RESULTS:Perceptually, TEP voice was more fluent and less strained after injection. Videostroboscopically, patients demonstrated improved PES volitional control and mucosal wave characteristics after Botox injection.CONCLUSION:Botox injection in total laryngectomy patients with poor‐quality TEP voice caused by PES spasm provides improved physiologic and biomechanical function of the PES, as demonstrated for the first time videostroboscopically. These findings help explain the perceptual ratings of TEP voice improvement noted after Botox injection. Video‐stroboscopy can be used to provide diagnostic information to help confirm the clinical impression of PES spasm, as well as to document the effects of Botox injection on PES function.
Ossiculoplasty in Canal Wall Down Mastoidectomy
Authors: Berenholz Leonard P. , Rizer Franklin M. , Burkey John M. , Schuring Arnold G. , Lippy William H. 
Published: February 2003

OBJECTIVE:The aim of this study was to evaluate the initial and longer term success of closing the air‐bone gap (ABG) to 20 dB in ossiculoplasty with canal wall down mastoidectomy.METHODS:This study was conducted at a private otologic practice. Patients included those who underwent ossiculoplasty from 1989 to 1996 with canal wall down mastoidectomy, whether primary or revision (33 from a total of 387 tympanomastoidectomies). Outcome measures included ABG closure, long‐term hearing stability, mastoid appearance, extrusion, and sensorineural hearing loss.RESULTS:Almost 64% of ABGs were closed to within 20 dB. The mean pure‐tone average improvement was 12.3 dB. The mean PTA hearing decline in the years after surgery was slightly less than 1 dB/year.CONCLUSION:Hearing improvement with a stable long‐term hearing result is possible with canal wall down mastoidectomy. The potential for hearing gain is greatest for patients having larger preoperative ABGs. (Otolaryngol Head Neck Surg 2000;123: 30‐3.)
Efficacy of Uvulopalatopharyngoplasty in Unselected Patients with Mild Obstructive Sleep Apnea
Authors: Senior Brent A. , Rosenthal Leon , Lumley Alicia , Gerhardstein Rebecca , Day Ryan 
Published: February 2003

OBJECTIVESUvulopalatopharyngoplasty (UPPP) is widely used as a first‐step procedure for the surgical management of obstructive sleep apnea (OSA) syndrome but best manages obstruction occurring at the level of the oropharynx alone and not the hypopharynx. Previous publications have noted mediocre results with use of this procedure in unselected patients with OSA, but less clear is the effectiveness of this procedure in the unselected patient with mild OSA (respiratory event index [REI] 5‐25). Using objective and subjective criteria, we retrospectively analyzed the results of UPPP in patients with mild OSA.METHODSWe examined 37 patients with mild OSA (REI 13.5 ± 5.1, range 5.6‐23.1) who had been operated on during 1996 with UPPP with or without tonsillectomy and/or septoplasty. Follow‐up polysomnography was obtained in 25 (68%) an average of 40.5 weeks after surgery and compared with findings before surgery. Subjective assessment of sleepiness was performed with the Sleep‐Wake Activity Inventory.RESULTSTen patients (40%) had a postoperative reduction in the REI of more than 50%, comparable with the improvements reported in those with more severe apnea. Those who did not have a reduction in REI after surgery actually saw an increase in average REI from 16.6 ± 5 to 26.7 ± 18.4. Similarly, subjective assessment of sleepiness with the Sleep‐Wake Activity Inventory showed no statistically significant improvement after surgery.CONCLUSIONOverall, these results indicate that UPPP alone in the unselected patient provides little benefit in the management of mild OSA, similar to findings for more severe OSA. Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to tailor the appropriate retropalatal and/or retrolingual procedures and thereby achieve excellent surgical outcomes.
Surgical Management of Carotid Body Tumors
Authors: Wang Steven J. , Wang Marilene B. , Barauskas Tanya M. , Calcaterra Thomas C. 
Published: February 2003

OBJECTIVEThe goal was to review our experience in the management of carotid body tumors at a tertiary referral center.METHODSA retrospective review was performed of patients at University of California‐Los Angeles Medical Center in whom carotid body tumor was diagnosed between 1973 and 1998.RESULTSTwenty‐nine patients with 36 carotid body tumors were identified. Thirty‐five operations were performed. Seventeen patients underwent preoperative embolization. The blood loss for these patients was less than for those without embolization. Five patients had preoperative cranial nerve deficits. Neurologic deficits were noted in 41% of patients immediately after surgery. In 24% of patients, the deficits were permanent.CONCLUSIONSurgical resection is the treatment of choice for carotid body tumors. Embolization immediately before surgery decreases blood loss and facilitates tumor removal. In our series, the risk of new postsurgical cranial nerve deficits was small. Observation of these tumors is not recommended because progressive growth is associated with increased risk of neurologic deficits.
Second Place—Resident Clinical Science Award 1999 Laryngeal Chemoreflex Severity and End‐Apnea Pao2 and Paco2
Authors: Heman‐Ackah Yolanda D. , Goding George S. 
Published: February 2003

OBJECTIVEThe laryngeal chemoreflex (LCR) is a model for investigating the sudden infant death syndrome. The severity of the LCR‐induced response may vary. This study examines the conditions under which recovery from the LCR‐induced apnea occurs.METHODSTwenty‐five piglets underwent normoxic laryngeal stimulation (Pao2 > 70 mm Hg); 11 then underwent hypoxic stimulation (Pao2 50‐65 mm Hg). Cardiovascular and respiratory responses were recorded.RESULTSRecovery Pao2 was lower during profound responses (Pao2 = 45.9 ± 12.8 mm Hg) than during moderate (Pao2 = 54.9 ± 7.5 mm Hg) and mild (Pao2 = 60.6 ± 10.3 mm Hg) responses (analysis of variance [ANOVA], P = 0.05). Recovery Paco2 did not vary (ANOVA, P > 0.05). Blood pressure and O2 saturation declined at faster rates with increasing severity of response (ANOVA, P < 0.05 for both).CONCLUSIONSResumption of respiration after LCR‐induced apnea is associated with a consistent level of Paco2. The severity of the response is associated with recovery Pao2 levels.
Osteoradionecrosis of the Maxillary‐Orbital Complex After Neutron Beam Radiotherapy
Authors: Marunick Mark T. , Bahu Samer J. , Aref Amr 
Published: February 2003

OBJECTIVENeutron beam radiotherapy (NRT) has been advocated for treatment of malignant salivary gland tumors and adenoid cystic carcinoma of the paranasal sinuses. The purpose of this study is to determine whether primary or adjuvant NRT results in a significantly increased rate of osteoradionecrosis (ORN) of the maxillary‐orbital complex (MOC).STUDY DESIGN AND SETTINGAll patients who received primary or adjuvant NRT involving the MOC and/or maxillofacial prosthetic rehabilitation at Wayne State University from 1992 to 1997 were evaluated (n = 9).RESULTSORN did not develop in any of the 5 patients who received primary NRT. All 4 patients who received adjuvant NRT after surgical resection had ORN involving the MOC within the irradiated fields.CONCLUSIONThe reported trend of ORN after definitive surgery and NRT shows a markedly increased complication rate.SIGNIFICANCEThe use of adjuvant NRT after definitive surgical resection involving the MOC should be considered with great caution.
New Approach for Cochlear Implantation: Cochleostomy Through the Middle Fossa
Authors: Colletti Vittorio , Fiorino Francesco G. , Carner Marco , Sacchetto Luca , Giarbini Nadia 
Published: February 2003

The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insertion of a cochlear implant. Fibroadhesive otitis media (n = 1), bilateral cavity radical mastoidectomy (n = 1), autoimmune inner ear disease (n = 2), previous cranial trauma (n = 1), genetic prelingual deafness (n = 5), and otosclerosis (n = 1) were the causes of deafness. A cochleostomy was performed on the most superficial part of the basal turn, and the electrode array was inserted up to the cochlear apex. Speech perception tests (1‐9 months after cochlear implant activation) yielded better results in these patients compared with a homogeneous group of postlingually deaf patients operated on through the traditional transmastoid route. Insertion of the implant through the middle fossa cochleostomy furnishes the possibility of stimulating areas of the cochlea (ie, the middle and apical turns) where a greater survival rate of spiral ganglion cells is known to occur, with improvement of information regarding the formants relevant for speech perception. (Otolaryngol Head Neck Surg 2000;123:467‐74.)
Image‐Guided Functional Endoscopic Sinus Surgery
Authors: Olson Garth , Citardi Martin J. 
Published: February 2003

INTRODUCTIONComputer‐aided surgery (CAS) technology in functional endoscopic sinus surgery (FESS) has engendered considerable discussion.OBJECTIVEThe goals of this study were to describe CAS preoperative planning (software‐based CT image analysis) and to develop intraoperative CAS strategies for endoscopic sinus surgery.STUDY DESIGNBetween October 1, 1997, and December 31, 1998, the StealthStation (Sofamor Danek, Memphis, TN) was used in 61 FESS cases, and a retrospective review of the findings was performed. The indication for surgery in all instances was chronic rhinosinusitis refractory to medical management. The StealthStation was used to review all CT scans before surgery. Anatomic fiducial registration supplemented by contour mapping was used.RESULTSLocalization accuracy was estimated to be within 2 mm or better. The StealthStation was used for both CT image review and intraoperative localization. CAS was useful in the frontal recess, sphenoethmoid region, posterior ethmoid system, and skull base area. CAS was deemed helpful in situations where the surgical anatomy was altered by previous surgery and extensive inflammatory disease (polyposis, fungal sinusitis, and pansinusitis).CONCLUSIONThe paradigm of image‐guided FESS surgery, which integrates CAS into FESS, will serve to increase surgical effectiveness and decrease surgical morbidity. (Otolaryngol Head Neck Surg 2000; 123:188‐94.)
Evaluation of Posttonsillectomy Hemorrhage and Risk Factors
Authors: Wei Julie L. , Beatty Charles W. , Gustafson Ray O. 
Published: February 2003

BACKGROUNDA 13‐year retrospective study was undertaken to determine the incidence of posttonsillectomy hemorrhage, to evaluate potential risk factors, and to assess the efficacy and safety of ambulatory tonsillectomy.METHODSFrom January 1985 to December 1997, 4662 patients underwent tonsillectomy at our institution. Ninety patients with posttonsillectomy bleeding were identified. For each patient with posttonsillectomy bleeding, 2 nonbleeding control subjects were selected and matched by age and sex to evaluate potential risk factors.RESULTSAge was the only factor found to be statistically significant among the bleeding patients and the control group. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. In our experience, secondary hemorrhage was more common than primary hemorrhage, presenting most frequently on postoperative days 5 to 7.CONCLUSIONSThe incidence of posttonsillectomy bleeding in this review was 1.93%, and about half (47%) of the patients with posttonsillectomy hemorrhage returned to the operating room for hemorrhage control. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. Patients with posttonsillectomy hemorrhage, regardless of management, had a 12% incidence of subsequent hemorrhage. We found no difference in the incidence of posttonsillectomy bleeding between outpatient and inpatient procedures.
Growth and Development of the Human Cricoid Cartilage: An Immunohistochemical Analysis of the Maturation Sequence of the Chondrocytes and Surrounding Cartilage Matrix
Authors: Mankarious Leila A. , Goetinck Paul F. 
Published: February 2003

OBJECTIVEThe goal was to determine maturational changes in the human cricoid cartilage.STUDY DESIGNThe study involved immunohisto‐chemical staining of collagen II (a marker of proliferating chondrocytes), matrilin‐1 (a marker of post‐proliferative chondrocytes), and collagen X (a marker of hypertrophic chondrocytes). Specimens included uninjured human cricoid cartilages at 18 and 41 weeks' gestation and 1, 4, and 13 years postpartum.RESULTSThis study demonstrated that type II collagen peaks in concentration at approximately 41 weeks' gestation. Matrilin‐1 is present in progressively lower concentration in the central core of the cricoid ring, but the peripheries of the ring contain the protein in relatively high concentration. Type X collagen is not expressed in the age groups tested.CONCLUSIONSThese biochemical markers lend further support to a chondrocyte proliferative phase that slows between 1 and 4 years of age. Chondrocytes then enter a phase histologically similar to the hypertrophic phase but are biochemically different than hypertrophic chondrocytes destined for endochondral ossification.
Is Tracheotomy Decannulation Possible in Oxygen‐dependent Children?
Authors: Picerno Nicolette A. , Bent John P. , Hammond Jeffrey , Pennington Weems , Guill Margaret F. , Hudson Valera L. , Deane Daniel A. 
Published: February 2003

OBJECTIVEThe goal was to determine whether decannulation can be safely achieved in children with persistent oxygen requirements.DESIGNThe study was a prospective evaluation of 12 oxygen‐dependent children at a tertiary care academic children's medical center.METHODSTwelve tracheotomy‐dependent children with persistent oxygen requirements were evaluated for decannulation. Patients requiring more than 35% FiO2 were not considered. Direct laryngoscopy and bronchoscopy were performed in all patients. Two required single‐stage laryngotracheoplasty to correct subglottic stenosis, 1 required tracheal resection, and 7 required removal of suprastomal granulation tissue. Oxygen was administered after decannulation through a nasal cannula.RESULTSDecannulation was successful in 92% (11 of 12) of patients. At final follow‐up, oxygen requirements decreased in 58% of patients after decannulation.CONCLUSIONSDecannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to reducing or eliminating their oxygen demand.
Factors Related to Outcome of Salvage Therapy for Isolated Cervical Recurrence of Squamous Cell Carcinoma in the Previously Treated Neck: A Multi‐Institutional Study
Authors: Krol Bryan J. , Righi Paul D. , Paydarfar Joseph A. , Cheng Elbert T. , Smith Ronald M. , Lai Daniel C. , Bhargava Vaibhav , Piccirillo Jay F. , Hayes John T. , Lue Allen J. , Scher Richard L. , Weisberger Edward C. , Wilson Keith M. , Tran Lynn E. , Rizk Nabil , Pellitteri Phillip K. , Terris David J. 
Published: February 2003

OBJECTIVEThe goal was to identify factors associated with the outcome of salvage therapy for patients with isolated cervical recurrences of squamous cell carcinoma in the previously treated neck (ICR‐PTN).STUDY DESIGN AND SETTINGSA tumor registry search for ICR‐PTN patients was performed at 7 participating institutions, and the charts were reviewed. Kaplan‐Meier plots for survival and time until rerecurrence were used to evaluate the significance of associated variables.RESULTSMedian survival and time until re‐recurrence were both 11 months. Survival was better in patients with the following characteristics: nonsurgical initial neck treatment, negative initial disease resection margins, no history of prior recurrence, ipsilateral location of the ICR‐PTN relative to the primary, and use of surgical salvage.CONCLUSIONSBy pooling the experience of 7 US tertiary care medical centers, we have identified 5 factors that are associated with outcome of salvage therapy for ICR‐PTN.SIGNIFICANCEConsideration of these factors, as well as the reviewed literature, should facilitate patient selection for salvage protocols.
Controlled Multicenter Study on Chronic Suppurative Otitis Media Treated with Topical Applications of Ciprofloxacin 0.2% Solution in Single‐Dose Containers or Combination of Polymyxin B, Neomycin, and Hydrocortisone Suspension
Authors: Miró Nuria ,   The Spanish Ent Study Group
Published: February 2003

Otic drops of either ciprofloxacin 0.2% solution (CIP) or a combination of polymyxin B, neomycin, and hydrocortisone suspension (PNH) were administered for 6 to 12 days to patients (14‐71 years old) with chronic suppurative otitis media in a randomized, nonblinded, multicenter clinical trial. Two hundred thirty‐two enrolled patients were analyzed for efficacy on a “per protocol” basis. The most frequently identified causal agents were Staphylococcus aureus (28% of the patients), Pseudomonas aeruginosa (19%), and Staphylococcus sp (9%). Clinical success was observed in 91% and 87% of the CIP‐and PNH‐treated patients, respectively. At 1‐month follow‐up, 4% of CIP and 6% of PNH patients showed a relapse of otorrhea. Bacteriologic eradication was seen in 89% and 85% of patients in the CIP and PNH groups, respectively. At 1‐month follow‐up, reinfection or recurrence of infection appeared in 3 patients in the PNH group and in 1 patient in the CIP group. Both treatments were well tolerated. The most frequently reported adverse events were pruritus, stinging, and earache. Audiometric tests did not show changes attributable to study drugs in any but 1 patient in the PNH group. This clinical trial shows that topical 0.2% ciprofloxacin solution in single‐dose containers is effective and well tolerated in patients with chronic suppurative otitis media.
Reduced‐Time‐Window Sestamibi Scanning for Nonlocalized Primary Hyperparathyroidism
Authors: Kacker Ashutosh , Scharf Steve , Komisar Arnold 
Published: February 2003

BACKGROUNDTechnetium Tc 99m sestamibi scan is the standard of care for localizing parathyroid adenomas.METHODS AND MATERIALWe performed a retrospective, single‐institution study of 111 consecutive patients with primary hyperparathyroidism who underwent standard sestamibi scan for localization of a parathyroid lesion. A revised protocol of reduced‐time‐window sestamibi scan was used in nonlocalized patients. The protocol was composed of single‐view scans at 15, 30, 45, and 120 minutes and tomograms at 60 minutes.RESULTSThirty‐five patients underwent surgery at our institution. Thirty‐one had adenomas, and 4 had hyperplasia. Three of 31 patients did not show localization on the standard scan and underwent reduced‐time‐window scans, which localized 2 more adenomas. These were confirmed at the time of surgery.CONCLUSIONWe suggest that all patients with a high degree of suspicion for a parathyroid adenoma, which is not visualized by a standard scan, undergo a reduced‐time‐window scan.
Assessment of the Airway in Obstructive Sleep Apnea Syndrome with 3‐Dimensional Airway Computed Tomography
Authors: Bhattacharyya Neil , Blake Simon P. , Fried Marvin P. 
Published: February 2003

OBJECTIVEThe goal was to evaluate 3‐dimensional airway CT for upper airway assessment in obstructive sleep apnea syndrome (OSAS).DESIGNAirway CT was obtained and 3‐dimensional airway models were constructed prospectively for 40 patients with OSAS and 10 controls. Airway dimensions were correlated with polysomnography, and comparison was made between patients with and without OSAS.RESULTSOSAS patients had a mean respiratory distress index of 51.9 events per hour. The mean minimum cross‐sectional area (XSA) in the neutral position was 67.1 mm2. Minimum XSA decreased in both the inspiratory and expiratory phases to 16.3 mm2 and 15.0 mm2, respectively (P < 0.001). Complete airway obstruction occurred in 1 or more phases of respiration in 28 patients. Neither airway XSA nor length of obstruction correlated with sleep apnea parameters. No statistically significant differences in airway dimensions were found between OSAS and control patients.CONCLUSIONSAirway CT demonstrates dynamic airway obstruction in OSAS but does not correlate well with clinically important disease parameters.
Increased Expression of Major Basic Protein (MBP) and Interleukin‐5 (IL‐5) in Middle Ear Biopsy Specimens from Atopic Patients with Persistent Otitis Media with Effusion
Authors: Wright Erin D. , Hurst David , Miotto Deborah , Giguere Chantal , Hamid Qutayba 
Published: February 2003

BACKGROUNDMolecular biologic evidence to support an etiologic role for allergy in the pathogenesis of persistent otitis media with effusion (OME) is lacking.OBJECTIVEThe goal of this article was to document expression of allergy‐associated Th‐2‐type cytokines and inflammatory cells in the middle ear mucosa of children with persistent OME.METHODSWith immunocytochemistry (CDS, major basic protein) and in situ hybridization (interleukin‐5 mRNA), middle ear biopsy specimens from 7 children with persistent OME were stained. Nonatopic stapedectomy patients with no history of otitis media served as controls (n = 7).RESULTSThere was a statistically significant (P < 0.05) difference in expression of CDS, major basic protein, and interleukin‐5 between experimental and control subjects. All 8 OME patients proved to be atopic by ELISA testing.CONCLUSIONSType I allergy involving a Th‐2‐type cytokine and cellular profile may be a contributing factor in the persistence of OME in atopic children.SIGNIFICANCEThe middle ear may serve as a target organ for allergic inflammation, suggesting that appropriate allergy management may be a useful adjunct to the management of OME.
Allergy and Health‐Related Quality of Life
Authors: Derebery M. Jennifer , Berliner Karen I. 
Published: February 2003

OBJECTIVEWe asked patients with allergies to complete the SF‐36 Health Survey, a health‐related quality‐of‐life (QOL) measure, to determine the impact of allergy on QOL.STUDY DESIGN AND SETTINGIn total, 377 adults—140 men (37%) and 237 women (63%)—seen in a tertiary care private neurotologic practice allergy clinic completed the questionnaire before beginning immunotherapy and dietary management. One hundred patients completed both initial and 1‐year follow‐up questionnaires. The SF‐36 measures 8 health concepts ranging from physical to mental health, and scale scores range from 0 to 100.RESULTSInitial mean scores ranged from a high of 79.1 for the physical functioning scale to a low of 47.2 for the vitality scale, lower (poorer) on all scales than norms for the general US population. Significant improvement occurred from initial to follow‐up on all scales. The largest improvements were in role functioning‐physical, role functioning‐emotional, and social functioning.CONCLUSIONFindings suggest that allergy symptoms can affect QOL and that treatment with specific immunotherapy and/or dietary management may lead to measurable improvements.SIGNIFICANCEThe significant impact of allergy must be recognized, and treatment should be offered. The SF‐36 can be used to evaluate treatment outcome.