bluuebunny/crossref_metadata_2025_split huggingface dataset:
Auditory Late Cortical Response and Speech Recognition in Digisonic Cochlear Implant Users
Authors: Maurer Jan , Collet L. , Pelster H. , Truy E. , Gallégo S. 
Published: November 2003

AbstractObjective The purpose of the study was to test for differences in late electrically evoked auditory potentials between subjects exhibiting “good” versus “poor” speech recognition performances with their cochlear implants.Methods Late auditory evoked responses were measured in 30 subjects equipped with the Digisonic (MXM, Antibes, France) cochlear implant, 15 of whom had “good” speech recognition scores (i.e., more than 89% correct phoneme identification without lip reading). The 15 other subjects had poorer speech recognition scores (i.e., less than 85%).Results Differences in N1P2 amplitude, as well as P1, N1, and P2 latencies, and N1‐P1 and N1‐P2 latency intervals were tested. Wave P2 latency was found to be significantly different between the two groups (P = .016), being shorter in “good” than in “poor” performers. The strength of the statistical relationship between electrophysiological and speech recognition variables (r2 = 17%) was substantially smaller than that observed using electrically evoked auditory brainstem response (EABR) for the same implanted device (r2 = 49% for the EABR wave III–V latency interval).Conclusions Some characteristics of late electrically evoked auditory potentials differ significantly among cochlear implant users depending on their speech recognition performance. However, the relationship between electrophysiological and speech recognition variables is more pronounced when early (brainstem) rather than late (cortical) evoked responses are considered.
Regular Tracheostomy Tube Changes to Prevent Formation of Granulation Tissue
Authors: Yaremchuk Kathleen 
Published: November 2003

AbstractObjectives/Hypothesis Tracheostomy is a commonly performed operative procedure that has been described since 2000 b.c. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long‐term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support.Study Design The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques.Methods A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention.Results The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P = .02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes.Conclusions A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications.
Laryngotracheal Injury After Percutaneous Dilational Tracheostomy in Cadaver Specimens
Authors: Hotchkiss Karin S. , McCaffrey Judith Czaja 
Published: November 2003

AbstractObjective To evaluate the stoma and surrounding insertion site for common laryngotracheal injury patterns after percutaneous dilational tracheostomy that may contribute to clinically significant tracheal stenosis.Study Design Preliminary prospective cadaver study.Methods A preliminary prospective cadaver study was performed in which percutaneous dilational tracheostomy (Ciaglia Blue Rhino kit) was placed in six fixed cadaveric specimens. Laryngotracheal segments were harvested. Two independent evaluators graded cadaver features and characteristic injuries in laryngotracheal specimens the tracheal site of stoma placement was identified. Cadaver features evaluated included gender, obesity, and ease of landmark identification. Mucosal and cartilage injuries were evaluated on a scale of 0 to 4, with 4 representing severe comminuted injuries beyond the intended stoma site.Results Accurate prediction of tracheal placement was achieved in only three (50%) of the specimens. In the remaining cadavers, one stoma site was placed higher than intended (16%) and two sites were lower than intended (33%). Mucosal injury was most severe at the anterior internal surface of the trachea with all specimens sustaining tears beyond one tracheal ring (mean mucosal injury score, 3.5). Cartilaginous injury was severe in five of six specimens (83%) that sustained multiple comminuted injuries to two or more adjacent rings (mean cartilage injury score, 3.34). Cricoid comminutions and a posterior membranous tracheal wall injury were each found in one specimen.Conclusions Laryngotracheal injuries found after percutaneous dilational tracheostomy in the study indicated that severe damage to mucosa and cartilage surrounding the intended stoma site occurs at the time of placement. These injuries may contribute to clinically significant tracheal stenosis preventing decannulation in patients undergoing percutaneous dilational tracheostomy. Two case studies that support this hypothesis are also presented.
The Safety of Flexible Endoscopic Evaluation of Swallowing With Sensory Testing in an Outpatient Otolaryngology Setting
Authors: Cohen Manderly A. , Setzen Michael , Perlman Philip W. , Ditkoff Michael , Mattucci Kenneth F. , Guss Joel 
Published: November 2003

AbstractObjective To study the safety of flexible endoscopic evaluation of swallowing with sensory testing in a private otolaryngology office setting.Study Design Five parameters were prospectively evaluated. These included airway compromise, epistaxis, change in heart rate, level of discomfort, and patient's willingness to repeat the examination in the future.Methods All persons undergoing flexible endoscopic evaluation of swallowing with sensory testing between July 1, 1999, and June 30, 2001, were prospectively evaluated. A flexible fiberoptic endoscope with a specially designed air port channel was passed transnasally (without topical anesthesia or nasal constriction) into the more patent nostril. Nasopharyngeal and laryngeal anatomy were first evaluated. Laryngopharyngeal sensory and motor function were then assessed, followed by a comprehensive swallowing evaluation. Five test parameters were examined during each study. Descriptive statistics were calculated.Results Three hundred forty‐nine consecutive examinations in 305 adult patients with dysphagia were performed during the study period. Mild epistaxis occurred in four patients (1.1%). There were no episodes of airway obstruction or laryngospasm. There was no statistically significant difference between the average pretest and post‐test heart rates; no patients became symptomatically bradycardic or tachycardic. The discomfort ratings were as follows: 44 patients (12.6%) rated the overall discomfort of the test as none, 169 (48.4%) thought it was mild, 110 (31.5%) described moderate discomfort, and 26 (7.5%) said it was severe. Three hundred forty‐two (98%) of the patients would repeat the test in the future; seven patients (2%) said that they would not.Conclusions Flexible endoscopic evaluation of swallowing with sensory testing is a safe, well‐tolerated procedure to objectively evaluate patients with dysphagia when performed by an experienced speech‐language pathologist with an otolaryngologist in attendance in an outpatient office setting.
Electrocochleography and Intranasal Allergen Challenge as Investigational Tools in Patients With Inhalant Allergy and Ménière's Disease
Authors: Eaton Debbie A. , Roland Peter S. , Mabry Richard L. , Shoup Angela G. 
Published: November 2003

AbstractObjectives To expand on a prior study investigating the relation between inhalant allergy and Ménière's disease using electrocochleography and to present data from five patients heretofore unmentioned in previous reports.Study Design Prospective study of five patients identified with Ménière's disease and inhalant allergy in the practices of two faculty otolaryngologists.Methods Patients were tested twice using electrocochleography: once as a baseline and again 20 minutes following intranasal challenge with the allergen to which they were most sensitive.Results Three patients had no prior history of immunotherapy, and all were found to have a >15% increase in summating potential (SP)/action potential (AP) ratio after antigen challenge. However, only one of these patients developed audiovestibular symptoms. Two patients had a history of immunotherapy. One of these patients was tested using three different antigens to which she was highly sensitive on skin testing, one of which provoked audiovestibular symptoms on environmental exposure. Postchallenge electrocochleography, however, demonstrated normal SP/AP ratios with only one antigen causing a >15% increase. The other patient had elevated SP/AP ratios both before and after challenge and developed no audiovestibular symptoms despite a >15% increase.Conclusions Previous work using this investigational tool has identified that all patients with a normal electrocochleography were asymptomatic from an audiovestibular standpoint at the time of postchallenge testing. An elevated SP/AP was not reliably correlated with audiovestibular symptoms in this group of patients. Further investigation in this area will examine the utility of using the variability of the SP and AP to predict audiovestibular symptoms.
Facial Fractures and Concomitant Injuries in Trauma Patients
Authors: Alvi Aijaz , Doherty Taylor , Lewen Gregory 
Published: November 2003

AbstractObjectives/Hypothesis Maxillofacial fractures often occur with serious concomitant injury in trauma patients, and knowledge of the type and severity of associated injuries can assist in rapid assessment and treatment. The objective was to identify the most commonly occurring injuries associated with facial fractures in severely injured trauma patients.Study Design Review of medical records.Methods A retrospective review was made of 151 patients with facial fractures presenting to a level‐one trauma center over a 4‐year span. All patients had an injury severity score of 12 or greater. Chart data recorded included demographics, etiology, presentation, facial fracture site, concomitant injury, imaging studies, hospital stay and course, interventions, and outcome.Results The most common cause or origin of facial fracture was assault (41%), followed by motor vehicle accident (26.5%). Orbital fracture was the most common overall facial fracture (24.2%), with nasal fractures being the most common isolated fracture (23.2%). Cerebral hematoma occurred in 43.7% of patients, with subdural hematoma being the most frequent. Pulmonary injury was the second most commonly associated injury (31.1%) with lung contusion being the most frequent. Seventy‐two patients (42%) required intubation, and 22 (14.8%) required tracheostomy during their hospital stay. The hospital complication rate was 50.3% and included primarily pulmonary complications, septicemia, renal failure, and severe anemia. Thirteen patients died during their hospital stay; 11 of them died of neurologic injuries, 1 of pulmonary failure, and 1 of overwhelming sepsis.Conclusions Cerebral and pulmonary injuries are often associated with maxillofacial fractures in severely injured trauma patients. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of patients with facial fractures.
Paranasal Sinus Development: A Radiographic Study
Authors: Shah Rahul K. , Dhingra Jagdish K. , Carter Barbara L. , Rebeiz Elie E. 
Published: November 2003

AbstractObjective To demonstrate the development of the paranasal sinuses in a pediatric population by computed tomography scans.Study Design Radiology records at a tertiary care institution were reviewed for the computed tomography scans of the face, orbit, or paranasal sinuses in patients aged 0 to 12 years.Methods Computed tomography scans were reviewed by a head and neck radiologist and otolaryngologist for the development of the frontal, maxillary, ethmoid, and sphenoid sinuses. The size of the pneumatized paranasal sinuses was measured in two planes and graded on a scale of 0 to 3. Ossification of the maxillary crest and vomer, obliteration of the foramen cecum, and development of agger nasi cells, Haller cells, and the superior turbinate were studied. Patients with syndromes, nasal stenosis, choanal atresia, or cystic fibrosis were excluded from the study.Results In all, 91 computed tomography scans in 66 patients were studied. Serial development could be followed in 16 patients who underwent repeat scans. Patients were divided into six age cohorts based on their age at the time of the scan: 0 to 3 months (10%), 3 to 12 months (13%), 1 to 3 years (13%), 3 to 5 years (20%), 5 to 8 years (29%), and 8 to 12 years (16%). Ethmoid sinuses were the first to fully develop, followed sequentially by maxillary, sphenoid, and frontal sinuses. Each sinus has a rapid rate of development during specified age cohorts.Conclusion The results will aid the physician when correlating the clinical and radiographic findings of pediatric patients aged 0 to 12 years who are being evaluated for sinus disease and potential surgical intervention.
Laryngopharyngeal Dysfunction From the Implant Vagal Nerve Stimulator
Authors: Zalvan Craig , Sulica Lucian , Wolf Steven , Cohen Jeffrey , Gonzalez‐Yanes Omar , Blitzer Andrew 
Published: November 2003

AbstractObjectives/Hypothesis The objective of the study was to examine the side‐effect profile of the vagal nerve stimulator. Vagal nerve stimulators have been used to treat intractable seizures in all age groups. They provide relief to the patient with a seizure disorder by decreasing the overall number and severity of seizure activities. Although significant complications are rare, many patients have some complaint, usually of their voice.Study Design A retrospective evaluation of four patients with intractable epilepsy.Methods Evaluation of charts and medical records and endoscopic examination of the larynx.Results In this small series, all four patients had implantation‐related paresis. Three of the four appear to have side effects from device activation.Conclusions Patients in whom a vagal nerve stimulator is placed can have adverse side effects. These can be related to the surgical manipulation of the vagus nerve, resulting in a temporary paresis of the vocal folds. A second set of side effects is related to the actual electrical stimulation of the device, and these side effects can directly affect the laryngeal musculature.
Choanal Atresia: A Twenty‐Year Review of Medical Comorbidities and Surgical Outcomes
Authors: Samadi Daniel S. , Shah Udayan K. , Handler Steven D. 
Published: November 2003

AbstractObjectiveTo review medical comorbid conditions and surgical outcomes for children treated for choanal atresia (CA).Study DesignRetrospective review (1979–1998).MethodsParticipants included 78 children, aged newborn to 18 years, in the setting of an academic pediatric hospital. Main outcome measures were type and number of procedures and airway patency.ResultsSeventy‐eight children (48 female and 30 male patients) were treated and followed for CA, with an average follow‐up of 35 months. Thirty‐five children (45%) had unilateral CA, and 43 children (55%) had bilateral CA. There was no statistically significant sex difference between unilateral and bilateral CA. Concomitant medical problems were common, mostly otitis media with effusion (32%), upper and lower airway diseases (32% and 23%, respectively), cardiac anomalies (19%), and gastrointestinal tract disorders (18%). Statistically significant correlations were found for bilateral CA and cardiac disorders (P= .04), CHARGE syndrome (P= .002), obstructive sleep apnea (P= .003), hematological problems (P= .001), and prematurity or failure to thrive (P= .006). Surgery was effective in establishing a patent airway in all cases. Average ages at first surgery were 25.2 months for unilateral and 2.4 months for bilateral CA. Unilateral CA required, on average, 2.7 total procedures, including dilation and removal of stents, compared with bilateral CA, which required 4.9 procedures. Nearly all children underwent correction by means of the transnasal approach.ConclusionsTo the knowledge of the authors, the present report encompasses the largest series of children treated for CA. The high incidence of comorbid conditions mandates thorough medical evaluation, particularly for otological, airway, cardiac, and gastrointestinal tract diseases.
Value of Acoustic Rhinometry for Measuring Nasal Valve Area
Authors: Çakmak Özcan , Coşkun Mehmet , Çelik Hüseyin , Büyüklü Fuat , Özlüoğlu Levent Naci 
Published: November 2003

AbstractObjective To assess the validity of acoustic rhinometry for measuring nasal valve area in human subjects.Study Design A comprehensive study that compared acoustic rhinometry data with computed tomography findings from scans obtained perpendicular to the acoustic axis and perpendicular to the floor of the nose.Methods Fifty nasal passages of 25 healthy adults with no nasal disease were examined by acoustic rhinometry and computed tomography. In each case, the area of the nasal valve as measured by acoustic rhinometry was compared with the area calculations from computed tomography sections taken in two different coronal planes, one perpendicular to the acoustic axis and one perpendicular to the floor of the nose. Computed tomography slices perpendicular to the floor of the nose were obtained at two different locations, a specific distance from the tip of the nose and a specific distance from the anterior nasal spine.Results There was a significant correlation between the nasal valve areas determined by acoustic rhinometry and computed tomography when imaging was obtained perpendicular to the acoustic axis. In contrast, when scanning was obtained perpendicular to the straight axis of the floor of the nose, the correlations between the acoustic rhinometry and computed tomography data were weak.Conclusions When any type of imaging is used for comparison with nasal valve areas determined by acoustic rhinometry, the cross‐sections should be perpendicular to the acoustic pathway. The results of the study show that acoustic rhinometry is a valuable method for measuring nasal valve area.
The Chemotactic Behavior of Eosinophils in Patients With Chronic Rhinosinusitis
Authors: Wei Julie L. , Kita Hirohito , Sherris David A. , Kern Eugene B. , Weaver Amy , Ponikau Jens U. 
Published: November 2003

AbstractObjective To characterize peripheral eosinophil migration in patients with chronic rhinosinusitis in the presence of nasal mucin and nasal tissue extracts.Study Design Prospective, controlled, ex‐vivo.Methods Peripheral blood eosinophils, nasal mucin, and nasal tissue were harvested at the time of sinus surgery in 10 patients, as well as obtained in 10 healthy control subjects. Extracts were prepared from nasal mucin and nasal tissue. A modified Boyden chamber was used to study eosinophil migration from both patients and healthy control subjects in the presence of both extracts.Results Patients with chronic rhinosinusitis and all healthy control subjects demonstrated a concentration‐dependent increased migration of eosinophils in the presence of both nasal mucin and nasal tissue extracts. The percentage of migration was consistently higher for eosinophils from patients with chronic rhinosinusitis compared with control subjects. The difference attained statistical significance in the presence of 50% tissue extract (median percentage of migration, 23.3% vs. 7.8% [P = .033]).Conclusions Nasal mucin and nasal tissue in chronic rhinosinusitis contains chemoattractants, which can induce active eosinophil migration. The eosinophil migration from patients with chronic rhinosinusitis was consistently higher compared with eosinophils from healthy control subjects. Because the eosinophils were obtained from the peripheral blood, this finding suggests activation of eosinophils in the systemic circulation in chronic rhinosinusitis.
Gentamicin Tympanoclysis: Effects on the Labyrinthine Sensory Cells
Authors: Pender Daniel J. 
Published: November 2003

AbstractObjectives The objective of the study was to determine whether a selective vestibular hair cell toxicity with sparing of the cochlear hair cells could be achieved by infusing different concentrations of gentamicin into the middle ears of adult cats.Study Design Prospective experimental animal study treating only the left ear of each cat, the right ear serving as individual control.Methods Gentamicin solution at concentrations of either 30 or 3 mg/mL was infused daily into the left middle ear of adult cats until overt ataxia occurred. After 1 month or 6 months, each cat was killed and its temporal bones prepared for optical microscopy.Results Animals treated with 30 mg/mL gentamicin until ataxic required a median of five daily doses. These animals had clear‐cut cochlear basal turn hair cell losses accompanying toxic lesions in the utricle and cristae. In contrast, animals treated with 3 mg/mL gentamicin until ataxic required an average of 19 daily doses. These animals had lesions restricted to the utricle and cristae with sparing of the cochlea hair cells. Animals that failed to develop ataxia manifested neither lesions of the cochlear nor vestibular hair cells.Conclusion Gentamicin tympanoclysis in the cat animal model, using a dilute solution and continued once daily until clinical ataxia occurs, is capable of producing selective vestibular hair cell toxicity while sparing cochlea hair cells.
Laryngopharyngeal Reflux Identified Using a New Catheter Design: Defining Normal Values and Excluding Artifacts
Authors: Maldonado Anastasia , Diederich Linda , Castell Donald O. , Gideon R. M. , Katz Philip O. 
Published: November 2003

AbstractObjective To define normal values for laryngopharyngeal reflux using an improved catheter design with adjustable electrode placement for pH monitoring.Study Design Cohort study of normal volunteers.Methods The setting was an institutional‐based gastroenterology practice. Subjects included 20 healthy volunteers with no history of laryngeal, pharyngeal, or reflux symptoms. These included 10 men and 10 women (mean age, 33 y; age range, 26–49 y). Ambulatory 24‐hour triple‐electrode monitoring of pH in distal esophagus, proximal esophagus, and pharynx using new bifurcated probe was performed. The distal electrode was placed 5 cm above the lower esophageal sphincter, with the proximal two electrodes straddling the upper sphincter. The main outcome measure was the number of true pharyngeal reflux episodes.Results Sixteen of 20 subjects had no episodes, and 2 subjects had only one episode of pharyngeal reflux. The two subjects exceeding this value (8 and 15 episodes, respectively) had abnormal distal and proximal esophageal reflux. Artifacts for pharyngeal reflux due to acidic meals or “pseudoreflux” were excluded. Subject tolerance of this new probe was excellent.Conclusion The triple‐electrode bifurcated adjustable pH probe provides a well‐tolerated technique to identify true hypopharyngeal acid reflux episodes. When artifacts produced by meals and pseudoreflux are excluded, 90% of normal subjects show no episodes or a single episode over a 24‐hour period.