bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Neck Dissection on Quality of Life
Authors: Kuntz Alice L. , Weymuller Ernest A. 
Published: November 2003

AbstractObjectives: For decades, the gold standard for treatment of cervical metastasis was radical neck dissection (RND). Current oncologic philosophy allows for treatment of appropriately staged neck disease with modified radical neck dissection (MRND) or selective neck dissection (SND). The purposes of this study were to determine the impact of various forms of neck dissection on patients' quality of life (QOL) and to evaluate the responsiveness of the University of Washington (UW) QOL shoulder domain.Study Design: Prospective accumulation of QOL data from patients treated for head and neck cancer at UW.Methods: Eighty‐four patients were identified from the UW QOL registry who had undergone neck dissection and had completed pretreatment and posttreatment QOL questionnaires at 6 and 12 months.Results: Compared with pretreatment scores, the MRND and RND groups reported worse shoulder function at 6 and 12 months (P < .0005). The MRND group reported greater shoulder disability at 6 months compared with the SND group (P = .002), but by 12 months, there was no difference between the two groups. Shoulder function for the RND group was worse than the SND group at 6 and 12 months (P = .004). There was a trend toward decreased pain after treatment in the SND and MRND groups. There were no significant differences in subjective appearance, activity, recreation, chewing, swallowing, or speech in the three groups after treatment.Conclusions: Consistent with findings of published functional studies, this study confirmed that the three forms of neck dissection affect patients' QOL differently. This study demonstrates that the UW QOL shoulder domain is a responsive instrument in assessing the effect of neck dissection on shoulder function.
Management of Tracheostomal Stenosis
Authors: Wax Mark K. , Touma B. Joseph , Ramadan Hassan H. 
Published: November 2003

AbstractBackground: Tracheostomal stenosis following laryngectomy is a distressing complication with major effects on patient rehabilitation. Management ranges from stenting with a prosthetic device to surgical revision. The goal is a widely patent stoma that is amenable to tracheoesophageal puncture.Objective: Review the long‐term results of different methods of tracheostomal revision.Methods: Review of 43 patients with symptomatic tracheostomal stenosis. End point was ability to function with no artificial stenting of their stoma.Results: Forty‐three patients underwent 55 revisions. The male‐to‐female ratio was 1.3:1.0. The age range was from 38 to 81 years (mean age, 59.5 y). Median time to revision was 11 months following the initial surgical procedure (range, 1‐150 mo). Thirty‐three patients underwent one revision; eight patients, two revisions; and two patients, three revisions. In 40 of 43 patients (93%) revision was successful. Of the last 21 patients who underwent revision, 18 had tracheoesophageal punctures placed. Fifteen developed excellent tracheoesophageal speech. The initial rates of success for these procedures were as follows: advancement flaps, 8 of 9; Z‐plasty, 13 of 15; V‐Y inset, 8 of 8; other procedures, 2 of 4; and dilation, 2 of 7 (P < .05 for dilation vs. all others). The ultimate success rates for these procedures were as follows: advancement flaps, 8 of 11; Z‐plasty, 15 of 18; V‐Y inset, 12 of 13; other procedures, 3 of 6; and dilation, 2 of 7. Other procedures and dilation were inferior (P < .05) compared with advancement flap, Z‐plasty, and V‐Y insets.Conclusion: Tracheostomal stenosis can be successfully managed in a multitude of ways.
Effects of Age, Body Mass Index, and Gender on Nasal Airflow Rate and Pressures
Authors: Crouse Ulla , Laine‐Alava M. T. 
Published: November 2003

AbstractObjectives: The purpose of this study was to evaluate the variation of airflow rate and oral‐nasal pressure with age, body mass index (BMI), and gender (i.e., to evaluate whether the effects of age, BMI, and gender on airflow rate and pressures are convergent with their effects on nasal cross‐sectional area and resistance).Study Design: A cross‐sectional study of 332 subjects (214 female and 118 male subjects) aged 16 to 82 years.Methods: The aerodynamic measurements of nasal airflow rate and nasal and oral pressures were performed by posterior rhinomanometry. Age, gender, weight, and height were recorded for each subject, and the BMI was calculated. The effects of age, BMI, and gender on airflow rate and nasal and oral pressures were estimated by ANOVA.Results: Nasal airflow rate and oral and nasal pressures increased with increasing BMI. In addition, the mean values of airflow rate and pressures were significantly higher in male than in female subjects. Increasing age was related to increased oral pressure, but was not associated with airflow rate or nasal pressure.Conclusions: This study suggests that, on the contrary to the findings in children and adolescents, BMI and gender should be taken into consideration when measuring the patency of upper airway in adults.
Esthesioneuroblastoma: Reflections of a 21‐Year Experience
Authors: Levine Paul A. , Gallagher Richard , Cantrell Robert W. 
Published: November 2003

AbstractObjectives: To evaluate the results of standardized treatment of esthesioneuroblastoma at a single institution during a 21‐year period and calculate pertinent parameters, i.e., metastatic disease (local, regional, distant), disease‐free survival, and complications of treatment.Study Design: A retrospective review was conducted of all patients treated at a single institution from September 1976 through May 1998.Methods: Only those patients who received their complete evaluation and treatment at our institution were included in this analysis. Thirty‐five patients met this criterion. In addition, results of epidemiological, pathological, and molecular analyses were evaluated to seek accurate indicators for clinical outcomes.Results: Six percent of patients presented with cervical metastatic disease, but ultimately 25.7% developed at least one episode of cervical metastases; 14.3% of patients developed a local recurrence an average of 6 years after diagnosis; and 37% of the patients ultimately developed at least one episode of metastatic disease. The disease‐free survival for this cohort of 35 patients was 80.4% at 8 years. CNS complications occurred in 25.7% of the patients, 22.9% had orbital complications, 20% had systemic posttreatment problems, 18.2% had chemotoxic sequelae, 8.6% had infectious complications, and 14.3% had cosmetic sequelae. No epidemiological, pathological, or molecular factors appeared to be more accurate clinical indicators than the Kadish staging system.Conclusions: This series of esthesioneuroblastoma patients (N=35) reflects an 8‐year disease‐free survival of 80.4%, representing a significant number of patients treated and followed at one institution for an extended period of time. No valuable pathological or molecular indicators to predict aggressive clinical behavior were found. The average time interval before recurrent disease developed was more than 6 years, far greater than that expected for other sinonasal malignancies. Therefore, extended follow‐up is necessary for this patient group.
Repair of a Rodent Nasal Critical‐Size Osseous Defect With Osteoblast Augmented Collagen Gel
Authors: Toung James S. , Ogle Roy C. , Morgan Raymond F. , Lindsey William H. 
Published: November 2003

AbstractObjectives/Hypothesis: Facial skeletal defects are a common challenge for the otolaryngologist. Type I collagen gels have shown promise in the repair of nonhealing critical size defects (CSDs) of facial bone by providing scaffolding for new bone growth by osteoblasts at the defect perimeter. The objective of the present study was to evaluate the effect that suspending osteoblasts within a type I collagen gel has on the repair of a rodent facial CSD.Study Design: Randomized controlled trial using a rodent model.Methods: A previously described facial CSD was created by removing the nasalis bones with a cutting burr to the level of the nasal mucosal membranes on 18 Sprague‐Dawley rats. Groups of six animals were treated with an implant containing either 300 μg of type I collagen gel, 12 × 105 osteoblasts suspended within type I collagen gel, or 12 × 105 fibroblasts suspended within type I collagen gel for comparison. After 30 days the animals were examined at necropsy with planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness.Results: All animals had complete coverage with a thin layer of bone. Histological sectioning revealed an increased thickness in the osteoblast augmented group. Radiodensitometric measurements revealed a statistically significant increase in bone repair in the osteoblast group compared with the collagen‐only group (P ≤ .0005) and the fibroblast group (P ≤ .04).Conclusion: Type I collagen gels augmented with an osteoblastic suspension significantly enhance the repair of nasal CSDs in a rodent model. The use of cultured bone precursor cells represents a leap forward in osteoengineering.
Repair of an Osseous Facial Critical‐Size Defect Using Augmented Fibrin Sealant
Authors: Tholpady Sunil S. , Schlosser Rodney , Spotnitz William , Ogle Roy C. , Lindsey William H. 
Published: November 2003

AbstractObjective: Osseous defects of the head and neck are a common challenge for the otolaryngologist. To develop improved reconstructive options, osteoconductive engineering experiments are being conducted. A nasal critical‐size defect (CSD) model has previously been described in which less than 7% bone healing is observed over 6 months. An implant containing fibrin sealant with and without osteoprogenitor cells is evaluated in this model.Study Design: Randomized controlled trial using a rodent model.Methods: A nasal CSD was surgically created in 18 male retired breeder Sprague‐Dawley rats. Six animals were not implanted with any material, six received fibrin sealant consisting of fibrin (25 mg/mL) and thrombin (1000 U/mL), and six were implanted with fibrin sealant and rat calvarial osteoprogenitor cells (1.8 × 106 cells/mL). Thirty days later, the animals were examined at necropsy by planimetry, histological analysis of new bone growth, and radiodensitometric analysis of bone thickness.Results: A thin layer of bone covered the defect in all of the treated animals. A statistically significant increase in bone density (P < .05) between fibrin sealant plus osteoprogenitor cells and each of the other groups was shown using radiodensitometric analysis. Histological analysis also confirmed this difference.Conclusion: Osteoprogenitor cells contained within fibrin sealant result in a greater augmentation of bone regeneration than controls or fibrin sealant alone.
Endoscopic Surgical Management of Sphenoid Sinus Disease
Authors: Rosen Frederick S. , Sinha Uttam K. , Rice Dale H. 
Published: November 2003

AbstractObjectives: To assess the outcome of functional endoscopic sphenoid sinus surgery, and to determine the predictors of outcome.Study Design: Retrospective chart review of 651 consecutive endoscopic sinus procedures performed between 1992 and 1997.Setting: USC University Hospital, University of Southern California, Los Angeles.Materials and Methods: Seventy‐four patients (11.4% of all endoscopic procedures) with sphenoid sinus disease were selected. All 74 patients were mailed a sinusitis‐specific questionnaire, and 46 of them (62.2%) responded. Outcome measures derived from clinician ratings were applied to all 74 patients, and those derived from self‐report were applied to 46. Outcome measures were determined from patient questionnaires at a minimum of 6‐month postoperative follow‐up, operative complications, and clinician perceptual ratings. Patient questionnaires addressed general patient satisfaction, symptom score, and medication usage. A statistical analysis was performed using χ2 test, linear regression, and one‐way nonparametric ANOVA.Results: Favorable surgical outcomes based on general patient satisfaction (84.8%, n = 39) and clinician perceptual rating (78.4%, n = 58) were noted. Minor postoperative complications were noted in 10 patients (13.5%) and 8 patients (10.8%) needed revision endoscopic procedures during follow‐up. Of the complications, eight (80%) occurred in revision endoscopic procedures. The use of an expanded, sinus‐specific symptom score revealed far fewer favorable outcomes (56.5%, n = 26). Seven outcome predictors were established, although none of the predictors held for more than one of the six outcome measures used.Conclusion: Endoscopic sphenoid sinus surgery is safe and effective. An expanded symptom score is recommended to assess the outcome of this procedure.
Recovery of Laryngeal Sensation After Superior Laryngeal Nerve Anastomosis
Authors: Blumin Joel H. , Ye Ming , Berke Gerald S. , Blackwell Keith E. 
Published: November 2003

AbstractObjectives/Hypothesis: Reliable motor reinnervation has been show in multiple laryngeal transplant studies; however, sensory reinnervation of the larynx after nerve anastomosis has yet to be demonstrated. The role of sensory nerve anastomosis in the transplanted larynx in unknown, but is thought to be necessary to provide airway protection. A canine model was developed to examine the possibility of reformation of sensory pathways in the larynx after nerve section and anastomosis.Study Design: Randomized controlled experiment.Methods: Ten canines were randomly assigned to two groups. Hydrochloric acid‐induced laryngospasm was demonstrated in every dog. All dogs then had their necks explored, and the internal branch of the superior laryngeal nerve was identified and transected bilaterally. Following nerve section all dogs were retested for an acid‐induced laryngospasm reflex. The control group had their wounds closed and were then awakened from anesthesia. The study group underwent microscopic anastomosis of their sensory nerves. Following a 6‐month period the two groups of dogs were compared for the presence of the laryngospasm reflex.Results: No dog in the control group had a response to the acid. All dogs in the study group had some response to the acid, although none of them had return of true laryngospasm.Conclusion: We concluded that sensory reinnervation does occur after nerve anastomosis, but the recovery of sensation may be incomplete or altered.
Morphological Assessment of the Soft Palate in Habitual Snoring Using Image Analysis
Authors: Reda Mohamed , Sims Andrew J. , Collins Melanie M. , McKee Gary J. , Marshall H. , Kelly Peter J. , Wilson Janet A. 
Published: November 2003

AbstractObjectives: Define differences in palatal and uvular dimensions between habitual snorers and healthy nonsnoring control subjects. Document the changes in palatal configuration after different types of palatoplasty.Study Design: A prospective controlled clinical study was performed analyzing video recordings of the soft palate and oropharynx of 251 subjects (121 habitual snorers, 79 patients after laser‐assisted uvulopalatoplasty ([LAUP], and 51 healthy volunteers).Methods: The recordings were captured using a rigid endoscope with a reference measure applied to the soft palate and a mark at the junction of the soft and hard palate. Four parameters were studied in the captured pictures after correction for the distortion deformity in fiberoptic endoscopic images: 1) length of soft palate, 2) length of uvula, 3) width of uvula, and 4) distance between posterior pillars.Results: Analysis showed that habitual snorers, compared with healthy volunteers have significantly increased soft palate length (P = .00001), increased uvula length (P = .0002) and width (P = .00001), and narrowed oropharyngeal isthmus (distance between the posterior pillars) (P = .04). In patients studied after LAUP, the length of the soft palate is significantly shorter (P = .00001) than in the preoperative cohort, and the oropharyngeal isthmus is significantly narrower (P = .00001). Moreover, this latter distance is significantly narrower (P = .00001) when compared with healthy volunteers.Conclusions: Habitual snorers have a long soft palate, a long wide uvula, and a narrowed oropharyngeal isthmus. LAUP shortens and tightens the elongated palate and causes a further reduction in the space between the posterior pillars.
Ho:YAG Laser Treatment of Hyperplastic Inferior Nasal Turbinates
Authors: Leunig Andreas , Janda Philip , Sroka Ronald , Baumgartner Reinhold , Grevers Gerd 
Published: November 2003

AbstractObjectives: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long‐term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates.Methods: Eighty‐five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty‐two of these patients were included in this clinical study and were followed for 1 year.Results: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire.Conclusions: Ho:YAG‐laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.
Abrasive Esophageal Cytology for the Oncological Follow‐Up of Patients With Head and Neck Cancer
Authors: Pellanda Antonio , Grosjean Pierre , Leoni Sandra , Mihaescu Anca , Monnier Philippe , Pasche Philippe 
Published: November 2003

AbstractObjectives: The occurrence of a second primary cancer in the esophagus in patients with head and neck squamous cell carcinoma is frequent and is associated with a poor prognosis. The aim of this study was to evaluate the yield of abrasive esophageal cytology as a means of screening for metachronous cancer of the upper aerodigestive tract.Study Design: We retrospectively reviewed the results of abrasive esophageal cytology performed twice yearly for the screening of patients with prior head and neck cancer.Methods: From 1987 to 1996, 320 patients treated for head and neck cancer underwent 1,673 abrasive cytology examinations of the esophagus during a mean follow‐up period of 4 years. Cytological results were classified as negative, suspect, or positive for malignancy.Results: Twenty‐five patients without symptoms had one or more suspect or positive cytologic findings, leading to 29 endoscopic examinations. These revealed 20 premalignant or early malignant lesions of the esophagus (2 dysplasias, 18 squamous cell carcinomas), 2 glandular carcinomas, and 10 clinically unsuspected oral or pharyngeal carcinomas. In seven patients, positive cytological results were associated with clinically visible head and neck cancer. Of the 34 patients with suspect cytological results for malignancy, 10 had no evidence of tumor at endoscopy and 24 had no endoscopic examination because of refusal or because suspected cells were not found in additional examinations. Negative results on cytological examination were found for 254 patients throughout their follow‐up, and none of them developed esophageal cancer during a mean follow‐up period of 3 years.Conclusions: For patients with head and neck cancer, abrasive sponge cytology is useful for detecting esophageal cancer at an early stage. In addition, it may reveal unsuspected second primaries or recurrences in the head and neck region.
Application of Antioxidants and Other Agents to Prevent Cisplatin Ototoxicity
Authors: Rybak Leonard P. , Whitworth Craig , Somani Satu 
Published: November 2003

AbstractObjective/Hypothesis: To review the recent data from experiments performed in this laboratory to test the hypothesis that cisplatin ototoxicity is related to depletion of glutathione and antioxidant enzymes in the cochlea and that the use of antioxidants or protective agents would protect the cochlea against cisplatin damage and prevent hearing loss.Study Design/Methods: Data were reviewed from experiments performed in this laboratory. Control rats were treated intraperitoneally with cisplatin 16 mg/kg. Experimental rats were given cisplatin in combination with one of the following protective agents: diethyldithiocarbamate, 4‐methylthiobenzoic acid, ebselen, or lipoic acid. Animals in each group underwent auditory brainstem response (ABR) threshold testing before and 3 days after treatment. Cochleae were removed after final ABR testing and analyzed for glutathione and activities of the enzymes superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and malondialdehyde.Results: Rats in the control group receiving cisplatin were found to have significant ABR threshold shifts. This was accompanied by a reduction of glutathione and the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase, catalase, and glutathione reductase) and an elevation of malondialdehyde. Experimental animals had preservation of ABR thresholds and levels of glutathione, antioxidant enzyme activity, and malondialdehyde that were similar to untreated animals.Conclusion: Cisplatin ototoxicity appears to be initiated by free‐radical production, which causes depletion of glutathione and antioxidant enzymes in the cochlea, and lipid peroxidation, manifested by an increase in malondialdehyde. These effects were blocked by each of a series of antioxidant compounds given in combination with cisplatin. A mechanism for cisplatin ototoxicity is elaborated with a proposed plan of chemoprevention using agents with different mechanisms of action. These substances could be used alone or in combination to reduce the severity of cisplatin ototoxicity in patients.
Neural Response Telemetry With the Nucleus CI24M Cochlear Implant
Authors: Shallop Jon K. , Facer George W. , Peterson Ann 
Published: November 2003

AbstractObjectives: To review our intraoperative and post‐operative testing protocol for cochlear implant patients. This study describes the methodologies and applications of a new technique called neural response telemetry (NRT) for the Nucleus CI24M cochlear implant system. NRT uses radiofrequency telemetry technology to measure the action potentials of the auditory nerve.Study Design: We have developed a specific protocol for intraoperative testing of the implant device before, during, and after implantation. This includes device integrity tests, visual detection of electrical stapedius muscle reflexes (VESR), and NRT.Methods: Our methodologies use the commercial software (Windows‐based Diagnostic and Programming System [WIN‐DPS] and NRT) for the Nucleus CI24M. We describe the details of our protocol used on all of the patients (14 adults and 14 children) who received CI24M implants at Mayo Clinic (Rochester, MN). Our protocol correlates the NRT threshold with the behavioral responses for each patient on at least four electrodes.Results: From August 1, 1998, to December 31,1998, we completed electrode integrity tests, NRT, and VESR testing intraoperatively on 12 patients with the Nucleus CI24M. We have measured normal implant function on all 28 of our CI24M patients with one exception. One of our children had a device failure after approximately 4 months as a result of head trauma. We have also obtained NRT results from an additional 10 patients postoperatively.Conclusions: The measurement of device and electrode array function is quite simple with the CI24M software. These measurements can be obtained intraoperatively as well as postoperatively. We conclude that VESR and NRT measurements can be very helpful in programming for patients with cochlear implants, especially children, because they provides us with target settings for the speech processor.