bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Fluctuating Sensorineural Hearing Loss: Problems in Medical Management
Authors: Dinces Elizabeth A. , Yang Steven , Balogun Anifat O. 
Published: November 2003

AbstractObjectives To discuss the diagnosis and management of children with fluctuating sensorineural hearing loss, especially focusing on those problems dealing with autoimmune inner ear disease.Study Design A retrospective chart review of a large pediatric otolaryngology practice. A series of 40 children with progressive hearing losses was identified. Of that group, 22 children, aged 1.5 to 12.2 years at first audiogram, were considered to have fluctuating sensorineural hearing loss (FSNHL). Criteria for inclusion in the FSNHL group were threshold variations of 15 dB or more in at least one ear at two or more of the standard audiometric frequencies on at least 2 testing days.Methods Charts were reviewed for age, sex, otologic history, laboratory evaluations, medical or surgical treatments, significant medical history, and family medical history.Results Twenty‐two children met the criteria for fluctuating sensorineural hearing loss. Of those with fluctuating hearing loss, 15 were idiopathic, 3 had positive lymphocyte transformation tests (LTT) suggestive of autoimmune inner ear disease (AIED), and 4 had fistula on middle ear exploration. Average fluctuation for all groups was 29.1 dB. Average duration of fluctuations was 4.95 years.Conclusions The majority of pediatric FSNHL cases (15 of 22) were idiopathic in nature. Of those FSNHL children with positive LTTs, only one was treated with steroid therapy. In the other patients with positive LTTs, parents or other physicians were often reluctant to treat, or the patient was lost to follow‐up. Mean fluctuations varied substantially across all standard audiometric frequencies for all groups.
A Histologic Analysis of Three‐Dimensional Versus Two‐Dimensional Tissue Expansion in the Porcine Model
Authors: Alex James C. , Bhattacharyya Tapan K. , Smyrniotis George , O'Grady Kevin , Konior Raymond J. , Toriumi Dean M. 
Published: November 2003

AbstractObjective Recently, a two‐dimensional Silastic Dacron stretching skin device has been developed for scalp reduction surgery. Attached subgaleally, this device stretches skin over time, while avoiding the visible volumetric distention that is typical of three‐dimensional tissue expanders. Unlike three‐dimensional expanders, the histological changes observed with a two‐dimensional stretching device have not been described in the literature. The present study compares the histological effects of two‐dimensional and three‐dimensional skin tissue expansion in the porcine model.Study Design A university Institutional Review Board–approved study in which 16 domestic piglets were used. The 16 piglets were divided evenly into four cohorts as follows: 1, 1‐week control cohort; 2, 1‐week experimental cohort; 3, 4‐week control cohort; and 4, 4‐week experi‐mental cohort.Methods Tissue expanders (three‐dimensional) and Dacron Silastic tissue stretchers (two‐dimensional) were surgically inserted into the lateral skin of 16 domestic pigs. Animals were killed at either 1 or 4 weeks based on group assignment. Light microscopic ocular micrometry and stereological point counting were used to determine the depth of the epidermis, dermis, and subdermal adipose tissue layer; width of the panniculus muscle; diameter of sweat gland follicles; percentage ratio of dermal collagen, blood vessels, and tissue space; and epidermal mitotic index in 100 specimens. One‐way ANOVA was used to evaluate statistical differences.Results Both tissue expanders yielded increased values compared with control subjects, with respect to epidermal, dermal, and fat widths and blood vessel counts, whereas adnexal structures in the panniculus muscle width were unaltered.Conclusions Although statistically the two types of expansion produced histologically similar changes, the degree of change varied according to the type of expander that was used and the duration of tissue expansion. Most notably, three‐dimensional expansion produced more tissue gain per unit area expanded at both the 1‐week and the 4‐week time intervals, and early (1‐week) two‐dimensional tissue expansion stimulated a greater angiogenic response than three‐dimensional expansion. These findings will assist the surgeon in understanding the physical changes that occur with these two forms of tissue expansion, as well as the potential clinical advantages and shortcomings of each method.
Endoscopic Arytenoid Repositioning for Unilateral Arytenoid Fixation
Authors: Amin Milan R. , Koufman James A. 
Published: November 2003

AbstractObjectives To describe a new endoscopic technique for medialization of the laterally fixed arytenoid. The surgical technique, endoscopic arytenoid repositioning, is described, and the results of a series of cases are discussed.Study Design Retrospective chart review.Methods Eight patients underwent the procedure. Six patients were available for long‐term follow‐up. Preoperative and postoperative voice ratings were compared to evaluate the success of the procedure. Follow‐up ranged from 3 to 64 months (mean follow‐up, 31.5 mo).Results Long‐term follow‐up in six cases revealed that 67% (4 of 6) patients had normal or near‐normal postoperative voices and one patient experienced moderate improvement. The mean preoperative voice score was 4.24, and the mean postoperative voice score was 1.83 (range, 1–5). The difference was statistically significant (P <0.001).Conclusions Endoscopic arytenoid repositioning is a newly described procedure with a very specific indication: a unilateral, laterally fixed arytenoid complex resulting in a severely dysphonic voice. Though technically demanding, this procedure provides a promising option for medialization of the posterior glottis in a scarred larynx.
Recurrent Respiratory Papillomatosis
Authors: Derkay Craig S. 
Published: November 2003

AbstractRecurrent respiratory papillomatosis (RRP) is the most common benign neoplasm of the larynx in children. Despite its benign histology, RRP has potentially morbid consequences and is often difficult to treat because of its tendency to recur and spread throughout the respiratory tract. Long neglected from an epidemiological standpoint, recent initiatives to better understand this disease process have been launched through coordination between the Centers for Disease Control and Prevention and the American Society of Pediatric Otolaryngology. In this clinical review, I discuss what we currently know regarding the etiology, epidemiology, and transmission of this disease. Clinical features including pertinent aspects of the history, physical examination, airway endoscopy, and other considerations are highlighted. A detailed description of the surgical and anesthetic management of these challenging cases is presented. Adjuvant modalities of surgical and nonsurgical treatment and their indications are discussed. Ongoing research initiatives and the Practice Guidelines of the Recurrent Respiratory Papillomatosis Task Force are also included.
Atypical Indications for OtoScan Laser‐Assisted Myringotomy
Authors: Bent John P. , April Max M. , Ward Robert F. 
Published: November 2003

AbstractObjective To describe the role of OtoScan laser‐assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media.Study Design Cross‐sectional review.Methods Twenty‐seven office‐based OtoLAM procedures were performed in 21 patients for “atypical” reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1).Results In each of the 20 cases available for follow‐up, middle ear disease resolved with closure of the laser‐assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction.Conclusions Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.
Chronic Otitis Media Sequelae in Skeletal Material From Medieval Denmark
Authors: Qvist Morten , Grøntved Aksel M. 
Published: November 2003

AbstractObjectives Chronic otitis media sequelae (COMS) have been identified in archaeological skeletal materials from various ages. COMS reflecting episodes of upper respiratory tract infection may be used as a paleopathological indicator of general health. Estimation of the frequency of COMS may be useful in the gross evaluation of general standard of living.Materials and Methods Temporal bones and auditory ossicles from 659 individuals from two Danish medieval rural parish cemeteries, dated to 1050–1200 and 1150–1350, respectively, were examined otomicroscopically.Results Osseous fistulae from mastoid abscesses, remodelling of the hypotympanon, and erosion of the incus were among the convincing indications of COMS. A minimum frequency of COMS of 1% to 7 % was found. The youngest material displayed the highest frequency of pathological changes.Conclusion Indications of a rising incidence of infectious middle ear disease in early medieval Denmark were found. This may reflect a deterioration of living conditions from the 11th through the 14th centuries.
Complications Associated With the Sistrunk Procedure
Authors: Maddalozzo John , Venkatesan T. K. , Gupta Pankaj 
Published: November 2003

AbstractObjective To assess the type and rate of complications in the postoperative period of pediatric patients undergoing the Sistrunk procedure.Study Design A retrospective review of patients with a diagnosis of thyroglossal duct cyst who had not had corrective surgery previously. An attempt to standardize the study was made as follows: all patients had surgery under the direction of one surgeon, using the Sistrunk procedure with minor modifications from its original description. Complications were divided into major and minor categories.Methods Charts were reviewed for age, se‐, preoperative assessment, and postoperative follow‐up. Complications were recorded. A postoperative telephone survey was conducted.Results A minor complication rate of 29% was observed. There were no recurrences or major complications.Conclusions The Sistrunk procedure remains the operation of choice for removal of the thyroglossal duct cyst. When the surgery is properly performed, with attention to key surgical landmarks, the risk of major complication is minimal. Complications that do occur are minor and wound related.
Modern Concepts of Frontal Sinus Surgery
Authors: Weber Rainer , Draf Wolfgang , Kratzsch Barbara , Hosemann Werner , Schaefer Steven D. 
Published: November 2003

AbstractObjectives/Hypothesis To validate the endonasal surgical approach to frontal sinus in inflammatory sinus disease, trauma, and selective tumor surgery, and to define the role of external approaches to the frontal sinus. Endonasal frontal sinusotomy can range from endoscopic removal of obstructing frontal recess cells or uncinate process to the more complex unilateral or bilateral removal of the frontal sinus floor as described in the Draf II–III drainage procedures. In contrast, the osteoplastic frontal sinusotomy remains the “gold standard” for external approaches to frontal sinus disease.Methods A retrospective review of 1286 patients undergoing either endonasal or external frontal sinusotomy by the authors at four university teaching programs from 1977. Prior author reports were updated and previously unreported patient series were combined.Results Six hundred thirty‐five patients underwent type I frontal sinusotomy, 312 type II sinusotomy, and 156 type III sinusotomy. A successful result was seen in these groups, 85.2% to 99.3%, 79% to 93.3%, and 91.5% to 95%, respectively. External frontal sinusotomy or osteoplastic frontal sinusotomy was successfully performed in 187 of 194 patients. Clinical symptoms, endoscopic findings, computed tomography, and magnetic resonance image scanning, and reoperation rate measured postoperative success.Conclusions A stepwise approach to the surgical treatment of frontal sinusitis, trauma, and selective benign tumors yields successful results as defined by specific criteria which vary from 79% to 97.8%. The details of specific techniques are discussed, essential points emphasized, and author variations noted.
Argon Plasma Surgery for the Inferior Turbinate of Patients With Perennial Nasal Allergy
Authors: Fukazawa Keijiro , Ogasawara Hiroshi , Tomofuji Seiichi , Fujii Megumi , Sakagami Masafumi 
Published: November 2003

AbstractObjectives Argon plasma coagulation (APC) is a new electrosurgical modality. The advantages of APC are coagulating of the target tissue without contact and the creation of uniformly deep devitalized and coagulated zones. The objectives of the present study were to determine the clinical effects of APC for the inferior turbinate of patients with nasal allergy and to clarify the histological changes in the mucosa after APC.Study Design In a prospective study, 95 patients with perennial nasal allergy were treated with APC. Nasal symptoms and intranasal findings were evaluated preoperatively and 1, 3, and 6 months, and 1 year after the APC. Mucosal specimens from the turbinates were examined under light and electron microscopy.Results Nasal stuffiness was improved in 77 of 79 (97.5%) patients after 1 month, in 50 of 51 (98.0%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 9 of 12 (75.0%) patients at 1 year after the APC. Rhinorrhea was improved in 46 of 75 (61.3%) patients after 1 month, in 40 of 51 (78.4%) patients after 3 months, in 16 of 21 (76.2%) patients after 6 months, and in 6 of 10 (60.0%) patients at 1 year after the APC. The sneezing was improved in 32 of 54 (59.3%) patients after 1 month, in 21 of 35 (60.0%) patients after 3 months, in 10 of 14 (71.4%) patients after 6 months, and in 6 of 8 (75.0%) patients at 1 year after the APC. In the intranasal findings, congestion of the inferior turbinate improved in 75 of 76 (98.7%) patients after 1 month, in 49 of 52 (94.2%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 7 of 11 (63.6%) patients at 1 year after the APC. The nasal discharge was reduced in 40 of 75 (53.3%) patients after 1 month, in 32 of 52 (61.5%) patients after 3 months, in 15 of 22 (68.2%) patients after 6 months, and in 5 of 11 (45.5%) patients at 1 year after the APC. No patients needed nasal packing after the APC.Conclusions This is the first report on the clinical effects of turbinate surgery for nasal allergy using APC. APC was useful for turbinate surgery of nasal allergy, especially for nasal stuffiness and congestion of the turbinate.
Evaluation of the Effect of Passive Smoking on Otitis Media in Children by an Objective Method: Urinary Cotinine Analysis
Authors: Ilicali Ömer Cenker , Keleş Nesil , Dèger Kemal , Sàgun Ömer Faik , Güldíken Yahya 
Published: November 2003

AbstractObjectives We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis.Study Design We designed a prospective case‐control study with follow‐up of the case group for 1 year after insertion of tympanostomy tubes to evaluate postoperative complications such as otorrhea and early e‐trusion (<6 months), in case a significant risk factor was found.Methods One hundred fourteen children between 3 and 8 years of age requiring tympanostomy tubes because of OME and ROM were chosen and compared with 40 age‐matched children. E‐posure to environmental tobacco smoke was assessed by cotinine urinalysis, which was performed by means of the radioimmunoassay method.Results In this study, 73.7% (84 of 114) of the children in the case group and 55.0% (22 of 40) of the children in the control group were found to be “e‐posed” (P = .0461). This difference was statistically significant. Comparing the cotinine urinalysis results with parental smoking histories, 23.1% (9 of 39) of the children without parental smoking histories were “exposed” to tobacco smoke versus 84.3% (97 of 115) of the children with parental smoking histories (at least one person smoking).Conclusions Our results indicate that sidestream smoking increases the risk of OME and ROM. Legal regulations and guidelines must be established to protect children from passive smoking. Because cotinine urinalysis is a noninvasive and reliable method for the determination of passive smoking, it can be used for that purpose.
Free Radical Production by Antibiotic‐Killed Bacteria in the Guinea Pig Middle Ear
Authors: Takoudes Thomas G. , Haddad Joseph 
Published: November 2003

AbstractObjectives Oxygen free radicals are implicated in the pathogenesis of otitis media. Recent investigations with animal models have demonstrated that free radical–mediated damage of the middle ear mucosa, measured as lipid hydroperoxide, occurs when the middle ear cavity is inoculated with Streptococcus pneumoniae. The present study was conducted to examine the effect of antibiotics on free radical–mediated damage in pneumococcal acute otitis media.Study Design Animal model of acute otitis media.Methods Seventy‐eight guinea pigs underwent bilateral middle ear inoculation with 100 μl of 1) sterile saline as a control, 2) 50 μg/mL amoxicillin, 3) 107 colony forming units (CFU)/mL Streptococcus pneumoniae killed with 50 μg/mL amoxicillin, or 4) 107 CFU/mL S pneumoniae. Animals were killed on postoperative day 1 or 5, and the middle ear mucosa was examined for lipid peroxidation as evidence of free radical damage.Results Mucosal lipid hydroperoxide was significantly elevated compared with control subjects on day 1 in both the antibiotic‐killed S pneumoniae group and the S pneumoniae–infected group. On day 5, the S pneumoniae–infected mucosa had significantly higher lipid hydroperoxide levels compared with the antibiotic‐killed group and the control subjects. Histological studies confirmed mucosal edema and the presence of inflammatory cells in the infected groups.Conclusions Antibiotic‐killed bacteria seem to produce free radical–mediated damage to the middle ear mucosa in the early phase of acute otitis media. The clinical implication of this study is that free radical damage to the middle ear mucosa may occur in otitis media despite appropriate antibiotic therapy.
Ionomeric Cement in the Human Middle Ear Cavity: Long‐Term Results of 23 Cases
Authors: Kupperman David , Tange Rinze A. 
Published: November 2003

AbstractObjectives The long‐term results of the implantation of glass ionomer cement in the human mastoid and middle ear were studied.Study Design A prospective study of the survival of bone cement in the middle ear.Methods Ionocem (Ionos, Medizinische Produkte Gmbh & Co., Seefeld/Obb, Germany), a two‐compound bone material that forms a stable, waterproof junction with bone, was implanted in 23 middle ears of 23 patients (13 male and 10 female patients). Closure of the dehiscence of the tegmen was performed in 7 cases, obliteration of the mastoid cavity in 10 cases, and ossicular chain reconstruction in 6 cases.Results The follow‐up period was 5.1 years. Complications attributable to operation were not seen, but adverse tissue reaction with severe middle ear infection and abundant otorrhea occurred in six cases after 12 months, requiring repeat operation. In three more cases, a spontaneous extrusion of the bone cement was seen after 4 years. The bone cement was totally extruded in nine cases. The mean survival time was 28 months.Conclusions The use of Ionocem for obliteration of the mastoid cavity or for the closure of dehiscence of the tegmen has a high risk of extrusion. Therefore, it is not the first‐choice material to use for obliteration or tegmen defect closure in the middle ear.
Optic Nerve Decompression in the Comatose and Conscious Patients After Trauma
Authors: Lübben Björn , Stoll Wolfgang , Grenzebach Ulrike 
Published: November 2003

AbstractObjective To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy.Study Design Retrospective analysis of 65 optic nerve decompressions.Methods The total collective of optic nerve decompressions comprised 65 patients treated within the period between February 1987 and December 1998. Thirteen of these 65 patients (average age, 32 y) were comatose and required critical care treatment, so visual acuity could not be measured. The indication for surgical decompression in all patients was based on the ophthalmological examination and the finding on computed tomography (CT) scan of a lesion inside the optic nerve canal or the orbit apex, respectively.Results In the comatose patients the time interval between trauma and surgery was 16.1 ± 12.1 hours (mean ± standard deviation). During the subsequent postoperative examinations (on average, 12.3 mo postoperatively) five patients showed a normal visual acuity (20/20), two patients a visual acuity of 20/30 and 20/50, and one a visual acuity of 20/200. Three patients (three eyes) remained amaurotic. Two patients died of the general and severe consequences of injury. The beneficial visual acuity results achieved within the group of comatose patients were equivalent to those achieved within the group of patients who were conscious during the preoperative examination. The success rate, defined as an improvement of three lines with a final visual acuity of at least 20/1000, was 57.7% versus 61.5%.Conclusion The results confirm our concept of early decompression of the optic nerve, based on close interdisciplinary cooperation and the ophthalmological findings.
Early Oral Feeding Following Total Laryngectomy
Authors: Medina Jesus E. , Khafif Avi 
Published: November 2003

AbstractObjectives The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy.Study Design Two‐part study includes, first, a sequential study and, second, a prospective analysis of our practice.Methods Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery.Results In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days.Conclusion Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice.