bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Therapy for Migraine‐Related Vestibulopathy and Vestibular Dysfunction With History of Migraine
Authors: Whitney Susan L. , Wrisley Diane M. , Brown Kathryn E. , Furman Joseph M. 
Published: November 2003

AbstractObjectives/Hypothesis To assess the efficacy of physical therapy for patients with a diagnosis of migraine‐related vestibulopathy (MRV) or vestibular dysfunction with a history of migraine headache.Study Design Retrospective case seriesMethods Thirty‐nine patients were identified through a retrospective chart review, 14 with a diagnosis of MRV and 25 with migraine headache. The patients were treated with a custom‐designed physical therapy e‐ercise program for a mean of 4.9 visits over a mean duration of 4 months. Patients completed the Dizziness Handicap Inventory (DHI), the Activities‐Specific Balance Confidence Scale (ABC), and the Dynamic Gait Inde‐ (DGI), reported the number of falls they had e‐perienced in the past 4 weeks, and rated the severity of their dizziness on an analogue scale of 0 to 100 at initial evaluation and at discharge.Results Significant differences were seen before and after therapy in each of the outcome measures used. The average decrease in DHI score was 12 points (P < .01). ABC scores increased an average of 14 points (P < .01). Subjects increased their DGI scores an average of 4 points (P < .01). The number of patients reporting more than one fall decreased by 78% at discharge. (P < .05). Baseline symptoms of dizziness decreased an average of 11 points (P < .05).Conclusions Patients with MRV and migraine headache demonstrated improvement in physical performance measures and self‐perceived abilities after vestibular physical therapy.
Impact of Facial Paralysis on Patients With Acoustic Neuroma
Authors: Cross Teedah , E. Sheard Charlotte , Garrud Paul , Nikolopoulos Thomas P. , O'Donoghue Gerard M. 
Published: November 2003

AbstractObjective To assess the psychological distress, the ways of coping with that stress, and the self‐esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored.Study Design Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self‐esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis.Patients One hundred three patients with facial paralysis after surgical removal of acoustic tumors.Results Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = −0.28, P = .005). High levels of distress were associated with low levels of self‐esteem, as shown by the significant negative correlation between level of distress and self‐esteem (r = −0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self‐esteem was the most important contributing factor (standardized coefficient β −0.60, P = .0001), followed by age (β −0.24, P = .006) and sex (β −0.21, P = .04). This model explained 44% of the distress variance.Conclusion Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self‐esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self‐esteem and decrease their distress, especially in these high‐risk groups.
Tonsillectomy As a Treatment of Obstructive Sleep Apnea in Adults With Tonsillar Hypertrophy
Authors: Verse Thomas , Kroker Béatrice A. , Pirsig Wolfgang , Brosch Sibylle 
Published: November 2003

AbstractObjectives High surgical success rates for adenotonsillectomy in children with sleep‐related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy.Study Design Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep‐related breathing disorders were evaluated based on the severity level of their preoperative apnea‐hypopnea index (AHI).Material and Methods Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow‐up time was 3 to 6 months.Results Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI ≥50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred.Conclusions Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.
Treatments for Snoring: A Comparison of Somnoplasty and an Oral Appliance
Authors: Cartwright Rosalind , Venkatesan T. K. , Caldarelli David , Diaz Frank 
Published: November 2003

AbstractObjectives Objectives of the study are 1) to test the effectiveness of somnoplasty (radiofrequency volumetric tissue reduction of the soft palate) for the control of loud, socially disruptive, snoring; 2) to test the long‐term efficacy of this treatment by spouse report; and 3) to compare the effectiveness of somnoplasty with another treatment.Study Design Twenty patients with complaints of loud snoring and a respiratory disturbance index no greater than 15 respiratory events per hour with sleep‐related episodes of oxygen desaturation no lower than 80% were offered an experimental treatment. Ten were treated with somnoplasty, and a comparison group of 10 matched patients used an oral appliance. All were restudied in the laboratory wearing a device programmed to count minutes of sleep during which snoring was loud, soft, or absent.Methods For the 10 somnoplasty patients, a spouse rating of snoring determined whether the patient received one or more treatments. Five patients had a single treatment to three sites, and five others had two such treatments. Ten patients wore an oral appliance of the tongue‐retaining type (Snore X, Fremont, CA).Results Seven of the 10 somnoplasty patients met the improvement criteria set for reduced loud snoring (a spouse rating of 3 or less on a 10‐point scale, and 10% or less of sleep time in loud snoring in the laboratory). The comparison group also had a significant improvement in the percentage of sleep time in loud snoring while wearing the Snore X appliance.Conclusion Since there was no significant difference between the two groups in percentage of sleep time spent in loud snoring while treated, the choice of method to control snoring must be based on factors other than efficacy.
Maxillomandibular Advancement for Persistent Obstructive Sleep Apnea After Phase I Surgery in Patients Without Maxillomandibular Deficiency
Authors: Li Kasey K. , Riley Robert W. , Powell Nelson B. , Guilleminault Christian 
Published: November 2003

AbstractObjective To assess the outcomes of maxillomandibular advancement (MMA) for the treatment of persistent obstructive sleep apnea syndrome (OSA) after phase I reconstruction in patients who do not have maxillomandibular deficiency.Methods From January 1997 to September 1998, 25 patients previously treated with phase I reconstruction (uvulopalatoplasty, genioglossus advancement, and/or hyoid suspension) who did not have maxillary and mandibular deficiencies underwent MMA for persistent OSA. Variables examined include age, sex, body mass index (BMI), respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), and cephalometric data. In addition, a minimum of 6 months after surgery, questionnaires containing a 10‐cm visual analogue scale (0 = no change, 10 = drastic change) were mailed to the patients. The questionnaire subjectively assessed the patient's perception of the facial appearance after surgery, whether there was pain or discomfort of the temporomandibular joint, the overall satisfaction with the treatment outcomes, and whether the patient would recommend the operation to other patients.Results Nineteen (76%) questionnaires were completed and returned by 15 men and 4 women. The mean age was 45.3 ± 6.6 years and the mean BMI was 33.1 ± 7.1 kg/m2. The mean RDI improved from 63.6 ± 20.8 to 8.1 ± 5.9 events per hour, and the mean LSAT improved from 73.3 ± 13.2% to 88.1 ± 4.1%. One patient was defined as an incomplete responder (RDI >20). One patient reported transient pain and discomfort of the temporomandibular joint. Although all of the patients felt that there were changes in their facial appearance after surgery, 18 of the 19 patients gave either a neutral or a favorable response to their facial esthetic results. All of these patients were satisfied with the overall outcomes and would recommend the treatment to others.Conclusion MMA is a highly effective treatment for persistent OSA after phase I surgery in patients who otherwise do not have maxillomandibular deficiency. The patient satisfaction is extremely high. Furthermore, previous concerns of unfavorable postoperative facial esthetics and temporomandibular joint dysfunction do not appear to be significant.
Tumor Necrosis Factor Gene Polymorphism in Chronic Sinusitis
Authors: Takeuchi Kazuhiko , Majima Yuichi , Sakakura Yasuo 
Published: November 2003

AbstractObjectives It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis.Study Design Thirty‐eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films.Methods Both tumor necrosis factor‐α (TNF‐α) and tumor necrosis factor‐β (TNF‐β) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects.Results A significantly higher frequency (P < .05) of TNFB*2 allele of TNF‐β gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF‐α and chronic sinusitis.Conclusion We concluded that TNF‐β gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.
Quantitative Analysis of Tympanic Membrane Disease Using Video‐Otoscopy
Authors: Jaisinghani Vikram J. , Hunter Lisa L. , Li Yaoli , Margolis Robert H. 
Published: November 2003

AbstractObjective To perform quantitative analysis of pathological changes in the tympanic membrane using video‐otoscopic images.Study Design Prospective case‐control study.Methods Forty‐two ears of children with chronic otitis media with effusion (OME) and 15 ears of normal children were included in this study. Tympanic membrane images were captured and digitized using a Welch‐Allyn (Skaneatales Falls, NY) VDX‐300 Illumination and Imaging system with S‐VHS input to a MIRO DC 30 (Pinnacle Systems, Mountain View, CA) visual board in a Power PC–based computer. These images were visualized and recorded during static and pneumatic pressure changes. Quantitative analysis of tympanic membrane disease was performed using Image Pro Plus Imaging software (Media Cybernetics, Del Mar, CA). The measurements included area of the tympanic membrane and its quadrants, area of tympanic membrane involved by disease, angle formed at the umbo, and length of the malleus versus vertical length of the tympanic membrane.Results Tympanosclerosis was present in 57% of ears and occurred most frequently in the anteroinferior quadrant, but the ma‐imum area of involvement was in the posteroinferior quadrant. The ratio of the angles formed at the umbo was significantly greater (P = .01) for the OME group compared with the control group. The ratio of the length of the umbo and the vertical length of the tympanic membrane was almost identical for the OME and the control groups (P = .4).Conclusions Video‐otoscopic images can be used for quantitative analysis of tympanic membrane disease. The ratio of the posterior angle to the anterior angle formed at the umbo seems to be a more reliable indicator of post otitis media than is a reduced length of the long process of malleus.
Complement C3 Cleavage and Cytokines Interleukin‐1β and Tumor Necrosis Factor‐α in Otitis Media With Effusion
Authors: Närkiö‐Mäkelä Mervi , Teppo Anna‐Maija , Meri Seppo 
Published: November 2003

AbstractObjectives To analyze whether complement C3a anaphylatoxin, other C3 fragments, interleukin‐1β (IL‐1β), or tumor necrosis factor‐α (TNF‐α) contributes to inflammation in chronic otitis media with effusion (OME).Methods The amount of C3a was measured by enzyme‐linked immunoassay. Further breakdown of C3 was analyzed by Western blotting. IL‐1β and TNF‐α concentrations were measured by radioimmunoassay. Bacteria were analyzed by culture and polymerase chain reaction.Results Highly elevated levels of C3a and other C3 cleavage fragments were found in all middle ear effusion (MEE) samples. The mean values (± SEM, n = 26) for C3a, IL‐1β, and TNF‐α were 5973 ± 1124 ng/mL, 1043 ± 490 pg/mL, and 79 ± 14.3 pg/mL, respectively. Comparison to an average C3 level of 555 (±108) μg/mL indicated that at least 40.5% ± 6% of total C3 had become activated within the MEE. C3a concentrations were higher in the group in which the effusion had been present in the middle ear for a prolonged period (≥4 mo) (P = .04). Children with multiple tube insertions had higher C3 (P = .006) and TNF‐α (P = .04) concentrations in their MEE samples than those receiving their first tubes. C3 and C3a concentrations in MEE correlated to each other (correlation coefficient [r] = 0.513, P = .0056), as did concentrations of IL‐1β and TNF‐α (r = 0.7016, P < .0001). No significant correlation was found between complement C3 or C3a levels and IL‐1β, TNF‐α, or bacterial growth.Conclusions Highly elevated levels of C3a in MEE indicate ongoing complement activation, which is stronger than in almost any other disease demonstrated previously. Elevated C3a levels contribute to chemotactic and inflammatory potential in the MEE and correlate with the chronicity of the disease.
Analysis of Treatment Results for Floor‐of‐Mouth Cancer
Authors: Sessions Donald G. , Spector Gershon J. , Lenox Jason , Parriott Sarah , Haughey Bruce , Chao Clifford , Marks James , Perez Carlos 
Published: November 2003

AbstractObjective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up.Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994.Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance.Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers.Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.
Efficacy of Concomitant Chemoradiation and Surgical Salvage for N3 Nodal Disease Associated With Upper Aerodigestive Tract Carcinoma
Authors: Ahmed Khwaja A. , Robbins Kevin T. , Wong Frank , Salazar Jorge E. 
Published: November 2003

AbstractObjectives/Hypothesis To determine whether an aggressive approach using trimodality therapy would improve the outcome in head and neck cancer patients with advanced (N3) nodal disease.Study Design In this retrospective, nonrandomized review, we analyzed a subset of patients who were treated in a targeted chemoradiation therapy protocol, consisting of 31 patients who received treatment between June 1993 and June 1997.Methods Patients received selective intra‐arterial infusions of cisplatin (150 mg/m2/wk for 4 weeks) and concomitant radiation therapy (2 Gy/fraction × 35 daily fractions over a 7‐wk period) to the primary and clinically positive nodal disease. The patients were re‐evaluated 2 months later and underwent salvage neck dissections if there was any residual disease.Results Classification of disease in the primary site was as follows: T1 in 2 patients, T2 in 6 patients, T3 in 14 patients, and T4 in 9 patients. Among the 31 patients who were assessed for response at the nodal site, 4 of 31 (13%) had a complete response, 21 of 31 (68%) had a partial response, and 1 of 31 (3%) had no response. Excluding the 5 patients who could not be evaluated, 4 of 26 patients (15%) had a complete response, 21 of 26 (81%) had a partial response, and 1 of 26 (4%) had no response. Nineteen patients subsequently underwent neck dissection, and five patients had histological evidence of residual disease. The remaining seven patients included four who had a complete response in their necks and three who died of intercurrent disease before re‐staging. Among the 23 patients who were rendered disease free, there were no recurrences within the neck, whereas 1 patient had recurrence at the primary site and 11 patients had recurrence at distant sites. With a median follow‐up of 15 months (range, 4–41 mo), the 3‐year overall survival and disease‐specific survival were 41% and 43%, respectively.Conclusions Targeted chemoradiation therapy followed by surgical salvage is a highly effective approach for regional control of patients with N3 nodal disease, whereas additional strategies are required to address the problem of distant metastases.
A Prospective Study of the Effects of Irradiation on the Carotid Artery
Authors: Muzaffar Kamil , Collins Sharon L. , Labropoulos Nicos , Baker William H. 
Published: November 2003

AbstractObjectives/Hypothesis To prospectively assess the effects of irradiation on the carotid artery in patients with head and neck cancer, as a possibly relevant factor in cancer treatment planning.Study Design Prospective study from a tertiary care academic setting on university (22 patients) and Veterans Affairs (14 patients) hospital patients; 1‐year follow‐up, including comparison of study data with age‐matched and sex‐matched control subjects from epidemiological studies.Methods Thirty‐si‐ patients with head and neck cancer who underwent therapeutic neck irradiation were e‐amined by high‐resolution ultrasound before and 1 year after treatment. Twelve patients were also studied at 2 years. Measurements included the intima‐media thickness (IMT) of the carotid artery wall, the degree of stenosis as estimated from velocity measurements, and the presence and size of plaque.Results The pretreatment carotid IMT at baseline was 0.68 mm and was comparable to age‐matched and se—matched control subjects. Significant increase in the IMT was observed on both the left (0.67 vs. 0.84 mm) and the right (0.7 vs. 0.87 mm) sides (P < .001) 1 year after irradiation. In 12 patients who completed 24 months of follow‐up the carotid IMT continued to significantly increase statistically compared with that at the first year after treatment (left side, 0.79 vs. 0.85 mm, P = .037; right side, 0.79 vs. 0.95 mm, P = .014). Statistically significant thickening of the carotid wall developed in all 36 patients by 1 year. Two patients experienced post‐treatment neurological events and an area of stenosis greater than 75%.Conclusions Neck irradiation significantly increases the thickness of the carotid wall during the first year after treatment—on average, 21 times more than in epidemiologically matched control volunteers. This phenomenon should be taken into consideration when planning treatment for the node‐negative (N0) neck.