bluuebunny/crossref_metadata_2025_split huggingface dataset:
Otological and Audiological Outcomes Five Years After Tympanostomy in Early Childhood
Authors: Valtonen Hannu J. , Qvarnberg Yrjö H. , Nuutinen Juhani 
Published: November 2003

AbstractObjective Ventilation tubes in the treatment of otitis media in young children remain controversial. Despite abundant research, few prospective long‐term follow‐up studies have included even a minority of patients under 1 year old. We investigated long‐term otological and audiological outcomes in children with recurrent acute otitis media and otitis media with effusion, who were treated early with ventilation tubes.Study Design Prospective follow‐up.Methods Three hundred five children under 17 months of age received a primary tympanostomy in the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281 (92.1%) who were monitored prospectively for 5 years made up the study group. At the final examination, pneumatic otoscope and otomicroscope were used and pure‐tone audiometric thresholds of air and bone conduction were measured to define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds).Results Of ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, respectively.Conclusions Hearing in general was well preserved, and no ear presented with adhesive otitis media or cholesteatoma. Adverse otological and audiological outcomes of these young children did not exceed those presented by others for older counterparts. Tympanic membrane perforations, ongoing otitis media with effusion, and pars tensa retractions were causes of mild conductive hearing loss. Because one third of ears continued to have middle ear disease or sequelae, we emphasize the proper follow‐up and restoration of middle ear ventilation with repeat ventilation tubes if not otherwise achieved.
Intratympanic Ciprofloxacin and the Human Labyrinthine Sampling Model
Authors: Becvarovski Zoran , Kartush Jack M. , Bojrab Dennis I. 
Published: November 2003

AbstractObjective The aim of the study was to investigate the potential absorption of intratympanic ciprofloxacin through the human round window membrane.Study Design A prospective study.Methods Ciprofloxacin was instilled into the middle ear of 10 patients undergoing acoustic tumor removal. The lateral semicircular canal and vestibule were subsequently opened and, using a microsyringe, labyrinthine fluid was aspirated. A sample each of serum and cerebrospinal fluid was also drawn.Results Into each middle ear, 0.5 mL ciprofloxacin (0.3%) was instilled. The time interval between the ciprofloxacin application to the round window membrane and sampling of labyrinthine fluid and plasma ranged from 9 to 120 minutes. There was no measurable ciprofloxacin in the labyrinthine fluid, cerebrospinal fluid, or serum of 10 patients.Conclusion The lack of measurable absorption of intratympanic ciprofloxacin into the inner ear indicates that the chance of ototoxicity when ciprofloxacin is used clinically, even in the presence of a tympanic membrane perforation, is low.
Is the Trachea a Marker of the Type of Environmental Pollution?
Authors: Foltinová Janka , Schrott‐Fischer Annelies , Zilínek Viliam , Foltin Viktor , Freysinger Wolfgang 
Published: November 2003

AbstractObjectives/Hypothesis The differentiated character of changes in the mucous relief of the trachea as induced by air containing pollutants from the wastes of nickel‐, mercury‐, and cement‐producing plants and by Candida albicans occurring in the waste disposal site of a large town are identified. The trachea was chosen because it is the entrance gate for the penetration of polluted air into the lungs. Changes on the trachea influence the character and extent of changes in lungs.Study Design Histological study with Viennese grey strain laboratory rabbits and rats caught directly on an investigated site.Methods We present new results of the functional morphology of the respiratory system as the results of scanning and transmission electron microscopy studies that can reveal character and range of damage of mucosal relief of trachea relevant to the functional dynamics of mucociliary clearance. Under physiological conditions this mechanism allows that only respirable dust particles enter the deep respiratory tract.Results In case of a damaged tracheal relief because of exposure to various aerosols, the functional morphology is changed, which aids in understanding the mechanisms damaging to mucociliary clearance induced by living in heavily polluted areas.Conclusion Understanding of these morphological changes on base of detailed electron microscopic findings sheds new light on elaborating novel diagnostic methods for clinical practice.
Neck Crepitance: Evaluation and Management of Suspected Upper Aerodigestive Tract Injury
Authors: Goudy Steven L. , Miller Frank B. , Bumpous Jeffrey M. 
Published: November 2003

AbstractObjective To determine safe criteria for the management of patients with crepitance of the neck.Hypothesis Upper aerodigestive tract injury may lead to significant morbidity and mortality. Historically, this kind of injury has been managed by immediate surgical exploration, repair, and drainage. More recently, a nonoperative approach has been advocated.Study Design Retrospective chart review of patients admitted to the University of Louisville Trauma Center with suspected upper aerodigestive tract injury.Methods We reviewed the charts of 236 patients admitted to the trauma service from 1995 to 1999 with the diagnosis of aerodigestive tract injury or subcutaneous emphysema.Results Nineteen patients were identified with cervical emphysema or cervical crepitance, or both, thought to be caused by an upper aerodigestive tract injury. The average patient age was 38.5 years; 68% of patients were men. The mechanisms of injury were motor vehicle accident (43%), gunshot wound (37%), assault (10%), blunt neck trauma (5%), and stabbing (5%). Each patient presented with cervical emphysema shown by radiograph or crepitance, or both; 21% had dysphagia and 63% were hoarse or had stridor. Location of the injury was tracheal or laryngeal in 37%, hypopharyngeal in 27%, oral pharynx in 16%, esophageal in 5%, and unidentified in 15% of patients. Because of suspected aerodigestive tract injury, 79% of patients were taken to the operating room for direct laryngoscopy and esophagoscopy, and abnormalities were found in 80%. The diameter of the average laceration of the upper aerodigestive tract was 1.6 cm. Associated injuries included mandible fractures in 37% of patients. Broad‐spectrum antibiotics were given to 95% of the patients. The initial management involved immediate surgical exploration in 55% of the total number of patients, with 83% of the surgically explored patients undergoing tracheotomy. The remaining 45% of patients were managed without surgery. Complications occurred only in operative patients, with aspiration occurring in 10%, bilateral hypoglossal nerve paralysis in 5%, and vocal cord paralysis in 5%. None of the patients developed postinjury or operative abscess.Conclusion The findings show that suspected upper aerodigestive tract injury can be managed without surgery but that a high index of suspicion for airway compromise and associated facial injuries must be considered.
Cancer of the Oral Cavity and Medical Malpractice
Authors: Lydiatt Daniel D. 
Published: November 2003

AbstractObjective To analyze malpractice litigation initiated by patients with cancer of the oral cavity as a result of allegations concerning their diagnosis and treatment.Study Design Retrospective review.Methods Jury verdict reviews from 1984 to 2000 were obtained from a computerized legal database and analyzed. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, and allegations of wrongdoing and provide case summaries. Fifty cases from 21 of all 50 states were obtained. Data were entered into a spreadsheet for analysis.Results Overall, a young age (mean age, 45 y) and poor oncological outcome (47% dead) were seen. The younger age group (<47 y) had a better outcome (65% without disease), were more often misdiagnosed (19%), won awards (60%), and had higher awards (average award, $755,824) as compared with those older than 47 years of age, who had 39% without disease, 0% misdiagnosed, and 52% who won awards that were less, on average, at $495,417. Failure to diagnose the cancer was alleged, overall, in 43 of 50 cases (86%), and in general practice, dentists, and otolaryngologist in 100%, 85%, and 89%, respectively. Suits alleging a delay in diagnosis of less than 3 months were defendant verdicts in 86%, and of more than 3 months, in 40%. Failures to perform biopsy and to refer were common allegations.Conclusions Young age of patients bringing litigation is seen in patients with oral cancer. These patients frequently have poor oncological outcomes. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.
Quality of Life After Parotid and Temporal Bone Surgery for Cancer
Authors: Kwok Henry C. K. , Morton Randall P. , Chaplin John M. , McIvor Nicholas P. , Sillars Hamish A. 
Published: November 2003

AbstractObjectives The purposes of this study were to examine the quality of life (QL) of patients who received treatment for cancer of the parotid or temporal region, and to identify factors contributing to it. The relationships between clinician‐based measures of treatment outcome and the patient‐based counterparts were also evaluated.Methods A retrospective, cross‐sectional study was conducted on 23 patients who had received either a temporal bone resection or a combination of parotidectomy and radiotherapy. The QL survey involved both global QL and measures of the appearance, communication, hearing, physical, psychological, and social domains. Patients were assessed clinically for their performance status, facial nerve function, disfigurement, and hearing and the results were compared with patient‐rated QL. Correlation between the QL variables and global QL was identified using Spearman correlation tests.Results Ongoing physical symptoms, communication difficulties, and social disturbances were associated with poorer global QL (P <.05). No correlation was detected between global QL and objective disfigurement, facial function, and measures of hearing loss. With the exception of hearing testing, clinical assessments generally did not correlate well with patient ratings.Conclusion QL measures provide insight into patients' perceptions of the treatment outcome but do not necessarily correlate with the clinicians' views. The use of a global QL measure overcomes the difficulty of extrapolating the impact of symptom scores or observational measures on patients' overall quality of survival.
Middle Turbinate Lateralization: A Simple Treatment for Rhinologic Headache
Authors: Kunachak Somyos 
Published: November 2003

AbstractObjective To introduce a minimally invasive method to eliminate the symptoms of contact‐point rhinologic cephalgia.Study Design A prospective study of 55 patients with chronic nasal or glabellar pain and endoscopically proven nasal origin.Methods All 55 patients in whom endoscopic examination demonstrated a contact point between the middle turbinate and the nasal septum were treated by fracturing the middle turbinate lateralward using a small metal tongue depressor under 10% lidocaine HCL topical anesthesia.Results Of the treated cohort, 48 (87%) of the patients had complete clinical symptom resolution after one treatment and all had resolution after two treatments. Recurrence occurred in 1 patient. There were no short‐term or long‐term adverse sequelae. The results persisted at a mean follow‐up time of 50 months (range, 6–84 mo).Conclusion Middle turbinate lateralization is safe and effective in eliminating the symptoms of rhinologic cephalgia induced by contact point between the middle turbinate and nasal septum.
Association of Laryngopharyngeal Symptoms With Gastroesophageal Reflux Disease
Authors: Tauber Stefan , Gross Manfred , Issing Wolfgang J. 
Published: November 2003

AbstractObjectives The prevalence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal disorders is probably greater than realized.Study Design Prospective study.Methods To investigate the incidence of gastroenterological diseases including GERD in patients complaining of nonspecific laryngopharyngeal symptoms, laryngological examinations and gastroenterological evaluation with esophagogastroduodenoscopy were performed in 30 patients who refused to undergo 24‐hour pH monitoring. Therapeutic intervention by behavioural and dietary modifications, antireflux medication, and eradication of Helicobacter pylori were assessed for changes in laryngeal findings and relief of symptoms.Results Posterior laryngitis was present in 26 patients and in 19 of them was accompanied by erythema and edema of the interarytenoid region. Gastroenterological diseases such as GERD (43%), hiatal hernia (43%), and Helicobacter pylori‐positive antrum gastritis (23%) were confirmed in 22 (73%) cases by esophagogastroduodenoscopy and histological examination of biopsy specimens. Medical antireflux treatment and eradication of Helicobacter pylori resulted in a remarkably therapeutic success rate of 90% because there was resolution of laryngopharyngeal symptoms and laryngeal findings in 20 of 22 patients with gastroenterological diseases for the mean follow‐up period of 8 months.Conclusions Laryngopharyngeal symptoms can be predictors of gastroesophageal diseases and GERD because the most frequent underlying cause is supposed to be associated with posterior laryngitis. Medical antireflux treatment is effective for relief of symptoms and mucosal healing of posterior laryngitis.
Nonsurgical Management of Parapharyngeal Space Infections: A Prospective Study
Authors: Sichel Jean‐Yves , Dano Itshac , Hocwald Eitan , Biron Adi , Eliashar Ron 
Published: November 2003

AbstractObjective/Hypothesis Parapharyngeal infections, which can potentially cause life‐threatening complications, may, in certain cases, be treated conservatively with no need for surgical drainage. A review of the literature reveals that the most recommended treatment of parapharyngeal infection is surgical drainage combined with intravenous antibiotic therapy. Several retrospective reports recommend conservative treatment with no surgical drainage.Study Design Prospective, nonrandomized.Methods A prospective study was performed on all patients with an infection limited to the parapharyngeal space.Results Twelve patients presented with clinical and radiological diagnosis of parapharyngeal infection during a 5‐year period. Five patients showed obvious presence of pus in other spaces and therefore were excluded. Seven patients with no gross extension into other spaces and with no respiratory distress or septic shock were treated with intravenous amoxicillin‐clavulanic acid for 9 to 14 days (average period, 11 days). All patients except one were children. All were cured with conservative management, and no surgical drainage was needed. None had any complications.Conclusion Our results confirm the effectiveness of nonsurgical treatment of infections limited to the parapharyngeal space, at least in the pediatric population.
Congenital Pyriform Aperture Stenosis: Surgery and Evaluation with Three‐Dimensional Computed Tomography
Authors: Lee Kuo‐Sheng , Yang Cheng‐Chien , Huang Jon‐Kway , Chen Yu‐Chun , Chang Ke‐Chang 
Published: November 2003

AbstractObjective We described the surgical efficacy of congenital pyriform aperture stenosis by measuring the width of the nasal pyriform aperture with three‐dimensional computed tomography.Methods Six patients with congenital pyriform aperture stenosis accepted surgical intervention. Three‐dimensional computed tomography was performed for preoperative and postoperative evaluation of nasal pyriform aperture width. We marked the midpoint between the tip of nasal bone and the anterior nasal spine. The distances between the bilateral nasal processes of the maxilla and between the lateral rims of the pyriform aperture were measured by crossing the midpoint horizontally.Results Among the six patients (three male and three female patients), the mean age was 76.2 ± 23.9 days. Silicon stents were removed 6 to 7 days after operation. During 9 months of follow‐up, there were no cases of restenosis, respiratory failure, or cyanosis. The mean preoperative and postoperative interprocess distances were 4.5 ± 0.84 and 8.7 ± 1.37 mm, respectively, and data were statistically significant at a confidence level of P <.05. The mean preoperative and postoperative interwall distances were 9.8 ± 0.75 and 10.8 ± 1.5 mm, respectively.Conclusions Congenital pyriform aperture stenosis should be suspected whenever there is both severe nasal obstruction and difficulty in passing a small catheter or nasogastric tube through the anterior nasal valve. Operation is the most extreme treatment, but it is effective for congenital pyriform aperture stenosis. Nasal stenting for 7 days seemed to be adequate. The use of three‐dimensional computed tomography to evaluate preoperative and postoperative nasal pyriform aperture is effective and reliable.
Bilateral Squamous Cell Carcinoma of the External Auditory Canals
Authors: Wolfe Stephen G. , Lai Stephen Y. , Bigelow Douglas C. 
Published: November 2003

AbstractObjectives To report a case of bilateral squamous cell carcinoma of the external auditory canals and to present a management algorithm for this difficult clinical scenario.Study Design Case report and literature review.Methods The study comprises a case report of a 69‐year‐old man who initially presented with complaints of bilateral otorrhea, left‐sided otalgia, and a left‐sided hearing loss. Following attempted treatment of a presumed case of otitis externa, biopsy of both external auditory canals revealed squamous cell carcinoma. A computed tomography scan demonstrated marked abnormal soft tissue in the left external auditory canal with no bony erosion and thickening of the soft tissue in the right external auditory canal.Results The left‐sided lesion required a lateral temporal bone resection, a partial superficial and deep‐lobe parotidectomy, and postoperative irradiation. The right‐sided lesion was more limited and was managed with a lateral temporal bone resection and tympanoplasty for hearing preservation.Conclusions Bilateral squamous cell carcinoma of the external auditory canals is an extremely uncommon but aggressive malignancy that may present with symptoms similar to a case of otitis externa, and this can result in delays in proper diagnosis. Early recognition is essential because management and prognosis are determined by the extent of the lesion.
Evaluation of Selective Lymph Node Sampling in the Node‐Negative Neck
Authors: Wein Richard O. , Winkle Mark R. , Norante John D. , Coniglio John U. 
Published: November 2003

AbstractObjective To determine whether intraoperative selective lymph node sampling before neck dissection in the node‐negative (N0) neck accurately reflects the disease content of the neck and can be used to assist in treatment selection.Study Design A prospective clinical study at a university medical center.Methods Over a 2‐year period, 36 patients with head and neck squamous cell carcinoma scheduled to undergo 41 elective neck dissections were enrolled. At the initiation of the neck dissection, biopsy of the “most suspicious” lymph node within the tumor's primary nodal drainage basin was performed, and the specimen was measured and sent for frozen‐section evaluation. The results of lymph node sampling were compared with the final histopathologic interpretation of the resected primary and neck dissection.Results Of the 41 N0 necks, 29% (12 of 41) were positive for occult metastases. Results of selective lymph node biopsy correlated with the results of neck dissection in 34 of 41 specimens (83%). The specificity and positive predictive value of node sampling were both 100%. The proportion of cases with a positive neck dissection with a positive sampled node (sensitivity) was 42% (5 of 12).Conclusion The results of selective lymph node biopsy with frozen‐section analysis in the N0 neck, as defined in the current study, did not reflect a technique with adequate sensitivity to alter intraoperative treatment strategy.
Telephone Appointment Visits for Head and Neck Surgery Follow‐up Care
Authors: Eaton Jeffrey , Rasgon Barry , Derbin Leslie Widrow , Hilsinger Raymond L. , Buenavista Tracy 
Published: November 2003

AbstractObjectives/Hypothesis To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow‐up care in a head and neck surgery clinic.Study Design Randomized, nonblinded cross‐sectional study.Methods After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow‐up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow‐up care. Study data were collected using telephone interviews and physician trackingforms.Results Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (χ2 = 25.4, P <.005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree “somewhat” or “strongly” that 1) the physician addressed their questions and concerns (χ2 = 24.0, P <.005); 2) the physician provided personal care and attention (χ2 =29.9, P <.005); and 3) the physician provided high‐quality care (χ2 =34.5, P <.005).Conclusions Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow‐up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow‐up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow‐up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow‐up visit.