bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meniere's Disease: The Incidence of Hydrops in the Contralateral Asymptomatic Ear
Authors: Conlon Brendan J. , Gibson William P. R. 
Published: November 2003

AbstractObjective: This study analyzes the incidence of endolymphatic hydrops in the asymptomatic contralateral ear of patients with classic Meniere's disease.Study Design: A retrospective study of 3000 subjects who underwent electrocochleography (ECOG) from 1988 to 1998.Methods: The presence of endolymphatic hydrops was determined by use of ECOG recordings, which were made through a transtympanic recording needle situated in the round window niche. Analysis was made of the 1‐kHz tone‐burst summation potential (SP), and comparison was made between asymptomatic contralateral “Meniere's ears” (n = 144) and asymptomatic normal “control ears” (n = 114).Results: Results demonstrated that more than 10% of the contralateral asymptomatic Meniere's ears have an ECOG recording that is highly suggestive of the presence of endolymphatic hydrops. In contrast, less than 2% of the control population demonstrate abnormal ECOG recordings. Furthermore, 15% of the population of contralateral Meniere's ears lie above the 95th percentile of the control population for 1‐kHz tone‐burst (100 dB) SP negativity.Conclusions: This study suggests that a high percentage of patients who have what appears to be unilateral Meniere's disease have evidence of endolymphatic hydrops in the contralateral asymptomatic ear. This finding has important clinical relevance for the management of patients in whom destructive surgery is planned and further highlights the importance of electrocochleography in the diagnosis and management of this disease process.
Endoscopic Transnasal Transsphenoidal Microsurgery Versus the Sublabial Approach for the Treatment of Pituitary Tumors: Endonasal Complications
Authors: Koren Ilan , Hadar Tuvia , Rappaport Zvi H. , Yaniv Eitan 
Published: November 2003

AbstractObjective: To evaluate the nasal complications after transnasal transsphenoidal operations for pituitary tumors, comparing two surgical techniques: traditional sublabial transseptal and endoscopic transseptal techniques.Study Design: We retrospectively evaluated by self‐reported questionnaire and endoscopic examination the nasal condition of 40 consecutive patients with pituitary tumors: 20 patients had endoscopic surgery and 20 had surgery with the traditional sublabial technique.Results: Compared with the traditional technique, the endoscopic approach was associated with a shorter operative time (about 40 min), shorter hospitalization time (about half), absence of recurrent epistaxis snoring and denture problems, and lower incidence of septal perforation, synechia, and crust formation. Furthermore, loss of nasal tip projection was found only in the group that had surgery with the sublabial technique.Conclusions: Endoscopically guided transseptal transsphenoidal surgery is simple to perform and time‐saving, and it results in fewer nasal and denture complications than the sublabial technique. At the same time, it allows the surgeon all the benefits of the binocular microscopic surgical field that are associated with the traditional approach.
Nasal Obstruction: An Alternative to Ostiomeatal Complex Dysfunction in Sinus Disease
Authors: Ganjian Emil , Gannon Patrick J. , Fliegelman Lawrence J. , Lawson William 
Published: November 2003

AbstractObjectives: Ostial patency is thought to be essential to the function of the maxillary sinus. Ostiomeatal complex dysfunction has been implicated as a major factor in the pathogenesis of sinus disease. However, recent work in our laboratory has indicated that other factors may also contribute to this process. The objective of this study was to determine the effect of nasal obstruction in maxillary sinus gas composition, independent of its effect on ostial ventilation.Study Design: Prospective controlled animal study.Method: Independent models of nasal obstruction and ostial occlusion in contralateral sinuses were established. Ipsilateral models of nasal obstruction and ostial occlusion were also created. Gas samples from each of the manipulated sinuses were analyzed on a gas chromatogram and compared.Results: Results revealed a dramatic and highly significant increase in antral carbon dioxide (CO2) concentrations in the sinuses ipsilateral to either an occluded ostium or an obstructed nostril, compared with the controls. These effects on CO2 concentrations were additive when ipsilateral nasal obstruction and ostial occlusion were created. Furthermore, the effect of nasal obstruction in modulation of antral CO2 levels was found to be beyond its effect on hypoventilation of the sinus and to be independent of ostial functional status.Conclusions: We have established independent models of nasal obstruction and ostial occlusion in the same animal. Our findings suggest that ostiomeatal complex dysfunction might not be the sole underlying factor in the pathogenesis of sinus disease in all individuals. Integrity of nasal airflow seems to have a significant effect on the maintenance of the aerobic antral environment, essential to the maintenance of normal sinus function. Modulation of maxillary sinus gas composition by nasal airflow, independent of ostial patency, may be explained by the possible presence of flow‐sensitive receptors in the upper respiratory tract mucosa. Work to identify such receptors is currently in progress.
A Prospective, Blinded Comparison of Clinical Examination and Computed Tomography in Deep Neck Infections
Authors: Miller William D. , Furst Ian M. , Sàndor George K.B. , Keller M. Anne 
Published: November 2003

AbstractObjectives/Hypothesis: To determine whether there is a scientific basis for the routine use of contrast‐enhanced computed tomography (CECT) in the evaluation of suspected deep neck infection (DNI).Study Design: We conducted a prospective, blinded comparison of clinical examination and CECT in DNI.Methods: Thirty‐five consecutive patients with suspected DNI were prospectively assessed by clinical examination and CECT for the presence and extent of surgically drainable purulent collections. Before CECT a surgeon recorded clinical data and predicted the extent of infection. A head and neck neuroradiologist, blinded to the clinical evaluation, predicted the extent of infection based on CECT. Final outcome (the presence of a purulent collection) was determined at surgery or in long‐term follow‐up. The clinical and CECT findings were compared with the final outcome to determine the sensitivity, specificity, and accuracy of each modality.Results: Twenty patients had purulent drainable collections. The accuracy of clinical examination alone in identifying a drainable collection was 63%, the sensitivity was 55%, and the specificity was 73%. The accuracy of CECT alone was 77%, the sensitivity was 95%, and the specificity 53%. When CECT and clinical examination were combined, the accuracy in identifying a drainable collection was 89%, the sensitivity was 95%, and the specificity 80%. If fluid collections with volumes of 2 mL or greater on CECT were considered, the accuracy of CECT would have been 85%, the sensitivity 89%, and the specificity 80%.Conclusion: CECT and clinical examination are both critical components in the evaluation of suspected DNI.
Applications of Distortion‐Product Emissions to an Otological Practice
Authors: Kimberley Barry P. 
Published: November 2003

AbstractObjectives: The multiple clinical applications of distortion‐product emissions (DPEs) to an otological practice are reviewed. Through an examination of studies involving thousands of infants, as well as adult ears, the relationships between measurements of DPEs and PTTs (PTTs) are examined. The cochlear physiology underlying generation of DPEs and the interpretation of these measurements are described in some detail. We study the contribution of phase measurements of DPEs to calculation of delay in cochlear traveling waves. The clinical applications of these measurements are described. The objective of this work is to demonstrate the clinical utility of DPEs through an examination of the correlation of the features of DPEs with PTTs in patients varying in age from newborn to the elderly.Study Design: Methods: Experimental design and methodology involved careful prospective selection of large numbers of subjects in each age group, novel techniques for recording DPEs, and multivariate statistical analysis of the data. Three separate experiments encompass issues surrounding the age groups of adults, neonates, and elderly individuals.Results: The results show that current techniques allow a 90% correct prediction of auditory PTTs for frequencies varying from 1,000 to 6,000 Hz, for patients of all ages.Conclusion: Techniques for measurement of DPEs currently represent an integral diagnostic component for an otological practice. The potential future application of measures of DPEs to diagnosis of tinnitus is described. With an extension of the technique for measuring DPEs to the phenomenon of reflectance, there may be promise of application to novel approaches to the treatment of tinnitus and the design of hearing aids.
Ketoprofen and Fentanyl for Pain After Uvulopalatopharyngoplasty and Tonsillectomy
Authors: Virtaniemi Jukka , Kokki Hannu , Nikanne Elina , Aho Mikko 
Published: November 2003

AbstractObjectives: The treatment of postoperative pain after uvulopalatopharyngoplasty (UPPP) and tonsillectomy presents a challenge. Opioids can cause sedation and respiratory depression. Nonsteroidal anti‐inflammatory drugs can increase postoperative bleeding. The authors have evaluated the severity of postoperative pain and the consumption of opioid in 53 adult patients undergoing either UPPP or tonsillectomy.Study Design: A prospective, parallel‐groups study.Methods: A general endotracheal anesthesia was used in each patient. After surgery patients received ketoprofen 1 mg/kg as an intravenous bolus, followed by a continuous infusion of 4 mg/kg during 24 hours. For rescue analgesia patient‐controlled intravenous fentanyl was used.Results: Both UPPP and tonsillectomy are associated with intense postoperative pain. More than 40% of the patients had high pain scores during the first 24 postoperative hours. Postoperative pain after UPPP was more severe and the difference was significant during swallowing (P < .05). The need for fentanyl in the UPPP group was twice that of the tonsillectomy group (P < .01). There was a high interindividual scatter in the patient‐controlled fentanyl attempts in both groups. The patients in the UPPP group needed significantly more oxygen supply during recovery (P = .007). No serious adverse effects occurred and none of the patients experienced postoperative bleeding that required any intervention.Conclusion: Individually tailored analgesic treatment protocol is essential for patients undergoing UPPP and tonsillectomy to ensure safe and effective pain alleviation.
Computerized Dynamic Posturography and Seasickness Susceptibility
Authors: Shahal Baruch , Nachum Zohar , Spitzer Orna , Ben‐David Jacob , Duchman Hava , Podoshin Ludwik , Shupak Avi 
Published: November 2003

AbstractObjective/Hypothesis: The neural mismatch theory emphasizes the role of conflicting multimodal sensory interactions in producing both motion sickness and the rearrangement process that finally leads to habituation to the adverse motion conditions. If this theory is, indeed, correct, the patterns of the response to the integrated signal from simultaneous multisensory stimulation, characterized by unusual relationships between the senses responsible for spatial orientation, should differ according to motion sickness susceptibility. Computerized dynamic posturography (CDP) provides the opportunity to simultaneously change the interactions between visual, somatosensory, and vestibular inputs, thus giving an indication of the relative importance of these senses in maintaining balance. The objective was to investigate balance strategies in naval crew members with differing susceptibility to sea conditions using CDP.Study Design: Cross‐sectional, parallel‐group design.Methods: Twenty subjects susceptible to seasickness (SS) and 20 nonsusceptible subjects (NSS), healthy male volunteers aged 18 to 25, were tested using the EquiTest system (NeuroCom, Inc., Clackamas, OR).Results: The SS group exhibited significantly less stability than the NSS group in condition 5 of the sensory organization test (SOT). The ratio of the SOT scores of conditions 5 to 1 (the vestibular organization pattern) was also found to be significantly lower in the SS group.Conclusions: The results suggest that SS might be more dependent on somatosensory and visual inputs and less on vestibular inputs for maintenance of balance compared with NSS. Higher susceptibility to seasickness might reflect abnormal weighting of sensory modalities during the integration process. This would result in disruption of the integration process required to maintain balance and a sense of orientation in space in conditions producing conflicting sensory inputs.
Effects of α‐Toxin of Staphylococcus aureus on the Ciliary Activity and Ultrastructure of Human Nasal Ciliated Epithelial Cells
Authors: Yun Yeong‐Seok , Min Yang‐Gi , Rhee Chae‐Seo , Jung In‐Ho , Koh Young Yull , Jang Tae Young , Jung Dong‐Hak 
Published: November 2003

AbstractObjective: The in vitro effects of staphylococcal α‐toxin on ciliary activity were investigated at different concentrations and exposure times.Study Design: Ciliated epithelial cells of the sphenoid sinus were taken from patients operated on for pituitary tumors. Video‐computerized analysis technique and transmission electron microscopy were used to analyze the effects of the toxin on ciliary activity.Methods: Ciliary beat frequency (CBF) was measured in four different concentrations of α‐toxin including 0.1, 1, 10, and 50 μg/mL. CBF was measured at 2, 4, 6, 12, 24, and 48 hours after administration of the toxin. To observe reversibility of the reduced ciliary activity, after 24‐hour incubation in the media containing 10 μg/mL of α‐toxin, the media were replaced with α‐toxin‐free media. The tissues were also processed for transmission electron microscopy to observe ultrastructural changes of the epithelial cells.Results: CBF increased significantly at 2‐hour incubation and then decreased significantly after 12‐hour incubation in 10 μg/mL of α‐toxin (P< .05, repeated‐measures ANOVA). The transmission electron microscopic findings showed mitochondrial swelling and a slight protrusion of the plasma membrane of the cilia. In toxin‐free media, loss of ciliary activity was not recovered.Conclusions: CBF increased at first, but with increasing incubation time ciliary movements decreased gradually and stopped eventually. This loss of CBF may be an irreversible change associated with ultrastructural changes in the mitochondria and the plasma membrane of the cilia.
Early Wound Complications in Advanced Head and Neck Cancer Treated With Surgery and Ir192 Brachytherapy
Authors: Smith Richard V. , Krevitt Lane , Yi Su Min , Beitler Jonathan J. 
Published: November 2003

AbstractObjectives: Brachytherapy, either as primary or adjuvant therapy, is increasingly used to treat head and neck cancer. Reports of complications from the use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I125) therapy. Early complications include wound breakdown, infection, flap failure, and sepsis, and late complications may include osteoradionecrosis, bone marrow suppression, or carotid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (Ir192).Study Design: A retrospective chart review of all patients receiving adjuvant brachytherapy at a tertiary medical center over a 4‐year period.Methods: Nine patients receiving Ir192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive margin control were evaluated. It was used during primary therapy in six patients and at salvage surgery in three. Early complications were defined as those occurring within 6 weeks of surgical therapy.Results: The overall complication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia, and local tissue erosion in one patient each. All complications occurred in patients receiving flap reconstruction and one patient required further surgery to manage the complication. Complication rates were not associated with patient age, site, prior radiotherapy, timing of therapy, number of catheters, or dosimetry.Conclusions: The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of radiotherapy. Further study should be under‐taken to identify those patients who will achieve maximum therapeutic benefit without prohibitive local complications.
Endoscopic Medial Maxillectomy for Inverted Papillomas of the Paranasal Sinuses: Value of the Intraoperative Endoscopic Examination
Authors: Sukenik Mark A. , Casiano Roy 
Published: November 2003

AbstractObjective: The extent of paranasal sinus involvement by inverted papilloma and the degree of surgery are often determined before surgery by computer tomography (CT). The sensitivity and specificity of preoperative CT versus intraoperative endoscopic examination are unknown.Study Design: Prospective.Methods: Nineteen patients with inverted papilloma who underwent endoscopic medial maxillectomy were staged tomographically. Findings were compared with pathological and intraoperative endoscopic findings.Results: Twenty sides were evaluated. The overall sensitivity and specificity for the preoperative CT evaluation were 69% and 20%, respectively. For intraoperative endoscopic evaluation they were 69% and 68%, respectively. Excluding the sphenoid sinus, the overall sensitivity for CT scan and intraoperative endoscopic evaluation increased to 87%. Excluding the anterior ethmoids, the overall specificity for CT scan and intraoperative endoscopic evaluation increased to 25% and 79%, respectively. The overall cure rate was 94% (18 patients) with an average follow‐up of 36 months (range, 16‐80 mo).Conclusion: Intraoperative endoscopic examination is comparable in sensitivity but better in specificity than preoperative CT analysis for differentiating between inverted papilloma and other disease. Both modalities of evaluation tend to overestimate the extent of disease (sensitivity). The presence of a normal intraoperative endoscopic examination may be a better way of determining the extent of mucosal removal during surgery. Endoscopic medial maxillectomy remains an effective surgical option for inverted papilloma removal.
Vocal Fold Paralysis After Anterior Cervical Diskectomy and Fusion
Authors: Morpeth James F. , Williams Mark F. 
Published: November 2003

AbstractObjective: The anterior approach to the cervical spine now serves as the surgical access of choice for cervical spine disease. Vocal fold paralysis (VFP) may follow the procedure as a complication. The authors describe their experience with patients having VFP after anterior cervical diskectomy and fusion (ACDF), with an emphasis on outcome and prognosis.Study Design: Retrospective.Methods: Medical records of patients who underwent ACDF between January 1987 and February 1998 were reviewed. Further detailed review of the patients with documented VFP after surgery was then performed.Results: Over the given time period 411 ACDFs were performed and 21 patients with this complication were identified (5%). All 21 patients had right‐sided approaches. Eighteen patients had right VFP, 2 had left VFP, and 1 had bilateral VFP. Symptoms included hoarseness (18), persistent cough (7), aspiration (13), and dysphagia (7). The patient with bilateral VFP presented with stridor and respiratory distress requiring tracheotomy. The complete records of 17 patients with 18 VFPs were available for review. Fifteen of 18 VFPs (83.3%) had complete resolution within 12 months. One patient had recovery after 15 months. All patients were treated conservatively with speech and swallowing therapy. One patient required Gelfoam injection and another medialization thyroplasty, both for aspiration symptoms.Conclusions: The data suggest that at least 80% of VFP after ACDF will recover within 12 months of the procedure. The authors recommend regular follow‐up and speech therapy for symptomatic patients. Medialization should be considered in patients with aspiration or persistent problems.
Avoiding Transfusion in Head and Neck Surgery: Feasibility Study of Erythropoietin
Authors: Sturgis Erich M. , Gianoli Gerard J. , Miller Robert H. , Fisher James W. 
Published: November 2003

AbstractObjective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery.Study Design: Retrospective chart review.Methods: Ninety‐nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed.Results: Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive.Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios.
Second Primary Neoplasms in Patients With Laryngeal Carcinoma
Authors: Nikolaou Angelos C. , Markou Constantinos D. , Petridis Dimitrios G. , Daniilidis Ioannis C. 
Published: November 2003

AbstractObjectives: To better define the characteristics of second primary malignancies appearing in patients suffering from head and neck cancers, and more specifically laryngeal carcinoma, and to elicit those parameters that may be of assistance in better diagnosing, treating, and predicting outcome in such patients.Study Design: Retrospective review of a group of 514 compliant subjects, examined and treated during an 8‐year period until 1996. After initial diagnosis and subsequent treatment, rigorous follow‐up ensured systematic screening of the subjects, who underwent standard examinations in outpatient clinics for periods of up to 56 months.Results: Of 514 cases followed, presence of second primary neoplasms was established in 42 or 8.17%, 8 being synchronous and 34 metachronous of the original primary lesion.Conclusions: Respiratory and upper gastrointestinal localizations were primarily affected, incidence was highest in septuagenarians, and staging of the primary was found to be irrelevant to the incidence rates of second primaries. No statistical significance was attached to the fact that supraglottic primary tumors showed slightly higher second primary rates; the same applying for well‐differentiated primary tumors compared with poorly differentiated ones. Modality of treatment‐surgery, and radiotherapy being the options in question‐did not in the long run statistically influence incidence rates. Throughout, reference to current literature and this study's relevance in light of similar efforts were taken into account.