bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Airway Edema Resulting From Use of Ecballium elaterium
Authors: Kloutsos Georgios , Balatsouras Dimitrios G. , Kaberos Antonis C. , Kandiloros Dimitrios , Ferekidis Eleftherios , Economou Constantinos 
Published: November 2003

AbstractObjectives To present a rare occurrence in ear, nose and throat practice of upper airway allergic edema from use of juice extracted from the fruit of Ecballium elaterium.Introduction Ecballium elaterium is a plant indigenous to the Mediterranean region that bears the common name squirting cucumber. Many people in this region for the treatment of sinusitis use the juice of its fruit. However, allergy‐prone patients after using it may sometimes present with edema at various sites of the upper respiratory tract. Otolaryngologists are frequently asked to diagnose and treat such an emergency situation.Study Design Retrospective review of the records of 42 patients with this condition during the last 4 years.Methods Patient records were retrospectively reviewed for age, sex, presenting symptoms, physical examination, and medical treatment. Seasonal distribution and data from the history of the patients were also considered. Skin prick and prick‐to‐prick testing to various allergens was performed in 12 patients.Results Most of the patients presented with localized swelling of the uvula and the nasal mucosa, whereas in the remainder of the patients various sites of swelling of the upper respiratory tract were observed. Skin tests elicited positive reactions to pollen weeds and to various fruits of the Cucurbitaceae family. Treatment of the patients with corticosteroids and antihistamines resulted in an uneventful recovery, and we did not need to resort to therapeutic modalities, such as intubation or tracheotomy.Conclusions We think a further study of the pharmaceutical properties of the plant's fruit juice is needed, especially regarding its curative properties of rhinitis and sinusitis. However, adverse reactions in some patients with a positive history of allergy should always be considered.
Laryngeal Pseudosulcus as a Predictor of Laryngopharyngeal Reflux
Authors: Hickson Charlene , Simpson C. Blake , Falcon Rhonda 
Published: November 2003

AbstractObjectives/Hypothesis Laryngeal pseudosulcus is an accurate prognostic indicator of laryngopharyngeal reflux (LPR) disease.Study Design Prospective study of 20 consecutive patients with laryngeal pseudosulcus. Pseudosulcus is infraglottic laryngeal edema that is thought to be secondary to LPR. All patients were evaluated with dual‐channel pH probe 24‐hour monitoring to evaluate for the presence of laryngopharyngeal reflux.Methods Twenty patients identified with laryngeal pseudosulcus on routine physical examination were included in the study. Each patient underwent a 24‐hour dual‐channel pH probe. The data were analyzed and compared with previously published normative data. The data included the total number of reflux episodes and the percentage of time the pH dropped below 4 at the proximal probe.Results Eighteen of the 20 patients with laryngeal pseudosulcus were found to have LPR. The mean number of reflux episodes at the proximal probe was 29.4 (range, 3–82). The mean percentage of time the pH dropped below 4 was 1.15%. In the upright position the mean value was 1.59% and in the supine position it was 0.19%. This gives pseudosulcus a positive predictive value for LPR of 90%.Conclusion This study shows laryngeal pseudosulcus to be an accurate predictor of laryngopharyngeal reflux disease.
Simultaneous Modified Evans Blue Dye Procedure and Video Nasal Endoscopic Evaluation of the Swallow
Authors: Donzelli Joseph , Brady Susan , Wesling Michele , Craney Mary 
Published: November 2003

AbstractObjective To investigate the results of the modified Evans blue dye test (MEBD) aspiration detection rate to the video nasal endoscopic examination of the swallow (VEES) during simultaneous studies with direct viewing of the subglottis through the tracheostomy site opening by means of endoscopy.Study Design Prospective, consecutive.Methods Fifteen consecutive simultaneous MEBD and VEES studies were completed on patients with tracheostomies at an acute care rehabilitation hospital over a 4‐month period. All patients were referred to the swallowing center for a video nasal endoscopic examination who had known or suspected dysphagia.Results Aspiration was present in 53% (8) of the studies as documented by the VEES. The MEBD showed an overall 50% false‐negative error rate for the detection of aspiration as compared with the VEES. The MEBD identified aspiration in 67% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%).Conclusion The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.
A Treatment for Vocal Cord Dysfunction in Female Athletes: An Outcome Study
Authors: Sullivan Marsha D. , Heywood Barbara M. , Beukelman David R. 
Published: November 2003

AbstractObjectives This article reports the outcome of a speech pathology treatment program for vocal cord dysfunction (VCD) in 20 adolescent female athletes.Study Design A retrospective, nonrandomized group design was used to collect the outcome data.Methods Twenty consecutive referrals of female athletes diagnosed as having symptoms of VCD during exercise were assessed, treated, and followed for at least 6 months after treatment.Results Ninety‐five percent of the participants reported the ability to control symptoms of VCD during exercise up to 6 months after treatment. Asthma medications were no longer used by 80% of the athletes. All of the females continued to participate in athletics.Conclusion Speech pathology intervention focusing on respiratory control of VCD in adolescent female athletes is an effective treatment resulting in the athletes' ability to control the symptoms of VCD in exercise for at least 6 months after treatment.
Virtual Endoscopic Evaluation of Labyrinthine Fistulae Resulting From Cholesteatoma
Authors: Briggs Russell D. , Vrabec Jeffrey T. , Cavey Matthew L. , Johnson Raleigh F. 
Published: November 2003

AbstractObjectives/Hypothesis Fistulae of the otic capsule occur in approximately 10% of cholesteatoma cases. Preoperative imaging of this complication is valuable in limiting intraoperative morbidity. Three‐dimensional virtual endoscopic imaging provides a new method for analysis of conventional computed tomography (CT) imaging data. The purpose of the study was to examine the feasibility and efficacy of this technique in detecting labyrinthine fistulae caused by cholesteatoma.Study Design Retrospective case study.Methods Fifteen patients with surgically confirmed lateral semicircular canal fistula and preoperative CT scan were included. Scans meeting inclusion criteria were imported into a software program for production of virtual endoscopic images. Dehiscent and normal lateral semicircular canals were navigated while varying threshold values for surrounding bone. Changes in threshold values produce the effect of thickening or thinning the bone enveloping the semicircular canal. Threshold parameters that produced easy circumnavigation (“open”) and intact inner surface of the lateral canal (“closed”) were recorded.Results The fistula group demonstrated a significantly lower “closed” threshold level and, consequently, a greater range of navigation between “open” and “closed” thresholds. Intrasubject absolute differences in threshold values between normal and abnormal ears appeared to be the most accurate method for detecting a fistula. The suggested imaging parameters displayed an overall sensitivity for fistula detection of 67% with a specificity of 93%.Conclusions The three‐dimensional virtual endoscopic algorithm shows promise as a method for confirmation of otic capsule dehiscences. Sensitivity for detection is suboptimal but can be improved by alterations in image acquisition parameters.
Percutaneous Endoscopic Gastrostomy: Strategies for Prevention and Management of Complications
Authors: Lin Ho‐Sheng , Ibrahim Hani Z. , Kheng Jennifer W. , Fee Willard E. , Terris David J. 
Published: November 2003

AbstractObjective The placement of percutaneous endoscopic gastrostomy (PEG) tubes is within the realm of the head and neck surgeon because most are proficient in the use of rigid and flexible esophagoscopes. The ability to provide comprehensive care for the patient with head and neck cancer provides further incentive for the head and neck surgeon to adopt this technique. Although it is a technically simple procedure, the surgeon must be aware of the range of complications that can occur with PEG. We review our experience with PEG focusing on the complications as well as strategies for the prevention and management of these complications.Methods A retrospective review of the records of patients who underwent PEG at Stanford University by the Head and Neck Surgery Service between July 1992 and December 1998 was conducted. A total of 103 patients were identified, of which 84 (82%) were patients with head and neck cancers. Complications associated with PEG were identified. All PEGs were performed using the pull technique.Results There was no mortality associated with the procedure. Minor complications occurred in 11 cases (10.7%). These included cellulitis (4), ileus (3), tube extrusion (1), clogged lumen (1), and peristomal leakage (2). The only major complication was a single case of PEG site metastasis.Conclusion The review of our experience with PEG tube placement revealed a low complication rate. Safe PEG placement was achieved by transillumination of the abdominal wall and confirmation by ballottement. In addition, appropriate patient selection, use of perioperative antibiotics, as well as meticulous post‐procedure care contributed to the low rate of complications. For the patients with head and neck cancer, a barrier should be placed between the tumor and the instrumentation at the time of tube placement.
Chromosomal Aneuploidy Precedes Morphological Changes and Supports Multifocality in Head and Neck Lesions
Authors: Ai Hong , Barrera Jose E. , Meyers Arlen D. , Shroyer Kenneth R. , Varella‐Garcia Marileila 
Published: November 2003

AbstractObjective To identify chromosome changes associated with the transformation of dysplastic lesions and to verify evidence for multifocality in synchronous premalignant lesions associated with head and neck squamous cell carcinoma (HNSCC).Study Design Chromosomal aneuploidy was evaluated in sections of formalin‐fixed, paraffin‐embedded tissues from 16 patients with HNSCC, including sites with normal squamous mucosa, dysplasia (low‐ and high‐grade), and invasive tumor.Methods A panel of 6 centromeric probes (chromosomes 1, 3, 7, 8, 9, and 17) was analyzed in dual‐color fluorescence in situ hybridization assays, using matched hematoxylin–eosin‐stained sections for histologic correlation.Results Imbalances for most of the targets tested were found in 20 of 24 invasive carcinoma sites, mainly represented by gain in copy number per cell. However, cell populations with chromosome losses and gains in multimodal patterns were concomitantly observed in a number of tumors, indicating a high degree of chromosome instability. The detection of chromosomal aneuploidy precedes the malignant transformation as indicated by findings of monosomy and trisomy in normal squamous mucosa, and in low‐grade and high‐grade dysplasia sites. Loss of chromosomes 3 and 17 prevailed in low‐grade dysplasias, and gain of chromosomes 7 and 8 were prevalent in high‐grade dysplasias. Synchronous low‐grade and high‐grade dysplastic lesions displayed discordant molecular signatures, suggesting a multifocal origin.Conclusions The interphase fluorescence in‐situ hybridization (FISH) assay with centromeric may detect early changes in the progression of dyplastic epithelia to invasive carcinoma and supports the field cancerization theory of multifocality.
Laryngospasm: An Atypical Manifestation of Severe Gastroesophageal Reflux Disease (GERD)
Authors: Maceri Dennis R. , Zim Shane 
Published: November 2003

AbstractObjectives To present a potentially life‐threatening manifestation of gastroesophageal reflux disease (GERD), laryngospasm. This review covers the diagnosis and management of eight patients treated by the authors.Study Design A retrospective analysis of 8 consecutive patients who were referred for the evaluation of unexplained laryngospasm. The medical therapy and lifestyle modifications of treatment are discussed.Methods The patient records were reviewed and tabulated for age, onset of symptoms, and history of GERD; the presence of an associated upper respiratory infection with persistent cough; and the development of syncope in the presence of laryngospasm.Results All 8 patients had initial control of laryngospasm. Three had complete control without relapse, 3 had initial control with rare relapse of mild laryngospasm, and 2 patients had initial control with frequent relapses. Six of the 8 had syncopal episodes as a consequence of the laryngospasm. All patients were initially treated with a proton pump inhibitor. Five of the 8 required the addition of an esophageal prokinetic agent to control the reflux and subsequent laryngospasm. Two patients are off all medications at the time of this writing and 4 of the 8 have had rare relapses after initial control of symptoms. Once control of the laryngospasm had been achieved, there were no subsequent episodes of syncope.Conclusions Based on the data collected in these 8 individuals, patients with reflux disease (known or unknown) can develop severe laryngospasm and possible syncope. The key factor seems to be the association of a recent or concurrent upper respiratory infection that results in a protracted cough that is more severe when supine and at times violent. The cough increases the amount of the refluxate, which is the noxious insult to the larynx.
Candidate's Thesis: Direct Evidence of Bacterial Biofilms in Otitis Media
Authors: Post J. Christopher 
Published: November 2003

AbstractObjectives/Hypothesis Bacteriologic studies of otitis media with effusion (OME) using highly sensitive techniques of molecular biology such as the polymerase chain reaction have demonstrated that traditional culturing methods are inadequate to detect many viable bacteria present in OME. The presence of pathogens attached to the middle‐ear mucosa as a bacterial biofilm, rather than as free‐floating organisms in a middle‐ear effusion, has previously been suggested to explain these observations. The suggestion has been speculative, however, because no visual evidence of such biofilms on middle‐ear mucosa has heretofore been collected. The hypotheses motivating the current study were: 1) biofilms of nontypable Hemophilus influenzae will form on the middle‐ear mucosa of chinchillas in an experimental model of OME, 2) these biofilms will exhibit changes in density or structure over time, and 3) biofilms are also present on tympanostomy tubes in children with refractory post‐tympanostomy otorrhea. The objective of this study was to collect visual evidence of the formation of bacterial biofilms in these situations.Study Design Laboratory study of bacteriology in an animal model and on medical devices removed from pediatric patients.Methods Experimental otitis media was induced in chinchillas by transbullar injection of nontypable H. influenzae. Animals were killed in a time series and the surface of the middle‐ear mucosa was examined by scanning electron microscopy (SEM) for the presence of bacterial biofilms. Adult and fetal chinchilla uninfected controls were similarly examined for comparison. In addition, tympanostomy tubes that had been placed in children's ears to treat OME and removed after onset of refractory otorrhea or other problems were examined by SEM and by confocal scanning laser microscopy for bacterial biofilms, and compared with unused control tubes.Results Bacterial biofilms were visually detected by SEM on the middle‐ear mucosa of multiple chinchillas in which H. influenzae otitis media had been induced. Qualitative evaluation indicated that the density and thickness of the biofilm might increase until at least 96 hours after injection. The appearance of the middle‐ear mucosa of experimental animals contrasted with that of uninjected control animals. Robust bacterial biofilms were also visually detected on tympanostomy tubes removed from children's ears for clinical reasons, in contrast with unused control tubes.Conclusions Bacterial biofilms form on the middle‐ear mucosa of chinchillas in experimentally induced H. influenzae otitis media and can form on tympanostomy tubes placed in children's ears. Such biofilms can be directly observed by microscopy. These results reinforce the hypothesis that the bacterial aggregates called biofilms, resistant to treatment by antibiotics and to detection by standard culture techniques, may play a major etiologic role in OME and in one of its frequent complications, post‐tympanostomy otorrhea.
Intratympanic Steroid Injections for Intractable Ménière's Disease
Authors: Barrs David M. , Keyser Jeffrey S. , Stallworth Christian , McElveen John T. 
Published: November 2003

AbstractObjective To examine whether intratympanic injection of dexamethasone is effective in controlling vertigo in patients with Ménière's disease who have persistent vertigo despite standard medical treatment, including a low‐salt/no‐caffeine diet and diuretics.Study Design A prospective study.Methods From August 1999 to November 2000, 21 patients with intractable Ménière's disease underwent intratympanic injections of 4 mg/mL dexamethasone over a period of 4 weeks as an office procedure. American Academy of Otolaryngology–Head and Neck Surgery guidelines for the definition and reporting of results in Ménière's disease were used. 1Results Complete relief of vertigo was maintained in 11 of the 21 patients (52%) at 3 months and in 9 of 21 patients (43%) at 6 months. Repeat injections in 5 patients who had initial control of vertigo, but later failed, yielded control in 3 (60%) patients. The complication rate was low: one patient had a 35‐decibel pure tone average decrease in hearing during treatment and one patient had a persistent tympanic membrane perforation.Conclusions Intratympanic injections of dexamethasone are a reasonable initial surgical treatment for persistent vertigo in Ménière's disease. The principal benefits are avoidance of systemic administration of steroids, lower cost than endolymphatic sac surgery, and ease of administration as an office procedure. The disadvantages are the need for repeated office visits for injections and the decreasing effectiveness over time.
Asymmetry of the Ethmoid Roof: Analysis Using Coronal Computed Tomography
Authors: Lebowitz Richard A. , Terk Alyssa , Jacobs Joseph B. , Holliday Roy A. 
Published: November 2003

AbstractObjectives/Hypothesis To determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof.Study Design Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans.Methods Retrospective review of 200 consecutive direct coronal sinus CT scans done at New York University Medical Center from July 25, 2000 to October 11, 2000. The height and contour of the fovea ethmoidalis were examined for symmetry between the right and left sides. When an asymmetry in the height of the fovea ethmoidalis existed, this difference was quantified.Results In 19 scans (9.5%), there was an asymmetry between the height of the fovea ethmoidalis on the right and left sides. Of these 19, 12 (63.2%) were lower on the right side, whereas 7 (36.8%) were lower on the left. Ninety‐six patients (48.0%) demonstrated a contour asymmetry with “flattening” of the ethmoid roof on one side, 46 on the right and 50 on the left. One patient demonstrated both height and contour asymmetry. The fovea ethmoidalis on the remaining 86 scans (43.0%) was symmetric.Conclusions In a patient population with sinus and nasal symptoms, the height and contour of the right and left fovea ethmoidalis were symmetric in less than 50% of individuals. The asymmetry was most often the result of a difference in contour with flattening of the fovea on one side. This underscores the importance of careful preoperative and intraoperative review of paranasal sinus CT scans in patients undergoing endoscopic sinus surgery.
Evaluation of the Utility and Cost‐Effectiveness of Obtaining Histopathologic Diagnosis on All Routine Tonsillectomy Specimens
Authors: Younis Ramzi T. , Hesse Sabine V. , Anand Vinod K. 
Published: November 2003

AbstractObjectives To evaluate the use and necessity of obtaining histopathology on patients undergoing tonsillectomy, and to provide indications and guidelines for requesting histopathology on tonsillectomy patients.Study Design At the University of Mississippi Medical Center, we have been routinely obtaining histopathologic diagnoses on every patient undergoing tonsillectomy or tonsillectomy and adenoidectomy. Specimens are separated into left and right tonsils and adenoids. This study was designed at our tertiary care academic center to evaluate the necessity for obtaining histopathologic diagnosis on each of these patients.Methods A retrospective review of histopathologic reports on all patients in both pediatric and adult age groups undergoing tonsillectomy or tonsillectomy and adenoidectomy between January 1994 and December 1999 was performed.Results A total of 2438 reports were reviewed. There were 2099 in the pediatric age group and 339 were adults. None of the children had an unusual histopathology finding other than lymphoid hyperplasia. Of the 339 adults, 34 had squamous cell carcinoma and 6 had lymphoma; however, these findings were suspected preoperatively by history and clinical manifestations.Conclusions The general practice guidelines mandate obtaining histopathologic diagnoses on most of the tissues received. Based on our review, histopathology of tonsillectomy and/or adenoidectomy may not be necessary, especially in children. In this era of cutting excess costs of health care dollars, waving histopathology in these cases may have major implications without compromising delivery of quality care.
Bipolar Scissors versus Cold Dissection Tonsillectomy: A Prospective, Randomized, Multi‐Unit Study
Authors: Raut V. , Bhat N. , Kinsella J. , Toner J. G. , Sinnathuray A. R. , Stevenson M. 
Published: November 2003

AbstractObjective To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy.Study Design A prospective, randomized, multi‐unit study.Settings Belfast City Hospital, Royal Victoria Hospital Belfast, and Ulster Hospital Dundonald.Patients Two hundred consecutive patients undergoing tonsillectomy for recurrent or chronic tonsillitis between March 2000 and September 2000.Outcome Measures (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain, and (4) complication rates, including primary and secondary hemorrhage.Results Seventeen patients were excluded from the study for various reasons. The mean age of the study population was 22 years (range, 10–54 y). Seventy‐two percent of patients were female. Twenty‐seven percent of patients were children aged 16 years or under. Median intraoperative blood loss was 5 mL for bipolar scissors tonsillectomy and 115 mL for cold dissection tonsillectomy (P <.001). The mean operative time was 13 minutes for bipolar scissors tonsillectomy compared with 20 minutes for the cold dissection method (P <.001). There was no statistically significant difference in the pain scores between the two methods (independent samples t = 1.35;P >.05). The overall primary hemorrhage rate was 2.1%, whereas the overall secondary hemorrhage rate was 16.9%. The hospital readmission rate was 10.3%. The primary and secondary hemorrhage rates were unaffected by the surgical method.Conclusions Bipolar scissors tonsillectomy is a safe technique with a similar morbidity to the cold dissection method. Its use is associated with a significant decrease in both surgical time and blood loss compared with the cold dissection method.