bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nasal Endoscopy and the Definition and Diagnosis of Chronic Rhinosinusitis
Authors: Stankiewicz James A. , Chow James M. 
Published: February 2003

OBJECTIVESAlthough endoscopy has been shown by a few authors to be a valuable tool for the diagnosis of chronic rhinosinusitis, its true role in the evaluation of the patient with chronic rhinosinusitis has not been elucidated. The current definition of chronic rhinosinusitis is a symptom‐based definition, and objective testing such as endoscopy or computed tomography (CT) is not included. However, the current treatment paradigm for chronic rhinosinusitis is dependent on the definition for diagnosis. Patients are treated with 4 weeks of antibiotics and decongestant/antihistamines/steroids based on the definition. This study aims to evaluate in a prospective fashion the place of endoscopy in the diagnosis of chronic rhinosinusitis.STUDY DESIGNA group of 78 patients meeting the definition of chronic rhinosinusitis were subjected to same‐day endoscopy and CT scanning.RESULTSSeventeen (22%) of 78 patients had positive endoscopic and CT results. There were 20 (26%) of 78 patients with negative endoscopic and positive CT results. Six (8%) patients had positive endoscopic and negative CT results, and 35 (45%) had negative endoscopic and negative CT results. Overall, 37 (47%) patients had positive CT results, and 41 (53%) patients had negative CT results. Endoscopy showing the presence of purulence, nasal polyps, or watery congested mucosa correlated well with CT results. Negative endoscopy correlated with CT results in 65% of patients.CONCLUSIONThe use of endoscopy to corroborate the diagnosis in nonpolypoid or nonpurulent rhinosinusitis in previously unoperated patients is questioned. Patients who meet the subjective definition of chronic rhinosinusitis should have a high degree of sensitivity and specificity with endoscopy or CT. The fact this is not the case questions the accuracy of the definition and the treatment paradigm.SIGNIFICANCEAccording to this study, positive endoscopic results correlated well with CT, and negative endoscopic results correlated in 71% of patients with negative CT results.
Ventilation Tube Removal: Does Treatment Affect Perforation Closure?
Authors: Schwartz Kara M. , Orvidas Laura J. , Weaver Amy L , Thieling Sarah E. 
Published: February 2003

OBJECTIVEThe study goal was to determine whether treatment of the tympanic membrane at the time of ventilation tube (VT) removal affects closure of the perforation.STUDY DESIGNWe conducted a retrospective chart review and telephone follow‐up of children who underwent VT removal from 1995 through 1998.RESULTSAmong 109 patients (162 ears; 58% male), the mean age at VT removal was 6.7 years. Most VTs (59%) were T‐tubes, and most (91%) were removed because of prolonged retention (mean 2.3 years). After VT removal, 111 ears (69%) received treatment, most commonly (44%) with 25% trichloroacetic acid (TCA). At the latest follow‐up, 151 of the ears (93%) had healed without additional treatment. Treatment failure occurred more frequently in ears not initially treated with TCA (TCA 3% failure, other treatment 13%, no treatment 8%) and in ears with VTs removed because of otorrhea.CONCLUSIONSMost perforations healed. TCA may promote closure, but a large randomized clinical trial is needed to eliminate physician bias.
Induction Chemotherapy Followed by Concomitant Chemoradiation‐Induced Regression of Advanced Cervical Lymphadenopathy in Head and Neck Cancer as a Predictor of Outcome
Authors: Ampil Federico L. , Mills Glenn M. , Caldito Gloria , Burton Gary V. , Nathan Cherie Ann O. , Aarstad Robert F. , Lian Timothy F. , Stucker Fred J. , Hardin John C. 
Published: February 2003

OBJECTIVEWe sought to determine whether induction chemotherapy followed by concomitant chemoradiation (ICCR)‐induced advanced neck disease regression could predict outcome, especially the need for complete neck dissection in patients with N2‐3 stage IV head and neck cancer (HNC).METHODSA retrospective study of 339 patients evaluated for treatment of stage IV HNC during the years 1988 to 1997 revealed 36 individuals with N2‐3 cervical lymphadenopathy who were treated with ICCR. Responses to treatment, patterns of failure, and survival rates were analyzed.RESULTSPrimary and regional tumor regressions were complete in 21 patients (58%), partial in 9 (25%), and absent in 6 (17%); the corresponding local failure rates were 5%, 44%, and 33% (P < 0.02). The regional failure rates were 24%, 89%, and 83%, respectively (P < 0.001); distant failure rates were 10%, 0%, and 0% (P > 0.99). The estimated 2‐year survival rates for complete and partial/nonresponders were 57% and 20%, respectively (P < 0.02).CONCLUSIONPatients with advanced regional metastases of HNC who respond completely to ICCR have an excellent chance for survival. However, such ICCR‐induced complete regression of regional tumor cannot reliably predict ultimate neck disease control.
Long‐Term Outcome of Facial Growth after Functional Endoscopic Sinus Surgery
Authors: Bothwell Marcella R. , Piccirillo Jay F. , Lusk Rodney P. , Ridenour Brock D. 
Published: February 2003

OBJECTIVEWe sought to determine whether functional endoscopic sinus (FES) surgery performed in children with chronic rhinosinusitis alters facial growth.STUDY DESIGN AND SETTINGThis was a retrospective age‐matched cohort outcome study performed at a tertiary care hospital.RESULTSSixty‐seven children participated. There were 46 boys and 21 girls, and the mean age was 3.1 years at presentation and 13.2 years at follow‐up. There were 46 children who underwent FES surgery and 21 children who did not undergo FES surgery. Quantitative anthropomorphic analysis was performed using 12 standard facial measurements. A facial plastic expert performed qualitative facial analysis. Both quantitative and qualitative analyses showed no statistical significance in facial growth between children who underwent FES surgery and those who did not undergo FES surgery.CONCLUSIONSIn this study, there was no evidence that FES surgery affected facial growth.SIGNIFICANCEThese results will aid physicians when discussing with parents the risks of FES surgery.
Percutaneous Laryngeal Collagen Augmentation for Treatment of Parkinsonian Hypophonia
Authors: Kim Soo H. , Kearney James J. , Atkins Joseph P. 
Published: February 2003

OBJECTIVEOur goal was to determine whether percutaneous laryngeal collagen augmentation improves hypophonia in parkinsonian patients.STUDY DESIGN AND SETTINGA retrospective review of 18 patients was performed. Patients and/or caretakers were called on the telephone and asked about their response to the procedure, if any. Videostroboscopic examinations for all patients were reviewed.RESULTSOf 18 patients, 11 (61%) reported improvement in their hypophonia for a period of at least 2 months. Five of 7 patients without improvement were relatively aphonic both before and after the procedure. Five of 7 patients without improvement had severe dysphagia, which in 3 necessitated gastrostomy tube placement. Four of 7 patients without improvement were not ambulatory at the time of the procedure.CONCLUSIONSPercutaneous laryngeal collagen augmentation is an effective treatment for parkinsonian hypophonia in a majority of patients. Patients with advanced neurologic disease with aphonia, difficulty with speech initiation, dysphagia, or ambulatory difficulty are less likely to respond to this procedure and should be so informed.
Laser Office Ventilation of Ears with Insertion of Tubes
Authors: Siegel Gordon J. , Chandra Rakesh K. 
Published: February 2003

OBJECTIVEMyringotomy with insertion of pressure equalization tubes has proven to be extremely effective in treating persistent serous otitis media (SOM). This study compares the advantages and disadvantages of this procedure when performed in the operating room or with a laser in an office setting.PATIENTS AND METHODSPatients selected either traditional myringotomy and tube (M&T; n = 29) done in an operating room under general anesthesia or Laser Office Ventilation of Ears with Insertion of Tubes (LOVE IT; n = 35) done in an office setting with only topical anesthesia. The reasons for selecting either M&T or LOVE IT and satisfaction with the procedure chosen were evaluated by survey, the results of which were compared statistically. Chart review was performed to determine the time and cost of the procedures, time interval from diagnosis to treatment, tube longevity, and complications.RESULTSOverall satisfaction was similar with both procedures. Patients and families were more likely to choose LOVE IT based on the anesthetic technique involved (P < 0.001, χ2). M&T required less time to perform, whereas the cost of LOVE IT was less. Tube longevity and complication rates were similar between the two procedures, and all complications were minor.CONCLUSIONSLOVE IT is a potential alternative to traditional M&T in the treatment of SOM. LOVE IT is most likely to be selected by patients/parents who wish to avoid a general anesthetic and provides a level of satisfaction similar to that of traditional M&T.
Rhino‐Orbital and Rhino‐Orbito‐Cerebral Mucormycosis
Authors: Talmi Yoav P. , Goldschmied‐Reouven Anna , Bakon Mati , Barshack Iris , Wolf Michael , Horowitz Zeev , Berkowicz Miriam , Keller Nathan , Kronenberg Jona 
Published: February 2003

BACKGROUNDRhino‐orbito‐cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols.METHODSAll had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases.RESULTSSixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end‐stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%.CONCLUSIONSROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival‐dependent classification of ROCM are offered.
The Effect of Upper Airway Surgery on Voice
Authors: Behrman Alison , Shikowitz Mark J. , Dailey Seth 
Published: February 2003

OBJECTIVEOur goal was to assess patient perception and acoustic characteristics of voice before and after upper airway surgery.STUDY DESIGN AND SETTINGWe conducted a prospective assessment of 44 surgical patients preoperatively and postoperatively at a tertiary care, academic hospital. Operations included septoplasty and turbinectomy (n = 28) and septoplasty, turbinectomy, uvulopalatopharyngoplasty, and tonsillectomy (n = 16). Patient opinion measures included Voice Handicap Index score, perception of vocal resonance, and change in voice. Acoustic measures included assessment of the relative amplitude of selected formants (resonances) of the vocal tract.RESULTSMean Voice Handicap Index scores were unchanged after surgery. Nine patients (20%) perceived their voice to be improved after surgery. None perceived the voice to be worse. Postoperative changes in relative formant amplitudes were statistically significant. These changes caused the acoustic features to become more representative of normative data than the preoperative values.CONCLUSIONUpper airway oeprations can affect acoustics and perception of voice.SIGNIFICANCEPatients are unlikely to perceive a change in voice as a result of upper airway surgeries, but in those cases where a difference is perceived, it is likely to be a positive change.
Management of Pediatric Ranula
Authors: Pandit Rajiv T. , Park Albert H. 
Published: February 2003

OBJECTIVEMany surgical techniques to manage ranulas have been described in the literature. These techniques include excision of the cyst with or without excision of the ipsilateral sublingual gland, marsupialization, cryosurgery, and CO2 laser excision. Few studies have described the approach toward management in pediatric patients.METHODSSix patients were treated for intraoral ranulas. Two patients had spontaneous resolution of their lesions. Four patients required dissection of the submandibular duct and lingual nerve to completely excise an oral cavity ranula and an ipsilateral sublingual gland.RESULTSThere were no recurrent lesions. One patient developed a lingual nerve injury but no numbness. The 2 patients with spontaneous resolution did not develop a subsequent lesion.CONCLUSIONOptimal management of pediatric oral cavity ranulas may include observation for 5 months for spontaneous resolution. If the lesion does not resolve or recurs repeatedly, surgical treatment is recommended. Submandibular duct dissection with relocation appears to enhance exposure to the floor of mouth. The pseudocyst and entire sublingual gland should be removed. Identification of the lingual nerve is necessary to accomplish this goal.
The Case for an Outpatient “Approach” for All Pediatric Tonsillectomies and/or Adenoidectomies: A 4‐Year Review of 1419 Cases at a Community Hospital
Authors: Postma Duncan S. , Folsom Fain 
Published: February 2003

OBJECTIVEWe sought to document the safety and efficacy of approaching all pediatric tonsillectomies and/or adenoidectomies (T/A) as outpatient procedures.STUDY DESIGN AND SETTINGWe conducted a 4‐year retrospective study of 1419 pediatric patients undergoing T/A at an outpatient center with procedures performed by a single group of surgeons.RESULTSNone of the 593 patients undergoing an adenoidectomy and only 5 (0.6%) of those having a tonsillectomy had significant bleeding postoperatively. There were no readmissions for airway problems. Children younger than age 3 were most likely to have complications and to be held for overnight observations.CONCLUSIONSMost children can be safely discharged after T/A. The higher incidence of perioperative complications in children who are younger than 3 years of age paralleled their higher rate of overnight observation.SIGNIFICANCEChildren less than 3 years of age require more careful observation, especially after tonsillectomy and more likely will need to be observed overnight than older children.
Auditory Brainstem Implantation: The University of Verona Experience
Authors: Colletti Vittorio , Fiorino Francesco , Carner Marco , Sacchetto Luca , Miorelli Veronica , Orsi Alessandro 
Published: February 2003

OBJECTIVEWe sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in the application of auditory brainstem implants (ABIs) in adults with monolateral and bilateral vestibular schwannoma (VS) and in children with cochlear nerve aplasia.STUDY DESIGNWe conducted a retrospective case review.SETTINGThe study was conducted at the ENT Department of the University of Verona, Italy.PATIENTSSix adult patients (5 men and 1 woman) with neurofibromatosis type 2 (NF2) were operated on for VS removal with ABI. An additional patient had a unilateral VS in the only hearing ear. Tumor size ranged from 12 to 40 mm. In addition, 2 children received ABIs for bilateral cochlear nerve aplasia.INTERVENTIONAn RS‐TM approach was used in all VS patients, and an RS approach was used in the subjects with cochlear nerve aplasia. After tumor excision, landmarks (VII, VIII and IX cranial nerves, choroid plexus) for the foramen of Luschka were carefully identified. The choroid plexus was then partially removed and the tela choroidea divided and bent back; the floor of the lateral recess of the fourth ventricle and the convolution of the dorsal cochlear nucleus became visible. In the 2 subjects with no cochlear nerve, the choroid plexus and VII and IX cranial nerves were used as landmarks. The electrode array was then inserted into the lateral recess and the correct position was monitored with the aid of electrically evoked auditory brainstem responses (EABR) and neural response telemetry (NRT).RESULTSCorrect implantation was possible in all patients. Auditory sensations were induced in all patients with various numbers of electrodes. Different pitch sensations could be identified with different electrode stimulation.CONCLUSIONSWe believe that the RS approach is the route of choice for patients who are candidates for ABI due to the easy and clear access to the cochlear nucleus area. This route avoids some of the drawbacks of the translabyrinthine approach, such as mastoidectomy, labyrinthectomy, sealing of the cavity and posterior fossa with abdominal fat, and contamination from the middle ear. For this reason, it is the route of choice in children with cochlear nerve aplasia or severe cochlear malformation and in adults with complete ossification of the cochlea or cochlear nerve disruption due to cranial trauma.
Pediatric External Auditory Canal Foreign Bodies: A Review of 698 Cases
Authors: Schulze Stacey L. , Kerschner Joseph , Beste David 
Published: February 2003

OBJECTIVEThe study goal was to determine the relationships between patient management factors and patient outcomes in pediatric patients with external auditory canal foreign bodies.STUDY DESIGN AND SETTINGRetrospective analysis was conducted of 698 consecutive cases of pediatric external auditory canal foreign bodies (n = 605 patients) who presented to a tertiary care pediatric referral center during a 6‐year period.RESULTSEmergency physicians frequently removed foreign bodies under direct visualization while otolaryngologists primarily used otomicroscopy. Both of these methods had high success rates overall (77% and 86%), but attempts under direct visualization had lower success rates with removing spherical objects, objects touching the tympanic membrane, and objects in the canal for more than 24 hours. Failed removal attempts resulted in higher complication rates.CONCLUSIONCertain foreign body and patient characteristics are associated with poor outcomes with removal attempts made under direct visualization. These cases should be referred directly to otolaryngologists for otomicroscopic removal.
Density of Middle Turbinate Subepithelial Mucous Glands in Patients with Chronic Rhinosinusitis
Authors: Malekzadeh Sonya , Hamburger Marc D. , Whelan Philip J. , Biedlingmaier John F. , Baraniuk James N. 
Published: February 2003

OBJECTIVEHistologic changes have not been systematically assessed in chronic rhinosinusitis. Quantitative histochemical studies evaluated the extent of sinus disease and gland density in the middle turbinates.STUDY DESIGN AND SETTINGSinus computed tomography scans of 34 patients with chronic rhinosinusitis were retrospectively graded 0 to IV according to the May classification. Middle turbinates from patients with chronic rhinosinusitis (n = 46) and normal patients (n = 7) were harvested during endoscopic sinus surgery. The areas of Alcian blue‐stained glands were assessed in paraffin sections using a computer‐assisted microscopy video system.RESULTSAlcian blue‐stained glands occupied 7.94% of normal mucosa. The staining in all grade III rhinosinusitis subjects was increased to 12.94% (P < 0.01). In contrast, grade IV pansinusitis was associated with nasal polyposis (6 of 6) with decreased gland area (3.04%,P < 0.01). When polyp patients were excluded from grade III rhinosinusitis, the Alcian blue‐staining area was 17.68% (P < 0.01).CONCLUSIONSDistinct polypoid and glandular histopathologic patterns are present in chronic rhinosinusitis.
Patient Outcome after Surgical Management of an Accessory Nerve Injury
Authors: Novak Christine B. , Mackinnon Susan E. 
Published: February 2003

OBJECTIVEThis study assessed patient outcome following surgical reconstruction of the accessory nerve after an iatrogenic injury.STUDY DESIGNA retrospective chart review of 8 patients was performed.RESULTSThere were 3 men and 5 women in the study, and the mean time between injury and nerve graft/repair surgery was 5 months. Four injuries were sustained during a lymph node biopsy. Electromyography revealed a complete accessory nerve injury in all cases. In 6 cases, a nerve graft was required (mean length, 3.6 cm), and in 2 cases, a direct nerve repair was possible. The trapezius muscle was successfully reinnervated in all cases. In total, full shoulder abduction was achieved in 6 cases; in the remaining 2 cases, the patients achieved shoulder abduction to 90°.CONCLUSIONFunctional deficit after accessory nerve injury is significant. Nerve graft/repair reconstruction reliably yields a satisfactory result, providing good scapular rotation and thus good shoulder function.
Fetal Central Auditory System Metabolic Response to Cochlear Implant Stimulation
Authors: Antonelli Patrick J. , Gerhardt Kenneth J. , Abrams Robert M. , Huang Xinyan 
Published: February 2003

OBJECTIVESThe purpose of this study was to examine the effects of profound auditory deprivation and its treatment by cochlear implantation and stimulation on the metabolic activity of the central auditory system in fetal sheep.METHODS: Six ovine fetuses at 85% to 90% gestation were bilaterally deafened by kanamycin perfusion and unilaterally implanted with cochlear electrode arrays. Half of the implanted animals were stimulated with an extrauterine sound processor, and half were not. Four animals served as hearing controls. One week postoperatively, central nervous system metabolic activity was evaluated in ambient laboratory noise by quantitative autoradiography using 14C‐deoxyglucose.RESULTSKanamycin perfusion deafened all treated animals as verified by auditory brainstem response and scanning electron microscopy. Glucose utilization in the inferior colliculus was markedly lower in deafened and unstimulated animals relative to hearing controls. Glucose utilization in implanted‐stimulated animals was similar to normal controls.CONCLUSIONSChanges in central auditory system metabolic activity associated with congenital deafness may be minimized by prompt auditory habilitation.
Unaided Speech in Tube‐Free Tracheostomy: The Supplementary Sling Procedure
Authors: Eliachar Isaac , Akst Lee M. , Eliashar Ron 
Published: February 2003

OBJECTIVEIn some patients after tube‐free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients.STUDY DESIGN AND SETTINGFrom September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed.RESULTSFifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow‐up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow‐up already show early improvement.CONCLUSIONThe supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube‐free tracheostomata.SIGNIFICANCEAs more patients undergo tube‐free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post‐laryngeal transplant patients.