Otolaryngology - Head and Neck Surgery - Articles in Press

Endoscopic resection of supraglottic (T1-T2-T3) and glottic (T2-T3) carcinomas using microdissection electrodes - Corrected Proof

Jorge Basterra, José R. Alba, Mireya Bonet, Enrique Zapater — 2010-01-22

Endoscopic electrosurgical resection of vocal cord carcinomas of stage T1 using microelectrodes (MEs) is a reliable surgical procedure; we have applied that experience to more advanced tumor stages in the glottis and the supraglottis. The present study describes the new electrode shape and the surgical technique.

Audiological and transient evoked otoacoustic emission findings in patients with vitiligo - Corrected Proof

Sundus Aslan, Gamze Serarslan, Emel Teksoz, Safak Dagli — 2010-01-22

Abstract: Objective: To investigate hearing loss in patients with vitiligo.Study design: Case-control study.setting: University hospital.subjects and Methods: Conventional pure-tone and high-frequency audiometric tests were obtained, and pure-tone average hearing thresholds were calculated for 22 consecutive cases with vitiligo and 22 sex- and age-matched controls. Transient evoked otoacoustic emission testing was also performed.Results: There was sensorineural hearing loss on pure-tone audiogram in 16 (36.4%) ears in patients with vitiligo. The hearing thresholds (in dB) were 16.02 ± 6.61 versus 12.39 ± 6.05, 15.68 ± 6.34 versus 13.18 ± 3.75, 15.80 ± 13.93 versus 7.39 ± 6.95, 25.11 ± 17.40 versus 15.91 ± 12.91, 29.89 ± 18.57 versus 17.84 ± 12.36, and 45.91 ± 23.31 versus 33.86 ± 15.99 in the patient and control groups at 0.25, 1, 4, 8, 10, and 12.5 kHz, respectively, and were statistically significantly different. Reduction of transient evoked otoacoustic emission amplitude was statistically significant at 4 kHz in patients with vitiligo (6.34 ± 3.98 dB vs 8.63 ± 5.15 dB, P = 0.023). There was no significant difference in reproducibility, stimulus intensity, stability, and average transient evoked otoacoustic emission amplitudes in patients with vitiligo.Conclusion: Hearing thresholds at pure-tone and high-frequency audiometry were higher in patients with vitiligo. Also, significantly lower high-frequency amplitudes were recorded during transient evoked otoacoustic emission testing in the disease group.

Transfusion criteria in free flap surgery - Corrected Proof

Sarah R. Rossmiller, Steven B. Cannady, Tamer A. Ghanem, Mark K. Wax — 2010-01-22

Abstract: Objective: The ideal hematocrit for patients undergoing free flap reconstruction is unknown. It is standard practice to keep hematocrit levels above 30 percent, although there is evidence that blood transfusions are associated with both infectious and noninfectious complications. We propose that lowering the trigger for postoperative transfusions from 30 percent to 25 percent will not increase flap-related complications and may reduce unnecessary blood transfusions.Study design: Observational cohort study.Setting: Tertiary care center.Subjects and methods: Patients undergoing free tissue transfer from January 2007 through February 2008 received blood transfusions for hematocrit < 30 percent, whereas patients having surgery from March 2008 through April 2009 received blood transfusions for hematocrit < 25 percent. Outcomes include flap-related complications, length of stay, number of units transfused, and lowest postoperative hematocrit.Results: In the group transfused for hematocrit < 30 percent, 123 patients underwent 129 free flaps. In the group transfused for hematocrit < 25 percent, 122 patients underwent 135 flaps. The mean lowest postoperative hematocrit levels were significantly lower in the group transfused for hematocrit < 25 percent compared with the group transfused for hematocrit < 30 percent (26.6% vs 28.4%, respectively, P < 0.0001). The group with hematocrit < 25 percent also received fewer units of blood transfused (1.47 vs 2.11, P = 0.028). Complication rates between the two groups were not significantly different aside from higher rates of fistula and respiratory failure in the group transfused for hematocrit < 30 percent. Flap loss was 2.3 percent compared with 6.7 percent (P = 0.138).Conclusion: For patients undergoing free flap surgery, a postoperative transfusion trigger of hematocrit < 25 percent decreases blood transfusion rates without increasing rates of flap-related complications.

Effect of oral tolerance in a mouse model of allergic rhinitis - Corrected Proof

2010-01-22

Abstract: Objective: Induction of oral tolerance (OT) is known to prevent allergic inflammation in models of asthma. This study investigated the preventive effect of OT and airway remodeling in a mouse model of allergic rhinitis (AR).Study design: An in vivo study using an animal model.Setting: Catholic Research Institutes of Medical Science.Methods: Forty six-week-old, female BALB/c mice were divided into four groups: control, AR, low-dose OT, and high-dose OT. To induce OT, mice were fed ovalbumin (OVA) before sensitization with OVA/aluminum hydroxide, 1 mg for six days in the low-dose OT group and a 25 mg single dose in the high-dose OT group. Mice in the AR group were fed phosphate-buffered saline. After sensitization followed by challenges with OVA during six weeks, nasal behaviors, interleukin (IL)-13 and interferon gamma (IFN-γ) levels in nasal lavage (NAL) fluids, as well as OVA-specific IgE levels in serum, were measured. The degree of goblet cell hyperplasia and thickness of lamina propria were observed in nasal tissues by periodic acid-Schiff and Masson's trichrome stain. A P value < 0.05 was accepted as statistically significant.Results: Both OT groups showed a significant decrease in inflammatory cells, IL-13 and IFN-γ in NAL fluids, as well as OVA-specific IgE levels in serum compared with the AR group. In addition, the degree of goblet cell hyperplasia and thickness of lamina propria were attenuated in both OT groups compared with the AR group. Further, these alterations did not differ significantly between the two OT groups.Conclusion: These results suggest that OT may effectively reduce allergic inflammation as well as airway remodeling in a mouse model of AR.

Maxillary removal and reinsertion: A favorable approach for extensive anterior cranial base tumors - Corrected Proof

Enver Ozer, Sumit Bapna, Amit Agrawal, David E. Schuller — 2010-01-22

Abstract: Objective: To analyze the long-term results and the complications related to an expanded series of maxillary removal and reinsertion (MRRI) with 18-year surgical experience.Study design: Case series with chart review of the MRRI patients in the last 18 years.Setting: The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute.Subjects and methods: Seventy-eight patients who underwent MRRI from February 1990 through February 2007. The median age was 51 years (range 11-77 yrs). Sixty-two (80%) patients had malignant lesions.Results: MRRI has been successfully completed in all 78 patients, with no intraoperative mortality. The most commonly encountered malignant neoplasm was squamous cell cancer (40.3%), followed by esthesioneuroblastoma (24.1%), adenoid cystic cancer (8%), and other neoplasms (27.4%). The most commonly encountered postoperative complication was diplopia, which has persisted in five (6.4%) patients in the short-term and in three (4%) patients in the long-term follow-up. Nasal asymmetry was the most common long-term complication (17.9%), followed by plate-associated problems (10.2%) and midface asymmetry (10.2%). Overall five-year survival for the patients with squamous cell carcinoma was 62 percent.Conclusions: MRRI is a favorable surgical technique for the treatment of anterior cranial base (ACB) tumors in adults and even in children. It improves operative morbidity by preserving both function and form of the maxillary region and gives excellent exposure to ACB.

Pituitary adenoma manifests as blood-tinged sputum - Corrected Proof

Reming Albert Yeh, Shuang Ying Hwang — 2010-01-07

A 57-year-old woman had visited our hospital four times complaining of intermittent blood-tinged sputum between the years 2000 to 2001. No bloody sputum or epistaxis was found in those visits. Workup for minor hemoptysis at the chest and otolaryngology departments revealed nothing except an occasional cough.

Life-threatening tension subcutaneous emphysema as a complication of open tracheostomy - Corrected Proof

Jason A. Showmaker, Matthew P. Page — 2010-01-07

Subcutaneous emphysema (SE) is the pathological presence of air in the subcutaneous tissues. It occurs postoperatively in a minority of surgical tracheotomies and is typically a benign, self-limited process resulting in temporary cosmetic disturbances without lasting sequelae. With severe SE, a tension phenomenon may develop and compress vital structures, resulting in potentially lethal impairment of cardiorespiratory function. This phenomenon, known as tension subcutaneous emphysema (TSE), has occurred following a variety of cardiothoracic procedures and percutaneous tracheostomy but has never been reported as a complication of open tracheostomy. We report on a patient who developed acute, life-threatening subcutaneous emphysema after an open tracheostomy and who was successfully treated with emergent subcutaneous decompression. The University of Missouri Health Sciences institutional review board approved this project.

Acoustic tumor observation and failure to follow-up - Corrected Proof

Todd A. Hillman, Douglas A. Chen, Matthew Quigley, Moises A. Arriaga — 2010-01-07

Abstract: Objective: To review the clinical course of patients undergoing observation for their acoustic tumor with evaluation of the incidence and contributing variables to failure to follow-up.Study design: Case series with chart review and telephone interview.SETTING: Single subspecialty practice.SUBJECTS AND METHODS: One hundred twenty-two patients underwent an observation period after their unilateral acoustic tumor was diagnosed. Follow-up patterns were noted and multiple patient variables were analyzed to determine risk factors that contributed to risk of failing to keep prescribed follow-up. Telephone interviews and/or public record reviews were conducted to determine the reasons for failing to follow-up.Results: Fifty-two (42.6%) patients failed to keep prescribed follow-up. No preoperative patient or tumor variables were correlated with the risk of failure to follow-up. The investigators were able to contact and interview 20 patients to determine reasons for not keeping follow-up. Of these patients, nine (45%) electively chose not to follow-up, six (30%) did not appear to have a clear understanding of their diagnosis or treatment options despite adequate counseling, and five (25%) had medical problems that took precedence over the acoustic tumor. Very few patients elected to reschedule follow-up even after contact was made.Conclusion: Failure to follow-up is a serious problem with acoustic tumor observation protocols. It is difficult to detect which patients are at risk for noncompliance. Patient noncompliance with observation protocols should be considered when determining the most appropriate treatment for each acoustic tumor patient.

Expression of cell-cycle regulators (cyclin D1, cyclin E, p27kip1, p57kip2) in papillary thyroid carcinoma - Corrected Proof

2010-01-07

Abstract: Objectives: To evaluate the expression of cell-cycle regulators in papillary thyroid carcinoma in relation to lymph node metastatic features, and to determine whether immunohistochemical staining of cell-cycle markers can predict lymph node metastasis.Study design: Cross-sectional study of prior surgical specimens.SETTING: Academic tertiary referral center.SUBJECTS AND METHODS: We reviewed the clinical records of patients who had undergone surgery for thyroid cancer and follicular adenoma between January 2005 and May 2008 at our clinic. Among these cases, 92 patients, comprising 28 patients with follicular adenoma, 32 with papillary thyroid carcinoma without lymph node metastasis, and 32 with papillary thyroid carcinoma with lymph node metastasis, were selected randomly. Formalin-fixed, paraffin-embedded tissues from the 92 patients were immunohistochemically stained for cyclin D1, cyclin E, p27kip1, and p57kip2, and protein expression levels were quantified and compared among the groups.Results: Tumor specimens from the papillary thyroid carcinoma group had significantly higher expression levels of cyclin D1 and cyclin E, and cytoplasmic expression of p57kip2 than the other two groups (P < 0.05). In particular, all malignant cases expressed cyclin D1, and cytoplasmic p57kip2 was expressed only in malignant cases. Furthermore, differences in the grade of cyclin D1 expression according to lymph node metastasis were statistically significant (P < 0.05).Conclusions: Our results suggest that immunohistochemistry of certain cell-cycle regulators may be helpful in the diagnosis of papillary thyroid carcinoma, and that cyclin D1 in particular may be a useful marker for evaluating lymph node metastasis.

Safety and efficacy of carbomethylcellulose foam in guinea pig middle ear surgery - Corrected Proof

Patrick J. Antonelli, Edith M. Sampson, Dustin M. Lang — 2010-01-07

Abstract: Objectives: Carbomethylcellulose (CMC) foam has been widely adopted to promote hemostasis and healing in sinus surgery. There has been interest in the use of CMC in middle ear surgery. The purpose of this study was to evaluate the safety and efficacy of CMC foam for use in middle ear surgery.Study design: Prospective, controlled.Setting: Academic research laboratory.Subjects and Methods: Adult guinea pigs underwent experimental tympanoplasty followed by packing of the middle ear (n = 19 per group) with CMC, hyaluronic acid (HA), or gelatin sponge (GS). Auditory evoked brainstem response testing and otomicroscopy were performed before and serially for eight weeks after surgery. Tympanic membrane healing, hemostasis, and retention of packing material were assessed.Results: All tympanic membranes treated with CMC healed by week eight. Less postoperative bleeding was observed with CMC than with HA or GS. Surgery elevated auditory thresholds, at least temporarily, in all groups. However, CMC was associated with greater auditory threshold elevation (15-25 dB) at eight weeks across all test frequencies relative to HA or GS (P < 0.01). Residual CMC and scarring were not found in the middle ear, indicating that the hearing loss was sensorineural. No head tilt posturing suggestive of vestibulopathy was seen.Conclusions: CMC was associated with hearing loss and may be ototoxic. Therefore, CMC should not be used in human middle ears given the presence of several nontoxic alternative materials.

Isolating Candida epiglottitis - Corrected Proof

Wu-Chia Lo, Shiann-Yann Lee, Wei-Chung Hsu — 2009-12-30

Isolated necrotizing fungal epiglottitis is rarely reported, and Candida is an uncommon cause that may develop in immunocompromised patients. This report demonstrates a treatment course more complex than those previously reported for Candida epiglottitis. Treatment using intravenous antifungal agents given for eight consecutive weeks combined with endoscopic approach for epiglottic necrotic tissue biopsy and debridement ultimately controlled the disease, which may be seen more frequently by otolaryngologists in the future.

Laryngeal cryptococcosis: Clinical presentation and treatment of a rare cause of hoarseness - Corrected Proof

Dan H. Gordon, Nicholas W. Stow, H. Manisha Yapa, Ron Bova, Deborah Marriott — 2009-11-25

Abstract: Objective: Laryngeal cryptococcosis is rare, with few reported cases in the literature. We present current investigation and treatment recommendations for this disease.Study design: A structured literature review; additional cases and expert opinion are presented.Results: Localized laryngeal cryptococcal infection most commonly presents with persisting hoarseness. Clinical suspicion of the disease is required for accurate diagnosis, with treatment based on the patient's immune status. Early microbiological advice and adequate follow-up is recommended to ensure disease resolution.Conclusion: Isolated laryngeal cryptococcosis is a rare presentation of fungal infection. It is easily treated and should be considered in the differential diagnosis of patients with persisting hoarseness.

A case of paranasal sinus lesions in IgG4-related sclerosing disease - Corrected Proof

Ryoukichi Ikeda, Toshiichi Awataguchi, Fumi Shoji, Takeshi Oshima — 2009-11-25

In 2001, IgG4-related sclerosing disease was first reported in connection with autoimmune pancreatitis. In that report, clinical manifestations were apparent in the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate. However, to date there has not been any report of the disease in the upper respiratory tract with the exception of only one description of a lesion in the pituitary gland that infiltrated the paranasal sinuses. We herein present a case of paranasal sinus lesions in IgG4-related sclerosing disease.

Ectopic olfactory neuroblastoma arising in the pterygopalatine fossa - Corrected Proof

Veronica Seccia, Riccardo Lenzi, Augusto Pietro Casani, Luca Muscatello — 2009-11-25

Esthesioneuroblastomas (ENBs) are uncommon tumors of neuroectodermal origin thought to arise from the basal cells of the olfactory neuroepithelium and are usually located in the superior nasal vault, intimately associated with the cribriform niche. These tumors have rarely been reported to be ectopic or to occur in other sites, such as the maxillary sinus.

Intranasal mycetoma-induced Splendore-Hoeppli phenomenon - Corrected Proof

Ju Wan Kang, Ja Seung Ku, Chang-Hoon Kim, Joo-Heon Yoon — 2009-11-06

The Splendore-Hoeppli phenomenon represents eosinophilic radiate structures surrounded by inflammatory cells, such as eosinophils and lymphocytes, and has been reported in infectious and noninfectious (inflammatory reactions to silk suture material) processes. This reaction can occur at various regions, such as the skin, subcutaneous tissue, and conjunctiva. To our knowledge, a case of intranasal Splendore-Hoeppli phenomenon has not been reported to date.

Preliminary results of the application of a silk fibroin scaffold to otology - Corrected Proof

2009-09-07

Abstract: The surgical treatment to repair chronic tympanic membrane perforations is myringoplasty. Although multiple autologous grafts, allografts, and synthetic graft materials have been used over the years, no single graft material is superior for repairing all perforation types. Recently, the remarkable properties of silk fibroin protein have been studied, with biomedical and tissue engineering applications in mind, across a number of medical and surgical disciplines. The present study examines the use of silk fibroin for its potential suitability as an alternative graft in myringoplasty surgery by investigating the growth and proliferation of human tympanic membrane keratinocytes on a silk fibroin scaffold in vitro. Light microscopy, immunofluorescent staining, and confocal imaging all reveal promising preliminary results. The biocompatibility, transparency, stability, high tensile strength, and biodegradability of fibroin make this biomaterial an attractive option to study for this utility.

Uvulopalatopharyngoplasty funded by the Australian government's Medicare scheme (1995-2007) - Corrected Proof

Nathaniel S. Marshall, Stuart MacKay, Richard Gallagher, Sam Robinson — 2009-09-02

Abstract: Objective: To describe the provision, through the Australian state-funded Medicare system, of uvulopalatopharyngoplasty (UPPP) and its laser-assisted variation (LAUP) to the population of Australia between 1995 and 2007.Study design: Case series using a comprehensive national administrative database.Setting: The Commonwealth of Australia.Subjects: The population of Australia.Methods: The raw numbers of procedures, reimbursement amounts in Australian dollars, and per capita adjustment nationwide and in each state/territory for UPPP and LAUP for each calendar year from 1995 to 2007 were downloaded from a publicly accessible database run by Medicare.Results: The Australian federal government paid AUD 8.2 million for 19,534 UPPP procedures and AUD 1.1 million for 3270 LAUP procedures in the calendar years 1995 to 2007, inclusive. There is substantive variability between states in provision. Over time, provision of UPPP has declined slightly compared with population growth and overall Medicare provision. LAUP provision has declined markedly.Conclusion: Provision of UPPP under Medicare in Australia has declined slowly relative to population growth and overall growth in Medicare per capita provision. Laser-assisted UPPP (LAUP) has steadily declined and is now rarely used compared with the peak in its provision in the mid 1990s.