Otolaryngology–Head and Neck Surgery

OBJECTIVE: Determine the admission rate and characterize the complications in uvulopalatopharyngoplasty (UPPP) patients scheduled to have outpatient surgery.

STUDY DESIGN AND SETTING: Retrospective review of patients undergoing UPPP between 2000 and 2004 in a tertiary care setting.

RESULTS: UPPP alone or in conjunction with tonsillectomy, septoplasty, or supraglottoplasty was carried out in 110 patients. Average preoperative respiratory disturbance index (RDI) was 35. Admission was required in 20 (18%) patients whereas 90 (82%) were discharged on the day of surgery. Admission due to desaturation was noted in 3 (3%) patients. The most common reasons for admission included pain and nausea. There were no major complications.

CONCLUSIONS: Careful preoperative selection of patients should permit many patients to undergo UPPP as outpatient surgery. Factors requiring admission may be assessed in the early postoperative period. The rate of respiratory events requiring postoperative admission after UPPP is low.

SIGNIFICANCE: UPPP can be carried out safely on an outpatient basis.

OBJECTIVE: To determine the relative incidence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in African-Americans compared to a cohort of Caucasian-Americans.

STUDY DESIGN AND SETTING: A prospective study of 2 groups of subjects (287 African-Americans and 236 Caucasian-Americans) to evaluate OSAHS severity based on subjective symptoms and anatomic findings. Subjects were from a public health and fitness fair attended by approximately 80,000 people where attendees were invited for an ENT screening.

RESULTS: Using OSAHS scores based on subjective symptoms and anatomic findings, the African-American group had a significantly higher incidence of “probable” OSAHS. In addition to symptoms of OSAHS, the questionnaire ascertained that African-American bed partners are more likely to accept loud snoring as compared to Caucasian-American bed partners.

CONCLUSIONS: OSAHS may be more common in African-Americans, but African-American bed partners are more likely to accept snoring. The medical community should strive to increase awareness and education about OSAHS in the African-American community.

OBJECTIVE: To assess efficacy of polyethylene terephthalate (PET) implants in the soft palate for the treatment of socially significant snoring.

DESIGN: A prospective, interventional case series.

SETTING: Hospital-based multi-specialty clinic.

PATIENTS: Twenty-five consecutive patients with socially significant snoring without history of obstructive sleep apnea.

INTERVENTION: Three PET implants were inserted into the soft palate of each patient (Pillar procedure, Restore Medical, Inc., St. Paul, Minnesota).

MAIN OUTCOME MEASURE: Change in snoring severity measured by the bed partner using a 10-centimeter visual analog scale (VAS) where 0 = “no snoring noise” and 10 = “extreme snoring noise causing (the bed partner) to leave the bedroom.”

RESULTS: Ninety-day follow-up data was collected for 21 patients. Four patients had incomplete follow-up. Snoring VAS rated by the bed partner had a baseline mean value of 8.5 ± 1.4, which decreased to 5.0 ± 2.1 at 30 days and to 4.4 ± 2.5 at 90 days (P < 0.001). All patients tolerated the procedure well and no procedure-related complications were observed. Two implants partially extruded in 1 patient within the 90-day follow-up period, for an implant partial extrusion rate of 2.7% (2/75 implants) and patient partial extrusion rate of 4% (1/25 patients). At 90 days, 75% of patients and 90% of their bed partners recommended the procedure.

CONCLUSIONS: In this case series, PET implants into the soft palate significantly reduced snoring with few extrusions and no complications. Controlled studies are needed to confirm effectiveness and to refine patient selection criteria.

OBJECTIVE: To evaluate the safety and long-term effectiveness of a new treatment for snoring using permanent palatal implants.

STUDY DESIGN: Prospective study with 35 patients referred to the clinic for the treatment of snoring. The patients were followed for 1 year, and a sleep analysis was performed and repeated at 360 days. During the procedure, 3 braided polyethylene terephthalate implants were placed in the palate of each patient.

RESULTS: The average duration for nonnarcotic analgesics was 1.3 days. No adverse events were observed. The mean snoring intensity was reduced from 7.1 at baseline to 4.8 at 1 year (P < 0.001). Bed partner satisfaction rate was very high at 70.6% after 1 year. Six patients (17.8%) experienced a total of 9 partial extrusions.

CONCLUSIONS: The palatal implant system is safe, and the effectiveness in treating snoring is comparable to other surgical methods. Advantages are virtually no tissue damage and minimal patient discomfort as a result of one standardized, low-cost procedure.

OBJECTIVE: To evaluate the initial short-term effectiveness of palatal implants in treating patients with mild to moderate obstructive sleep apnea (OSA). Previous published studies have focused on snoring without OSA.

STUDY DESIGN: A prospective, nonrandomized study of 25 previously untreated patients with an apnea-hypopnea index (AHI) of 10 to 30 and a body mass index (BMI) of ≤30. Three permanent implants (Pillar; Restore Medical, St Paul, MN) were placed in the soft palate of each patient with a specially designed delivery tool in an office setting under local anesthesia after a formal polysomnography. A repeat polysomnography was obtained after 90 days.

RESULTS: The AHI was reduced from a mean of 16.2 to a mean of 12.1 (P < 0.05) for the study group. Twenty of 25 patients (80%) experienced a decrease in the AHI. Twelve of 25 patients (48%) showed a post-90-day implant AHI of 10 or less, a benchmark for the possible cessation of continuous positive airway pressure therapy. The Epworth Sleepiness Score decreased from 9.7 to 5.5 (P < 0.001) and the visual analog Scale of snoring intensity reported by bed partners decreased from 8.4 to 4.3 (P < 0.001).

CONCLUSION: The palatal implant method can significantly improve AHI and other sleep-related parameters in patients with mild to moderate OSA and a BMI of ≤30. Short-term results are comparative to those reported for uvulopalatopharyngoplasty but achieved in a low-cost, single-stage, outpatient office setting with low morbidity.

OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA).

STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery.

RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 ± 20.0 vs 20.7 ± 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B.

CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful.

OBJECTIVE: Food allergies in childhood have been found to vary in frequency from 6% to 8% in the general population. Previous studies indicate milk allergy affects approximately 2.5% of infants and egg allergy has been estimated at 1.6% to 2.6%. Numerous allergists believe that the prevalence of food allergies is rising, similar to the rise in other atopic conditions. Prior studies have demonstrated that food-specific IgE is a useful test for diagnosing symptomatic allergies to certain foods, including milk and eggs, and could decrease the need to perform cumbersome multiple double-blind, placebo-controlled food challenges in children based on history alone. The purpose of this study was to determine the prevalence of food allergies and elevated IgE in a consecutive series of pediatric otolaryngology patients.

STUDY DESIGN AND SETTING: ImmunoCap™ studies were drawn in a 2-year series of children undergoing ENT procedures of bilateral myringotomy with tubes (BMT) with or without adenoidectomy or tonsillectomy or adenoidectomy alone between 2001 and 2003. Sera was analyzed for increased total IgE antibodies, as well as specific IgE antibodies to antigens, including milk, egg, beef, and environmental allergens. A positive patient history or family history of allergy were documented.

RESULTS: A total of 242 patients were assessed. Of the study population, milk allergy was found in 10.7%; egg white allergy was found in 5.0%. The prevalence of elevated IgE among participants was 11.2%. The overall food allergy prevalence was 14.5%.

CONCLUSIONS: Although we cannot imply causality, the study demonstrated an increased prevalence of food allergy in children undergoing ENT procedures, specifically milk and eggs, than in previous population studies.

OBJECTIVE: To compare the presence of fungi in the sinus mucosa of patients with and without chronic rhinosinusitis.

STUDY DESIGN AND SETTING: Prospective observational study using polymerase chain reaction and conventional culture to detect fungi in the sinus mucosa. Middle meatus mucosal samples were collected from 31 patients with chronic rhinosinusitis and 14 control subjects.

RESULTS: Fungi were detected in 6.5% of subjects with chronic rhinosinusitis and in none of the control subjects using polymerase chain reaction. Fungi were detected in 29% of subjects with the combination of inhalant allergies, nasal polyposis, and asthma. Fungi were detected in none of the subjects without the combination of these three comorbidities (P = 0.03).

CONCLUSION: Polymerase chain reaction assay appears to be able to detect fungi in chronic rhinosinusitis.

SIGNIFICANCE: Fungi may not be implicated in the pathogenesis of most chronic rhinosinusitis.

OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the inflammatory burden and optimization of drainage of the sinuses has been suggested as a last resort for these patients.

STUDY DESIGN: A prospective, questionnaire-based study was conducted in a group of 23 patients who underwent Denker's procedure for refractory chronic rhinosinusitis. Symptoms were evaluated before Denker's procedure and 12 months and 2 years after surgery.

RESULTS: Patients reported improvement of feelings of congestion in 74%, rhinorrhea in 70%, and nasal obstruction in 60% of the cases. The following postoperative improvements were statistically significant: rhinorrhea (P = 0.001), feelings of congestion (P = 0.02), and nasal obstruction (P = 0.03). Reduced olfactory perception and asthma did not improve.

CONCLUSION: Radical surgery may be a viable treatment option in case of recurrent ESS failure.

OBJECTIVE: To compare the incidence of bony erosion associated with allergic fungal rhinosinusitis (AFRS) with the incidence of bony erosion seen in other types of inflammatory sinusitis.

STUDY DESIGN: Retrospective review.

RESULTS: AFRS was diagnosed in 27 patients, and 15/27 (56%) had bony skull base or orbital erosion. Non-AFRS chronic sinusitis required surgery in 158 patients, but only 8 (5%) had bony skull base or orbital erosion (P < 0.01). AFRS patients were 12.6 times (P < 0.01) more likely to have bony erosion than non-AFRS patients. African American males were 15.0 times (P < 0.01) more likely to have bony erosion than whites and African American females combined.

CONCLUSION: Bony erosion with intracranial and intraorbital extension is much more common in AFRS than all other types of inflammatory sinusitis combined. African American males have a higher incidence of AFRS, as well as intracranial and intraorbital extension.

OBJECTIVE: To analyze the vascular and glandular elements of the nasal septal swell body (NSB) and quantitatively compare these to the inferior turbinate (IT) and non-swell body portion of septum.

STUDY DESIGN: Fourteen healthy adults undergoing septoplasty and IT reduction were submitted to unilateral biopsies of the NSB, the adjacent inferior turbinate, and inferior septum. Photomicrography with morphometric analysis was used to determine the relative area proportions of each tissue type.

RESULTS: NSB was rich in seromucinous glands (49.9% ± 7.0%) compared to IT (19.9% ± 5.5%), P < 0.01. Conversely, IT mucosa demonstrated increased area proportion of venous sinusoids (28.3 ± 13.9) compared to NSB (10.0 ± 6.0), P < 0.01. Inferior septal mucosa had glandular and vascular elements similar in proportion to that of NSB.

CONCLUSIONS AND SIGNIFICANCE: NSB is a highly glandular structure of the anterior-superior septum, with moderate proportion of venous sinusoids. Located at the distal valve segment, the NSB appears structured for secretory function and vasoactive airflow regulation.

OBJECTIVE: Investigate familial aggregation of sinonasal polyps (NP) and correlate the severity of chronic rhinosinusitis (CRS) with a family history of NP.

STUDY DESIGN AND SETTING: A questionnaire documenting NP, asthma, or aspirin intolerance was completed by 174 CRS patients. Severity of sinus disease was stratified as isolated NP, NP with concomitant asthma, and Samter's triad (polyps, asthma, and aspirin intolerance).

RESULTS: Compared to controls, CRS patients had a higher incidence of a family history of NP. Additionally, patients stratified with severe CRS had a higher incidence of relatives with NPs.

CONCLUSIONS: Familial aggregation of NP is demonstrated in CRS patients and correlates with disease severity.

EBM rating: B-2b

OBJECTIVE: To evaluate the practicability of Odiosoft-Rhino (OR), a new experimental method for assessing the nasal airflow and resistance, in normal subjects and to compare the results with acoustic rhinometry (AR) findings.

STUDY DESIGN AND SETTING: OR and AR were carried out in 72 healthy subjects. Their visual analogue scales of nasal obstruction, minimal cross sectional areas (MCA₁ and MCA₂), and nasal expiration sounds were analyzed and noted for both nasal cavities.

RESULTS: Statistically significant correlations (P < 0.05) were found between OR and AR in 2,000 to 4,000 Hz and 4,000 to 6,000 Hz with MCA₁ and MCA₂.

CONCLUSIONS: OR is a noninvasive and rapid test. It is easy to carry out and requires little patient cooperation. It seems that it may give compatible results with other reliable methods that assess nasal airflow.

SIGNIFICANCE: We assume that OR is a sensitive method for evaluating nasal airflow in normal subjects in an easy way.

EBM rating: A-1b

OBJECTIVES: Nasal polyposis has a great impact on the quality of life. The aim of this study was to evaluate the association between quality of life and atopy, sinus opacification, and nasal patency in severe nasal polyposis.

METHODS: One hundred nine patients completed the Medical Outcome Study Short Form-36 (SF-36) survey. Symptoms, polyp size, atopy, nasal patency, and sinus opacification were also scored.

RESULTS: Patients showed worse scores in all SF-36 domains, except for physical functioning, compared with Spanish population. Atopic patients had worse scores in role physical, body pain, vitality, and mental health than nonatopic patients. Atopic patients showed lower physical component summary (44.7 ± 1.1) and mental component summary (38.4 ± 1.0) than nonatopic patients (48.3 ± 1.6, 40.6 ± 1.3; P < 0.05), respectively. There were no correlations between quality of life and symptoms, polyp size, CT scan, nasal patency, and atopy.

CONCLUSION: Nasal polyposis has a considerable impact on quality of life and atopy worsens this impact.

EBM rating: C-4

OBJECTIVE: This study compares innervated and denervated flaps for the lower lip reconstruction in terms of oral sphincter function and sensation.

STUDY DESIGN AND SETTING: A prospective trial.

METHODS: This study was carried out on 31 patients with lower lip carcinoma. They were divided in 2 groups: 18 patients with denervated local flaps and 13 patients with innervated flaps. During the follow-up period, all patients were evaluated by electromyography tests and an assessment of the sensation on the lower lip and sphincter function was undertaken by clinical parameters.

RESULTS: Compound muscle action potential (CMAP) was obtained in all patients. The amplitudes of CMAP were below normal and the values for distal motor latency (DML) were slightly longer than normal values. Interference patterns were observed on whistling in all cases. There were no differences in terms of sphincteric function in each group.

CONCLUSIONS: The denervated random local flaps used for the lower lip reconstruction have no functional inferiority when compared to the innervated-pedicled local flaps.

SIGNIFICANCE: This study demonstrates that denervated flaps can be employed for a functional lip reconstruction.

EBM rating: B-2b

OBJECTIVE: To describe the voice characteristics of pediatric unilateral vocal fold paralysis (UVFP).

STUDY DESIGN AND SETTING: Retrospective series from a children's hospital, 1996 to present.

RESULTS: Forty-two patients with a mean age of 7.1 years were diagnosed with UVFP in our voice clinic (prevalence = 5.4%). Paralysis was left sided in 88%, and was most commonly seen after cardiac surgery (28.5%) and prolonged intubation/prematurity (16.7%). Voice analysis showed a moderate degree of breathiness, mild-to-moderate hoarseness and straining, mild muscle tension, and soft loudness. Twenty-six percent of patients required surgical intervention, including injection into the paralyzed fold (7 patients) and medialization thyroplasty (4 patients). Pre-operatively, breathiness was worse (P < .05) in patients undergoing surgical intervention.

CONCLUSIONS: Voice characteristics of pediatric UVFP include increased breathiness, hoarseness, straining, muscle tension, and soft loudness. One-fourth of patients underwent surgical intervention; breathiness was the predominant abnormal voice characteristic in the operative cohort.

SIGNIFICANCE: The voice characteristics of pediatric patients with UVFP are described.

EBM rating: C-4

OBJECTIVE: The purpose of this study is to assess the clinicopathologic and immunohistochemical features of intraoral mucoepidermoid carcinomas and its relationship with the prognosis.

STUDY DESIGN AND SETTING: From 1953 to 1993, 27 patients with intraoral mucoepidermoid carcinomas surgically treated were selected for this study. Clinical data were obtained from the medical records, the microscopic slides were reviewed, the tumors were graded, and immunohistochemical analysis for p53, PCNA, cerbB-2, and CEA were carried out.

RESULTS: The tumors were more frequent in patients between 40 and 60 years of age (40.7%), without gender predilection. Hard palate was the most common site with 13 cases (48%). T2 was the more frequent stage (48%) and 2 patients (7.4%) were staged as N + . Most tumors (48%) were classified as low grade of malignancy. The expression of PCNA was associated to high-grade tumors (P = .00610) and c-erbB-2 to low grade tumors (P = .03958). No recurrence was noted in most of the cases (22 cases, 81.5%). Three cases (11.1%), however, showed local recurrence and 2 patients (7.4%) died because of the disease. The analysis of the overall survival rate showed that male patients (P = .04249), stage N (P = .05948), high grade of malignancy (P = .0009), strong expression of PCNA (P = .09128), and weak expression of c-erbB-2 (P = .03334) had the lowest survival rates.

CONCLUSION: Our results showed that patients with intraoral mucoepidermoid carcinoma had a reduced survival expectation if they were of the male gender, with regional metastasis, high grade of malignancy, strong expression of PCNA and weak expression of c-erbB-2.

OBJECTIVE: Intracordal injection for vocal fold augmentation is easy and simple and does not require a cervical skin incision. We reported previously on the 1-year results of injected autologous auricular cartilage for volumetric augmentation in paralyzed canine vocal cord. This study evaluates the long-term histomorphologic results of injected autologous auricular cartilage for the augmentation of the paralyzed canine vocal fold at 2 and 3 years.

STUDY DESIGN AND SETTING: A prospective trial of autologous cartilage augmentation of vocal cord in animal model. Five dogs were operated on. A piece of auricular cartilage was harvested from the ear and minced into tiny chips with a scalpel. Fat was harvested from inguinal area and minced with a scalpel. The minced cartilage and fat-paste (0.2 ml) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle using direct laryngoscopy. Three animals were sacrificed at 2 years, two at 3 years. Each subject underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior vocal fold were made.

RESULTS: There was no significant complications perioperatively or postoperatively. The injected cartilage that seemed to have lost viability existed in the vocalis muscles until 36 months. Fibrotic change was exhibited in the surrounding injected cartilage. There were no differences between 2 and 3 years in histomorphologic results of the injected cartilage.

CONCLUSION: The autologous auricular cartilage graft is well tolerated and may be a very effective material for long-term volumetric augmentation in the paralyzed vocal cord.

OBJECTIVE: Determine presentation and survival rates for malignant pediatric salivary gland neoplasms.

METHODS: All cases of malignant neoplasms involving the parotid or submandibular gland in patients ages birth to 18 years were extracted from the Surveillance, Epidemiology, and End Results database (1988–2001). Variables included age, gender, tumor histology, size, follow-up time, and vital status. Kaplan-Meier survival curves were constructed.

RESULTS: 113 primary salivary gland malignancies (103 parotid, 10 submandibular) were identified. Mean age at presentation was 13.2 years. Female:male ratio of 5:4. Mean tumor size was 2.5 cm. Among parotid tumors, there were 44 (43%) mucoepidermoid carcinomas and 35 (34%) acinic cell carcinomas. At a mean follow-up of 69.4 months, 6 (5.8%) patients with parotid malignancy were deceased; none of the submandibular malignancies were fatal. Mean Kaplan-Meier survival for parotid gland lesions was 153 months, with rhabdomyosarcomas exhibiting significantly worse survivals as compared to other malignancies (P < 0.001, log-rank test).

CONCLUSIONS: Both epithelial and mesenchymal tumors present in the pediatric salivary gland. Survival for both parotid and submandibular gland malignancies is good in children.

OBJECTIVE: The purpose of our investigation was to report our experience with a color flow doppler (CFD) ultrasonography for postoperative monitoring of free tissue transfers.

METHODS: A retrospective analysis of head and neck free tissue transfers at a single institution between 2000 and 2005 (n = 84; 80 successful, 4 failures). CFD measured blood flow velocity (cm/sec) and resistance to flow in the pedicle vein and artery on postoperative days 1, 3, and 7.

RESULTS: Analysis of artery/vein ratio revealed vascular congestion by postoperative day 3 which later resolved. In flap failures, there was a significant reduction (P < 0.05) in venous blood flow by postoperative day 3. Waveform morphology representing vascular resistance and origin of donor flap did not correlate with flap outcome (r 2 = 0.23 and 0.44 respectively).

CONCLUSION: Postoperative monitoring of free tissue transfers may allow for detection of poor perfusion. CFD is an objective method of studying blood flow postoperatively.

OBJECTIVES: To evaluate the impact of clinical, histopathological, and molecular biological parameters on the prognosis of nasopharyngeal carcinoma (NPC).

STUDY DESIGN AND SETTING: The clinical records of 48 patients with a diagnosis of NPC were retrospectively reviewed. In situ hybridization for Epstein-Barr virus encoded small RNA 1 (EBER-ISH) was applied for 30 paraffin-embedded specimens available. Prognostic factors of NPC were meticulously analyzed.

RESULTS: The EBER-ISH signal was shown to be highly significant as a favorable prognostic factor (P = 0.007). Although EBV was more commonly associated with Type III NPC, EBER-ISH-positive Type I-II NPC had also significantly better survival rate than EBER-ISH-negative Type I-II NPC (P = 0.036).

CONCLUSIONS: In addition to the WHO histopathological grade, the 1997 UICC staging, nodal status, and distant metastasis at presentation, the EBER-ISH signal was shown to be significant as a prognostic factor.

SIGNIFICANCE: This is the first report to describe the EBER-ISH as an independent prognostic factor of NPC regardless of histopathology.

OBJECTIVE/HYPOTHESIS: Fine needle aspiration (FNA) is an accurate, cost-effective tool for the study of salivary gland lesions. Although complications are extremely rare, salivary gland FNA can lead to hemorrhage, facial nerve injury, and cellulitis at the needle puncture site. Some studies suggest that FNA can cause infarction or metaplastic transformation of benign Warthin's tumors. We review our recent experience with FNA of the parotid gland, focusing on possible complications and pitfalls.

STUDY DESIGN AND SETTING: The medical records of all patients who underwent FNA of the parotid gland from 2000 to 2002 in the Department of Otolaryngology-Head and Neck Surgery of a major tertiary-care referral center were reviewed. Cytological results were compared to the histological diagnosis and complications were recorded.

RESULTS: Of the 256 lesions aspirated, 99 patients (39%), were cytologically diagnosed as benign tumors, including 31 (12%) Warthin's tumors, of which 16/17 resected and confirmed histologically. Five patients with Warthin's tumor had post-FNA parotitis and were treated accordingly.

CONCLUSIONS: The combination of cystic spaces surrounded by oncocytic cells and a poor blood supply makes the tumor susceptible to infarction and inflammation. Our findings indicate that FNA is a strong and reliable tool in the investigation of the salivary glands. Nevertheless, when Warthin's tumor is clinically suspected on the basis of its location (tail of the parotid gland), cystic texture, patient sex (male) and age, one should consider parotitis as a possible complication.

OBJECTIVE: We designed a retrospective study to evaluate the incidence of contralateral neck metastases in squamous cell carcinoma of the pyriform sinus.

STUDY DESIGN AND SETTING: Sixty-three patients with strictly unilateral squamous cell carcinoma of the pyriform sinus who underwent bilateral neck dissection at the time of primary surgery were included in this study. The medical records of all patients were reviewed. A multivariate statistical analysis was performed, considering some clinical and histologic parameters of T stage and N stage in relation to contralateral neck metastases.

RESULTS: Contralateral neck metastases were histopathologically confirmed in more than 20% of the cases examined (13 out of 63 patients), of whom 3 were clinically staged as N2c, 2 N2b, 5 N2a, 2 N1 and 1 N0. The percentage of occult contralateral neck metastases was 77% (10/13 cases). Poorly differentiated tumors (P = .02) and the involvement of the lateral wall (P= .036) showed a statistically significant correlation with stage pN2c. Also T size and ipsilateral N stage were associated with the presence of contralateral neck metastases.

CONCLUSIONS: Our data suggest that elective bilateral neck dissection is recommended in patients with locally advanced squamous cell carcinoma of the pyriform sinus.

BACKGROUND: Sinonasal carcinomas, including nonkeratinizing (NK) squamous cell carcinoma (SCC) and sinonasal undifferentiated carcinoma (SNUC), are uncommon malignant neoplasms arising from the Schneiderian respiratory epithelium of the nasal cavity and paranasal sinuses. Due to their low frequency, the cytogenetic data on these tumors is limited.

METHODS: Seventeen patients who were operated on in our institution for extirpation of paranasal carcinomas were enrolled in this study. Fourteen pathologically confirmed samples of sinonasal carcinomas were cytogenetically analyzed using G-banding techniques after short-term culture. Three samples did not grow on culture.

RESULTS: Five of the 14 sinonasal carcinomas had an abnormal karyotype (36%). Of the 9 NK SCCs, 3 had abnormal karyotypes with numerical and structural chromosomal anomalies. Of the 5 patients with SNUC, 2 had an abnormal karyotype. One case of SNUC had a diploid complex karyotype. Another case of SNUC had a near triploid composite karyotype with 60–69 chromosomes. The chromosome arms that involved frequent breakpoint and rearrangements were: 1p, 6p, 7p, and 12q. We found that 3 of the 3 patients who died of disease displayed an abnormal karyotype, whereas 2 of the 11 patients who are alive displayed an abnormal karyotype (P = 0.027).

CONCLUSIONS: The study revealed that more than a third of the paranasal carcinomas carry an abnormal karyotype. No specific common aberrations were found in these tumors. To our knowledge this is the first attempt to investigate sinonasal squamous and undifferentiated carcinomas on a genetic level using G-banding technique. Additional studies are required in order to determine whether cytogenetic data may serve as an adjunct to conventional pathology for the diagnosis and prognosis assessment of these rare and highly aggressive tumors.

OBJECTIVES: To describe a relatively large series of patients with uncommon malignant lymphoepithelial lesions (MLEL) in the salivary glands, to present treatment-outcome data to support therapeutic decision-making, and to evaluate the incidence of cooccurrence of MLEL and Epstein-Barr virus (EBV).

STUDY DESIGN AND SETTING: Ten patients with MLEL were treated between 1987 and 2002. All lesions were surgically removed, with or without neck dissection, and the patients treated with radiotherapy or radiotherapy and chemotherapy. Histopathology and in situ hybridization studies for EBV-encoded RNA (EBER1) were performed.

RESULTS: With aggressive treatment, outcomes were good, regardless of the presenting stage, except when distal metastases were present. All 10 patients tested positive for EBV.

CONCLUSION AND SIGNIFICANCE: This and previous investigations support the use of aggressive surgical excision of the tumor and local metastases and radiotherapy or radiotherapy and chemotherapy, as optimal treatment for MLEL. The EBV finding may indicate a role for EBV in the pathogenesis of MLEL.

OBJECTIVES: Concerts have long periods of intense sound with short break intervals. Hearing concerns are well known to performers; concertgoers largely ignore them. Preperformance and postperformance audiograms were compared to assess hearing threshold shifts with and without earplugs.

METHODS: A prospective, randomized study in which 29 volunteers attended 3 concerts, encompassing 3 music genres. Audiograms, seating location, sound intensity, and earplug-use data were collected. Data were analyzed to determine frequency test-retest variability.

RESULTS: Sound levels averaged 99.8 dBA, and the maximum was 125.6 dBA. Sixty-four percent (9/14) of participants without earplugs showed significant threshold shifts compared with 27% (4/15) of those using earplugs. No significant differences existed between music genres or seating location.

CONCLUSIONS: This study showed a high incidence of threshold shifts in unprotected concertgoers. Sound levels exceeded all Occupational Safety and Health Act rules despite standardized sound systems. A significant reduction in threshold shifts was seen with the use of earplugs.

OBJECTIVE: To determine if treated Pseudomonas aeruginosa otitis media (PA OM) increases the risk of sensorineural hearing loss (SNHL) with stapedotomy.

STUDY DESIGN AND SETTING: PA OM was induced in 28 guinea pigs. Half of the animals underwent unilateral stapedotomy before antibiotic therapy (untreated), and half underwent stapedotomy after treatment (treated). Control animals underwent saline injections followed by stapedotomy. Electrocochleographic thresholds were measured before and after stapedotomy. Temporal bones were analyzed histomorphologically.

RESULTS: Less SNHL was seen after stapedotomy in treated ears than in untreated ears (P = 0.0268). SNHL after stapedotomy in treated ears was similar to controls (P = 0.9370). Severe damage to cochlear outer hair cells was found in untreated ears.

CONCLUSIONS: Ears with PA OM treated previously are not at increased risk of SNHL with stapedotomy.

SIGNIFICANCE: Stapedotomy may be carried out with caution in the setting of inactive, chronic OM.

OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation.

STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations.

RESULTS: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion.

CONCLUSION: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo.

SIGNIFICANCE: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment.

OBJECTIVES: To identify the main tomographic findings of otosclerosis and to evaluate the usefulness of high-resolution computed tomography as a diagnostic method for this osteodystrophy.

STUDY DESIGN AND SETTING: A prospective and multi-center study consisting of computed tomography (CT) of the temporal bone was conducted on 54 patients with a clinical and surgical diagnosis of otosclerosis. Twenty-two patients were included in the control group.

RESULTS: The CT scan was positive in 87% of the patients. The tomographic findings were mainly bilateral and fenestral foci were more prevalent.

CONCLUSIONS: CT showed a high rate of positivity, mainly for fenestral lesions. Foci anterior to the oval window were the most prevalent in this population.

SIGNIFICANCE: CT is useful as a diagnostic method and therapeutic indicator of otosclerosis.

Cough is the most common presenting complaint in adults seeking medical treatment in an ambulatory setting. Chronic cough (persisting greater than 3 weeks) can be associated with myriad diseases that may overlap multiple medical specialties. For this reason, a thorough assessment of the patient with chronic cough relies on a multidisciplinary approach and close cooperation between pulmonary medicine, gastroenterology, and otolaryngology. Despite this daunting task, success can be achieved in up to 90% of patients with chronic cough if a systematic and thorough approach is used. The purpose of this review is to summarize the state-of-the-art in the diagnosis and treatment of chronic cough for the practicing otolaryngologist.