New Research in Medical Journal for Ear, Nose, and Throat Specialists

Newswise — The July 2004 issue of Otolaryngology—Head Neck Surgery, the peer-reviewed, scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery is now available. Abstracts of these research studies can be viewed at: http://www.mosby.com/oto

In this issue:

1. Special report: Reassessment of the ORL"HNS Workforce: Perceptions and Realities. This Workforce Study re-examined the current scope and geographic distribution of otolaryngology practices and assessed the otolaryngologists' role in relation to other specialists in the diagnosis and treatment of disorders of the ear, nose, throat, and related structures of the head and neck.

2. Endoscopic Treatment of Laryngeal and Tracheal Stenosis—Has Mitomycin C Improved the Outcome? The management of a narrowing of the larynx and trachea remains a challenging problem despite advances in endoscopic surgical techniques. Scar formation and restenosis is the main cause of failure, and this study assesses the efficacy of two adjuvant treatments: endoscopic steroid injection and topical Mitomycin C application.

3. Pediatric Suprastomal Granuloma: Management and Treatment. Suprastomal granulomas (SSG), are nodular inflammatory lesions, usually small or granular, firm, persistent, present near the opening of a tracheotomy, and are a common complication of this procedure to aid breathing in children, Occasionally these lesions must be removed; three otolaryngologist—head and neck surgeons report on their experience on the management of SSG requiring excision.

4. Wireless pH Testing as an Adjunct to Unsedated Transnasal Esophagoscopy: The Safety and Efficacy of Transnasal Telemetry Capsule Placement. The introduction of 48-hour wireless pH testing offers clinicians a new alternative for the objective documentation of reflux. The success of transnasal wireless pH capsule placement has not been previously described. This study found that transnasal placement of a wireless pH capsule is a safe and effective diagnostic adjunct to unsedated transnasal esophagoscopy.

5. Prevalence of Extraesophageal Reflux in Patients with Symptoms of Gastroesophageal Reflux. Extraesophageal reflux (EER) is gastroesophageal reflux that reaches the structures above the upper esophageal sphincter (UES). Previous studies have proposed that EER differs significantly from gastroesophageal reflux disease (GERD) in terms of the symptoms, patterns, manifestations, and complications. A Swedish study set out to compare the prevalence of extraesophageal reflux (EER) in patients with heartburn, posterior laryngitis (PL), and in healthy controls.

6. Intracordal Injection of Autologous Auricular Cartilage in the Paralyzed Canine Vocal Fold. Vocal fold augmentation by injectable material under direct visual control is an easy and simple operation. However, when autologous fat or bovine collagen is used, resorption, or the loss of the material, creates a problem. This study is to evaluate the histology of minced and injected autologous auricular cartilage and fat graft in the augmentation of unilateral vocal fold paralysis using a canine model.

7. Removal of Fish Bones in the Oropharynx and Hypopharynx Under Video Laryngeal Telescopic Guidance. Nothing can be so annoying or possibly more dangerous that the inadvertent swallowing of small fish bones. A new study examines whether a video laryngeal telescopic guidance is effective and safe to use in removal of fish bones in the oropharynx and hypopharynx.

8. Fusaric Acid: A Novel Agent and Mechanism to Treat HNSCC. A new class of carboxylic or organic acids may present an agent destructive for tumors found in head and neck squamous cell cancer (HNSCC). Fusaric acid (FA) can effect a complex formation involving a metal ion and two or more polar groupings of a single molecule, especially zinc, and inactivate zinc finger proteins involved in DNA repair and protein synthesis.

9. Predictors of Wound Complications after Laryngectomy: A study of over 2000 Patients. Postoperative wound infections after laryngectomy cause substantial morbidity, and lead to extended hospital stays and increased resource consumption. These complications, which range from seven percent to 41 percent in the antibiotic era, typically include cellulitis, wound splitting or bursting, and pharyngo-cutaneous fistulas. A new study identifies risk factors for and the rate of wound complications after laryngectomy in a large, prospectively collected national dataset, and generates a predictive model.

10. Extended Pericranial Flap and Bone Graft Reconstruction in Anterior Skull Base Surgery. Anterior skull-based tumors that were once thought to be inoperable are now safely removed with low operative mortality. Many techniques have been described for the reconstruction of anterior skull base defects after the removal of malignant and benign tumors. The reconstructive options include pericranial flaps, myocutaneous flaps, combined galea and pericranial flaps, pedicled bone grafts, and free bone grafts. A new study seeks to find what procedure is most effective.

11. c-myc and bcl-2 Expression in Supraglottic Squamous Cell Carcinoma of the Larynx. Most recent studies on head and neck carcinoma have concentrated to understand tumor biology and to find more reliable predictive factors. Recently, attention has been focused on cellular oncogenes as potential prognostic predictors of the head and neck carcinoma. The genes c-myc and bcl-2 are known to be involved in cell cycle control and/or regulation of programmed cell death and might have an impact on the biological behavior of tumors. A new study evaluates the expression of c-myc and bcl-2 oncogenes and to investigate their prognostic significance in squamous cell carcinoma of supraglottic larynx.

12. Expression of Mucin Gene Products in Laryngeal Squamous Cancer. Mucins are high-molecular-weight glycoproteins present at the outer surface of mammalian cells. British researchers explored the expression of mucin (MUC) genes 3, 4, 5AC, 5B, 6, and 7 in early and late laryngeal squamous cancers using the in situ hybridization technique. They found a survival advantage for patients with advanced-stage nonmetastatic cancer when the MUC 4 gene is expressed.

13. Z-Palatoplasty (ZPP): A Technique for Patients without Tonsils. Uvulopalatopharyngoplasty (UP3) remains the most common surgical procedure performed as treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS). However, no procedure has been studied for post-tonsillectomy patients. Many patients, especially post-tonsillectomy patients, end up with an extremely narrow palatal arch further contributing to airway obstruction. A research effort examines whether a modified uvulopalatoplasty based on a bilateral Z-plasty would be more effective in treating patients without tonsils who have obstructive sleep apnea/hypopnea syndrome.

14. Significance of Asymptomatic Tonsil Asymmetry. When only one of the two tonsils is enlarged, the specialist will often suspect malignancy. A new study evaluates the incidence of occult malignancy in patients with asymptomatic unilateral tonsillar enlargement, a condition that necessitates immediate tonsillectomy.

15. Postoperative Infection in Cochlear Implant Patients. Recently, the association of meningitis with cochlear implants has raised concern over the safety of these devices. A research team examined the incidence of all postoperative infections in patients undergoing cochlear implant surgery. Cochlear implant surgeries in 462 adults and 271 children were reviewed. Patients with evidence of a postoperative infection or infectious complication related to cochlear implantation were identified, and data on patient characteristics, surgery, and treatment outcome were obtained.

16. Ototoxic Protection of Sodium Thiosulfate: Daily vs Constant Infusion. Cisplatin (cis-diamminedichioroplatinum II; CP) is a widely used chemotherapeutic agent, which has proven effective in the treatment of a wide range of solid neoplastic tumors. Unfortunately, well-documented side effects have limited the dosage and duration of CP treatment regimens. Among the many toxic side effects caused by CP are nephrotoxicity, peripheral neuropathy, and ototoxicity. Ototoxicity, or damage to the ear, is the most frequent dose-limiting side effect. Sulfur-containing compounds that contain a thioether, thiol, or thiol functional group have been reported to provide protection from CP-induced cytotoxicity. A new study examines this claim.

17. Surgery of Cerebellopontine Angle Epidermoid Cysts: Role of the Widened Retrolabyrinthine Approach Combined with Endoscopy. Epidermoid cysts are cholesteatomas, or a spherical, unilocular cyst of the dermis, comprised of encysted keratin and sebum. They can form in the cerebellopontine angle (CPA), which is the angle formed at the junction of the cerebellum, pons, and medulla. They are rare, representing only seven percent of lesions at this site. Despite the rarity of this condition, a research team evaluated the use of the retrolabyrinthine approach (RLA), combined with endoscopy, to assess preservation of cranial nerve function and complete surgical removal of these cysts.

18. Informed Consent in Functional Endoscopic Sinus Surgery: The Patient's Perspective. Informed consent is essential prior to functional endoscopic sinus surgery (FESS). The content of the discussion between patient and physician is often determined by the latter. Many doctors discuss all potential complications. This may provoke anxiety or deter patients from beneficial surgery. This unique study views the process from the patient's perspective.

19. Surgical Management of Paranasal Sinus Mucoceles: A Long-Term Study of 60 Cases. Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, a CT scan is necessary to accurately analyze the regional anatomy and extent of the lesion. Standard treatment is surgical marsupialization, the removal of a cyst or other such enclosed cavity by resecting the anterior wall and suturing the cut edges of the remaining wall to adjacent edges of the skin, thereby creating a pouch. This is performed through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. This study describes the indications for the endonasal surgical approach and the long-term postoperative followup.