摘要:

AbstractDistortion product emission (DPE) growth functions, demographic data, and pure tone thresholds (PTTs) were recorded in 229 normal‐hearing and hearing‐impaired ears. Half of the data set (115 ears) was used by a discriminant analysis routine to classify DPE and demographic features into either a normal PTT group or an impaired PTT group (PTT greater than 30 dB SPL [sound pressure level]) at six frequencies in the audiometric range. The six discriminant functions developed from this classification process were then used to predict PTT group membership in the remaining 114‐ear data set. Frequency‐specific prediction accuracy was approximately 85% overall.Of the 45 DPE and demographic variables evaluated, the DPE amplitude associated with an f2(a primary tone of frequency) of moderate level (50 dB SPL) and a frequency corresponding to PTT was generally most predictive. DPE features associated with frequencies immediately adjacent to the PTT frequency also appear to be useful. DPE level was found to be weakly correlated with subject age; perhaps for this reason, age was frequently included in discriminant functions. This study describes the DPE measures that can most reliably categorize PTTs as normal or impaired in large populations with varied cochlear hearing

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00001

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractChronic rhinosinusitis is extremely common in patients with cystic fibrosis. It causes numerous problems in these patients and can put them at risk for life‐threatening illness. Potential problems include nasal obstruction, congestion, sinus pain and pressure, infection (usually withPseudomonasorganisms), hyposmia or anosmia, and the seeding of bacteria into the lower respiratory tract. Cystic fibrosis patients with chronically infected sinuses are at increased risk for pneumonia following lung transplantation. A prophylactic protocol has been developed for the management of chronic sinusitis in patients with cystic fibrosis. These patients are fully evaluated at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. Based on the results of the evaluation, they are treated with endoscopic sinus surgery, partial middle turbinectomy, septoplasty, and a large middle meatal maxillary antrostomy. Surgery is followed by a rigorous regimen of pulsatile hypotonic saline nasal irrigation to wash away tenacious cystic secretions. Tobramycin (Nebcin®) is given once daily in the nasal irrigant to inhibit the growth ofPseudomonasorganisms. At the USCD Nasal Dysfunction Clinic, this prepulmonary transplantation protocol is now used in all cystic fibrosis patients with chronic sinusit

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00002

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractCerebrospinal fluid (CSF) fistula represents a potentially lethal complication and requires a high index of suspicion to make the diagnosis. A 12‐year retrospective study of pediatric basilar skull fractures identified 147 patients with temporal bone fractures, of which 37 patients exhibited evidence of CSF fistula. The diagnosis is made from a combination of clinical, radiographic, and chemical evaluation. The evolution of diagnostic techniques are reviewed, and the more recent and sensitive tests, such as beta‐2 transferrin, are emphasized. Treatment of CSF fistula is nonsurgical in most cases. Surgical exploration and mastoid obliteration were required in two patients, and the indications for surgical treatment are explored. The use of antibiotic prophylaxis is controversial and not routinely indica

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00003

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe use of tissue expanders in eyelid reconstruction has seen limited application. To determine the efficacy of tissue expanders in the correction of cicatricial ectropion, an animal model was developed. Lower‐eyelid blepharoplasty with overcorrection was performed on 18 New Zealand white rabbits. After 1 month, if significant ectropion was present, tissue expanders (1.8‐cm3Cylindrical/Microdome [CUI Corporation, Carpinteria, Calif.]) were inserted on one side, the other eye being the control. These were inflated in the following weeks to a total volume of 2 cm3. The tissue expanders were then removed, and the animals were followed for 1 month. Although the early results were encouraging, the ectropion progressed toward its preoperative severity. It appears that lower‐eyelid ectropion remains a therapeutic problem that is only partially corrected with tissue expansion

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00004

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe status of the cricothyroid muscle, which is innervated by the superior laryngeal nerve, is believed to influence the vocal fold position in laryngeal paralysis. It is believed that isolated lesions of the recurrent laryngeal nerve generally result in the paralyzed vocal fold assuming a paramedian position but that with lesions of both the superior and recurrent laryngeal nerves, a more lateral (intermediate or cadaveric) vocal fold position can be expected.Twenty‐six consecutive patients with unilateral vocal fold paralysis underwent transnasal fiberoptic laryngoscopy (TFL) and laryngeal electromyography (LEMG). By TFL, the vocal fold positions were paramedian in 8 patients, intermediate in 7, and lateral in 11. By LEMG, 13 patients had isolated recurrent laryngeal nerve lesions and 13 patients had combined (superior and recurrent laryngeal nerve) lesions.There was no correlation between the vocal fold position and the status of the cricothyroid muscle, i.e., the status of the cricothyroid muscle by LEMG did not predict the vocal fold position nor did the vocal fold position by TFL predict the site of lesion. In addition, we investigated the possibility that the degree of thyroarytenoid muscle recruitment (tone) might correlate with vocal fold position, but no relation was found. We conclude that1.the cricothyroid muscle does not predictably influence the position of the vocal fold in unilateral paralysis;2.thyroarytenoid muscle recruitment (tone) does not appear to influence vocal fold position; and3.still unidentified and unknown factors may be responsible for determining vocal fold position in laryngeal paralysi

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00005

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractA prospective study was conducted to compare the accuracy of clinical examination, computed tomography (CT), and positron emission tomography (PET) in identifying head and neck squamous cell carcinoma metastatic to cervical lymph nodes. The findings in the necks of 49 patients evaluated by clinical examination and CT were compared to the findings in the same necks by PET, a newly available metabolic imaging modality. Pathology specimens were available for 45 of the necks. The findings of PET and CT correlated in 84% of cases. In the cases that did not correlate, CT proved correct in four of five cases. PET (82%) and CT (84%) were comparable and were both better than clinical examination (71%) in correctly identifying the presence or absence of metastatic disease.

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00006

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractEndoscopic sinus surgery has emerged in the last decade as the treatment of choice for chronic sinusitis. Reports of complications of the procedure from different centers vary depending on the technique used and the experience of the surgeon.Between August 1990 and August 1993, 337 patients underwent endoscopic sinus surgery at West Virginia University. Most of the cases were performed by senior residents under faculty supervision.Minor complications were encountered in 15.1% of the cases and major complications in 1.5% of the patients.The most common major complication was cerebrospinal fluid leak. All patients with cerebrospinal fluid leaks were diagnosed and treated successfully at the time of surgery. Middle turbinate adhesions and orbital penetration were the most common minor complications. Routine partial middle turbinectomy did not decrease the adhesion rate.Endoscopic sinus surgery is a relatively safe procedure, even when performed by residents under adequate supervision.

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00007

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractIrradiation has been demonstrated to cause decreased mucociliary clearance in animal models. We sought to verify this effect clinically by using the saccharin transport test to evaluate nasal mucociliary clearance in 9 patients previously treated with radiation therapy to the nasal cavity. The patients also completed a questionnaire examining the prevalence of nasal symptoms before and after radiation therapy. Patients who received radiation therapy had no clearance of saccharin from the nasal cavity at a minimum of 20 minutes. The controls had a median clearance time of 5 minutes. The patients noted a higher prevalence of nasal congestion, drainage, and facial pain after radiation therapy. This study demonstrates that radiation therapy to the nasal cavity causes a decrease in nasal mucociliary clearance. This alteration should be considered when selecting therapy for malignancies in the nasal area.

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00008

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractLaser Doppler flowmetry is a noninvasive technique commonly used to monitor skin perfusion after free‐tissue transfer or replantation in reconstructive surgery. Several investigators have expressed concern about the reliability of the quantitative value provided by laser Doppler flowmeters (LDF) and the extent to which they reflect nutrient blood flow. This experiment was designed to compare quantitatively the skin blood flow in the pig measured by LDF and by 15‐μm radioactive microspheres (RMs). It was observed that the skin blood flow rates measured by LDF and RMs in the normal skin and in acute random‐pattern and arterialized skin flaps were highly correlated (r= 0.93,P<.01). However, the skin blood flow rates measured by LDF were consistently higher (P≤.05) than the corresponding flow rates measured by RMs, and this discrepancy increased considerably at low skin blood flow rates (<2 mL/min/100 g). We speculated that the LDF most likely measured both nutrient and arteriovenous shunt flow in the skin and that this arteriovenous shunt flow at least in part caused the discrepancy in skin blood flow rates measured by the LDF and RMs because the 15‐um RMs are known to measure nutrient blood flow only. The inherent variations and errors in LDF technique were also

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00009

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractAccurate assessment of patient outcome after sinus surgery requires the collection of valid and reliable data. Symptom‐based surveys were administered in a prospective manner to 104 patients with chronic sinusitis, Test‐retest reliability for the Chronic Sinusitis Survey based on duration of symptoms (0.86,P<.0001) was superior to that for a similar survey based on severity of symptoms (0.57,P<.0001). Results of the Chronic Sinusitis Survey also correlated significantly with subscales of a general health assessment in the extent to which chronic sinusitis limits physical activity (0.40,P<.01), interferes with work or other activities (0.36,P<.01), and affects patient perception of bodily pain (0.46,P<.001). The Chronic Sinusitis Survey is an efficient and reliable method to follow health status and health‐related quality of life outcomes in patients with chronic sinu

ISSN:0023-852X    

DOI:10.1288/00005537-199504000-00010

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY