diplophonia
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mobile linear accelerators that can deliver intraoperative elec- tron beam radiotherapy (IOERT). The Mobetron can deliver a concentrated electron beam directly to a tumor bed during an operation without damaging surrounding tissues and with- out the need of moving the patient to a shielded radiation suite. It is especially useful for delivering high-dose radiation to areas of suspected or known local residual tumor following resection. The purpose of this study is to report our initial experience with IOERT and whether it is beneficial for the treatment of advanced head and neck cancer. Methods: 9 patients were treated with IOERT beginning in April 2001. The average follow-up time was 8 months (range, 3-15 months). Patients were selected to receive IOERT based on their advanced stage and potential for having residual tumor after resection. Patients received between 1000 and 1500 centigrays of electron beam radiation. 6 of 9 patients received postoperative radiation and/or chemotherapy. Results: 4 of 9 patients developed loco-regional recur- rences. There were no intraoperative complications. 2 patients had skin necrosis postoperatively which was not felt to be due to the IOERT; both required a rotation flap for closure. 1 patient developed an oropharyngeal fistula. Conclusion: The Mobetron machine is capable of target- ing radiation directly to areas of suspected residual tumor in the operative bed. Our initial experience indicates that IOERT may be an important adjunct to the treatment of advanced head and neck cancers. P058 Occult Papillary Thyroid Carcinoma in Postmortem Species: Prevalence at Autopsy Clementino Arturo Solares MD (presenter) Cleveland OH Objectives: The purpose of this study was to determine the prevalence of occult papillary thyroid carcinoma (OPTC) in a sample of cadavers from Guatemala. Methods: Cross-sectional study of cadaver samples. We analyzed 150 glands that were removed during autopsy from 150 cadavers (34 women and 116 men) who were admitted to the morgue of the Judicial Bureau in Guatemala City between January and March 2000. Results: A total of 17 glands showed macroscopic evi- dence of disease, but only 3 glands (1 female and 2 male) showed microscopic evidence of malignancy. This corre- sponded to a 2% prevalence rate. The sex prevalence of OPTC was 3% (1/34) for women and 2% (2/116) for men, with a male-to-female ratio of 1:1.7, which was not statisti- cally significant (P 0.05). Conclusion: We concluded that the prevalence of OPTC in Central America is low but comparable to literature reports. There appears to be no sex predilection as opposed to the clinically evident papillary thyroid carcinoma, which devel- ops more commonly in females. P059 Inhibition of Proteases with Alpha 1–Antitrypsin and Ilomastat in Human Otitis Media Patrick J Antonelli MD (presenter); Gregory S Schultz PhD; David J Sundin PharmD; Philip A Pemberton PhD; Philip J Barr PhD Gainesville FL; Gainesville FL; Alameda CA; Alameda CA; Alameda CA Objectives: Proteases of both the serine and metallopro- tease families have been shown to play a role in the pathogenesis of otitis media. Inhibitors of proteases from each of these families have been shown to beneficially impact disease progression in a number of related chronic inflammatory conditions. The purpose of this study was to assess the activity of protease inhibitors, alpha 1–antitryp- sin (AAT) and ilomastat, on human middle ear effusions (MEEs), with a view to their potential utility as human therapeutic agents. Methods: MEEs were prospectively collected from 100 patients presenting for middle ear surgery, most commonly tympanostomy tube placement, or treatment of acute post- tympanostomy otorrhea. MEEs were analyzed for the pres- ence of matrix metalloproteinases (MMPs) and human neu- trophil elastase (HNE) and the inhibitory activity of AAT and ilomastat on these proteases, respectively. Results: MMP levels were highest in post-tympanostomy otorrhea, and HNE was highest in chronic suppurative OM and post-tympanostomy otorrhea. High levels of MMP and HNE (3 mAU/min) were found in 52% and 37% of MEEs. Ilomastat and AAT demonstrated significant inhibition (30% reduction) in 80% and 82% of MEEs with high levels of MMP and HNE activity, respectively. Conclusion: Proteases are commonly found in OM. Ilo- mastat and AAT are potent inhibitors of proteases in human OM. Investigation into the potential therapeutic benefits of these protease inhibitors is warranted. P060 Laryngoscopic Findings of Diplophonia in the Unilateral Vocal Fold Paralysis Ki Hwan Hong MD (presenter) Chonju South Korea Objectives: Diplophonia is the voice of two separate tones through quasi-periodic variations in the vocal fold vibration when an imbalance in the tension and the level applied to the vocal folds. The purpose of this study is to investigate the relationship of diplophonia to the endoscopic features of the vocal fold in unilateral vocal fold paralysis. Methods: A retrospective review using video-recorded images of the larynx with unilateral vocal fold paralysis was done. A total of 104 patients selected for this study com- POSTERS Otolaryngology– Head and Neck Surgery P230 Scientific Posters August 2003
Transcript of diplophonia
mobile linear accelerators that can deliver intraoperative elec-tron beam radiotherapy (IOERT). The Mobetron can delivera concentrated electron beam directly to a tumor bed duringan operation without damaging surrounding tissues and with-out the need of moving the patient to a shielded radiationsuite. It is especially useful for delivering high-dose radiationto areas of suspected or known local residual tumor followingresection. The purpose of this study is to report our initialexperience with IOERT and whether it is beneficial for thetreatment of advanced head and neck cancer.
Methods: 9 patients were treated with IOERT beginning inApril 2001. The average follow-up time was 8 months (range,3-15 months). Patients were selected to receive IOERT basedon their advanced stage and potential for having residualtumor after resection. Patients received between 1000 and1500 centigrays of electron beam radiation. 6 of 9 patientsreceived postoperative radiation and/or chemotherapy.
Results: 4 of 9 patients developed loco-regional recur-rences. There were no intraoperative complications. 2 patientshad skin necrosis postoperatively which was not felt to be dueto the IOERT; both required a rotation flap for closure. 1patient developed an oropharyngeal fistula.
Conclusion: The Mobetron machine is capable of target-ing radiation directly to areas of suspected residual tumor inthe operative bed. Our initial experience indicates that IOERTmay be an important adjunct to the treatment of advancedhead and neck cancers.
P058
Occult Papillary Thyroid Carcinoma in PostmortemSpecies: Prevalence at AutopsyClementino Arturo Solares MD (presenter)Cleveland OH
Objectives: The purpose of this study was to determine theprevalence of occult papillary thyroid carcinoma (OPTC) in asample of cadavers from Guatemala.
Methods: Cross-sectional study of cadaver samples. Weanalyzed 150 glands that were removed during autopsy from150 cadavers (34 women and 116 men) who were admitted tothe morgue of the Judicial Bureau in Guatemala City betweenJanuary and March 2000.
Results: A total of 17 glands showed macroscopic evi-dence of disease, but only 3 glands (1 female and 2 male)showed microscopic evidence of malignancy. This corre-sponded to a 2% prevalence rate. The sex prevalence ofOPTC was 3% (1/34) for women and 2% (2/116) for men,with a male-to-female ratio of 1:1.7, which was not statisti-cally significant (P � 0.05).
Conclusion: We concluded that the prevalence of OPTCin Central America is low but comparable to literature reports.There appears to be no sex predilection as opposed to theclinically evident papillary thyroid carcinoma, which devel-ops more commonly in females.
P059
Inhibition of Proteases with Alpha 1–Antitrypsin andIlomastat in Human Otitis MediaPatrick J Antonelli MD (presenter); Gregory S Schultz PhD; David
J Sundin PharmD; Philip A Pemberton PhD; Philip J Barr PhD
Gainesville FL; Gainesville FL; Alameda CA; Alameda CA;
Alameda CA
Objectives: Proteases of both the serine and metallopro-tease families have been shown to play a role in thepathogenesis of otitis media. Inhibitors of proteases fromeach of these families have been shown to beneficiallyimpact disease progression in a number of related chronicinflammatory conditions. The purpose of this study was toassess the activity of protease inhibitors, alpha 1–antitryp-sin (AAT) and ilomastat, on human middle ear effusions(MEEs), with a view to their potential utility as humantherapeutic agents.
Methods: MEEs were prospectively collected from 100patients presenting for middle ear surgery, most commonlytympanostomy tube placement, or treatment of acute post-tympanostomy otorrhea. MEEs were analyzed for the pres-ence of matrix metalloproteinases (MMPs) and human neu-trophil elastase (HNE) and the inhibitory activity of AAT andilomastat on these proteases, respectively.
Results: MMP levels were highest in post-tympanostomyotorrhea, and HNE was highest in chronic suppurative OMand post-tympanostomy otorrhea. High levels of MMP andHNE (�3 mAU/min) were found in 52% and 37% of MEEs.Ilomastat and AAT demonstrated significant inhibition(�30% reduction) in 80% and 82% of MEEs with high levelsof MMP and HNE activity, respectively.
Conclusion: Proteases are commonly found in OM. Ilo-mastat and AAT are potent inhibitors of proteases in humanOM. Investigation into the potential therapeutic benefits ofthese protease inhibitors is warranted.
P060
Laryngoscopic Findings of Diplophonia in theUnilateral Vocal Fold ParalysisKi Hwan Hong MD (presenter)
Chonju South Korea
Objectives: Diplophonia is the voice of two separate tonesthrough quasi-periodic variations in the vocal fold vibrationwhen an imbalance in the tension and the level applied to thevocal folds. The purpose of this study is to investigate therelationship of diplophonia to the endoscopic features of thevocal fold in unilateral vocal fold paralysis.
Methods: A retrospective review using video-recordedimages of the larynx with unilateral vocal fold paralysis wasdone. A total of 104 patients selected for this study com-
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P230 Scientific Posters August 2003
plained about voice change due to a paralyzed vocal foldunilaterally. Video recordings were obtained using the laryn-geal telescope. The paralyzed positions, bowing, shapes of theparalyzed arytenoids, and level differences between two vocalfolds were evaluated according to the existence of diplopho-nia or not.
Results: A large number of patients of paramedian paral-ysis showed diplophonia when the bowing of paralyzed vocalfold was shown. However, the diplophonia was not highlyshown in patients with median and intermediate paralysis.The diplophonia also seems to have occurred when the ver-tical mismatch was shown.
Conclusion: The diplophonia depends largely on the par-alyzed position, apt glottal gap such as paramedian position,with presence of bowing of paralyzed vocal fold and verticalmismatch.
P061
Minimally Invasive Surgery for Maxillary Fungal BallsAlbert R Yeh MD (presenter); Shuang-ying Hwang MD
Taipei Taiwan (Republic of China); Kuei Shan Hsiang Taiwan
(Republic of China)
Objectives: Functional endoscopic sinus surgery (FESS)successfully substitutes many conventional external ap-proaches in sinus disorders; however, impacted or periph-erally located maxillary fungal balls are sometimes diffi-cult to remove. The Caldwell-Luc approach is useful in thiscondition, but its side effects involve suffering for thepatients.
Methods: This prospective study was conducted from Oc-tober 1995 to October 2002; among 417 patients who re-ceived FESS performed by the senior author, there were 11patients whose maxillary sinus fungal balls were difficult toremove through the middle antrostomy, even an extendedone. For these patients, we added a small-sized inferior antr-ostomy to insert the commercially available curving instru-ment for manipulation.
Results: This combined method was successfully used inall 11 difficult cases, with a similar morbidity of FESS. A keypoint of the combined antrostomies is the inferior antrostomyof limited size. It serves as an instrument channel. No matterwhether it was made at the inferior meatus or the caningfossa, with the view from the middle meatus, the diameter ofthe inferior antrostomy could be limited. This limited sizeminimizes the postoperative discomfort and keeps the mu-cous transportation of maxillary sinus near normal.
Conclusion: When impacted or peripherally located, max-illary fungal balls are difficult to remove by the conventionalFESS technique; this combined method offers a minimalinvasive route for the surgeon instead of the Caldwell-Lucapproach, if the patients were selected carefully.
P062
Underlying Conditions for Pediatric Cochlear ImplantInfectionsTina Chung-Ting Huang MD (presenter); Frank L Rimell MD;Samuel C Levine MDEdina MN; Minneapolis MN; Minneapolis MN
Objectives: Infection of the cochlear implant device is anuncommon complication of cochlear implantation. These pa-tients may require explantation, and while these patients maybe reimplanted at a later date, a cause for the infection shouldbe explored in order to avoid further complications.
Methods: University of Minnesota cochlear implant pa-tients were identified who developed an infection of theirdevice. Four patients were identified, all of whom were chil-dren. Workup for the cause of the infection included animmune deficiency panel including a pre- and post-strepto-coccal vaccine antibody titer.
Results: All four children received IV antibiotics but even-tually required explantation of the device for resolution of theinfection. All were reimplanted without complications. Whileno evidence for underlying pathology had previously beenidentified, all the children were found to have varying types ofimmune deficiencies on further investigation. They receivedthe streptococcal vaccine, and pre- and post-vaccine titers,particularly the post-vaccine titer, showed abnormalities con-sistent with immune deficiency.
Conclusion: This series demonstrates that when infectionof the cochlear implant occurs, an underlying cause should besought since patients may have an undiagnosed conditionpredisposing to infection. The streptococcal vaccine is nowrecommended for cochlear implant patients. The pre- andpost-vaccine immunoglobulin response appears to be a reli-able method of detecting immune deficiency and is a goodinitial step in the workup.
P063
Late Optic Nerve Decompression after TraumaIngo O Ott MD (presenter); Gerald Baier MD; Konrad SchwagerMDWurzburg Germany; Wurzburg Germany; Wurzburg Germany
Objectives: The surgical decompression of the optic nerveafter traumatic loss of vision is under discussion. Some institu-tions favor a non-surgical therapeutic approach with high-dosecorticosteroids, whereas others prefer a straightforward surgicalregimen. It is questionable if optic nerve decompression shouldstill be performed several days after the traumatic event.
Methods: 5 patients presented to the Department of Oph-thalmology with a loss of vision after acute head trauma witha delay of 1 to 5 days. The patients were between 13 and 58years of age. One patient was completely blind, anotherpatient had only residual light perception, and two patientsonly recognition of hand motion. Indication for optic nerve
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