Byron J. Bailey

CT Evaluation of the Paranasal Sinuses in Symptomatic and Asymptomatic Populations

The frequency of concha bullosa, paradoxical middle turbinate, and septal deviation on coronal computed tomographic scans evaluating sinus disease is known, but the incidence in normal subjects is unknown. We compared 100 consecutive scans performed for evaluation of sinus disease with 82 consecutive scans performed for evaluation of orbital pathology. Patients with sinus disease had significantly more frequent findings of disease in the osteomeatal complex and all sinuses. Concha bullosa was more common in patients with sinus disease (p < 0.05), as was septal deviation (p < 0.01). Paradoxical turbinate was equally common. Concha bullosa was associated with anterior ethmoid disease (p < 0.04). Septal deviation was associated with osteomeatal complex disease (p < 0.01) and with anterior (p < 0.04) and posterior (p < 0.04) ethmoid disease. Paradoxical turbinate was not associated with sinus abnormalities. These data imply a possible causal relationship between concha bullosa or septal deviation and sinus disease.

Complications of endoscopic sinus surgery in a residency training program

Endoscopic sinus surgery (ESS) is now taught in most otolaryngology residency programs in the United States. However, this is technically challenging surgery and concerns exist regarding patient safety early in the surgeons learning curve. The authors reviewed 193 cases of ESS performed by residents, under faculty supervision at our program, between 1987 and 1992. Sixty-seven percent of patients underwent bilateral anterior ethmoidectomy, 40% had bilateral total ethmoidectomy, and 44% had bilateral middle turbinate reduction. The overall complication rate was 22% and included one major complication. Synechiae accounted for 50% of minor complications. There was no correlation between middle or inferior turbinate reduction and the formation of synechiae. Posterior ethmoidectomy was not associated with a significant increase in complications. We conclude that ESS can be safely performed by otolaryngology residents in carefully structured and supervised training programs.Endoscopic 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.

Duplicate publication in the field of otolaryngology-head and neck surgery

OBJECTIVE: This study establishes the approximate prevalence and patterns of duplicate publication in the medical literature in the specialty of otolaryngology-head and neck surgery. STUDY DESIGN AND SETTING: All of the authors and articles published in the American Medical Association Archives of Otolaryngology-Head and Neck Surgery were identified and listed for an 8-year period. During this time, 1965 authors published 1082 articles in the Archives, and this same set of authors published a total of almost 50,000 articles during the 12-year period between January 1977 and December 1988. Of the same set of 1965 authors, we picked 1000 at random and found that they had published a total of 24,353 articles. The titles of these articles were then screened for similar titles, and when similarities were noted, the complete articles were obtained when possible and compared for the degree and pattern of duplicate publication. RESULTS: Of the 1000 authors studied, we found that 228 authors had published 938 articles with similar titles. We were able to obtain the full copy of 886 (94%) of the 938 articles in question, which were written by 226 (99%) of the 228 authors. We found that in the case of 25 authors, there was no duplication despite the similar titles, but in the case of 201 (20% of the 1000) authors, 644 articles were published with some degree of duplication (1.8% duplication rate). CONCLUSIONS: The most common duplicate publication involves sequential publication of very similar data and conclusions. Duplicate publications failed to reference prior articles by the same author 32% of the time or referenced the prior articles only partially (11% of the time). Artificial segmentation of a single study into multiple arbitrary segments composed 20% of the duplicate publication. Duplicate publication across different specialties was noted to account for 4% of the instances. Most of the authors duplicated only once or twice, and most duplicators do reference their prior publications. SIGNIFICANCE: Duplicate publication is an example of inappropriate academic conduct. Because it tarnishes the reputation of the duplicating author and represents an unfair practice in terms of displacing the work of others, efforts should continue to educate authors, particularly young academicians, to avoid the practice of duplicate publication.

Laser Arytenoidectomy for Bilateral Vocal Cord Paralysis

The CO2 surgical laser was found to be a useful tool for the performance of endoscopic arytenoidectomy for bilateral vocal cord paralysis. The dog was found to be a less-than-perfect experimental model for human bilateral abductor vocal cord paralysis. Documentation by measurements of arterial blood gases and direct in vivo measurements of airway resistance following bilateral recurrent laryngeal nerve section and endoscopic arytenoidectomy was attempted.

Combined Epstein‐Barr Virus and Human Papillomavirus Infection in Nasopharyngeal Carcinoma

Epstein‐Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV‐positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c‐myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c‐myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV‐containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV‐negative and none of the nine HPV‐positive NPCAs. (All HPV‐positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV‐negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.

Primary tracheoesophageal fistula procedure for voice restoration: The university of texas medical branch experience†‡

Voice restoration for laryngectomees is challenging, but in recent years the tracheoesophageal (TE) fistula procedure using a oneway valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients.

Predictors of Residency Performance: A Follow-up Study

In a 1990 study we investigated resident applicant characteristics associated with successful matching into otolaryngology. 1 Of the 175 applicants studied, 87 matched, for a 49.7% success rate. Successful matching was much more likely for applicants with a history of excellent academic achievement in medical school. Of the 88 applicants who did not match during the year that was originally studied, 30 matched to otolaryngology in subsequent years. Of the 58 who never matched in otolaryngology, there is no evidence of board certification for 30. Of the other 28, 12 are board certified in anesthesia; 3 in radiology; 2 each in family medicine, internal medicine, general surgery, psychiatry, and physical medicine, and rehabilitation; and 1 each in pathology, emergency medicine, and dermatology. Of the total of 117 who matched in otolaryngology, 109 began residency training, and 107 finished otolaryngology training. Program directors answered questionnaires about 100 of 107 of these residents, detailing aspects of residency performance. The only correlation found between a highly satisfactory residency performance and characteristics that could be evaluated at the time of interviewing for residency positions was with excellent academic performance in medical school.

Laryngoscopy and Laryngoscopes-Who's First?: The Forefathers/Four Fathers of Laryngology

edical history is full of examples of contested claims for priority, being the first to devise an important concept, to recommend an advance in diagnostic techniques, or to propose significant new forms of treatment. We all remember the debate between researchers in the United States and France over the priority for discovery of the HIV virus. In today’s world, being first someLaryngoscopy-The process or method of examination of the interior of the larynx in a living subject (as with a laryngoscope).

Calcium Sulfate as a Mandibular Implant

Mandibular reconstruction has posed significant problems, particularly when dealing with loss of mandibular substance. Various implant substances have been utilized in attempts to repair mandibular defects. These have included metals, synthetic material, and organic substances. All have posed significant problems, particularly with rejection and inability of the implant to develop a stable fusion with the surrounding bone. Recently, calcium sulfate has been successfully used as an implant in frontal sinuses, mastoid cavities, and, in one report, as a mandibular implant. The present study looks at the ability of calcium sulfate to induce osteoneogenesis in canine mandibles with and without the presence of a periosteal covering around the implant. Infection somewhat limited the success of the study, but in those animals without major infections, successful replacement of the calcium sulfate by normal bone occurred both with and without the presence of periosteum.

Are Clinical Classifications for Laryngeal Cancer Satisfactory

All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.