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Transtympanic gentamicin distribution and induction of apoptotic marker proteins
Scientific Posters
P001 Botulinum Toxin Therapy for Adductor Dysphonia: Dose Efficacy in an Eleven-Year Experience William D Leight (presenter); Subinoy Das MD; Owen P Palmer; Mark C Weissler MD Durham NC; Durham NC; Chapel Hill NC; Chapel Hill NC
Objectives: Adductor spasmodic dysphonia, the most common form of laryngeal dystonia, is a debilitating and often disabling problem. Botulinum toxin has been shown to be successful in providing symptomatic relief, but the optimal dosing regimen has not been firmly established. Botulinum toxin is a potent neuroparalytic agent. Potency is expressed in mouse units, where 1 unit is the median lethal dose (LD50) for mice. Most physicians deliver doses between 0.5 and 15 units for spasmodic dysphonia. The purpose of this study is to determine the dose of botulinum toxin that maximizes duration of benefit and minimizes side effects. Methods: A retrospective chart review was done on 1503 injections performed by the senior author at a single institution over a period of 11 years. A multivariate analysis was performed examining dose, length of benefit, and severity of side effects. Both unilateral and bilateral injections were included. Results: The optimal dose of botulinum toxin was determined to be 3.75 to 5 units for unilateral injections and 1.25 to 2.5 units for bilateral injections. The mean duration of benefit was 5.8 months for unilateral and 5.4 months for bilateral injections. Doses greater than these did not significantly lengthen the duration of benefit but were associated with greater severity of side effects including excessive breathy hypophonia, aspiration, and dysphagia. Conclusion: Adductor spasmodic dysphonia is optimally treated with botulinum toxin using relatively low doses. Higher doses commonly used in the past do not provide greater length of benefit and are associated with higher complication rates.
P002 The Colonization of Helicobacter Pylori in Human Palatine Tonsils Hsin-Ching Lin MD (presenter); Chih-Ying Su MD Feng Shan City Taiwan (Republic of China); Kaohsiung Taiwan (Republic of China)
August 2003
Objectives: Helicobacter pylori (HP) has been argued to be strongly associated with peptic ulcers or even gastric cancer. Some literature has implicated the oral cavity as an HP reservoir. In this study, we further investigate the difference in colonization by HP between recurrent inflammatory and simple hyperplastic human palatine tonsil tissues. Methods: Fifty-one consecutive patients who underwent tonsillectomy for recurrent or chronic tonsillitis (tonsillitis group, 26 patients) or sleep-related breathing disorders (SRBD group, 25 patients) were enrolled. A 2- to 3-mmdiameter-wide specimen was taken from each tonsil and placed in Pronto Dry kits (Medical Instruments Corp, Solothurn, Switzerland) to detect the presence of HP. A pinkmagenta color change in the external ring of the prepared kits indicated a positive reaction. The patient was considered to be positive for HP if either or both tonsil tissues were proven in positive Pronto Dry tests. Results: The Pronto Dry test results were positive in 20 patients (39.2%) and negative in 31 patients (60.8%). Eight of the 20 patients showed a positive reaction in both tonsil tissues, and 12 were positive on only one side. The HPpositive rate in the tonsillitis and SRBD groups was 46.2% (12/26) and 32% (8/25), respectively (chi-square test, P ⫽ 0.3007). Conclusion: HP does in fact colonize human palatine tonsil tissues (39.2%). Although the presence of HP in recurrent inflammatory tonsil tissues seemed to have a higher positive rate than in simple hyperplastic ones, it showed no statistical significance. Due to our small patient group, a more extended study is needed. P003 Transtympanic Gentamicin Distribution and Induction of Apoptotic Marker Proteins Pamela C Roehm MD PhD (presenter); Keith A Allen BS; Michael E Hoffer MD; Carey D Balaban PhD Pittsburgh PA; San Diego CA; San Diego CA; Pittsburgh PA
Objectives: Studies of systemic aminoglycoside ototoxicity have revealed evidence of spiral and Scarpa’s ganglion cell death and damage. This study shows collection and retention of gentamicin in inner ear ganglion cells occurs with subsequent expression of apoptotic markers following transtympanic gentamicin application. Methods: In a chinchilla model, we observed effects of
Otolaryngology–Head and Neck Surgery P211
POSTERS
The scientific posters provide an opportunity for visual presentation of charts, drawings, and photographs, supplemented with 1 or 2 pages of text. Authors will post the times they will be available for questions. The posters will be available Sunday to Tuesday, September 21-23, from 7:00 AM to 8:00 PM in Hall A4 of the Orange County Convention Center.
Scientific Posters
minipump or transtympanic injection of gentamicin into the middle ear. Temporal bones were decalcified and examined using histologic methods to determine the distribution of gentamicin and involvement of apoptotic marker proteins (cleaved caspases 3, 7, 9, and intact PARP). Additionally, autoradiographic analysis of temporal bones from animals injected with tritiated gentamicin was performed to confirm gentamicin distribution. Results: Initially gentamicin was found throughout the temporal bones, with greatest staining in inner ear ganglion cells, vestibular dark cells, and stria vascularis, and decreased amounts in contralateral temporal bone. Over 14 days, evidence of gentamicin decreased to background levels in other areas of the ipsilateral temporal bone. Dark staining of the lining of the cochlear aqueduct and staining of cell bodies in ipsilateral dorsal and ventral cochlear nucleus suggest the cochlear aqueduct as the most likely path of gentamicin to the contralateral ear. Apoptotic marker proteins varied in peak expression time in inner ear ganglion cells, with initial expression in 24 to 72 hours. Conclusion: Transtympanic injection leads to specific distribution of gentamicin in both ears with most likely transmission via the cochlear aqueduct. This then stimulates expression of apoptotic marker proteins. This may have profound implications for clinical practices of transtympanic gentamicin and ototopic antibiotic use.
P004 Health-Related Quality of Life Five Years after Diagnosis of Laryngeal Carcinoma Eva Hammerlid MD PhD (presenter); Mats Nordgen MD; Kristin Bjordal MD PhD; Morten Boysen MD PhD; Helmut Abendstein MD; Ewa Silander MD; Marianne Ahlner-Elmqvist RN BEd; Magnus Jannert MD PhD Goteborg Sweden; Malmo Sweden; Oslo Norway; Oslo Norway; Trondheim Norway; Goteborg Sweden; Malmo Sweden; Malmo Sweden
Objectives: To evaluate the health-related quality of life (HRQL) of patients with laryngeal carcinoma in a prospective longitudinal multicenter study at diagnosis and after 1 and 5 years in relation to tumor location and treatment modality. Methods: Three standardized HRQL questionnaires were used to evaluate HRQL: the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30); the EORTC QLQ–Head and Neck Cancer Module (EORTC QLQ-H&N35); and the Hospital Anxiety and Depression Scale (HADS). Results: 86 patients (mean age, 66 years; 72% males) with laryngeal carcinoma were included. Some significant changes in HRQL were found between diagnosis and 5 years after diagnosis, depending on the treatment given. The patients’
ability to speak improved while some general functions deteriorated and treatment-related side effects increased. When comparing HRQL at 1 and 5 years after diagnosis, it appears that most values at the 1-year follow-up assessment persist until 5 years, but a few deteriorate. The HRQL at diagnosis predicts survival after 5 years quite well and the global quality of life scale at diagnosis predicts HRQL after 5 years fairly well. Conclusion: The use of HRQL questionnaires is valuable when comparing different treatments and as an aid in predicting treatment side effects. Evaluation of HRQL at diagnosis for patients with laryngeal carcinoma is of value for the prognosis of HRQL over time and for the prognosis of survival.
P005 Pediatric Sleep Apnea: Can Sleep Studies Predict Adverse Outcomes after Adenotonsillectomy? Tina P Elkins MD (presenter); Jeevan B Ramakrishnan BS; Kevin D Pereira MD; Ron B Mitchell MD; Michael D Poole MD PhD Cypress TX; Houston TX; Houston TX; Albuquerque NM; Houston TX
Objectives: To determine if polysomnography is a reliable indicator in predicting postoperative cardiopulmonary complications and the need for hospital admission after adenotonsillectomy in children with obstructive sleep apnea. Methods: Retrospective review of the medical records of children with polysomnography-documented sleep apnea undergoing adenotonsillectomy at two university-based tertiarycare children’s hospitals from October 1999 to September 2002. The charts were reviewed for details of the sleep study, perioperative and postoperative course, and complications, if any, during the hospital stay. The findings were compared with the clinical examination to determine if the complications could be independently predicted by the clinical examination alone. Results: A total of 150 patients were studied and data tabulated. The majority of patients who had significant sleep apnea could have been diagnosed on clinical grounds alone. The preoperative evaluation could reliably determine the need for postoperative admission in a vast majority of the cases. Unexpected admission occurred in 6 patients prior to discharge from the hospital, and no adverse cardiopulmonary complications were encountered in those who were discharged on the day of surgery. Conclusion: Polysomnography could not independently determine the need for hospital admission or predict postoperative cardiopulmonary complications in children with obstructive sleep apnea. The severity of sleep apnea and hence the need for hospital admission could be reliably predicted on clinical grounds alone.
POSTERS
P212
Otolaryngology– Head and Neck Surgery August 2003
P001 Botulinum Toxin Therapy for Adductor Dysphonia: Dose Efficacy in an Eleven-Year Experience William D Leight (presenter); Subinoy Das MD; Owen P Palmer; Mark C Weissler MD Durham NC; Durham NC; Chapel Hill NC; Chapel Hill NC
Objectives: Adductor spasmodic dysphonia, the most common form of laryngeal dystonia, is a debilitating and often disabling problem. Botulinum toxin has been shown to be successful in providing symptomatic relief, but the optimal dosing regimen has not been firmly established. Botulinum toxin is a potent neuroparalytic agent. Potency is expressed in mouse units, where 1 unit is the median lethal dose (LD50) for mice. Most physicians deliver doses between 0.5 and 15 units for spasmodic dysphonia. The purpose of this study is to determine the dose of botulinum toxin that maximizes duration of benefit and minimizes side effects. Methods: A retrospective chart review was done on 1503 injections performed by the senior author at a single institution over a period of 11 years. A multivariate analysis was performed examining dose, length of benefit, and severity of side effects. Both unilateral and bilateral injections were included. Results: The optimal dose of botulinum toxin was determined to be 3.75 to 5 units for unilateral injections and 1.25 to 2.5 units for bilateral injections. The mean duration of benefit was 5.8 months for unilateral and 5.4 months for bilateral injections. Doses greater than these did not significantly lengthen the duration of benefit but were associated with greater severity of side effects including excessive breathy hypophonia, aspiration, and dysphagia. Conclusion: Adductor spasmodic dysphonia is optimally treated with botulinum toxin using relatively low doses. Higher doses commonly used in the past do not provide greater length of benefit and are associated with higher complication rates.
P002 The Colonization of Helicobacter Pylori in Human Palatine Tonsils Hsin-Ching Lin MD (presenter); Chih-Ying Su MD Feng Shan City Taiwan (Republic of China); Kaohsiung Taiwan (Republic of China)
August 2003
Objectives: Helicobacter pylori (HP) has been argued to be strongly associated with peptic ulcers or even gastric cancer. Some literature has implicated the oral cavity as an HP reservoir. In this study, we further investigate the difference in colonization by HP between recurrent inflammatory and simple hyperplastic human palatine tonsil tissues. Methods: Fifty-one consecutive patients who underwent tonsillectomy for recurrent or chronic tonsillitis (tonsillitis group, 26 patients) or sleep-related breathing disorders (SRBD group, 25 patients) were enrolled. A 2- to 3-mmdiameter-wide specimen was taken from each tonsil and placed in Pronto Dry kits (Medical Instruments Corp, Solothurn, Switzerland) to detect the presence of HP. A pinkmagenta color change in the external ring of the prepared kits indicated a positive reaction. The patient was considered to be positive for HP if either or both tonsil tissues were proven in positive Pronto Dry tests. Results: The Pronto Dry test results were positive in 20 patients (39.2%) and negative in 31 patients (60.8%). Eight of the 20 patients showed a positive reaction in both tonsil tissues, and 12 were positive on only one side. The HPpositive rate in the tonsillitis and SRBD groups was 46.2% (12/26) and 32% (8/25), respectively (chi-square test, P ⫽ 0.3007). Conclusion: HP does in fact colonize human palatine tonsil tissues (39.2%). Although the presence of HP in recurrent inflammatory tonsil tissues seemed to have a higher positive rate than in simple hyperplastic ones, it showed no statistical significance. Due to our small patient group, a more extended study is needed. P003 Transtympanic Gentamicin Distribution and Induction of Apoptotic Marker Proteins Pamela C Roehm MD PhD (presenter); Keith A Allen BS; Michael E Hoffer MD; Carey D Balaban PhD Pittsburgh PA; San Diego CA; San Diego CA; Pittsburgh PA
Objectives: Studies of systemic aminoglycoside ototoxicity have revealed evidence of spiral and Scarpa’s ganglion cell death and damage. This study shows collection and retention of gentamicin in inner ear ganglion cells occurs with subsequent expression of apoptotic markers following transtympanic gentamicin application. Methods: In a chinchilla model, we observed effects of
Otolaryngology–Head and Neck Surgery P211
POSTERS
The scientific posters provide an opportunity for visual presentation of charts, drawings, and photographs, supplemented with 1 or 2 pages of text. Authors will post the times they will be available for questions. The posters will be available Sunday to Tuesday, September 21-23, from 7:00 AM to 8:00 PM in Hall A4 of the Orange County Convention Center.
Scientific Posters
minipump or transtympanic injection of gentamicin into the middle ear. Temporal bones were decalcified and examined using histologic methods to determine the distribution of gentamicin and involvement of apoptotic marker proteins (cleaved caspases 3, 7, 9, and intact PARP). Additionally, autoradiographic analysis of temporal bones from animals injected with tritiated gentamicin was performed to confirm gentamicin distribution. Results: Initially gentamicin was found throughout the temporal bones, with greatest staining in inner ear ganglion cells, vestibular dark cells, and stria vascularis, and decreased amounts in contralateral temporal bone. Over 14 days, evidence of gentamicin decreased to background levels in other areas of the ipsilateral temporal bone. Dark staining of the lining of the cochlear aqueduct and staining of cell bodies in ipsilateral dorsal and ventral cochlear nucleus suggest the cochlear aqueduct as the most likely path of gentamicin to the contralateral ear. Apoptotic marker proteins varied in peak expression time in inner ear ganglion cells, with initial expression in 24 to 72 hours. Conclusion: Transtympanic injection leads to specific distribution of gentamicin in both ears with most likely transmission via the cochlear aqueduct. This then stimulates expression of apoptotic marker proteins. This may have profound implications for clinical practices of transtympanic gentamicin and ototopic antibiotic use.
P004 Health-Related Quality of Life Five Years after Diagnosis of Laryngeal Carcinoma Eva Hammerlid MD PhD (presenter); Mats Nordgen MD; Kristin Bjordal MD PhD; Morten Boysen MD PhD; Helmut Abendstein MD; Ewa Silander MD; Marianne Ahlner-Elmqvist RN BEd; Magnus Jannert MD PhD Goteborg Sweden; Malmo Sweden; Oslo Norway; Oslo Norway; Trondheim Norway; Goteborg Sweden; Malmo Sweden; Malmo Sweden
Objectives: To evaluate the health-related quality of life (HRQL) of patients with laryngeal carcinoma in a prospective longitudinal multicenter study at diagnosis and after 1 and 5 years in relation to tumor location and treatment modality. Methods: Three standardized HRQL questionnaires were used to evaluate HRQL: the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30); the EORTC QLQ–Head and Neck Cancer Module (EORTC QLQ-H&N35); and the Hospital Anxiety and Depression Scale (HADS). Results: 86 patients (mean age, 66 years; 72% males) with laryngeal carcinoma were included. Some significant changes in HRQL were found between diagnosis and 5 years after diagnosis, depending on the treatment given. The patients’
ability to speak improved while some general functions deteriorated and treatment-related side effects increased. When comparing HRQL at 1 and 5 years after diagnosis, it appears that most values at the 1-year follow-up assessment persist until 5 years, but a few deteriorate. The HRQL at diagnosis predicts survival after 5 years quite well and the global quality of life scale at diagnosis predicts HRQL after 5 years fairly well. Conclusion: The use of HRQL questionnaires is valuable when comparing different treatments and as an aid in predicting treatment side effects. Evaluation of HRQL at diagnosis for patients with laryngeal carcinoma is of value for the prognosis of HRQL over time and for the prognosis of survival.
P005 Pediatric Sleep Apnea: Can Sleep Studies Predict Adverse Outcomes after Adenotonsillectomy? Tina P Elkins MD (presenter); Jeevan B Ramakrishnan BS; Kevin D Pereira MD; Ron B Mitchell MD; Michael D Poole MD PhD Cypress TX; Houston TX; Houston TX; Albuquerque NM; Houston TX
Objectives: To determine if polysomnography is a reliable indicator in predicting postoperative cardiopulmonary complications and the need for hospital admission after adenotonsillectomy in children with obstructive sleep apnea. Methods: Retrospective review of the medical records of children with polysomnography-documented sleep apnea undergoing adenotonsillectomy at two university-based tertiarycare children’s hospitals from October 1999 to September 2002. The charts were reviewed for details of the sleep study, perioperative and postoperative course, and complications, if any, during the hospital stay. The findings were compared with the clinical examination to determine if the complications could be independently predicted by the clinical examination alone. Results: A total of 150 patients were studied and data tabulated. The majority of patients who had significant sleep apnea could have been diagnosed on clinical grounds alone. The preoperative evaluation could reliably determine the need for postoperative admission in a vast majority of the cases. Unexpected admission occurred in 6 patients prior to discharge from the hospital, and no adverse cardiopulmonary complications were encountered in those who were discharged on the day of surgery. Conclusion: Polysomnography could not independently determine the need for hospital admission or predict postoperative cardiopulmonary complications in children with obstructive sleep apnea. The severity of sleep apnea and hence the need for hospital admission could be reliably predicted on clinical grounds alone.
POSTERS
P212
Otolaryngology– Head and Neck Surgery August 2003