Faculty Bibliography

OBJECTIVES: To explore distribution of stage at diagnosis and relative survival rates among US adults with oral cavity cancer in relation to race, and over time. METHODS: We obtained 1973-2002 oral cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program, and computed proportions for each oral cavity site by stage at diagnosis, tumor size, and 5-year relative survival rates among Whites and Blacks. RESULTS: A total of 46 855 cases of oral cavity cancer were reported to the SEER registry among adults > or =20 years between 1973 and 2002. African-Americans had a significantly higher proportion of cancer, mainly in the tongue, that had spread to a regional node or to a distant site at diagnosis than Whites: 67% versus 49% of tongue cancers reported from 1973 to 1987 (P < 0.001), and 70% versus 53% of those reported from 1988 to 2002 (P < 0.001). They had a significantly higher proportion of tongue cancer that were >4 cm in diameter at time of diagnosis (59% versus 44%; P < 0.001), and black men in particular experienced lower 5-year relative survival rates than white men, in particular, for tongue cancer (25% versus 43% from 1973 to 1987, and 31% versus 53% from 1988 to 2002). CONCLUSION: There are significant racial disparities with respect to stage at diagnosis and survival among adults with oral cancer reported to the SEER registry from 1973 to 2002. One possible explanation for the lower survival among Blacks may be a difference in access to, and utilization of, healthcare services

Neurotologic and skull base surgery involves working around important neurovascular and neurotologic structures and can incur unwarranted complications. Knowledge of surgical anatomy, good preoperative planning, intraoperative monitoring, and excellent microsurgical technique contribute to minimizing and avoiding complications. In the event of a complication, however, the neurotologic surgeon should be prepared to manage it. In this article, the authors focus on the management of complications encountered in neurotologic skull base surgery, including hemorrhage, stroke, cerebrospinal fluid leak, extraocular motility deficits, facial paralysis, hearing loss, dizziness, lower cranial nerve palsies, and postoperative headache.

OBJECTIVE: To evaluate the long-term hearing outcomes of neurofibromatosis type 2 (NF2) patients with cochlear implants. METHODS: Retrospective analysis of cochlear implant performance in NF2 patients using open- and closed-set speech perception testing. RESULTS: Patients with NF2-associated bilateral vestibular schwannomas frequently become profoundly deaf. The aim of surgical resection should be to preserve serviceable hearing in at least one ear; however, this goal can be difficult to achieve. Frequently, tumor size or poor preoperative hearing status can require a surgical approach that leaves the patient with a profound, bilateral sensorineural hearing loss. If the cochlear nerve is preserved anatomically after vestibular schwannoma surgery, and if promontory stimulation confirms the functionality of the cochlear nerve, then cochlear implantation is an excellent option to restore hearing. We present six cochlear implant patients with NF2 who attained a significant improvement in open- and closed-set speech understanding with a mean follow-up of 7.9 (range: 5-13) years after surgery. In all but one case, the hearing results did not deteriorate over the follow-up period. CONCLUSION: Early surgical intervention for vestibular schwannomas in NF2 patients when the cochlear nerve can be spared is an important consideration to allow for possible cochlear implantation. A 6- to 8-week recovery period for the anatomically intact cochlear nerve may be necessary to obtain a positive promontory stimulation response following tumor resection and should be performed prior to cochlear implantation

OBJECTIVE: To examine the Epstein-Barr virus (EBV) IgA and DNA assays as a screening tool for nasopharyngeal carcinoma (NPC) in a nonendemic US population. STUDY DESIGN AND SETTING: Prospective study performed at a teaching hospital in New York City. There were two groups of 155 patients: new NPC patients and controls. An otolaryngologic examination and serial blood testing for serologic markers were performed. RESULTS: Sensitivity and specificity of EBV IgA and DNA assays were determined. Screening scenarios involving series and parallel testing were evaluated to determine economic feasibility. Series testing provided a sensitivity, specificity, and positive and negative predictive values of 90.6, 93.5, 78.4, and 97.5 percent, respectively. Parallel testing increased the sensitivity to 100 percent. CONCLUSION: NPC screening in a high-risk, nonendemic population using EBV-specific serologic markers is effective. Series testing is a statistically sound and economically feasible strategy. SIGNIFICANCE: The development of a cost-effective NPC screening strategy in a high-risk, nonendemic population in the United States.

OBJECTIVE: To investigate the presence of aquaporin (AQP) water channels 1, 2, and 3 in stratified squamous vocal fold epithelium. DESIGN: Immunolocalization analysis of excised ovine vocal fold epithelia. SUBJECTS: Sheep. INTERVENTIONS: Ovine vocal fold epithelia were prepared for immunoelectron microscopy using primary antibodies directed against AQP-1, AQP-2, and AQP-3. Photographic profiles of epithelium exposed to each antibody were used to calculate the immunogold labeling density of the plasma membrane and cytoplasm. MAIN OUTCOME MEASURES: Density of immunolabeling was compared across 3 regions that represent cell layers closest to the glottal lumen for the plasma membrane and cytoplasm, respectively. RESULTS: Labeling densities of AQP-1 and AQP-2 were significantly greater for the plasma membrane region of the luminal cells than for deeper cell layers. Cytoplasmic labeling and labeling of circular structures was greatest for cell layers 2 through 5 beneath the vocal fold surface compared with the surface cell layer. Immunogold labeling of AQP-3, an aquaglyceroporin, in vocal fold epithelium was inconclusive. CONCLUSION: Aquaporins 1 and 2, associated with the plasma membrane region of ovine vocal fold epithelial cells, demonstrate the presence of an intrinsic mechanism to permit transcellular water flux in response to osmotic gradients

Myoepithelial tumors of the soft tissues have only recently been described. Two cases of lower extremity malignant myoepithelial tumors are reported. One case of malignant mixed tumor overlying the gastrocnemius muscle was treated with wide local excision, but metastasized to regional lymph nodes 14 months after surgical excision. One patient with malignant myoepithelioma of the right lower leg was treated with limb amputation and is alive without disease at 46 months. A review of the literature discloses 120 additional cases of soft tissue myoepithelial tumors, 102 of which are myoepitheliomas and 18 are mixed tumors. Thirty-seven percent of the myoepitheliomas met the criteria for malignancy, and 33% of the mixed tumors were malignant. Of these, 30% had locally recurrent disease and 32% developed metastatic disease. Treatment benefit from chemotherapy and radiation therapy is unclear

OBJECTIVE: To test the validity of the subzygomatic fossa as a possible landmark in identifying the origin of the zygomaticus major muscle (ZMM). METHODS: Twenty-three fresh cadaver facial halves were dissected. Four references points were identified in each cadaver head: the zygomatic arch, the malar eminence, the modiolus, and the ZMM insertion notch. The ZMM insertion notch is a palpable landmark that is typically identified midway between the zygomatic arch and the malar eminience. A straight line was drawn from the ZMM insertion notch to the modiolus. An additional line was drawn from the malar eminence to the modiolus. An incision was made along the each line to the depth of the facial muscles. The presence or absence of the ZMM was recorded, and the location of the ZMM insertion notch was characterized in each cadaver. RESULTS: The ZMM insertion notch was palpated and identified in 23 of 23 facial halves. It was accurate in identifying the course of the ZMM in all 23 facial halves. The line created by the malar eminence to the modiolus was inaccurate in all 23 facial halves. CONCLUSION: The ZMM insertion notch is a reliable landmark for identification of the ZMM

Noncoplanar polychlorinated biphenyls (PCBs) are widely dispersed in human environment and tissues. Here, an exemplar noncoplanar PCB was fed to rat dams during gestation and throughout three subsequent nursing weeks. Although the hearing sensitivity and brainstem auditory responses of pups were normal, exposure resulted in the abnormal development of the primary auditory cortex (A1). A1 was irregularly shaped and marked by internal nonresponsive zones, its topographic organization was grossly abnormal or reversed in about half of the exposed pups, the balance of neuronal inhibition to excitation for A1 neurons was disturbed, and the critical period plasticity that underlies normal postnatal auditory system development was significantly altered. These findings demonstrate that developmental exposure to this class of environmental contaminant alters cortical development. It is proposed that exposure to noncoplanar PCBs may contribute to common developmental disorders, especially in populations with heritable imbalances in neurotransmitter systems that regulate the ratio of inhibition and excitation in the brain. We conclude that the health implications associated with exposure to noncoplanar PCBs in human populations merit a more careful examination

Recent studies have demonstrated that delivery of genes to the inner ear can achieve a variety of effects ranging from support of auditory neuron survival to protection and restoration of hair cells, demonstrating the utility of vector based gene delivery. Translation of these findings to useful experimental systems or even clinical applications requires a detailed understanding of the pharmacokinetics of gene delivery in the inner ear. Ideal gene delivery systems will employ a well tolerated vector which efficiently transduces the appropriate target cells within a tissue, but spare non-target structures. Adenovectors based on serotype 5 (Ad 5) are commonly used vectors, are easy to construct and have a long track record of efficacious gene transfer in the inner ear. In this study we demonstrate that distribution of Ad5 vector occurs in a basal to apical gradient with rapid distribution of vector to the vestibule after delivery via a round window cochleostomy. Transduction of the vector and expression of the delivered transgene occurs by 10 min post vector delivery. At 24 h post delivery only 16% of vector that was initially detectable within the inner ear by quantitative PCR remained. Perilymph sampling was used to determine that vector concentrations in perilymph peaked at 30 min post delivery and then declined rapidly. Understanding these basic distribution patterns and parameters for delivery are important for the design of gene delivery vectors and vital for modeling dose responses to achieve safe efficacious delivery of a therapeutic agent.