Bio

Clinical Focus


  • Otolaryngology - Head & Neck Surgery (Ear, Nose and Throat)
  • Otolaryngology

Academic Appointments


Honors & Awards


  • Member, Alpha Omega Alpha (1961)
  • President, American Academy of Otolaryngology-Head and Neck Surgery (1990-91)
  • President, American Academy of Facial Plastic and Reconstructive Surgery (1984-85)

Professional Education


  • Internship:Santa Clara Valley Medical Center (1962) CA
  • Residency:Stanford University School of Medicine (1966) CA
  • Board Certification: Otolaryngology, American Board of Otolaryngology (1968)
  • Medical Education:USC Keck School of Medicine (1961) CA
  • M.D., U.S.C. School of Medicine, Medicine (1961)

Research & Scholarship

Current Research and Scholarly Interests


Our research is focused on developing surgical procedures and ancillary devices that will restore hearing loss and/or improve auditory perception and clarity. In addition, research to develop improved techniques to treat obstructive sleep apnea surgically is performed with emphasis on implanted materials to maintain tongue position during sleep. New methods to determine the site of obstruction are also under development. Research in improving facial movement following facial nerve injury is also an interest of the laboratory using nerve and muscle transfers.

Clinical Trials


  • Indirect Magnetic Resonance Lymphangiography of the Head and Neck Region Using Conventional Gadolinium-based Contrast Not Recruiting

    To determine the ability of magnetic resonance lymphangiography using conventional gadolinium injected directly into the tumor site and PET scan in detecting microscopic nodal metastasis in patients with newly diagnosed H&N cancers

    Stanford is currently not accepting patients for this trial. For more information, please contact Bill Loo, (650) 736 - 7143.

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  • Identification of Secreted Markers for Tumor Hypoxia in Patients With Head and Neck or Lung Cancers Recruiting

    To correlate tumor oxygenation as measured by the Eppendorf electrode with the serum level of secreted proteins known to be induced by tumor hypoxia.

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  • Cervical Nodal Mets in Squamous Cell Carcinoma of H&N - MRI, FDG-PET, & Histopathologic Correlation Not Recruiting

    The purpose of this study is to determine the value of novel non-invasive medical imaging methods for detecting the spread of head and neck squamous cell carcinoma to the lymph nodes in the neck by comparing their results to findings at the time of surgery.

    Stanford is currently not accepting patients for this trial. For more information, please contact Quynh-Thu Le, (650) 498 - 6184.

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  • Cisplatin and ZD1839 + Re-Irradiation in Recurrent Squamous Cell Cancer of the Head and Neck Not Recruiting

    To determine safety profile of the epidermal growth factor receptor (EGFR) antagonist, ZD1839 in combination with cisplatin and radiation therapy in patients with local-regional recurrent squamous cell cancer of the head and neck. To study the effects of ZD1839 combined with either cisplatin or radiotherapy on signal transduction pathway gene expression in tumor cells in patients with local-regional recurrent squamous cell cancer of the head and neck using micro array analysis from tumor samples taken at the time of relapse and during treatment.

    Stanford is currently not accepting patients for this trial. For more information, please contact Priscilla Wong, (650) 725 - 4777.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • Continuous lesser palatine nerve block for postoperative analgesia after uvulopalatopharyngoplasty. Clinical journal of pain Ponstein, N. A., Kim, T. E., Hsia, J., Goode, R., Borges, P., Mariano, E. R. 2013; 29 (12): e35-8

    Abstract

    OBJECTIVES:: Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP. CASE REPORT:: Three patients were scheduled to undergo elective UPPP and tonsillectomy for OSA with scheduled postoperative hospital admission. Each patient gave written consent to share the details of his or her case. Upon completion of the surgical procedure, but before emergence from general anesthesia, a 20-G multiorifice epidural catheter was inserted into the left nasal passage, passed into the oropharynx, and either tunneled posteriorly within the anterior portion of the soft palate with the aid of a 16-G angiocatheter or placed submucosally within the soft palate by the surgeon. Each catheter was secured using clear adhesive dressings along the cheek and anchored to the ipsilateral shoulder. A continuous infusion of ropivacaine 0.2% at 2 mL/h was delivered using a disposable infusion device postoperatively, in addition to the prescribed oral and intravenous opioids. No immediate or long-term complications due to catheter placement were identified during the patient follow-up. DISCUSSION:: Continuous lesser palatine nerve block may be a useful regional anesthetic technique in the multimodal postoperative pain management of opioid-sensitive OSA patients undergoing UPPP and deserves further study.

    View details for DOI 10.1097/AJP.0b013e3182971887

    View details for PubMedID 23669453

  • A Self-Adjusting Ossicular Prosthesis Containing Polyurethane Sponge OTOLOGY & NEUROTOLOGY Yamada, H., Goode, R. L. 2010; 31 (9): 1404-1408

    Abstract

    Middle ear ossicular replacement prostheses whose length can adjust in vivo to changes in middle ear dimensions following insertion may have acoustic advantages.Optimal tension is an important factor in the acoustic performance of incus-stapes replacement prostheses. Length is the primary determinant of postinsertion tension with conventional prostheses. Postoperative changes in prosthesis tension may occur leading to a worsening of postoperative hearing.Testing of a self-adjusting prosthesis (SAP) containing a polyurethane sponge attached to the head of a titanium partial ossicular replacement prosthesis (PORP) was performed in 5 fresh temporal bones. This SAP was compared with optimal length PORPs at different tensions. Sound input was 80 dB sound pressure level at 0.1 to 10 kHz. Stapes footplate displacement was measured using a laser Doppler vibrometer before and after incus removal and after PORP and SAP insertion between the malleus and stapes. One to 3 glass shims were then inserted between the malleus and optimal length PORP and SAP to change prosthesis tension. Measurement of stapes displacement was repeated with increased prosthesis lengths of 0.15, 0.30, and 0.45 mm.There was a clear tendency in the optimal length PORPs for a decrease in footplate displacement below 1.0 kHz, in general proportional to the increasing length. The SAP provided equivalent transmission as the optimal length PORP below 4.0 kHz and better transmission below 1.0 kHz at the varying increased lengths.An SAP seems to decrease the effect of changes in prosthesis length between the malleus and stapes at lower frequencies.

    View details for DOI 10.1097/MAO.0b013e3181f6c8b7

    View details for Web of Science ID 000284111700009

    View details for PubMedID 21113980

  • Advanced-staged tonsillar squamous carcinoma: Organ preservation versus surgical management of the primary site HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Shirazi, H. A., Sivanandan, R., Goode, R., Fee, W. E., Kaplan, M. J., Pinto, H. A., Goffinet, D. R., Le, Q. 2006; 28 (7): 587-594

    Abstract

    Our aim was to review our experience in the management of advanced tonsillar squamous cell carcinoma (SCC) and to compare treatment outcomes between patients treated with and without surgery to the primary site.The records of 74 patients with advanced-stage tonsillar SCC were reviewed. The median age at diagnosis was 58 years. Thirty-eight patients received definitive surgery to the primary site, and 36 were treated with an organ-preservation approach (OP) using radiotherapy +/- chemotherapy.No significant difference in overall survival (OS) or freedom from relapse (FFR) by treatment was found. T classification and N status were significant independent predictors on multivariate analysis for OS and FFR. Major late toxicity was noted in 10 patients in the surgical group and nine in the OP group.Patients treated with OP and primary surgery had comparable OS and FFR. T classification and N status were significant independent predictors for tumor relapse and survival. On the basis of these results, we favor organ-preservation therapy for patients with advanced-stage tonsillar SCC.

    View details for DOI 10.1002/hed.20372

    View details for Web of Science ID 000238690100003

    View details for PubMedID 16475199

  • Round window membrane motion with air conduction and bone conduction stimulation HEARING RESEARCH Stenfelt, S., Hato, N., Goode, R. L. 2004; 198 (1-2): 10-24

    Abstract

    The vibration patterns of the round window (RW) membrane in human cadaver temporal bone specimens were assessed by measurements of the velocity of reflective targets placed on the RW membrane with an approximate spacing of 0.2 mm. The velocity was measured in the frequency range 0.1-10 kHz by a laser Doppler vibrometer in four specimens with air conduction (AC) stimulation and in four specimens with bone conduction (BC) stimulation. The response pattern was investigated by analyzing the velocity response of all targets on the RW membrane, by making iso-amplitude and iso-phase contour plots of the membrane surface, and by creating animations of the surface vibration at several frequencies. Similar response pattern was found with AC and BC stimulations. At frequencies below 1.5 kHz, the RW membrane vibrates nearly as a whole in an in-and-out motion and above 1.5 kHz, the membrane moves primarily in two sections that vibrate with approximately 180 degrees difference. Indication of some traveling wave motion of the RW membrane at those frequencies was also found. At higher frequencies, above 3 kHz, the membrane motion is complex with a mixture of modal and traveling wave motion. An increase of the stimulation level did not alter the vibration pattern; it only gave an increase of the RW membrane vibration amplitude corresponding to the increase in stimulation. When the mode of stimulation at the oval window was altered, by the insertion of a 0.6 mm piston, the vibration pattern of the RW membrane changed.

    View details for DOI 10.1016/j.heares.2004.07.008

    View details for Web of Science ID 000225640000002

    View details for PubMedID 15567598

  • Time delay of acoustic transmission in human middle ear PROCEEDINGS OF THE 3RD SYMPOSIUM ON MIDDLE EAR MECHANICS IN RESEARCH AND OTOLOGY Hato, N. T., Gyo, K., Stenfelt, S., Welsh, J. T., Goode, R. L. 2004: 51-55
  • MEASUREMENT OF THE OSSICULAR VIBRATION RATIO IN HUMAN TEMPORAL BONES BY USE OF A VIDEO MEASURING SYSTEM ACTA OTO-LARYNGOLOGICA Gyo, K., ARITOMO, H., Goode, R. L. 1987; 103 (1-2): 87-95

    Abstract

    Vibration modes of the ossicles and the lever function were studied in human cadaver temporal bones with an intact cochlea. After placing tiny steel spheres on the ossicles, ossicular vibration to a sound stimulus was measured by observing the displacements of the spheres under a microscope with strobe illumination by means of a video measuring system. The lever ratio varied from 1.9 at 0.6 kHz (minimum) to a peak of 6 near 2 kHz. This relatively high lever ratio at higher frequencies was considered to be caused by a shift of the malleus-incus rotation axis secondary to the loading of the cochlear fluid on the ossicular system. Dependence of the lever ratio on frequency indicated that the rotation axis of the ossicles was not fixed, but variable according to frequency due to a relative increase in the translational movements of the rotation axis of the malleus and incus with frequency.

    View details for Web of Science ID A1987F633500012

    View details for PubMedID 3564932

  • Effects of middle ear pressure changes on umbo vibration. Auris, nasus, larynx Gyo, K., Goode, R. L. 1987; 14 (3): 131-137

    Abstract

    Effects of middle ear pressure changes on umbo vibration were studied in 5 fresh human temporal bones taken from cadavers. Umbo vibration to a constant sound pressure of 120 dB SPL at the tympanic membrane was measured with an MTI 1000 Fotonic Sensor. The results showed that there was a loss of umbo vibration at lower frequencies below 2 kHz; 5.0 +/- 1.0 dB loss at -100 mmH2O, 9.2 +/- 1.3 dB loss at -200 mmH2O, and 13.1 +/- 1.8 dB loss at -300 mmH2O. In contrast, there was a slight increase in umbo vibration at around 2-3 kHz. The effect was considered to be mainly due to increased stiffness of the tympanic membrane and decreased air volume in the middle ear cavity.

    View details for PubMedID 3451732

  • The Floating Mass Transducer on the Round Window Versus Attachment to an Ossicular Replacement Prosthesis OTOLOGY & NEUROTOLOGY Shimizu, Y., Puria, S., Goode, R. L. 2011; 32 (1): 98-103

    Abstract

    The Vibrant Soundbridge floating mass transducer (FMT) is part of a commercially available implantable hearing device in which the FMT can be placed in the round window (RW) niche or attached to a partial (V-PORP) or total ossicular replacement prosthesis (V-TORP) contacting the stapes head or footplate. The goal is to provide efficient transfer of sound vibration into the cochlea. The hypothesis is that the FMT location on the prosthesis is superior to the RW location.No direct comparisons of the 3 FMT sites have been performed using the same measurement location.A new measurement method called the third window method was used in eleven fresh human temporal bones to compare the sites. A small hole was made into the scala tympani of the temporal bones preserving the endosteum. A reflective target was placed on the third window endosteum and displacement of the cochlear fluid was measured using a Polytec HLV-1000 laser Doppler vibrometer. The input to the FMT at all locations was a constant 316 millivolts (mV); the frequency range was 0.5 to 8.0 kHz.The V-PORP and V-TORP FMT locations both provided statistically significant better performance above 1.0 kHz than the RW site but not below that frequency. The V-PORP and V-TORP responses were similar at all test frequencies.In this temporal bone model, the FMT provided better higher frequency performance when attached to a PORP or TORP than in the RW niche.

    View details for DOI 10.1097/MAO.0b013e3181f7ad76

    View details for Web of Science ID 000285334400021

    View details for PubMedID 20930654

  • MEMRO 2009-Middle-ear science and technology HEARING RESEARCH Puria, S., Goode, R. L., Steele, C. 2010; 263 (1-2): 1-2

    View details for DOI 10.1016/j.heares.2010.03.079

    View details for Web of Science ID 000278583700001

    View details for PubMedID 20347945

  • Are Hyoid Procedures a Reasonable Choice in the Surgical Treatment of Obstructive Sleep Apnea? LARYNGOSCOPE Chau, J. K., Goode, R. L. 2010; 120 (2): 221-222

    View details for DOI 10.1002/lary.20784

    View details for Web of Science ID 000274605000001

    View details for PubMedID 20091788

  • Brow Elevation Ratio A New Method of Brow Analysis ARCHIVES OF FACIAL PLASTIC SURGERY Kim, B. P., Goode, R. L., Newman, J. P. 2009; 11 (1): 34-39

    Abstract

    To introduce a novel quantitative method measuring preoperative and postoperative brow position and apply it to a cohort of patients undergoing endoscopic brow suspension.Retrospective review of patients who underwent endoscopic brow- and forehead-lift using a consistent operative technique and method of fixation. Changes in brow position were measured using standardized digital photographs of patients taken before and after surgery. Brow elevation was determined using a novel measurement system based on the ratio of the vertical height of the brow to the distance between the lateral corneal limbus and the medial canthus.Sixteen consecutive patients (32 eyebrows) underwent surgery between January 7, 2003, and January 15, 2006, without any major complications. With follow-up ranging from 6 to 31 months (mean follow-up, 18 months), a statistically significant elevation of brow position was found. Mean brow ratio measurements increased by 18.0% on the right side and 16.1% on the left side, for an overall mean increase in brow position of 17.1%. The brow elevation ratio remained increased by a mean of 16.8% for patients who were followed up for almost 2 years and beyond.The brow elevation ratio can be applied to patients undergoing brow suspension procedures with standard office photography. The ratios provide the surgeon with a quantitative dimension for assessing outcomes of brow elevation and can be used in comparative analysis of each patient's baseline brow position.

    View details for Web of Science ID 000262556900006

    View details for PubMedID 19153291

  • Effect of absence of malleus on ossiculoplasty in human temporal bones OTOLARYNGOLOGY-HEAD AND NECK SURGERY Shimizu, Y., Goode, R. L. 2008; 139 (2): 301-306

    Abstract

    We evaluated the effect of malleus presence or absence on middle ear sound transmission after middle ear reconstruction in a temporal bone model.Human cadaveric temporal bone study.The velocity of the stapes footplate was measured using a laser Doppler vibrometer. After baseline measurements in eight intact temporal bones, reconstructed middle ear transmission with and without the malleus was analyzed. Furthermore, to assess the influence of interposed cartilage, cartilage pieces of three different diameters were inserted and the three test conditions compared.Reconstruction without a malleus tended to be slightly worse at 0.6 to 3.0 kHz. However, these differences were not statistically significant. In the cartilage experiments, the large-diameter cartilage was the worst at 0.25 kHz and 0.5 kHz but was better than the medium-diameter cartilages at 3.0 kHz and 4.0 kHz (P < 0.05).Absence of the malleus impaired middle ear sound transmission slightly in the mid frequencies compared to reconstruction with the malleus present; the differences were not statistically significant.

    View details for DOI 10.1016/j.otohns.2008.04.011

    View details for Web of Science ID 000258113800024

    View details for PubMedID 18656734

  • The unhappy patient following facial plastic surgery: what to do? Facial plastic surgery clinics of North America Goode, R. L. 2008; 16 (2): 183-?

    Abstract

    Some patients are unhappy with the results of facial plastic surgery, even if the surgeon is pleased with the outcome. Dealing with this potential problem begins with the preoperative assessment as to how the patient might handle a result that is less than perfect. "When in doubt, don't" is a good rule but needs refinement. This article, based on some 40 years of experience, attempts to provide that refinement.

    View details for DOI 10.1016/j.fsc.2007.11.006

    View details for PubMedID 18355702

  • Success and failure in treatment of sleep apnea patients OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Goode, R. L. 2007; 40 (4): 891-?

    Abstract

    A variety of surgical procedures exist to treat obstructive sleep apnea in adults. Some, such as tracheotomy and maxillomandibular advancement, have very high cure rates, over 90%. These procedures have significant disadvantages, however, and there is a need to define the best combination of low morbidity procedures to provide similar success. To do this, better means to diagnose the sites of obstruction must be used and new procedures must be developed. This article reviews where we are in reaching these goals.

    View details for DOI 10.1016/j.otc.2007.04.006

    View details for Web of Science ID 000248384900012

    View details for PubMedID 17606029

  • Mature results from a randomized phase II trial of cisplatin plus 5-fluorouracil and radiotherapy with or without tirapazamine in patients with resectable stage IV head and neck squamous cell carcinomas CANCER Le, Q. T., Taira, A. I., Budenz, S., Dorie, M. J., Goffinet, D. R., Fee, W. E., Goode, R., Bloch, D., Koong, A., Brown, J. M., Pinto, H. A. 2006; 106 (9): 1940-1949

    Abstract

    The objective of this article was to report the results from a randomized trial that evaluated the efficacy and toxicity of adding tirapazamine (TPZ) to chemoradiotherapy in the treatment of patients with head and neck squamous cell carcinomas (HNSCC).Sixty-two patients with lymph node-positive, resectable, TNM Stage IV HNSCC were randomized to receive either 2 cycles of induction chemotherapy (TPZ, cisplatin, and 5-fluorouracil [5-FU]) followed by simultaneous chemoradiotherapy (TPZ, cisplatin, and 5-FU) or to receive the same regimen without TPZ. Patients who did not achieve a complete response at 50 Grays underwent surgical treatment. Stratification factors for randomization included tumor site, TNM stage, and median tumor oxygen tension. The primary endpoint was complete lymph node response.The addition of TPZ resulted in increased hematologic toxicity. There was 1 treatment-related death from induction chemotherapy. The complete clinical and pathologic response rate in the lymph nodes was 90% and 74% for the standard treatment arm and the TPZ arm, respectively (P = .08) and 89% and 90% at the primary site in the respective treatment arms (P = .71). The 5-year overall survival rate was 59%, the cause-specific survival rate was 68%, the rate of freedom from recurrence was 69%, and the locoregional control rate was 77% for the entire group. There was no difference with regard to any of the outcome parameters between the 2 treatment arms. The significant long-term toxicity rate also was found to be similar between the 2 arms.The addition of TPZ increased hematologic toxicity but did not improve outcomes in patients with resectable, Stage IV HNSCC using the protocol administered this small randomized study. The combination of induction and simultaneous chemoradiotherapy resulted in excellent survival in these patients.

    View details for DOI 10.1002/cncr.21785

    View details for Web of Science ID 000237187400010

    View details for PubMedID 16532436

  • Bone-conducted sound: Physiological and clinical aspects OTOLOGY & NEUROTOLOGY Stenfelt, S., Goode, R. L. 2005; 26 (6): 1245-1261

    Abstract

    The fact that vibration of the skull causes a hearing sensation has been known since the 19th century. This mode of hearing was termed hearing by bone conduction. Although there has been more than a century of research on hearing by bone conduction, its physiology is not completely understood. Lately, new insights into the physiology of hearing by bone conduction have been reported. Knowledge of the physiology, clinical aspects, and limitations of bone conduction sound is important for clinicians dealing with hearing loss and is the purpose of this review.The data were compiled from the published literature in the areas of clinical bone conduction hearing, bone conduction hearing aids, basic research on bone conduction physiology, and recent research on bone conduction hearing from our laboratory.Five factors contributing to bone conduction hearing have been identified: 1) sound radiated into the external ear canal, 2) middle ear ossicle inertia, 3) inertia of the cochlear fluids, 4) compression of the cochlear walls, and 5) pressure transmission from the cerebrospinal fluid. Of these five, inertia of the cochlear fluid seems most important. Bone conduction sound is believed to reflect the true cochlear function; however, certain conditions such as middle ear diseases can affect bone conduction sensitivity, but less than for air conduction. The bone conduction route can also be used for hearing aids; since the bone conduction route is less efficient than the air conduction route, bone conduction hearing aids are primarily used for hearing losses where air conduction hearing aids are contraindicated.

    View details for Web of Science ID 000233259100031

    View details for PubMedID 16272952

  • Transmission properties of bone conducted sound: Measurements in cadaver heads JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA Stenfelt, S., Goode, R. L. 2005; 118 (4): 2373-2391

    Abstract

    In the past, only a few investigations have measured vibration at the cochlea with bone conduction stimulation: dry skulls were used in those investigations. In this paper, the transmission properties of bone conducted sound in human head are presented, measured as the three-dimensional vibration at the cochlear promontory in six intact cadaver heads. The stimulation was provided at 27 positions on the skull surface and two close to the cochlea; mechanical point impedance was measured at all positions. Cochlear promontory vibration levels in the three perpendicular directions were normally within 5 dB. With the stimulation applied on the ipsilateral side, the response decreased, and the accumulated phase increased, with distance between the cochlea and the excitation position. No significant changes were obtained when the excitations were on the contralateral side. In terms of vibration level, the best stimulation position is on the mastoid close to the cochlea; the worst is at the midline of the skull. The transcranial transmission was close to 0 dB for frequencies up to 700 Hz; above it decreased at 12 dB/decade. Wave transmission at the skull-base was found to be nondispersive at frequencies above 2 kHz whereas it altered with frequency at the cranial vault.

    View details for DOI 10.1121/1.12005847

    View details for Web of Science ID 000232712700032

    View details for PubMedID 16266160

  • Fluid volume displacement at the oval and round windows with air and bone conduction stimulation JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA Stenfelt, S., Hato, N., Goode, R. L. 2004; 115 (2): 797-812

    Abstract

    The fluids in the cochlea are normally considered incompressible, and the fluid volume displacement of the oval window (OW) and the round window (RW) should be equal and of opposite phase. However, other channels, such as the cochlear and vestibular aqueducts, may affect the fluid flow. To test if the OW and RW fluid flows are equal and of opposite phase, the volume displacement was assessed by multiple point measurement at the windows with a laser Doppler vibrometer. This was done during air conduction (AC) stimulation in seven fresh human temporal bones, and with bone conduction (BC) stimulation in eight temporal bones and one human cadaver head. With AC stimulation, the average volume displacement of the two windows is within 3 dB, and the phase difference is close to 180 degrees for the frequency range 0.1 to 10 kHz. With BC stimulation, the average volume displacement difference between the two windows is greater: below 2 kHz, the volume displacement at the RW is 5 to 15 dB greater than at the OW and above 2 kHz more fluid is displaced at the OW. With BC stimulation, lesions at the OW caused only minor changes of the fluid flow at the RW.

    View details for DOI 10.1121/1.1639903

    View details for Web of Science ID 000188944100035

    View details for PubMedID 15000191

  • Basilar membrane and osseous spiral lamina motion in human cadavers with air and bone conduction stimuli HEARING RESEARCH Stenfelt, S., Puria, S., Hato, N., Goode, R. L. 2003; 181 (1-2): 131-143

    Abstract

    It is generally accepted that bone conduction (BC) stimuli yield a traveling wave on the basilar membrane (BM) and hence stimulate the cochlea by the same mechanisms as normal air conduction (AC). The basis for this is the ability to cancel or mask a BC tone with an AC tone and the ability to generate two tone distortion products with a BC tone and an AC tone. The hypothesis is proposed that BC stimulates the BM not only through the hydrodynamics of the scala vestibuli and scala tympani, but also through osseous spiral lamina (OSL) vibrations. To test this hypothesis the BM and OSL response with AC as well as BC stimulation was measured with a laser Doppler vibrometer. Human temporal bones mounted on a shaker were used to record the velocities of the bone per se, the BM and the OSL. The measurements were then converted to relative BM and OSL velocities. The results from the basal turn of the cochlea show similar behavior with AC and BC stimulation. The motion of the OSL at the edge where it connects to the BM is in phase and is typically 6 dB lower than the BM motion. With BC stimulation, there is less phase accumulation in the OSL after the cochlea is drained; the OSL moves due to inertial forces and resonates at approximately 7 kHz. Inertial vibration of the OSL may partially contribute to the total response of BC sound, especially at the high frequencies, although current models of the cochlea assume a rigid OSL. The measurements reported here can be used to include a flexible OSL in cochlear models.

    View details for DOI 10.1016/S0378-5955(03)00183-7

    View details for Web of Science ID 000184250700016

    View details for PubMedID 12855371

  • Three-dimensional stapes footplate motion in human temporal bones AUDIOLOGY AND NEURO-OTOLOGY Hato, N., Stenfelt, S., Goode, R. L. 2003; 8 (3): 140-152

    Abstract

    The literature provides conflicting information on whether the motion of the stapes footplate is piston-like or some other type of motion, such as rotational or rocking. Examination of the three-dimensional (3D) motion of the stapes footplate appears to be an excellent way to understand this complicated motion. Five microsphere reflective targets were placed on the stapes footplate in ten fresh human cadaver temporal bone preparations, and their vibration measured through an extended facial recess approach using a laser Doppler vibrometer. The five target sites on the stapes footplate were center, anterior, posterior, superior and inferior. The stimulus was a sound input of 80-120 dB SPL at the tympanic membrane over a frequency range of 0.1 to 10 kHz. The 3D motion of the stapes footplate was calculated using the velocity amplitude and phase obtained for each target. For frequencies up to 1.0 kHz the vibration of the stapes footplate was primarily piston-like; this motion became complex at higher frequencies, with rotary motion along both the long and short axis of the footplate. When the cochlea was drained, stapes footplate motion became essentially piston-like for all frequencies.

    View details for DOI 10.1159/000069475

    View details for Web of Science ID 000182395900003

    View details for PubMedID 12679625

  • Factors contributing to bone conduction: The outer ear JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA Stenfelt, S., Wild, T., Hato, N., Goode, R. L. 2003; 113 (2): 902-913

    Abstract

    The ear canal sound pressure and the malleus umbo velocity with bone conduction (BC) stimulation were measured in nine ears from five cadaver heads in the frequency range 0.1 to 10 kHz. The measurements were conducted with both open and occluded ear canals, before and after resection of the lower jaw, in a canal with the cartilage and soft tissues removed, and with the tympanic membrane (TM) removed. The sound pressure was about 10 dB greater in an intact ear canal than when the cartilage part of the canal had been removed. The occlusion effect was close to 20 dB for the low frequencies in an intact ear canal; this effect diminished with sectioning of the canal. At higher frequencies, the resonance properties of the ear canal determined the effect of occluding the ear canal. Sectioning of the lower jaw did not significantly alter the sound pressure in the ear canal. The sound radiated from the TM into the ear canal was investigated in four temporal bone specimens; this sound is significantly lower than the sound pressure in an intact ear canal with BC stimulation. The malleus umbo velocity with air conduction stimulation was investigated in nine temporal bone specimens and compared with the umbo velocity obtained with BC stimulation in the cadaver heads. The results show that for a normal open ear canal, the sound pressure in the ear canal with BC stimulation is not significant for BC hearing. At threshold levels and for frequencies below 2 kHz, the sound in the ear canal caused by BC stimulation is about 10 dB lower than air conduction hearing thresholds; this difference increases at higher frequencies. However, with the ear canal occluded, BC hearing is dominated by the sound pressure in the outer ear canal for frequencies between 0.4 and 1.2 kHz.

    View details for DOI 10.1121/1.1534606

    View details for Web of Science ID 000180874900022

    View details for PubMedID 12597184

  • Factors contributing to bone conduction: The middle ear JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA Stenfelt, S., Hato, N., Goode, R. L. 2002; 111 (2): 947-959

    Abstract

    Measurement of the motion of the malleus umbo and stapes footplate during bone conduction (BC) stimulation was conducted in vitro in 26 temporal bones using a laser Doppler vibrometer over the frequency range 0.1 to 10 kHz. For lower frequencies, both ossicular sites followed the motion of the temporal bone. The differential motion between the malleus and the surrounding bone was greater than the differential motion of the stapes footplate; both resonated near 1.5 kHz. Different lesions were shown to affect the response: (1) a mass attached to the umbo lowered the resonance frequency of the ossicular vibration; (2) fixation of either the malleus or stapes increased the stiffness and shifted the resonance frequency upward; and (3) dislocation of the incudo-stapedial joint did not significantly affect the ossicular vibration. The sound radiated from the tympanic membrane was approximately 85 dB SPL at an umbo differential velocity of 1 mm/s for low frequencies in an open ear canal and about 10 dB higher for an occluded one; at higher frequencies (above 2 kHz) resonances of the canal determine the response. It was also found that the motion between the footplate and promontory was within 5 dB when the specimen was stimulated orthogonal to the vibration direction of the ossicles than in line with the same. Measurement of the differential motion of the umbo in one live human skull gave similar response as the average result from the temporal bone specimens.

    View details for Web of Science ID 000173784900032

    View details for PubMedID 11863197

  • Acoustic role of the buttress and posterior incudal ligament in human temporal bones OTOLARYNGOLOGY-HEAD AND NECK SURGERY Hato, N., Welsh, J. T., Goode, R. L., Stenfelt, S. 2001; 124 (3): 274-278

    Abstract

    In middle ear surgery using intact ear canal wall techniques, the buttress, which is the bony bridge at the medial end of the posterior-superior bony ear canal, is commonly retained during posterior tympanotomy. In some cases, the surgical exposure may be improved by resectioning the buttress, and this requires sectioning the posterior incudal ligament. To date, the acoustic effects of removing the buttress with sectioning of the attached ligament have not been studied.Using a laser Doppler vibrometer system, 15 human cadaver temporal bones were measured with 80 dB sound pressure level at the tympanic membrane over the 0.1 to 10 kHz frequency range.The resection of the buttress and sectioning the posterior incudal ligament had no effect on stapes footplate velocity.These results suggest that the posterior incudal ligament does not play a significant role in the acoustic function of the ossicles.

    View details for DOI 10.1067/mhn.2001.113664

    View details for Web of Science ID 000167530700008

    View details for PubMedID 11240990

  • Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics. Archives of facial plastic surgery Greene, D., Koch, R. J., Goode, R. L. 1999; 1 (4): 292-296

    Abstract

    To compare the surgical efficacy and wound-healing characteristics of the tissue adhesive octyl-2-cyanoacrylate (approved by the Food and Drug Administration) with traditional suture closure in upper blepharoplasty.Prospective, randomized, blinded study comparing cosmetic and functional outcome and time efficiency. Twenty subjects underwent upper eyelid blepharoplasty. Each patient had a control side and an experimental side determined randomly. One eyelid incision was closed with octyl-2-cyanoacrylate (Dermabond; Ethicon Inc, Somerville, NJ) tissue glue, and the other with 6.0 suture (polypropylene or fast-absorbing gut). Comparisons were performed for the time for closure by each method, wound healing, and patient satisfaction. Macrophotographs of the wounds at 1, 2, and 4 weeks after surgery were graded by 5 observers blinded to the closure method, using a 10-point scale and a modified Hollander wound evaluation scale.No statistically significant difference was found between the quality of octyl-2-cyanoacrylate closure and suture closure at 1 month. There were no differences in wound complications, duration of healing, inflammation, or final incision appearance. By 2 weeks, the sides were indistinguishable in 15 (75%) of the patients. Time for closure averaged 7 minutes with suture and 8 minutes with glue.Octyl-2-cyanoacrylate glue is an excellent alternative to suture closure, producing equivalent quality of closure at all time points and no difference in appearance. This adhesive was sufficient to withstand the forces of closure in upper eyelid blepharoplasty without dehiscence in the absence of sutures.

    View details for PubMedID 10937118

  • Who needs a sleep test? The value of the history in the diagnosis of obstructive sleep apnea. Ear, nose, & throat journal Goode, R. L. 1999; 78 (9): 710-?

    Abstract

    Many experts believe that a polysomnogram to screen for obstructive sleep apnea should be performed on every patient who has a history of loud snoring and sleepiness. In contrast, the author believes that with a careful history and physical examination, there is no need to study all such patients, at least not until home polysomnography units become as convenient and economical as pulse oximetry.

    View details for PubMedID 10502893

  • Radiofrequency ablation of the nerve to the corrugator muscle for elimination of glabellar furrowing. Archives of facial plastic surgery Utley, D. S., Goode, R. L. 1999; 1 (1): 46-48

    Abstract

    Glabellar furrows are caused by hyperdynamic activity of the corrugator supercilii muscles. A minimally invasive, percutaneous technique for eliminating glabellar furrows is described. An insulated, bipolar needle is inserted vertically through the eyebrow skin to entrap the corrugator nerve plexus. To confirm proper positioning, a stimulating current is delivered to the needle during observation of corrugator supercilii muscle response. Radiofrequency energy is then delivered to the needle, thereby ablating the intervening nerve tissue. This technique is in the early stage of optimization and is being evaluated in an ongoing Stanford University Human Subjects protocol, Stanford, Calif. The preliminary results are reported herein.

    View details for PubMedID 10937076

  • A human temporal bone study of stapes footplate movement AMERICAN JOURNAL OF OTOLOGY Heiland, K. E., Goode, R. L., Asai, M., Huber, A. M. 1999; 20 (1): 81-86

    Abstract

    This study was designed to determine whether stapes movement is pistonlike or complex.The literature provides conflicting information on whether stapes footplate motion is only pistonlike or has other types of movement, such as hingelike or rocking.Using 10 freshly harvested human cadaver temporal bones, 3 targets were placed on the stapes footplate through an extended facial recess approach. The targets were 0.5-mm pieces of reflective adhesive material positioned on the long axis of the footplate at the anterior crus, central footplate, and posterior crus. Displacement and phase of the three targets were measured from 0.2 to 10 kHz at a 90dB sound pressure level input at the tympanic membrane. The measuring system was a sophisticated laser Doppler vibrometer (LDV). A computer program (Tymptest) calculated footplate displacement and relative phase at the three sites and the ratio of anterior-posterior rocking movement of the footplate long axis to displacement at the center.Below 2.0 kHz, stapes vibration is predominately pistonlike. Above 2.0 kHz, anterior-posterior rocking motion increases logarithmically with frequency, and, near 4.0 kHz, rocking and pistonlike motion are approximately equal.Stapes footplate vibration is primarily pistonlike up to 2.0 kHz but becomes more complex at higher frequencies because of an increase in anterior-posterior rocking motion. Hingelike movements were not observed. This information may be helpful in the design of ossicular replacement prostheses that mimic or improve upon normal stapes vibration.

    View details for Web of Science ID 000079244800019

    View details for PubMedID 9918179

  • Evaluation of a cement incus replacement prosthesis in a temporal bone model ACTA OTO-LARYNGOLOGICA Asai, M., Heiland, K. E., Huber, A. M., Goode, R. L. 1999; 119 (5): 573-576

    Abstract

    In reconstruction of the ossicular chain for a damaged incus, it is important that the incus replacement prosthesis (IRP) length is ideal in order to provide optimal tension between the tympanic membrane or malleus and stapes head to achieve the best post-operative hearing result. Even though the length of commercially available IRPs can be adjusted, it still may be difficult to achieve clinically. We describe experiments in a human temporal bone model using dental cement as an IRP after removal of the incus. This cement IRP (CIRP) hardens in situ and becomes the length of the gap to be spanned so that tension should be ideal. Two different CIRPs were studied; one was a conventional rod-type CIRP connecting either the umbo or mid-malleus handle to the stapes head. The second was a Y-shaped CIRP (Y-CIRP), connecting two sites on the malleus to the stapes head. The wide Y-CIRP connected the malleus head and umbo to the stapes head, while the narrow Y-CIRP connected the malleus neck and mid-handle to the stapes head. The acoustic performance of these experimental CIRPs was studied using a laser Doppler vibrometer system in 12 fresh human temporal bones. The CIRP demonstrated better acoustic performance than conventional IRPs studied previously in the same model. While all the CIRPs showed similar function below 2.0 kHz, the narrow Y-CIRP appeared best above 3.0 kHz. A prosthesis of this type may have an acoustic advantage over conventional IRPs.

    View details for Web of Science ID 000082013700010

    View details for PubMedID 10478598

  • Analysis of the best site on the stapes footplate for ossicular chain reconstruction ACTA OTO-LARYNGOLOGICA Asai, M., Huber, A. M., Goode, R. L. 1999; 119 (3): 356-361

    Abstract

    Experiments were performed in 22 fresh human temporal bones to compare the relative acoustic function of three stapes footplate sites for an incus stapes superstructure replacement prosthesis (I-SRP). The three sites evaluated were the anterior, centre and posterior footplates. A new round window (RW) measurement method was used to make the comparisons. A small glass microsphere was placed in the centre of the RW as a target. A Polytec laser Doppler vibrometer was used to measure round window displacement in response to 50 pure tones between 200 and 10,000 Hz presented at 80 dB SPL at the tympanic membrane (TM). After a baseline measurement of RW displacement in the intact temporal bone, the incus was removed and a cement I-SRP (CIRP) formed between the mid-malleus handle and each of the three test footplate sites, in random order. RW displacement was again measured after placement of the CIRP at each of three sites. We found the centre site to be 3.0-7.0 dB better than the anterior site above 2,000 Hz. There were no differences between the anterior and centre sites below 2,000 Hz. The posterior site was the worst at all frequencies.

    View details for Web of Science ID 000080244900014

    View details for PubMedID 10380743

  • Direct bonded orthodontic brackets for maxillomandibular fixation LARYNGOSCOPE Utley, D. S., Utley, J. D., Koch, R. J., Goode, R. L. 1998; 108 (9): 1338-1345

    Abstract

    Mandibular fracture treatment often includes arch bar maxillomandibular fixation (MMF), either alone or in combination with open reduction/internal fixation (ORIF) techniques. The glove perforation rate associated with arch bar placement, the incidence of blood-borne pathogen positivity in facial fracture patients, and the injurious effects of arch bars on dental enamel and gingiva have prompted the development of safer alternatives to arch bar MMF. This study evaluates the efficacy, ease of use, and safety profile of one such alternative: orthodontic direct bonded bracket fixation (MMF/DBB).Prospective study of consecutive mandible fracture patients treated with MMF/DBB.Thirty-two patients with mandibular fractures were evaluated from January 1994 to July 1997. Fourteen were appropriate for treatment with MMF/DBB (12 men and two woman; mean age, 24.6+/-7.2 y; range, 16-42 y). Fracture sites included symphysis, angle, condylar neck, coronoid, and body. Nine patients underwent MMF/DBB alone; five underwent MMF/DBB with subsequent ORIF.No infection, malocclusion, malunion/nonunion, or enamel/ gingiva injury occurred. Mean follow-up was 6 months (range, 1-12 mo). Oral hygiene with MMF/DBB was superior to historical controls using arch bars.MMF/DBB can serve as the single treatment method with satisfactory results in patients with favorable, less complicated mandible fractures, although with increased experience, we have treated several more complex cases with MMF/DBB alone. In cases necessitating ORIF, MMF/DBB can be performed preoperatively to align fracture segments and reestablish occlusion. This facilitates placement of osteosynthesis plates and reduces ORIF operative time. MMF/DBB is an economical, safe technique that minimizes blood-borne-pathogen risk to the operative team, eliminates periodontal injury, facilitates postoperative dental hygiene, and is painless to apply and remove.

    View details for Web of Science ID 000075753300015

    View details for PubMedID 9738753

  • Cavernous sinus syndrome caused by a primary paranasal sinus non-Hodgkin's lymphoma JOURNAL OF LARYNGOLOGY AND OTOLOGY Williams, Z., Norbash, A., Goode, R. L. 1998; 112 (8): 777-778

    Abstract

    Although uncommon, non-Hodgkin's lymphomas occasionally arise from the nose and paranasal sinuses. Rarely, they may invade into the cavernous sinus and produce signs and symptoms that characteristically include unilateral ophthalmoplegia, sensation loss in the distribution of the ophthalmic and other divisions of the trigeminal nerve, sympathetic nerve paralysis and proptosis. In this report, we present a case of cavernous sinus syndrome (CSS) caused by infiltration of non-Hodgkin's lymphoma from the adjacent paranasal sinuses and address issues regarding its diagnosis and treatment.

    View details for Web of Science ID 000075469600013

    View details for PubMedID 9850323

  • The failing flap in facial plastic and reconstructive surgery: Role of the medicinal leech LARYNGOSCOPE Utley, D. S., KOCH, J., Goode, R. L. 1998; 108 (8): 1129-1135

    Abstract

    To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous-congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented.Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous-congested flap.A retrospective review of four cases of failing, venous-congested flaps was performed.The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous-congested flap. Leeches are an immediate and efficacious treatment option.1. Review of the literature indicates that the survival of the compromised, venous-congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous-congested flap is a safe, efficacious, economical, and well-tolerated intervention.

    View details for Web of Science ID 000075257600005

    View details for PubMedID 9707230

  • Closed dressings after laser skin resurfacing ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Newman, J. P., KOCH, J., Goode, R. L. 1998; 124 (7): 751-757

    Abstract

    To evaluate the safety, efficacy, and patient acceptance of closed dressings after full facial resurfacing with the carbon dioxide laser.Prospective cohort of men and women undergoing full facial carbon dioxide laser resurfacing.Ambulatory surgical center at a university hospital.Forty consecutive patients randomized to 1 of 4 dressing groups.All patients underwent full facial resurfacing with a carbon dioxide laser system. One of 5 closed dressings (single- or 3-layer composite foam, plastic mesh, hydrogel, or polymer film) was placed immediately after the procedure. Closed dressings were changed on postoperative day 2 and removed on postoperative day 4.Objective postoperative criteria of erythema, scarring, reepithelialization, and surface irregularities were recorded and photodocumented. Comparisons were made among the closed dressing groups as well as with a group of historical control subjects treated with open dressings. The ease of application, office time for preparation and application, and cost of the individual dressings were collected. Patient characteristics of overall acceptance, comfort, and ease of maintenance were recorded with a visual analog scale.There were no complications of scarring, surface irregularities, or contact dermatitis from the application or maintenance of the closed dressings. There were no significant differences in the number of days of postoperative erythema or in the rate of facial reepithelialization among the groups. Most patients preferred not to continue with the closed dressings past 2 days. Positive features from the use of closed dressings included reduction in crust formation, decreased pruritus, decreased erythema, and decreased postoperative pain, compared with historical controls. Negative features included time in preparation and application of the dressings. Costs ranged from $9.79 to $50 per dressing change.Closed dressings are safe and offer benefits noted during the first 4 postoperative days. Patients can be expected to maintain a closed dressing for at least 24 hours but no longer than 4 days. The positive features of closed dressings and patient acceptance outweigh the cost and office time involved with their application and maintenance.

    View details for Web of Science ID 000074784900003

    View details for PubMedID 9677108

  • Sniffing and smelling: separate subsystems in the human olfactory cortex NATURE Sobel, N., Prabhakaran, V., Desmond, J. E., Glover, G. H., Goode, R. L., SULLIVAN, E. V., Gabrieli, J. D. 1998; 392 (6673): 282-286

    Abstract

    The sensation and perception of smell (olfaction) are largely dependent on sniffing, which is an active stage of stimulus transport and therefore an integral component of mammalian olfaction. Electrophysiological data obtained from study of the hedgehog, rat, rabbit, dog and monkey indicate that sniffing (whether or not an odorant is present) induces an oscillation of activity in the olfactory bulb, driving the piriform cortex in the temporal lobe, in other words, the piriform is driven by the olfactory bulb at the frequency of sniffing. Here we use functional magnetic resonance imaging (fMRI) that is dependent on the level of oxygen in the blood to determine whether sniffing can induce activation in the piriform of humans, and whether this activation can be differentiated from activation induced by an odorant. We find that sniffing, whether odorant is present or absent, induces activation primarily in the piriform cortex of the temporal lobe and in the medial and posterior orbito-frontal gyri of the frontal lobe. The source of the sniff-induced activation is the somatosensory stimulation that is induced by air flow through the nostrils. In contrast, a smell, regardless of sniffing, induces activation mainly in the lateral and anterior orbito-frontal gyri of the frontal lobe. The dissociation between regions activated by olfactory exploration (sniffing) and regions activated by olfactory content (smell) shows a distinction in brain organization in terms of human olfaction.

    View details for Web of Science ID 000072612300047

    View details for PubMedID 9521322

  • Distortion of the auriculocephalic angle following rhytidectomy - Recognition and prevention ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Newman, J. P., Koch, R. J., Goode, R. L., Brennan, H. G. 1997; 123 (8): 818-820

    Abstract

    Distortion of ear protrusion after rhytidectomy results in an aesthetically unfavorable appearance. We have seen cases in which the auriculocephalic angle has widened postoperatively, producing a noticeable deformity. Herein, we report 3 cases that resulted in abnormal postsurgical ear protrusion. We also discuss prevention through the use of conchal setback sutures.

    View details for Web of Science ID A1997XQ52500005

    View details for PubMedID 9260546

  • Scanning laser Doppler vibrometry of the middle ear ossicles. Ear, nose, & throat journal Ball, G. R., Huber, A., Goode, R. L. 1997; 76 (4): 213-?

    Abstract

    This paper describes measurements of the vibratory modes of the middle ear ossicles made with a scanning laser Doppler vibrometer. Previous studies of the middle ear ossicles with single-point laser Doppler measurements have raised questions regarding the vibrational modes of the ossicular chain. Single-point analysis methods do not have the ability to measure multiple points on the ossicles and, consequently, have limited ability to simultaneously record relative phase information at these points. Using a Polytec Model PSV-100, detailed measurements of the ossicular chain have been completed in the human temporal bone model. This model, when driven with a middle ear transducer, provides detailed three-dimensional data of the vibrational patterns of the middle ear ossicles. Implications for middle ear implantable devices are discussed.

    View details for PubMedID 9127520

  • Laser Doppler vibrometer (LDV) - A new clinical tool for the otologist AMERICAN JOURNAL OF OTOLOGY Goode, R. L., Ball, G., Nishihara, S., Nakamura, K. 1996; 17 (6): 813-822

    Abstract

    We describe a laser Doppler system (LDS) that can be used clinically for the measurement of tympanic membrane (TM), malleus and prosthesis head displacement in response to sound inputs of 80-to 100-dB sound-pressure level (SPL). It also has the potential for use in the operating room to perform measurements of prosthesis and stapes displacement. The information provided by such testing gives the otologist knowledge of TM and ossicular function that is unique in evaluating middle ear function; it should help select the best type of reconstruction in a given case and direct us toward new and better methods of TM and ossicular reconstruction. The results of umbo displacement measurements in 95 human ears are reported. Examples are provided of LDS measurements in representative ears and how they can be of help to the clinician. The potential of multisite TM-displacement testing is demonstrated in two temporal bones, including before and after partial ossicular replacement prosthesis (PORP) insertion.

    View details for Web of Science ID A1996VQ20300002

    View details for PubMedID 8915406

  • Combined use of superpulsed carbon dioxide laser and cryotherapy for treatment of facial rhytids ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Nasri, S., Newman, J. P., Goode, R. L. 1996; 122 (11): 1169-1173

    Abstract

    To compare the effect of superpulsed carbon dioxide (CO2) laser alone with that of cryotherapy in combination with CO2 laser in treatment of facial rhytids.A randomized prospective study.Facial Plastic Surgery Clinic at Standford University Medical Center, Standford, Calif.Twenty patients with perioral rhytids were randomized in the study, 11 in the laser group and 9 in the cryotherapy and laser group.Patients in the laser group were treated with superpulsed CO2 laser. Initially, the shoulders of rhytids were spot treated. The area was then wiped and rehydrated. The entire surface was then treated with a second pass. A third pass, if deemed necessary, was then used to treat the shoulders. Patients in the combined group underwent cryotherapy of the entire perioral region followed by CO2 laser treatment similar to that previously described.Improvement in facial rhytids with laser treatment alone was compared with improvement using cryotherapy and laser. A skin wrinkle grading system was used and patients were graded by 3 independent observers. Close-up photographs were obtained preoperatively and postoperatively. A questionnaire was filled out by each patient 1 month following treatment and was used to rate overall patient satisfaction.There was no statistically significant difference between the 2 groups regarding final outcome, amount of anesthetic agents required for each patient, or rate of complications.Superpulsed CO2 skin resurfacing alone is as effective as combined cryotherapy and superpulsed CO2 laser for treatment of perioral rhytids.

    View details for Web of Science ID A1996VQ70600004

    View details for PubMedID 8906050

  • MEASUREMENTS OF THE STAPES SUPERSTRUCTURE ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY aWengen, D. F., Nishihara, S., Kurokawa, H., Goode, R. L. 1995; 104 (4): 311-316

    Abstract

    Ten human stapes from fresh temporal bones were measured to obtain relevant distances of the stapes superstructure. The dimensions of the parts of the superstructure are as follows: 1) stapes head 1.14 mm (range, 0.91 to 1.49) in diameter parallel to the axis of the footplate and 0.83 mm (range, 0.65 to 1.08) perpendicular to it; 2) stapes head to shoulders 0.93 mm (range, 0.81 to 1.07), head to foramen 1.26 mm (range, 1.15 to 1.39), and head to lateral surface of stapes footplate 3.19 mm (range, 2.91 to 3.45); 3) neck width parallel to the axis of the footplate 1.18 mm (range, 0.88 to 1.47) and 0.64 mm (range, 0.48 to 0.88) perpendicular to it; 4) anterior crus 0.58 mm wide (range, 0.41 to 0.74) at the shoulder of the arch and 0.51 mm (range, 0.39 to 0.65) closer to the stapes footplate; 5) posterior crus 0.65 mm wide (range, 0.46 to 0.77) at the shoulder of the arch and 0.55 mm (range, 0.38 to 0.75) closer to the stapes footplate; and 6) maximum width of entire superstructure near footplate 2.48 mm (range, 2.06 to 2.98).

    View details for Web of Science ID A1995QT45500011

    View details for PubMedID 7717624

  • TREATMENT OF TYMPANIC MEMBRANE RETRACTION WITH THE HOLMIUM LASER OTOLARYNGOLOGY-HEAD AND NECK SURGERY Kurokawa, H., Goode, R. L. 1995; 112 (4): 512-519

    Abstract

    Politzerization, the Valsalva maneuver, and ventilation tube insertion are available treatments for tympanic membrane retraction. Ventilation of the middle ear cavity can correct tympanic membrane retraction in many cases, but not in all. Retraction may be localized or diffuse. This article describes experiments performed to evaluate a new method to "tighten" retracted or flaccid tympanic membranes with a holmium laser in a human temporal bone model. Ten temporal bones with mild-to-moderate retraction of the posterior superior quadrant or pars flaccida were treated with a series of laser pulses around and to the area of retraction. Umbo displacement before and after laser treatment was performed with a laser Doppler vibrometer to evaluate the effect on the acoustic function of the tympanic membrane. In all ears, the posterior superior quadrant retraction appeared to be completely corrected. Laser treatment of the posterior superior quadrant retraction produced improvement in umbo displacement below 1.0 kHz. After treatment of pars flaccida retraction, the configuration was improved a small amount; however, no increase in umbo displacement was found.

    View details for Web of Science ID A1995QR87600002

    View details for PubMedID 7700655

  • THE HISTORY AND DEVELOPMENT OF THE IMPLANTABLE HEARING-AID OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Goode, R. L., Rosenbaum, M. L., Maniglia, A. J. 1995; 28 (1): 1-16

    Abstract

    Implantable hearing aids have an interesting and colorful history. These devices have usually been investigational, but this has changed. Currently, several implantable devices are available for ongoing clinical trials in humans. They have promise in providing improved hearing in certain cases of conductive, mixed, and sensorineural hearing loss.

    View details for Web of Science ID A1995QH01000002

    View details for PubMedID 7739857

  • CURRENT STATUS AND FUTURE OF IMPLANTABLE ELECTROMAGNETIC HEARING-AIDS OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Goode, R. L. 1995; 28 (1): 141-146

    Abstract

    Partially implantable electromagnetic hearing aids have several potential advantages over conventional hearing aids. As conventional hearing aids improve in the quality of sound they deliver, however, the role of implant aids must be redefined. One area where they may provide the most benefit is in patients with moderate to severe hearing loss.

    View details for Web of Science ID A1995QH01000012

    View details for PubMedID 7739860

  • THE TMJ EAR CONNECTION CRANIO-THE JOURNAL OF CRANIOMANDIBULAR PRACTICE Morgan, D. H., Goode, R. L., Christiansen, R. L., TINER, L. W. 1995; 13 (1): 42-43

    Abstract

    This article documents the existence of three structures that traverse through the petrotympanic fissure. These structures are the mandibular malleolar ligament, the chorda tympani nerve and the anterior tympanic artery. The mandibular malleolar ligament or the disk-malleolar ligament originates on the anterior process of the mallous. It traverses through the petro-tympanic fissure and attaches to the posterior portion of the capsule and disk of the temporomandibular joint. The chorda tympani nerve supplies sensory feeling to the posterior two thirds of the tongue. The anterior tympanic artery supplies blood to the area of the tympanic membrane. Clinical experience with implants that impinge or cover ear problems and other symptoms. Removal of these implants and placements with devices that do not cover these structures often relieve these symptoms.

    View details for Web of Science ID A1995QD02800011

    View details for PubMedID 7586001

  • EXPERIMENTAL-MODELS OF OSSICULOPLASTY OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Goode, R. L., Nishihara, S. 1994; 27 (4): 663-675

    Abstract

    Measurement of the acoustic properties of middle ear prostheses in an appropriate model prior to insertion in humans should be part of the routine of the prosthesis development and testing process, but it is not. This article describes a human temporal bone model suitable for such testing and discusses the results of several commonly used prostheses evaluated in the model. By comparing existing and new experimental prostheses in such a model, we should be better able to develop prostheses capable of providing improved hearing results following middle ear reconstruction.

    View details for Web of Science ID A1994PC57500004

    View details for PubMedID 7984368

  • EXPERIMENTAL-STUDY OF THE ACOUSTIC PROPERTIES OF INCUS REPLACEMENT PROSTHESES IN A HUMAN TEMPORAL BONE MODEL AMERICAN JOURNAL OF OTOLOGY Nishihara, S., Goode, R. L. 1994; 15 (4): 485-494

    Abstract

    Many middle ear prostheses are available for reconstruction of a missing or damaged incus. Little is known of the relative acoustic performance of these prostheses in vitro and the parameters (mass, shape, tension, angulation, area of head) that modify this performance. This report describes experiments in a human temporal bone model comparing the effect on stapes displacement of six commercially available incus replacement prostheses (IRP). Measurements were performed using a laser Doppler vibrometer before and after incus removal and IRP placement between the tympanic membrane (TM) and stapes head. In addition, experiments were performed on the effect of increasing prosthesis mass, varying the tension between TM and stapes head, changing the surface area in contact with the TM, and comparing different TM contact sites. All prostheses tested showed reasonable acoustic performance compared to the baseline condition. Optimum tension between the TM and stapes head produced the best overall sound transmission. The mid-malleus and umbo locations were the best malleus contact sites; however, the posterior TM contact site also worked well. Increased mass improved low frequency transmission and impaired higher frequency transmission, whereas a larger contact area with the TM contributed to increased gain in the mid frequencies.

    View details for Web of Science ID A1994PG16600005

    View details for PubMedID 8588603

  • NEW KNOWLEDGE ABOUT THE FUNCTION OF THE HUMAN MIDDLE-EAR - DEVELOPMENT OF AN IMPROVED ANALOG MODEL AMERICAN JOURNAL OF OTOLOGY Goode, R. L., KILLION, M., Nakamura, K., Nishihara, S. 1994; 15 (2): 145-154

    Abstract

    Conventional teaching regarding the acoustic function of the human middle ear is that it serves as an impedance matching system to offset the loss that occurs when sound passes from the low-impedance sound field to the high-impedance cochlear fluid. A transformer analogy is often used with the pressure transformation produced by the eardrum; footplate area ratio and the lever ratio considered to be approximately 27 dB. Recent data on middle ear function has shown this to be only partially correct. A transformer analogy is not appropriate since the pressure gain of the middle ear decreases above 1000 Hz and does not depend on the cochlear load at all frequencies. Experiments are described of umbo, malleus short process, and stapes displacement in human temporal bones using a laser Doppler measuring system (LDS). The measurements support previous studies that indicate that in addition to a roll-off in tympanic membrane function above 1000 Hz, there is slippage in the ossicular lever system that causes an increasing "lever ratio" above 1000 Hz, thought to be caused by translational movement of the ossicular rotation axis near the short process. An improved analog circuit model of the external and middle ear has been developed that produces results equivalent to those found in the temporal bones.

    View details for Web of Science ID A1994MZ14100005

    View details for PubMedID 8172293

  • EFFECT OF CHANGES IN MASS ON MIDDLE-EAR FUNCTION OTOLARYNGOLOGY-HEAD AND NECK SURGERY Nishihara, S., ARITOMO, H., Goode, R. L. 1993; 109 (5): 899-910

    Abstract

    Vibrating systems such as the middle ear are affected by changes in mass. After disease or ear surgery, significant changes in mass may contribute positively or negatively to the postoperative hearing threshold. This article describes experiments in 15 human temporal bones of the addition or reduction of mass on the middle ear transfer function. Measurement of stapes and umbo vibration was performed using a Laser Doppler Vibrometer before and after the addition of different masses at several sites on the tympanic membrane (TM) and ossicular chain. The input was 61 pure tones swept from 147 to 19433 Hz at 80 dB SPL. The addition of mass onto the TM produced varying detrimental effects on sound transmission, depending on the location and amount of mass. The insertion of ventilation tubes, weighing 12 to 17 mg each, produced losses at 1.5 to 5.0 kHz compared with tympanotomy alone. Addition of mass to the umbo and malleus head produced a loss at mid and high frequencies, whereas addition of mass on the incus long process and stapes also produced a high-frequency decrease in stapes displacement. Reduction of TM mass by removal of the epithelium produced an increase, especially at 2.0 to 4.0 kHz.

    View details for Web of Science ID A1993MJ89100020

    View details for PubMedID 8247572

  • MEASUREMENT OF UMBO VIBRATION IN HUMAN-SUBJECTS - METHOD AND POSSIBLE CLINICAL-APPLICATIONS AMERICAN JOURNAL OF OTOLOGY Goode, R. L., Ball, G., Nishihara, S. 1993; 14 (3): 247-251

    Abstract

    A commercial laser doppler vibrometer (LDV) was used to evaluate umbo displacement at sound pressure levels of 60, 70, and 80 dB SPL at the tympanic membrane (TM) of six subjects. Thirty-five pure-tone test frequencies, five per octave, were tested from 140 to 19,433 Hz. A computer program (Tymptest) produced and controlled the tones as well as improved the signal-to-noise ratio of the LDV. The test took about an hour to perform and provided reproducible results in all subjects. In addition, measurement of umbo displacement using the same system was made in 15 fresh human temporal bones for comparison. Results in the humans revealed a relatively flat umbo displacement from 140 to 1000 Hz, with a gradually sloping roll-off of -8.25 dB per octave from 1000 to 7000 Hz. From 8000 to 14,000 Hz the roll-off increased to -12.5 dB per octave. At the mean resonant frequency of the middle ear, 1000 Hz, and an 80 dB SPL input, umbo displacement was 0.045 micron. The human temporal bones showed similar results. Possible future clinical applications of this measurement include the identification of ears with acoustically inefficient TMs (tin ears). By identifying and studying such ears we should be able to develop methods to improve their function and produce hearing threshold increases of 15 dB or more at key speech frequencies. In addition, analysis of umbo and TM vibration in reconstructed middle ears should help us achieve better postoperative hearing results.

    View details for Web of Science ID A1993LA58600006

    View details for PubMedID 8372921

  • COSTOCHONDRAL PHARYNGEAL IMPLANTS FOR VELOPHARYNGEAL INSUFFICIENCY LARYNGOSCOPE Terris, D. J., Goode, R. L. 1993; 103 (5): 565-569

    View details for Web of Science ID A1993LB29700015

    View details for PubMedID 8483374

  • PHARMACOLOGICAL AND SURGICAL ENHANCEMENT OF COMPOSITE GRAFT-SURVIVAL ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY FANN, P. C., HARTMAN, D. F., Goode, R. L. 1993; 119 (3): 313-319

    Abstract

    A previously described rabbit ear model was used to address the following issues: (1) the role of surgical delay in composite tissue transfer, (2) optimal enhancement of graft survival using the corticosteroid methylprednisolone, (3) pharmacologic salvage of the failing composite graft, and (4) efficacy of a nonsteroidal dual cyclooxygenase/lipooxygenase inhibitor (SK&F 86002) in enhancing graft survival. Preoperative and immediate postoperative steroid treatment groups exhibited a significant improvement in graft survival area compared with the untreated control group. Preoperative initiation of steroid therapy was more effective than a strictly postoperative regimen. SK&F 86002, advance preparation of the recipient bed, and delayed steroid administration did not improve graft survival compared with the untreated control group. The most promising treatment, preoperative initiation of steroid therapy, was further evaluated in a double-blinded placebo-controlled study. The steroid group demonstrated a significantly improved mean survival area, as well as mean graft weight, compared with the placebo control group.

    View details for Web of Science ID A1993KQ55900009

    View details for PubMedID 8435171

  • Injectable collagen. Facial plastic surgery Burgess, L. P., Goode, R. L. 1992; 8 (3): 176-182

    View details for PubMedID 1286826

  • TOBRAMYCIN-IMPREGNATED METHYLMETHACRYLATE FOR MANDIBLE RECONSTRUCTION ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Goode, R. L., REYNOLDS, B. N. 1992; 118 (2): 201-204

    Abstract

    Reconstruction of the mandible to restore continuity following resection is described in four cases using a tobramycin-impregnated methylmethacrylate implant fabricated at the time of surgery. Methylmethacrylate has excellent biocompatibility and strength and has been used in surgery for over 20 years. The technique uses readily available materials and is similar in concept to reconstruction with a metal plate. Potential advantages are: (1) the presence of a potent antibiotic within the implant that is released over a period of months to minimize postoperative infection and (2) the capability of the material to accurately fit any defect, either when used alone or in combination with a plate or rod. Three of the four patients whom we present are doing well; one implant became exposed following postoperative radiotherapy and had to be removed.

    View details for Web of Science ID A1992HC81000022

    View details for PubMedID 1540354

  • IMPLANTABLE HEARING DEVICES MEDICAL CLINICS OF NORTH AMERICA Goode, R. 1991; 75 (6): 1261-1266

    Abstract

    The use of implantable hearing devices to help persons with hearing loss is still in its infancy. The advantages and disadvantages of various models of implantable hearing devices currently being developed are discussed, and their clinical use is described. Other hearing aid assistive devices are also discussed, particularly the electromagnetic implant hearing aid.

    View details for Web of Science ID A1991GQ72700005

    View details for PubMedID 1943318

  • ESOPHAGOGRAPHY AND ESOPHAGOSCOPY - COMPARISON IN THE EXAMINATION OF PATIENTS WITH HEAD AND NECK-CARCINOMA ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY NINOMURCIA, M., Vincent, M. E., Vaughan, C., Fee, W. E., Goode, R. L., Robbins, A. H., ZBORALSKE, F. F. 1990; 116 (8): 917-919

    Abstract

    We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

    View details for Web of Science ID A1990DT07500004

    View details for PubMedID 2378717

  • Comments on "Acoustic Transfer Characteristics in Human Middle Ears Studied by a SQUID Magnetometer Method" [J. Acoust. Soc. Am. 82, 1646-1654 (1987)]. journal of the Acoustical Society of America Goode, R. L., Nakamura, K., Gyo, K., ARITOMO, H. 1989; 86 (6): 2446-2449

    Abstract

    The study by Brenkman et al. [J. Acoust. Soc. Am. 82, 1646-1654 (1987)] of malleus umbo and anterior crus of stapes displacement in 14 human temporal bones shows a mean -7.3-dB/oct slope above 1.0 kHz for stapes displacement in response to a 80-dB SPL input at the eardrum. The slope they obtained for midfrequency (1.0-4.0 kHz) stapes displacement is significantly flatter than what was found previously [Gyo et al., Acta Otolaryngol. 103, 87-95 (1987); Gundersen, Prostheses in the Ossicular Chain (University Park, Baltimore, MD, 1971); Kringlebotn and Gundersen, J. Acoust. Soc. Am. 77, 159-164 (1985); Vlaming and Feenstra, Clin. Otolaryngol. 11, 353-363 (1986a)]; in these studies, stapes displacement rolled off at -12.0 to -14.9 dB/oct above 1.0 kHz. It appears that their mean midfrequency stapes displacement slope has been flattened by some unusual results in a small number of ears. Possible reasons for these results are discussed.

    View details for PubMedID 2600315

  • CURRENT STATUS OF ELECTROMAGNETIC IMPLANTABLE HEARING-AIDS OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Goode, R. L. 1989; 22 (1): 201-209

    Abstract

    The indications for use of implantable hearing aids are presented. Features of the devices that are currently available are presented. Comparisons with conventional hearing aids are also made.

    View details for Web of Science ID A1989T060600013

    View details for PubMedID 2649854

  • CRANIAL BONE-GRAFTS FOR POSTTRAUMATIC FACIAL DEFECTS LARYNGOSCOPE PETROFF, M. A., Burgess, L. P., ANONSEN, C. K., Lau, P., Goode, R. L. 1987; 97 (11): 1249-1253

    Abstract

    Recent interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct post-traumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating post-traumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.

    View details for Web of Science ID A1987K719700001

    View details for PubMedID 3312882

  • SURGICAL-TREATMENT OF THE MARGINAL MANDIBULAR LIP DEFORMITY OTOLARYNGOLOGY-HEAD AND NECK SURGERY Glenn, M. G., Goode, R. L. 1987; 97 (5): 462-468

    Abstract

    Unilateral permanent paralysis of the lower lip after section or compression of the marginal mandibular branch of the facial nerve is not rare. It may occur after trauma or as a result of parotid, ear, or upper neck surgery. Surgical treatment of the deformity--which we term the marginal mandibular lip--is indicated to improve cosmesis and restore oral competence during eating and speech. We describe our experience with partial resection of the paralyzed lower lip as an effective yet simple method of surgical correction. We also review the alternate methods of treatment for comparison.

    View details for Web of Science ID A1987K874700006

    View details for PubMedID 3120123

  • HEAT MYRINGOTOMY FOR THE TREATMENT OF SEROUS OTITIS-MEDIA OTOLARYNGOLOGY-HEAD AND NECK SURGERY Goode, R. L., Schulz, W. 1982; 90 (6): 764-766

    Abstract

    A new heat myringotomy device is described that produces a 2-mm myringotomy which remains open three to four weeks without the need for a ventilation tube. The device can be used in the office in young children under iontophoretic anesthesia and may eliminate the need for tube insertion in 50% of chronic serous otitis media cases.

    View details for Web of Science ID A1982QC19200015

    View details for PubMedID 10994426

Conference Proceedings


  • The temporalis muscle flap for reconstruction after head and neck oncologic surgery Hanasono, M. M., Utley, D. S., Goode, R. L. LIPPINCOTT WILLIAMS & WILKINS. 2001: 1719-1725

    Abstract

    To explain the applications, technique, and potential complications of the temporalis muscle flap used for immediate or delayed reconstruction of head and neck oncologic defects.Fresh cadaver dissection and 5-year retrospective chart review.A fresh cadaver dissection was performed to illustrate the surgical anatomy of the temporalis muscle flap with attention to specific techniques useful in avoiding donor site morbidity (facial nerve injury and temporal hollowing). A chart review was performed for 13 consecutive patients from the last 5 years who underwent temporalis muscle flap reconstruction after oncologic resection of the lateral and posterior pharyngeal wall, hard and soft palate, buccal space, retromolar trigone, and skull base.Patient follow-up ranged from 2 to 45 months. Nine patients had radiation therapy. There were no cases of flap loss. Resection of the zygomatic arch followed by wire fixation facilitates flap rotation and minimizes trauma to the flap during placement into the oropharynx. Preservation of the temporal fat pad attachment to the scalp flap decreases temporal hollowing and protects the facial nerve. Replacing the zygoma and preserving the anterior third of the temporalis muscle in situ further diminishes donor-site hollowing.Compared with other regional flaps, such as the pectoralis myocutaneous flap, the temporalis muscle flap is associated with low donor-site esthetic and functional morbidity and offers great flexibility in reconstruction. The temporalis muscle flap is a useful, reliable flap that belongs in the armamentarium of surgeons who are involved with reconstruction of head and neck tissue defects.

    View details for Web of Science ID 000171422900009

    View details for PubMedID 11801932

  • Current status of topical nasal antimicrobial agents Goh, Y. H., Goode, R. L. JOHN WILEY & SONS INC. 2000: 875-880

    Abstract

    The nasal cavity and paranasal sinuses are probably one of the last frontiers in the head and neck region where the use of topical antimicrobial agents is not yet established. Although the anatomy of the nasal cavity and the paranasal sinuses can theoretically be exploited for the administration of antimicrobials in rhinosinusitis, very few studies have been conducted to test the feasibility of this mode of therapy. We review the anatomical and physiological factors that should be considered in the use of topical nasal antimicrobial agents and the current status of topical nasal antimicrobial usage, and we make recommendations for the administration of topical nasal antimicrobial agents.

    View details for Web of Science ID 000087494900001

    View details for PubMedID 10852500

  • Prevention and correction of temporal hair loss in rhytidectomy Brennan, H. G., Toft, K. M., Dunham, B. P., Goode, R. L., Koch, R. J. LIPPINCOTT WILLIAMS & WILKINS. 1999: 2219-2225

    Abstract

    Routine incisions in the temporal area for rhytidectomy often remove hair-bearing skin anterior to the ear. This results in a cosmetic deformity, making the surgical intervention clearly visible. This is especially problematic for revision rhytidectomy or for patients with naturally high hairlines. This article describes a systematic approach to the temporal hairline and introduces a novel, hair-bearing, transposition flap that corrects iatrogenic loss of the preauricular tuft of hair.

    View details for Web of Science ID 000083854900043

    View details for PubMedID 11149791

  • Advantages of a new miniature hearing aid for mild to moderate hearing loss Goode, R. L., Krusemark, J. LIPPINCOTT WILLIAMS & WILKINS. 1999: 1919-1923

    Abstract

    To evaluate the performance of a new, miniature, behind-the-ear hearing aid designed for individuals with mild to moderate high-frequency hearing loss who need an aid but are reluctant to try one. The aid is essentially invisible, leaves the ear canal open, and can be fit in less than 30 minutes without an ear impression. The cost is less than $500.A 4-week trial of the aid in 63 ears (62 subjects) with mild to moderate bilateral hearing loss.A questionnaire was completed at the end of the study by each subject asking them to evaluate several features of the aid (cosmesis, comfort, understanding speech, amplification, and so forth) and to compare their unaided performance in quiet and in noise with the test hearing aid. A rating scale of 1 to 10 was used, with 10 being excellent and 1 poor.Subjective improvement in understanding speech in both quiet (5.8-->7.3) and noise (4.6-->5.9) occurred with the aid. Cosmesis, comfort, and appearance were highly rated (mean scores, > 8).This aid appears to have several features (comfort, cost, performance, and cosmesis) that make it ideal as a first aid for patients with mild to moderate losses.

    View details for Web of Science ID 000084030700004

    View details for PubMedID 10591347

  • Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy Utley, D. S., Goode, R. L., Hakim, I. JOHN WILEY & SONS INC. 1999: 683-686

    Abstract

    We hypothesized that the success rate of radiofrequency energy (RFe) tissue ablation of the inferior turbinate for nasal obstruction achieved by previous investigators would be improved by using a longer needle electrode and creating two lesions per turbinate.Ten patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. A 40-mm needle delivered RFe to two sites in each inferior turbinate. Patients used a visual analog scale (VAS) to grade nasal obstruction preoperatively and at 1 week and 8 weeks after surgery. Preoperative and postoperative digital images of the nasal cavity were graded for obstruction (0% to 100%) in a blinded manner.All patients (100%) were subjectively improved at 8 weeks. Mean obstruction (VAS) improved from 50%+/-21% to 16%+/-15% (right side) and from 53%+/-29% to 13%+/-13% (left side). Mean improvements were 68% (right side) (P = .004) and 75% (left side) (P = .001). Mean obstruction graded during blinded review of nasal cavity images improved from 73.5%+/-8% to 51%+/-8% (right side) and from 76%+/-6% to 64%+/-7% (left side). Of nine patients using medications for nasal obstruction before treatment, eight (89%) noted no further need for medications at 8 weeks.The use of RFe for submucosal tissue ablation in the hypertrophied inferior turbinate is an effective modality for reducing symptoms of nasal obstruction. Improved results may occur by using a longer needle and creating two lesions per turbinate. Of patients in this study, 100% reported improvement of nasal obstruction.

    View details for Web of Science ID 000080253000001

    View details for PubMedID 10334213

  • Acoustic effect of malleus head removal and tensor tympani muscle section on middle ear reconstruction Asai, M., Roberson, J. B., Goode, R. L. WILEY-BLACKWELL. 1997: 1217-1222

    Abstract

    In the reconstruction of ears with a missing incus, an incus replacement prosthesis (IRP) is commonly used to connect malleus and stapes. In some cases, it is necessary to resect the malleus head and/or section the tensor tympani muscle (TTM) tendon. The acoustic effects of these maneuvers have not been well studied. We performed experiments in a temporal bone model to measure the effect of these maneuvers on middle ear sound transmission. Measurements of umbo and stapes displacement were made before and after malleus head removal and TTM section plus incus replacement with an IRP. After malleus head removal, there was a peak gain in stapes displacement of 6 dB below 0.5 kHz and 8 dB above 2.5 kHz. TTM section had a similar but lesser effect. A clinical example is described.

    View details for Web of Science ID A1997XV10400011

    View details for PubMedID 9292606

  • Contemporary management of the aging brow and forehead Koch, R. J., Troell, R. J., Goode, R. L. WILEY-BLACKWELL. 1997: 710-715

    Abstract

    Management of the aging brow and forehead has recently evolved based on available innovative technologies. Likewise, procedure-specific indications have changed based on collective surgical experiences. No longer is the approach based solely on hair pattern or degree of brow ptosis. Patients require varying combinations of brow elevation (prior to blepharoplasty), correction of brow asymmetries, and hairline-preserving forehead elevation. Some may only require excisional or paralytic procedures of the frontalis muscle (horizontal forehead creases), corrugator supercilii muscles (vertical glabellar furrows), and procerus muscle (horizontal glabellar furrows). We present a 3-year experience using a problem-specific approach. This incorporates endoscopic technology, botulinum toxin type A purified neurotoxin complex (Botox, Allergan, Irvine, CA) intramuscular injection, and traditional procedures such as the coronal, pretrichial, midforehead, and direct browlift. Current indications, patient selection, and results are also discussed.

    View details for Web of Science ID A1997XC73700002

    View details for PubMedID 9185724

  • Serum-free keloid fibroblast cell culture: An in vitro model for the study of aberrant wound healing Koch, R. J., Goode, R. L., Simpson, G. T. LIPPINCOTT WILLIAMS & WILKINS. 1997: 1094-1098

    Abstract

    The purpose of this study was to develop an in vitro serum-free keloid fibroblast model. Keloid formation remains a problem for every surgeon. Prior evaluations of fibroblast characteristics in vitro, especially those of growth factor measurement, have been confounded by the presence of serum-containing tissue culture media. The serum itself contains growth factors, yet has been a "necessary evil" to sustain cell growth. The design of this study is laboratory-based and uses keloid fibroblasts obtained from five patients undergoing facial (ear lobule) keloid removal in a university-affiliated clinic. Keloid fibroblasts were established in primary cell culture and then propagated in a serum-free environment. The main outcome measures included sustained keloid fibroblast growth and viability, which was comparable to serum-based models. The keloid fibroblast cell cultures exhibited logarithmic growth, sustained a high cellular viability, maintained a monolayer, and displayed contact inhibition. Demonstrating model consistency, there was no statistically significant difference between the mean cell counts of the five keloid fibroblast cell lines at each experimental time point. The in vitro growth of keloid fibroblasts in a serum-free model has not been done previous to this study. The results of this study indicate that the proliferative characteristics described are comparable to those of serum-based models. The described model will facilitate the evaluation of potential wound healing modulators, and cellular effects and collagen modifications of laser resurfacing techniques, and may serve as a harvest source for contaminant-free fibroblast autoimplants. Perhaps its greatest utility will be in the evaluation of endogenous and exogenous growth factors.

    View details for Web of Science ID A1997WM06000027

    View details for PubMedID 9091908

  • Transcalvarial suture fixation for endoscopic brow and forehead lifts Newman, J. P., LAFERRIERE, K. A., Koch, R. J., NISHIOKA, G. J., Goode, R. L. AMER MEDICAL ASSOC. 1997: 313-317

    Abstract

    To evaluate the safety and effectiveness of transcalvarial suture fixation during endoscopic repair of brow ptosis.Case series.A private ambulatory surgicenter and a Veterans Affairs Hospital.Fifty patients with brow ptosis with minimum follow-up of 12 months.Patients had improvement in brow position in all cases. There were no adverse effects of performing cortical tunnels and suture fixation.Transcalvarial suture fixation can be performed safely with good to excellent results and avoids the need for screw or plate fixation.

    View details for Web of Science ID A1997WN50200011

    View details for PubMedID 9076239

  • Surgical morbidity of neck dissection after chemoradiotherapy in advanced head and neck cancer Newman, J. P., Terris, D. J., Pinto, H. A., Fee, W. E., Goode, R. L., Goffinet, D. R. ANNALS PUBL CO. 1997: 117-122

    Abstract

    The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.

    View details for Web of Science ID A1997WH40500005

    View details for PubMedID 9041815

  • Power microdebrider for functional endoscopic sinus surgery Goode, R. L. SAGE PUBLICATIONS LTD. 1996: 676-677

    View details for Web of Science ID A1996UF98100029

    View details for PubMedID 8643288

  • SOUND PRESSURE GAIN PRODUCED BY THE HUMAN MIDDLE-EAR Kurokawa, H., Goode, R. L. MOSBY-YEAR BOOK INC. 1995: 349-355

    Abstract

    The acoustic function of the middle ear is to match sound passing from the low impedance of air to the high impedance of cochlear fluid. Little information is available on the actual middle ear pressure gain in human beings. This article describes experiments on middle ear pressure gain in six fresh human temporal bones. Stapes footplate displacement and phase were measured with a laser Doppler vibrometer before and after removal of the tympanic membrane, malleus, and incus. Acoustic insulation of the round window with clay was performed. Umbo displacement was also measured before tympanic membrane removal to assess baseline tympanic membrane function. The middle ear has its major gain in the lower frequencies, with a peak near 0.9 kHz. The mean gain was 23.0 dB below 1.0 kHz, the resonant frequency of the middle ear; the mean peak gain was 26.6 dB. Above 1.0 kHz, the second pressure gain decreased at a rate of -8.6 dB/octave, with a mean gain of 6.5 dB at 4.0 kHz. Only a small amount of gain was present above 7.0 kHz. Significant individual differences in pressure gain were found between ears that appeared related to variations in tympanic membrane function and not to variations in cochlear impedance.

    View details for Web of Science ID A1995RZ48900002

    View details for PubMedID 7567003

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