|Year : 2001 | Volume
| Issue : 1 | Page : 34-40
Selected abstracts from the second international congress of the jordanian society of otorhinolaryngology, head and neck surgery, 25-27 october 2000 Amman, Jordan
|Date of Web Publication||9-Jul-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Selected abstracts from the second international congress of the jordanian society of otorhinolaryngology, head and neck surgery, 25-27 october 2000 Amman, Jordan. Saudi J Otorhinolaryngol Head Neck Surg 2001;3:34-40
|How to cite this URL:|
. Selected abstracts from the second international congress of the jordanian society of otorhinolaryngology, head and neck surgery, 25-27 october 2000 Amman, Jordan. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2001 [cited 2021 May 5];3:34-40. Available from: https://www.sjohns.org/text.asp?2001/3/1/34/289360
| Memorial Lecture|| |
Dr. Hassan Badran
A famous Andalusian Arab Physician, born and died in Seville 1072 - 1162 A.D. Avenzoar family originated in Arabia. His grandfather traveled to the east studied and practiced medicine in Baghdad, Cairo and Tunisia.
The practice of Avenzoar has influenced medical medicine because he resorted to logic and experimentation and abstained from astrology and mythology. Although he was inspired by Greek Medicine (it became Arabic) He was a close friend to Averroes, the well known Andulsian philosopher. Avenzoar wrote many books, some translated to Hebrew and Latin.
I consider Avenzoar one of the earliest pioneers of E.N.T. specialty because of the following practices.
- He described the middle ear infection and treatment.
- Removal of F.bodies from the nose.
- Anosmia and treatment.
- Nasal polyposis (Multipod disease) and treatment.
- Removal of F. bodies from the ear.
- Engorgmentof tongue and Uvula + treatment.
- Facial paralysis and treatment.
- Reccurret laryngeal nerve paralysis and treatment.
- Tuours of trachea + eosophagus + treatment, to- Reduction of nasal fracture.
- Experimental tracheostomy on goat.
- He used a hollow metallic tubes for feeding patients with dysphagia.
| Otitis Media And Antibiotic, Sense Or Nonsense|| |
Prof. Schmelzer, Bert
A.Z. Middelheim Lindendreef Antwerp - Belgium
In children, otitis media represents a common infectious pathology of the middle ear cavity, the antrum and the mastoid. Since many years, this syndrome has been preferably treated with antibiotics. We reconsidered the prescription behaviour of most physicians in the light of the experience of a Dutch Group of General practitioners. Our analysis revealed that only in the highly exceptional number of cases a treatment with antibiotics is required. To this group of exceptions belong children under 12 months of age and infections induced by streptococcus pneumoniae. We propose to install a treatment with antibiotics only in cases the infection recurs within three weeks time. In other condition antibiotics are not obligatory. Treatment of pain symptoms and release of (middle ear) pressure by means of paracentesis are frequently apply as highly effective alternative strategies. It is our conviction that the use of antibiotics should be strictly confined to a restricted number of indications to prevent potential resistances as well as a negative impact on the immunity system.
| Cochlear Implant and middle ear implant|| |
Prof. Jean-Pierre Bebear Bordeaux- France
The cochlear implant consists in surgical implanting electronic prosthesis and direct stimulation of cochlear nerve by intracochlear electrodes.
It’s, indicated for total or profound bilateral deafness, post and pre lingual, acquired or congenital without possibility of conventional hearing aid. The cochlear implantation requires a multi disciplinary team (ENT, speech therapist, hearing aid dispenser, psychologist and psychiatrist for children) for the realization of complete evaluation and re-education. The implants used in our department are Nucleus and Clarion Implant witch common points are: multielectrode, under-sktn stimulator, microphone and speech processor, The Surgical technique consists in Lenhardt incision, cortical mastoidectomy with large posterior tympanotomy and placement of the electrode into the cochlear canal then fixation of the receptor and stimulator to the cortical bone. The results are very encouraging- A normal conversation is possible in 10% of eases, the speech discrimination with labial reading is good. Familiar noise recognition and alert reaction are normal. The prosthetic grain is 30 to 45 dB for all children with limited psychological and affective disorders. A normal education is more and frequent with early implantation. The middle ear implant represent a significant improvement in the treatment of hearing impairment. The vibrant Soundbridge is an implantable middle ear hearing device indicated for patients with a symmetrical bilateral hearing loss after failure of conventional hearing aid. The middle ear function and tympanometry must be normal. A retrocochlear pathology must be eliminated. The device consists in tile surgical implantation of vibrating Osscilular Prosthesis and the externally worn Audio processor. A floating mass (FM’T‚) is attached to the long process of the incus which is a titanium clip and reproduces, amplifies the natural movement of the ossicular chain. The surgery consists in mastoidectomy with large posterior tympanotomy, fixation of internal receiver then placement of the FMT on the incus.
To date, there is 350 implanted patients since 1996. The results are very encouraging. The immediate benefits are: elimination of the occlusion effect, absence of feedback, improving sound quality of own voice and natural sound quality. The functional gain is same or superior to conventional hearing aid. The middle car implant is an interesting alternative for unsatisfied hearing aid users.
| Partially - Implantable Middle Ear Electromagnetic Hearing Device|| |
Emerging technology soon provide the hearing impaired with more functionally-acceptable methods of sound amplification.
The SOUNDTEC DDHS is a partially implantable hearing device now under clinical application in a controlled study. The DDHS implantable portion of a tiny hermetically sealed magnet.
This is attached to the incudo-stapedial joint in an outpatient procedure using a trans-canal stapedectomy approach under local aanesthesia.
External components of the device consists of a wide dynamic range compression sound processor,presently configured behind the ear, and an electromagnetic coil assembly placed in a deep well-vented ear canal mold.
Advantages of this approach and device include ease speed of the surgical procedure, abscnce ot implanted electronics, and functional excellence as demonstrated in early clinical trials.
Following a five-patient feasibility study, the United States Food and Drug Administi-ration approved the current clinical trial. Preliminary results of this study will he revealed and compared to those obtained with well-fitted conventional hearing aids.
| A topical steroid without an antibiotic efficiently cures external otitis.|| |
Prof. Sten Hellstrom, Emgrard P.
Department of Clinical Sciences, Otorhinolaryngology, University Hospital of UMEA UMEA Sweden.
External otitis, one of the most common diagnosis in otorhinolaryngological practices occurs in various conditions in which the ear canal skin is compromised. Though it is not a life threatening disease, external otitis causes discomfort and pain and results in many costly visits at the outpatient office. The inflammatory process involved in external otitis is not clearly defined and as a result, s dry, red or moist inflamed/infected external auditory canal can be treated in various ways. In a clinical survey on Swedish therapy strategies for external otitis, 11 well-defined groups of topical and systemic agents were distinguished. These included giucorticoidd, glucocorticoid with antibiotics, and an acid with antibiotics, an ethanol mixture, antimycotics, oils and dyes for topical administration and anthista- rnines, antimycotics and antibiotics for systemic treatment.
A normal healthy ear canal contains bacteria e.g. staphylococcus albus, alpha hemolytic streptococci and even pseudomonas aerruginosa. However, many of the bacteria and fungal infections of the ear do not start until the skin in the canal is traumatized or exposed to extreme humidity. To create external otitis it therefore seems logic to primary interfere with these.
In the clinical study 30 patients with external otitis received betamethasone dipropriat in a 0.05% solution for 11 days. The external ear canal status improved rapidly and all cases except one were cured at day lq. Eighty percent of the ear canals showed positive cultures for bacteria. The study suggests that external otitis . whether culture-positive or not, can be cured using a group III steroid alone.
The clinical results encouraged us to develop an animal model for external otitis which rests on mechanical irritation of the ear canal skin. In this experimental otits condition we compared a group III steroid, betamethasone dipropionate, which a group 1 steroid, hydrocrtisonee, with an antibiotic added. The group III steroid cured the external otitis more rapidly than a weaker steroid with antibiotics added whether or not the ear canal was infected, and whether or not the infection was caused by either bacteria or fungi.
It is concluded that a strong steroid cures external otitis more efficiently than a weaker steroid with antibiotics added. This suggestion will now be investigated in a full-scale randomized clinical study.
| The relation between age & time of cochlear implantation|| |
Mohammad Jamal A. Makhdoum, Saudi Arabia SM Snik, Anneke M. Vermeulen, Jan PL Brokx and Paiul Van Den Broek, Netherlands.
The issue of whether an upper age limit should be set for cochlear implantation on congenially dead subjects has often been debated. To gain more insight, the speech perception abilities were analyzed of 12 congenitally deaf subjects whose age at the time of cochlear implantation ranged from 4 to 33 years. Subjects implanted during adulthood only showed progress during the first few months after the speech processor had been fitted and their long- term results were poor compared to those of children implanted early in life. This latter group showed steady improvement over the whole evaluation period. The present results support the notion that the earlier in life Implantation is performed, the better the development of speech perception. Based on the progress-over-time profiles and data on actual daily use of the cochlear implant, it can be suggested that implantation of congenitally deaf subjects during or after puberty offers only limited benefit.
| Tympanosclerosis: Review of literature and incidence among patients with middle ear infection.|| |
Saad Asiri, MD Alaa Hasham, MD, Fatma Al Anazy, MD, Seraj Zakzouk, MD, FRCS, Adel Banjar, MD, FRCS.
Security Forces Hospital, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.
The aim of the study was to review the literature of tympanoslcerosis espicially its pathogenesis, to study the general incidence of tympanosclerosis among patients with chronic suppurative otitis media (CSOM), its association with cholesteatoma and also the type of hearing loss as well as its relation to the degree and site of tympanosclerosis.
Seven hundred and seventy-five patients with (CSOM) were studied retrospectively. A lull history was taken and through ENT examinations were carried out.
Pure tone audiograms (PTA ) of all patients were done and analyzed. The operative finding of tympanosclerosis as well as middle ear status were inspected. The incidence of tympanosclerosis was found to be 11.6% ( 90 patients out of 775 CSOM cases ). Most tympanosclerosis cases had dry ear, ( 85.6% ). Of the 57.8 per cent who had myringosclersosis, there PTA showed an AB gap 20-40 dB. When sclerosis affect both tympanic membranes and middle ear,61% of patients had an AB gap >40.The association of cholesteatoma and tympanosclerosis may be regarded as uncommon,2.2%
| Epidemiology of hearing loss in Omani population. MJ Al Khabori, Samiya Al Harthhy, ShaikhaAI Mujaini, Fatma Bakhi.|| |
Al Nahdha Hospital Muscat- Sultanate of Oman.
The Ministry of Health in collaboration with World Health Organization carried out a community based national survey for causes of hearing loss and common ear disease between October 1996 and February 1997. Results of this survey revealed that the national prevalence of bilateral deafness was 5.5%. The severe type of hearing disability (disabling deafness ) was prevalent at a rate of 2.1%. Chronic suppurative otitis media with effusion and dry perforation of the tympanic membrane were the major causes among Omani population below 25 years of age and presbycusis was the major causative agent in Omani population above 45 years of age. The results strongly point out the need for strengthening the primary era health care component in Oman.
| Hearing survey related to the age of diagnosis of children with sensorineural hearing loss in Jordan.|| |
Asem El-Omaari, MDKHMC Amman, Jordan.
Objectives: Early identification and intervention of hearing impaired children are accepted as important factors of preventive measures of childis health care. Ideally identification and rehabilitation of congenital hearing loss should not be delayed beyond the age of six.
Methodology: This study was conducted on 800 hearing impaired children using hearing threshold measurement to identify whether these objectives have been achieved in Jordan.
Results: The average age of diagnosis is 3.8 years. The gap between the age of prenatal suspicion and the age of> diagnosis is about 2 years. There is a strong negative correlation between the degree of hearing loss and the age of diagnosis. On average mild hearing loss appears to be diagnosed at about 7 years, moderate hearing loss is at 4 years, severe hearing loss at 2.6 years and profound hearing loss at 1.6 years.
Conclusion and Recommendations: It can be concluded from this study that there is unacceptable delay in the diagnosis of hearing loss in Jordan. Evidently, this delay is due to poor awareness and lacked appreciation of the health professionals and public to the importance of early identification, early intervention and methods of testing hearing threshold of neonates and infants. There is a real need in Jordan for adoption of universal hearing nscreening program for neonates and infants.
| Risk factors for Bell’s palsy|| |
Salman Al-Assaf, MD; Mohammed Holly, MD.
From the Department of Otolaryngology, Prince Ali Hospital, Karak, Jordan.
From the Department of Internal Medicine, Prince Ali Hospital Karak, Jordan.
Objective: To assess the incidence of risk factors like hypertension, diabetes and lipid disturbance in a group of patients with Bellis palsy.
Methods: This was a prospective study involving 82 patients with Bell’s palsy seen at Otolaryngology and Internal Medicine Departments at Prince Hashem Hospital 1998, and Prince Ali Hospital in 1999. All patients were tested for diabetes melli- tus, hypertension and hyperlipideamia, unless they were already diagnosed; in this case they were checked for control..
Results: 31.7% of patients with Bell’s palsy were found to be hypertensive, 65.3% of them lad uncontrolled hypertension. 25.6% of patients were diabetic, half of whom lad uncontrolled diabetes. A mixture of diabetes and hypertension was found in 5 patients. 14.6% of patients in this study had abnormal lipid levels, 83.3% of them had high triglyceride levels, and 90% were diabetic.
Conclusion: There is still some evidence to suggest that diabetes mellitus and hypertension especially if they are not controlled, can be responsible, or at least, considered in as risk factors for a number of cases of Bell’s palsy; although this correlation is less evident in other published studies.
Key Words : Bell’s palsy, Risk factors
| Rhinology - Allergy|| |
Pro Dr. Claus Bachert
Ghent University Hospital, Belgium.
Nasal polyposis (NP) is believed to be a multifac- trial disease that is frequently associated with asthma and other respiratory diseases. Etiology and pathomechanism of this disease, are so far ill- defined. The abundance of eosinophils in nasal polyps is the first key question ‘to understand this disease. The second key question concerns the precise pathomechanism by which eosinophils may contribute to tissue damage, inflammation and polyp formation.
A main histological characteristic of the early stage of polyp formation is the presence of pseudo cysts in the core of the polyp. Albumin staining is pronounced and resembles a network-like structure within the pseudocysts. Numerous EG2 eosinophils are present at the top of the stage polyps, forming a subepithelial cap. The retention of albumin most likely driven the eosinophilic inflammation, therefore seems to be a hallmark of the polyp formation. We could demonstrate in several studies that (IL )- 5 I s the key cytokine for eosinopilic activation and survival in human nasal polyps. In our studies, IL- 5 was found in most of nasal polyp samples, whereas no IL-5 could be detected in controls. Comparison between nasal polyps and controls showed significant higher concentrations of IL-5, eotaxin and ECP in polyp supernatants. Interesting, IL-5, eotaxin and ECP protein concentrations were significantly correlated with each other, indicating the importance of the cytokine IL-5, and the cytokine eotaxin.
Eosinoplilic infiltration into tissues is usually followed by elimination of these cells by programmed cell death. Cytokine-mediated inhibition of the apoptosis clearly contributes to the accumulation of eosinophils in tissues. Simon et al., in a cooperation with our group demonstrated that,anti-ll,-5 mAb decreased tissue eosinophil numbers by inducing apoptosis in an ex-vivo polyp model. As shown by immunohistochemistry and mRNA analysis .eosinophils may be a major source of IL- 5 in Humans, and this is also evident for human nasal polyps. Thus, eosinophils could he able to create an autocrine
Loop for their activation and survival within the tissues.
These results offer an important new insight into the regulation of eosinophilic inflammation and the pathomechanism underlying polyp formation and will lead to specific therapeutic targets in the near future.
| Electron microscopic and functional aspects of the human vomeronasal organ.|| |
Volker Jahnke, M.D., F.A.C.S.
Berlin - Germany
The vomeronasal organ or Jackobson Organ is essential for phermone detection and reproduction behaviors in most mammals. The purpose of this presentation is to describe the fine studies show a duct-like invagination of the epithelium surrounded by numerous exocrine glands with short ducts; their fine structure suggests serous secretion.
In the depth of the invagination, pseudostratified columnar epithelial cells are seen, with plump processes, kinocilia and microvilli at the apical cell membrane. There are several cell types which differ regarding their organelles and electron density; the light sensory cells exhibit neurofiliments. Underneath the typical basement membrane „ in the very vascular lamina propria. Numerous myelinated and unmyelinated axons are present. These morphological findings which are unique in the human body suggest that a chemosensory epithelium corresponding to the vomeronasal organ may exist . Its central connections and the possible functional significance for pheromone detection are unknown. Preservation of the vomeronasal organ in endonasal surgery could become important both clinically and medico legally, should function to be demonstrated in humans. Recent research suggesting such function, as well as medical and social aspects of phermones will be discussed.
| Scientific revolution and the chronic rhinosinusitis story|| |
Eugene B. Kern, MD May Clinic. USA.
Chronic rhinosinusitis is the most common, chronic disuse in the United States a number of questions that have been unresolved; for example, what is the cause of rhinosinusitis?. What drugs or treatment are FDA approved for chronic rhinosinusitis? How many patients have been cured with antibiotics? Why has the prevalence of the disease doubled in the past twenty years? Why do steroids work? If this is an allergic problem, why are allergic medications ineffective? Perhaps a better question is how can bacteria invade the tissues and cause acute exacerbations in chronic rhinosinusitis, and what is the current paradigm for thinking about chronic rhinosinusitis?
Paradigm is a system of thinking and assumptions that are used in tile every day practice And research of a given field. An example of a paradigm and a paradigm shift in history is the geocentric theory of the universe to the heliocentric theory of universe. First recent work by colleagues in our laboratories have shown that in chronic rhinosinusitis, the eosinophil is present in almost all cases. In addition, our investigations have shown that fungi is present in almost all cases but not in the tissue but in the mucus.
The reason there has been a problem in trying to understand this disorder is that we were looking in the tissue and not in the mucus. The reaction seems to be occurring in the mucus. We believe the pathophsiology is primarily that of the eosinophil leaving the vasculature, going through the epithelial cells, finding the target fungi, and then destroying the fungi. The eosinophil releases its major basic protein,, which not only destroys the fungi but also injures the epithelium. This then allows secondary bacterial invasion.
We propose a name change from chronic rhinosinusitis to eosinphilic fungal rhinosinusitis because it is descriptive and best explains the current thinking and answers many of the anomalies of the old bacterial paradigm with the new paradigm in which the disorder is stimulated by the fungus and mediated by the eosinophil.
| Histopathological results of 160 nasal biopsies at KHMC|| |
Hassan Al-Husban, MD, Nadia Hatter, MD. K.H.M.C. Amman-Jordan
Objectives: to study the results of 160 biopsies taken from the nose and paranasal sinuses in ENT department, KHMC. Percentage and distribution of benign and malignant tumors according to age, sex and site of origin were assessed.
Materials and Methods: this is a retrospective study of 160 cases treated over a period of 8 years in ENT department, KHMC in Jordan between January 1990 and December 1997. The results of these biopsies were taken from histopathological reports and medical data from medical files.
Results: From the 160 patients submitted to nasal biopsy there were 130 patients (81.25%) with non-neoplastic lesions. The majority of them have nasal polyps (80 patients,50% of all nasal biopsies. 20 patients (12%) with benign neoplasms. The most common benign nasal neoplasm taken for biopsy was inverted papilloma (8 patients,5%)• 10 patients (6.25%) with malignant neoplasms. The most common malignancy were squamous cell carcinoma (6 patients,3.75%).
No evidence of malignancy was reported in 100% of patients who were diagnosed preoperatively as bilateral nasal polyps.
Conclusions: The prevalence of different nasal masses was assessed. It was similar to many published series.
preoperative diagnosis, especially when based on proper clinical investigations go with histopathological diagnosis in most cases.
Bilateral nasal polyps are almost always benign, and no need to repeat the biopsy every time.
Antrochoanal polyps are more common in children and adolescents (age less than 20 years).
Squamous cell carcinoma is the most common malignant nasal tumor, and may present in different age groups.
Rare tumors such as squamous cell carcinoma of the nasal septum, embryonal rhabdomyosrcoma and chodrosarcoma were encountered in this study.
Keywords: nasal biopsy, neaoplastic, and non-neo- plastic lesions, benign and malignant tumours.
| Pediatric laryngotracheal stenosis|| |
George H. Zalzal,MD Washington D.C., USA.
Implement a plan to evaluate pediatric laryngotracheal stenosis and the factors to be considered in implementing successful treatment. Learn basic endoscopic and open surgical techniques, how and when to implement them and what outcome to be expected regarding airway, voice and deglutition.
Pediatric laryngotracheal stenosis is a serious disease with grave consequences to both patients and family when not adequately assessed and treated.
Systematic evaluation of supraglottis glottic, subglottic and tracheal lesions is achieved by physical examination, radiology and endosocpy. The assessement of severity, length, consistencey and multicentricity of the stenosis is essential to decide the need for treatment and whether it will be endosocpic or open surgical repair.
The decision making process regarding the type of procedure ranging from single stage repair to resection and multi stage repair with grafts and stents is described. Details of grafting and stents with examples are provided. Preoperative, perioperative and postoperative diagnostic and treatment measures such as reflux management, airway ventilatory support, sedation, use of laser and antibiotics can have beneficial or deleterious ellects. Recommendations will be made regarding the indications for their use. Once it is determined that tne Procedure has been successful, decanulation process is started.
Successful outcome of over 90% decanulation rate form a single procedure should be achieved.
Outocme measures regarding airway patency, voice and feeding difficulties will be discussed.
| Adoptive Immunotherapy in the management of head and Neck Cancer|| |
The Cleveland Clinic Foundation U.S.A.
Objective: To evaluate the feasibility and toxicity of systemic adoptive cell immunotherapy in patients with unresected squamous cell carcinoma of the head and neck (SCCHN).
Design: Non-randomized phase I clinical trial.
Setting: academic tertiary care hospital.
Patients: Between April 1996 and September 1998, seventeen patients with confirmed recurrent and metastatic squamous cell carcinoma of the upper aerodiagestive tract were enrolled. Two patients did not receive T cells due to poor vaccine response. Fifteen patients were successfully treated with T cell immunotherapy.
Intervention: patients were vaccinated on the thigh with GM-CSF following by 3 additional daily injections of GM-CSF at the vaccination site. Eight to ten days later, tumor vaccine draining inguinal lymph nodes were resected and lymph node lymphocytes activated with staphylococcus enterotoxin and expanded in interleukin-2 in vitro. Resulting Cultured cells were infused into patients peripherally on an outpatient basis.
Results: infusion toxicity was limited to grade 2 reactions in 3/16 treatments. One patient required overnight hospitalization for fever and emesis. Median cell expansion was 37 fold (range 4-416x) a and median cell close was 7.5 x 109 (range 1.3 x 108 - 4.2 x 1010). Infused cells were predominantly, CD3+ (<91%) being a mixture of CD4+ CD8+ cells. Three patients demonstrated favorable clinical stabilization of previously progressive disease. Two patients experienced favorable clinical courses following adoptive T cell transfer including one who is three after surgical resection of a vertebral body metastasis.
Conclusions: adoptive immunotherapy is a technically feasible and safe treatment with low toxicity which may demonstrate therapeutic activity with unresectable SCCHN.
| Oncogene expression in laryngeal carcinoma.|| |
Cairo - Egypt
Education Objective: At the conclusion of the presentation, the participant should be ablle to discuss tile potential role of oncogene in carcinogenesis of laryngeal carcinoma. Despite the advancement in diagnosis and of laryngeal carcinoma, there has been no significant improvement in the survival rate in the last three decades. This failure emphasizes the need to look at cancer from different angle. Recently the study of oncogenes has significantly contributed to improve our understanding of cancer at the molecular level. This article discusses the current experience of Ain Shams University in oncogene expression in laryngeal carcinoma. Three different oncogenes were studied: C-erbB 2, p21 Ras and EGFR. The study involved 100 patients with different benign, pre- malignant and malignant laryngeal lesions. Immunohistochemistery using specific monoclonal antibody was used to study the oncogene expression in laryngeal tissues. The overall results showed : a- significant association between oncogene expression and carcinogenesis of laryngeal carcinoma: b-pre-malignant lesions had significant oncogene expression confirming its premaligant nature, and necessitating aggressive treatment and closer follow up of these lesions. C- although the mucosa near the malignant lesion were normal by hemotoxylin staining, it showed significant expression of oncogene which may explain recurrence d-oncogene expression was associated with histological grading, indicating aggressiveness of the tumor.
This study supports the role of oncogenes in etiology of laryngeal carcinoma and suggests the addition of another M to classical TNM classification of cancer where this second M denotes molecular attribute.
Keywords: C-erbB 2, EGFR, oncogene, laryngeal cancer.