bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracheotomy in Children with Juvenile-Onset Recurrent Respiratory Papillomatosis: The Children's Hospital of Pittsburgh Experience
Authors: Shapiro Andrew M. , Rimell Frank L. , Pou Anna , Shoemaker David , Stool Sylvan E.
Published: October 2014

Despite the risk of airway obstruction, tracheotomy has been viewed with trepidation in the management of recurrent respiratory papillomatosis (RRP). The literature suggests that the injury associated with the tracheotomy site may initiate the progression of disease to the distal airway. Alternatively, patients who require tracheotomy for RRP may be predisposed to distal spread because of more aggressive disease. In an effort to clarify this issue, we reviewed the Children's Hospital of Pittsburgh experience with 35 patients with RRP between 1984 and 1994; 13 patients received tracheotomies. Tracheotomy patients presented at a younger age with more widespread disease, often involving the distal airway prior to tracheotomy. Although distal spread occurred in 50% of patients, it was generally limited to the tracheotomy site. Overall, outcome in the tracheotomy group was satisfactory. Complications related to the tracheotomy were rare. We conclude that tracheotomy is an appropriate option for significant airway compromise in patients with RRP.
Vocal Fold Paralysis following the Anterior Approach to the Cervical Spine
Authors: Netterville James L. , Koriwchak Michael J. , Courey Mark S. , Winkle Mark , Ossoff Robert H.
Published: October 2014

The anterior cervical approach is commonly used for access to the cervical spine. Vocal fold paralysis (VFP), a complication of this approach, is underrepresented in the literature. A review of the database of the Vanderbilt Voice Center revealed 289 patients with VFP, including 16 patients who developed paralysis as a result of an anterior cervical approach. The paralysis was on the right side in all but 1 patient. Compared to patients who developed VFP after thyroidectomy and carotid endarterectomy, patients with VFP after an anterior cervical approach have a higher incidence of aspiration and dysphagia, suggesting the presence of trauma to the superior laryngeal and pharyngeal branches as well as the recurrent branch of the vagus nerve. Two patients had partial return and 1 patient had complete return of vocal fold movement within 10 months. Of the remaining 13 patients, 8 underwent vocal fold medialization with improvement of symptoms. Two patients are 6 and 7 months postinjury and await vocal fold medialization. Two patients are 27 months and 45 months postinjury and are considering vocal fold medialization. The remaining patient was lost to follow-up. An anatomic-geometric analysis of the right and left recurrent laryngeal nerves was performed by using measurements obtained from computed tomography scans of 8 patients with idiopathic unilateral VFP, as well as experience gained through surgical and cadaveric dissections. We conclude 1) the anterior cervical approach may place multiple branches of the vagus nerve at risk; 2) because of anatomic-geometric factors, die right-sided anterior cervical approach may carry a greater risk to the ipsilateral recurrent laryngeal nerve than does the left; and 3) an understanding of the anatomy and geometry presented herein allows relatively safe exposure from either side of the neck.
Supraglottic and Pharyngeal Sensory Abnormalities in Stroke Patients with Dysphagia
Authors: Martin John H. , Diamond Beverly , Aviv Jonathan E. , Sacco Ralph L. , Keen Monte S. , Blitzer Dario Zagar Andrew
Published: October 2014

Dysphagia and aspiration are two devastating sequelae of stroke, accounting for nearly 40,000 deaths from aspiration pneumonia each year in the United States. While motor deficits in the larynx and pharynx are thought responsible for dysphagia and aspiration in stroke patients, no prior study has evaluated whether these patients also have sensory deficits. The aim of this study was to evaluate the sensory capacity of the laryngopharynx (LP) in supratentorial or brain stem stroke patients who presented with dysphagia. Fifteen stroke patients (mean age, 66.7 ± 13.8 [SD] years) were prospectively evaluated by means of our previously described method whereby air pulse stimuli were delivered via a flexible fiberoptic telescope to the mucosa innervated by the superior laryngeal nerve. There were 15 age-matched controls. No LP sensory deficits were found in any of the age-matched controls. In all stroke patients studied, either unilateral (n = 9) or bilateral (n=6) sensory deficits were identified. Deficits were defined as either a moderate impairment in sensory discrimination thresholds (3.5 to 6.0 mm Hg) or a severe sensory impairment (>6.0 mm Hg). These sensory discrimination thresholds were significantly greater than in age-matched controls (7.05 ± 0.17 mm Hg for the supratentorial group and 6.05 ± 1.22 mm Hg for the infratentorial group versus 2.61 ± 0.69 mm Hg for the controls). Among patients with unilateral deficits, sensory thresholds were moderately to severely elevated in all 9 cases on the affected side compared with the unaffected side (p < .01, Fisher's exact test). Moreover, the sensory thresholds of the unaffected side were not significantly different from those of age-matched controls (2.51 ± 0.25 mm Hg versus 2.61 ± 0.69 mm Hg, respectively). All 6 patients with bilateral deficits had severe impairments. The results of an outcome assessment in 13 of 15 patients revealed that 2 out of 5 patients with moderate LP sensory impairment and 5 out of 8 with severe impairment developed aspiration. Our results show for the first time that stroke patients with dysphagia have significant sensory deficits in the LP and that these impairments are likely to contribute to the development of aspiration.
Learning Disabilities and Central Auditory Dysfunction
Authors: Welsh Louis W. , Welsh John J. , Healy Michael P.
Published: October 2014

Hearing loss, whether peripheral or central, compounds the communication and educational problems of the learning disabled student A central auditory processing disorder uniquely interferes with both the input and integration of verbal information, further resulting in a potentially permanent cognitive dysfunction during the developmental period of acquisition of language. Illustrative cases are presented that indicate the panorama of cognitive dysfunction associated with the learning disabled status. Methods of evaluation and identification and diagnostic criteria are correlated with auditory, visual, and academic performance. Comments regarding clinical awareness, prompt recognition, and ensuing individualized remediation are submitted.
Subglottic Air Pressure: A Key Component of Swallowing Efficiency
Authors: Eibling David E. , Gross Roxann Diez
Published: October 2014

The relationship between tracheostomy and swallowing dysfunction has been long recognized. Often this dysfunction is manifested by aspiration, for which a number of etiologic factors may be responsible. Disruption of glottic closure has been previously demonstrated in association with the presence of an indwelling tracheostomy tube. The plugging or removal of the tracheostomy tube, or the use of an expiratory air valve, has been demonstrated to decrease aspiration and improve swallowing function. Measurement of subglottic pressure through an indwelling tracheostomy tube during swallowing demonstrated pressure peaks occurring concomitant with swallowing and laryngeal elevation. This presentation will review the evidence supporting the role of subglottic pressure rise in swallowing efficiency. Current investigational activity will be reviewed, and new areas for study will be suggested.
Atlantoaxial Subluxation and Cervical Osteomyelitis: Two Unusual Complications of Adenoidectomy
Authors: Baker Leslie L. , Bower Charles M. , Glasier Charles M.
Published: October 2014

Grisel's syndrome (atlantoaxial subluxation) and cervical osteomyelitis are two unusual complications of adenoidectomy. We present two patients; one with atlanto-axial subluxation following uncomplicated tonsillectomy and adenoidectomy, and one with cervical osteomyelitis following uncomplicated adenoidectomy. Both patients presented with persistent postoperative neck pain. Surgical intervention, as well as long-term intravenous antibiotics, was required. A high index of suspicion, as well as cervical spinal series with flexion-extension views, is necessary for diagnosis. Flexible nasopharyngoscopy and computed tomography of the cervical spine also aided in diagnosis and treatment planning. With early diagnosis and proper treatment, the prognosis is good. Neurologic sequelae were prevented in both of our patients.
Cystic Fibrosis and the Sinonasal Tract
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Cystic fibrosis is considered to be one of the most common fatal inherited diseases. Sinonasal manifestations are not outstanding as compared with those in the lower respiratory tract. Panopacification of the paranasal sinuses is, however, almost universal on radiologic examination of patients, although many of these patients do not have sinonasal symptoms. Approximately 10% to 20% of cystic fibrosis patients will eventually require surgical treatment of their sinuses. All treatment, including surgery, is transiently effective; none is curative.
Postintubation Arytenoid Subluxation
Authors: Talmi Yoav P. , Wolf Michael , Nusem-Horowitz Sima , Bar-Ziv Jacob , Kronenberg Jona
Published: October 2014

Arytenoid subluxation (AS), ie, malpositioning of the arytenoid cartilage with abnormal but existent contact between the joint surfaces, is an uncommon entity, and fewer than 70 cases have been reported, 26 of which were in a recently published series. Usually, AS is the result of upper airway instrumentation, and only a few cases were reported to occur with external trauma to the neck. Some predisposing factors and possible mechanisms have been suggested, but the reason for its occurrence remains obscure. Hoarseness and, to a lesser degree, dysphagia, odynophagia, cough, and sore throat may be indicative of AS. Diagnosis is established by the clinical course, laryngoscopy, and computed tomography. Electromyography and strobovideolaryngoscopy are additional diagnostic measures described. We report 7 cases of postintubation AS of long standing. Three of these patients had prior unilateral vocal cord paralysis, formerly undescribed as a possible contributing factor for AS. The pertinent literature is reviewed and treatment options are discussed.
Pediatric Sino-Orbital Desmoid Fibromatosis
Authors: Maillard Alberto A. J. , Kountakis Stilianos E.
Published: October 2014

Desmoid fibromatosis is a rare tumor of the head and neck. Only five cases involving the sino-orbital region have been previously reported in the literature. In this report we describe the sixth such case, involving a 2-year-old boy, and review the literature.
Autologous Fat Injection for Unilateral Vocal Fold Paralysis
Authors: Shindo Maisie L. , Zaretsky Lauren S. , Rice Dale H.
Published: October 2014

This study evaluates the efficacy of autologous fat injection for medialization of the paralyzed vocal fold. In 21 patients with unilateral vocal fold paralysis, autologous abdominal fat was injected into the thyroarytenoid muscle to achieve medialization. All patients were followed up with serial videolaryngoscopy and voice evaluation. At 2 months' follow-up, the voice was judged to be excellent in 10 patients, slightly breathy but significantly better than the preoperative voice in 6 patients, and markedly breathy in 4 patients. At 3 to 4 months' follow-up, of the 10 patients with excellent results, 5 maintained an excellent voice, 3 had developed slight breathiness, and 1 had developed severe breathiness. Long-term (6 to 12 months) results were available in 11 patients, and all of them maintained the same voice quality that was noted during the 3 to 4 months' examination. Magnetic resonance imaging of the larynx was obtained in 7 patients at intervals ranging from 1 to 7 months and compared to the baseline scan obtained at 1 week postoperative to assess the amount of fat remaining in the muscle. The images showed fat volume to persist, but a decrease in the fat signal was observed over time. The results suggest that the duration of medialization with autologous fat is variable, but appears to last at least 2 to 3 months. This loss of volume after 3 months seems to be due to absorption of the fat and possibly muscle atrophy. Autologous fat injection is relatively safe and easy to perform, and is an ideal method of temporary vocal fold medialization in patients in whom return of vocal fold function is expected.
Treatment of Chronic Paranasal Sinus Pain with Minimal Sinus Disease
Authors: Acquadro Martin A. , Montgomery William W.
Published: October 2014

A common problem for otolaryngologists are patients who present with recurrent, persistent sinus pain that appears out of proportion to the findings on physical examination. Often these patients have a history of recurrent sinusitis that required antibiotics or surgical intervention. Many have had repeated surgical procedures because of this pain. Other common past medical histories may include allergic rhinitis, facial trauma, or dental disease. Patients who have experienced documented acute sinusitis in the past will often present de novo with similar symptoms, but lack any objective evidence of a new active sinus infection. However, the diagnosis of sinusitis is not clearly removed from the patient's or clinician's mind, and the patient is further frustrated by the lack of adequate diagnosis, treatment, and resolution of symptoms. These patients may or may not be experiencing an upper respiratory tract infection or allergy with nasal drainage. Often, they are emotionally distraught from recurrent and persistent pain, the lack of resolution of their symptoms, dependency on narcotics and other analgesics, multiple consultations with a variety of clinicians, and the impingement of their symptoms on employment, interpersonal relationships, and societal and family obligations. If sinusitis is not found to be present, the otolaryngologist must help the patient understand this point, reassure him or her that the otolaryngologist will still be vigilant for the development of sinusitis, and refocus the history and workup for some other cause of the recurrent and persistent paranasal pain. We review various treatment approaches to paranasal pains that are not the result of sinusitis.
Microbiology of Tracheal Granulation Tissue Associated with Silicone Airway Prostheses
Authors: Brown Mark T. , Montgomery William W.
Published: October 2014

Granulation tissue formation and contraction is inevitable during the healing of open wounds. The presence of infection and a foreign body, such as a silicone airway prosthesis or other tracheotomy tube, magnifies this response. In airway reconstruction, wound contraction secondary to chronic inflammation is a liability. Cultures of granulation tissue were taken from 12 patients with silicone cannulas of T-Tubes. Polymicrobial colonization predominated, with variable combinations of gram-positive, gram-negative, and anaerobic organisms being present. On the basis of sensitivity data, amoxicillin-clavulanate potassium and ciprofloxacin hydrochloride were chosen as empirical antimicrobials. Anecdotally, impressive decreases in the quantity of granulation tissue were seen. We recommend a prospective trial to more accurately define the role of antibiotics in this setting.
Role of Substance P in the Vascular Response of Nasal Mucosa in Nasal Allergy
Authors: Konno Akiyoshi , Hanazawa Toyoyuki , Numata Tsutomu , Nagata Hiroshi , Terada Nobuhisa , Motosugi Hideaki
Published: October 2014

The effects of topically administered substance P (SP) on nasal blood flow and nasal airway resistance (NAR) were evaluated in 11 subjects with perennial nasal allergy. The change in NAR induced by SP was compared with those induced by nasal challenge with histamine, leukotriene EM (LTD4), and antigen. In doses ⩾ 16 nmol, SP caused a significant increase of nasal blood flow within 5 minutes that lasted for less than 20 minutes. In doses ⩾16 nmol, SP caused a dose-dependent, short-lasting, significant increase in NAR. The magnitude of the increase in NAR was LTD4 > SP > histamine when compared on a molar basis. Our results may suggest that SP released from C fiber terminals is partially involved in an early nasal vascular response after antigen challenge by acting on adjacent vascular smooth muscle to cause a transient vasodilatation of both resistance and capacitance vessels only while sensory stimulation persists in subjects with nasal allergy.
High-Resolution Computed Tomographic Evaluation of the Cochlear Capsule in Otosclerosis: Relationship between Densitometry and Sensorineural Hearing Loss
Authors: Güneri E. Alpin , Ceryan Kerm , Ada Emel , Güneri Ataman
Published: October 2014

Otosclerotic cochlear involvement is a rather frequent disease that has not been clearly understood in terms of diagnosis and management. Objective evaluation methods are needed to confirm the clinical diagnosis, investigate the relationship with hearing impairment, and validate the results of treatment In this study two ear groups with bone conduction hearing loss (BCHL) were investigated with audiometry and high-resolution computed tomography (HRCT). In the first group (n = 22) the diagnosis of fenestral otosclerosis was confirmed at operation; the second group (n = 9) was composed of ears clinically suspicious for purely cochlear involvement. Additionally, a control group (n = 14) of otologically normal ears was also studied. Foci of demineralization were demonstrated in 58% of the ears in the two groups; the sensorineural hearing loss (SNHL) in those ears was significantly worse than in those with normal radiologic findings. Three methods of HRCT densitometry were used to determine the abnormal regions in the cochlear capsule; the results suggested that hypodense regions were consistent with a greater degree of SNHL, in contrast to the hyperdense ones in ears with better cochlear reserves. Agreement was found between the location of the density change and the frequency topography of the SNHL; densitometric values were correlated with the bone conduction thresholds for certain frequencies. It is concluded that the spongiotic foci are responsible for the SNHL, since there was a correlation between their location and the SNHL frequency. The determination of better hearing in those ears with sclerotic foci supports the hypothesis that the sclerotic phase may not be a healing process following the spongiotic phase, and that it can be the first stage of the disease.
Metastatic Breast Carcinoma Presenting as Cavernous Sinus Syndrome
Authors: Ryan Matthew W. , Rassekh Christopher H. , Chaljub Gregory
Published: October 2014

From the Departments of Otolaiyngology-Head and Neck Surgery (Ryan, Rassekh) and Radiology (Chaljub), The University of Texas Medical Branch, Galveston, Texas.
Hodgkin's Disease: Old and Recent Clinical Concepts
Authors: Carbone Antonino , Gloghini Annunziata , Weiss Lawrence M. , Ferlio Alfio
Published: October 2014

The diagnosis of Hodgkin's disease (HD) is still primarily based on the histopathologic criteria presented by Lukes et al in 1965. Over the past three decades, however, advances in immunohistochemistry, molecular studies, and virologic findings have provided evidence that HD exhibits significant heterogeneity. Whereas the nodular sclerosis subtype is the major subset of the “classic” disease, it has become evident that the nodular, lymphocytic predominance subtype may represent a minor distinct subset, and possibly a distinct disease entity. Furthermore, there is strong evidence that the mixed cellularity subtype may be an Epstein-Barr virus-related disorder. Finally, based on phenotypic and genotypic features, the existence of a “continuum” between a fraction of HD cases, including the lymphocytic depletion subtype, and CD30-positive anaplastic large cell lymphomas has been suggested.
Study on Adhesion Factors in Lymphocyte Migration to the Middle Ear Mucosa
Authors: Bundo Junichi , Yoshida Kazuhide , Watanabe Noritake , Mogi Goro
Published: October 2014

We investigated influences of adhesion factors on the migration of antigen-specific IgA-forming cells (ASAFCs) to the middle ear mucosa by means of an in vitro lymphocyte binding assay. Peyer's patch (PP) lymphocytes from guinea pigs with mucosal immunization, which are rich in ASAFCs, more frequently bound with the inflamed middle ear mucosa than those of PP and spleen cells from animals with systemic immunization, in which antigen-specific IgG-forming cells (ASGFCs) were induced (p > .001). The bindings were not affected by antigenic and nonantigenic stimuli to the middle ear mucosa for producing otitis media. On human middle ear mucosa from 10 patients with acute mastoiditis and chronic otitis media, endothelial cells of newly grown vessels were stained strongly with intercellular adhesion molecule (ICAM)-1, and weakly with vascular cell adhesion molecule (VCAM)-1, platelet endothelial cell adhesion molecule (PECAM), and endothelial leukocyte adhesion molecule (ELAM)-1. Many lymphocytes bound mainly to these endothelial cells, and a few cells were observed bound to the basal portion of epithelial cells. The binding of lymphocytes was significantly, but not completely, inhibited by anti-ICAM-1 antibody (p < .001). These findings suggest that PP lymphocytes with activated mucosal immunity more frequently migrate to the inflamed middle ear mucosa, and that those migrations, after extravasation, may be regulated by the interaction between various binding factors and their receptors on lymphocytes, which is different from that of adhesion molecules and their ligands in the extravasation.
Effects of Peritonsillar Infiltration on Post-Tonsillectomy Pain
Authors: Podoshin Ludwig , Gerstel Rita , Goldsher Moshe , Fradis Milo , Vaida Sonia , Malatskey Shelton , Gaitini Luis
Published: October 2014

The concept that local infiltration of the operative area with a local anesthetic when using general anesthesia could alleviate postoperative pain is well known. We tested this concept on 129 patients scheduled for elective tonsillectomy. The patients were investigated in a double-blind, randomized study, and the operation was carried out via the standard technique of infiltrating the peritonsillar area preoperatively. The results indicated that preincisional infiltration of the tonsils with bupivacaine hydrochloride markedly decreased the intensity of pain following tonsillectomy, well beyond the immediate postoperative period.
Patterns of Persistent Otitis Media in the First Year of Life in Aboriginal and Non-Aboriginal Infants
Authors: Boswell Judith B. , Nienhuys Terry G.
Published: October 2014

Australian Aboriginal infants experience very early otitis media (OM). A previous study reported that OM with effusion (OME) or acute OM (AOM) was observed in the first 8 weeks of life in 95% of 22 Aboriginal infants, but that OME was seen in only 30% of 10 non-Aboriginal infants. Tympanic membrane perforation was reported for 1 Aboriginal subject at 8 weeks of age. This requires further investigation, because early OM onset has been demonstrated in non-Aboriginal groups to increase the risk of chronic and persistent ear disease in later childhood. This prospective study used otoscopy and tympanometry to describe the course of OM in infants examined repeatedly from soon after birth. Disease course was described in two ways, based upon earlier findings from other studies of Aboriginal schoolchildren. First, patterns of disease in the first year were identified; non-Aboriginal infants had occasional episodes of OME or AOM from which they recovered spontaneously, usually within 1 month; Aboriginal infants had persistent AOM, OME, or tympanic membrane perforation with discharge that rarely, if ever, resolved to normal. Second, conditional probabilities were calculated for ear state transitions at consecutive ear examinations, and a model of the course of OM was proposed for the Aboriginal infants. Results also suggested that binaural patterns of chronic OM described previously in Aboriginal schoolchildren may already be established in the first year of life. These findings will help service providers determine when to intervene to avoid the chronic consequences of early OM.
Diagnosing Nasal Hyperreactivity with Positional Rhinomanometry
Authors: Altissimi Guido , Rossetti Marco , Gallucci Luigi , Simoncelli Costantino
Published: October 2014

Positional rhinomanometry is a physiologic method for estimating nasal resistance, which is variable, difficult to predict, and linked to vasomotor activity of the functional system culminating in the turbinate valves. Thirty subjects suffering from allergic rhinitis, 25 patients affected by aspecific rhinitis, and 40 healthy controls underwent positional rhinomanometry. Test positions included the seated (baseline), supine, and recumbent (homolateral and contralateral to the nasal fossa under examination). In patients with perennial allergic rhinitis and in those with aspecific rhinitis, positional rhinomanometry elicited two pathologic responses: either an average percentage rise of more than 80% in nasal resistance in the supine and homolateral and contralateral recumbent positions compared with basal values, or a paradoxical fall in the supine and homolateral recumbent positions.
Pathology Consultation Thyroid Gland Ectopias
Authors: Batsakis John G. , El-Naggar Adel K. , Luna Mario A.
Published: October 2014

Failures of descent of the medial anlage of the thyroid and incomplete obliteration of its vertical tract lead to midline or near-midline ectopias such as lingual thyroid and thyroglossal cysts. Each poses special diagnostic and therapeutic considerations. “Ectopias” of the thyroid gland lateral to the carotid artery and jugular vein, however, cannot be readily explained by current embryological information. In these instances, and especially for intranodal thyroid tissue, a metastasis from an occult thyroid primary is the mandatory first consideration.
Sudden Deafness: A Comparison of Anticoagulant Therapy and Carbogen Inhalation Therapy
Authors: Kallinen Johanna , Laippala Pekka , Laurikainen Esa , Grénman Reidar
Published: October 2014

Sudden deafness (SD) is a sudden or rapidly progressive, partial or complete, typically unilateral sensorineural hearing impairment that has no known specific etiologic factor. This study was designed to compare, in a group of 168 consecutive patients with SD, the effect of anticoagulant therapy and carbogen inhalation therapy. Special attention was paid to the shape of the audiogram relative to the clinical outcome and the treatment modality. We found that the configuration of the audiogram of SD patients is prognostic of the outcome, and that patients with a low-frequency—sloping hearing impairment have a better prognosis compared to the patients with a high-sloping loss. Anticoagulant treatment was most effective in low-sloping hearing losses, while carbogen inhalation may be more effective for patients with high-sloping hearing losses.
Blood Flow in Common Carotid and Vertebral Arteries in Patients with Sudden Deafness
Authors: Ohinata Yoshimitsu , Haginomori Shin-Ichi , Makimoto Kazuo , Araki Michitoshi , Kawakami Michiro , Takahashi Hiroaki
Published: October 2014

Blood flow was measured in the common carotid artery (CCA) and the vertebral artery (VA) by the ultrasonic Doppler method in 14 male patients with sudden deafness and 70 normal adults. In the patients, blood flow on the affected side was slower than that on the normal side or that of the control group. Although these differences were not statistically significant in the CCA or in the VA, significant differences in the blood flow were noted between the group with a hearing loss of greater than 50 dB and the group with a loss of less than 50 dB. A negative correlation was found between blood viscosity and blood flow in both CCAs and both VAs. After stellate ganglion block (SGB), the blood flow of the CCA and VA increased on the side of the SGB and decreased on the opposite side. The changes in blood flow after SGB decreased with age, presumably because of changes in the blood vessel walls and a weaker response to sympathetic nerve receptors in the arterial wall.
Secretory Otitis Media in Adults: II. The Role of Mastoid Pneumatization as a Prognostic Factor
Authors: Sadé Jacob , Fuchs Camil
Published: October 2014

The sequelae of secretory otitis media (SOM) were monitored in 72 adult patients with SOM who were followed up for an average of 33 months. It was found that SOM became chronic and retraction of the tympanic membrane appeared as a function of the pneumatization of the mastoid. Ears with poor pneumatization (less than 6 cm2) developed chronic SOM in 52.2% of cases, as compared with 20% in cases with well-pneumatized ears (6 cm2 and above). Atelectasis developed in 37.3% of poorly pneumatized ears, and in only 5.7% of well-pneumatized ears. These sequelae may therefore be linked pathogenetically to the extent of pneumatization, as both the SOM and the sequelae appeared many years after formation and maturation of the pneumatic system. This study supports other studies that view the mastoid pneumatic system as an organ, as a middle ear pressure buffer. Well-pneumatized ears rarely develop a negative pressure and are seldom associated with chronic sequelae. Ears with poorly pneumatized mastoids lack the physiological function of such a pressure buffer. Ears with a tendency to develop a negative gas balance, whether as a result of deficient ventilation or excessive diffusion, will therefore develop a negative pressure more readily when their pneumatic system is underdeveloped, and consequently will be more prone to develop chronic sequelae.
Chronic Maxillary Atelectasis
Authors: Salman Salah , Weber Alfred L. , Kass Erik S. , Rubin Peter A. D. , Montgomery William W.
Published: October 2014

Chronic maxillary atelectasis is a descriptive term that refers to a persistent decrease in the sinus volume of the maxilla from inward bowing of the antral walls. Case reports with comparable clinical presentations have appeared sporadically in the literature; however, this disorder has remained poorly defined. The purpose of this study is to provide a formal definition of this condition by the establishment of diagnostic and staging criteria. A 10-year case analysis identified 22 adults, and a review of the literature revealed another 25. The average age at presentation in our study was 38.3 years. Most patients were symptomatic, and some presented with diplopia and hypoglobus. Inward bowing of the antral wall(s) and persistent opacification on computed tomography made the diagnosis. Chronic maxillary atelectasis was separated into three stages according to the degree of wall deformation. While most patients were symptomatic, a past history of absent or mild symptoms referable to the nose and sinuses was encountered more often in those patients with osseous wall deformation (p = .041). Mild or absent symptoms at the time of diagnosis should not be considered a negative risk factor for the development of facial deformity, especially if the sinus has features consistent with complete pneumatization. A middle meatal antrostomy appears to relatively safely correct the sinus problem, while orbital floor reconstruction for hypoglobus, found in stage III of the disease, can be accomplished effectively via a transconjunctival approach using a combination of bone allograft and porous polyethylene sheets.
Usher's Syndrome Type IC: Clinical Studies and Fine-Mapping the Disease Locus
Authors: Marietta Jacquie , Walters Katherine S. , Burgess Robert , Moore Kenneth C. , Ni Li , Hejtmancik J. Fielding , Fukushima Kunihiro , Smith Richard J. H.
Published: October 2014

Usher's syndrome type I is a heterogeneous group of diseases characterized by severe to profound sensorineural hearing loss, absent vestibular function, and progressive pigmentary retinopathy. Other identifying clinical features have not been documented. In this study, we examined olfactory acuity, plasma levels of polyunsaturated fatty acids and sarcosine, and cilia ultrastructure in a homogeneous cohort of patients with Usher's syndrome type IC. The normal age-dependent decline in olfactory acuity was observed, and normal plasma levels of polyunsaturated fatty acids and sarcosine were found. However, the incidence of compound cilia in biopsies from the inferior turbinate was significantly higher than that reported in control populations. By reconstructing haplotypes in affected persons, D11S902 and D11S1310 were identified as flanking markers over an interval that contains a candidate gene, KCNC1. No mutations in the coding sequence of this gene could be demonstrated in affected persons.
Summating Potential and Action Potential Gradients on and in the Vicinity of the round Window in Guinea Pig
Authors: Badr-El-Dine Mohamed , Gerken George M. , Meyerhoff William L.
Published: October 2014

The purpose of this study was to determine the spatial gradients of summating potential (SP) amplitudes, action potential (AP) amplitudes, and SP/AP ratios for recording loci on the round window (RW) membrane and in its vicinity. Sixteen guinea pigs were tested by means of free-field click and tone burst (2.0 kHz) stimuli. Seven recording regions were specified: five equal-area regions on the RW membrane and two basal promontory regions. Statistically significant differences were found between the promontory regions and the RW membrane regions for the SP, AP, and SP/AP obtained with click stimuli, and for the SP and AP obtained with tone burst stimuli. The SP/AP ratio for tone burst stimuli did not differ significantly across the seven regions. The RW membrane was found to be isoelectric, but there were marked spatial gradients on the basal promontory. These results are of consequence for the interpretation of transtympanic electrocochleography recordings.
“Endolymphatic Sacitis” in a Case of Active Meniere's Disease
Authors: Danckwardt-Lillieström Niklas , Kinnefors Anders , Frtoerg Ulla , Rask-Andersen Helge
Published: October 2014

An ultrastructural analysis of an entire intraosseous endolymphatic sac (ES) from a patient with active, well-documented Meniere's disease was performed for the first time. The results were compared with those obtained from ES biopsy material from patients with acoustic neuromas. The ES was small in size and showed signs of focal inflammation with intraepithelial invasion by mononuclear cells. At these places the normal fine structure, including the vascular anatomy, was altered. The possible relationship between these changes and Meniere's disease is discussed.
Distortion Product Emissions in Normal-Hearing and Low-Frequency Hearing Loss Carriers of Genes for Waardenburg's Syndrome
Authors: Liu Xue Zhong , Newton Valerie E.
Published: October 2014

Eight patients with Waardenburg's syndrome (WS) with normal hearing and 3 additional patients exhibiting a low-frequency hearing loss were tested for the level of the acoustic distortion product 2f1-f2 by means of the Otodynamics Distortion Product Analyser (ILO92). Wide notches in distortion product otoacoustic emissions (DPOAEs) between 1,000 and 3,000 Hz were found in 7 (12 ears, 87.5%) examined patients with normal audiograms, which was a significantly higher rate than that found in the control group (10%). The 3 patients with low-frequency hearing loss gave a consistent pattern in audiometric configuration shown by both pure tone audiograms and DPOAEs. It is concluded from these initial results that DPOAEs may be a useful approach to identifying subclinical pathologic aberrations in the inner ear in WS patients, and may be a predictor of low-frequency sensorineural hearing loss.
Analysis of Pain and Endoscopic Sinus Surgery for Sinusitis
Authors: Acquadro Martin Andrew , Salman Salah Daoud , Joseph Michael Patrick
Published: October 2014

This prospective clinical descriptive study was designed to see whether patients who had endoscopic sinus surgery for sinusitis had relief of pain, and whether they had new pain postoperatively. The sample was 252 consecutive patients who underwent endoscopic sinus surgery after presenting with inflammatory sinus disorders meeting specific clinical definitions of sinusitis and criteria for surgically treatable sinus disorders developed by the treating surgeon. Of the 252 consecutive endoscopic sinus surgery patients, 106 (42%) had no preoperative pain and 146 (58%) patients had preoperative sinus pain. At 6- to 12-month postoperative evaluations, patients with no preoperative pain did not develop any new postoperative pain. Among the 146 patients with preoperative pain, 82 (56%) had no pain, residual symptoms, or further sequelae, and were considered cured; 42 (29%) reported a marked improvement of pain or discomfort; 9 (6%) had the same degree of pain or discomfort as before; 3 (2%) reported worse pain or discomfort; and 10 (7%) reported new pain or discomfort. These results suggest that the application of consistent definitions and clinical criteria for various forms of surgically treatable sinusitis will more likely predict improvement of pain and discomfort following surgical treatment. The risk of developing new pain and discomfort following endoscopic sinus surgery in individuals without preoperative pain or discomfort is negligible. The risk of worsening pain or new pain was less than 10% in patients with preoperative pain. Ongoing efforts such as the International Conference on Sinus Disease in the development of consistent terminology, staging, and therapy, and future modifications from additional clinical experience, should result in more predictable and effective care in the surgical treatment for pain of sinus disease.
Cricohyoidoepiglottopexy for Glottic Carcinoma with Fixation or Impaired Motion of the True Vocal Cord: 5-Year Oncologic Results with 112 Patients
Authors: Chevalier Dominique , Laccourreye Ollivier , Laccourreye Henri , Brasnu Daniel , Piquet Jean-Jacques
Published: October 2014

The medical charts and operative files of 112 patients (combined inception cohort) with well to moderately differentiated invasive glottic squamous cell carcinoma presenting fixation (22) or impaired motion (90) of the true vocal cord (TVC) consecutively treated with cricohyoidoepiglottopexy (CHEP) at our institutions from 1972 to 1989 were retrospectively reviewed. A minimum 5-year follow-up was always achieved. The Kaplan-Meier 5-year actuarial survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate for the entire group of patients were 84.7%, 5.4%, 6.4%, 1.2%, and 10.8%, respectively. The 5-year absolute and cause-specific survival rates were 85.5% and 94.1% for patients with fixation of the TVC and 81.3% and 96% for patients with impaired motion of the TVC. The 5-year actuarial local control rates for patients with fixation or impaired motion of the TVC were 95.4% and 94.4%, respectively. Local recurrence was statistically more likely in patients with positive margins (p = .007). Nodal recurrence was statistically more likely in patients with local recurrence (p = .0005). Permanent tracheostomy related to postoperative laryngeal stenosis was requested in 2 patients. Aspiration-related completion total laryngectomy and/or permanent gastrostomy were never requested. Overall, local control and laryngeal preservation were achieved in 97.3%, and 95.5% of patients, respectively. At our institutions, the change from the conservative treatment modalities of radiotherapy and vertical partial laryngectomy to CHEP has brought about an increase in long-term survival, local control, and laryngeal preservation rates when compared to historical controls using vertical partial laryngectomy or radiotherapy.
Effect of Adult-Onset Deafness on the Human Central Auditory System
Authors: Moore Jean K. , Niparko John K. , Miller Michele R. , Perazzo Lucy M. , Linthicum Fred H.
Published: October 2014

Degenerative change in the central auditory system was assessed in seven subjects with profound bilateral adult-onset deafness. The degree of transneuronal atrophy was determined by measuring cell size at three levels of the brain stem auditory pathway (anteroventral cochlear nucleus, medial superior olivary nucleus, and inferior colliculus). Within subjects, the relative degree of cell shrinkage was similar across all levels of the central pathway. Across subjects, the best neuronal preservation was seen in a case of viral labyrinthitis with 1 year of bilateral deafness and a near-normal population of cochlear ganglion cells. Reduction in cell size was greatest in cases of bacterial labyrinthitis or Scheibe degeneration with reduced populations of ganglion cells and longer periods of deafness. At the level of the cochlear nucleus, there was no consistent difference in cell size between the side stimulated by a functioning prosthetic device and the nonstimulated side.
Magnetic Resonance Imaging of the Development of Otitis Media with Effusion Caused by Functional Obstruction of the Eustachian Tube
Authors: Alper Cuneyt M. , Seroky James T. , Tabari Reza , Doyle William J.
Published: October 2014

In this study, magnetic resonance imaging (MRI) was used to define in vivo the effect of experimental functional obstruction of the eustachian tube (ET) on vascular permeability and the development of middle ear (ME) effusion. After collection of baseline data for ME pressure and MRI, the right tensor veli palatini muscle of 10 cynomolgus monkeys was injected with botulinum toxin A to induce ET obstruction. The left tensor veli palatini muscle was injected with saline in 4 monkeys. Right and left ME pressures and compliances were measured twice daily over a follow-up period of 36 days, and MRI scanning sessions including administration of a contrast agent, gadopentetate dimeglumine, were repeated on days 3, 6, 11, 15, 21,29, and 36 in 6 animals and on days 15, 21, 29, and 36 in 4 animals. Two right ears did not develop underpressures, 5 developed persistent underpressures, and 3 developed underpressures that resolved. No changes in MRI parameters were noted for the ears that did not develop underpressures, but a progressive brightening of the ME on T2-weighted images, indicative of the development of inflammation and effusion, was noted for the others. Also, an increasing rate of transfer of the contrast agent between the vascular and ME compartments, indicative of increasing vascular permeability, was observed to track the temporal changes in ME pressure. These results support a causal relationship between ET dysfunction, ME underpressures, increased vascular permeability, and otitis media with effusion.
Clinicopathological Consultation Lymphoepithelial Carcinoma of the Larynx, Hypopharynx, and Trachea
Authors: Weiss Lawrence M. , Devaney Kenneth O. , Ferlito Alfio , Rinaldo Alessandra , MacMillan Christina , Carbone Antonino , Barnes Leon
Published: October 2014

Lymphoepithelial carcinoma of the larynx, hypopharynx, and trachea is a rare neoplasm composed of large, poorly differentiated, nonkeratinized cells intermingled with small nonneoplastic lymphocytes and plasma cells. It is histologically similar to its more common counterpart occurring in the nasopharynx. In contrast to nasopharyngeal carcinoma, most cases have not been associated with Epstein-Barr virus (EBV), although rare cases have been reported to be EBV-positive. The diagnosis often requires immunohistochemistry or electron microscopy for confirmation. The neoplasm seems to behave in a fashion reminiscent of nasopharyngeal carcinoma. Lymph node metastasis occurs in the majority of patients, and eventual visceral dissemination occurs in one fourth. Radiotherapy is the main treatment for the primary tumor and regional metastases, but chemotherapy is indicated for more advanced disease. The initial stage is the primary determinant of prognosis. Death from disease occurs in about one third of patients.
Prognostic Significance of BCL-2 Expression in Localized Squamous Cell Carcinoma of the Head and Neck
Authors: Grey Philip , Chawla Prashant , Friedman Michael , Venkatesan T. K. , Caldarelli David D. , Bloch Isac , Coon John S.
Published: October 2014

This study was conducted to determine whether Bcl-2 overexpression in localized squamous cell carcinoma of the head and neck (SCCHN) might serve as a marker for tumors unlikely to respond to standard treatment. Tissue samples from 33 patients undergoing surgery or irradiation for early-stage SCCHN during the years 1977 to 1992 were stained for Bcl-2. All patients had either T1N0 lesions of the oral cavity, pharynx, or larynx or T1 NO or T2N0 lesions of the true vocal cords. Of the 33 patients, 26 remained disease-free after at least 3 years of follow-up; the remaining 7 patients developed either tumor recurrence or a second primary tumor, 4 of which were fatal. Twelve patients had tissue specimens staining positive for Bcl-2; 6 of these patients had a poor outcome, and 6 had a good outcome. The relationship between poor outcome and overexpression of Bcl-2 in tumor cells was statistically significant (p =.0047 by Fisher's exact test). For tumors overexpressing Bcl-2, there was no significant difference in recurrence rate between those undergoing surgery and those undergoing radiotherapy as the primary mode of treatment. The overexpression of Bcl-2 in early lesions in this study predicted a cure rate of 50%, as opposed to the generally expected 90%, suggesting that Bcl-2 is a significant prognostic indicator in early SCCHN. Future studies will determine if altering the treatment will improve outcome in these patients.
Head and Neck Langerhans Cell Histiocytosis
Authors: Devaney Kenneth O. , Ferlito Alfio , Putzi Mathew J. , Rtnaldo Alessandra
Published: October 2014

Among the potential sites of involvement by Langerhans cell histiocytosis (LCH), the head and neck region is the most commonly cited. Though principally a pediatric disease, LCH can affect any age group. It can be unifocal (skeletal) or multifocal (skeletal and/or visceral); it appears as though the presence of visceral lesions is more common in the youngest patients, and may be associated in some with a rapidly progressive course resulting in death. Head and neck manifestations may mimic such varied entities as eczema, otitis media, osteomyelitis, and cholesteatoma. Current approaches to therapy are less aggressive than they were in the past, and are particularly intended to monitor for and treat any complicating secondary infections (which may develop in the youngest patients with multifocal disease including visceral involvement). The prognosis is very good for unifocal skeletal system disease, and poor for multifocal disease with involvement of tissues other than bone.
Role of Adenoids in the Pathogenesis of Otitis Media: A Bacteriologic and Immunohistochemical Analysis
Authors: Linder Thomas E. , Marder Hans-Peter , Munzinger Jürg
Published: October 2014

Adenoidectomy is frequently performed in children suffering from recurrent or chronic otitis media with effusion and is thought to produce a long-term effect in preventing further episodes of otitis media. Bacteriologic analysis of adenoids from 60 patients revealed a significantly elevated colonization rate of middle ear pathogens in children with a present or previous history of ear disease compared to children with adenoidal hypertrophy only. The predominant pathogen was nontypeable Haemophilus influenzae, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Quantitative analysis did not demonstrate a bacterial overload in the otitis group. Lectin histochemical analysis of the adenoids revealed no significant differences between the three groups; nevertheless, colonization with S pneumoniae demonstrated an increased labeling pattern with succinylated wheat germ agglutinin, indicating the exposure of N-acetyl-glucosamine as part of its own receptor structure. On the basis of these results, we support the concept of adenoidectomy in order to remove a bacterial focus; however, we could not verify the hypothesis of bacterial overgrowth in the nasopharynx.