bluuebunny/crossref_metadata_2025 huggingface dataset:
Transient Hypocalcemia after Thyroidectomy
Authors: Bourrel Christophe , Uzzan Bernard , Tison Pierre , Despreaux Gilles , Frachet Bruno , Modigliani Elisabeth , Perret Gérard-Yves
Published: October 2014

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.
High-Speed, Light-Intensified Digital Imaging of Vocal Fold Vibrations in High Optical Resolution via Indirect Microlaryngoscopy
Authors: Hess Markus M. , Gross Manfred
Published: October 2014

Digital imaging of vocal fold vibrations is mainly limited by lighting problems. We present a new technique for high optical resolution of vocal fold vibrations (via indirect microlaryngoscopy) using a light intensifier camera. Superficial epithelial structures and secretions can be followed during vibrations by means of high magnification. Recordings of up to 2.4 seconds and 6,000 frames per second, combined with simultaneous recording of acoustic and electroglottographic signals, are possible. This technique allows instant slow-motion monitor control and subsequent documentation on a normal video recording system. We also present preliminary findings of typical vocal fold motion patterns.
Oral Blast Injury Caused by an Accident
Authors: Efrati Yigal , Eshel Gideon , Sarfaty Shlomo , Segal Samuel , Klin Baruch , Vinograd Itzhak
Published: October 2014

Blast trauma within the oropharyngeal cavity may be associated with superficial or deep injuries. Superficial injury generally needs only observation; deeper injury that violates the retropharyngeal space may produce dissecting emphysema into the neck and mediastinum followed by prevertebral soft tissue infections and mediastinitis. Injury involving the parapharyngeal space might damage vital cervical vessels. Life-threatening complications may result unless treatment is adequate. Three children who sustained oropharyngeal blast injury are presented. The direct cause was the blast effect of a new, spoiled, orange-flavor beverage just released on the market. The bottle cap of the soft drink and its effervescent liquid “exploded” into their mouths while they were trying to open the bottle with their teeth. Obviously, the failure to observe due precautions, as frequently happens among children, contributed to the occurrence of the accidents. This paper describes the diagnosis, management, and relevant educational and preventive measures of the problem.
Audiological Study in Guinea Pigs with Type I Allergy Induced in the Inner Ear
Authors: Uno Kengo , Fukuda Hironori , Miyamura Kenichiro , Masuyama Keisuke , Kanzaki Yorinori , Ishikawa Takeru
Published: October 2014

Time course studies of electrocochleography and the auditory brain stem response were performed in guinea pigs that were passively sensitized by sera containing antidinitrophenyl reaginic antibody and specifically challenged by dinitrophenyl—bovine serum albumin injected through the stylomastoid foramen. A negative summating potential on electrocochleography was observed from 12 to 48 hours, but not at 72 hours, after the specific challenge. A threshold increase on the auditory brain stem response was observed 15 minutes after the specific challenge; the threshold recovered to the prechallenge level within 7 days. Further, we used Tranilast, a blocking agent of chemical mediator release from mast cells, before the specific challenge. A negative summating potential and head deviation were not observed after the use of this agent. These results suggest that the auditory change provoked in the inner ear of the sensitized guinea pig may have been induced by type I allergy.
Effect of Influenza a Virus on Ciliary Activity and Dye Transport Function in the Chinchilla Eustachian Tube
Authors: Park Keehyun , Coticchia James M. , Bakaletz Lauren O. , Lim David J.
Published: October 2014

Previous studies have shown that influenza A virus inoculated via a transbullar approach can cause severe disorders of the chinchilla eustachian tube. In this study, we inoculated chinchillas both intranasally and transbullarly with influenza A virus (A/Alaska/6/77) to assess the effect of this virus on both the ciliary activity of eustachian tube epithelium and eustachian tube transport function. Data indicated that while the nature of the major lesions was indistinguishable, the differing routes of inoculation did influence the time course and initial location of virus-induced histopathology. Analysis of ciliary beat frequency and dye transport function indicated a maximal decrease approximately 7 to 14 days postinoculation, with return to normal function by 28 days postinoculation. Light and transmission electron microscopic observations of the evolution of histopathology and return to normal histology correlated well with functional assessment data.
Experimental Otitis Media with Effusion Induced by Platelet Activating Factor
Authors: Rhee Chung-Ku , Jung Timothy T. K. , Miller Stanley , Weeks Douglas
Published: October 2014

This study tested the hypothesis that platelet activating factor (PAF) in the middle ear can induce otitis media with effusion (OME) and that PAF antagonists can prevent PAF-induced OME. An initial trial of 16 μg of PAF was injected into chinchilla bullae, and all ears developed middle ear effusion (MEE) within 48 hours. Subsequent trials were performed to test dose dependency. Interestingly, 1 or 16 μg of PAF caused more MEE and inflammation than did 4 or 8 μg. A dose of 0.5 μg PAF did not cause MEE. Middle ear effusion from injected bullae contained the full spectrum of lipoxygenase and cyclooxygenase products; additionally, more PAF was detected than was injected. Finally, a PAF antagonist (WEB 2170) injected intraperitoneally prevented PAF-induced OME. This study demonstrates that PAF injected into the middle ear can induce OME and that PAF antagonists effectively prevent PAF-induced OME. These findings suggest that PAF plays an important role in the pathogenesis of OME.
Congenital Ankyloglossia with Deviation of the Epiglottis and Larynx: Symptoms and Respiratory Function in Adults
Authors: Mukai Susumu , Mukai Chikako , Asaoka Kazuyuki
Published: October 2014

We operated on 38 adult patients with congenital ankyloglossia with deviation of the epiglottis and larynx. The results were as follows. 1) Most patients had Angle's class III malocclusion, irregular alignment of the upper teeth, and high hard palate. 2) Fifty percent of the patients in our study population had obstructive respiratory failure. Their vital capacity increased significantly after the operation, but changes of forced expiratory volume in 1 second were not prominent. 3) Subjective symptoms of this disease were stiffness of the shoulders, a cold feeling in the extremities, an obstructed feeling in the throat, insomnia, fatigue, dry skin, irritability and/or anxiety, and nervousness. These improved postoperatively. 4) Objective symptoms included snoring, muscle cramps, difficulty in playing wind instruments, hoarseness, and incorrect articulation. The objective symptoms, except for incorrect articulation, improved postoperatively.
Mucosal Fine Structure in Experimental Sinusitis
Authors: Westrin Karl Magnus , Stierna Pontus , Carlsöö Bengt , Hellström Sten
Published: October 2014

Rabbit maxillary sinuses were inoculated with Streptococcus pneumoniae and Bacteroides fragilis, and the histologic response in the sinus mucosa was observed over a 12-week period. An increased height of the cylindric cells and hyperplasia of the basal cells were frequent findings irrespective of the pathogen inoculated. The disease was found to influence the character of the secretory product from epithelial secretory cells and to degranulate the subepithelial glands. Ciliary loss was a transitional finding. A reduction in the number of mitochondria, the occurrence of deformed short microvilli, and cytoplasmic blebbing were seen in the cells devoid of normal cilia. It is inferred from this study that pneumococcal sinusitis in rabbits is a self-limiting process, and the mucosal sequelae of the acute infection are persisting goblet cells, slight focal fibrosis, and edema. Inoculation with B fragilis produces a chronic inflammatory process, with infiltration of mononuclear cells, luminal dilatation of the glands exhibiting zymogen granule depletion, and an increased thickness of the whole mucosal layer.
Microendoscopic Laser Diverticulotomy for Hypopharyngeal Diverticulum
Authors: Benjamin Bruce , Gallagher Richard
Published: October 2014

Progressive dysphagia due to a pharyngeal pouch eventually requires surgical treatment. Thirty-four patients treated by laser diverticulotomy in a 6-year period were reviewed for age, length of hospitalization, associated medical problems, postoperative course, and results. The operative technique is described in detail, and a new, slimmer diverticuloscope is introduced. Microendoscopic laser diverticulotomy offers excellent visualization by means of the operating microscope together with a double-lipped diverticuloscope and is a minimally invasive, relatively simple, controlled procedure with proven, predictable results and few complications. It can be recommended as the treatment of choice for patients of all ages, whether the pouch is large or small.
New Technique for the Sterile Introduction of Flexible Nasopharyngolaryngoscopes
Authors: Silberman Harvey D. , Hampel Avraham , Kominsky Alan H.
Published: October 2014

Since the inception of flexible fiberoptic endoscopes, disinfection of these instruments has been a problem. Soaking in glutaraldehyde does not always achieve sterilization, and often damages the scopes. Ethylene oxide can sterilize endoscopes; however, it is economically impractical because of a required downtime of 24 hours. Thus, it is obvious, especially with respect to human immunodeficiency virus, hepatitis B virus, and Mycobacterium, that a new technique to attain sterility is necessary. This paper discusses a new method of sterile introduction of the flexible nasopharyngolaryngoscope. The technique employs disposable sterile sheaths that are prepackaged and made from a thermoplastic elastomer with a clear optical end. The sheaths can be applied in seconds and tightly adhere to the flexible insertion portion of the scope. Results to date indicate that the performance of the endoscope is unhindered by using the sheaths. Furthermore, there has been no break in the integrity of the sheaths or damage to instruments. It is our opinion that these devices will greatly improve the level of sterility while at the same time reducing costs and downtime.
Indications for Open Surgical Removal of Airway Foreign Bodies
Authors: Marks Steven C. , Marsh Bernard R. , Dudgeon David L.
Published: October 2014

Airway foreign bodies can usually be extracted by skillful application of endoscopic techniques. We report our experience in the management of 2 infants in whom sharp, pointed objects dictated consideration for an open surgical approach. Clinical presentation and treatment options will be discussed in the successful management of these 2 patients, one with a crab claw in the subglottis and the other with an electronic diode in the lung. Extensive training and a full complement of modern instruments are required, but in highly selected cases, an open surgical procedure entails less risk than endoscopic extraction.
Traumatic Macroglossia
Authors: Saah Daniel , Braverman Itzhak , Elidan Josef , Nageris Benny
Published: October 2014

A case of severe macroglossia resulting from trauma (tongue biting) during eclampsia and causing respiratory obstruction is described. Despite medical treatment with steroids and antibiotics for a week, followed by tracheostomy, no significant improvement was observed. After an energetic but cautious maneuver of reducing and restraining the tongue in the oral cavity, the swelling reduced dramatically in 24 to 48 hours. Earlier manual replacement of the tongue into the oral cavity is advised in order to arrest the cycle of venous and lymphatic obstruction and congestion that leads to further edema and increased tongue swelling. The mechanism of traumatic macroglossia is discussed.
Nonneoplastic Vascular Lesions of the Middle Ear
Authors: Suarez Patricia A. , Batsakis John G.
Published: October 2014

Nonneoplastic vascular lesions in the middle ear may be arterial or venous. For the former, ectopic location of the internal carotid artery is the most common; a high jugular bulb is the most common venous abnormality. Both may be clinically misdiagnosed without radiographic studies and, in the event, lead to disaster.
Teflon Granulomas and Overinjection of Teflon: A Therapeutic Challenge for the Otorhinolaryngologist
Authors: Kasperbauer Jan L. , Slavit David H. , Maragos Nicholas E.
Published: October 2014

We have found that Teflon granulomas and the overinjection of Teflon with the resulting laryngeal dysfunction, although uncommon, present a challenge to the otorhinolaryngologist, due in large part to the inflammatory reaction to the injected Teflon. This report addresses the management of 16 patients (12 women and 4 men) treated surgically for symptoms secondary to Teflon granulomas or vocal folds that had been overinjected with Teflon. The presenting symptoms varied and included airway obstruction, cough, choking, swallowing difficulties, and dysphonia. In each case the granuloma and Teflon were removed endoscopically via a lateral cordotomy. A second procedure to address dysphonia due to vocal cord lateralization was frequently required and presents the challenge for the surgeon to select the appropriate procedure and time of intervention. The results of this retrospective review suggest that resolution of inflammatory changes and fibrosis subsequent to Teflon removal requires significant lengths of time and that thyroplasty techniques provide a means for medialization without reintroduction of the original inflammatory material.
Vocal Granuloma, Including Sclerosis of the Arytenoid Cartilage: Radiographic Findings
Authors: Benjamin Bruce , Roche James
Published: October 2014

Vocal granulomas are uncommon benign tumors that may not respond readily to medical treatment or surgical removal. Gastroesophageal reflux is said to be a causative factor. Osteosclerosis of the arytenoid cartilage was found on computed tomographic scan in a series of 21 consecutive patients. The relationship of vocal granuloma to so-called contact ulcer (better called contact pachydermia) is discussed. Imaging of the granuloma and the arytenoid has little, if any, place in management, but should be recognized in the differential diagnosis of a vocal cord mass if the mass lies immediately adjacent to a sclerotic arytenoid.
Pathology Consultation Squamous Odontogenic Tumor
Authors: Batsakis John G. , Cleary Karen R.
Published: October 2014

The squamous odontogenic tumor is almost exclusively an intraosseous lesion of the jaw bones. Only 1 extraosseous variant has been reported. The tumor is histologically benign, with only occasional recurrences after surgical removal. Malignant alteration is unknown, but the lesion must be distinguished from intraosseous squamous cell carcinomas.
Correlation between Stroboscopy and Electromyography in Laryngeal Paralysis
Authors: Kokesh John , Robinson Lawrence R. , Flint Paul W. , Cummings Charles W.
Published: October 2014

Twenty patients with vocal fold motion impairment were reviewed to correlate the findings of electromyography (EMG) and stroboscopy. The causes of motion impairment were idiopathic, previous surgery with recurrent laryngeal nerve injury, neck and skull base trauma, and neoplasm. The EMG studies were analyzed to assess the status of innervation of the immobile vocal fold. The presence or absence of the mucosal wave prior to therapeutic intervention was determined with stroboscopic examination. Eight of 10 patients with EMG evidence of reinnervation or partial denervation were found to have mucosal waves, and 3 of 10 patients with EMG evidence of denervation were found to have mucosal waves. Six patients developed mucosal waves after surgical medialization, despite evidence of denervation by EMG criteria. These findings support the premise that tension and subglottic pressure, rather than status of innervation, determine the presence of the mucosal wave.
Localized Amyloidosis of the Larynx: Evidence for Light Chain Composition
Authors: Troxler Robert F. , Kane Kelly , Berg Alan M. , Grillone Gregory , Cohen Alan S. , Kasznica John , Skinner Martha
Published: October 2014

We report the biochemical characterization of amyloid fibrils from a patient with localized amyloidosis of the epiglottis and larynx. Biopsy specimens showed amorphous material consistent with amyloid deposits with a plasmacytic infiltrate. Both plasma cells and amyloid deposits stained positively by immunohistochemistry for κ light chains. Amyloid fibrils were isolated. The major constituent resolved as a 13 kd band was sequenced and found to be consistent with a κ1 light chain. A tryptic digest was carried out and 3 tryptic peptides were sequenced defining the first 45 residues of the protein and residues 110 through 119. Four amino acid substitutions were found, 3 of which have not been described previously. This study defines the immunoglobulin origin of amyloid deposits in localized amyloidosis. The benign nature of localized amyloidosis suggests that a localized clone of plasma cells producing an amyloidogenic light chain may represent the pathogenetic mechanism of this disease, which appears to be a form of plasma cell dyscrasia.
Location of the Preepiglottic Space and its Relationship to the Paraglottic Space
Authors: Sato Kiminori , Kurita Shigejiro , Hirano Minoru
Published: October 2014

An investigation was carried out to determine the location of the preepiglottic space (PES) and its relationship to the paraglottic space (PGS). Excised human adult larynges served as materials for this study. The distribution of the PES of the larynx was determined histologically in 3 whole organ serial sections: sagittal, horizontal, and coronal. The results are summarized as follows. 1) The PES exists not only anterior, but also posterolateral and inferolateral to the epiglottis. 2) Its posterior end is located in the vicinity of the anteroposterior midpoint of the thyroid lamina. 3) The PES is adjacent to the PGS posteroinferiorly and is separated by fibrous tissue (the thyroglottic ligament). Posterosuperiorly, the 2 spaces are not clearly delineated from each other.
Late Waves in the Response Recorded from the Intracranial Portion of the Auditory Nerve in Humans
Authors: Møller Aage R.
Published: October 2014

We showed in previous studies that the click-evoked responses from the exposed eighth nerve in some patients contain quasiperiodic components that appear in the interval between 4 and 16 milliseconds after the click stimulus, and that the phase of these oscillatory components reverses when the click polarity is reversed. When the responses to clicks of opposite polarity are subtracted from each other, these late waves appear as a prolonged quasiperiodic oscillation with a frequency around 700 Hz. These late components appear more frequently in patients with high-frequency hearing losses than in patients with normal hearing. We have attributed these components to prolonged and in-phase oscillations of a large portion of the basilar membrane, possibly caused by the generation of standing waves on the basilar membrane. The results of the present study show that these oscillations correspond closely in both frequency and phase to the late oscillations that are seen in the cross-correlograms of the responses from the exposed eighth nerve to pseudorandom noise. The finding that similar quasiperiodic components can be retrieved from the responses from the exposed eighth nerve to both transient and continuous sounds is taken as an indication that the neural activity that these components represent reflects some general property of the cochlear frequency analyzer. We also found that the speech discrimination is not noticeably different in patients with such waves compared with what it is in patients with similar hearing loss who do not have such waves. This is taken as an indication that spectral analysis in the cochlea is less important in speech discrimination than previously assumed. The importance of timing of auditory nerve activity for speech perception is indicated by the finding that surgical trauma of the intracranial portion of the auditory nerve that only causes a moderate degree of deterioration of the pure tone threshold reduces speech discrimination scores to zero.
Extracranial, Extraspinal Meningiomas of the Head and Neck
Authors: Kershisnik Matthew , Callender David L. , Batsakis John G.
Published: October 2014

The head and neck is the most frequent location for extraneuraxial meningiomas, be they wholly extracranial or extraspinal or extensions of central nervous system meningiomas. Regardless of anatomic site of origin, nearly all meningiomas arise from meningocytes of arachnoid granulations. Ectopic arachnoid cell clusters have a predilection for areas of dural penetration of cranial nerves, and it is in these areas that most extracranial meningiomas are found. Surgical excision is the mainstay of treatment and must be planned by radiologic studies to determine the extent of the tumor and the presence or absence of a companion central nervous system meningioma. The often locally invasive and aggressive behavior of the meningiomas belies their benign histologic appearance.
Interferon Alfa-2A Therapy for Airway Hemangiomas
Authors: Ohlms Laurie A. , McGill Trevor J. I. , Jones Dwight T. , Healy Gerald B.
Published: October 2014

Hemangioma is a well-recognized cause of airway obstruction in the infant with stridor. Corticosteroid and laser therapy are effective in stabilizing the airway in most cases. There are, however, some extensive airway lesions that are not adequately managed by these modalities. This report describes the use of recombinant interferon alfa-2a in 15 patients with life-threatening airway hemangiomas. All patients had failed corticosteroid and/or laser therapy. Multiple upper airway sites were involved, including the base of the tongue, supraglottis, subglottis, trachea, and mediastinum. Eleven patients have completed therapy and are doing well. Four patients have resolving lesions on the drug regimen. Life-threatening airway lesions unresponsive to conventional treatment should be considered for a trial of interferon alfa-2a.
Limitations of Electromyography and Magnetic Stimulation for Assessing Laryngeal Muscle Control
Authors: Ludlow Christy L. , Van Pelt Frederick , Yeh James , Rhew Karen , Cohen Leonardo G. , Hallett Mark
Published: October 2014

The development of new phonosurgical techniques has increased the level of interest in the field of neurolaryngology. This field requires valid techniques for determining if muscle activation is normal. Laryngeal electromyography is being used more frequently to assess muscle innervation and synkinesis. Further, magnetic stimulation has been introduced as a noninvasive technique for nerve stimulation. Technical limitations that affect the clinical utility of both these techniques are reviewed: 1) difficulties obtaining selective and accurate electromyographic laryngeal muscle recordings, 2) normal variation in movement and muscle activation patterns within and between normal individuals when producing the same speech syllables, and 3) variation in laryngeal muscle response latencies between and within normal subjects during peripheral magnetic stimulation. Given the normal variation in laryngeal electromyography and magnetic stimulation response latencies, these techniques may not yet be reliable or accurate for assessing reinnervation or synkinesis following recurrent laryngeal nerve injury.
Lymphatic Drainage System after Left Radical Neck Dissection
Authors: Har-El Gady , Lucente Frank E.
Published: October 2014

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.
Desmoplastic Melanomar
Authors: Batsakis John G. , Raymond A. Kevin
Published: October 2014

Desmoplastic melanoma is an uncommon type of malignant melanoma that has a predilection for the skin of the head and neck. Because of a progressive metaplasia of melanocytes and an accompanying desmoplasia, the neoplasm can be mistaken for benign or malignant soft tissue lesions. The neurotropism exhibited by many desmoplastic melanomas is a strong adverse factor for prognosis; otherwise, the biologic behavior is not unlike that of conventional melanomas.
Anatomic Considerations in Complications of Endoscopic and Intranasal Sinus Surgery
Authors: Streitmann Michael J. , Otto Randal A. , Sakai Connie S.
Published: October 2014

Complications of endoscopic and classic intranasal sinus surgery have been documented by case reports and large retrospective reviews. The most serious complications have involved violation of the intracranial space or orbit. Hemorrhage has also proven to be a significant cause of morbidity, either of itself, or by limiting visualization and thus contributing to other injuries. Although numerous studies have been performed to determine various anatomic relationships, relatively few have addressed relationships that use practical reference points easily accessible to the endoscopic or intranasal sinus surgeon. In an effort to reduce the risk of complications such as blindness, orbital hematoma, and injury to the lacrimal sac or central nervous system, we have performed 50 cadaver dissections and measured 7 anatomic landmarks that may aid the surgeon in preventing these complications. We have also included a review of the literature concerning the complications of endoscopic and intranasal sinus surgery addressed herein.
Histocytochemistry of Glycoconjugates in Nasal Inverted Papilloma
Authors: Huang Hai , Jing Desheng , Zhou Shuimiao , Li Zhaoji , Ma Dalie
Published: October 2014

In order to investigate the changes in cellular distribution of the glycocalyces in nasal inverted papilloma, formalin-fixed, paraffin-embedded biopsy specimens of inverted papilloma were analyzed by the avidin-biotin-peroxidase complex technique for the demonstration of peanut agglutinin (PNA) receptors, concanavalin A ( Canavalia ensiformis agglutinin; ConA) receptors, carcinoembryonic antigen (CEA), and keratin, and compared with normal nasal mucosa, nasal polyps, and papillary adenocarcinoma. The inverted papillomas were positive for PNA and CEA, to the same degree as papillary adenocarcinoma. Their PNA binding was related to the degree of dysplasia. The ConA reaction was intermediate between that of normal mucosa and adenocarcinoma. The results suggest that the alteration of cellular glycoprotein structure in inverted papilloma is associated with its biologic characterization.
Subglottic Hemangioma: Ten Years' Experience with the Carbon Dioxide Laser
Authors: Sie Kathleen C. Y. , McGill Trevor , Healy Gerald B.
Published: October 2014

Patients with subglottic hemangioma present with biphasic stridor during infancy. The natural history of this lesion is characterized by progressive airway obstruction during the proliferative phase of the lesion, followed by resolution of symptoms during the subsequent involutive phase. Although this is a benign neoplasm, it can be associated with a fatal outcome. Treatment options have been directed at maintaining airway patency during the proliferative phase. The senior author (G.B.H.) originally described the role of the carbon dioxide laser in management of these patients in 1980. Thirty-one patients were treated for subglottic hemangioma at The Children's Hospital, Boston, between 1980 and 1990. The 10-year experience of management of subglottic hemangioma with endoscopic vaporization using the carbon dioxide laser is reviewed to assess the efficacy of this technique.
Comparison of Muscle Activation Patterns in Adductor and Abductor Spasmodic Dysphonia
Authors: Van Pelt Frederick , Ludlow Christy L. , Smith Paul J.
Published: October 2014

Patients with adductor and abductor spasmodic dysphonia were compared with normal controls on speech items particularly difficult for the two patient groups. Intrinsic and extrinsic laryngeal muscles were measured during adduction for voicing and for a glottal stop, and during abduction after a vowel and after a glottal stop. Muscle activity was measured while the patients attempted the speech items, with considerable difficulty, but not during periods of complete voice loss. Muscle activity at rest, activity increases for speech, and percent changes for adduction and abduction did not differ from normal in either patient group. The results demonstrated normal muscle activation levels and changes for speech in the patients, and suggested that symptoms occur when spasmodic bursts intrude on an otherwise normal pattern.
Cytokeratin Patterns of Normal Middle Ear Epithelia in Humans, Cats, and Chinchillas
Authors: Sano Shin-Ichi , Haruna Shin-Ichi , Schachern Patricia A. , Paparella Michael M.
Published: October 2014

We describe the cytokeratin patterns of epithelia from the tympanic orifice, tympanic cavity, and mastoid cavity of humans, cats, and chinchillas, and compare these findings with those of tracheal epithelium and external canal epidermis. Our findings are as follows: 1) middle ear epithelium from all locations demonstrates some type of cytokeratin staining, 2) broad-spectrum cytokeratin antibodies stain epithelia of middle ear cleft, tracheal epithelium, and external canal epidermis in all species, 3) specific cytokeratin antibodies reveal species-related differences in middle ear and tracheal epithelia, 4) middle ear and tracheal epithelia usually have the same pattern, and 5) none of the monospecific cytokeratin antibodies have a positive reaction with external canal epidermis. These findings suggest that the cytokeratin patterns of middle ear epithelium are useful in studying the hyperplastic and metaplastic changes in otitis media; however, caution must be exercised when making interspecies comparisons.
Arytenoidectomy in Children
Authors: Bower Charles M. , Choi Sukgi S. , Cotton Robin T.
Published: October 2014

Vocal cord paralysis is the second most common cause of stridor in early infancy, and as many as 52% of patients will not recover spontaneously. Bilateral vocal cord paralysis often requires a tracheotomy for airway distress. If resolution of the bilateral vocal cord paralysis does not allow for decannulation, arytenoidectomy is an option. A retrospective review of 30 children with bilateral vocal cord paralysis who underwent an arytenoidectomy was undertaken. An external arytenoidectomy via laryngofissure was performed in 19 patients, a laser arytenoidectomy in 12 patients, and a Woodman procedure in 1 patient. Twenty-five of the 30 patients (83%) were decannulated. Decannulation was more likely after a laryngofissure (84%) than after a laser arytenoidectomy (56%). The probability of decannulation was related to the presence of concomitant conditions and the need for other airway procedures. While breathiness, hoarseness, and pitch change were common, all patients had an adequate voice postoperatively and demonstrated little change from the preoperative voice disturbance. Aspiration was a rare complication. After an adequate period of observation for spontaneous resolution, arytenoidectomy via external laryngofissure is recommended to aid in the decannulation of children with bilateral true vocal cord paralysis.
Olfactory Mucosa of Patients with Olfactory Disturbance following Head Trauma
Authors: Yamagishi Masuo , Okazoe Ryusuke , Ishizuka Yoichi
Published: October 2014

The olfactory mucosa in 7 patients with olfactory disturbance following head trauma were sampled for biopsy with special biopsy forceps and examined by immunohistochemical staining with anti—neuron-specific enolase (NSE) and S-100 protein (S-100) antibodies. The residual olfactory receptor cells and nerve bundles were counted, and the degree of degeneration was determined. In 5 patients, olfactory receptor cells that reacted with anti-NSE antiserum remained, although the number varied with the patient, and in 2 patients the receptor cells disappeared. In the lamina propria, the S-100–immunoreactive olfactory nerves were retained in 6 patients. The outcome was poor in all cases regardless of the number of residual receptor cells and nerve bundles. These results indicate that the degree of impairment of the peripheral olfactory region after head trauma differs from case to case, and that even if the receptor cells and nerve bundles remain, it is difficult to improve the condition, although some cases of malingering may be contained.
Comparison of Aerodynamic and Electroglottographic Parameters in Evaluating Clinically Relevant Voicing Patterns
Authors: Peterson K. Linnea , Verdolini-Marston Katherine , Barkmeier Julie M. , Hoffman Henry T.
Published: October 2014

The purpose of the present study was to identify one or more aerodynamic or electroglottographic measures that distinguish among voicing patterns that are clinically relevant for nodule pathogenesis and regression: a presumably pathogenic pattern (pressed voice), a neutral pattern (normal voice), and two presumably therapeutic patterns (resonant voice and breathy voice). Trained subjects with normal voices produced several tokens of each voice type on sustained vowels /a/, /i/, and /u/. For each token, maximum flow declination rate, alternating current flow, and minimum flow were obtained from inverse-filtered airflow signals, and closed quotient and closing time were obtained from electroglottographic signals. The results indicate that for /a/ and /i/ (but not for /u/), the closed quotient provides a sensitive tool for distinguishing the voice types in physiologically interpretable directions. Further, post-hoc analyses confirmed a direct relationship between the closed quotient and videoscopic ratings of laryngeal adduction, which previous work links to nodule pathogenesis and regression.
Some Aspects of Vocal Fold Bowing
Authors: Tanaka Shinzo , Hirano Minoru , Chijiwa Keichi
Published: October 2014

Bowing of the vocal fold frequently occurs in patients with vocal fold paralysis (VFP), those with sulcus vocalis, and those who have had laser surgery. Additionally, there are vocal folds that present bowing with no noticeable organic lesion. For the purpose of investigating the causes and mechanisms of vocal fold bowing, consecutive fiberscopic videorecordings of 127 patients with VFP, 33 with sulcus vocalis, 33 with laser surgery, and 33 with dysphonia having no clinically noticeable organic lesion were reviewed. Sixty-nine percent of the paralyzed vocal folds had bowing, and the occurrence of bowing was significantly related to the activity of the thyroarytenoid muscle as measured by electromyography. The cricothyroid activity had no significant relationship to vocal fold bowing. All vocal folds with sulcus presented with bowing. Thirty-five percent of the vocal folds that had had laser surgery had bowing. The extent of tissue removal was closely related to the occurrence of bowing. Twelve cases with no organic lesion had vocal fold bowing. Of these 12 patients, 8 were male and 9 were older than 60 years. Some aging process in the mucosa was presumed to be the cause of the bowing in this age group of patients without clinically noticeable organic lesions. Causes of vocal fold bowing in the younger group of patients without organic lesions were not determined in this study.
Lipid Analysis of Lavage Samples from the Equine Guttural Pouch (Auditory Tube Diverticulum)
Authors: Baptiste Keith E. , Cake Max H.
Published: October 2014

The guttural pouch is a large, air-filled diverticulum of the auditory tube, present in the horse and other species. Lipid analysis of saline lavage from the equine guttural pouch has demonstrated the presence of phospholipids and neutral lipids in amounts that are variable but consistently greater than in any other species described. A stain specific for choline-containing phospholipids has demonstrated the presence of phospholipid-containing vesicles only within the cells of subepithelial, seromucoidlike glands, suggesting that these cells incorporate phospholipids in their secretions. The functional significance of surface-active agents in the guttural pouch may be different from that proposed for other species because of the unique anatomical design and the different proposed functions of the guttural pouch.
Interleukin-8 Gene Expression in Middle Ear Effusions
Authors: Takeuchi Kazuhiko , Maesako Kenichi , Yuta Atsushi , Sakakura Yasuo
Published: October 2014

Interleukin-8 (IL-8), a monocyte- and macrophage-derived cytokine, displays potent chemotactic-activating properties toward neutrophils, and thus may contribute to the pathogenesis of otitis media with effusion (OME). The objective of this investigation was to demonstrate the expression of the IL-8 gene in middle ear effusions (MEEs) of children and adults with OME. Ribonucleic acids (RNAs) were extracted from MEEs from 16 ears of 13 pediatric patients and 12 ears of 12 adult patients with OME. The RNAs were reverse-transcribed and amplified by the polymerase chain reaction. Interleukin-8 transcripts were detected in 75% of both pediatric (12/16) and adult MEEs (9/12). The levels of expression of IL-8 and β-actin messenger RNAs were quantitated. No significant difference was observed in IL-8/β-actin ratios between pediatric MEEs and adult MEEs. These data suggest that IL-8 may contribute to neutrophil involvement in both pediatric and adult OME.
Tracheomalacia Caused by Arterial Compression in Esophageal Atresia
Authors: Triglia Jean Michel , Guys Jean Michel , Louis-Borrione Claude
Published: October 2014

After surgical repair of esophageal atresia (EA), any persistent respiratory distress unexplained by operative complications should lead to performance of tracheoscopy to evaluate the possibility of tracheomalacia. In a review of 46 cases of EA repair, 12 patients developed severe airway problems, manifested mainly by acute apneic episodes. These were related to an anterior extrinsic tracheal compression from vascular structures: the innominate artery alone in 8 patients, and in combination with the aortic arch in 4 patients. Aortopexy, evaluated by intraoperative tracheoscopy, provided good results in 10 patients with a mean follow-up of 2 years. After EA repair, respiratory symptoms, often related to feeding, should be recognized as a possible indication of severe compression of the trachea by the great vessels. The analysis of endoscopic features should allow consideration of patients as candidates for aortopexy, as long as they have resolved their symptoms after conservative therapy, and after investigation of all other possible sources of pulmonary problems. Gastroesophageal reflux must be recognized (7 cases in the series), but does not contraindicate aortopexy if the latter is deemed necessary. In selected cases, the relief of compression, controlled by intraoperative endoscopy, is considered a key component of a comprehensive program to treat children after EA repair.
Identification, Classification, Treatment, and Prognosis of Laryngeal Paraganglioma
Authors: Ferlito Alfio , Barnes Leon , Wenig Bruce M.
Published: October 2014

This study details the clinicopathologic features of 62 cases of laryngeal paraganglioma (LP), including 54 acceptable cases identified in the literature (although clinical information is lacking on 7 of these) and 8 previously unpublished cases identified from the Registry of Otolaryngic-Endocrine Pathology at the Armed Forces Institute of Pathology. Demographic findings show that the overwhelming majority of cases affect women (41:14), mainly in the fourth to sixth decades of life (age range, 14 to 83 years; median, 44 years), with a prevalence in the supraglottic larynx. These neoplasms are treated by surgical resection and are benign. Despite the characteristic pathologic features associated with LP, it is sometimes confused with other neoplasms, particularly neuroendocrine carcinomas of the larynx, and this confusion leads to unfortunate designations such as malignant paraganglioma and metastasizing paraganglioma of the larynx. Judging from the cases reported in this study and those identified in the literature, we conclude that malignant biologic behavior associated with LP is extraordinarily rare (<2%). Because of the misdiagnoses of LP, the prognosis associated with this entity has been skewed to suggest that LP may behave aggressively. This has led to the inappropriate classification of LP among the malignant categories of laryngeal neuroendocrine neoplasms. The goal of this study is to detail the features diagnostic of LP and to discuss the appropriate treatment, prognosis, and classification of these neoplasms.
Method for in Vivo Measurement of Mucociliary Activity in the Human Nose
Authors: Lindberg Sven , Runer Thomas
Published: October 2014

The aim of the investigation was to develop a method for observing mucociliary activity in the human nose in vivo without possible artifacts introduced by anesthesia or surgical intervention. A probe containing an optical system was constructed for the purpose, mucociliary activity on the nasal septum being photoelectrically analyzed by computer. Challenges with pharmacologic substances were administered with a standardized nebulizer delivering an aerosol heated to 33°;C. The baseline mucociliary wave frequency in vivo was 691.7 ± 93.0 waves per minute (11.5 ± 1.6 Hz), and the corresponding ciliary beat frequency in vitro was 800.7 ± 85.4 beats per minute (13.3 ±1.4 Hz). The coefficients of variation were 13.4% between individuals and 11.3% ±2.1% (range 8.3% to 14.3%) within a subject. The method showed good reproducibility regarding recordings from different spots on the mucosa and on a day-to-day basis. Challenge with the β2-agonist terbutaline sulfate produced an increase of mucociliary activity of 40.6% ± 7.8% (mean ± SEM), which is consistent with previous results in animal models. This is the first report of a method suitable for in vivo studies of the mucociliary effects of challenge with autonomic agonists and airway irritants in humans.
Complication of Jet Ventilation during Microlaryngeal Surgery
Authors: Braverman Itzhak , Sichel Jean-Yves , Goldsher Moshe , Halimi Patrick , Kadari Avishag
Published: October 2014

Complications during jet ventilation for microlaryngoscopy, which is usually a relatively safe procedure, are rare. Those described have included hypoventilation, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, and gastric distention. We describe herein a case of a life-threatening complication during jet ventilation with a Carden's tube that ended in laparotomy.
Value of Radiography in the Management of Possible Fishbone Ingestion
Authors: Sundgren Pia C. , Burnett Anita , Maly Pavel V.
Published: October 2014

A retrospective study was performed on 42 consecutive patients to examine the value of radiography in the management of complaints of fishbone ingestion. All patients underwent an oral examination followed by radiographic examination with plain films, barium swallows, barium and water swallows, and an endoscopic examination. All radiographs were reviewed by two unbiased, experienced radiologists. Of the 7 cases with fishbone found at endoscopic examination, only two (29%) bones were seen by the primary radiologist and 5 (71 %) by the reviewing radiologists. Except for one case in which all three radiologists detected a fishbone that passed during the examination, and thereby was not found on endoscopy, no fishbones were found at the radiographic examination that were not seen on the endoscopic examination. Thus, radiography added no valuable information but only delayed the endoscopic examination with ensuing removal of the foreign body, which had to be performed regardless of the outcome of the radiographic examination. Therefore, we suggest that patients with a short history of complaints of fishbone ingestion, ie, 48 hours or less, should first be evaluated with oral and endoscopic examination.
Ventilating Tracheal Resectoscope
Authors: Dunham Michael E. , Holinger Lauren D.
Published: October 2014

The ventilating tracheal resectoscope (Karl Storz) combines the advantages of a ventilating bronchoscope and the resecting cystoscope for removal of soft tissue from the airway. The resectoscope offers several distinct advantages over other methods of granulation tissue removal. The procedure is done under direct vision with magnification and illumination of a rod-lens optical system. Suprastomal granulation tissue is resected cleanly, without tearing or stripping of adjacent mucosa. Hemorrhage is readily controlled with the coagulating mode. The resectoscope can also be used for removing benign tumors (such as recurrent respiratory papillomatosis) from the trachea and bronchi. Its use in the efficient removal of malignant tumors and subglottic soft tissue has also been described.
Technical Approach for Reanimation of the Chronically Denervated Larynx by Means of Functional Electrical Stimulation
Authors: Zealear David L. , Rainey Cheryl L. , Tanabe Tetsuya , Jerles Matthew L. , Herzon Garrett D.
Published: October 2014

Functional electrical stimulation (FES) of the posterior cricoarytenoid (PCA) muscle to produce vocal fold abduction offers an alternative approach to current surgical therapies for bilateral vocal fold paralysis. The purpose of this study was to characterize the application of FES to chronically denervated PCA muscles. Specific goals were to develop a stimulus delivery system for the PCA muscle, determine a practical means of implantation, and identify stimulus parameters effective in activating chronically denervated muscle. Seventeen dogs were implanted with planar electrode arrays 3 months after unilateral recurrent laryngeal nerve resection. A nail-bed electrode array allowed discrete activation of the PCA muscle and gave the greatest abductions, with minimal charge dissipation. Muscle mapping revealed hot-spot regions on the PCA muscle surface, in which stimulation produced maximum abduction. A conservative stimulus paradigm effective in activating chronically denervated muscle was a 1-second pulse train of 2-millisecond-duration pulses, delivered at a tetanizing frequency of 30 Hz and an amplitude of 4 to 14 mA.