bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Tracheal Tube Created with Vascularized Fascia
Authors: Delaere Pierre R. , Liu Ziying , Feenstra Louw
Published: October 2014

An experimental fascial transferable bed was developed in the rabbit model. This tissue is reliable in bringing a viable mucosal graft inside the larynx. A vascular connective tissue sheet with full-thickness mucosa and autogenous cartilage for external support are needed. In this study a tracheal tube was preformed to study the use of autogenous cartilage as support for a circumferential lumen.
Hemodynamic Changes in the Head and Neck after Ligation of the Unilateral Carotid Arteries: A Study Using Color Doppler Imaging
Authors: Takeuchi Yousuke , Suzuki Haruhiko , Numata Tsutomu , Hino Takeshi , Konno Akiyoshi , Kaneko Toshio
Published: October 2014

For evaluation of the hemodynamics of the collateral circulation to the ligated external carotid artery (ECA) region, we measured the blood flow direction and volume in branches of the ECA in patients with unilateral carotid artery ligation before and during digital suppression of the common carotid artery (CCA) on the ligated and nonligated sides with color Doppler imaging and angiography. The main collateral pathway to the ligated ECA region was the ipsilateral occipital artery through Richter's anastomosis from the vertebral artery in the case of unilateral ECA ligation, and was the contralateral carotid artery in the case of unilateral CCA, ECA, and internal carotid artery resection. The superior and inferior labial arteries were important as the collateral pathway from the contralateral ECA.
Does Topical Antibiotic Prophylaxis Reduce Post—Tympanostomy Tube Otorrhea?
Authors: Garcia Philip , Gates George A. , Schechtman Kenneth B.
Published: October 2014

Purulent otorrhea is the most common complication of tympanostomy tube (TT) insertion. It may occur in the postoperative period or at any time during the sojourn of the tube. The efficacy of topical antimicrobial prophylaxis against purulent postoperative otorrhea (PPO) has been examined in 5 prospective, randomized studies; all demonstrated a reduction in PPO from topical antimicrobial prophylaxis, but in only 1 study was the difference statistically significant. Because the 5 studies used 2 different experimental designs — By-patient, and by-ear — a single meta-analysis could not be done. However, the by-patient studies met the criteria for meta-analysis, which demonstrated a combined odds ratio of 0.12 (95% confidence interval 0.04 to 0.37, p = .0002). This represents an 85% reduction in otorrhea, which is judged to be clinically as well as statistically significant. We conclude from the available evidence that prophylactic use of topical antimicrobial agents following TT insertion consistently reduces the rate of PPO. However, the low incidence of PPO and the heterogeneity of the published studies prevent making a final judgment for or against the continued use of these agents. Therefore, given that these potentially ototoxic agents are frequently administered to prevent postoperative otorrhea, further study of this subject is warranted. In the meantime, we recommend judicious use of these agents following TT insertion in those cases at higher risk for PPO, namely those with mucoid or purulent effusion.
Acoustic Analysis of Vocal Instability in Cerebellar Dysfunctions
Authors: Ackermann Hermann , Ziegler Wolfram
Published: October 2014

Acoustic analysis of vocal instability during the production of isolated vowels, including computation of mean fundamental frequency (F0), period-to-period variability (jitter), pitch fluctuations, and between-trial variation of F0, was performed in 20 patients with cerebellar cortical dysfunction. Eleven subjects suffered from purely cerebellar atrophy (CA). In the remaining 9 patients olivopontocerebellar atrophy (OPCA) had been diagnosed. A subgroup of both the CA and OPCA subjects presented with enlarged pitch fluctuations and/or increased jitter values. It is conceivable that asymmetrically distributed motor deficits at the laryngeal level and altered gain settings of laryngeal and/or respiratory reflexes account for the observed phonatory instability. Moreover, 5 of the 20 cerebellar patients had a pitch level exceeding the upper limit of the normal range. Presumably, this deviation reflects increased vocal effort.
Lymphocyte Migration to the Middle Ear Mucosa
Authors: Kato Hirofumi , Bundo Junichi , Watanabe Noritake , Mogi Goro
Published: October 2014

We investigated the migration of antigen-specific IgA—forming cells to the middle ear mucosa. Antigen-specific lymphocytes of IgA and IgG classes were induced in guinea pigs according to an immunization strategy previously described. From those animals, chromium 51–labeled lymphocytes of Peyer's patches and spleen were transferred to radiated chimera recipients. The radioactivity levels of the middle ears with antigenic and nonantigenic stimuli were significantly higher than those of the control ears (p < .05). Those levels of radioactivity were influenced neither by origins and subsets of transferred cells nor by antigenic stimuli to the mucosa (p > .05). Many labeled cells were observed in the middle ear effusion, while few were found in the inflamed mucosa. These findings suggest that in the early stage of inflammation, lymphocytes, including antigen-specific T and B cells, may be recruited from the blood circulation to the inflamed middle ear mucosa by nonspecific inflammatory processes that may mask antigen-specific factors in lymphocyte migration.
Mycoplasma and Chlamydia in Adenoids and Tonsils of Children Undergoing Adenoidectomy or Tonsillectomy
Authors: Huminer David , Levy Rudi , Pitlik Silvio , Samra Zmira
Published: October 2014

The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1%, core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.
Aneurysmal Bone Cysts of the Jaws
Authors: Kershisnik Matthew , Batsakis John G.
Published: October 2014

Aneurysmal bone cysts of the jaws are histologically the same as those found in the more usual appendicular sites for this lesion. They may be primary or secondary (associated with another definable osseous lesion) and have a 2:1 or 3:1 predilection for the mandible over the maxilla. Curettage is associated with relatively high recurrence rates, while surgical excision, with negative margins, of primary lesions markedly reduces this incidence.
Meditation on the Pathogenesis of Hypopharyngeal (Zenker's) Diverticulum and a Report of Endoscopic Treatment in 545 Patients
Authors: van Overbeek Jos J. M.
Published: October 2014

Much discussion in the literature concerning Zenker's diverticulum is related to etiology. Various theories have been propounded, but no single conclusion is generally accepted. We believe that an anatomic predisposition plays a prominent role. Considerations for this conclusion will be discussed. In the otorhinolaryngology departments of University Hospital and Martini Hospital (Groningen, the Netherlands) 545 patients with a diverticulum were treated endoscopically since 1964. Initially we used the procedure described by Dohlman. With the increase in the number of patients, the technique and instruments used have improved. In 1981 we started to apply a microendoscopic procedure with a special double-lipped scope and the carbon dioxide laser. The rate of complications was very low, and 91% of the patients are highly satisfied. In view of our results, we feel justified in maintaining that endoscopic treatment is a relatively safe and effective method.
Gastroesophageal Reflux Disease as a Likely Cause of “Idiopathic” Subglottic Stenosis
Authors: Jindal Jay R. , Milbrath Mary M. , Hogan Walter J. , Shaker Reza , Toohill Robert J.
Published: October 2014

The cause of subglottic stenosis (SGS) is unknown for a subgroup of patients in which there is a female predominance. Seven women ranging in age from 39 to 66 years developed symptomatic and progressive SGS. Six of the 7 patients failed to respond to all measures of conservative and radical surgical intervention. After recent thorough evaluation for gastroesophageal reflux disease (GERD) followed by medical management for such, these 6 patients have stabilized and have responded to surgical management. The seventh patient recently presented with SGS, was evaluated and treated for GERD, and has not required any surgical management. This study suggests that GERD laryngitis may be pertinent in the development of SGS. Medical management of GERD thus appears vital to successful treatment of idiopathic SGS.
Non-Hodgkin's Lymphomas of the Nose and Paranasal Sinuses in the Pediatric Population
Authors: Bumpous Jeffrey M. , Martin David S. , Curran Perrin , Stith John A.
Published: October 2014

Paranasal and nasal neoplasms often elude early diagnosis in the pediatric population. This report examines 3 cases of nasal and paranasal sinus lymphomas out of 29 lymphomas and lymphoproliferative disorders seen from 1983 to 1990. Diagnostic delays are common. The development of orbital signs and symptoms often leads to diagnosis. Computed tomography and magnetic resonance imaging are important in delineating the extent of disease and allow appropriate staging. Transnasal biopsy yields the definitive diagnosis, with low associated morbidity. Aggressive chemotherapy and irradiation prolongs survival; with this regimen all of our patients have remained alive, although 1 has residual disease. B-cell lymphomas are more common than T-cell varieties in children. One patient demonstrated B-cell immunodeficiency and preleukemia prior to developing primary paranasal sinus non-Hodgkin's lymphoma; this case reiterates the systemic nature of lymphoma. Key differences between children and adults in the manifestations of nasal and sinus lymphomas are emphasized.
Innominate Artery Compression of the Trachea in Infants
Authors: Jones Dwight T. , Jonas Richard A. , Healy Gerald B.
Published: October 2014

Innominate artery compression of the trachea in infants can cause severe biphasic stridor, cyanosis, and respiratory arrest. These episodes are sometimes referred to as “dying spells.” In the past, aortopexy has been used for the treatment of this problem, but since many have questioned its success, its use has not been popularized or generally accepted. Over the past 4 years, 12 children have been successfully treated for innominate artery compression of the trachea with aortopexy. These children all initially presented with significant respiratory and/or feeding difficulties. Preoperative and postoperative videos were obtained to document the degree of tracheal compression and/or lumen size before and after surgery. Since treatment, all patients have been without further feeding problems or cyanosis. When performed in selected patients, aortopexy is successful in relieving tracheal obstruction from innominate artery compression. This article discusses proper patient selection, operative technique, and follow-up care. The management of compression in patients with less severe symptoms will also be addressed.
Management of Severe Congenital Tracheal Stenosis
Authors: Dunham Michael E. , Holinger Lauren D. , Backer Carl L. , Mavroudis Constantine
Published: October 2014

We have managed 23 infants and children with severe tracheal stenosis due to congenital complete tracheal rings producing a long-segment stenosis of the trachea. Nineteen (83%) have survived this life-threatening cause of airway obstruction, 7 of whom also had pulmonary artery slings. Pericardial patch tracheoplasty facilitated by partial cardiopulmonary bypass is currently our preferred technique for surgical repair. Eighteen patients (78%) underwent operative intervention, 3 of whom (17%) have died since surgery. The mean follow-up is 4.5 years. Bronchoscopy is essential for preoperative diagnosis and accurate intraoperative incision of the trachea, and is critical for long-term postoperative airway management. The more distal lesions are associated with increased complications and a higher mortality rate.
Granular Cell Tumors
Authors: Kershisnik Matthew , Batsakis John G. , Mackay Bruce
Published: October 2014

The skin and subcutaneous tissue and mucosae of the head and neck are areas of predilection for granular cell tumors. These often histogenetically enigmatic lesions have two principal clinicopathologic presentations: an infantile (congenital) epulis form of the gnathic gingiva and a noncongenital soft tissue and aerodigestive form. Recurrences of either form are largely attributable to marginal excision and, for all sites, approach 15%. A malignant granular cell tumor is recognized, but requires rigorous histologic confirmation.
Pathology of Olfactory Mucosa in Patients with Alzheimer's Disease
Authors: Yamagishi Masuo , Ishizuka Yoichi , Seki Kohji
Published: October 2014

Characteristic changes that appear in the biopsied olfactory mucosa of patients with Alzheimer's disease (AD) were examined with immunohistochemical staining. Specimens were obtained from patients with clinical diagnoses of AD. Patients with vascular dementia and age-matched patients without dementia were used for controls. In most AD cases, neurofibrillary tangle-like abnormal tau protein (Tau) immunoreactivity was seen in the dendrites and perikarya of the olfactory receptor cells and in the nerve bundles. A senile plaquelike extracellular mass was found in the olfactory epithelium, and it reacted strongly to an anti-Tau antiserum and weakly to an antiamyloid-β protein antiserum. Ubiquitin (Ubq) immunoreactivity was also observed in the dendrites. Tau immunoreactivity of the perikarya and extracellular mass, and Ubq immunoreactivity were especially characteristic of the olfactory mucosa of AD patients. From these results, it is clear that the same pathologic changes in the brain are also present in the olfactory mucosa of patients with AD. Not only disruption of the central olfactory pathway, but also an olfactory disturbance of AD patients is caused by peripheral changes. Furthermore, an olfactory mucosal biopsy could be a useful method for a definitive diagnosis of AD.
Nonsyndromic Hearing Loss: An Analysis of Audiograms
Authors: Liu Xuezhong , Xu Lirong
Published: October 2014

We examined features of the audiograms of 136 individuals, from 28 families, affected by nonsyndromic genetic hearing loss. There were 83 (12 families) with autosomal dominant (AD) loss, 50 (15 families) with autosomal recessive (AR) loss, and 3 (1 family) with X-linked recessive loss. The main audiogram shapes found were sloping (50.3%), residual (26.5%), and flat (21.0%). Specific shapes (ascending and U-shaped) only occurred in 3.7% of AD cases. Audiogram shapes were found to be significantly different between AD and AR families, and showed intrafamilial and interfamilial variability. In the AR group, the main shapes were residual and sharply sloping, and in the AD group, sharply sloping, flat, and gently sloping. There was a significant difference in the degree of hearing loss between AD and AR types, with AD being milder than AR. It has been shown that there is more marked intrafamilial variation in the degree of hearing loss in AD families than in AR ones. The results suggest that the audiograms of nonsyndromic hearing loss are usually nonspecific and that counseling of family members would be better based on the specific family's condition rather than on group information.
Preliminary Report on L-Forms: Possible Role in the Infectious Origin of Secretory Otitis Media
Authors: Goksu Nebil , Bengisun Sedef , Ataoglu Haluk , Kemaloglu Yusuf K. , Ozbilen Suat
Published: October 2014

Infection and inflammation of the middle ear cleft are important factors in the pathogenesis of secretory otitis media. Although high percentages of negative cultures are confronted in many studies, strong evidence pointing to the infectious nature of this disease could not be overlooked. Many authors agree about the failure of conventional culture methods in identifying the responsible pathogen or pathogens. Besides, some agents, such as some kinds of antibiotics, lysozyme, and perhaps some undetected materials, are capable of changing bacterial behavior and consequently the clinical course. Effusions taken from 40 ears with secretory otitis media were cultured by means of conventional brain-heart infusion broth and special hypertonic thioglycollate broth. Strikingly, bacterial L-forms were detected in 6 specimens in thioglycollate broth, with no growth in the conventional broth. We concluded that these atypical forms of bacteria, the L-forms, may play an important role in the bacteriologic aspect of secretory otitis media.
William Wright, Aurist: Nineteenth Century Pneumatic Practitioner and a Discoverer of Anesthesia
Authors: Bergman Norman A.
Published: October 2014

William Wright (1773–1860) was Surgeon-Aurist in Ordinary to Her Majesty Queen Charlotte of England. One interesting feature of his otologic practice was his employment of gases and vapors in treating deafness and other disorders of the ear. Among aeroform substances that he advocated for such uses were nitrous oxide and ether—gases that were destined to become anesthetic agents in another quarter of a century. Wright made the observation that inhalation of ether vapor would suppress the cough elicited by instrumentation of an inflamed and sensitive ear canal. He used ether inhalation beginning about 1820 in his practice for this purpose, and in so doing appears to have administered some of the earliest anesthetics on record.
Peritonsillar Abscess: Repeated Needle Aspiration versus Incision and Drainage
Authors: Wolf Michael , Even-Chen Iris , Kronenberg Jona
Published: October 2014

The study evaluates the management of peritonsillar abscess (PTA) by comparing needle aspiration versus incision and drainage of the abscess. Twenty-four of 86 patients treated by needle aspiration underwent a single aspiration, and 38 had 2, 19 had 3, and 5 had 4 aspirations before the abscess resolved. A significant amount of pus, up to 8, 5, and 3 mL, respectively, was detected in the subsequent aspirations. Recurrent PTA was noted in 20 patients (23.26%). In 9 of these patients (10.47%) the recurrent episode occurred immediately (in less than 1 month) and was considered residual disease. Seventy-four patients were treated by incision and drainage, and none had an immediate recurrence. Only 3 (4.05%) patients developed a late recurrent episode. The difference in the recurrence rate between the two groups is statistically significant. A history of recurrent tonsillitis prior to abscess formation did not show a significant influence on the recurrence rate. A high incidence of streptococcal infections was noted in both groups, with anaerobes detected in only 15% of samples. There was a good response to penicillin-resistant organisms. Although needle aspiration is a tempting modality for treating PTA in community clinics, one should be aware of the risks of a higher incidence of residual and recurrent disease in comparison to incision and drainage, as well as the need for repeated aspirations.
Use of Laryngeal Muscular Tenotomy for Bilateral Midline Vocal Cord Fixation
Authors: Rontal Michael , Rontal Eugene
Published: October 2014

As experience has increased in the treatment of bilateral vocal cord fixation, a significant and fundamental refinement in the concept of repair has evolved. By the use of selective tenotomy of the interarytenoid and thyroarytenoid muscles, the arytenoid and the vocal cord can be made to move away from the midline and thus open the glottis. This has allowed a drastic reduction in the amount of arytenoid that must be removed and prevents both aspiration and arthritis of the joint with subsequent stiffness. The procedure can be performed as an endoscopic or microscopic open procedure. All eight patients treated by this method have been decannulated by 6 weeks postoperation, have returned to full function, have not had aspiration, and have no worsening of their voices. The use of this concept and technique has led to a relatively safe and reliable method of rehabilitating patients with bilateral midline vocal cord paralysis.
Amyloidosis of the Larynx in a Child
Authors: O'Halloran Laurence R. , Lusk Rodney P.
Published: October 2014

Localized laryngeal amyloidosis is a rare and benign process. Only three cases have been reported in children. We present the case of a 9-year-old girl with localized laryngeal amyloidosis that was excised via laryngofissure. The patient presented with a 3- to 4-week history of progressive hoarseness. Direct laryngoscopy revealed a smooth, firm, submucosal mass extending from the anterior aspect of the left false vocal cord to the vocal process. Biopsy of the mass revealed findings consistent with amyloidosis. The mass was approached via laryngofissure and excised with the thyroid cartilage and left true vocal cord left intact. An extensive workup for systemic amyloidosis was negative, including bone marrow biopsy. The postoperative recovery was uneventful, with good vocal quality and a sluggish but mobile left true vocal cord. This case is significant because of the young age of the child, the extent of disease, and the use of laryngofissure for excision.
Nasal Dermoid Sinus Cyst
Authors: Cauchois Régis , Testud Richard , Laccourreye Ollivier , Küffer Roger , Bremond Dominique , Monteil Jean-Paul
Published: October 2014

Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.
Proliferative Verrucous Leukoplakia and Verrucous Hyperplasia
Authors: Murrah Valerie A. , Batsakis John G.
Published: October 2014

Proliferative verrucous leukoplakia and hyperplasia are irreversible clinicopathologic lesions of the oral cavity and upper respiratory tract with considerable potential for evolving into verrucous or other forms of squamous cell carcinoma. Proliferative verrucous leukoplakia is a disease of the oral cavity in which verrucous hyperplasia is a part of its developmental spectrum. Verrucous hyperplasia, at other head and neck mucosal sites, may be associated with papillomas or be a de novo lesion. Human papillomavirus, as a cefaclor, plays a role in some of the lesions. In the instance of verrucous hyperplasia, the authors consider it an early form of verrucous carcinoma and recommend it be treated accordingly.
Tracheotomy and the Role of Postoperative Chest Radiography in Adult Patients
Authors: Barlow Darryk W. , Weymuller Ernest A. , Wood Douglas E.
Published: October 2014

A retrospective review of 100 adult tracheotomies performed by the University of Washington Department of Otolaryngology—Head and Neck Surgery was done to evaluate our complication rate and the role of postoperative chest radiography (CXR). In an attempt to identify specific risk factors for pneumothorax (PTX), the following items were reviewed: age, urgency (elective, urgent, and emergent), awake or general anesthesia, diagnosis (reason for tracheotomy), “difficulty” of tracheotomy, postoperative signs or symptoms of PTX, and findings on postoperative CXR. The series had a PTX rate of 2%. Both patients with complications reviewed here had definite risk factors, or signs and symptoms of PTX. The causes, risk factors, and treatments for PTX are reviewed. Postoperative CXR is indicated in cases at increased risk for PTX, and in patients with clinical signs or symptoms of PTX. Had we followed our proposed criteria, we would have performed postoperative CXR 13 times instead of 93. This would have resulted in a total savings of $10,020. We conclude that postoperative CXR after a routine, uncomplicated tracheotomy is of low yield and incurs unnecessary expense.
Malignant Laryngeal Tumors in Children: A 15-Year Experience with Four Patients
Authors: Ohlms Laurie A. , McGill Trevor , Healy Gerald B.
Published: October 2014

Malignant laryngeal neoplasms in children are uncommon and present diagnostic and therapeutic challenges. A 15-year retrospective review of laryngeal tumors at our institution identified four patients with malignant neoplasms. These children, 7 months to 16 years of age, were treated for squamous cell carcinoma, choriocarcinoma, rhabdomyosarcoma, and primitive neuroectodermal tumor. This report details these cases, emphasizing diagnostic approaches, treatment decisions (medical oncologic management, surgical resection), and rehabilitation measures for postlaryngectomy communication. A multi-institutional pediatric head and neck tumor registry would be a useful reference to assist with individual treatment decisions.
Jejunal Graft Reconstruction of Pharyngoesophageal Defects without Microvascular Anastomoses
Authors: Panje William R. , Hetherington Hugh E.
Published: October 2014

The purpose of this article is to describe transplantation of jejunal grafts without microvascular anastomoses for reconstruction of the pharynx and/or upper esophagus following oncologic resections. Even though use of free flaps including jejunum, a method that requires revascularization, continues to offer superior results in pharyngoesophageal reconstruction, the technique described in this article provides a readily available alternative. This timesaving technique is particularly useful if the surgeon encounters intraoperative complications related to either the microvascular anastomoses or to an unstable patient. The principal advantages of jejunal graft reconstruction include the absence of a need for microvascular anastomoses, a decreased operating time, a one-stage operation, and the replacement of pharyngoesophageal mucosa with like tissue. The disadvantages include the need for laparotomy, the requirement for a well-vascularized tissue bed, delayed wound healing, the need for stenting, and delayed initiation of oral intake.
Sarcomas of the Nasal Cavity and Paranasal Sinuses
Authors: Sercarz Joel A. , Mark Rufus J. , Storper Ian , Tran Luu , Calcaterra Thomas C.
Published: October 2014

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.
Polymerase Chain Reaction Amplification of Herpes Simplex Viral Dna from the Geniculate Ganglion of a Patient with Bell's Palsy
Authors: Burgess Robert C. , Bale James F. , Michaels Leslie , Smith Richard J. H.
Published: October 2014

Bell's palsy is the most common cause of facial paralysis. In this study, we demonstrate the presence of herpes simplex viral type 1 (HSV-1) genomic DNA in the geniculate ganglion of a patient who had Bell's palsy. This association suggests that in this patient, HSV-1 may have caused Bell's palsy. If HSV-1 is a cause of Bell's palsy, treatment with acyclovir may be beneficial. Additional studies should be done to establish the prevalence of HSV-1 as an etiologic agent of Bell's palsy.
Phasic Changes in Human Nasal and Skin Blood Flow: Relationship with Autonomic Tone
Authors: Mevio Emilio , Bernardi Luciano
Published: October 2014

To assess the autonomic control of the microcirculation in human skin and nasal mucosa, the spontaneous fluctuations of a laser Doppler signal recorded on forearm skin and nasal mucosa were compared with heart rate fluctuations and the respiratory signal in 11 healthy subjects by means of spectral analysis. Possible direct mechanical-thermal effects of airflow on the nasal mucosa were evaluated by comparing recordings obtained when the subjects were breathing through either the nose or the mouth. Comparison of the spectral analysis of the signal obtained for skin and nasal mucosa blood flow allowed us to define the characteristics of the autonomic tone of the microcirculation in these two areas. The skin is mainly influenced by sympathetic activity, and the nasal blood flow is regulated by both sympathetic and parasympathetic activity.
Combined Thyroplasty Type I and Inferior Constrictor Myotomy
Authors: Montgomery William W. , Hillman Robert E. , Varvares Mark A.
Published: October 2014

The preoperative evaluation and technique of combined thyroplasty and inferior constrictor myotomy are described and illustrated. The results in cases in which thyroplasty type I and inferior constrictor myotomy were done as separate procedures are compared to those in cases in which thyroplasty and inferior constrictor myotomy were combined in the same operation. The end results obtained with these two approaches did not differ significantly; however, with the exception of brain stem disease, patients undergoing the combined procedure at an early date are more likely to be spared gastrostomy and aspiration pneumonia. Diseases of the brain stem (ie, stroke and metastatic disease such as breast cancer) respond poorly to an inferior constrictor myotomy. In such cases the patient can best be rehabilitated with a thyroplasty type I along with a gastrostomy or laryngeal closure procedure.
Diagnosis and Management of External Penetrating Cervical Esophageal Injuries
Authors: Armstrong William B. , Detar Thomas R. , Stanley Robert B.
Published: October 2014

External penetrating injuries of the esophagus are more likely to cause serious morbidity and even mortality than those involving the pharynx. However, the cervical esophagus is extrathoracic in location, and controversy exists regarding the diagnosis and surgical management of penetrating injuries at this level. A retrospective review of 23 such injuries showed that contrast esophagography had only a 62% success rate in identification of cervical esophageal violations, compared to 100% for rigid esophagoscopy. Even large penetrations were successfully treated with limited debridement, primary repair when possible, muscle interposition flaps to separate common injuries of the tracheal wall, and, most important, external drainage of the adjacent neck spaces. Esophageal stricture occurred only when complex esophageal diversion procedures were performed, either as an unnecessary primary operation, or as a lifesaving secondary operation necessitated by infectious complications caused by delayed diagnosis and treatment of the esophageal violation. Penetrating injuries of the cervical esophagus can therefore be managed more as a pharyngeal injury if diagnosis and appropriate surgical treatment occur in a timely fashion.
Statistical Analysis of Otosclerosis Surgery Performed by Jean Marquet
Authors: Somers Thomas , Marquet Thérèse , Govaerts Paul , Offeciers Erwin
Published: October 2014

The early and long-term hearing results of 1,681 primary otosclerosis operations performed by the same surgeon, Jean Marquet, were reviewed retrospectively and analyzed with very strict statistical standards. Significantly better short- and long-term results were achieved with the stapedotomy technique compared to total stapedectomy, mainly at the higher frequencies (4 and 8 kHz) important for speech discrimination. Whatever technique was used to open the footplate (micropick, microdrill, or laser), no statistical audiometric difference could be found. The results were equal whether or not the stapedial tendon was preserved. Perioperative problems like pronounced oozing, difficult anatomic relationships, and accidental perilymph aspiration could affect hearing at higher frequencies. The calibrated hole technique was equally as good as conventional oval window sealing in sealing of the fenestra to prevent fistula. The stapedotomy technique was found the safest, having fewer complications.
Changes in Cerebrospinal Fluid Pressure in Daily Life
Authors: Sakikawa Yasuhiko , Kobayashi Hitome , Nomura Yasuya
Published: October 2014

The purpose of the present study was to measure changes in cerebrospinal fluid pressure (CSF-P) during actions of daily life. A spinal tap was performed on 23 inpatients. During the procedure, the patients were requested to perform the following four actions: nose blowing with one side closed, nose blowing with both sides closed, breath holding, and sniffing. The CSF-P was recorded before and during these actions. Of these, nose blowing with both sides closed resulted in the greatest elevation of pressure. Three patients with perilymph fistula showed larger changes than the other 20 patients. Conversely, sniffing lowered the CSF-P in all cases. The present study suggests that daily physical actions cause significant elevations of CSF-P. Such changes may be responsible for the development of perilymph fistula.
Benign Pathologic Responses of the Larynx
Authors: Gray Steven D. , Hammond Elizabeth , Hanson Darrin F.
Published: October 2014

Benign laryngeal lesions were examined for patterns of injury indicated by deposition of fibronectin and collagen type iv. An immunoperoxidase technique was used to compare 33 fresh or paraffin-embedded tissues with regard to their staining of monoclonal antibodies directed against fibronectin and collagen type iv. Two types of patterns were recognized. One pattern showed intense fibronectin deposition in the superficial layer of the lamina propria, often coupled with basement membrane zone injury, indicated by thick collagen type IV bands. The other pattern showed rare basement membrane zone injury and very little fibronectin deposition. The first pattern correlated more with nodules, the second pattern more with Reinke's edema and some polyps. A better understanding of the effects of excessive deposition of structural glycoproteins such as fibronectin and of abnormal proteoglycan deposition may lead to a better characterization of vocal fold disease and its causation and, ultimately, better treatment.
Airway Complications of Jet Ventilation in Neonates
Authors: Nicklaus Pamela J.
Published: October 2014

Four cases of airway complications in infants surviving jet ventilation have been observed at the Children's Hospital of New Mexico. Two cases of necrotizing tracheobronchitis in preterm infants are presented: one was treated with bronchoscopy and removal of the necrotizing tissue; the second was placed on extracorporeal membrane oxygenation, prior to dilation of the affected area. A third child developed subglottic stenosis after intubation with an oversized jet endotracheal tube. A fourth child, with a history of prematurity and jet ventilation as a neonate, was found at 3 years of age to have tracheal webs in the lower third of his airway. Management and follow-up of these four cases, as well as a literature review of the known airway complications of jet ventilation, are presented.
Role of Modern Imaging Technology in the Implementation of Pediatric Cochlear Implants
Authors: Silberman Bruno , Garabedian Eréa-Noël , Moatti Lucien , Denoyelle Françoise , Roger Gilles
Published: October 2014

Since 1989, 40 patients have received cochlear implants in our institution. Over the past 2 years, 17 children among these patients have undergone radiographic assessment combining magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) scanning. Imaging is not essential, and is only used after assessment by a multidisciplinary team. However, the imaging results influence the choice of implant, and sometimes the side to be implanted. The first study is always CT, as it detects congenital abnormalities, and for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification that contraindicates or complicates cochlear implantation. These signs are not always visible with tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for postoperative confirmation of implant position in case of failure or complication. Over the past 3 years, MRI has been combined with tomodensitometry, especially with children having a history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A GE Signa 1.5-T unit was used by the authors, employing sequences of volumetric acquisition (steady state free precision with 1.5-mm image slices and an angle of 15° to 35°). Hence, modern imaging plays an important role when the decision to implant has already been made, particularly in the case of profoundly deaf children. We always use MRI in combination with a CT scanner in children with a history of meningitis.
Vestibular and Sensory Interaction Deficits Assessed by Dynamic Platform Posturography in Patients with Multiple Sclerosis
Authors: Nelson Susan R. , Di Fabio Richard P. , Anderson John H.
Published: October 2014

Vestibular impairments have not been routinely identified in patients with multiple sclerosis (MS), because of the confounding effects of deficits in other neural systems. In this study, 35 patients with MS were evaluated by means of a systematic alteration of the sensory environment (dynamic posturography) in order to identify those patients who became unstable when vestibular inputs were needed to maintain stance. Subjects were assigned to either a high-function (HF) or a low-function (LF) group on the basis of a functional status assessment score obtained prior to the posturography test. For the HF group, 30% (7/23) had abnormal posturography scores. Of those subjects, 3 had a vestibular dysfunction pattern or a somatosensory-vestibular impairment. In contrast, 58% of the LF group (7/ 12) had abnormal posturography scores. Nearly all of these LF patients (677) had a vestibular dysfunction pattern or a combined visual-vestibular or somatosensory-vestibular impairment. Posturography might serve as one method to evaluate the functional consequences of a vestibular deficit in patients with MS.
Recurrent Pleomorphic Adenoma of the Parotid Gland: Report of 126 Cases and a Review of the Literature
Authors: Phillips P. Perry , Olsen Kerry D.
Published: October 2014

The records of 126 patients with recurrent pleomorphic adenoma of the parotid gland treated at our institution from 1965 to 1985 were retrospectively reviewed. Multiple variables were analyzed to determine tumor behavior and treatment results. Of the study patients, 61% were female and 39% male, with a mean age of 35.6 years at the time of treatment at our institution. The average follow-up period was 14.5 years. Tumor recurrence was 32.5% after one operation at our institution, 7.1% after two operations, and 1.6% after three. Malignant disease occurred in 9 (7.1%) patients. After all surgical procedures, partial facial nerve paralysis was noted in 13.5% and total paralysis in 5.5%. These results suggest low morbidity and good success in tumor eradication with an aggressive surgical approach.
Degeneration of Vestibular Sensory Cells Caused by Ablation of the Vestibular Aqueduct in the Gerbil Ear
Authors: Kimura Robert S. , Trehey Jennifer A. , Hutta Jessica
Published: October 2014

The vestibular aqueduct of the gerbil has a unique anatomic feature that makes it possible to selectively obliterate the endolymphatic sac with or without interfering with its venous drainage. In animals in which only the endolymphatic sac was ablated, endolymphatic hydrops was slight in the cochlea and was absent in the vestibular labyrinth. The cochlear and vestibular sensory cells were normal. In animals in which both the endolymphatic duct and the vein were obliterated, hydrops was slight, with the exception of a few cochleas that showed moderate hydrops. The sensory cells of the posterior canal cristae had degenerated in all specimens, while varied pathologic changes in cochlear and vestibular sensory cells were present in some specimens. These results suggest that hydrops is primarily due to blockage of the endolymphatic duct and sac and that degeneration of sensory cells occurs when blood flow in the vestibular aqueduct is impeded. Pathologic changes in the endolymphatic sac, including the vascular plexus at the endolymphatic sac, may play an important role in the production of endolymphatic hydrops and vestibular symptoms in Meniere's disease.
Evidence Linking the 68 Kilodalton Antigen Identified in Progressive Sensorineural Hearing loss Patient Sera with Heat Shock Protein 70
Authors: Billings Peter B. , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2014

Immunoblotting against bovine inner ear extracts has previously identified a 68 kd antigen reactive with 22% to 58% of sera of patients with rapidly progressive sensorineural hearing loss (PSNHL) of suspected autoimmune causation. Efforts to purify and characterize this diagnostic antigen suggest that it is ubiquitous rather than inner ear-specific, and may represent the highly inducible heat shock protein (hsp) 70. The antigens identified by PSNHL sera and anti-hsp 70 monoclonal antibodies copurify on ion exchange and adenosine triphosphate affinity chromatography, and comigrate on one- and two-dimensional gel electrophoresis. Additionally, immunoblotting with positive patient sera shows dramatically increased expression of the 68 kd antigen by bovine kidney cells following heat shock in culture. Reactivity with stress proteins of various classes has been reported in a number of autoimmune diseases; however, anti—hsp 70 appears uniquely associated with ulcerative colitis and PSNHL.
Cytokine Regulation of Gelatinase Production by Head and Neck Squamous Cell Carcinoma: The Role of Tumor Necrosis Factor-Alpha
Authors: Mann Eric A. , Hibbs Margaret S. , Wang Xtn Ze , Spiro Jeffrey D. , Clawson Michael , Bowik Carol , Chen Lei L.
Published: October 2014

Gelatinases (GLs) belong to a family of enzymes known as matrix metalloproteinases (MMPs), which are produced by both normal and neoplastic cells. These enzymes have been implicated in tumor invasion and metastasis, although the mechanism of regulation of tumor MMP production is unknown. Since our previous studies have shown that numerous cytokines are present in the tumor microenvironment, our goal was to establish the effect of selected cytokines on GL production by both established tumor cell lines and primary cultures of head and neck squamous cell carcinoma (HNSCC). Supernatants of HNSCC cell lines SCC-25 and FADU stimulated with interleukin (IL)-1α and IL-1β demonstrated modest induction of 92 kd GL production by zymogram analysis when compared with controls; IL-2, IL-6, and interferon-γ had no consistent effect on MMP production. Stimulation of cell lines with tumor necrosis factor (TNF)-α (104 to 10 U/mL), however, dramatically enhanced production of 92 kd GL by both cell lines in a dose-dependent fashion, although tissue inhibitor of metalloproteinase (TIMP) expression was unaffected. Northern blot analysis showed that this enhancement of 92 kd GL occurred at the messenger RNA level. Stimulation of short-term primary tumor cultures with TNF-α resulted in significant enhancement of 92 kd GL expression in one of four cultures and enhancement of 72 kd GL expression in all cultures. The observed increase in GL expression by TNF-α suggests a role for this cytokine in the regulation of GL expression by tumor cells during invasion and metastasis.
Vascular Permeability of the Stria Vascularis and Morphology of the Endolymphatic Sac in two Types of Experimental Endolymphatic Hydrops
Authors: Sakagami Masafumi , Tomiyama Schunichi , Umemoto Masanori , Fukazawa Keuiro , Kubo Takeshi
Published: October 2014

We produced two kinds of experimental endolymphatic hydrops. One was induced by obliteration of the endolymphatic sac (ES), and the other was induced by both systemic keyhole limpet hemocyanin immunization and secondary keyhole limpet hemocyanin challenge into the ES. The vascular permeability of the stria vascularis in acute and chronic phases was compared between both models by light and electron microscopy using the tracer method of horseradish peroxidase. Both models showed that the number of strial capillaries showing horseradish peroxidase leakage was significantly higher in the acute phase than in the chronic phase. In the acute phase, the ES showed acute inflammation in both models. In the chronic phase, extensive fibrosis occurred in the ES obliteration model, whereas the ES appeared to have a normal shape in the immunologically induced model. The mechanism of hydrops formation will be compared between the two models.
Nasotracheal Airway-Oropharyngeal Alimentary Canal: A Microvascular Technique for Reconstruction of the Upper Airway after Total Laryngectomy
Authors: Hagen Rudolf , Schwab Burkard , Marten Sabine
Published: October 2014

Every patient who has to be laryngectomized because of a carcinoma is concerned with the loss of his or her voice and the presence of a permanent tracheostoma in his or her neck. While various methods for producing a substitute voice are available (esophageal voice, voice devices, voice-shunt operations with or without voice prosthesis), it is usually impossible after laryngectomy to reconstruct a complete upper airway so that the tracheostoma can be closed. One potential method for reconstruction of the airway is its division into a nasotracheal airway and an oropharyngeal alimentary canal. Ten Alsatian dogs were laryngectomized, and a microvascularly anastomosed jejunal autograft was inserted as a junction between the tracheal stump and the circularly exposed nasopharynx, while the pharynx was reconstructed separately. One week postoperatively, oral feeding could be started again; at the same time breathing was possible via the reconstructed nasotracheal airway, which was kept open by insertion of a silicone tube. By means of this microvascular technique, a complete nasal airway could be reconstructed surgically after laryngectomy.