bluuebunny/crossref_metadata_2025 huggingface dataset:
Flow Fields and Acoustics in a Unilateral Scarred Vocal Fold Model
Authors: Murugappan Shanmugam , Khosla Sid , Casper Keith , Oren Liran , Gutmark Ephraim
Published: October 2014

Objectives:

From prior work in an excised canine larynx model, it has been shown that intraglottal vortices form between the vocal folds during the latter part of closing. It has also been shown that the vortices generate a negative pressure between the folds, producing a suction force that causes sudden, rapid closing of the folds. This rapid closing will produce increased loudness and increased higher harmonics. We used a unilateral scarred excised canine larynx model to determine whether the intraglottal vortices and resulting acoustics were changed, compared to those of normal larynges.

Methods:

Acoustic, flow field, and high-speed imaging measurements from 5 normal and 5 unilaterally scarred canine larynges are presented in this report. Scarring was produced by complete resection of the vocal fold mucosa and superficial layer of the lamina propria on the right vocal fold only. Two months later, these dogs were painlessly sacrificed, and testing was done on the excised larynges during phonation. High-speed video imaging was then used to measure vocal fold displacement during different phases. Particle image velocimetry and acoustic measurements were used to describe possible acoustic effects of the vortices.

Results:

A higher phonation threshold was required to excite the motion of the vocal fold in scarred larynges. As the subglottal pressure increased, the strength of the vortices and the higher harmonics both consistently increased. However, it was seen that increasing the maximum displacement of the scarred fold did not consistently increase the higher harmonics. The improvements that result from increasing subglottal pressure may be due to a combination of increasing the strength of the intraglottal vortices and increasing the maximum displacement of the vocal fold; however, the data in this study suggest that the vortices play a much more important role.

Conclusions:

The current study indicates that higher subglottal pressures may excite higher harmonics and improve loudness for patients with unilateral vocal fold scarring. This finding implies that therapies that raise the subglottal pressure may be helpful in improving voice quality.
Serial Electromyography of the Thyroarytenoid Muscles Using the NIM-Response System in a Canine Model of Vocal Fold Paralysis
Authors: Scott Andrew R. , Chong Peter Siao Tick , Brigger Matthew T. , Randolph Gregory W. , Hartnick Christopher J.
Published: October 2014

Objectives:

We sought to determine whether serial intraoperative laryngeal electromyography (L-EMG) or evoked L-EMG predicts vocal fold (VF) recovery following iatrogenic injury.

Methods:

Six beagles were sedated, and bipolar needle electrodes were inserted into each thyroarytenoid (TA) muscle. Endotracheal tube surface electrodes were also placed. As the sedation lightened, L-EMG activity was recorded from all electrodes with an intraoperative nerve monitoring system. The neck was opened, and direct recurrent laryngeal nerve (RLN) stimulation was performed. Subsequently, 4 animals underwent crush injury of the left RLN, and 2 animals underwent nerve transection. The L-EMG procedures were repeated every 1 to 2 weeks until left VF motion was observed in the dogs that suffered RLN crush injury. At each time point, the neck was opened and both RLNs were stimulated.

Results:

Fibrillation potentials were detected in all animals after RLN injury. A change to electrical silence was seen in the animals in the crush injury group that were evaluated during the week preceding VF recovery. Fibrillation potentials and VF immobility persisted in the transection group throughout the complete time course of these experiments. The first appearance of an evoked response coincided with or occurred after the return of left VF motion in the crush injury group. The threshold, latency, and amplitude differed from those of the controls and approached normal values over time. No response was detected in the transected nerves.

Conclusions:

The disappearance of fibrillations on intraoperative L-EMG was noted in the animals tested the week before the return of VF motion, and the return of motor unit action potentials was seen along with return of VF function. Evoked L-EMG was not helpful in predicting the return of VF mobility, but it may help quantify degrees of RLN injury and predict the speed of recovery.
Cell Density of the Lamina Propria of Neonatal Vocal Folds
Authors: Rosenberg Tara L. , Schweinfurth John M.
Published: October 2014

Objectives:

We undertook 1) to measure the cell density within the lamina propria of the neonatal vocal folds and 2) to examine changes in cell density in the lamina propria with increasing gestational age of the neonatal vocal folds.

Methods:

Intact neonatal larynges were obtained from fresh cadaveric specimens. Hematoxylin and eosin–stained slides were used to visualize the laryngeal structures, and photomicrographs of the vocal folds were taken at 100× magnification. The cell density of the lamina propria was calculated by counting the cells within each of five 100-μm2 regions within the study area, and the totals were then averaged for each area.

Results:

A total of 62 sections from 14 larynges with gestational ages of 19 to 36 weeks were examined. Histologic analysis revealed a uniform appearance of the vocal fold without apparent layers. The cell density of the lamina propria was 30 or more cells per 100 μm2 for 51.2% of larynges with less than 27 weeks of gestation. However, only 14.3% of the larynges with 27 or more weeks of gestation had an average cell density of 30 or more cells per region (p < 0.005).

Conclusions:

As described by previous studies, the lamina propria of the neonatal vocal folds is a hypercellular monolayer. The process of vocal fold maturation appears to occur earlier than previously thought, with decreasing cell density in the lamina propria by 27 weeks' gestation.
Clinical Outcomes of Bedside Percutaneous Dilatational Tracheostomy with Suspension Laryngoscopy for Airway Control
Authors: Sharp Dawn B. , Castellanos Paul F.
Published: October 2014

Objectives:

We sought to describe outcomes of a new technique blending suspension laryngoscopy (SL) with percutaneous dilatational tracheostomy (PDT), addressing concerns of airway control and risks of dire complications.

Methods:

A retrospective review of 67 cases included “all comers,” in that if the patient could undergo any type of tracheostomy, SL-PDT was offered, and it was performed in all but 1 patient. Patient demographics, intubation time, time from consultation to procedure, and perioperative complications were reviewed.

Results:

Sixty-six patients underwent SL-PDT; 54 procedures were performed bedside in the intensive care unit, and 12 in the operating room. Use of the operating room was due to lack of intensivist availability or possible need for an emergent surgical airway. Early in the series, 1 patient required open tracheostomy because of unfavorable anatomy. Two major complications occurred: 1 perioperative airway obstruction and 1 severe bradycardic event. The 2 patients were resuscitated without significant sequelae. Three minor complications occurred: 2 cases of endotracheal bleeding and 1 transient bradycardic event.

Conclusions:

Bedside SL-PDT is relatively safe and effective, and offers advantages over traditional PDT and open tracheostomy. This novel technique may encourage a concerted multidisciplinary effort, including otolaryngologists, to continue to improve bedside airway management in critically ill patients.
Flexible Endoscopic Evaluation of Swallowing in Healthy Young and Older Adults
Authors: Butler Susan G. , Stuart Andrew , Kemp Shannon
Published: October 2014

Objectives:

Scant data exist on normal swallowing as assessed endoscopically. A lack of understanding for the range of normal swallowing may lead to inaccurate diagnoses and overly aggressive management of patients with dysphagia. Accordingly, the purpose of this study was to determine the effects of age (ie, young versus older), gender, bolus volume (ie, 5 versus 10 mL), and bolus condition (ie, water versus milk) on Penetration-Aspiration Scale scores, bolus dwell time, pharyngeal closure duration, and residue in healthy adults.

Methods:

Twenty-three young adults (mean, 30.0 years of age) and 21 older adults (mean, 75.0 years of age) participated. Measurements were acquired during manoendoscopic swallowing assessments. The participants contributed 8 swallows, affording a study total of 352 swallows for analysis.

Results:

The older adults demonstrated penetration on 19 swallows and aspiration on 11 swallows out of 168 swallows. There was a significant difference in the proportion of Penetration-Aspiration Scale scores across age and gender groups. Longer bolus dwell times were seen in older adults and with milk boluses, whereas residue severity was less in young adults and with water boluses.

Conclusions:

Endoscopic data on normal swallowing physiology were generated. These data may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.
Balloon Dilation of the Frontal Recess in Patients with Chronic Frontal Sinusitis and Advanced Sinus Disease: An Initial Report
Authors: Catalano Peter J. , Payne Spencer C.
Published: October 2014

Objectives:

Balloon dilation of the sinus ostia and transition spaces is a relatively new tool in the management of chronic rhinosinusitis. Although studies of its safety and application have been reported, its efficacy in specific indications has yet to be clearly defined. The purpose of this study was to evaluate the use of balloon dilation of the frontal recess for the treatment of chronic frontal sinusitis in patients with advanced sinus disease.

Methods:

This was a prospective study of 20 patients who presented with chronic frontal sinusitis that had failed medical therapy and required operative intervention. Balloon dilation of the frontal recess was performed to improve drainage and ventilation of the frontal sinus. Preoperative and postoperative computed tomography scans were compared for change in the radiologic stage of disease based both on the Lund-Mackay staging system and on the Lund grade (extent of mucosal thickening).

Results:

Twenty patients met the inclusion criteria during the study period and were followed for several months after operation. All patients underwent a frontal sinus procedure with balloon dilation either alone or in concert with other minimally invasive techniques. A total of 29 sinuses were available for analysis. No significant complications resulted from the procedure. Pretreatment and posttreatment Lund-Mackay scores showed significant improvement in patients with certain subsets of chronic rhinosinusitis.

Conclusions:

Balloon dilation of the frontal recess is a relatively safe intervention that can be used in the treatment of chronic frontal sinusitis, even in patients with advanced disease.
Preoperative and Postoperative Intracranial Complications of Acute Mastoiditis
Authors: Mallur Pavan S. , Harirchian Sanaz , Lalwani Anil K.
Published: October 2014

Objectives:

We determined the clinical characteristics and treatment outcomes of an unusual cluster of intracranial complications seen in acute mastoiditis (AM).

Methods:

We performed a retrospective review of pediatric patients treated for AM in a tertiary care hospital from March 2006 to March 2007.

Results:

Eleven children, 6 months to 10 years of age (mean age, 3.8 years), were treated for AM confirmed by computed tomography, which identified asymptomatic intracranial complications in 8 of the 11 patients: These were sigmoid sinus thrombosis (4 patients), epidural abscess (4), perisigmoid abscess or bony erosion (2), and tegmen mastoideum dehiscence (1). All patients required operative intervention with tympanomastoidectomy, although only 2 patients required neurosurgical intervention, consisting of evacuation of epidural abscess and sigmoid sinus thrombosis, respectively. Cultures yielded routine organisms and 1 multidrug-resistant strain of Streptococcus pneumoniae. One patient developed reaccumulation of the subperiosteal abscess that required revision mastoidectomy, and another patient developed postoperative sigmoid sinus thrombosis.

Conclusions:

Although uncommon, intracranial complications of AM may present without clinical signs or symptoms. Computed tomography of the temporal bone with contrast is essential for identifying asymptomatic complications. Mastoidectomy remains the mainstay of surgical treatment. Neurosurgical intervention and anticoagulation may be avoided with protracted postoperative intravenous antibiotics. Postoperative vigilance is crucial, as complications may evolve despite aggressive therapy.
Assessing the Additional Disease Burden of Polyps in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil
Published: October 2014

Objectives:

This study was undertaken to determine the differential disease burden between chronic rhinosinusitis (CRS) cases with and without nasal polyposis (NP).

Methods:

A consecutive series of adult patients who met clinical and radiographic criteria for CRS was assessed with the Rhinosinusitis Symptom Inventory, nasal endoscopy, and computed tomography. Three clinical groups were examined: 1) CRS without NP, 2) CRS with primary NP (no prior surgery), and 3) CRS with recurrent NP (prior surgery). The groups were compared with respect to symptom presentation, medical resource utilization, and medication costs.

Results:

Two hundred eighty-six CRS cases without NP, 131 CRS cases with primary NP, and 45 CRS cases with recurrent NP were studied; their mean Lund scores were 8.8, 13.2, and 16.3, respectively (p < 0.001). Statistically significant differences in severity for nasal (p = 0.002), facial (p = 0.025), oropharyngeal (p = 0.017), and systemic symptoms (p = 0.042) between groups were noted, whereas total symptoms did not differ between groups (p = 0.339). Medication use and physician visits were similar between groups (p = 0.335 and p = 0.951, respectively). The aggregate yearly medication costs were significantly greater for the recurrent polyp group ($866) than for either the non-polyp group ($570; p = 0.013) or the primary polyp group ($565; p = 0.020).

Conclusions:

Patients with non-polyp CRS and those with primary polyp CRS present with different symptom phenotypes, but exhibit similar total symptom burdens and medical resource consumption. The presence of polyps does not necessarily confer a dramatic additional disease burden in CRS.
Characteristics of Isolated Sphenoid Sinus Aspergilloma: Report of Twelve Cases and Literature Review
Authors: Lee Ta-Jen , Huang Shiang-Fu , Chang Po-Hung
Published: October 2014

Objectives:

Isolated sphenoid sinus aspergilloma (ISSA) is a form of fungal sinus infection that is distinct from allergic fungal sinusitis, invasive fungal disease, and Aspergillus granulomas. In this study, we identify the characteristics of patients with ISSA to achieve timelier intervention for this easily neglected disease.

Methods:

In a retrospective study of patients with ISSA in our institution (1995 to 2006), 12 were identified.

Results:

Sixty-seven percent of our patients were more than 50 years of age, and a female preponderance was noted. Headache and postnasal drip were the two most common symptoms, and the samples from 78% of our patients with postnasal drip were blood-tinged. Computed tomographic scanning provided a sensitivity of 64%, whereas endoscopic examination failed to identify abnormalities in any patients.

Conclusions:

Four characteristics were identified in the diagnosis of ISSA: Female; usually above 50 years of age; with postnasal drip (especially blood-tinged); and headache (particularly periorbital or retro-orbital).
Role of Subglottal Shape in Turbulence Reduction
Authors: Oren Liran , Khosla Sid , Murugappan Shanmugam , King Richard , Gutmark Ephraim
Published: October 2014

Objectives:

In previous work, we found that airflow at the superior edge of the vocal folds, in the excised canine larynx, can be laminar even when the tracheal airflow is predominantly turbulent. Turbulent flow directly above the folds may lead to an irregular or “rough” voice. Thus, it is important to determine the mechanism of turbulence reduction. From fluid mechanics, it is known that a smoothly converging duct will reduce turbulence. In this study, we tested the hypothesis that the majority of the turbulence reduction is due to the smooth converging shape of the subglottis.

Methods:

In 3 excised canine larynges, hot-wire anemometry was used to measure the turbulence intensity (TI) below the cricoid cartilage and 2 to 3 mm above the superior edge of the vocal folds. Laminar flow was seen when the TI was approximately less than 2%. For our measurements, flow into the subglottis had an average TI of more than 20% (high turbulence) in the shear layer and a TI of more than 15% in the center of the jet. The larynges were tested under steady conditions (folds not phonating) with the vocal processes approximated.

Results:

For the center of the jet, there is moderate turbulence below the cricoid cartilage and laminar flow 2 to 3 mm above the folds. For the shear layer, there is very high turbulence below the cricoid cartilage and low turbulence 2 to 3 mm above the folds.

Conclusions:

The smooth converging shape of the subglottis can produce a significant reduction in turbulence. These findings may have important voice implications for operations that may change the subglottal shape (such as vocal fold medialization or airway reconstruction).
Postviral Vagal Neuropathy
Authors: Rees Catherine J. , Henderson Arthur H. , Belafsky Peter C.
Published: October 2014

Objectives:

Postviral vagal neuropathy (PVVN) is a clinical diagnosis characterized by laryngeal complaints initiated by an upper respiratory tract infection (URI). Little is known about the natural history of this disease, and only small case series have been reported. We describe the clinical presentation, symptoms, patient demographics, and natural history of PVVN.

Methods:

A cross-sectional survey of all patients with a diagnosis of PVVN from January 1, 2006, to December 31, 2006, was prospectively administered, detailing disease onset, type and duration of symptoms, demographics, and previous treatment. The Reflux Symptom Index, Voice Handicap Index, and laryngoscopic findings were collected for each patient.

Results:

Forty-four patients with PVVN were identified. The mean age (±SD) was 48 ± 13 years, and 73% of the patients were female. The most common initial URI symptoms were cough (89%), nasal congestion (75%), and rhinorrhea (64%). Fifty-nine percent of the patients took antibiotics, and the mean time between symptom onset and presentation to the laryngologist was 83 ± 127 weeks. The most common persistent symptoms were cough (52%), throat clearing (48%), dysphonia (41.5%), and vocal fatigue (43%). Fifty-seven percent of the patients consulted 3 or more physicians for their symptoms. The mean Voice Handicap Index was 13.4 ± 10.3, and the mean Reflux Symptom Index was 17.7 ± 11. Fortynine percent of the patients had evidence of vocal fold paresis on strobovideolaryngoscopy.

Conclusions:

PVVN is a clinical entity characterized by a complex of laryngeal symptoms that begin after a URI. The symptoms include chronic cough, excessive throat clearing, dysphonia, and vocal fatigue. Affected individuals are typically in their fifth decade of life and appear more likely to be women. Most patients have seen multiple physicians, and the time to laryngologist referral is often delayed.
Marsupialization of Vocal Fold Retention Cysts: Voice Assessment and Surgical Outcomes
Authors: Hsu Cheng-Ming , Armas Gian Luca , Su Chih-Ying
Published: October 2014

Objectives:

Although total excision remains the standard treatment for vocal fold retention cysts, postoperative deficits and damage to the vocal folds still occur. Marsupialization is a more conservative technique and can prevent these complications.

Methods:

In this prospective clinical series, 25 patients underwent the marsupialization procedure. Under a direct laryngomicroscope, the cystic wall margin was retracted medially with microforceps. An incision was made with microscissors encircling the equator of the cyst. The cyst contents drained from the cystic cavity when the capsule was sectioned. For 7 patients with concomitant marked vocal fold atrophy, strap muscle transposition laryngoplasty was simultaneously performed.

Results:

All patients had complete preoperative and postoperative voice parameter analyses. A subjective improvement in voice quality was reported by 23 of the 25 patients (92%). A small recurrent vocal fold cyst was detected in 1 patient. Small vocal fold deficits and sulcus vocalis were detected in 2 and 4 patients, respectively. Only 1 patient described a worse voice after operation. No other complications were noted.

Conclusions:

Marsupialization of vocal fold retention cysts is a simple, relatively safe, and effective surgical treatment. Voice improvement, a low incidence of recurrence, and minimal vocal fold deficits demonstrate the validity of this technique. Marked preoperative vocal fold atrophy or postoperative glottal gap can be managed with medialization laryngoplasty.
Superficial Parotidectomy via Facelift Incision
Authors: Lohuis Peter J. F. M. , Tan M. Liane , Bonte Katrien , van den Brekel Michiel W. M. , Balm Alfons J. M. , Vermeersch Hubert B.
Published: October 2014

The stigma of a visually prominent facial scar following parotid surgery can be distressing to a young patient. The surgical technique of parotidectomy via a facelift incision is described and evaluated. Thirty patients with a benign lesion of the parotid gland underwent a partial superficial parotidectomy via a modified facelift incision. After operation, all patients had excellent cosmesis and complete function of the facial nerve. The facelift incision provides adequate exposure of the parotid gland for (partial) superficial parotidectomy. It can be offered as an alternative to a select group of patients who present with a small, mobile tumor in the tail of the parotid gland and an explicit request for an invisible postoperative scar.
Influence of Blood Pressure Manometer Feedback on the Parameters of the Vestibular Evoked Myogenic Potential Test
Authors: Suh Myung-Whan , Kim Ji Soo , Koo Ja-Won
Published: October 2014

Objectives:

The objective of this study was to evaluate the merits of a blood pressure (BP) manometry feedback method for measurement of vestibular evoked myogenic potentials.

Methods:

Sixty ears of 30 normal volunteers were prospectively investigated. The vestibular evoked myogenic potentials were recorded under 3 different conditions: In the feedback-negative (FB–) condition, ie, in a sitting position without feedback; in the feedback-positive (FB+) condition, ie, in a sitting position with self-monitored BP feedback (using a BP cuff); and in a supine condition, ie, in a supine position without feedback. The interaural amplitude difference (IAD) ratios and interaural latency differences were analyzed.

Results:

The mean IAD ratio was smaller in the FB+ condition than in the FB– and supine conditions, but the difference was without statistical significance. The upper limits of the normal range of the IAD ratios were 39.5%, 18.3%, and 25.9% for the FB–, FB+, and supine conditions, respectively. The interaural latency difference of p13 was significantly smaller in the supine condition than in the FB– and FB+ conditions.

Conclusions:

Although the reduction of the mean IAD ratio did not reach statistical significance by feedback monitoring in our study, feedback using a BP manometer may have some clinical significance, in that a more stable IAD ratio may be obtained with a narrower normal range and a smaller variation.
Demonstration of Nasopharyngeal and Middle Ear Mucosal Biofilms in an Animal Model of Acute Otitis Media
Authors: Hoa Michael , Syamal Mausumi , Sachdeva Livjot , Berk Richard , Coticchia James
Published: October 2014

Objectives:

We performed this study to determine the role of nasopharyngeal and middle ear (ME) biofilms in acute otitis media (AOM).

Methods:

Sixty female 6-month-old chinchillas, free of ME disease, were utilized. Experimental animals were inoculated with influenza A followed by Streptococcus pneumonia 7 days later. Control animals were inoculated with Sorensen's phosphate buffer. Daily otoscopy and tympanometry was performed, and the animals were painlessly sacrificed on days 1, 2, 5, 8, and 14. All mucosae were harvested and prepared for scanning electron microscopy.

Results:

The ME inflammation, initially detected on day 2 after bacterial inoculation, peaked on day 8. Eight percent of the dually inoculated chinchillas displayed type B tympanograms, and 40% displayed type C. Otoscopic evaluation of tympanic membrane inflammation was rated from 0 to 4 (0 = normal and 4 = severe drainage and/or inflammation) according to an otoscopic grading system. Ten percent of the experimental chinchillas had a grade 2 score, 20% had grade 3, and 6.7% had grade 4. The controls demonstrated no abnormal tympanometric or otoscopic findings. Scanning electron microscopic imaging showed dense biofilms on 83% of the nasopharynges and 67% of the MEs on day 8 in the experimental animals. All animals with ME biofilms had biofilms in the nasopharynx. The controls did not demonstrate biofilm formation.

Conclusions:

The study parallels the natural pathogenesis of AOM in humans. The demonstration of mucosal biofilms in both the nasopharynx (58%) and the ME (47%) of animals with ME inflammation and/or infection lends further support to the importance of mucosal biofilms in the pathogenesis of AOM.
Lamina Propria Cellularity and Collagen Composition: An Integrated Assessment of Structure in Humans
Authors: Muñoz-Pinto Dany , Whittaker Peter , Hahn Mariah S.
Published: October 2014

Objectives:

In this study, we quantitatively examined cell density, collagen types I and III, and regional variations in collagen fiber thickness and orientation in the human midmembranous vocal fold lamina propria (LP).

Methods:

Lamina propria samples were solubilized with proteinase K or with cyanogen bromide. Cell density was assessed in proteinase K digests by measuring DNA and normalizing it to tissue total protein. Collagen types I and III were quantified by enzyme-linked immunosorbent assay–based detection of collagen type–specific peptides generated by cyanogen bromide digestion. In addition, LP total collagen was determined by measuring sample hydroxyproline levels. Variations in collagen fiber thickness and orientation with LP region were evaluated by examining picrosirius red–stained LP sections with circularly polarized light.

Results:

The mean (±SEM) cell density in the LP and associated epithelium was approximately 0.57 ± 0.09 million cells per milligram of tissue total protein. Collagen type III composed an average of 34% to 40% of LP total collagen. Quantitative histology indicated that the superficial LP contained an average of 70% thin, 26% intermediate, and 4% thick collagen fibers. This is in contrast to the intermediate and deep LPs, each of which contained less than 25% thin and more than 50% thick collagen fibers. The angular deviations in collagen fiber orientation were relatively large and were similar in magnitude across all LP layers.

Conclusions:

The total cell density of the LP and associated epithelium was intermediate between that of hyaline cartilage and dermis. The ratio of collagen type III to total collagen in the LP was similar to that of highly elastic lung parenchyma and roughly twice that of the comparatively less-elastic dermis. The average thickness of collagen fibers increased markedly with increasing LP depth, and the relatively large angular deviations in fiber orientation appeared to correspond in part to the crimped nature of LP collagen fibers.
Acquired Atresia of the External Auditory Canal: Recurrence and Long-Term Results
Authors: Magliulo Giuseppe
Published: October 2014

Objectives:

I describe the clinical symptoms and signs of acquired atresia of the external auditory canal (EAC) and the technique used to manage it.

Methods:

Forty-one consecutive patients affected by acquired atresia of the EAC were assessed by otoscopy, pure tone audiometry, computed tomography, and traditional and echo-planar diffusion-weighted magnetic resonance imaging. The anatomic and functional hearing results were evaluated.

Results:

At surgery for acquired atresia of the EAC, an EAC cholesteatoma was found in 3 of the 41 patients. Twenty-three of the 41 patients were followed for at least 5 years. Recurrence was seen in 9 of the 25 ears (36%) over the entire period of observation. Twenty-one, 23, and 22 of the patients had a normal or nearly normal contour and size of the ear canal at 6 months, 1 year, and 5 years, respectively. The results were similar for the air-bone gap.

Conclusions:

The main complication following surgery was recurrence. There was recurrence at 6 months in 4 patients (16%). Recurrence was seen in 12% of the cases at the 5-year follow-up. Similar findings were clear on evaluation of the hearing results. This result demonstrates that the surgical procedure, even when performed correctly, did not afford a stable, long-lasting outcome in a cohort of patients.
Ultrasound-Guided Needle Localization of Recurrent Paratracheal Thyroid Cancer
Authors: Fletcher Aaron M. , Preston Todd W. , Kuehn David M. , Clark Eve D. , Van Daele Douglas , Hoffman Henry
Published: October 2014

Objectives:

Ultrasound-guided needle localization techniques have been used to direct the resection of targeted axillary lymph nodes in the management of breast cancer. To date, there has been only one other description of this technique as a localization method to direct cancer resection in the neck. We offer further support for the broader application of this technique by reporting its use in the successful identification and resection of recurrent papillary thyroid cancer after a paratracheal node dissection failed to localize the cancer.

Methods:

We report a case and discuss the relevant literature regarding ultrasound-guided localization and resection of recurrent well-differentiated thyroid cancer.

Results:

We were able to achieve successful identification and resection of recurrent papillary thyroid cancer using this technique.

Conclusions:

This technique may be useful in the treatment of selected cases of recurrent thyroid cancer to increase the efficacy and safety of surgical resection.
Use of Nasal Septal Bone to Straighten Deviated Septal Cartilage in Correction of Deviated Nose
Authors: Jang Yong Ju , Kim Jun Mo , Yeo Nam-Kyung , Yoo Ji Hoon
Published: October 2014

Objectives:

Septoplasty for correction of deviated nose often requires removal of the deviated part of the quadrangular cartilage and the perpendicular plate of the ethmoid bone or vomer. In most cases, the removed bone is discarded. We describe our experience using septal bone for deviated nose correction, and analyze the postoperative results.

Methods:

A retrospective study was performed on 23 patients who underwent correction of deviated nose using nasal septal bone to straighten deviated septal cartilage from January 2004 to August 2008. The subjective satisfaction of patients was evaluated 6 to 12 months after rhinoplasty with a questionnaire. Aesthetic outcomes were evaluated by 2 independent rhinoplastic surgeons who compared preoperative and postoperative photographs. To evaluate outcomes objectively, we made anthropometric measurements of the deviated nose before and after surgery using facial photographs.

Results:

All patients indicated cosmetic satisfaction and improvement in nasal obstruction. The outcome analysis by 2 independent rhinoplastic surgeons indicated that 13 patients had excellent, 5 patients had good, and 5 had fair outcomes. Anthropometric measurements of the deviated nose showed that both the curved deviated angles and the linear deviated angle had improved (p < 0.05).

Conclusions:

Use of nasal septal bone to straighten deviated septal cartilage appears to be feasible in corrective rhinoplasty, and may be particularly beneficial in cartilage-depleted patients.
The Changing Face of Paranasal Sinus Fungus Balls
Authors: Robey Ashley B. , O'Brien Erin K. , Richardson Brynn E. , Baker John J. , Poage David P. , Leopold Donald A.
Published: October 2014

Objectives:

We describe the clinical, radiographic, and histopathologic characteristics of fungus balls.

Methods:

We performed a retrospective review of 24 consecutive patients with the diagnosis of a paranasal sinus fungus ball (mycetoma) from 2001 to 2008.

Results:

We found that 18 of the 24 primarily involved sinuses had bony thickening, and 13 of the 24 had notable dilatation of the ostium. Eleven of the 24 patients were found to have some degree of immunocompromise (from organ transplantation, diabetes, etc). The patient's immune status correlated with the type of fungus involved. (Mucor-like fungi were more common in immunocompetent patients, and aspergillus-like fungi were more common in immunocompromised patients.) Also, there was a predilection for immunocompetent patients to have dilatated ostia, whereas immunocompromised patients were more likely to have a nondilatated ostium (p = 0.019).

Conclusions:

Our series of paranasal sinus fungus balls defines a group of patients heretofore poorly described in the literature. Our data reveal an increased incidence in immunocompromised patients. We also found consistent radiographic patterns, correlations between immune status and the fungal pathogen, correlations between ostial enlargement and immune status, and the presence of cranial nerve pareses. These represent new findings that merit further study.
Bone-Anchored Hearing Aid Surgery in Older Adults: Implant Loss and Skin Reactions
Authors: de Wolf Maarten J. F. , Hol Myrthe K. S. , Mylanus Emmanuel A. M. , Cremers W. R. J.
Published: October 2014

Objectives:

We evaluated the clinical outcome measures of fixture loss and skin reactions in older-adult users of percutaneous bone-anchored hearing aids (BAHAs).

Methods:

We performed a retrospective analysis of 224 older adults (at least 60 years of age) who underwent implantation of 248 implants with the simplified Nijmegen surgical technique between January 1995 and May 2007.

Results:

During a mean follow-up of 39 months (range, 0 to 144 months), 16 of the 248 implants were lost (6.5%). The causes were failed osseointegration in 9 cases, trauma in 6 cases, and implant loss in irradiated bone in 1 case. There were no losses due to infection. Implant loss was not significantly correlated with age. In 40 implants (16.9%), severe skin reactions of Holgers grade 2 or more were observed. Skin revision surgery was performed around 6 implants (2.4%). None of the patients had an 8.5-mm abutment to overcome severe skin reactions.

Conclusions:

The outcome of BAHA surgery in older adults was favorable. The rate of implant loss was comparable with that in the overall population of BAHA recipients. There were low risks of severe skin reactions or developing thick skin around the implant.
Prostaglandin E2 Receptor EP2, EP3, and EP4 Agonists Inhibit Antigen-Induced Mucus Hypersecretion in the Nasal Epithelium of Sensitized Rats
Authors: Hattori Reiko , Shimizu Shino , Majima Yuichi , Shimizu Takeshi
Published: October 2014

Objectives:

Prostaglandin (PG) E2 is a potential anti-inflammatory mediator that attenuates airway inflammation. To elucidate the functions of the PGE2 receptors (EP1, EP2, EP3, and EP4) in allergic inflammation, we examined the in vivo effects of EP agonists on mucus hypersecretion and eosinophil infiltration in rat nasal epithelium.

Methods:

We induced hypertrophic and metaplastic changes in goblet cells in nasal epithelium of ovalbumin-sensitized rats by intranasal challenge with ovalbumin. The effects of subcutaneous injections of EP agonists on mucus production and eosinophil infiltration were examined.

Results:

The EP4 agonist (1 to 100 μg/kg) dose-dependently inhibited ovalbumin-induced mucus production. The EP2 and EP3 agonists (100 μg/kg) also significantly inhibited mucus production. The EP3 agonist inhibited antigen-induced eosinophil infiltration, whereas the EP1 agonist showed no effect. This suppression of mucus production by the EP4 agonist was only effective when the EP4 agonist was given in the effector phase; administration in the induction phase resulted in no effect.

Conclusions:

These results indicate that PGE2 acts as an anti-inflammatory mediator via the EP receptors of airways in allergic inflammation. Selective EP agonists may provide a new therapeutic strategy for airway mucus hypersecretion.
Monitored Anesthesia Care with Target-Controlled Infusion in Vibroplasty
Authors: Canale Andrea , Lacilla Michelangelo , Perotti Marco , Pallavicino Fabrizia , De Siena Luigi , Albera Roberto
Published: October 2014

Objectives:

Correct positioning of a floating mass transducer during middle ear implant surgery is often problematic. With the use of monitored anesthesia care (MAC), however, deep sedation is maintained during surgery, followed by conscious sedation in which the patient can respond to test questions that investigate correct device position and function. The main aim of this study was to determine whether intraoperative audiometric assessment was feasible with MAC with target-controlled infusion in vibroplasty. An additional aim was to determine whether MAC was sufficiently comfortable for patients during the procedure.

Methods:

The study group comprised 8 patients who underwent vibroplasty under sedation. Before suturing, audiometric assessment was done by stimulating the external auditory processor with pure tones at 0.5, 1, 2, and 4 kHz. Blood pressure, arterial oxygen saturation level, heart rate, and end tidal carbon dioxide level were monitored during the procedure and at awakening.

Results:

Audiometric assessment was successfully completed in all 8 patients. The selected parameters indicated that no patient experienced pain or discomfort during surgery; the absence of discomfort was confirmed 1 to 2 hours after the operation by simple questioning.

Conclusions:

We found MAC to be an efficient and relatively safe technique for verifying the correct coupling of the floating mass transducer with the middle ear during vibroplasty. The patients were able to respond appropriately to questions and commands; moreover, none reported having experienced pain or discomfort during the operation.
Comparison of Intraoperative Bleeding between Microdebrider Intracapsular Tonsillectomy and Electrocautery Tonsillectomy
Authors: Nguyen Carolyn V. , Parikh Sanjay R. , Bent John P.
Published: October 2014

Objectives:

We sought to assess the quantity of intraoperative bleeding from microdebrider intracapsular tonsillectomy (IT) relative to electrocautery tonsillectomy (ET).

Methods:

Intraoperative tonsil bleeding was measured prospectively for all children younger than 19 years of age who underwent primary tonsillectomy for recurrent tonsillitis or adenotonsillar hypertrophy at a tertiary care academic children's hospital. We performed IT in 57 patients (33 male, 24 female; mean age, 64.3 months) and ET in 51 patients (20 male, 31 female; mean age, 92.4 months).

Results:

Microdebrider IT resulted in more intraoperative bleeding than ET (27.9 versus 8.7 mL, p = 0.003; and 1.2 versus 0.2 mL/kg, p < 0.001). The median and maximum blood losses, respectively, were 0.6 and 9.5 mL/kg for IT and 0 and 2.0 mL/kg for ET. Blood loss for ET was not related to whether a resident versus an attending physician was the operating surgeon (p = 0.11). A linear regression model did not demonstrate greater bleeding with recurrent tonsillitis (IT, p = 0.39; ET, p = 0.89) or with increased patient age (IT, p = 0.08; ET, p = 0.62).

Conclusions:

Microdebrider IT produces more intraoperative bleeding than ET. The difference in blood loss is statistically but not clinically significant. Microdebrider IT causes bleeding within acceptable limits, and thus patients and physicians should not be discouraged from choosing this procedure solely on the basis of the amount of intraoperative blood loss.
Mycobacterium Chelonae Infections Involving the Head and Neck
Authors: Mullin David , Jothi Sumana , Healy David
Published: October 2014

Objectives:

We describe the manifestations, diagnosis, and treatment of rare head and neck infections caused by Mycobacterium chelonae, including a case of maxillary osteitis and skull base osteomyelitis.

Methods:

A comprehensive literature search (MEDLINE from 1951; BIOSIS from 1969; EMBASE from 1980) was performed for the presentation, diagnostic evaluation, and outcomes of patients with M chelonae infections.

Results:

We report 4 cases of M chelonae infection, including a nasal abscess following septorhinoplasty with a cartilaginous graft, a case of chronic unilateral nasal obstruction, and the first reported cases of skull base osteomyelitis and maxillary osteitis secondary to M chelonae. All 4 cases involved immunocompetent individuals.

Conclusions:

Mycobacterium chelonae should be considered in cases of abscesses that persist despite broad-spectrum intravenous antibiotics, and in cases of maxillary sinusitis with bony involvement that do not respond to traditional treatment methods.
Tracheal and Tracheostomal Hypergranulation and Related Stenosis in Long-Term Cannulated Patients: Does the Tracheostomy Procedure Make a Difference?
Authors: Ledl Christian , Mertl-Roetzer Marion
Published: October 2014

Objectives:

Long-term cannulated patients are at risk of developing tracheal and tracheostomal hypergranulation. This study evaluated the incidence of hypergranulation and related tracheal stenosis in long-term cannulated patients. The relation between hypergranulation, specific tracheostomy techniques, and the duration of cannulation was investigated.

Methods:

A prospective observational study was conducted to analyze tracheostomal and tracheal hypergranulation in long-term cannulated patients. We compared complication rates in 344 postacute patients. Tracheas and tracheostomas were inspected visually and endoscopically at admission and at regular tube changes every 2 weeks until decannulation or discharge.

Results:

Hypergranulation appeared 3 times as often in the tracheostoma (n = 338) as in the trachea (n = 109). There was no influence of the tracheostomy procedure on the frequency (p = 0.931), location (tracheostoma, p = 0.947; trachea, p = 0.918), or severity (stenoses grade I, p = 0.910; grade II, p = 0.649; grade III, p = 0.304) of the hypergranulation. The main factors to account for hypergranulation were the duration of cannulation (p < 0.001) and age (p = 0.033).

Conclusions:

There was no influence of tracheostomy techniques on hypergranulation. Its development depends on the duration of cannulation. It is recommended to keep the duration of cannulation as short as possible with respect to the underlying neurologic impairment.
Local Neurotoxins for Prevention of Laryngeal Synkinesis after Recurrent Laryngeal Nerve Injury
Authors: McRae Bryan R. , Kincaid John C. , Illing Elisa A. , Hiatt Kelly K. , Hawkins Jan F. , Halum Stacey L.
Published: October 2014

Objectives:

Persistent vocal fold motion impairment after recurrent laryngeal nerve (RLN) injury is not characteristically due to absent reinnervation, but often results from spontaneous aberrant reinnervation (synkinesis). We administered local neurotoxins to selected laryngeal muscles after RLN injury to determine whether aberrant reinnervation could be selectively inhibited.

Methods:

Unilateral RLN transection was performed in 24 male rats. Three weeks later, the denervated laryngeal adductor complex was injected with phenol, high- or low-dose vincristine sulfate (VNC), or saline solution. One month later, rat larynges were evaluated via videolaryngoscopy and laryngeal electromyography (LEMG). Larynges from euthanized animals were analyzed via immunofluorescent staining for the presence of reinnervation.

Results:

One animal that received phenol and 3 animals that received high-dose VNC died of toxicity-related complications. In the surviving neurotoxin-treated animals, videolaryngoscopy showed increased lateralization of the immobile vocal fold. Only 1 phenol-injected rat had adductor complex motor recruitment (score of 3+) with LEMG. The other neurotoxin-treated animals demonstrated an absence of adductor complex reinnervation, with only insertional activity and fibrillations (no motor units/recruitment). Spontaneous ipsilateral abductor reinnervation was not affected by the adductor injections.

Conclusions:

Low-dose VNC injections appear to be relatively safe and effective in selectively inhibiting spontaneous aberrant reinnervation after RLN injury in an animal model.
Level of Complete Dissection of the Ethmoid Sinuses with a Computed Tomographic Image Guidance System
Authors: Rawlings Brad A. , Han Joseph K.
Published: October 2014

Objectives:

We sought to determine the adequacy of endoscopic total ethmoidectomy with the use of a computed tomographic (CT) image guidance system.

Methods:

Endoscopic ethmoid sinus dissections were performed on cadavers by otolaryngologists. All cadavers were scanned before dissection. On each side of the cadaver, the ethmoid sinuses were examined independently. A complete endoscopic ethmoidectomy was performed with a CT image guidance system. After the endoscopic ethmoidectomy, the cadaver underwent a postdissection CT scan. The postdissection CT images were then evaluated for the level of complete dissection of the anterior and posterior ethmoid sinuses.

Results:

There were 18 ethmoid sinuses in the study. One specimen underwent a complete total ethmoidectomy with no residual cells. There were 4 complete anterior ethmoidectomies and 5 complete posterior ethmoidectomies. Overall, the average numbers of residual anterior ethmoid and posterior ethmoid air cells were 1.39 and 1.22, respectively. This difference was not statistically significant. The skull base was dissected more completely than the lamina papyracea, with a significant difference (p = 0.03). There was no difference in terms of residual cells between the left and right ethmoid sinuses (p > 0.05).

Conclusions:

Even with the use of a CT image guidance system, a complete ethmoidectomy was still difficult to achieve. Residual ethmoid sinus cells were more commonly found along the lamina papyracea than along the skull base.
Functional Results of Reinke's Edema Surgery Using a Microdebrider
Authors: Honda Keigo , Haji Tomoyuki , Maruyama Hagino
Published: October 2014

Objectives:

We evaluated the functional results of Reinke's edema surgery using a microdebrider.

Methods:

In this prospective nonrandomized study from 2004 through 2008, functional surgery using a microdebrider was performed on patients with severe Reinke's edema. Comparisons were conducted for preoperative and postoperative phonatory function using both subjective grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S) scoring and objective Multi-Dimensional Voice Program parameters. Statistical analysis was done by paired t-test, and a p value of less than 0.05 was considered significant.

Results:

Seventeen patients were enrolled in this study, with a median age of 56 years and a median observation period of 129 days. The male-to-female ratio was 1 to 2.4. No major complications were observed in the perioperative period. Significant improvement was observed in the subjective values of G, R, B, and S. Improvement was also observed in the fundamental frequency, pitch perturbation quotient, and amplitude perturbation quotient calculated by the Multi-Dimensional Voice Program.

Conclusions:

The microdebrider is a useful tool in functional surgery for severe Reinke's edema and gives good functional outcomes. Surgeons can swiftly complete the key steps of removing pathological submucosal tissue and preserving the normal epithelium with an excellent surgical view.