bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated with Clinical Outcomes in Acute Otitis Media
Authors: Hotomi Muneki , Yamanaka Noboru , Ikeda Yorihiko , Shimada Jun , Faden Howard
Published: October 2014

Acute otitis media (AOM) is a common disease in childhood. If predictors of outcome in AOM were known, it would be possible to individualize therapy. Our aim was to identify factors that predict the outcome in AOM. We enrolled 368 children with AOM (ages, 10 to 86 months). The severity of symptoms and the severity of tympanic membrane changes were graded with a scoring system. Nasopharyngeal colonization with middle ear pathogens was determined on day 1. Three outcomes were assessed: persistence of symptoms at day 5, persistence of tympanic membrane changes at day 28, and recurrence of acute symptoms prior to day 28. Persistence of symptoms at day 5 was associated with younger age (35 versus 44 months; p < .001), higher symptom score on day 1 (3.5 versus 2.9; p < .05), and colonization with Streptococcus pneumoniae (61% versus 41%; p < .05). Persistence of tympanic membrane changes at day 28 was associated with younger age (39 versus 45 months; p < .01), higher tympanic membrane score on day 1 (4.1 versus 3.6; p < .01), and nasopharyngeal colonization with S pneumoniae, especially drug-resistant S pneumoniae (33% versus 13%; p < .05). Recurrence of acute symptoms prior to day 28 occurred in 14% of the children. Streptococcus pneumoniae was the only pathogen associated with an increased recurrence rate (23%) as compared to the group without pathogens (7%; p < .05). Age, severity of disease at presentation, and nasopharyngeal colonization patterns were proven to be important determinants of outcome in AOM.
Flexible Bronchoscopic Removal of a Distal Bronchial Foreign Body with Cinefluoroscopic Guidance
Authors: Hockstein Neil G. , Jacobs Ian N.
Published: October 2014

A 15-year-old girl presented to the emergency department with cough and bloody sputum. A chest radiograph demonstrated a radiopaque foreign body (a tongue stud) in the right lower lobe. Rigid and flexible bronchoscopy failed to localize the foreign body. Under fluoroscopic guidance, the foreign body was identified in a right lower lobe distal bronchus; it could be visualized from a distance with a 3.5-mm flexible bronchoscope. An endobronchial biopsy forceps was passed through the suction port of the bronchoscope, but the view of the foreign body was obstructed by the biopsy forceps. The bronchoscope could not be advanced closer to the foreign body, because its diameter was greater than that of the bronchus. Under cinefluoroscopic guidance, the endobronchial biopsy forceps was then used to remove the foreign body. A chest radiograph obtained after removal was normal. The patient was discharged home the following day. Removal of distal bronchial foreign bodies can be challenging, because the bronchial diameter may preclude the advancement of the bronchoscope. Cinefluoroscopy is a relatively safe therapeutic adjunct that may avert the need for thoracotomy.
Audiological Characteristics of Some Affected Members of a Dutch DFNA13/COL11A2 Family
Authors: De Leenheer Els M. R. , Bosman Arjan J. , Huygen Patrick L. M. , Kunst Hendrik P. M. , Cremers Cor W. R. J.
Published: October 2014

Members of a Dutch DFNA13/ COL11A2 family were evaluated with pure tone audiometry, stapedial reflexes, otoacoustic emissions, loudness scaling, difference limen for frequency, gap detection, and speech perception in quiet and noise. The tone audiometry showed a predominant loss for the low and middle frequencies, with only a few otoacoustic emissions at thresholds better than 25 dB hearing level. The stapedial reflexes appeared elevated, and loudness growth curves were shifted parallel to those for normal-hearing subjects, indicating a shift of the dynamic range toward higher presentation levels. The data for the difference limen for frequency, gap detection, and speech perception in noise fell within the (near-)normal range. Despite elevated thresholds, all suprathreshold functions showed fairly normal properties, suggesting an attenuation of signal energy in the cochlea with limited degradation of the cochlea's signal analyzing capabilities. The effect of DFNA13/ COL11A2 may thus be characterized as a cochlear conductive loss.
Receiver Operating Characteristic Analysis of Aerodynamic Parameters Obtained by Airflow Interruption: A Preliminary Report
Authors: Jiang Jack , Stern Jennifer
Published: October 2014

Aerodynamic parameters provide objective and quantitative measures of laryngeal functional status. Jiang et al previously introduced an airflow interruption technique that can determine mean phonatory airflow, subglottic pressure, and phonation threshold pressure simultaneously and noninvasively. In this study, we performed receiver operating characteristic (ROC) analysis to evaluate this airflow interruption apparatus for voice profile analysis in subjects with laryngeal polyps or nodules or with Parkinson's disease. Patients with polyps (n = 14), nodules (n = 9), and Parkinson's disease (n = 12) were evaluated with the airflow interruption apparatus. Normal subjects served as controls. Mean airflow, subglottic pressure, and phonation threshold pressure were determined. Discriminant analysis was used to create linear equations combining all three parameters in order to obtain a new combined parameter. Solutions to the linear equations yielded values for the combined parameter that took into account mean airflow, subglottic pressure, and phonation threshold pressure. Combined parameter values were used as data to generate ROC curves. Laryngeal polyps were distinguished from the normal larynx with a sensitivity of 0.929 and a specificity of 0.933 at the point of maximal efficiency. The area under the ROC curve was 0.977 (Az). Patients with Parkinson's disease were distinguished from normal subjects with a sensitivity of 0.667 and a specificity of 0.909 at the point of maximal efficiency. The area under the ROC curve was 0.7958 (Az). Nodules were able to be distinguished from normal with a sensitivity of 0.889 and a specificity of 1.00. The area under the ROC curve was 0.9565 (Az). Our conclusions are twofold. First, aerodynamic parameters may be combined for simultaneous consideration by the construction of linear equations by means of discriminant analysis. Second, the airflow interruption apparatus, when used for voice function evaluation, has high sensitivity and specificity.
The Glasgow Children's Benefit Inventory: A New Instrument for Assessing Health-Related Benefit after an Intervention
Authors: Kubba Haytham , Swan Iain R. C. , Gatehouse Stuart
Published: October 2014

Most health-related quality-of-life measures make an assessment at a single point in time. Comparing results before and after an intervention is often difficult, because the difference measured is usually small compared with the variation between individuals. A retrospectively applied measure specifically worded to assess benefit would be very useful for clinical research. Such a measure exists for adults. We aimed to develop a similar measure for children. We chose potential items after reviewing existing health-related quality-of-life measures, published literature, and parental interviews. A draft questionnaire was given to a group of parents and modified. The resulting Glasgow Children's Benefit Inventory (GCBI) comprised 24 questions on the consequences of a specified intervention on various aspects of the child's day-to-day life, without reference to any specific symptoms, and was worded to apply to children of any age. The questionnaire was mailed to the parents of all 1,777 children who had undergone tonsillectomy or ventilation tube insertion at one hospital during the period January 1998 to December 2001. There were 670 questionnaires returned. The GCBI scores correlated well with parental satisfaction with surgery and with estimates of technical success (residual sore throats, reported hearing impairment, ear infections). The questionnaire had high internal consistency. Factor analysis showed 4 dimensions in the pattern of responses relating to emotion, physical health, learning, and vitality. The GCBI is a means to retrospectively assess benefit after an intervention in children, and we have shown initial evidence of reliability and validity. Although not restricted to any branch of pediatric medicine, it is eminently suitable for use in pediatric otolaryngology.
Postural Stability after Vestibular Schwannoma Surgery
Authors: Levo Hilla , Blomstedt Göran , Pyykkö Ilmari
Published: October 2014

Factors related to postural stability and the course of recovery after vestibular schwannoma surgery were analyzed in a retrospective study of 177 patients and in a prospective study of 44 patients. Before surgery, 7 of the 44 patients in the prospective group complained of postural instability. The body sway velocity was measured. In the retrospective study, the sway velocity was abnormal under nonvisual control in 63% of the patients and under visual control in 34%. The sway velocity correlated with tumor size, smooth pursuit deficit, and postoperative work history. We compared patients with abnormal postural control to those with normal postural control, and found that the former relied to a greater extent on visual information and the latter on proprioceptive information. In the prospective study, the sway velocity increased after the operation, and 1 year after surgery it had not returned to preoperative values. In the logistic regression analysis, a translabyrinthine approach, rehabilitation, the patient's age, and preserved function of the facial nerve predicted a good outcome of postural stability. The retrosigmoid approach and depression were the most significant risk factors for postoperative gait difficulties. Vestibular rehabilitation increased the reliance on proprioception for maintenance of postural control and improved postural stability.
Vagal Nerve Stimulation: Clinical and Electrophysiological Effects on Vocal Fold Function
Authors: Shaffer Monica J. , Szabo Charles A. , Jackson Carlayne E. , Simpson C. Blake
Published: October 2014

More than 16,000 vagal nerve stimulators (VNSs) have been implanted for refractory epileptic seizures. The most commonly reported side effect is hoarseness. This study examines the effects of VNS placement on vocal fold function. Eleven patients who had undergone VNS placement at our institution were recruited. Subjective evaluation by a panel of speech and language pathologists of both connected speech and videolaryngoscopy recordings were used both at rest and during VNS activation. Additional subjective evaluation included use of the Voice Handicap Index for the study group. These results were compared to data from age- and sex-matched controls. Objective data included maximum phonation time in the study and control groups, as well as laryngeal electromyography performed on the VNS-implanted patients only. Motor unit potential morphology and recruitment, as well as spontaneous activity, were analyzed bilaterally for the cricothyroid and thyroarytenoid muscles. Significant differences were found between the study and control groups subjectively for vocal quality and videolaryngoscopy parameters. Vocal fold tension, supraglottic muscular hyperfunction, and reduced vocal fold mobility were the most common findings during VNS activation. Two of 10 patients had immobile left vocal folds in the absence of active stimulation. The maximum phonation time was generally reduced in the subject group, but this reduction did not reach statistical significance. Finally, 6 of 10 patients had abnormal electromyographic results, including large-amplitude polyphasic motor unit potentials and decreased recruitment. We conclude that implantation of a VNS can affect vocal fold function. The effects are magnified during periods of active stimulation. There is the potential for nerve degeneration after prolonged repetitive stimulation, and there may be a trend toward greater vocal fold dysfunction with higher stimulation parameters.
Acute Vocal Fold Wound Healing in a Rabbit Model
Authors: Branski Ryan C. , Verdolini Katherine , Rosen Clark A. , Hebda Patricia A.
Published: October 2014

Several authors have eloquently described the characteristics of vocal fold scar, a long-term consequence of vocal fold injury. However, events in the acute stage of mucosal injury, which lead up to fibrosis, have been largely overlooked. The current study describes acute events with regard to mucosal re-formation in a rabbit model. Vocal fold injury was induced surgically. A fibrinous clot was present 1 day after injury. Massive cellular infiltration was noted on day 3, and complete epithelial coverage was achieved by day 5. Also, neo-matrix deposition was noted as early as 5 days after injury, and more mature collagen was seen by day 7. The general timetable described in the current study can contribute to the experimental foundation for the development of regenerative models of healing in the vocal folds. Most notably, the proliferation phase of wound healing appears to occur approximately 3 days after injury, indicating a critical time for intervention. Manipulation and/or alteration of naturally occurring neo-matrix deposition and organization may yield improved biophysical function of the injured vocal fold.
Supracricoid Hemilaryngopharyngectomy in Patients with Invasive Squamous Cell Carcinoma of the Pyriform Sinus
Authors: Laccourreye Ollivier , Garcia Dominique , Ishoo Edwin , Kania Romain , de Mones Erwan , Hans Stéphane
Published: October 2014

On the basis of a retrospective review of an inception cohort of 135 patients, with an isolated, previously untreated, moderately differentiated to well-differentiated invasive squamous cell carcinoma of the pyriform sinus and a minimum of 3 years of follow-up, consecutively managed with a supracricoid hemilaryngopharyngectomy (SCHLP) at a single tertiary referral care center and locally controlled, the authors review in detail the surgical technique, highlight the potential technical pitfalls, and document the complications and long-term functional outcome. The overall postoperative mortality rate was 3.7%. The overall mortality rate directly related to the SCHLP was 1.5%. A significant surgical complication directly related to SCHLP completion was noted in 9.6% of cases. The mean lengths of time to removal of the tracheotomy and feeding tubes were 9 and 19 days, respectively. The mean duration of hospitalization was 25 days. Normal swallowing without aspiration by the first postoperative month was noted in 64.6% of patients. Temporary grade 1–2 aspiration and grade 3 aspiration were noted in 26.9% and 8.5% of patients, respectively. Overall, in our series, successful oral alimentation without gastrostomy or completion total laryngectomy was achieved in 91.9% of patients by the first postoperative year, and the incidences of permanent gastrostomy, completion total laryngectomy, and aspiration-related death were 0.7%, 1.5%, and 0.7%, respectively. A significant late complication related to the use of postoperative radiotherapy was noted in 26.5% of cases. From a functional point of view, such results suggest that SCHLP should be integrated among the various conservation treatment options available to patients with selected invasive squamous cell carcinoma of the pyriform sinus.
Osteoplastic Maxillotomy for Treatment of Neoplasms of the Nasopharynx and Infratemporal Fossa
Authors: Carrillo Jose F. , Celis Miguel Angel , Rivas Bernardo , Ramirez-Ortega Margarita , Ochoa Francisco J.
Published: October 2014

Approaches to the infratemporal fossa and nasopharynx are difficult because of the anatomic complexity of these regions. We describe our experience with osteoplastic maxillotomy, with our own modifications, and evaluate oncological outcomes and postoperative quality of life. Ten patients underwent osteoplastic maxillotomy, 3 of whom had a diagnosis of malignancy, and 7 of whom had nasopharyngeal angiofibromas (NPAs). A Weber-Fergusson incision was made to develop facial flaps and preserve the vascularity of the maxilla. Osteotomies were performed through the facial aspects of the maxilla, on the orbital rims, and on the malar eminence for the medial variant of the procedure. The anterolateral variant involved descent of the temporalis muscle with preservation of the facial nerve, and a zygomatic osteotomy. Four craniotomies were done. Two patients had the medial variant of the procedure, and 8 had the anterolateral variant. The complications were transient and mild. The patients who had malignancies are alive with no disease, and there was 1 recurrence among the 7 patients with NPAs. We found excellent aesthetic results in 8 of the 10 patients, and no change in basic functions in 8 patients. Osteoplastic maxillotomy allows resection of massive NPAs with no significant bleeding. Resection of malignant lesions with good results is feasible.
Vestibular Evoked Myogenic Potentials in Neurofibromatosis 2
Authors: Wang Cheng-Ping , Hsu Wei-Chung , Young Yi-Ho
Published: October 2014

Neurofibromatosis 2 (NF2) is characterized by bilateral vestibular neurofibromas. Although the facial nerve, the cochlear nerve, and the superior division of the vestibular nerve can be evaluated before surgery, whether the inferior division of the vestibular nerve is affected remains undetermined without an operation. A total of 7 patients with NF2 (2 men and 5 women) underwent pure tone audiometry, caloric testing, vestibular evoked myogenic potential (VEMP) testing, and magnetic resonance imaging. Audiometry revealed mean hearing levels of less than 26 dB for 1 ear, 26 to 70 dB for 8 ears, 71 to 90 dB for 3 ears, and more than 90 dB for 2 ears. Caloric testing revealed an absent response in 71% of the 14 ears. Seven ears underwent VEMP testing, and only 1 ear (14%) displayed absent VEMPs. Magnetic resonance imaging depicted space-occupying lesions in all 14 auditory canals: small tumors in 3 ears, medium tumors in 7 ears, and large tumors in 4 ears. The tumor size of NF2 is related to the caloric response, but is unrelated to the mean hearing level or VEMPs. In conclusion, NF2 originates from the superior vestibular nerve more often than the inferior vestibular nerve. It more often infiltrates the cochlear nerve than the inferior vestibular nerve.
Correlation between Nasosinusal Symptoms and Topographic Diagnosis in Chronic Rhinosinusitis
Authors: Bonfils Pierre , Norès Jean-Marc , Halimi Philippe , Avan Paul , Le Bihan Catherine , Landais Paul
Published: October 2014

Rhinitis and sinusitis concern roughly a quarter of the population in the Western world. They are associated with a wide range of symptoms: nasal obstruction, anterior and posterior nasal discharge, sneezing episodes, facial pain or congestion, and taste and smell disorders. The aim of this prospective study was to evaluate the clinical significance of these various symptoms as a function of the topographic diagnosis of chronic rhinosinusitis. The study involved 474 patients with signs of chronic perennial and persistent rhinosinusitis. The disorders of the nasal cavities and paranasal sinuses were classified into three main diagnostic categories: chronic rhinitis, localized sinusitis (mainly, anterior sinusitis), and diffuse rhinosinusitis (ie, nasal polyposis). A principal components analysis was performed. The symptom patterns of the three main clinical entities differed greatly. Most of the following clinical signs — nasal obstruction, anterior and posterior nasal discharge, sneezing, and facial congestion — are found in all diagnostic categories and hold no specific clinical significance. By contrast, four symptoms seem to have a substantial differentiating potential: anosmia and complete loss of flavor for diffuse rhinosinusitis, cacosmia for localized anterior sinusitis, and severe facial pain for localized sinusitis. This study proposes a new analysis of the relationship between symptoms of chronic rhinosinusitis and findings on a sinus computed tomography scan.
Combined Horizontal and Posterior Canal Benign Paroxysmal Positional Vertigo in Three Patients with Head Trauma
Authors: Bertholon Pierre , Chelikh Larbi , Timoshenko Andrei P. , Tringali Stéphane , Martin Christian
Published: October 2014

We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30°) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.
State-Dependent Laryngomalacia in Sleeping Children
Authors: Smith Joseph L. , Smallman Bettina , Sweeney Dawn M. , Mortelliti Anthony J.
Published: October 2014

Laryngomalacia is a common congenital laryngeal abnormality. Despite its being widely discussed in the literature, the pathophysiology is not clearly understood. Both anatomic and neuromuscular theories have been suggested to explain laryngomalacia. We report 4 cases of laryngomalacia in which the presenting signs occurred during sleep. Awake flexible nasopharyngolaryngoscopy failed to demonstrate supraglottic structure collapse. Only while the patients were breathing spontaneously under general anesthesia was laryngomalacia noted. A proposed algorithm for diagnosis and treatment is included. These 4 cases of state-dependent laryngomalacia support a neuromuscular cause for laryngomalacia.
Subtotal Carbon Dioxide Laser Arytenoidectomy for the Treatment of Bilateral Vocal Fold Immobility: Long-Term Results
Authors: Plouin-Gaudon Isabelle , Jamart Jacques , Lawson Georges , Remacle Marc
Published: October 2014

Sixty-nine patients underwent subtotal carbon dioxide laser arytenoidectomy for treatment of bilateral vocal fold immobility between 1985 and 2000. The population included 69 patients whose mean age was 56 years (SD, 16 years; range, 11 to 82 years). The mean follow-up was 50 months (SD, 44 months; range, 1 to 181 months). The overall postoperative peak expiratory/peak inspiratory flow ratio (normal value, 1) significantly improved (closer to 1; p = .0036). Voice analyses were also undertaken for 27 patients, almost exclusively after operation, given the context of initial emergency. The maximum phonation time averaged 6.57 seconds (median, 6 seconds). The phonation quotient remained high, with a mean of 503 (median, 440), and the mean conversational voice intensity remained around 59 dB. The median frequency analysis type was 3. The advantage of subtotal arytenoidectomy lies in the fact that it maintains a certain degree of rigidity along the posterior limit of the arytenoid frame, preventing inward collapse of the mucosa and thus lowering the risk of aspiration.
Roles of Free Radicals, Nitric Oxide, and Scavenging Enzymes in Nasal Polyp Development
Authors: Karlidaǧ Turgut , Keles Erol , İlhan Nevin , Yakclin Sinasi , Kaygusuz İrfan , Yildiz Mücahot
Published: October 2014

The aim of this study was to investigate the role of nitric oxide (NO), free oxygen radicals, and scavenging enzymes in the development of nasal polyp (NP) disease. This study included 41 patients who underwent endoscopic surgery because of NPs. Control specimens were taken from the inferior turbinate of 32 patients who underwent septoplasty. The levels of malondialdehyde (MDA), NO, and superoxide dismutase (SOD) were measured in intraoperative specimens of polyp tissue and turbinate mucosa. The levels of tissue NO were 191.06 ± 26.62 μmol/mg of protein in patients with NPs and 145.30 ± 19.19 μmol/mg of protein (p < .001) in the control group. The levels of MDA in the study and control groups were 12.47 ± 2.12 nmol/mg and 8.83 ± 1.08 nmol/mg (p < .01), respectively. The levels of SOD in the study and control groups were 50.77 ± 14.74 U/mg and 77.93 ± 15.31 U/mg (p < .001), respectively. It was determined that the levels of MDA in plasma and erythrocytes were higher in the patients with NPs than in the control group (p < .05). The levels of NO in plasma and erythrocytes in both groups were similar. The levels of SOD in plasma and erythrocytes were lower in patients with NPs than in the control group (p > .05). Increases in the levels of tissue MDA and NO and decreases in scavenging enzymes in patients with NPs as compared to control groups may indicate the presence of free radical damage in patients with nasal NPs. New studies are needed to clarify the efficacy of using antioxidants in the treatment of NPs.
Traction of Lateral Cricoarytenoid Muscle for Unilateral Vocal Fold Paralysis: Comparison with Isshiki's Original Technique of Arytenoid Adduction
Authors: Sonoda Satoshi , Kataoka Hideyuki , Inoue Takayo
Published: October 2014

Between 1995 and 1997, we performed Isshiki's original method of arytenoid adduction alone or as an adjunct to type I thyroplasty for the treatment of unilateral vocal fold paralysis. From 1997 onward, we performed arytenoid adduction by traction of the lateral cricoarytenoid muscle (Iwamura's method), because it reduces discomfort to the patient and avoids rotation of the thyroid cartilage. Preliminary experiments and surgical procedures involving traction of the lateral cricoarytenoid muscle are described. Of 21 patients with a maximum phonation time of less than 9 seconds, 14 underwent type I thyroplasty as an adjunct to our method of arytenoid adduction and 7 underwent arytenoid adduction alone. Sixteen patients (76%) were able after surgery to extend their maximum phonation time beyond 10 seconds; this result compares favorably with the results of Isshiki's original adduction technique. We describe useful anatomic landmarks for approaching the lateral cricoarytenoid muscle in the hope that more voice surgeons will adopt this approach in the treatment of unilateral vocal fold paralysis.
Complications of Mastoiditis in Children at the Onset of a New Millennium
Authors: Oestreicher-Kedem Yael , Popovtzer Aron , Raveh Eyal , Buller Nora , Kornreich Liora , Nageris Ben
Published: October 2014

The aim of the present study was to review our recent experience in the diagnosis and treatment of acute mastoiditis and its complications in a single tertiary-care, university-affiliated pediatric center. Ninety-eight children with 101 episodes of acute mastoiditis were included in the study. The mean interval from onset of illness to mastoiditis was 4.5 days. Ear cultures most often grew Streptococcus pneumoniae and Pseudomonas aeruginosa (23.7% each). Complications occurred in 15.8% of episodes. The only factor differentiating children with and without complications was white blood cell count. These findings indicate that acute mastoiditis not only is a complication of prolonged infection of the middle ear, but may also present as an acute infection of the mastoid bone that can progress within 48 hours. The complication rate remains high, and antibiotic treatment at the onset of symptoms does not prevent complications. A high white blood cell count on admission may serve as a predictive factor of complicated cases.
Meta-Analysis of Upper Probe Measurements in Normal Subjects and Patients with Laryngopharyngeal Reflux
Authors: Merati Albert L. , Ulualp Seckin O. , Lim Hyun J. , Toohill Robert J.
Published: October 2014

We report a meta-analysis of a series of studies in which 24-hour ambulatory pH monitoring was performed in 1) normal subjects, 2) the normal control subjects in studies of laryngopharyngeal reflux (LPR), and 3) the patients with LPR in these controlled studies. The statistical analysis utilized the fixed-effects model by Mantel-Haenszel and the random-effects mixed model. There were 16 studies from the past 12 years that fulfilled the inclusion criteria. They involved 793 subjects (264 normal and 529 with LPR). The numbers of positive pharyngeal reflux events for normal subjects and for patients with LPR differed with a p value of <.0001. There was also a significant difference in the mean percentage of acid exposure times between normal subjects and patients with LPR (p = .003). We conclude that the upper probe gives accurate and consistent information in normal subjects and patients with LPR. The numbers of reflux events and acid exposure times are most important in distinguishing normal subjects from patients with LPR. The technology and methodology of probe testing is quite reliable and is consistent on a worldwide basis.
Pulsed Dye Laser Treatment of Laryngeal Granulomas
Authors: Clyne Stephen B. , Koufman Jamie A. , Halum Stacey L. , Postma Gregory N.
Published: October 2014

Laryngeal granulomas are effectively treated with antireflux therapy and speech therapy. Failure to respond leads to treatment with Botox or surgical excision. We report on the use of the pulsed dye laser for treating chronic granulomas that do not respond to standard therapy. We performed a retrospective review from September 2002 to September 2003. Patients identified with chronic granulomas that were not responding to standard therapy were treated in our office with the pulsed dye laser. Ten patients were identified; the mean age was 58 years. Two patients underwent more than one pulsed dye laser treatment. Five of the 10 had resolution of their lesions, and 3 had a partial response. Two were unchanged. The average follow-up was 6 months, and there were no complications. We conclude that in-office use of the pulsed dye laser is a relatively safe and effective method for treating laryngeal granulomas that do not respond to antireflux therapy and speech therapy.
Direct Revascularization is Superior for Rat Parathyroid Allotransplantation with Fk506
Authors: Nelson Marc , Dan Olivia , Strome Marshall
Published: October 2014

Parathyroid gland allotransplantation has been a challenging goal for decades. Our objective was to optimize a parathyroid allotransplantation model for analysis of short-term or low-dose immunosuppressive regimens. Rats that had undergone parathyroidectomy received parathyroid allografts either by direct microvascular anastomoses as part of a composite laryngotracheal graft or by direct implantation into hind limb muscle. All rats were maintained on daily low-dose FK506 (tacrolimus). Intact serum parathyroid hormone (PTH) levels for both groups were recorded over a period of at least 45 days and compared with a repeated-measures mixed model. We found that microvascular anastomosis was superior to implantation for parathyroid gland survival, as all revascularized grafts immediately produced normal levels of PTH, whereas implanted grafts had a significantly slower recovery of function (p < .001). Four of the 11 implanted grafts (36%) never produced detectable PTH levels. Using this model, we are developing innovative strategies that will lead to successful parathyroid allotransplantation without the need for chronic immunosuppression.
Purulent Chondritis of the Laryngeal Framework Cartilages
Authors: Eliashar Ron , Goldfarb Abraham , Gross Menachem , Sichel Jean-Yves
Published: October 2014

This manuscript reports on our experience with purulent chondritis of the laryngeal cartilages (PCLC), an entity that has not yet been described. Three patients had a diagnosis of PCLC. The probable causes were relapsing polychondritis, a previous prolonged intubation, and an idiopathic cause. The patients suffered from hoarseness and inspiratory stridor for 1 to 3 months before diagnosis. None complained of pain in the neck. Laryngoscopy showed supraglottic edema. A computed tomography scan revealed abscess formation between the intact inner and outer perichondria of the thyroid cartilage. The treatment included rigid endoscopy, external incision and drainage, and prolonged medical therapy. The culture results were Staphylococcus aureus in the first 2 cases and Aspergillus fumigatus in the third. The second patient (in whom the cricoid cartilage was also affected) required emergency tracheotomy. The other 2 patients did not require airway intervention. The rarity of PCLC and the relatively mild symptoms require a high index of suspicion for its diagnosis.
Taste Disorders after Tonsillectomy: Case Report and Literature Review
Authors: Collet Stéphanie , Rombaux Philippe , Eloy Philippe , Bertrand Bernard
Published: October 2014

The authors describe a case of dysgeusia that occurred during the recovery period after a tonsillectomy. The cause was thought to be a lesion to the lingual branch of the glossopharyngeal nerve because of the location of the symptoms at the posterior region of the buccal cavity and because of the raised electrogustometric thresholds in the posterior region of one half of the tongue. Clarification of this type of case was made by a review of the literature from 1966 to June 2004, carried out with the aid of Medline. From a medicolegal standpoint, it is important to inform the patient of the risk of dysgeusia after tonsillectomy, especially if that patient has a profession in which taste plays an essential role.
Response of Visual Loss in Allergic Fungal Sinusitis to Oral Corticosteroids
Authors: Graham Scott M. , Carter Keith D.
Published: October 2014

Visual loss associated with allergic fungal sinusitis is most often treated with surgery followed by oral corticosteroids. A case is presented in which, because of substantial medical comorbidities, surgery could not be initially performed and the visual loss was corrected with prednisone alone. This case serves to reinforce the central role of corticosteroids in treatment of this enigmatic condition.
Anatomy of the Cricothyroid Articulation: Differences between Men and Women
Authors: Fllho João Aragão Ximenes , Bohadana Saramira Cardoso , Tsuji Domingos Hiroshi , Perázzio Andréia Felix , Sennes Luiz Ubirajara
Published: October 2014

A greater difficulty in exposing the arytenoid cartilage during rotation surgeries has been observed for men. The objective of the present study was to describe the position of the cricothyroid articulation and the distance between the right and left articulations, and to compare these findings between genders. The following measurements were obtained for 16 cadavers (9 men and 7 women): angulation of the cricothyroid articulation in the cricoid ring, dimensions of the thyroid articular surface of the cricoid cartilage, and distance between the cricothyroid and cricoarytenoid articulations. The cricothyroid articulation angle was narrower in men than in women (p = .04). The major diameter of the articular facet of the thyroid cartilage was wider in men (p = .001). The longer lamina of the thyroid cartilage, as well as the more posterior position of the cricothyroid articulation, in men might explain the greater difficulty in exposing the arytenoid cartilage during laryngeal framework surgeries observed for this group of patients.
Protective Glottic Closure: Biomechanical Effects of Selective Laryngeal Denervation
Authors: Sasaki Clarence T. , Hundal Jagdeep S. , Kim Young-Ho
Published: October 2014

Glottic closure constitutes the primary mechanism for prevention of intradeglutitive and postdeglutitive aspiration. Laryngeal paralysis therefore exerts a considerable impact on deglutition, yet little is understood regarding the biomechanical effects of selective denervation on the laryngeal protective function. We measured the glottic closing force (GCF) in each of 6 male, 40-kg Yorkshire pigs 1) after selective unilateral superior laryngeal nerve (SLN) section; 2) after selective unilateral recurrent laryngeal nerve (RLN) section; and/or 3) after combined SLN-RLN section as both right and left SLNs were simultaneously stimulated to evoke the glottic closure response. Stimulation was provided through an oscilloscope with bipolar platinum-iridium electrodes, and the GCF was measured with a pressure transducer positioned between the vocal cords. Six repetitive measures of GCF were obtained before nerve section, and 6 after nerve section, in each subject. Unilateral SLN section reduced the GCF to 54.14% of control, RLN section reduced the GCF to 23.39% of control, and combined SLN-RLN section reduced the GCF to 22.67% of control. These findings underscore the profound differential effects exerted by isolated lesions on the glottic closure function.
Reepithelialization of Orthotopic Tracheal Allografts Prevents Rejection after Withdrawal of Immunosuppression
Authors: Govindaraj Satish , Fedorova Elena , Genden Eric M. , Chaboki Houtan , Bromberg Jonathan S. , Cleven Heidi , Mayer Lloyd
Published: October 2014

Prior work has demonstrated that immunosuppressed orthotopic tracheal allografts undergo progressive reepithelialization over a 48-day period with recipient-derived tracheal epithelium. We hypothesized that reepithelialization of tracheal allografts would prevent rejection after withdrawal of immunosuppression. BALB/c murine tracheal grafts were transplanted orthotopically into either syngeneic or allogeneic C57/BL6 recipients. The recipients were either not immunosuppressed, immunosuppressed with cyclosporine A (10 mg/kg per day) continuously, or immunosuppressed for 48 days and then withdrawn from immunosuppression. The grafts were assessed for acute and chronic rejection 10 days and 50 days after immunosuppression withdrawal. The immunosuppressed allograft recipients maintained a ciliated epithelium acutely and chronically after immunosuppression withdrawal. Ten days after immunosuppression withdrawal, there was a mild cellular infiltrate, which resolved 50 days after withdrawal. Electron microscopy, lymphocyte subpopulation assays, and lamina propria analysis demonstrated that immunosuppression withdrawal did not result in tracheal allograft rejection. In vitro and in vivo assessments did not demonstrate evidence of systemic or local immune tolerance. We conclude that reepithelialization of orthotopic tracheal allografts with recipient-derived mucosa prevents rejection of allograft segments. Tracheal transplantation may require only transient immunosuppression, which can be withdrawn after tracheal reepithelialization.
Techniques and Outcomes of Laryngeal Cleft Repair: An Update to the Great Ormond Street Hospital Series
Authors: Kubba Haytham , Bailey Martin , Gibson Daren , Hartley Ben
Published: October 2014

We present an update to the Great Ormond Street Hospital series of laryngeal clefts, describing a further 35 clefts of Benjamin-Inglis types 1 through 3 treated between 1992 and 2003. Associated congenital anomalies were common. Most type 1 and smaller type 2 clefts were repaired endoscopically, whereas larger clefts were repaired through an anterior approach. Increasing use was made recently of a 3-layer repair with an interposition graft of temporalis fascia. The rates of complication, revision surgery, and death were 54%, 26%, and 6%, respectively. Most of the children are now orally fed, and 9 still have a tracheotomy.
Myotomy Length Determinants in Endoscopic Staple-Assisted Esophagodiverticulostomy for Small Zenker's Diverticula
Authors: Richtsmeier William J.
Published: October 2014

A small Zenker's pouch is a major challenge for endoscopic staple-assisted esophagodiverticulostomy (ESED). This study tested the stapler dimensions so as to identify limitations they impose on ESED. Combining ESED with additional endoscopic suturing could extend the incision and consequently the myotomy. Zenker's diverticulum residual pouch measurements were performed with a previously reported latex glove model and in patients undergoing surgery. Two stapler designs were compared by measuring the residual pouch length for both the stock and modified staplers. One other stapler model cannot be modified without damaging the mechanism. The Endostitch was used to place an additional suture at the apex of the staple line, allowing cutting between the staples while leaving a closed distal incision. All three staplers suitable for ESED leave a residual pouch of 1.5 cm when unmodified. The modified anvil staplers gave a smaller residual pouch by 4 to 5 mm. An additional septal reduction can be accomplished by suturing the area distal to the staple line and incising the party wall beyond the stapler cut. The absolute amount of residual pouch with an additional myotomy is 3 mm. The combined staple-suture technique has proven relatively safe thus far. To provide a maximally efficient myotomy in a patient with a short pouch, the surgeon needs to be aware of the stapler differences. Modifications of the staplers may decrease the depth of the residual pouch, but may carry an added liability. A minimum residual pouch can be achieved with a combination of stapler and suture techniques, but is more technically demanding than the original ESED description.
Laryngeal Thrush
Authors: Sulica Lucian
Published: October 2014

Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable — a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
Length of the Human Vocal Folds: Proposal of Mathematical Equations as a Function of Gender and Body Height
Authors: Filho João Aragão Ximenes , de Melo Erich Christiano Madruga , de Giacomo Carneiro Christiano , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara
Published: October 2014

To obtain a mathematical equation that could estimate the length of the intermembranous part of the vocal fold as a function of body height and gender, we removed the larynges from 39 cadavers (22 men and 17 women) after recording the subject's height, age, and cause of death. The dimensions of the vocal folds were determined with a digital pachymeter. The following equations were obtained: y = 0.18x − 15.8 for men and y = 0.24x − 28.1 for women, where y is the length of the intermembranous part of the vocal folds in millimeters and x is the height of the individual in centimeters. We conclude that it is possible to estimate the normal expected length of the intermembranous portion of the male and female vocal folds on the basis of body height.
Effect of Isoproterenol on the Regulation of Rabbit Airway Ciliary Beat Frequency Measured with High-Speed Digital and Fluorescence Microscopy
Authors: Zhang Luo , Han Demin , Sanderson Michael J.
Published: October 2014

To investigate how isoproterenol, a β-adrenergic agonist, regulates airway ciliary beat frequency (CBF), we simultaneously quantified changes in rabbit airway CBF and intracellular calcium concentration ([Ca2+]i) in response to isoproterenol (100 μmol/L) by using high-speed (240 frames per second) and fluorescence microscopy. At approximately 30°C, isoproterenol induced a change in CBF that could be separated into two parts. First, isoproterenol induced a moderate increase in the basal CBF that was calcium-independent. This response was unaffected by buffering the [Ca2+]i with 1,2-bis(2-aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid tetrapotassium salt (BAPTA). Second, isoproterenol induced a transient increase in CBF that was superimposed on the increased basal CBF and correlated with a simultaneous transient increase in [Ca2+]i. This transient increase in CBF was abolished by BAPTA. We conclude that isoproterenol initially increases CBF through a calcium-independent mechanism, probably via protein kinase A, and subsequently through a calcium-dependent mechanism mediated by an increase in [Ca2+]i.
Larynx and Cervical Trachea in Humidification and Heating of Inhaled Gases
Authors: Dias Norimar Hernandes , Braz José Reinaldo Cerqueira , Martins Regina Helena Garcia , Carvalho Lídia Raquel
Published: October 2014

To evaluate the participation of the larynx and cervical trachea in conditioning inspired gases, we randomly allocated 16 mixed-breed dogs to two groups: group TT (tracheal tube; n = 8) and group LMA (laryngeal mask airway; n = 8). The dogs were anesthetized with pentobarbital sodium and mechanically ventilated for 3 hours. The parameters studied were temperature and absolute humidities of ambient, inhaled, and tracheal air. There was a small increase in tracheal air temperature compared to inhaled air temperature, but no significant difference between groups. The absolute humidity of tracheal air was greater in group LMA than in group TT (23 mg H2O • L–1 and 14 mg H2O • L–1, respectively; p < .0001). The difference in absolute humidity between the tracheal air and the inhaled air was higher in group LMA at all times (p < .0001). We conclude that the larynx and cervical trachea of the dog participate in humidification and heating of inhaled air by means of air contact with mucosa in this airway segment.
Timing of Glottic Closure during Swallowing: A Combined Electromyographic and Endoscopic Analysis
Authors: Van Daele Douglas J. , McCulloch Timothy M. , Palmer Phyllis M. , Langmore Susan E.
Published: October 2014

Objectives:

We performed a case series to enhance our understanding of the coupling between neuromuscular events and glottic closure.

Methods:

We performed combined flexible video laryngoscopy and electromyography in 4 healthy human subjects. Hooked-wire electrodes were placed in the superior pharyngeal constrictor, longitudinal pharyngeal, cricopharyngeus, thyroarytenoid, genioglossus, suprahyoid, and posterior cricoarytenoid muscles. A flexible endoscope tip was positioned in the oropharyngeal-hypopharyngeal region. The subjects performed multiple trials each of 10-mL normal and super-supraglottic liquid swallows.

Results:

Arytenoid movement consistently preceded full glottic closure and was associated with cessation of activity of the posterior cricoarytenoid muscle. In 89% of normal swallows, the glottis was partially open in the video frame before bolus passage. The maximum amount of thyroarytenoid electromyographic activity occurred during endoscopic white-out. When subjects executed a super-supraglottic swallow, early thyroarytenoid activity coincided with arytenoid contact.

Conclusions:

The initial medialization of the arytenoids is due to a decrease in motor tone of the posterior cricoarytenoid muscle. Full glottic closure typically occurs late in the process of swallowing, with activation of the thyroarytenoid muscle. Shifting of arytenoid medialization and glottic closure earlier in the super-supraglottic swallow indicates that glottic closure is under significant voluntary control.