bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Fetal Upper Respiratory Tract Function as Revealed by Ultrasonography
Authors: Isaacson Glenn , Birnholz Jason C.
Published: October 2014

The respiratory functions of the oropharynx, larynx, and trachea of normal human fetuses in utero were explored by means of realtime, two-dimensional ultrasonography combined with color-flow and spectral Doppler analysis. Coronal and transverse images revealed the maturation of coordinated respiratory activity of these structures in the late second and early third trimesters. Observation of the effects of these movements upon the flow of amniotic fluid in the fetal respiratory tract provides an appreciation of the early role of the upper airway in the modulation of fetal breathing.
Squamous Cell Carcinoma in an Inverted Papilloma of the Buccal Mucosa
Authors: Boesen Peter V. , Robinson Robert A. , Laszewski Michael J. , Dawson Douglas E.
Published: October 2014

Inverted papillomas of the oral cavity are rare lesions. Although in the seven oral cases previously reported the lesions were benign, approximately 10% to 15% of inverted papillomas of the nasal cavity and paranasal sinuses develop or are associated with squamous cell carcinoma. This report presents a case of squamous cell carcinoma arising in an inverted papilloma of the buccal mucosa. Histologically, this lesion demonstrated the morphologic features of inverted papilloma in the superficial portion, and squamous carcinoma in deeper sections, This case suggests that although rare, inverted papillomas of the oral cavity should be considered potentially malignant or capable of harboring a malignancy.
Remodeling Patterns in the Bony Otic Capsule of the Dog
Authors: Sørensen Mads Sølvsten , Jørgensen Martin Balslev , Bretlau Poul
Published: October 2014

Quantum-type bone remodeling was studied in undecalcified temporal bones and long bone specimens from adult mongrel dogs by means of combined microradiography, osteofluorochrome labeling, and osteoid staining. The overall turnover rate of capsular bone was estimated to be low compared to that of extracapsular compact bone. Evolving secondary osteons were distributed centrifugally relative to the perilymphatic space. Moreover, a zone of bone tissue enclosing perilymphatic spaces was found completely devoid of evolving secondary osteons. Throughout the otic capsule, segmentary perivascular foci of resorption and formation were present. These findings indicate that remodeling of capsular bone is subject to sustained local inhibition. The significance of this conclusion is considered with special reference to otosclerosis.
Prospective Randomized Clinical Trial of Advanced Cochlear Implants: Preliminary Results of a Department of Veterans Affairs Cooperative Study
Authors: Cohen Noel L. , Waltzman Susan B. , Fisher Susan G.
Published: October 2014

This study is a randomized clinical trial to compare the efficacy and safety of one single-channel implant (the 3M/Vienna intracochlear device) and two multichannel cochlear implants (the Nucleus 22-channel device and the Smith & Nephew Richards Ineraid device). Seven Veterans Administration centers are participating in the study. The patient population consists of 82 veterans with postlingual, bilateral profound sensorineural hearing losses who obtain no benefit from amplification. All potential subjects were screened with a battery of audiologic tests. The three device groups are balanced on baseline patient characteristics. One month after operation, the devices were stimulated and programmed and the patients evaluated. Follow-up evaluations were completed at 3 and 12 months poststimulation and then annually until the end of the study. The 12-month data indicate that performance with the multichannel devices is superior to that with the single-channel device.
Transport of 5-Hydroxydopamine and Horseradish Peroxidase through the Perilymph-Endolymph Barrier
Authors: Sakagami Masafumi , Ikeda Katsuhisa , Duvall Arndt J. , Juhn Steven K. , Matsunaga Toru
Published: October 2014

The distribution of 5-hydroxydopamine (5-OHDA) and horseradish peroxidase (HRP) in the cochlea was examined by light and electron microscopy after perilymphatic perfusion. Reaction product of 5-OHDA was observed along the endolymphatic surface of the cochlear duct in both 10-minute and 30-minute perfusions, while that of HRP was observed only in the 30-minute perfusion. Both tracers were found in pinocytotic vesicles of Reissner's membrane, Claudius' cells, and Hensen's cells. No labeling was seen in tight junctions of the epithelial cells lining the scala media. The epithelial cells of the spiral prominence showed various degrees of degeneration in the 5-OHDA experiment. These morphologic findings suggest that 5-OHDA and HRP can enter the endolymphatic space from the perilymphatic space by pinocytosis and that the degree of transport depends on the size of the particles.
Effect of Age at Onset of Deafness on Children's Speech Perception Abilities with a Cochlear Implant
Authors: Osberger Mary Joe , Todd Susan L. , Robbins Amy M. , Berry Stacey W. , Miyamoto Richard T.
Published: October 2014

The speech perception abilities of 37 children with cochlear implants (single-channel or multichannel) were examined as a function of age at onset of deafness. There was no significant difference in the speech perception abilities of implanted children who were born deaf and those of implanted children who lost their hearing during the first 3 years of life. In contrast, the performance of children whose age at onset of deafness was 5 years or later was significantly better than that of the children with congenital or early-acquired deafness on tests of stress pattern categorization, closed-set word identification, open-set identification of common phrases, and lipreading enhancement.
Prediction of Behavioral Threshold and Comfort Values for Nucleus 22-Channel Implant Patients from Electrical Auditory Brain Stem Response Test Results
Authors: Shallop Jon K. , Goin Donald W. , VanDyke Linda , Mischke Robert E.
Published: October 2014

We have studied the prediction of behavioral threshold and comfort values for 11 patients who use the Nucleus 22-channel cochlear implant by means of the results of electrical auditory brain stem response (EABR) procedures. For prediction purposes, EABR and behavioral testing were done in the same electrode mode configuration for three specific electrodes. The results of this investigation suggest that EABR threshold current level is consistently near the behavioral comfort current level, rather than the patient's behavioral threshold level.
Orthostatic Postural Control in Vestibular Neuritis: A Stabilometric Analysis
Authors: Gagey Pierre-Marie , Toupet Michel
Published: October 2014

Posturographic data for 182 vestibular neuritis patients were recorded on a static posturographic platform (stabilometry) with the patients' eyes both open and closed. Three of the parameters studied are presented here: mean position of the center of pressure, area of the statokinesigram, and Romberg's quotient. Vestibular neuritis modifies the performance of the fine-postural system in unpredictable ways, varying with the subject. It may disturb either the mean position of the center of pressure or the integration of visual input. Sixty of the patients in this study did not use visual input to stabilize their position in relation to their surroundings. The value of stabilometry as a method for observing the integration of visual input in the control of orthostatic posture is discussed.
Inexpensive Cochlear Implant Device
Authors: Kanchanarak Chalee , Siriratwatanakul Narin , Saeng-In Akachai , Boonyanukul Seetone , Krairojananan Tawanwong
Published: October 2014

We have developed a cochlear implant (CI) device modified from the House/3M cochlear implant device. The cost of raw materials was about $25. We used a new and simple technique for coating the implanted coil. We modified the circuit and removed the amplitude-modulated circuit. With this modification, the device uses less electricity and fewer transistors. There are slightly more than 3,000 patients using CI devices all over the world. Millions of profoundly deaf patients are poor and cannot afford the CI device that is now commercially available. Any university with well-trained otolaryngologists and physicists or electrical engineers can perform this technique.
Primary Culture of Strial Marginal Cells of Guinea Pig Cochlea: Growth, Morphologic Features, and Characterization
Authors: Achouche Josué , Wu An H. , Liu Der S. , Huy Patrice Tran Ba
Published: October 2014

To further investigate the cellular mechanisms involved in the formation of endolymph, primary cultures of marginal cells of guinea pig were established. Minute explants obtained by mechanical dissociation of stria vascularis were plated on collagen type I precoated impermeable substrate in serum-free, hormone-supplemented medium. A confluent layer of epithelial-like cells was obtained within 2 weeks. The cultured cells formed domes, demonstrating that they retain some of their transepithelial properties. Polarization was also suggested by electron microscopic observation of apical microvilli and tight junctions. Immunohistochemical methods revealed that the cultured cells coexpressed cytokeratin and vimentin, demonstrating their epithelial origin, although some degree of dedifferentiation occurred. Thus, a primary culture of marginal cells can be established that may be a suitable model for an in-depth investigation of the function of the marginal cells.
Management of Flap Necrosis in Cochlear Implantation
Authors: Haberkamp Thomas J. , Schwaber Mitchell K.
Published: October 2014

Skin flap complications are the most commonly reported problems in cochlear implant surgery when the anteriorly based C-shaped flap is used for the incision. If the prosthesis is exposed by flap necrosis, local skin flaps may be used to obtain coverage. Unfortunately, the long-term viability of such flaps may be compromised by the pressure exerted by the transmitter. Two cases of flap necrosis severe enough to expose the prosthesis have been successfully managed by relocating the device to a position superior to the auricle, under healthy skin. In one case the receiver was removed owing to infection and reimplanted at a later date. In this case, the electrode array was left in place at explantation in order to stent the cochlea. The surgical techniques and flap designs for this procedure are presented. No further surgical complications have developed in either case. The devices are performing well for both patients at this time. We have found relocation of the implant a useful technique in the management of major flap necrosis. This technique may also be useful to prevent flap necrosis should excessive flap thinning occur during the implant operation.
Laser Surgery for the Treatment of Larynx Carcinomas: Indications, Techniques, and Preliminary Results
Authors: Eckel Hans Edmund , Thumfart Walter Franz
Published: October 2014

The authors have developed four different types of endolaryngeal laser resections for the treatment of larynx carcinomas. These new techniques are based on traditional concepts employed in partial larynx resections. From 1986 onward, 110 patients with laryngeal cancers were treated by endoscopic laser surgery. One hundred six patients were operated on for cure and 4 for palliation. In 9 cases of T3 tumor, complete removal of the tumor was not possible, requiring total laryngectomy. In all T2 cancers of the glottis and subglottis (n = 36), a total resection was possible. Additional staged neck dissection was performed in 16 cases, and postoperative radiotherapy in 10 cases. Follow-up investigations of the patients treated for cure (n = 106) cover a period of 3 to 42 months (mean, 22 months). These revealed 6 recurrences in the larynx, which were treated by laryngectomy. Recurrences in the cervical nodes were seen in 2 patients following resection of a supraglottic tumor and a subglottic tumor, respectively. Seven patients could not be followed up, 4 patients died of intercurrent disease, and 87 patients are alive and free of tumor. At present the number of recurrences and the rate of survival show no significant difference from those previously reported after conventional surgery. The phonatory function is not always predictable and still remains to be investigated. The authors believe that laser surgery may obviate the need for total laryngectomies in selected cases of laryngeal cancer, especially in T2 tumors. However, T3 tumors should not be treated by endolaryngeal laser surgery.
Characteristics of Late Responses to Superior Laryngeal Nerve Stimulation in Humans
Authors: Ludlow Christy L. , Van Pelt Frederick , Koda Junji
Published: October 2014

To characterize human thyroarytenoid and cricothyroid muscle responses to stimulation of the internal (sensory) and external (motor) branches of the superior laryngeal nerve (SLN), three awake subjects were studied at rest and during muscle activation with stimulation at different current levels. When only the external branch was stimulated, direct cricothyroid muscle responses were obtained without responses in either thyroarytenoid muscle. When only the internal branch was stimulated, no cricothyroid responses were obtained, but two late thyroarytenoid responses occurred (R1 and R2). The R1 response was usually ipsilateral and had a mean onset latency of 18 milliseconds, while the R2 response was bilateral and occurred between 66 and 70 milliseconds. Both responses tended to decrease in latency and increase in amplitude with increased stimulation level. The similarity of Rl to the adductor response and R2 to other late responses is discussed.
Role of Injectable Collagen in the Treatment of Glottic Insufficiency: A Study of 119 Patients
Authors: Ford Charles N. , Bless Diane M. , Loftus Jean M.
Published: October 2014

Injectable bovine collagen has been used for treatment of glottic insufficiency at the University of Wisconsin Clinical Science Center since 1983. This report reviews our experience in treating 119 patients with a variety of vocal fold disorders manifested by glottic insufficiency. Many of the patients were referred because of prior treatment failures or problems that were impossible to treat with other modalities. Results were assessed by comprehensive voice evaluations using subjective patient self-assessments, perceptual judgments made by a panel of experts who had no prior knowledge of the study, objective assessments, and videostroboscopy. Objective assessment included vocal function measures and acoustic analysis. Results indicate that collagen not only is comparable to other injection filler substances but also has unique advantages as a bioimplant. Collagen injection seems uniquely suited for treatment of several problems, including vocal fold atrophy, focal defects, minimal glottic insufficiency, and scarred vocal folds that are not managed optimally with Teflon injection. Overall there were no serious complications and treatment was effective for a broad spectrum of problems. In most instances the correction persisted, and in those instances in which injected collagen seemed improperly distributed, the vocal fold was recontoured or the implant removed without appreciable damage to the surrounding tissues. Injectable collagen has been extensively studied and deserves to be included in the armamentarium of the laryngeal surgeon.
Perichondrial Microvascular Free Transfer: Creation of a Compound Flap for Laryngeal Reconstruction in Rabbits
Authors: Delaere Pierre R. , Boeckx Willy D. , Guelinckx Paul J. , Vandamme Bouwdewijn , Ostyn Frans
Published: October 2014

A free revascularized compound perichondrial flap was used over an intralaryngeally placed stent for reconstruction of a frontal laryngeal defect. The microvascular flap replaced the cartilaginous and mucosal defect. Short-term results showed successful reconstruction with a patent airway and viable mucosa. The vascularized sheet of perichondrium was not chosen for its neochondrogenetic effect, but it served as a vascular bed, nourishing the mucous and cartilaginous components in the compound flap. It is suggested that for clinical purposes the reliable fascia forearm flap, which is available in large amounts, can be used as a transferable vascularized bed with a thickness comparable to that of the perichondrial flap.
Experimental Blunt Injury to the Larynx
Authors: Lee Shiann Yann
Published: October 2014

This article deals with the fracture line distribution and severity of laryngeal trauma. Laryngeal trauma was experimentally inflicted on 100 human laryngeal specimens with the impact of a 2.0-kg weight falling by gravity from a height of 100 cm. According to the previous pilot experiment and clinical experiences, the author classified the severity of fracture into four grades. The results showed no significant sex difference in the severity of fracture with reference to age distribution, especially severe injury in older age groups. The pattern of fracture lines of the laryngeal cartilage was observed and traced in four selected locations, including the thyroid notch, central zone of the thyroid cartilage, cricothyroid region, and cricoid. The distributions of fracture lines are illustrated. The experiment is described in detail.
Acquired Laryngomalacia: Epiglottis Prolapse as a Cause of Airway Obstruction
Authors: Woo Peak
Published: October 2014

Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. It occurs primarily in patients who have lost pharyngeal airway support because of previous surgery or after head injury and coma. Eight cases of epiglottis prolapse are presented. One patient had epiglottis prolapse after resection of floor of mouth cancer and another after laryngeal fracture. The rest of the cases were seen in patients recovering from head injury and coma. Videolaryngoscopy shows the larynx to assume an ovoid shape within the pharynx. There is loss of the usual anterior to posterior pharyngeal and laryngeal dimension. The epiglottis is in a more horizontal position at rest. During inspiration, the epiglottis prolapses into the endolarynx, causing subtotal airway obstruction. Laryngeal obstruction due to epiglottis prolapse can prevent decannulation in the head-injured and can be the cause of obstructive sleep apnea. Endoscopic carbon dioxide laser epiglottectomy was successful in management of these cases.
Angiogenic Growth Factors: Their Effects and Potential in Soft Tissue Wound Healing
Authors: Hom David B. , Maisel Robert H.
Published: October 2014

Since their discovery 30 years ago, angiogenic growth factors have been demonstrated to stimulate neovascularization in vitro and in animal studies. Over the last decade, knowledge gained in the field of angiogenic growth factors has grown immensely. These angiogenic growth factors exist in four major families: fibroblast growth factor (FGF), transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF). Each has the ability to induce soft tissue vascularization in microgram quantities. In animal models, FGF, TGF-β, PDGF, and EGF have been shown to enhance soft tissue wound healing. In human clinical trials, EGF and a mixture of PDGFs have been demonstrated to accelerate epidermal regeneration in cutaneous wounds. These factors have considerable therapeutic potential in the areas of soft tissue wound healing and otolaryngology. This article reviews important aspects of angiogenic growth factors and discusses their future potential in soft tissue wound healing.
Transmandibular Transpterygoid Approach to the Nasopharynx, Parapharyngeal Space, and Skull Base
Authors: Yumoto Eiji , Okamura Hiroshi , Yanagihara Naoaki
Published: October 2014

The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasms had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.
Presence of an 80 Kilodalton Protein, Cross-Reacted with Monoclonal Antibodies to Pulmonary Surfactant Protein A, in the Human Middle Ear
Authors: Kobayashi Kazutoyo , Ohtani Seiji , Yamanaka Noboru , Saito Tetsuya , Kataura Akikatsu , Akino Toyoaki
Published: October 2014

We report the presence of a middle ear protein that has the same epitope as human surfactant protein A. Monoclonal antibodies (PC-6 and PE-10) against human pulmonary surfactant protein A stained faint granules of the mucosal epithelial cell cytoplasm in the orifice of the eustachian tube immunohistochemically. These antibodies also reacted with middle ear effusion of patients with otitis media with effusion by dot immunoassay, and recognized an 80 kd protein by Western blot analysis. These findings indicate that a protein immunoreactive with PC-6 and PE-10 occurs in the mucosal epithelial cells of the middle ear, and is also present in middle ear effusion. It is therefore likely that this 80 kd protein might be secreted from the mucosal epithelial cells to the middle ear cavity.
Communication Status following Laryngectomy: The Iowa Experience 1984–1987
Authors: Morris Hughlett L. , Van Demark Duane R. , Smith Alice E. , Maves Michael D.
Published: October 2014

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75 % were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.
Choanal and Angiomatous Polyps of the Sinonasal Tract
Authors: Batsakis John G. , Sneige Nour
Published: October 2014

Choanal and angiomatous polyps can be distinguished from ordinary sinonasal polyps by either a distinctive clinical presentation (choanal) or the histopathologic appearance (angiomatous). Nearly all choanal polyps arise within paranasal sinuses, with the antrochoanal polyp the most common. The angiomatous polyp is most often a secondary change in a choanal polyp and can be mistaken for vascular neoplasms, eg, angiofibroma
Giant Air Cell of the Petrous Apex: A Possible Cause of Facial Hypalgesia
Authors: Sakai Makoto , Ogata Tetsuro , Sato Mutsumi , Kaga Tatsumi , Miyake Hirosato , Iida Masahiro , Watabe Tsuneya
Published: October 2014

A giant air cell of the left petrous apex was found in a 23-year-old man with ipsilateral facial hypalgesia. The size of the giant air cell depicted on computed tomography was 1.5 × 2.0 × 2.0 cm. A coronal T1-weighted magnetic resonance image showed that the trigeminal nerve was compressed superomedially by a large signal void area that was probably a result of excessive pneumatization of the petrous apex. It is suggested that the facial hypalgesia was caused by the compression by the giant air cell of the petrous apex on the trigeminal nerve.
Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma
Authors: Tos Mirko , Thomsen Jens , Youssef Mahmoud , Turgut Suat
Published: October 2014

Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.
Radiographic Analysis of Deep Cervical Abscesses
Authors: Welsh Louis W. , Welsh John J. , Gregor Frank A.
Published: October 2014

Correlation of the radiographic examination and the clinical evaluation of deep cervical abscesses contributes to the surgical program for exposure and drainage. The deep cervical spaces are analyzed with reference to local anatomy, sources of infection, potential for lateral and vertical extension, and identification of regional expansion by standard and computed tomography. Guidelines and recommendations are proposed for clinical application and supported by illustrative cases.
Aerobic Bacteriology of Chronic Suppurative Otitis Media without Cholesteatoma in Children
Authors: Fliss Dan M. , Meidan Naftali , Dagan Ron , Leiberman Alberto
Published: October 2014

Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious. We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables. Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15%. Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%). The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone. The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps. We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.
Facial Canal Dehiscence: Histologic Study and Computer Reconstruction
Authors: Takahashi Haruo , Sando Isamu
Published: October 2014

The incidence, location, shape, and dimensions of dehiscences in the facial canal to the middle ear space were studied in 160 temporal bones obtained from 129 individuals 24 gestational weeks to 109 years of age at death by means of light microscopy and our computer reconstruction and measurement method. Dehiscences were observed in 95 of the 129 individuals (74%) and in 119 of the 160 bones (74%). The incidence was found to be quite high among fetuses and newborns, lowest in individuals in their twenties and then again quite high in the geriatric population (χ2 test, χ2 = 5.45 and 4.41, p < .05). The most frequent site of dehiscence was the oval window area, particularly in its posterior half (57% of all ears) on the inferior to inferomedial aspects of the canal; these dehiscences were clearly demonstrated in reconstructed images. The incidence of dehiscence in the area of the cochleariform process was 16%, and all these dehiscences were on the lateral to superolateral aspect of the canal. The second genu area and the mastoid portion were sites of dehiscence in 21% and 18%, respectively, of specimens; more than half of the dehiscences in the second genu area and mastoid portion were on the lateral to anterolateral and posterior aspects of the facial canal, respectively. The shape of the dehiscence tended to be oval in the oval window area, but rather irregular in the other areas. The dehiscences ranged from 0.4 to 2.64 mm in length, from 0.12 to 1.59 mm in width, and from 0.03 to 1.87 mm2 in surface area. The proximity of these dehiscences to the field of otologic surgery is stressed.
Skull Base Dumbbell Tumor: Surgical Experience with Two Adolescents
Authors: Eavey Roland D. , Chapman Paul H. , Weber Alfred , Swearingen Brooke , Davis Kenneth R. , Janfaza Parviz , Liebsch Norbert , Ferguson William S.
Published: October 2014

Pediatric skull base tumors are rare and until recently were considered unresectable. We present two patients with tumors of similar anatomic position with an extracranial component in the infratemporal fossa and parapharyngeal space, an isthmus at the foramen ovale, and a superior component in the middle cranial fossa in the region of the cavernous sinus. A 15-year-old girl experienced contiguous spread of a spindle cell sarcoma; an 18-year-old boy developed a chondrosarcoma. A middle fossa approach provided the advantage of surgical avoidance of structures such as the middle ear and mastoid, facial nerve, and mandible. Postoperative recovery was rapid. Our impression is that preoperative carotid artery occlusion and a middle fossa approach for tumor resection can be performed in a young patient with acceptable morbidity and at least short-term benefit. Surgery can, therefore, provide an additional therapeutic approach to complement irradiation and chemotherapy.
Rat Model for a Vascularized Laryngeal Allograft
Authors: Strome Scott , Sloman-Moll Erik , Wu Justin , Samonte Bernadette R. , Strome Marshall
Published: October 2014

A new rat model was developed to reexamine the potential for laryngeal transplantation. The final anatomic derivation evolved from two earlier developmental phases. The first model had only a single arterial anastomosis; the second had an end-to-end arterial anastomosis with an end-to-end arteriovenous shunt. The final product employed an end-to-side arterial shunt and an end-to-side arteriovenous shunt for revascularization. The allografts were sited in tandem with the intact recipient larynges and were not innervated. A total of 16 animals were studied in phase 3; 2 died and the remaining 14 had a 64% arterial patency at intervals of 1 to 14 days. Our purpose is to detail the relevant technical considerations of this new model and compare it with historical controls.
Olfactory Evoked Potentials and Contingent Negative Variation Simultaneously Recorded for Diagnosis of Smell Disorders
Authors: Auffermann Heike , Mathe Frank , Gerull Günther , Mrowinski Dieter
Published: October 2014

Objective diagnosis of olfaction can be performed by registration of cortical olfactory evoked potentials (OEP) and of contingent negative variation (CNV). The CNV is a negative voltage developing at the vertex after discrimination of one of two smells while the patient is expecting a second stimulus. By an adequate procedure, including a long time window for averaging (2.56 seconds) with appropriate filters, the two tests can be performed simultaneously in a single session of less than 10 minutes. Anosmia is determinable by both OEP and CNV, although CNV shows less variability. On the other hand, CNV requires attention and some cooperation of the patient. Parosmia is accessible by CNV only; two odor qualities presented in random order have to be distinguished. Hyposmia can also be detected; just above the discrimination threshold, CNV amplitudes tend to be large — even enhanced — whereas OEP amplitudes may still be undetectable.
Evaluation of Brain Collateral Circulation by the Transcranial Color Doppler—Guided Matas' Test
Authors: Takeuchi Yousuke , Numata Tsutomu , Hino Takeshi , Konno Akiyoshi , Kaneko Toshio , Suzuki Haruhiko , Kobayashi Shigeki
Published: October 2014

For the determination of the indication for reconstruction of the carotid artery in patients with head and neck cancer, a color Doppler—guided Matas' test was performed to examine brain collateral circulation and blood flow of the middle cerebral artery (MCA) and internal carotid artery (ICA). Both SSA-270A convex (3.75 MHz) and linear (3.75 MHz and 2.5 MHz) array probes (Toshiba Co, Ltd) were used for this investigation. A temporary occlusion test (60 seconds) by digital pressure on the common carotid artery was performed on 30 patients with head and neck cancer. The results were classified into four groups according to the relative flow volume (percent blood flow volume before the test) of the MCA: group A, with a flow volume of 87% or more; group B, with a flow volume between 72% and 86%; group C, with a flow volume between 57% and 71%; and group D, with a flow volume of 56% or less. The relative flow volume of the MCA was correlated with the ICA stump pressure and single photon emission computed tomography during a balloon Matas' test (ICA occlusion). This test seems to be useful in predicting the risk of carotid resection without reconstruction and in determining the indication for reconstruction of the carotid artery.
Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis
Authors: Crumley Roger L.
Published: October 2014

A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.
Histamine Metabolism in Nasal Polyps
Authors: Abe Yoshiyuki , Matsunaga Toru , Ogino Satoshi , Irifune Morihiro , Imamura Ikuo , Harada Tamotsu , Fukui Hiroyuki
Published: October 2014

We attempted to determine the relationship of nasal polyps to histamine (HA) metabolism. Compared to that in allergy-related nasal polyps and infection-related nasal polyps, the level of HA in aspirin-induced asthma—related polyps was significantly lower. Large differences between the groups were not observed in HA-synthesizing enzyme activity, but degradative enzyme activity was much higher in aspirin-induced asthma—related polyps than in other types of nasal polyps tested. These findings suggest the possibility that the amount of HA in polyps associated with aspirin-induced asthma was less because of greatly enhanced degradation. We found, in addition, that in nasal tissues such as polyps, histamine- N-methyl transferase, rather than histaminase, was the principal degradative enzyme.
Thyroarytenoid Intramuscular Pressures
Authors: Cooper Donald S. , Pinczower Eric , Rice Dale H.
Published: October 2014

The aim of this research has been to investigate the measurement of laryngeal intramuscular fluid pressures as a technique for assessment of laryngeal muscle activity for diagnostic or experimental purposes. Simultaneous measurements of contractile force, intramuscular fluid pressure, and electromyographic signals were made under isometric conditions in the vocal fold muscles of anesthetized dogs during supramaximal stimulation of the recurrent laryngeal nerve. Covariation of force and pressure was studied in twitch and tetanic contractions, over a range of stimulation frequencies. Tetanic pressure rises were usually smaller than in human limb muscles, but were of sufficient magnitude that effects on blood flow and muscle metabolism are probable. Analysis of relations between pressure and force records demonstrated that intramuscular pressure variations correlated closely to isometric force in their time course. This finding suggests the potential significance of this measure as a relatively nonintrusive indicator of the level of force of muscles involved in laryngeal function, and as a physiological measure of importance.
Erythromycin in Acute Laryngitis in Adults
Authors: Schalén Lucyna , Kamme Carl , Eliasson Ingvar , Schalén Claes
Published: October 2014

Moraxella catarrhalis and Hemophilus influenzae are isolated from the nasopharynx in 50% to 55% and 8% to 15%, respectively, of cases of acute laryngitis in adults. This finding indicates that these organisms, M catarrhalis in particular, are in some way involved in the pathogenesis of the disorder. In the present double-blind, placebo-controlled trial, the effect of erythromycin ethylsuccinate (0.5 g twice a day for 5 days) on the elimination of nasopharyngeal pathogens and reduction of clinical signs of upper respiratory tract infection, as well as on subjective complaints, was evaluated in 106 adults with acute laryngitis. The bacterial isolation rates at presentation were M catarrhalis 50%, H influenzae 18%, and Streptococcus pneumoniae 4%. In the 99 patients who completed the study, the elimination of M catarrhalis after 1 week was better in the erythromycin group (25 of 30 cases) than in the placebo group (6 of 19 cases; p ≤ .00038). The elimination of H influenzae was unaffected by erythromycin. Otolaryngologic examination did not reveal any significant group differences regarding laryngitis, pharyngitis, or rhinitis. Voice quality was improved after 1 week, irrespective of treatment. However, as compared to the placebo group, the erythromycin group reported fewer voice complaints after 1 week and fewer coughing complaints after 2 weeks. As acute laryngitis in adults is self-limiting, and subjective symptoms are spontaneously reduced after 1 week in most cases, antibiotic treatment does not seem warranted as a general policy. However, erythromycin may be justified in patients who are professionally dependent on voice function.
Round Window Membrane in Serous and Purulent Otitis Media: Structural Study in the Rat
Authors: Johansson Ulf , Hellström Sten , Anniko Matti
Published: October 2014

The rat was used as an animal model to reveal structural alterations in the round window membrane (RWM) during serous otitis media (SOM) and purulent otitis media (POM) over a 6-week period. Comparison of POM animals and control animals showed that the RWM in the former became almost six times as thick as that in controls, whereas that of SOM animals was twice as thick. The structural changes in the RWM in POM animals were confined mainly to the epithelium facing the middle ear cavity and the subepithelial space, which was invaded by inflammatory cells and exhibited dilated vessels. The normal flat epithelium was transformed via cuboidal cells to a cylindric epithelium containing both ciliated and goblet cells. In SOM animals, light microscopy revealed only minor changes in the RWM structure. Ultrastructurally, however, the connective tissue layer exhibited dense aggregations of collagen, increased numbers of fibroblasts, and, in one case, elastic fibers. This last phenomenon was not observed in either POM ears or normal ears. The study showed that various inflammatory conditions of the middle ear, both noninfectious (SOM) and infectious (POM), can cause different structural alterations of the RWM. These structural changes may influence passage through the RWM differently.
Analysis of Prevalence of Human Papillomavirus in Laryngeal Carcinomas Study of 40 Cases Using Polymerase Chain Reaction and Consensus Primers
Authors: Brandwein Margaret S. , Uuovo Gerard J. , Biller Hugh
Published: October 2014

In this study we determined the frequency of association of human papillomavirus (HPV) and laryngeal carcinomas and investigated the possibility that HPV may be associated with larger or more aggressive tumors. Laryngeal squamous cell carcinomas from 40 patients who did not have preexisting papillomas by clinical history were retrieved from formalin-fixed, paraffin-embedded blocks and analyzed for HPV. Twenty-two cases were tumors of the true vocal folds, and 18 were supraglottic. Clinical follow-up was available for 25 patients. We used the polymerase chain reaction (PCR) with the “hot start” modification and consensus primers that can detect over 30 distinct HPV types. Three of the 40 patients (8%) had detectable HPV DNA. These 3 patients did not have unusual age demographics and were smokers. All but 1 of the 22 HPV-negative patients who were questioned were also smokers. We compared the outcomes for large (4 cm or greater) HPV-positive and -negative tumors. Six of the 40 tumors were 4 cm or greater and involved contiguous structures. Two of these 6 were HPV-positive, and these patients died of disease after 3 and 16 months, respectively. Of the 4 HPV-negative patients with tumors greater than 4 cm, 3 are disease-free at 41, 42, and 3 months, respectively, and 1 was lost to follow-up. The third HPV-positive patient had a tumor less than 1 cm, and is disease-free after 38 months. While the number of HPV-positive cases is too small for definitive conclusions, it is possible that for large tumors the presence of HPV DNA may portend a worse prognosis. However, in the population of patients with laryngeal carcinoma whom we have studied, we conclude that the L1 region of HPV DNA is rarely seen to be present in the tumors by “hot start” PCR, and hence HPV is probably not a common cancer promoter for laryngeal carcinoma.
Pathology Consultation Peripheral Epithelial Odontogenic Tumors
Authors: Batsakis John G. , Hicks M. John , Flaitz Catherine M.
Published: October 2014

Peripheral epithelial odontogenic tumors are the extraosseous equivalents of the much more often encountered central gnathic odontogenic tumors. The peripheral tumors arise in the mandibular or maxillary gingiva from the surface mucosa or dental lamina rests in the submucosa. Ameloblastoma is the most common histologic type. It, like all other peripheral epithelial odontogenic tumors, follows a benign, nonaggressive clinical course.
Silastic Medialization and Arytenoid Adduction: The Vanderbilt Experience
Authors: Netterville James L. , Stone R. E. , Civantos Francisco J. , Luken Elizabeth S. , Ossoff Robert H.
Published: October 2014

From April 1987 to April 1992, 116 phonosurgical procedures were performed to treat glottal incompetence. The initial numbers of these surgical procedures included the following: 29 primary Silastic medializations, 3 primary Silastic medializations with arytenoid adduction, 53 secondary Silastic medializations, 4 secondary Silastic medializations with arytenoid adduction, and 11 bilateral Silastic medializations. These procedures are useful in treating unilateral true vocal cord paralysis, scarring, bowing, or paresis, as well as bilateral true vocal cord bowing. Of the initial 100 patients, 16 later underwent a revision with either a larger implant's being placed or an arytenoid adduction. Primary Silastic medialization is the placement of an implant under general anesthesia in the same surgical setting in which laryngeal innervation is sacrificed. Secondary Silastic medialization is the placement of an implant under local anesthesia for a preexistent vocal cord malfunction. In either case, overall voice results for unilateral paralysis are very good. Primary Silastic medialization significantly decreases the postoperative rehabilitation period in skull base patients because of the immediate postoperative glottal competence and decreased use of perioperative tracheotomy. Bilateral implants yielded good results in 6 patients with presbylaryngis, but 6 other patients with bowing from other causes experienced only moderate improvement in speech quality. There were no implant extrusions; however, 1 implant was removed secondary to a persistent laryngocutaneous fistula in a patient who had previously undergone laryngeal irradiation. This was the only complication in this series.
Postural Control in Young and Elderly Adults When Stance is Challenged: Clinical versus Laboratory Measurements
Authors: Shepard Neil T. , Schultz Albert , Gu Mian Ju , Alexander Neil B. , Boismier Thomas
Published: October 2014

The use of dynamic posturography (EquiTest) for the characterization of postural control biomechanics would be aided by specific knowledge of what the measured data imply about body segment movements. To investigate this issue, the biomechanics of a group of 15 healthy elderly subjects were compared to those of healthy young subjects by using both dynamic posturography and a laboratory movement and force measuring system. The results from EquiTest were analyzed by 1) routine clinical interpretation of data and 2) a clinical research interpretation by subjecting the EquiTest parameters to additional statistical comparison of mean performance of the young and elderly groups. The young-elderly differences from the 2 EquiTest analyses were then compared to the young-elderly differences derived from the laboratory protocol. The routine clinical interpretation of EquiTest data identified the same increases in sway shown by the laboratory study, but did not reveal the more subtle differences indicated by the laboratory study. When the EquiTest data were subjected to additional statistical analysis, the characterization of difference between young and elderly subjects was the same as that of the laboratory study, with the exception of issues of head versus trunk movement, a measure not made by EquiTest. This essential similarity in the characterization of elderly compared to young subjects by both systems suggests 1) that EquiTest is able to detect subtle differences in biomechanics of postural control between young and elderly healthy adult groups and 2) that implied movements of center of gravity, trunk versus lower limbs, and strength of reaction measures are consistently detected by both EquiTest and the laboratory kinematics and dynamics measurement systems.