bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Carotid Body Tumors: Report of Three Cases
Authors: Pacheco-Ojeda Luis
Published: October 2014

The aim of the current report was to describe 3 cases of malignant carotid body tumor (CBT) and to review the literature. My clinical records of 87 CBTs in 81 patients (6 bilateral) were reviewed, 79 of which were operated on. Three malignant cases were found. The first was in a 40-year-old man who presented with pulmonary metastases 6 years after resection of a CBT. He was treated with chemotherapy and interferon, but died with disseminated disease 2 years later. The second case was in a 56-year-old woman who had a 5-cm, fixed, hard mass in the upper aspect of the neck and a paralysis of the left vocal cord. This lesion was completely resected, and a shunt and reconstruction with a saphenous vein graft were performed. Pathology revealed a malignant chemodectoma with invasion to 2 of the 5 lymph nodes removed. Radiotherapy (50 Gy) was given after the operation. She is well and free of disease 68 months after the resection. The third case was in a 61-year-old woman who presented with an 8-cm nontender, hard, immobile mass in the left upper neck that displaced the left wall of the oropharynx toward the midline. A carotid arteriogram showed a CBT. On computed tomography, the tumor extended to the infratemporal fossa with no bone involvement. The lesion was embolized with a 40% reduction in vascularity. At surgical exploration, the tumor involved the sternocleidomastoid muscle and the lymph nodes at levels II and III, and the internal carotid artery could not be dissected free at the skull base, so only a partial resection was performed. This patient was lost to follow-up. These 3 cases are in agreement with the literature. Locoregional control is usually obtained with complete primary tumor resection and lymphadenectomy and eventual radiotherapy. Surgery with radiotherapy seems to be effective for isolated metastases. Current multidisciplinary treatments have been unsuccessful in controlling disseminated disease.
Endobronchial Tumors in Children: An Uncommon Clinical Entity
Authors: Scott Kirby J. , Darrow David , Greinwald John H. , Smith Richard J. H.
Published: October 2014

We performed a retrospective chart review of 10 children in whom endobronchial tumors were diagnosed in a tertiary-care children's medical center from 1988 to 1998. Of the 10 patients, 6 were male and 4 were female (8 white, 1 Hispanic, 1 African American). The mean age at presentation was 5.2 years. Eight tumors were benign, and 2 were malignant; 4 were on the right side, 3 were on the left side, and 3 were bilateral. Histologic findings included 3 bronchial papillomas, 3 inflammatory masses, 1 endobronchial hemangioma, 1 leiomyoma, 1 mucoepidermoid carcinoma, and 1 bronchial carcinoid. Endobronchial tumors in children are a rare disorder. The diagnosis requires a high index of suspicion in children with atypical or chronic respiratory complaints. Newer adjuvant medical therapies and surgical innovations offer improved disease control in these patients, and a multidisciplinary approach is often warranted.
Microbiology of Serous Otitis Media in Children: Correlation with Age and Length of Effusion
Authors: Brook Itzhak , Yocum Paula , Feldman Bruce , Shah Kiran , Epstein Stephen
Published: October 2014

The purpose of this study was to correlate the microbiology of serous otitis media in children with the duration of the condition and the patient's age. Aspirates of serous ear fluids from 114 children were examined for aerobic and anaerobic bacteria. Bacterial growth was noted in 47 patients (41%). Aerobic organisms only were recovered in 27 aspirates (57% of the culture-positive aspirates); anaerobic bacteria only in 7 (15%); and mixed aerobic and anaerobic bacteria in 13 (28%). A total of 83 bacterial isolates were recovered, accounting for 1.8 isolates per specimen (1.2 aerobes and 0.6 anaerobe). There were a total of 57 aerobic isolates, including Haemophilus influenzae (15 isolates), Streptococcus pneumoniae (13), and Staphylococcus sp (12). Twenty-six anaerobes were recovered, including anaerobic gram-positive cocci (10), Prevotella spp (8), and Propionibacterium acnes (4). The rate of positive cultures (20 of 36; 56%) was higher in patients younger than 2 years of age than in those older than 2 years of age (27 of 78; 35%). Streptococcus pneumoniae and H influenzae were more often isolated in children younger than 2 years of age and those with effusion for 3 to 5 months, whereas anaerobes were recovered more often in those older than 2 years of age and those with effusion for 6 to 13 months. These data illustrate the effects of the length of effusion and age on the recovery of aerobic and anaerobic bacteria in serous otitis media.
Vestibular Findings in Professional Divers
Authors: Sharoni Zohara , Shupak Avi , Nachum Zohar , Spitzer Orna , Gadoth Natan
Published: October 2014

The purpose of the present study was to investigate possible inner ear changes related to professional diving, by the documentation of auditory and vestibular function in 13 asymptomatic professional divers and 12 nondiver controls. A higher average pure tone hearing threshold, although of no clinical significance, was found in the study group (8.53 ± 4.85 versus 6.67 + 3.54 dB hearing level, p =.04). In the vestibular evaluation, the smooth harmonic acceleration test phase leads for 0.01,0.02. and 0.04 Hz were significantly lower in the divers (0.01 Hz, 38.46° ± 7.15° versus 45.83° ± 9.02°, p = .02; 0.02 Hz, 21.08° ±5.19° versus 25.17° ± 5.78°, p = .05; 0.04 Hz, 12.38° + 3.69° versus 14.25° ± 3.14°, p =.05). We suggest that the lower smooth harmonic acceleration phase values found in the professional divers, reflecting longer vestibulo-ocular reflex primary time constants and enhancement of the velocity storage mechanism, are the result of a habituation process that augments the low-frequency response of the canal-ocular system.
Correlation between Microbiology and Previous Sinus Surgery in Patients with Chronic Maxillary Sinusitis
Authors: Brook Itzhak , Frazier Edith H.
Published: October 2014

Aspirates of 108 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. There were 295 bacterial isolates: 109 aerobic and facultative, and 186 anaerobic. The predominant aerobic isolates were Staphylococcus aureus (17 isolates), α-hemolytic streptococci (14), Pseudomonas aeruginosa (12), Moraxella catarrhalis (10), and Haemophilus spp (8). The predominant anaerobes were Peptostreptococcus spp (61), Prevotella spp (45), Fusobacterium spp (15), and Propionibacterium acnes (14). Analysis of the medical histories revealed a correlation only between the microbial results and previous sinus surgery. Pseudomonas aeruginosa and gram-negative aerobic bacilli (GNAB) were more often isolated in patients who had surgery (9 of 33 patients had P aeruginosa and 17 had GNAB) than in patients who did not have surgery (3 of 75 had P aeruginosa and 7 had GNAB; p <.001). Anaerobes were isolated more often in patients who did not have surgery (69 of 75 patients) than in those who had previous surgery (21 of 33 patients; p <.001). These findings illustrate the unique microbiological features of chronic maxillary sinusitis that persist after sinus surgery.
Thyroarytenoid Muscle: Functional Subunits Based on Morphology and Muscle Fiber Typing in Cats
Authors: Imamura Rui , Yoshida Yoshikazu , Fukunaga Hiroyuki , Nakashima Tadashi , Hirano Minoru
Published: October 2014

Using parvalbumin immunohistochemistry to determine the distribution of muscle fiber types in the feline thyroarytenoid muscle (TA), we clearly distinguished the vocalis (with predominance of “slow” type 1 fibers) from the external TA (in which “fast” type 2 fibers predominated, especially in its rostral part). Reconstruction of serial frontal sections of the TA allowed the stereoscopic study of each division. The existence of a rudimentary laryngeal ventricle separating the true and false vocal folds in cats was demonstrated anatomically and histologically, and its relationships to each division of the TA were established. Our results suggest that the vocalis, fitted for enduring activities, is suited for voice control. The fast, rostral part of the external TA seems suited to laryngeal sphincteric demands, while its caudal counterpart may act in both functions. The anatomic individualization of the divisions of the TA may suggest that they play distinct physiological roles and may imply that they should not be considered a single functional unit.
Role of Laryngoscopy, Dual pH Probe Monitoring, and Laryngeal Mucosal Biopsy in the Diagnosis of Pharyngoesophageal Reflux
Authors: McMurray J. Scott , Gerber Mark , Rudolph Colin , Stern Yoram , Willging J. Paul , Walner David , Cotton Robin T.
Published: October 2014

There is no standard for determining significant pharyngoesophageal reflux. This prospective blind comparison study compared dual pH probe studies, direct laryngoscopy, and mucosal biopsy in children without symptoms of gastroesophageal reflux who underwent airway evaluation. Significant reflux to the lower esophageal probe did not correlate with statistical significance with reflux to the upper probe. In this group of asymptomatic patients, a positive lower pH probe finding did not correlate with upper or lower esophageal mucosal inflammation. Eosinophilia in the esophageal mucosa is diagnostic of gastroesophageal reflux disease, and was seen in 5 of the laryngeal biopsies. A weak correlation was seen between positive findings at laryngoscopy and positive posterior cricoid biopsy in this group. There may be no consistent way to predict significant pharyngoesophageal reflux in asymptomatic patients. Single-probe pH testing will not predict significant pharyngoesophageal reflux with mucosal changes. Laryngoscopy and upper pH probe findings only weakly correlate with significant histologic findings. Laryngeal and posterior cricoid biopsy may be the only sensitive test for mucosal injury. Clinical trials of empiric antireflux therapy should be used to determine whether the laryngeal changes seen in these patients are reversible.
Assessment of Vestibular Schwannoma Growth: Application of a New Measuring Protocol to the Results of a Longitudinal Study
Authors: Stipkovits Ernestine M. , Graamans Kees , Van Dijk Johannes E. , Vasbinder G. Boudewijn C. , Beek Frederik J. A.
Published: October 2014

This study pertains to a group of 44 patients with unilateral vestibular schwannoma who did not undergo surgery. Prospectively, the dimensions of the tumor were depicted at regular intervals by means of magnetic resonance imaging and then judged independently by an otolaryngologist and a neuroradiologist. Retrospectively, the size of the tumor was quantified by measuring the maximum surface of the lesion in the axial plane. The retrospective surface measurements confirmed the assessments made in the prospective part of the study: growth in 18% of the patients and shrinkage in 7%; 75% remained unchanged. This approach is a pragmatic means to determine whether the size of a tumor has changed over the course of time.
Transnasal Treatment of Congenital Choanal Atresia with the KTP Laser
Authors: Pototschnig Claus , Appenroth Elisabeth , Völklein Claudia , Thumfart Walter F.
Published: October 2014

This retrospective analysis presents a minimally invasive method for a transnasal approach to treat bilateral and unilateral choanal atresia and stenosis in infants and children. We describe an advanced surgical technique that applies the use of a KTP laser and give recommendations for preoperative diagnosis and postoperative assessment. We report 13 cases of bilateral and unilateral choanal atresia or stenosis treated over a 3½-year period. We used a transnasal approach and endoscopic control. For bilateral choanal atresia, the operation was performed within the first few days of birth. For unilateral choanal atresia or stenosis, surgery was performed several weeks after birth. In all cases, an intranasal stent was inserted. Our findings demonstrate that this transnasal approach provides significant benefits. A primary advantage is the diminished risk of intraoperative or postoperative complications. Additional benefits include lower rates of re-obstruction and a decreased incidence of subsequent disease, including chronic secretory otitis media.
Epidermal Inclusion Cyst versus Thyroglossal Duct Cyst: Sistrunk or Not?
Authors: Sullivan Daniel P. , Liberatore Lisa A. , Sassoon Jodi , April Max M. , Ward Robert F.
Published: October 2014

Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Controversy exists as to the proper surgical management of an anterior neck EIC: is simple excision adequate treatment, or is a Sistrunk procedure necessary? A retrospective review of the operative logs of the two senior authors (M.M.A., R.F.W.) from 1993 to the present revealed 16 children, ages 6 months to 9 years (mean, 4.5 years), with a diagnosis of anterior neck EIC. An accurate intraoperative diagnosis of an EIC in all cases allowed for a simple excision of the mass rather than a Sistrunk procedure. The final histologic diagnosis was EIC in all 16 patients. Follow-up of these 16 patients for a mean of 4.5 years revealed no recurrences or complications. When the diagnosis of EIC can be made confidently in the operating room, simple excision is an adequate surgical treatment.
Bilateral Chylothorax following Neck Dissection: A New Method of Treatment
Authors: Al-Sebeih Khalid , Sadeghi Nader , Al-Dhahri Saleh
Published: October 2014

Chylothorax is a serious condition with a high rate of morbidity that may lead to death. Although it is encountered more frequently with certain thoracic procedures, it is considered to be a rare complication of neck dissection. Different forms of management have been postulated; however, no consensus of treatment has been achieved. A case of severe bilateral chylothorax that developed after bilateral neck dissection in a patient with laryngeal carcinoma is presented. Somatostatin injection was successful after total parenteral nutrition failed to control the chylothorax. On the basis of this case and the review of the literature discussed here, we advocate the use of somatostatin with other conservative measures in the management of chylothorax.
Perilymphatic Fistula and Meniere's Disease
Authors: Fitzgerald Dennis C.
Published: October 2014

There continues to be considerable confusion concerning the diagnosis and treatment of perilymphatic fistulas (PLFs) and Meniere's disease. This paper reports an 8-year experience with patients whose symptoms were compatible with Meniere's disease but who had some other element that raised the possibility of their having a PLF. This review is a retrospective report on 64 patients who had fluctuating hearing loss, vertigo, tinnitus, and aural fullness typical of Meniere's disease. However, they also had a positive fistula test and/or symptoms beginning immediately after head trauma. They all underwent at least a unilateral PLF repair, and some also underwent an endolymphatic sac–mastoid shunt operation. This report provides a literature review to help put this series' results into perspective. Of those 40 patients who underwent an initial PLF repair, 58% had a successful outcome. Of the 10 patients who underwent an initial PLF repair plus an endolymphatic sac–mastoid shunt, 70% had a successful outcome. Since it is often difficult to distinguish patients with PLFs and secondary endolymphatic hydrops (Meniere's syndrome) from patients with Meniere's disease (idiopathic endolymphatic hydrops), PLF repair is a reasonable first operation, reserving an endolymphatic sac–mastoid shunt operation as a secondary procedure if needed. The decision to consider a PLF repair is guided by a positive fistula test or an immediate onset of Meniere's disease symptom complex after head or ear trauma.
Immunopathologic Study of Chronic Sinusitis: A Proposal for Atopic and Non-Atopic IgE-Activated Mast Cell Allergic Inflammation
Authors: Loesel Lawrence S.
Published: October 2014

Paranasal sinus mucosa was examined in this study for mast cell membrane–bound IgE. The study material was from 54 patients identified in hospital records as having one of the following diagnoses: chronic sinusitis, chronic sinusitis with asthma, or chronic sinusitis with associated nasal polyps. Formalin-fixed tissue samples taken during endoscopic sinus surgery were routinely processed and examined with hematoxylin and eosin stains. Additional sectioned tissue was analyzed by fluorescence microscopy for mast cells after the use of anti-IgE and anti-tryptase antisera; 45% of the cases of chronic sinusitis, 50% of the cases of chronic sinusitis with polyposis, and 69% of the cases of chronic sinusitis with asthma exhibited 10 or more IgE-positive mast cells in the sinus mucosa. Significant numbers of individuals with chronic sinusitis have coexistent allergic disorders. Some individuals in this study who were not allergic by hospital record review also manifested IgE-positive mast cells in the sinus mucosa; a basis for this finding is proposed.
Ludwig's Angina: Report of a Case and Review of Management Issues
Authors: Barakate Michael S. , Hemli Jonathan M. , Jensen Michael J. , Graham Antony R.
Published: October 2014

Ludwig's angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection. We present a case of Ludwig's angina together with a brief review of the relevant literature.
Characterization of the Medial Surface of the Vocal Folds
Authors: Berry David A. , Montequin Douglas W. , Clark Martyn J. O. , Titze Ingo R.
Published: October 2014

A method is developed for the quantification of the medial surface of the vocal folds in excised larynges. Lead molds were constructed from the glottal airway of a canine larynx for 3 distinct glottal configurations corresponding to “pressed” folds, just barely adducted folds, and 1-mm-abducted folds as measured between the vocal processes. With a high-resolution laser striping system, the 3-dimensional molds were digitally scanned. Low-order polynomials were fitted to the data, and goodness-of-fit statistics were reported. For all glottal configurations, a linear variation (flat surface) approximated the data with a coefficient of determination of 90%. This coefficient increased to roughly 95% when a quadratic variation (curvature) was included along the vertical dimension. If more than the top 5 mm or so of the folds was included (the portion usually corresponding to vibration), a cubic variation along the vertical dimension was necessary to explain a change in concavity at the conus elasticus. These findings suggest the utility of a model based on a convergence coefficient and a bulging coefficient. For all glottal configurations, the convergence coefficients and bulging coefficients can be computed. Because pre-phonatory conditions have a profound influence on vocal fold vibration and on the quality of phonation, such shaping parameters are highly significant. With the viability of this method substantiated, it is envisioned that future studies will characterize greater quantities of glottal shapes, including those of human vocal folds.
Mass Loading on the Ossicles and Middle Ear Function
Authors: Gan Rong Z. , Wood Mark W. , Dyer Robert K. , Dormer Kenneth J.
Published: October 2014

The middle ear as a levered vibrating system for sound transmission from the external to the inner ear is affected by changes in ossicular chain mass. Mass loading of the ossicles may impair ossicular dynamics and sound transmission to the inner ear. It is incumbent on otologic surgeons and researchers of middle ear mechanics to consider the mass loading effect on middle ear function in clinical and physiological applications. The residual hearing and frequency response can change after surgery or implantation of middle ear prostheses. We conducted experiments on mass loading effects on the middle ear transfer functions by using laser Doppler interferometry and a human temporal bone model. Two implant mass loading conditions were tested on 17 fresh or fresh-frozen temporal bones and compared with the unloaded condition for the frequencies 250 to 8,000 Hz. The results show that the linearity of the middle ear function did not change, although displacement of the stapes footplate decreased after the increased masses were placed on the incudostapedial joint. The greater the mass of the implant, the less displacement was measured at the stapes footplate. We conclude that there is a quantitative limit to increased mass on the ossicular chain above which the mass will remarkably impair hearing thresholds.
Unique Presentation of a Bronchial Foreign Body in an Asymptomatic Child
Authors: Freiman Michael A. , McMurray J. Scott
Published: October 2014

A child who aspirates a foreign body may present in many ways. We present the case of an 8-year-old boy whose initial presentation consisted only of his preoccupation with his lost toy and his gesturing toward his oral cavity. There was no witnessed coughing or choking episode, and there were no initial physical examination findings of note, and no abnormalities on appropriate radiographic studies. The patient was transferred to our institution for further evaluation and management. Our careful examination revealed a slight wheeze at the left upper lobe. Endoscopy was immediately performed, and bronchoscopy revealed a yellow, tubular, plastic foreign body in the left main bronchus through which the patient was breathing freely. This was removed without incident by means of optical graspers. The physical characteristics of this foreign body, including its small size, relatively inert material, and large lumen, allowed this patient to present relatively asymptomatically. This case demonstrates the need for a high index of suspicion in the evaluation and management of foreign bodies in the aerodigestive tract.
Anterior Window Laryngoplasty: A New Anatomic Approach for Posterior Glottic and Subglottic Stenosis
Authors: Valdez Tulio A. , Schumann Roman , Wang Zhi , Shapshay Stanley M.
Published: October 2014

This study explores the feasibility of an anterior thyroid window as a new approach for posterior glottic stenosis. An anterior window was made on the thyroid cartilage of human cadaver larynges, with its superior edge below the level of the vocal cords and an inferior pedicle composed of the inferior border of the thyroid cartilage attached to the cricothyroid membrane, which was left intact. By obtaining direct exposure of the posterior glottis and cricoarytenoid joints, mucosal graft suturing and exploration of the joints were easily achieved with an operating microscope. This study demonstrates the anatomic feasibility of an anterior window laryngoplasty as an alternative approach to treating posterior glottic stenosis while preserving the cartilage framework and avoiding the anterior commissure. This technique may improve endolaryngeal manipulation by providing a closer and more direct exposure than do endoscopic techniques, and by having fewer possible complications than traditional open techniques.
Effects of Length and Depth of Vibration of the Vocal Folds on the Relationship between Transglottal Pressure and Fundamental Frequency of Phonation in Canine Larynges
Authors: Kataoka Kenichi , Kitajima Kazutomo
Published: October 2014

The relationship between fundamental frequency of phonation (Fo) and the change in Fo per unit change of transglottal pressure (dF/dP) was investigated in 3 excised canine larynges. The effects of the length and depth of vocal fold vibration on the relationship between dF/dP and Fo were evaluated. A positive correlation between dF/dP and Fo was observed when an increase in Fo was accompanied by a decrease in the depth of vibration while the length of vibration reached a plateau. Although a negative correlation between dF/dP and Fo was observed in only 1 case, this relationship seemed relevant to the length of vibration. These results help to clarify the adjustments of length and depth of vibration involved in regulating Fo.
Role of Interleukin-1β in a Murine Model of Otitis Media with Effusion
Authors: Watanabe Tetsuo , Hirano Takashi , Kurono Yuichi , Suzuki Masashi , Mogi Goro
Published: October 2014

To clarify the role of interleukin-lβ (IL-lβ) in the pathogenesis of otitis media with effusion (OME), we developed and investigated a murine model of this disease. Specific pathogen—free male BALB/c mice received intratympanic injections of 20 μg of endotoxin derived from nontypeable Haemophilus influenzae. Three days after injection, middle ear effusions were observed through the eardrum. Similar pathological changes were observed after inoculation with 100 ng of recombinant IL-lβ. Anti—IL-1 receptor antibodies inhibited the pathological changes induced by the endotoxin. In situ hybridization showed expression of IL-lβ messenger RNA in the epithelium of the middle ear mucosa. These results suggest that IL-lβ might be associated with endotoxin-induced inflammation in the middle ear and might play an important role in the induction of otitis media with effusion.
Bell's Palsy: Electrodiagnostics are Not Indicative of Cerebrospinal Fluid Abnormalities
Authors: Birkmann Christiane , Halber Marco , Bamborschke Stephan , Haupt Walter F.
Published: October 2014

Electrodiagnostic testing (electromyography, electroneuronography, and blink reflex) and cerebrospinal fluid (CSF) examination (cell count, immunoglobulins, and antigen-specific intrathecal immunoglobulin G synthesis against herpes simplex virus, varicella zoster virus, cytomegalovirus, and Borrelia burgdorferi sensu latu) were performed in 56 patients with Bell's palsy. The CSF was normal in 45 patients and abnormal in 11 patients. Acute borreliosis was the most common specific pathological CSF finding (4 of 11). Electromyography revealed abolished volitional activity in 22% of patients with normal CSF and in 36% with pathological CSF. Electroneuronographic tests with an amplitude decrease of more than 90% on the affected side or abolished responses were found in 20% of patients with normal CSF and in 18% with pathological CSF. Abolished orbicularis oculi reflexes were seen in 67% of patients with normal CSF and in 82% with pathological CSF. Concerning electrodiagnostic testing, no statistically significant difference between patients with normal and abnormal CSF was found, so we conclude that electrodiagnostic testing has no indicative value for abnormal CSF in Bell's palsy.
Tracheoesophageal Puncture in the Office Setting with Local Anesthesia
Authors: Desyatnikova Stella , Caro James J. , Cohen James I. , Andersen Peter E. , Wax Mark K.
Published: October 2014

Tracheoesophageal puncture (TEP) with voice prosthesis placement is currently the method of choice for vocal rehabilitation of patients who have undergone total laryngectomy. Occasionally, secondary TEP needs to be performed. We have used a TEP technique that is performed in the clinic setting with local anesthesia and no sedation. The purpose of this study was to review our technique and experience and to evaluate results, complications, and patients' acceptance of the procedure. We performed a retrospective chart review of the records of 14 patients who had undergone total laryngectomy and secondary TEP placement in the clinic setting. The procedure was well tolerated. The voice results were fair to good in 11 of 12 patients. There was 1 complication, a false passage between the trachea and the esophagus. Voicing was immediate in 12 of the 14 cases. We conclude that TEP can be performed in the office setting with local anesthesia. The voice results are excellent, and the procedure is well tolerated by the patient. Proper patient selection and regular follow-up by a speech-language pathologist are important.
Airflow Resistance of Airflow-Regulating Devices Described by Independent Coefficients
Authors: Verkerke Gijsbertus Jacob , Geertsema Albert Anne , Schutte Harm Kornelis
Published: October 2014

Rehabilitation after laryngectomy includes more and more the use of airflow-regulating devices such as shunt valves (SVs), tracheostoma valves (TSVs), and heat and moisture exchange (HME) filters. In determining the quality of those devices, airflow resistance is a very important factor. It is currently defined as pressure drop divided by airflow. However, for most applications, this definition does not result in a pressure- and airflow-independent parameter. Therefore, a new set of parameters is defined and applied to pressure-airflow curves of airflow-regulating devices. Pressure drop over TSVs and HME filters appears to have a squared relationship with flow. In SVs, it has a linear relationship. The new set of parameters describes the pressure-airflow relationship properly for all considered devices. In conclusion, theoretical predictions of flow mechanics appear to be valid for SVs, TSVs, and HME filters. Only 2 coefficients are necessary to describe the pressure-flow characteristics of these airflow-regulating devices, independent of pressure drop over and flow through the device.
Penicillin Treatment Failure in Group A Streptococcal Tonsillopharyngitis: No Genetic Difference Found between Strains Isolated from Failures and Nonfailures
Authors: Orrling Arne , Melhus Åsa , Karlsson Eva , Stjernquist-Desatnik Anna
Published: October 2014

Despite penicillin (pcV) treatment, tonsillopharyngitis caused by group A streptococci (GAS) is associated with bacterial failure rates as high as 25%. The reason for this rate of failure is not fully understood. One explanation might be that certain DNA profiles of GAS strains are responsible for treatment failures. Using arbitrarily primed polymerase chain reaction (AP-PCR), we compared the DNA profiles of GAS strains from 4 patients with several treatment failures following pcV treatment of tonsillopharyngitis with the profiles of strains of the same T type from patients who were clinically and bacteriologically cured after a single course of pcV. The isolates were obtained during the same time period and from the same geographic area. Thirty-seven strains of T types 4, 12, and R28 were investigated. Eleven different DNA profiles could be detected with the AP-PCR technique. Five DNA profiles were identified as T type 12, 3 as T type 4, and 3 as T type R28. The DNA profiles of the strains from the 4 patients with several treatment failures differed, but all isolates from each one of these patients exhibited the same or a very similar profile. The DNA profiles of the failure strains were also represented in nonfailure strains. Treatment failure in these 4 patients therefore seems to be due to insufficient eradication of GAS, rather than to reinfection with a new strain. The finding that the same DNA profile can be present in both failure and nonfailure strains suggests that the treatment failure may be to some extent host-related and not only due to bacterial factors.
Motion-Specific Laryngeal Reinnervation Using Muscle-Nerve-Muscle Neurotization
Authors: Hogikyan Norman D. , Urbanchek Melanie , Johns Michael M. , Carroll William R. , Kileny Paul R. , Kuzon William M.
Published: October 2014

There is no current treatment method that can reliably restore physiologic movement to a paralyzed vocal fold. The purposes of this study were to test the hypotheses that 1) muscle-nerve-muscle (M-N-M) neurotization can be induced in feline laryngeal muscles and 2) M-N-M neurotization can restore movement to a paralyzed vocal fold. Muscle-nerve-muscle neurotization can be defined as the reinnervation of a denervated muscle via axons that are induced to sprout from nerves within an innervated muscle and that then traverse a nerve graft interposed between it and the target denervated muscle. a paralyzed laryngeal muscle could be reinnervated by axons from its contralateral paired muscle, thus achieving motion-specific reinnervation. Eighteen adult cats were divided into sham, hemilaryngeal-denervated, and M-N-M—reinnervated thyroarytenoid muscle groups. Five of the 6 reinnervated animals had histologic evidence of axons in the nerve graft, 4 of the 6 had evoked electromyographic evidence of crossed reinnervation, and 1 of the 6 had a return of appropriately phased adduction. This technique has great potential and should be further investigated.
Regression of Laryngeal Dysplasia after Serial Microflap Excision
Authors: Schweinfurth John M. , Powitzky Eric , Ossoff Robert H.
Published: October 2014

There is no consensus on the ideal management of premalignant lesions of the larynx. Published reports describe the use of mucosal stripping, microsurgical techniques, CO2 laser excision and ablation, and even conservation laryngeal surgery and radiotherapy. We performed a retrospective evaluation of 43 men and 11 women who underwent serial excision of dysplastic lesions with the microflap technique between 1990 and 2001. The average age of the patients was 57.2 years; 64% had a history of cigarette smoking, and 46% a history of alcohol consumption. The lesions were located on the middle part of the left vocal fold in 65% and on the mid-portion of the right vocal fold in 66%. The patients were followed for an average of 4.4 years. Of the 20 patients with severe dysplasia or carcinoma in situ treated with the microflap technique, only 1 progressed to invasive disease. Overall, there was a reduction in the severity of dysplasia after each procedure (p = .0008). The microflap technique reliably reduced the severity of dysplastic lesions of the vocal fold and was effective in local disease control.
Histopathology of Cochlear Implants in Humans
Authors: Nadol Joseph B. , Burgess Barbara J. , Gantz Bruce J. , Coker Newton J. , Ketten Darlene R. , Kos Isabel , Roland J. Thomas , Shiao Jiun Yih , Eddington Donald K. , Montandon Pierre , Shallop Jon K.
Published: October 2014

The insertion of an intrascalar electrode array during cochlear implantation causes immediate damage to the inner ear and may result in delayed onset of additional damage that may interfere with neuronal stimulation. To date, there have been reports on fewer than 50 temporal bone specimens from patients who had undergone implantation during life. The majority of these were single-channel implants, whereas the majority of implants inserted today are multichannel systems. This report presents the histopathologic findings in temporal bones from 8 individuals who in life had undergone multichannel cochlear implantation, with particular attention to the type and location of trauma and to long-term changes within the cochlea. The effect of these changes on spiral ganglion cell counts and the correlation between speech comprehension and spiral ganglion cell counts were calculated. In 4 of the 8 cases, the opposite, unimplanted ear was available for comparison. In 3 of the 4 cases, there was no significant difference between the spiral ganglion cell counts on the implanted and unimplanted sides. In addition, in this series of 8 cases, there was an apparent negative correlation between residual spiral ganglion cell count and hearing performance during life as measured by single-syllable word recognition. This finding suggests that abnormalities in the central auditory pathways are at least as important as spiral ganglion cell loss in limiting the performance of implant users.
Effect of Inhibitor of Tumor Necrosis Factor-Alpha on Experimental Otitis Media with Effusion
Authors: Jeun Eun-Ju , Park Yong-Soo , Yeo Sang W. , Choi Young-Chul , Jung Timothy T. K.
Published: October 2014

Tumor necrosis factor (TNF)-α is important in the pathogenesis of otitis media with effusion (OME). The purpose of this study was to determine the effect of TNF-α antagonist on the outcome of lipopolysaccharide (LPS)-induced OME in rats. Otitis media was induced by injecting Pseudomonas aeruginosa LPS transtympanically. Another (combination) group was pretreated with TNF-α antagonist, soluble TNF receptor type I (sTNF RI), before transtympanic injection of LPS. Saline and phosphate-buffered saline solutions were used as controls. Twelve hours after the transtympanic injection, otoscopic examination and aspiration of middle ear effusion (MEE) were done. The temporal bones in each group were examined histopathologically, and the vascular permeability of the middle ear mucosa was measured by the Evans blue vital dye technique. In the LPS and combination groups, MEE developed in 90% and 0% of ears, respectively. The combination group showed less inflammation, less mucosal thickening, and significantly decreased vascular permeability as compared to the LPS group. Transtympanic administration of sTNF RI appears to suppress the development of LPS-induced OME. This study suggests that TNF-α antagonist, along with antibiotics, may have an adjunctive role in the future treatment of MEE.
Phonatory Mechanisms after Vertical Partial Laryngectomy with Glottic Reconstruction by False Vocal Fold Flap
Authors: Biacabe Bernard , Crevier-Buchman Lise , Laccourreye Ollivier , Hans Stéphane , Brasnu Daniel
Published: October 2014

A prospective randomized study was designed to compare phonatory mechanisms in patients treated with frontolateral partial laryngectomy (FLPL) with or without glottic reconstruction with false vocal fold (FVF) mucosal flap. Objective voice assessment was based on computerized acoustic recordings and videolaryngostroboscopy performed before, 1 year after, and 2 years after surgery. Phonatory mechanisms were studied according to the surgical technique and correlated with acoustic recordings. The results showed that supraglottic structures participated in laryngeal closure and voice production in 80% of cases in which a standard FLPL was performed. The FVF mucosal flap was involved in both laryngeal closure and voice production in 54% of patients treated with glottic reconstruction. The type of laryngeal closure (glottic or supraglottic) statistically influenced the acoustic measurements. As glottic closure is more frequent in patients treated with glottic reconstruction, the authors recommend performing reconstruction of the glottis with an FVF mucosal flap when an FLPL is indicated.
Heat Radiation during Caloric Vestibular Test: Thermographic Demonstration in Temporal Bone Experiments
Authors: Pau Hans W. , Just Thilo , Sievert Uwe , Wild Walter
Published: October 2014

Since Bárány's descriptions in 1906, cold and warm irrigations of the external ear canal have been used for unilaterally testing vestibular excitability. The fluid kinetics within the endolymph have been studied thoroughly, whereas relatively few published articles deal with the mechanisms of heat transfer from the external to the internal ear. Even though heat conduction via the bone seemed to be well established in the textbooks, Feldmann and co-workers found heat radiation to be a very important factor. Using a rather uncommon method, we tried to make this heat radiation more apparent: in temporal bone experiments, temperature distribution was followed by thermography. Temporal bone specimens were prepared in such a way that heat distributions became visible after experimental caloric irrigations of the external ear canal. Temperature changes could well be verified by changes in coloration of the 2-dimensional thermograms. Conclusions were drawn from registrations performed in 2 projections, 90° to each other, allowing cautious statements about 3-dimensional distribution. The velocity of heat transfer at the very onset of the reaction can only be explained by radiation, whereas later, other mechanisms, such as conduction via the bone or convection via the middle ear gas, may have some influence. Our results support Feldmann's findings and underline the significance of radiation in the heat transfer mechanism.
Botulinum Toxin Type a Induces Apoptosis in Nasal Glands of Guinea Pigs
Authors: Rohrbach Saskia , Olthoff Arno , Giefer Birgit , Laskawi Rainer , Götz Werner
Published: October 2014

Nasal hypersecretion is predominantly caused by overaction of nasal glands, which are mainly under cholinergic control. In this work, we investigated the influence of botulinum toxin A (BTA) on the nasal mucosal tissue of the maxillary sinus turbinates of guinea pigs (n = 10) that were painlessly sacrificed 10 days (short-term group) or 3 months (long-term group) after local treatment with 20 units of BTA (Botox) or 0.2 mL of 0.9% sodium chloride (control). Histologic investigation of the nasal mucosal tissue of the BTA-treated animals (short-term group) showed degeneration of glands and ducts and apoptotic nuclei on TUNEL staining of these structures. The control animals revealed normal glandular tissue and no apoptosis. The animals of the long-term group showed almost normal glandular tissue and only a few apoptotic nuclei. In conclusion, BTA induces temporary apoptosis in the nasal glandular compartment of guinea pigs.
Safety and Efficacy of Transcervical Resection of Parapharyngeal Space Neoplasms
Authors: Malone James P. , Agrawal Amit , Schuller David E.
Published: October 2014

There are several surgical approaches for resection of parapharyngeal space (PPS) neoplasms. The purpose of this study was to evaluate local disease control, facial nerve injury, and need for mandibulotomy associated with resection of PPS neoplasms via the transcervical approach with submandibular gland excision. A retrospective chart review of 33 patients who underwent resection of a PPS neoplasm between October 1991 and July 2000 was performed. Of the 33 patients, 3 patients developed local recurrence after a median follow-up of 24 months. None of the patients experienced facial nerve paresis or paralysis. Three patients (9.1%) required a mandibulotomy for further exposure. This study demonstrated that the transcervical approach with submandibular gland excision for resection of PPS neoplasms provides excellent local disease control with minimal risk of facial nerve injury or need for mandibulotomy and/or tracheotomy.
Surgery for Pediatric Subglottic Stenosis: Disease-Specific Outcomes
Authors: Hartley Benjamin E. J. , Willging J. Paul , Hartnick Christopher J. , Lacy Peter D. , Myer Charles M. , Liu James , Cotton Robin T.
Published: October 2014

To set the foundation to develop a disease-based, operation-specific model to predict the outcome of pediatric airway reconstruction surgery, we performed a retrospective database review of children operated on at a single, tertiary-care children's hospital. Over the 12-year period 1988 to 2000, a total of 1,296 airway reconstruction procedures were performed. Out of these, charts were identified for 199 children who underwent laryngotracheal reconstruction for a sole diagnosis of subglottic stenosis. Children were excluded from the study if their disorder included supraglottic, glottic, or upper tracheal disease. The main outcome measures were Myer-Cotton grade-specific decannulation and extubation rates, including both operation-specific and overall results. There were 101 children who underwent double-stage laryngotracheal reconstruction. The operation-specific decannulation rates for Myer-Cotton grades 2, 3, and 4 were 85% (18/21), 37% (23/61), and 50% (7/14) (χ2 analysis, p =.0007). The overall decannulation rates were 95% (20/21), 74% (45/61), and 86% (12/14) (χ2 analysis, p =.04). There were 98 children who underwent single-stage laryngotracheal reconstruction. The operation-specific extubation rates for Myer-Cotton grades 2, 3, and 4 were 82% (37/45), 79% (34/43), and 67% (2/3) (χ2 analysis, p =.63). The overall extubation rates were 100% (45/45), 86% (37/43), and 100% (3/3) (χ2 analysis, p =.03). Logistic regression analysis showed no effect of age (less than or greater than 2 years of age) on operation-specific or overall outcome parameters. We conclude that laryngotracheal reconstruction for pediatric subglottic stenosis remains a challenging set of procedures in which multiple operations may be required to achieve eventual extubation or decannulation. Children with Myer-Cotton grade 3 or 4 disease continue to represent a significant challenge, and refinements of techniques are being examined to address this subset of children. Disease-based, operation-specific outcome statistics are the first step in the development of a meaningful predictive model.
Matrix Metalloproteinase-1 and Tissue Inhibitor of Metalloproteinase-1 Gene Expressions and Their Differential Regulation by Proinflammatory Cytokines and Prostaglandin in Nasal Polyp Fibroblasts
Authors: Hong Chi-Yuan , Hsiao Tzu-Yu , Liu Chia-Ming , Shun Chia-Tung , Wang Chih-Chiang , Wang Juo-Song , Lin Sze-Kwan
Published: October 2014

Chronic inflammation of the paranasal sinus leads to nasal polyp (NP) formation. In this study, we investigated the effect of stimulation of the proinflammatory cytokines interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α) and prostaglandin (PG) E2 on the production of messenger RNA (mRNA) of matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in nasal polyp fibroblasts (NPFs) and nasal mucosa fibroblasts (NFs). The mRNAs of IL-1α, TNF-α, MMP-1, and TIMP-1 in 40 surgical specimens of NPs were studied by in situ hybridization to corroborate the in vitro findings. The results indicated a significant amount of constitutive MMP-1 mRNA in NPFs and cytokine-induced MMP-1 steady-state mRNAs in NFs. The effect of stimulation of cytokines on TIMP-1 mRNA synthesis was unremarkable in NPFs and NFs. Exogenous PGE2 enhanced cytokine-stimulated MMP-1 mRNA synthesis in NPFs. In situ hybridization revealed that cells expressing MMP-1 and TIMP-1 mRNAs (primarily plasma cells, fibroblasts, and endothelial cells) gathered around areas with loose stroma, suggestive of rapid extracellular matrix degradation. These data suggest that the pathogenesis of nasal polyposis could be related to production of MMP-1 and consequent promotion of matrix collagenolysis.
Nontraumatic Atlantoaxial Rotary Subluxation in the Pediatric Otolaryngology Patient
Authors: Holcomb J. David , Jaffe Debra M. , Bauman Nancy M. , Greinwald John H. , Smith Richard J. H.
Published: October 2014

Nontraumatic atlantoaxial rotary subluxation (NAARS) is a relatively uncommon entity, with inconsistent presentations. It most commonly follows infectious processes or operative procedures. We present our experience with 4 pediatric otolaryngology patients with NAARS who were treated at the University of Iowa Hospitals and Clinics during a 2-year period beginning in 1997. A review of the symptoms, physical findings, and radiographic abnormalities is presented. Treatment options, varying from muscle relaxants to surgical fusion, are discussed. A high index of suspicion in evaluating children with a stiff neck or pain on attempted motion is essential in order to facilitate prompt diagnosis and appropriate intervention.
Treatment of Postparotidectomy Salivary Fistula with Botulinum Toxin
Authors: Guntinas-Lichius Orlando , Sittel Christian
Published: October 2014

We report on the successful treatment with botulinum toxin type A local injections of a salivary fistula that occurred after superficial parotidectomy. In a 58-year-old woman, transcutaneous discharge of saliva in the preauricular region had persisted in spite of 2 surgical revisions. Moreover, facial weakness and synkinesis had developed as a result of an iatrogenic lesion that had occurred at the time of primary surgery and required immediate reanastomosis of the main nerve trunk. Botulinum toxin A was injected into the deep lobe of the remaining parotid gland under ultrasonographic guidance. Additionally, botulinum toxin A was injected into the left orbicularis oculi muscle in order to improve the synkinesis. No adverse effects were observed. The sialorrhea was stopped for 11 months, and the synkinesis of the facial muscles was reduced significantly for 4 months. We conclude that botulinum toxin A injection is a successful alternative for the treatment of chronic salivary fistula.