bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Otorrhea: Bacteriology of a Common Complication of Tympanostomy Tubes
Authors: Mandel Ellen M. , Casselbrant Margaretha L. , Kurs-Lasky Marcia
Published: October 2014

We prospectively followed 246 children with tympanostomy tubes and observed acute otorrhea through a functioning tube at least once in 50% of subjects. Pathogens typical of acute otitis media ( Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes) were found in 42% of all episodes; Pseudomonas aeruginosa or Staphylococcus aureus was found in 44% of all episodes. Pathogens of acute otitis media were found in 50.0% of subjects under 6 years old versus 4.4% of subjects 6 years or over at the first episode (p < .001). Pseudomonas aeruginosa was found more often in children 6 years or older (43.5% versus 20.5% at the first episode, p = .052). Pathogens typical of acute otitis media were less prevalent in the summer months (14.7% versus 52.2% for the first episode, p = .001), while P aeruginosa was more prevalent in summer (44.1% versus 16.4% for the first episode, p = .006). This suggests that while many younger children with acute otorrhea may respond to treatment with oral antimicrobials alone, outpatient therapy of older children may involve use of topical antipseudomonal agents that may be complicated by the question of the safety of such medications.
Severe Complications of the Anterior Cricoid Split Operation and Single-Stage Laryngotracheoplasty
Authors: Zeitouni Anthony G. , Manoukian John
Published: October 2014

The management of congenital and acquired subglottic stenosis has been considerably facilitated with the introduction of the anterior cricoid split operation and, more recently, the single-stage laryngotracheoplasty. These procedures are followed by a 1- to 2-week period of sedation, during which the patient is paralyzed and completely dependent on mechanical ventilation. Although these procedures have proven very successful at achieving decannulation, the postoperative period can be the source of significant complications. This is illustrated with 4 cases of severe postoperative complications. The possible pathophysiologic causes are discussed, and the literature concerning the postoperative complications of these procedures is reviewed. The avoidance of neuromuscular blockade must be weighed against the possible increased need for narcotics and increased risk of self-extubation. An intensive care unit setting proficient in the care of these patients is necessary for a successful outcome.
Middle Ear Deformity in Arthrogryposis Multiplex Congenita
Authors: Quinn S. James , Bleach Nigel R. , Richards Anthony E. S.
Published: October 2014

Arthrogryposis multiplex congenita (AMC) is a rare congenital syndrome consisting of two or more joint contractures in different parts of the body. Otolaryngological abnormalities have been previously described in a significant proportion of cases. However, to date, the only frequent otologic deformity recorded in the published literature has been low-set ears. We present a case with a combination of AMC and a bilateral conductive hearing loss due to an unusual middle ear deformity. To our knowledge, no such case has been previously reported.
Bacteriology of Chronic Suppurative Otitis Media
Authors: Erkan Mustafa , Sevük Erdoǧan , Aslan Tahsin , Güney Ercihan
Published: October 2014

Aspiration of exudate through an open perforation was performed in 183 patients with chronic otitis media. The pus was cultured aerobically and anaerobically. Aerobes only were isolated from 71 patients (39%); 20 patients (11%) had only anaerobes; and 91 patients (50%) had both aerobes and anaerobes. Only 1 specimen had no growth. There were 259 aerobic isolates. Pseudomonas aeruginosa was recovered from 68 patients. Other aerobes commonly recovered included Staphylococcus aureus and Klebsiella pneumoniae. There were 178 anaerobic isolates. Only anaerobic gram-positive cocci were isolated in 20 instances. Sixty-three Bacteroides isolates were recovered, including 12 Bacteroides fragilis group and 21 Bacteroides melaninogenicus.
Pharyngocutaneous Fistula after Total Laryngectomy: Incidence, Cause, and Treatment
Authors: Papazoglou George , Terzakis George , Doundoulakis George , Dokianakis George
Published: October 2014

Postoperative pharyngocutaneous fistula is a major complication of total laryngectomy that prolongs the short hospitalization of 2 to 3 weeks to many weeks or even months. It is a common complication that increases the morbidity and mortality of the procedure. In the Department of Otolaryngology of the Red Cross Hospital of Athens, 310 patients underwent total laryngectomy from January 1980 through December 1989. Twenty-eight patients developed a fistula (incidence 9%). The incidence, predisposing factors, and methods of treatment of this complication are analyzed and discussed.
Localizing Value of Optokinetic Afternystagmus
Authors: Hain Timothy C. , Mattox Douglas , Herdman Susan J. , Zee David S. , Holliday Michael , Byskosh Arkadiush T.
Published: October 2014

Previous reports have indicated that optokinetic afternystagmus (OKAN) becomes asymmetric after the occurrence of unilateral peripheral vestibular lesions, and suggested that OKAN may be used for localizing the side of the lesion. These studies did not take into account spontaneous nystagmus. We compared OKAN in 12 subjects with unilateral vestibular loss after resection of acoustic neuroma to OKAN in 30 normal subjects. After offsetting the data for spontaneous nystagmus, we calculated the initial amplitude, the time constant, and the slow-phase cumulative eye position (SCEP) parameters of OKAN. The directional asymmetry of parameters to rightward and leftward stimulation were also calculated. The mean SCEP, initial amplitude, and time constant parameters were reduced significantly in the patients, and each also showed a directional asymmetry, such that they were greater for stimulation toward the side of the lesion. The directional preponderance of the SCEP parameter had the highest sensitivity for the side of the lesion, being abnormally elevated in 58.3% of patients with unilateral loss. We conclude that OKAN might be useful in combination with other subtests of abattery, but that by itself OKAN is only moderately sensitive to unilateral peripheral vestibular loss.
Torn Earlobe: A New Approach to Management with a Review of 68 Cases
Authors: Reiter David , Alford Eugene L.
Published: October 2014

The torn earlobe is a common problem, yet no objective analysis of causation or management is found in the literature. We present a series of 68 patients with statistical data on earlobe characteristics and cleft-related historical factors. We describe three new methods of repair: two for full clefts and one for partial clefting (ie, elongation of the piercing site without penetration of the inferior rim). We report follow-up from 4 to 10 years, with a 91% success rate for lobe appearance and a 1.2% recurrence of clefting. We offer guidelines for repair and repiercing based on lobe thickness and shape. We make recommendations for earring use based on lobe characteristics and historical development of the defect.
Dynamic Properties of the Posterior Cricoarytenoid Muscle
Authors: Cooper Donald S. , Shindo Maisie , Hast Malcolm H. , Sinha Uttam , Rice Dale H.
Published: October 2014

The aim of this research was to investigate the contractile properties of the posterior cricoarytenoid (PCA) muscle. Simultaneous measurements were made of the isometric force, temperature, and electromyographic activity of the dorsal cricoarytenoid muscle of anesthetized dogs during supramaximal stimulation of the recurrent laryngeal nerve for twitch and tetanic contraction. The conduction delay between stimulation of the recurrent nerve at the level of the larynx and the onset of the muscle action potential averaged 2.0 ± 0.2 milliseconds (ms), and the latent period between the onset of electrical activity of the muscle and the onset of contraction had a mean duration of 3.3 ± 0.8 ms. The mean of isometric contraction times found was 33.3 ± 2.0 ms, shorter than most previous studies of canine PCA muscle. Tetanic frequency defined as smooth contraction was higher than previous estimates. Considerations of scaling of physiological time based on animal mass were applied to analysis of the experimental findings to make possible systematic comparison of previous findings across species and animal size.
Auditory Effect of Kanamycin Given to Newborn Guinea Pigs Whose Mothers Received Kanamycin during Pregnancy
Authors: Wang Zhi , Liou Li
Published: October 2014

Clinical and experimental data indicate that aminoglycoside ototoxicity occurs more frequently in individuals previously exposed to ototoxic drugs. This study investigated the auditory effect of repetitive administration of kanamycin on newborn guinea pigs that had previously been exposed, in utero, to kanamycin administered to their mothers. Sixteen pregnant guinea pigs in the late stages of gestation were divided into two groups, one receiving kanamycin 500 mg/kg per day intramuscularly for 8 days, and the other acting as a control. After birth, the mothers and their newborns in both groups were examined for auditory brain stem response (ABR) and then treated with kanamycin 500 mg/kg per day for 4 days. The results from the second examination demonstrated that the group receiving prior treatment with kanamycin, despite their good ABR responses during the first measurement, showed significantly elevated auditory thresholds compared to the control group. Therefore, any ototoxic drugs should be used with extreme caution in newborns having had prior exposure to the drugs in utero, even if they have a “normal” auditory response after birth.
Electronic Speckle Pattern Interferometry of the Vibrating Larynx
Authors: Gardner Glendon M. , Conerty Michelle , Castracane James , Parnes Steven M.
Published: October 2014

Laser holography is a technique that creates a three-dimensional image of a static object. This technique can be applied to the analysis of vibrating structures. Electronic speckle pattern interferometry uses a laser for illumination of the vibrating object and solid state detectors and digital hardware technology for capturing and processing the image in real time. This was performed on a human cadaver larynx and is the first time an interferogram of vibrating vocal cords has ever been obtained. Dark and bright interference fringes are seen that represent the vibratory motion of the vocal folds. These are presented in still photos as well as real-time on videotape. This method can provide advantages over current techniques of laryngeal study: it is sensitive to motion in the vertical dimension, and the digital data can be quantitatively analyzed. Application of this technique to study the larynx should eventually be a valuable clinical tool and provide quantitative research data.
Ear Surgery in Treacher Collins Syndrome
Authors: Marres Henri A. M. , Marres H. M. A. , Cremers W. R. J. , Huygen Patrick L. M.
Published: October 2014

The autosomal dominant hereditary Treacher Collins syndrome manifests itself phenotypically in dysmorphogenesis of particularly the first, but also the second branchial arch system. Consequently, 50% of patients with Treacher Collins syndrome have a congenital, generally pure conductive hearing loss resulting from a major or minor ear anomaly. The outcome of surgery to improve patients' hearing varies and is sometimes even disappointing. Thorough analysis of 33 cases (39 operated ears) and the strict application of a classification for the anomaly to each ear enabled us to gain insight into the most suitable surgical policy and to form a prognosis for reconstructive ear surgery.
Expression of Intercellular Adhesion Molecule-1 during Inner Ear Inflammation
Authors: Suzuki Masashi , Harris Jeffrey P.
Published: October 2014

This study was designed to investigate the expression of intercellular adhesion molecule-1 (ICAM-1) on the spiral modiolar vein (SMV) with its collecting venules (CVs) and the venules of the endolymphatic sac during inner ear inflammation. These data will further elucidate the role of adhesion molecules in extravasation of inflammatory cells from blood vessels during an inner ear immune response. Labyrinthitis was induced in rats by inoculation of keyhole limpet hemocyanin into the scala tympani of animals who had been systemically sensitized to it. Expression of ICAM-1 was examined with a mouse monoclonal antibody to rat ICAM-1 by immunohistochemistry. ICAM-1 was found weakly on the epithelium of SMVs and CVs as early as 6 hours postchallenge, reaching a maximum by day 2 and then fading away gradually. The maximum influx of immunocompetent cells into the cochlea was seen between days 3 and 7. Staining for ICAM-1 was observed on the epithelium of the endolymphatic sac and perisaccular region at 12 and 24 hours, respectively, and this was associated with infiltration of cells into these areas 3 days postchallenge. By day 28, the inner ear had developed endolymphatic hydrops, but at this time it showed almost no significant staining with anti-ICAM-1. The molecule was also expressed in the mesothelium of perilymph, the perineurium of cochlear nerves, the spiral ligament, and the basal cells of the stria vascularis following immunization. Our data provide evidence that endothelial cells of the SMV and its CVs, as well as other inner ear sites, have the potential to express ICAM-1. This expression precedes the influx of immune cells; therefore, it is possible that this ligand plays a pivotal role in the onset of inflammation in the inner ear. This study also confirmed that the immune response results in endolymphatic hydrops as a long-term consequence.
Glutathione in the Upper Respiratory Tract
Authors: Testa Benedetto , Mesolella Massimo , Costa Giuseppe , Testa Domenico , Maione Francesco , Giuliano Antonio , Iaccarino Fulvia
Published: October 2014

Glutathione (GSH), a major extracellular antioxidant, has been found in high concentrations in the epithelial lining fluid of the lower respiratory tract The GSH concentrations in nasal fluid, in normal and pathologic conditions, were investigated and found to be very low. A GSH aerosol (600 mg daily for 10 days) increased GSH levels in the nasal mucosa and induced a statistically significant improvement in nasal obstruction, rhinorrhea, and ear fullness. Thus, GSH administered by aerosol could be a means of defending the epithelial respiratory cells against a toxic oxidant.
Intervascular Smooth Muscle Fibers and Muscular Bolsters in Nasal Swell Bodies of Humans
Authors: Grevers Gerhard , Kamargakis Wasilios Nikolaos
Published: October 2014

There is strong clinical evidence that the cavernous tissue (swell bodies) of nasal mucosa plays an important role in congestion of the nose. Still, the complex mechanisms responsible for the unique behavior of these vessels have not yet been identified, and even the morphology of these structures is still a matter of controversy. The present study was performed on nasal mucosal specimens from inferior turbinates of humans by means of histology and transmission electron microscopy. Besides the evaluation of the vascular wall structure of the nasal swell bodies, special attention was given to two morphological peculiarities: intervascular smooth muscle fibers and muscular bolsters. Intervascular smooth muscle fibers are composed of bundles of smooth muscle cells varying in diameter between 14 and 35 μm; they are attached to the muscular coat of the vessels of the cavernous tissue. Muscular bolsters are distinct protrusions of the vascular wall in nasal swell bodies; they are found not only at the transition between different vessels, but also irregularly within the course of veins of the cavernous tissue. The authors report on their understanding of the functional significance of intervascular smooth muscle fibers and muscular bolsters within the cavernous tissue for swelling mechanisms in the nose and discuss their results in light of the literature.
Pituitary Gland Involvement of the Sinonasal Tract
Authors: Langford Lauren , Batsakis John G.
Published: October 2014

Involvement of the upper aerodigestive tract by a pituitary adenoma is due either to downward extension of an intracranial tumor or to a tumor arising from ectopic (Rathke's pouch) remnants. Sites of predilection for the ectopic adenoma are headed by the sphenoid bone and sinus, followed by the soft tissue of the dorsal pharynx and clivus. Both invasive sellar and ectopic adenomas can be destructive, with the extracranial extension of pituitary adenomas being more locally aggressive. There have been no examples of metastasizing ectopic pituitary tumors.
Langerhans' Cell Histiocytosis of the Head and Neck in Children
Authors: Angeli Simon I. , Hoffman Henry T. , Alcalde Juan , Smith Richard J. H.
Published: October 2014

This is a retrospective analysis of a 29-year institutional experience with Langerhans' cell histiocytosis (LCH) in children. Cases of LCH were categorized by disease extent into three groups: group 1, with a solitary focus of LCH; group 2, with multiple non-vital organ foci; and group 3, with vital organ disease. Sixteen patients averaging 7.3 years of age and with 11.0 years of follow-up presented in group 1. One child experienced a spontaneous remission; all other children responded to local treatment. The skull was the most common site of involvement. Eight children averaging 4.6 years in age and with 8.0 years of follow-up presented in group 2; 3 children had diabetes insipidus. Treatment included radical surgery, radiotherapy, and chemotherapy; however, disease persisted in all patients. Iatrogenic complications were a significant cause of morbidity and mortality. Only 1 patient, 1 year of age, presented with lung and liver involvement (group 3). He died after a fulminant course. Current recommendations for diagnosis, evaluation, and treatment of LCH are discussed.
Tracheoesophageal Puncture in Irradiated Patients
Authors: LaBruna Anthony , Huo Jerry , Klatsky Iris , Weiss Michael H.
Published: October 2014

Tracheoesophageal puncture (TEP) with use of a voice prosthesis is widely accepted as an excellent method of postlaryngectomy vocal rehabilitation. Many patients with advanced cancer require postoperative radiotherapy (RT), while other cancer patients have been treated with RT as a primary treatment and come to laryngectomy for salvage. The influence of RT on outcome of the TEP procedure with respect to successful speech and potential complications has not been widely discussed. We retrospectively reviewed 77 consecutive cases of TEP in patients who had received RT and laryngectomy for laryngeal cancer. All cases had a minimum of 6 months of follow-up. All 77 patients were successful in obtaining speech with the TEP, and 75 (97%) continued to be TEP users thereafter. Eight patients (10%) developed complications in the course of treatment. There was no mortality. In selected patients, TEP after RT is a relatively safe and effective method of vocal rehabilitation.
Trade-off between Airway Resistance and Optical Resolution in Pediatric Rigid Bronchoscopy
Authors: Marzo Sam J. , Hotaling Andrew J.
Published: October 2014

Contemporary pediatric rigid bronchoscopy reflects the culmination of years of work by prominent endoscopists aided by technical developments in optical physics and refinements in optical lens manufacturing. Improved neonatal and pediatric care has allowed survival of premature infants, many with bronchopulmonary diseases. Rigid bronchoscopy in these infants is demanding and has necessitated the development of miniaturized telescopic bronchoscopes. This study documents airway pressures through bronchoscopes with and without endoscopic telescopes, analyzes and quantitates optical resolution, discusses the trade-offs between these instruments in airway resistance and optical resolution, and makes recommendations regarding which combinations of endoscopes and bronchoscopes provide the best resistance and resolution profiles. We conclude that the size 1.9-mm endoscopic telescope provides the most favorable resistance and resolution profile for the size 2.5 to 3.0 bronchoscopes, the 2.8-mm telescope is ideal for the 3.5 bronchoscope, and the 4.0-mm telescope works best with the 4.0 and larger bronchoscopes. Furthermore, optical forceps and side-channel forceps used during bronchial foreign body removal cause little change in airway resistance.
Otoacoustic Emission Measurements in Evaluation of the Immediate Effect of Ventilation Tube Insertion in Children
Authors: Tilanus Stijn C. , van Stenis Desiree , Snik Ad F. M.
Published: October 2014

It is generally acknowledged that hearing assessment is needed before and after possible surgical intervention in children with otitis media with effusion. The conventional method in young children is visual reinforcement audiometry, which requires much time and cooperation from the child. The assessment of otoacoustic emissions may be an alternative, as it is proven to be rapid, easy, and objective as a screening procedure. We studied the applicability of click-evoked otoacoustic emissions to assess hearing acuity in children with otitis media with effusion who were scheduled for ventilation tube insertion. To avoid cooperation problems, the measurements were performed in the operating room immediately before and after ventilation tube insertion with the child under general anesthesia. None of the ears tested (n = 29) showed any increase in otoacoustic emissions when preoperative and postoperative levels were compared. At follow-up visits, however, 80% of the tested ears did. The acute outcome may be best explained by assuming that the surgical manipulations themselves were responsible, either through their fatiguing effects on the outer hair cells caused by the suctioning noise, or through their mechanical effects on the middle ear processes that govern reverse transmission from the cochlea to the outer ear canal. We conclude that it is not worthwhile to measure otoacoustic emissions directly after ventilation tube insertion to assess the effect on hearing acuity, although they may be valuable in the outpatient setting.
Effects of Compound Injection of Pyrola Rotundifolia L and Astragalus Membranaceus Bge on Experimental Guinea Pigs' Gentamicin Ototoxicity
Authors: Xuan Weijun , Dong Mingmin , Dong Minsheng
Published: October 2014

In attempting to find drugs effective in preventing and remedying ototoxic injury caused by aminoglycoside antibiotics, we relied on the theory that the induction of ototoxic injury by aminoglycoside antibiotics is related to a decrease of cyclic adenosine monophosphate and RNA content in the cochlea or a dysfunction of the kidney. We selected Pyrola rotundifolia L and Astragalus membranaceus Bge from traditional Chinese herbal medicine, made a compound injection of them, and observed the effect on the pattern of gentamicin ototoxicity in guinea pigs. By electrocochleography and morphology by scanning electron microscopy, the experimental results indicated that the Chinese herbal compound possessed the definite effect of protecting the guinea pig cochlea. The determination of blood urea nitrogen, urinary N-acetyl-d-aminoglucosidase, and urinary protein and observation of renal morphology showed that it also protected the kidney against nephrotoxic nephritis of gentamicin. The conjecture that protection of the kidney by the Chinese herbs may be one of the important factors in preventing ototoxicity supports some explanations of ototoxic mechanisms induced by aminoglycoside antibiotics.
Treatment of Vocal Fold Immobility by Glutaraldehyde—Cross-Linked Collagen Injection: Longc-Term Results
Authors: Remacle Marc , Dujardin Jean-Marc , Lawson Georges
Published: October 2014

Fifty-three cases of unilateral vocal fold immobility treated by glutaraldehyde—cross-linked (GAX) collagen over a 6-year period with a mean follow-up of 4.5 years were reviewed for assessment of the immediate and long-term effects on phonation. The mean amount injected was 1.47 mL. No long-term local or systemic reaction to the collagen was seen. The median preoperative maximum phonation time (MPT) was 7.5 seconds, the median immediate postoperative MPT 12 seconds, and the median long-term postoperative MPT 11 seconds. The median preoperative phonatory quotient (PQ) was 564 mL/s. The median immediate postoperative PQ was 320 mL/s, whereas the median long-term postoperative PQ was 385 mL/s. The quantitative improvement in the voice as measured by the PQ was thus 67% for the short range and 49% for the long range. The decline in the results over time was 20.3%. Vocal frequency analysis showed that the fundamental frequency and harmonics returned and were maintained in the long term for more than 80% of the patients with the help of speech therapy. This relative stability is explained by the findings of previous histological work. The fact that collagen, unlike Teflon, does not cause an inflammatory reaction and the partial maintenance of the improvement achieved, which is to be compared with the instability of the effects produced by resorbable substances, make it the “least objectionable” injectable for the treatment of unilateral glottic fold immobility. One must overcompensate 20% to 30%, given the results of the long-term stability studies.
Factors Influencing Regional Lymph Node Metastasis from Laryngeal Carcinoma
Authors: Kowalski Luiz P. , Franco Eduardo L. , de Andrade Sobrinho Jozias
Published: October 2014

A series of 103 cases of laryngeal carcinoma subjected either to a unilateral or to a bilateral comprehensive neck dissection was reviewed with reference to risk factors influencing regional lymph node metastasis. The sensitivity of clinical examination was only 67.4%, while the specificity was 88.3%. Most metastases were in the upper and middle jugular chain of nodes (levels 2 and 3). Only patients with positive nodes at levels 2, 3, and/or 4 had histologically positive nodes at levels 1 or 5. Selected demographic, clinical, and pathologic variables were analyzed with respect to their potential predictive value regarding the risk of histologically proven neck node metastasis. Logistic regression analysis demonstrated that tumor site and histologic grade were the most important predictors of lymph node metastasis. Considering only N0 cases, the likelihood of occult metastasis was significantly affected exclusively by tumor site (higher risk for supraglottic lesions).
Effect of Magnetic Resonance Imaging on Implantable Eyelid Weights
Authors: Marra Silvio , Konior Raymond J. , Leonetti John P. , Raslan Wasim
Published: October 2014

Implanted upper eyelid gold weights are used to prevent corneal injury in patients with facial nerve paralysis. Some of these individuals require postoperative radiographic surveillance for recurrent lateral skull base disease. Magnetic resonance imaging (MRI) provides the most accurate radiologic assessment; however, there is concern about the safety of performing MRI in patients with any metallic implant. Potential risks include local tissue heating and implant migration. Gold weights of 0.8 and 1.4 g were placed in an open chamber and were exposed to a magnetic field of 1.5 T. There was no measurable motion or displacement of the weights. The results were similar in 6 rats in which gold weights were subcutaneously implanted. Additionally, histologic examination of the implant sites revealed no adverse tissue effects attributable to MRI-generated heating of the implants. When carbon steel implants in the rat model were subjected to the magnetic field, there was no displacement of the implants and no adverse tissue effects were noted, despite the fact that a carbon steel implant in an open chamber demonstrated significant migration. The absence of motion of the gold weight implants combined with the lack of adverse tissue effects suggests the relative safety of performing MRI in patients with previously placed gold weights as upper eyelid implants.
Bone Resorption in Human Cholesteatoma: Morphological Study with Scanning Electron Microscopy
Authors: Uno Yoshihumi , Satto Ryusuke
Published: October 2014

The detailed mechanism of bone resorption in cholesteatoma was investigated by means of eroded ossicles obtained during middle ear surgery for cholesteatoma. In the light microscopic study, multinucleate osteoclasts with ruffled borders were found in contact with the eroded bone, which appeared to be osteoclastic lacunae. Scanning electron microscopy revealed the lacunae to be many absorption bays, 30 to 100 μm in diameter, clustered on the surface of eroded areas. Numerous cone-shaped stubs of digested collagen fiber bundles, consisting of scores of collagen fibrils and degenerated extracellular organic substances, were visible at higher magnification on the bottom of the absorption bay. The pattern of fusion and twining of the disarranged collagen fibrils at the top of the partly digested fiber bundles was clearly rendered by the alkali-water maceration method for scanning electron microscopy. We infer from the morphological evidence that osteoclastic resorption may be one of the major mechanisms of bone destruction in cholesteatoma, and that demineralization and degeneration of extracellular organic substances precede disruption of collagen fibrils at the front of bone resorption.
In Vivo Observation with Magnetic Resonance Imaging of Middle Ear Effusion in Response to Experimental Underpressures
Authors: Swarts J. Douglas , Alper Cuneyt M. , Chan Kenny H. , Seroky James T. , Doyle William J.
Published: October 2014

In this study, magnetic resonance imaging (MRI) was used to define, in vivo, the effect of acute middle ear (ME) underpressures on vascular permeability and the development of effusion. The MEs of four cynomolgus monkeys were unilaterally inflated with oxygen and carbon dioxide on different occasions and followed for a period of approximately 4 hours by tympanometry and MRI scanning. Carbon dioxide inflations caused the rapid development of ME underpressures of less than −600 mm H2O by 10 minutes. The MRI scans showed a progressive brightening of the ME and all associated air cells, indicative of the accumulation of effusion in three of the four experiments. An MRI contrast agent was administered to the vascular compartment during the course of the experiment and was rapidly transferred to the ME space, indicating vascular permeability to the agent. The contralateral, control side did not develop significant underpressures, effusion, or increased vascular permeability. Inflation with oxygen caused lesser underpressures and no accompanying changes in the MRI scans. These data support the hydrops ex vacuo theory and confirm the usefulness of MRI for in vivo documentation of the development of ME effusions and changes in vascular permeability of the mucosa in the experimental setting.
Histologic Investigation of the Macula Flava of the Human Newborn Vocal Fold
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

This investigation was carried out to determine the histologic structure of the maculae flavae of human newborn vocal folds. Light microscopic and transmission electron microscopic observations were made with excised human newborn larynges. The results are summarized as follows. 1) Immature maculae flavae were present at the anterior and posterior ends of the bilateral vocal folds. 2) They were round in shape and about 1 × 1 × 1 mm in size. 3) The maculae flavae were composed of fibroblasts, elastic and collagenous fibers, and ground substance. 4) The fibroblast density was great. 5) In newborn maculae flavae, fibroblasts actively started to form elastic and collagenous fibers. 6) The macula flava of the newborn appears to be an important structure in the growth and development of the vocal ligament.
Facial Nerve Paralysis Induced by Herpes Simplex Virus in Mice: An Animal Model of Acute and Transient Facial Paralysis
Authors: Sugita Toshiaki , Fujiwara Yasuo , Murakami Shingo , Hirata Yoshinari , Yanagihara Naoaki , Kurata Takeshi
Published: October 2014

We have been the first to succeed in producing an acute and transient facial paralysis simulating Bell's palsy, by inoculating herpes simplex virus into the auricles or tongues of mice. The KOS strain of the virus was injected into the auricle of 104 mice and the anterior two thirds of the tongue in 30 mice. Facial paralysis developed between 6 and 9 days after virus inoculation, continued for 3 to 7 days, and then recovered spontaneously. The animals were painlessly sacrificed between 6 and 20 days after inoculation for histopathologic and immunocytochemical study. Histopathologically, severe nerve swelling, inflammatory cell infiltration, and vacuolar degeneration were manifested in the affected facial nerve and nuclei. Herpes simplex virus antigens were also detected in the facial nerve, geniculate ganglion, and facial nerve nucleus. The pathophysiologic mechanisms of the facial paralysis are discussed in light of the histopathologic findings, in association with the causation of Bell's palsy.
Differential Diagnosis of Pulsatile Neck Masses by Doppler Color Flow Imaging
Authors: Takeuchi Yousuke , Numata Tsutomu , Konno Akiyoshi , Suzuki Haruhiko , Kaneko Toshio
Published: October 2014

A pulsatile neck mass (PNM) requires careful judgment in its evaluation, and it is difficult and inaccurate to diagnose a PNM only by physical examination, even though a thrill or bruit is present. Doppler color flow imaging (DCI) was performed as an initial evaluation in nine patients with PNMs. Intravenous digital subtraction angiography, intra-arterial angiography, X-ray computed tomography, and magnetic resonance imaging were performed in selected cases. The DCI revealed seven vascular masses (three tortuosities of the common carotid artery, two tortuosities of the brachiocephalic artery, one pseudoaneurysm, and one traumatic arteriovenous fistula) and two nonvascular masses (one neurofibroma and one metastatic lymph node). The clinical diagnoses of all the vascular masses were defined by DCI. In nonvascular masses, fine-needle aspiration biopsy could be performed relatively safely and accurately by monitoring the feeding artery or the common carotid artery by DCI. This method was quite useful for the initial evaluation in the differential diagnosis of PNMs.
Quantitative Bacteriology of Tonsils Removed from Children with Tonsillitis Hypertrophy and Recurrent Tonsillitis with and without Hypertrophy
Authors: Kuhn Jeffrey J. , Church L. W. Preston , Brook Itzhak , Bianchi David A. , Waters Catherine L. , Thompson David H.
Published: October 2014

The aerobic and anaerobic bacterial species and their numbers were studied in tonsillar specimens from children who had undergone elective tonsillectomy: 6 patients with recurrent tonsillitis (RT), 9 with recurrent tonsillitis with hypertrophy (RTH), and 8 with obstructive tonsillar hypertrophy (OTH). Mixed flora were present in all tonsils, yielding an average of 6.7 isolates (5.6 aerobic or facultative and 1.1 anaerobic bacteria). The highest recovery rate of organisms per tonsil was in patients with OTH (7.7 per tonsil), compared to 6.3 per tonsil in RT and 5.9 per tonsil in RTH. The predominant aerobic and facultative organisms were Haemophilus influenzae (22 isolates), Neisseria sp (16), Staphylococcus aureus (14), and Eikenella corrodens (14), and the predominant anaerobic bacteria were Fusobacterium sp (8), Bacteroides sp (7), and Prevotella melaninogenica (5). The number of bacteria per gram of tonsillar tissue varied between 104 and 108. A higher concentration of S aureus and H influenzae was found in hypertrophic tonsils (RTH and OTH) as compared to RT. These findings suggest the presence of an increased bacterial load and supports an etiologic role for H influenzae and S aureus in hypertrophic tonsils with and without inflammation (RTH and OTH). Further studies to elucidate the effect of selective antimicrobial therapy directed at these organisms may offer an alternative management of hypertrophic tonsils.
Cervical Lymph Node Status and Survival in Laryngeal Carcinoma: Prognostic Factors
Authors: Uhlman Dorothy , Adams George , Resnick Jeffrey M. , Niehans Gloria A. , Knapp Dennis , Gapany Markus , Jaszcz Waclaw
Published: October 2014

Elective cervical lymphadenectomy often is performed for laryngeal carcinoma to eliminate metastatic disease that escapes clinical and radiographic detection. We investigated characteristics of the primary tumor that might predict cervical lymph node status. We obtained archival tissue from 88 laryngectomies—65 with concurrent cervical lymphadenectomies. Of the 40 clinically negative necks that were dissected, 17% showed lymph node metastasis by pathologic examination. The primary tumors were examined immunohistochemically for expression of epidermal growth factor receptor (EGFR), p53, cathepsin D, proliferating cell nuclear antigen (PCNA), and Ki-67–specific antigen, and by flow cytometry for DNA ploidy—cell cycle analysis. Seventy-seven percent of the cases showed aberrant p53 staining, 99% expressed EGFR, 40% produced cathepsin D, 29% were aneuploid, and 54% had a moderate or high synthesis phase fraction (SPF). High grade, aneuploidy, and tumor vascular invasion independently predicted cervical node metastasis (p < .04 each). Supraglottic locale (p < .16) and a raggedly infiltrating invading margin (p < .13) were weakly associated with node positivity. Advanced clinical T status, the expression of EGFR, p53, and cathepsin D, the PCNA and Ki-67 indices, and SPF did not correlate with node metastasis. The presence of cervical node metastasis predicted poor disease-free (p < .005) and overall survival (p < .04). Advanced clinical T status correlated with brief overall survival (p < .02). Tumor site, histopathologic parameters, ploidy, SPF, PCNA and Ki-67 indices, and the expression of p53, EGFR, and cathepsin D did not affect survival. The presence of vascular invasion, high grade, and aneuploidy may help identify which patients would benefit from elective cervical lymphadenectomy. The correlation of cervical lymph node status and clinical T category with survival confirms the results of previous studies.
Jet Stylets as an Aid for Replacement of Tracheostomy Tubes
Authors: Hannallah Medhat , Ved Sudha , Brager Robert , Troost Thomas
Published: October 2014

Difficulty in tracheostomy tube replacement can be life-threatening in a patient who is dependent on the tracheostomy for ventilation. The use of jet stylets for tracheostomy tube replacement in these patients facilitates the tube exchange and allows for jet ventilation if any difficulty is encountered during the tube replacement. We describe two cases in which jet stylets proved to be helpful during tracheostomy tube replacement and discuss considerations that are important for the safe use of these devices.
Benign Lesions of the Vocal Folds: Histopathology and Phonotrauma
Authors: Dikkers Frederik G. , Nikkels Peter G. J.
Published: October 2014

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane—like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.
Angiogenesis as a Prognostic Marker in Early Head and Neck Cancer
Authors: Dray Todd G. , Hardin Nicholas J. , Sofferman Robert A.
Published: October 2014

Experimental evidence suggests that tumor growth beyond the earliest stages is dependent on angiogenesis, or neovascularization, and that angiogenesis may also promote metastasis. Recent clinical studies demonstrate that angiogenesis is a prognostic marker in breast, lung, and prostate cancer. To investigate whether tumor angiogenesis also correlates with metastasis and survival in early head and neck carcinoma, we quantified the microvascularity of 106 primary carcinomas prior to treatment and correlated the counts with eventual outcome after 3 to 15 years of follow-up. Microvessels were stained immunocytochemically for von Willebrand factor and then counted by light microscopy. Microvessels were counted per 200x and 400x fields, and their density was graded from 1 to 4, in the area of most intense neovascularization. We found that neither microvessel counts nor density grades correlated with metastatic disease, local recurrence, or survival in early head and neck carcinoma. These results are in contradistinction to those recently reported for other tumor sites.
Role of Capsaicin-Sensitive Trigeminal Nerves in Development of Hyperreactive Nasal Symptoms in Guinea Pig Model of Nasal Allergy
Authors: Konno Akiyoshi , Nagata Hiroshi , Motosugi Hideaki , Nomoto Minoru , Terada Nobuhisa
Published: October 2014

The effect of capsaicin pretreatment on frequency of sneezing, decrease of nasal patency, and increase of vascular dye leakage induced by antigen or histamine challenge on the guinea pig nasal mucosa was investigated. The animals were sensitized intraperitoneally with ovalbumin. Capsaicin pretreatment significantly inhibited sneezing induced by nasal challenge with histamine and antigen, indicating that capsaicin-sensitive sensory nerves constitute an afferent pathway of the sneezing reflex in nasal allergy. Although capsaicin pretreatment tended to inhibit the decrease of nasal patency and the increase of vascular dye leakage of the nasal mucosa induced by antigen challenge, this tendency was not statistically significant. The present study indicated that the participation of a local reflex via capsaicin-sensitive trigeminal nerves in nasal vascular responses observed after antigen challenge in the guinea pig model of nasal allergy is rather small compared to the large direct vascular effects of chemical mediators released from basophilic cells in the nasal mucosa.
Hyoepiglottic Ligament in Supraglottic Cancer
Authors: Zeitels Steven M. , Kirchner John A.
Published: October 2014

The hyoepiglottic ligament (HL) is a connective tissue structure that serves as the roof of both the paraglottic and the preepiglottic spaces and thereby anatomically separates the supraglottic larynx from the tongue base. Whole mount serially sectioned larynges with supraglottic cancer were reviewed to help clarify cephalad spread of cancer in this region. The whole mount slides were analyzed from 70 laryngectomy specimens that were resected for supraglottic cancer. The HL was breached by cancer in 13 specimens, and all of these displayed clinical and histopathologic invasion of the preepiglottic and paraglottic spaces. Invasion of the suprahyoid epiglottis was noted in 9 specimens, and invasion of the aryepiglottic fold in 4. There were no instances in which cancer escaped from the deep compartments of the supraglottic larynx to the tongue base without synchronous erosion of the suprahyoid epiglottis (insertion of the medial HL) or the pharyngoepiglottic fold (lateral HL). The HL is a resilient connective tissue barrier to the spread of cancer from the supraglottis to the tongue base. This investigation reinforced the concept that, typically, the HL acts as a deep cephalad surgical boundary in resecting supraglottic cancer that 1) is confined to the laryngeal membranes and 2) does not clinically invade the suprahyoid epiglottis.
Airway Measurement Using Morphometric Analysis
Authors: Santos Mary C. , Strande Louise , Doolin Edward J.
Published: October 2014

Measurement of airway size using endoscopic morphometry was investigated. Endoscopic images of the porcine tracheobronchial tree were obtained via a Storz system at a known distance from the telescope. The bronchi were marked with transluminal wires, transected, and imaged. All images were analyzed morphometrically with a computer image at multiple sites (N = 20). The endoscopic measurements were plotted against the macro lens images so that a straight line with a slope of 1 would indicate a consistent correlation. Area measurements for all images had a slope of 0.67 (r = .885); however, for images with area < 80 mm2 the slope was 1 (r = .928) and for images with area > 80 mm2 the slope was −0.63 (r = .757). Minor axis measurements had a slope for all images of 0.71 (r = .879), for images with area < 80 mm2 of 0.93 (r = .875), and for images with area > 80 mm2 of −0.34 (r = .482), and major axis had a slope for all images of 0.73 (r = .904), for images with area < 80 mm2 of 0.88 (r = .923), and for images with area > 80 mm2 of−0.59 (r = .771). Accurate area measurements as well as major and minor axis measurements can be obtained for airways with area < 80 mm2 by means of this system. Each bronchoscope-telescope unit has an optimal target size for which measurements are accurate.
Otorhinolaryngological Complications of Progressive Facial Hemiatrophy (Romberg's Disease)
Authors: Matthias Christoph , Terstegge Klaus , Siemes Hartmut
Published: October 2014

Progressive facial hemiatrophy (PFH) is characterized by slowly progressive atrophy of subcutaneous tissue. Bone, muscles, nerves, the eye, and the brain may be affected by atrophy. Four patients suffering from various otorhinolaryngological complications of PFH or Romberg's disease are reported. Unilateral hearing loss could be located in the inner ear of one patient by audiologic examination. Localized bone destruction and disintegration of a portion of the anterior wall of the frontal sinus were observed in a patient after more than three decades. Marked shrinking of the homolateral parotid gland and homolateral masticatory spasm are reported as further otorhinolaryngological manifestations. The various complications of PFH call for close interdisciplinary cooperation.
Developmental Lesions of the Head and Neck: Terminology and Biologic Behavior
Authors: Ferlito Alfio , Devaney Kenneth O.
Published: October 2014

As much confusion has been generated in the literature by the inaccurate or improper use of terms describing developmental lesions such as hamartoma, choristoma, and teratoma, a number of different benign and malignant developmental lesions are described and distinguished in the hope that these lesions can be more reliably identified and consequently also more adequately managed.
Resurfacing of a Large Laryngeal Wound with Mucosa Grafting: A Combined Technique Using Endoscopic Suture and Laser Soldering
Authors: Shapshay Stanley M. , Wang Zhi , Perrault Donald F. , Volk Mark , Pankratov Michail M.
Published: October 2014

Resurfacing of a large laryngeal wound has traditionally been accomplished via an open approach—transplanting free mucosa either onto the wound directly or upon a stent. This study proposes a new approach for wound resurfacing that combines endoscopic suturing with a laser welding technique. By means of a carbon dioxide (CO2) laser, a large (20 × 25 mm) defect in laryngeal mucosa involving the glottic and subglottic area was created in five dogs. Two of the animals served as controls and received no further treatment. In the remaining three animals the wound was resurfaced with buccal mucosal grafts fixed in place by standard suture placement and a technique of CO2 laser-assisted tissue soldering. The accessible edges of the graft were soldered endoscopically with human albumin-based tissue adhesive “activated” by low power (0.8 to 1.0 W) of a CO2 laser. All animals were examined endoscopically 1 week after surgery and sacrificed painlessly 4 weeks after surgery. The treated animals showed a viable mucosal graft with improved wound healing and voice function compared to that of the control animals. This new approach combines suture fixation of the inferior aspect of the mucosal graft, an area not well exposed endoscopically, and endoscopic laser soldering techniques for the repair of large laryngeal wounds.