bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Infliximab on Experimentally Induced Otitis Media in Rats
Authors: Lee Dong-Hee , Yeo Sang-Won , Chang Ki-Hong , Park So-Young , Oh Jeong-Hoon , Seo Jae-Hyun
Published: October 2014

Objectives:

We performed a prospective randomized and controlled animal study to investigate the effects of infliximab on experimental otitis media in rats.

Methods:

Seventy-two Sprague-Dawley rats were randomly allocated to 3 study groups and 1 control group. Infliximab was injected intravenously. Histopathologic changes were determined by hematoxylin-eosin staining. Fluorescence microscopy was performed to examine the leakage of the exudates. Vascular permeability was measured by the Evans blue dye technique.

Results:

In comparison with the control group, we found significant differences in the extent of middle ear mucosa without active inflammation and the presence of reparable lesions in all study groups treated with infliximab. A significant reduction of extravasated Evans blue dye in all study group animals was found as compared with the control group animals.

Conclusions:

This study suggests that the monoclonal tumor necrosis factor α antibody, infliximab, can reduce inflammatory activity in experimental otitis media in rats.
Hearing Impairment in Genotyped Wolfram Syndrome Patients
Authors: Plantinga Rutger F. , Pennings Ronald J. E. , Huygen Patrick L. M. , Bruno Rocco , Eller Philipp , Barrett Timothy G. , Vialettes Bernard , Paquis-Fluklinger Veronique , Lombardo Fortunato , Cremers W. R. J.
Published: October 2014

Objectives:

Wolfram syndrome is a progressive neurodegenerative syndrome characterized by the features “DIDMOAD” (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness). We sought to study the audiometric data of genotyped Wolfram syndrome patients with sensorineural hearing impairment.

Methods:

Pure tone threshold data of 23 Wolfram syndrome patients were used for cross-sectional analysis in subgroups (age less than 16 years or between 19 and 25 years, gender, and origin).

Results:

All subgroups, with 1 exception, showed a fairly similar type of hearing impairment with, on average, thresholds of about 25 dB (range, 0 to 65 dB) at 0.25 to 1 kHz, gently sloping downward to about 60 dB (range, 25 to 95 dB) at 8 kHz. The subgroup of Dutch women, which was excluded from the calculations of the average hearing thresholds, showed a higher degree of hearing impairment. Only the latter subgroup showed progression; however, contrary to the previous longitudinal analysis, progression was not significant in the present cross-sectional analysis, presumably because of the high degree of cross-subject variability.

Conclusions:

This unique collection of audiometric data from genotyped Wolfram syndrome patients shows no substantial progression in sensorineural hearing impairment with advancing age, no relation to the types of WFS1 mutations identified, and, with exclusion of the subgroup of Dutch female patients, no significant sex-related differences.
Two Sites of Head and Neck Squamous Cell Carcinoma: Utility of Loss of Heterozygosity
Authors: Sharma Arun , Wayne Sigrid , Nikiforova Marina N. , Johnson Jonas T. , Walvekar Rohan R.
Published: October 2014

Objectives:

The prevalence of distant metastasis and second primary tumors is increasing with improved locoregional control in patients with head and neck squamous cell carcinoma. Traditionally, clinicopathologic evidence has been the gold standard used to distinguish distant metastasis from second primary tumors. We report a case in which loss of heterozygosity testing was used to clarify the clonal relationship between the 2 sites of head and neck squamous cell carcinoma.

Methods:

A patient with squamous cell carcinoma in the larynx and mandible underwent loss of heterozygosity testing.

Results:

The loss of heterozygosity testing confirmed that the mandibular cancer was a metastatic presentation of the laryngeal squamous cell carcinoma.

Conclusions:

We conclude that loss of heterozygosity testing can be useful in differentiating distant metastasis from second primary cancers in patients with 2 sites of head and neck squamous cell carcinoma, consequently providing important prognostic and staging information.
Preoperative Laryngeal Nerve Screening for Revision Anterior Cervical Spine Procedures
Authors: Paniello Randal C. , Martin-Bredahl Katherine J. , Henkener Lori J. , Riew K. Daniel
Published: October 2014

Objectives:

Anterior cervical spine procedures carry an inherent risk of recurrent laryngeal nerve (RLN) injury. Patients with persistent RLN paresis may be asymptomatic because of compensation from the opposite side. If such patients undergo an opposite-side anterior approach for revision surgery, they are at risk for a second RLN injury, creating the potential for bilateral vocal fold paresis and possible need for tracheotomy. A program of routine screening for laryngeal paresis was implemented for these patients. This retrospective study reviews the results of this screening process.

Methods:

Patients referred for preoperative laryngeal nerve screening were identified. Their charts were reviewed for the results of the videolaryngoscopic examination, and for any recommendations made based on the findings. Relevant history and other physical findings were recorded.

Results:

Fifty screening laryngeal examinations were performed in 47 patients, of whom 31 (66%) had previously undergone a single anterior cervical approach procedure, and 16 (34%) had undergone more than one. Thirteen of the examinations (26%) revealed abnormal laryngeal findings, including paresis or paralysis in 11 cases (22%), of which 5 were asymptomatic. The findings resulted in a recommendation of a cervical approach from the already-involved side. None of the revision procedures resulted in bilateral vocal fold paralysis. The risk of laryngeal nerve injury appears to increase as higher cervical levels are approached.

Conclusions:

Minimally symptomatic injuries of the laryngeal nerves from prior neck surgery create a potential serious risk of bilateral vocal fold paralysis with subsequent procedures. Preoperative laryngeal screening is a simple and effective method for reducing this risk.
Evaluation of Functional Recovery of Recurrent Laryngeal Nerve Using Transoral Laryngeal Bipolar Electromyography: A Rat Model
Authors: Tessema Belachew , Pitman Michael J. , Roark Rick M. , Berzofsky Craig , Sharma Sansar , Schaefer Steven D.
Published: October 2014

Objectives:

We developed a standardized method of minimally invasive transoral laryngeal (ToL) bipolar electromyography (EMG) for evaluation of recurrent laryngeal nerve (RLN) recovery after a controlled crush injury in a rat model.

Methods:

Ten 200- to 250-g Sprague-Dawley rats underwent a controlled crush injury to the left RLN performed with 60 seconds of use of a calibrated aneurysm clamp with a closing force of 0.61 N. Serial ToL bipolar EMG was performed on adductor muscles and the posterior criocoarytenoid muscle during spontaneous vocal fold motion under anesthesia. Each animal underwent ToL EMG immediately after surgery and 1, 3, and 6 weeks after surgery.

Results:

The EMG signals showed normal motor unit potentials and recruitment patterns 3 weeks after crush injury. Endoscopic evaluation of vocal fold mobility yielded consistently normal findings 6 weeks after crush injury.

Conclusions:

We have developed a standardized method of crush injury to the rat RLN model and a minimally invasive transoral bipolar spontaneous EMG technique to serially evaluate and follow nerve injury and recovery in rats. This model is intended to simulate intraoperative RLN injury, to elucidate the electrophysiological events that occur during nerve recovery, and to form the basis for studying agents to enhance such recovery.
Injection of Botulinum Toxin into External Laryngeal Muscles in Pediatric Laryngeal Paralysis
Authors: El-Hakim Hamdy
Published: October 2014

Objectives:

I undertook to demonstrate the effect of injecting botulinum toxin type A (BTA) into cricothyroid, sternothyroid, and sternohyoid muscles in cases of bilateral laryngeal paralysis (BLP). Tracheostomy remains the consistently reproducible and accepted method to salvage the airway obstruction in BLP. The bypass, however, acknowledges the current lack of knowledge and consensus on the pathogenesis.

Methods:

I performed a retrospective chart review of BLP cases treated with BTA in a tertiary care pediatric center. The injections were performed under direct vision through an open transcervical approach. The main outcome measures used were improvement of airway symptoms and endoscopic findings, tracheostomy requirement, and incidence of recovery of function.

Results:

In total, 24 patients with BLP were identified. Over a 2-year period, 7 patients were treated with BTA. Six patients had congenital idiopathic BLP. One of these had trisomy 7. One patient acquired the paralysis after cardiac surgery. No patients required a tracheostomy, except for the infant with trisomy 7. Six patients recovered function completely, and the seventh recovered it partially (range, 4 weeks to 12 months).

Conclusions:

Injection of BTA into external laryngeal muscles may be an alternative to tracheostomy in BLP. It is proposed that the toxin relaxes the glottic aperture by paralyzing the cricothyroid and strap muscles and that it may aid in appropriate reinnervation of the larynx via mechanisms beyond the neuromuscular junction.
Interleukin-10 is an Essential Modulator of Mucoid Metaplasia in a Mouse Otitis Media Model
Authors: Tsuchiya Katsuyuki , Komori Masahiro , Zheng Qing Yin , Ferrieri Patricia , Lin Jizhen
Published: October 2014

Objectives:

Inflammatory cytokines are involved in the development of mucous cell metaplasia and hyperplasia (MCM) in otitis media (OM). However, which cytokines play an essential role in the MCM of OM is not clear at the moment.

Methods:

In this study, we hypothesized that interleukin-10 (IL-10) played an indispensable role in the MCM of bacterial OM, and we used IL-10 knockout mice to test this hypothesis.

Results:

In wild-type mice, both Streptococcus pneumoniae and Haemophilus influenzae triggered the development of MCM in the middle ear mucosa. In IL-10 knockout mice, the number of goblet cells and mucin-producing cells in the middle ear was significantly reduced after bacterial middle ear infection compared with that in wild-type mice.

Conclusions:

We conclude that IL-10 plays an essential role in the MCM of bacterial OM. Interleukin-10 is a potential target for the treatment of MCM in OM.
Novel Technique for Peritonsillar Abscess Drainage
Authors: Chang Eugene Hanyoung , Hamilton Grant S.
Published: October 2014

Objectives:

We propose a novel technique for peritonsillar abscess (PTA) drainage in which the patient is lying in the Trendelenburg position. We provide evidence that this novel technique is relatively safe and effective in PTA drainage.

Methods:

We queried otolaryngology training programs in regard to techniques of PTA drainage after receiving Institutional Review Board approval. Respondents were asked to rate their own level of success in draining PTAs, as well as the perceived satisfaction and comfort of the patient. These were rated on a scale of 1 (never successful or comfortable) to 5 (always successful or comfortable).

Results:

We collected 138 responses. The respondents included residents (67%), faculty (30%), and medical students (3%). The overwhelming majority of respondents placed the patient in a seated position (97%); only 4 respondents used the Trendelenberg position. On average, physicians who drained PTAs in the Trendelenberg versus the seated position had a higher success rating (5 versus 4.37) and a higher patient comfort rating (4.75 versus 3.31).

Conclusions:

We propose a novel PTA drainage technique in which the patient is in the Trendelenburg position. We provide evidence that our technique is rarely used in otolaryngology, and provides success rates and patient comfort levels that are greater than those of the current standard of the seated position.
Incapacitating Unilateral Tinnitus in Single-Sided Deafness Treated by Cochlear Implantation
Authors: Van de Heyning Paul , Vermeire Katrien , Diebl Martina , Nopp Peter , Anderson Ilona , De Ridder Dirk
Published: October 2014

Objectives:

Tinnitus is a well-known, difficult-to-treat symptom of hearing loss. Users of cochlear implants (CIs) have reported a reduction in tinnitus following implantation for bilateral severe-to-profound deafness. This study assessed the effect of electrical stimulation via a CI on tinnitus in subjects with unilateral deafness and ipsilateral tinnitus who underwent implantation in an attempt to treat tinnitus with the CI.

Methods:

Twenty-one subjects who complained of severe intractable tinnitus that was unresponsive to treatment received a CI. Tinnitus loudness was measured with a Visual Analog Scale; loudness percepts were recorded with the device activated and deactivated. Tinnitus distress was measured with the Tinnitus Questionnaire before and after implantation.

Results:

Electrical stimulation via a CI resulted in a significant reduction in tinnitus loudness (mean ± SD; 1 year after implantation, 2.4 ± 1.8; 2 years after implantation, 2.5 ± 1.9; before implantation, 8.5 ± 1.3). With the device deactivated, tinnitus loudness was still reduced to between 6.1 and 7.0 over 24 months. The Tinnitus Questionnaire revealed a significant positive effect of CI stimulation.

Conclusions:

Unilateral tinnitus resulting from single-sided deafness can be treated with electrical stimulation via a CI. The outcomes of this pilot study demonstrate a new method for treatment of tinnitus in select subjects, perhaps an important new indication for cochlear implantation.
Giant Hypervascular Lesion of the Sinonasal Tract Invading the Anterior Skull Base and Orbit: A Puzzling Case
Authors: Lombardi Davide , Galtelli Cristina , Khrais Tarek , Morassi Maria Laura , Nicolai Piero
Published: October 2014

The sinonasal tract may be involved in a wide variety of hypervascular lesions, either benign or malignant, and differential diagnosis may be challenging. We present the case of a 26-year-old man with an aggressive ethmoid hypervascular mass invading the anterior skull base and orbit. Because of massive intraoperative bleeding and difficult dissection of the lesion from the periorbita, the planned cranioendoscopic approach had to be converted into a standard craniofacial resection by a combined Lynch and coronal incision. The definitive diagnosis was consistent with lobular capillary hemangioma associated with intravascular papillary endothelial hyperplasia. Two years after surgery, the patient is free of disease. Lobular capillary hemangioma is a hypervascular lesion that may involve the sinonasal tract. The case presented herein is exceptional, both in the presentation and in the difficulties encountered in diagnosis and treatment, because of the concurrence of lobular capillary hemangioma and intravascular papillary endothelial hyperplasia.
Dexmedetomidine Sedation for Laryngeal Framework Surgery
Authors: Jense Ryan J. , Souter Karen , Davies Jo , Romig Christopher , Panneerselvam Ashok , Maronian Nicole
Published: October 2014

Objectives:

Sedation for laryngeal framework surgery has lacked easy modulation between appropriate pain control, airway protection, and the alertness appropriate for vocal testing. Our objective was to determine whether dexmedetomidine hydrochloride could safely and effectively be used as the sole intravenous anesthetic agent in conjunction with local anesthesia for laryngeal framework procedures.

Methods:

We undertook a prospective review of 14 patients who underwent laryngeal framework surgery with dexmedetomidine anesthesia in 2004 and 2005. All dexmedetomidine doses, sedation levels, and vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation level, were recorded every 15 minutes by the anesthesiologist throughout the duration of the procedures. Operative conditions were noted by the surgeon, focusing special attention on airway protection, patient arousability, and patient comfort.

Results:

Dexmedetomidine sedation produced hemodynamic and respiratory values that were maintained near preoperative values, and overall pharyngeal-laryngeal integrity provided superior operating conditions for the patient and the operating surgeon.

Conclusions:

We believe that dexmedetomidine provides excellent sedative and operative conditions for awake laryngeal framework procedures. Coupled with local anesthesia, dexmedetomidine produced virtually no undesirable hemodynamic or respiratory effects, while allowing for adequate sedation the majority of the time. The operative conditions were markedly improved over those of previous standard monitored anesthesia regimens.
Patient Compliance with Proton Pump Inhibitor Therapy in an Otolaryngology Practice
Authors: Chheda Neil N. , Postma Gregory N.
Published: October 2014

Objectives:

Proton pump inhibitors (PPIs) are used for the treatment of numerous otolaryngological disorders. It has been demonstrated that administration of the medication 15 to 45 minutes before a meal optimizes acid suppression. The rate of compliance with optimal PPI dosage patterns in an otolaryngology practice is not known. We sought to determine the rate of PPI compliance in patients seen in an otolaryngology practice.

Methods:

We conducted an interview at a tertiary voice and swallowing center of 200 consecutive patients who were taking PPIs.

Results:

Overall, 54% of patients took their PPI in an optimal manner. The rate of compliance was significantly higher for patients who had their PPI prescribed by an otolaryngologist (62%) than for patients whose PPI was prescribed by a non-otolaryngologist (40%).

Conclusions:

Nearly half of all patients seen at a voice and swallowing center were not compliant with optimal PPI usage. This percentage is similar to that found for other long-term medications. Patient education can lead to higher rates of compliance, improved acid control, and possibly improved treatment outcomes.
Clinical Application of in Situ Tissue Engineering Using a Scaffolding Technique for Reconstruction of the Larynx and Trachea
Authors: Omori Koichi , Tada Yasuhiro , Suzuki Teruhisa , Nomoto Yukio , Matsuzuka Takashi , Kobayashi Ken , Nakamura Tatsuo , Kanemaru Shinichi , Yamashita Masaru , Asato Ryo
Published: October 2014

Objectives:

The objective of the present study was to demonstrate the efficacy of the clinical application of in situ tissue engineering using a scaffolding technique for laryngeal and tracheal tissue.

Methods:

We have developed a tissue scaffold made from a Marlex mesh tube covered by collagen sponge. Based on successful animal experimental studies, in situ tissue engineering with a scaffold implant was applied to repair the larynx and trachea in 4 patients.

Results:

In 1 patient with subglottic stenosis, the thyroid cartilage, cricoid cartilage, and cervical trachea with scarring and granulation were resected and reconstructed by use of the scaffold. In 3 patients with thyroid cancer, the trachea and cricoid cartilage with tumor invasion were resected and the scaffold was implanted into the defect. Postoperative endoscopy during the observation period of 8 to 34 months showed a well-epithelialized airway lumen without any obstruction.

Conclusions:

Our current technique of in situ tissue engineering using a scaffold shows great potential for use in the regeneration of airway defects.
Lemierre's Syndrome: What are the Roles for Anticoagulation and Long-Term Antibiotic Therapy?
Authors: Bondy Peter , Grant Thomas
Published: October 2014

Objectives:

We wanted to describe what Lemierre's syndrome is and what risk factors may be involved, and to understand the roles, if any, of antibiotics and anticoagulants in the treatment of this syndrome.

Methods:

We performed a review of the pertinent literature regarding Lemierre's syndrome, as well as a review of otology, obstetrics and gynecology, and internal medicine literature looking at both anticoagulation and long-term antibiotic treatment for septic thrombosis.

Results:

The vast majority of patients with Lemierre's syndrome are successfully treated nonsurgically with antibiotics and, often, anticoagulation as well. Surgical intervention is reserved for those cases with persistent showering of septic emboli or continued propagation of the thrombosis. Although anticoagulation is commonly used in other specialties for similar septic thromboses, its role in Lemierre's syndrome is unclear at the present.

Conclusions:

Because Lemierre's syndrome is so rare, it is difficult to ascertain absolutely the need for either anticoagulation or long-term antibiotic therapy. At this time, the risks and benefits of providing either therapy must be weighed against the potential complications of incompletely treating septic thrombosis.
Canal Wall—Down Tympanoplasty with Soft-Wall Reconstruction Using the Pedicled Temporoparietal Fascial Flap: Technique and Preliminary Results
Authors: Haginomori Shin-Ichi , Nonaka Ryuzaburo , Takenaka Hiroshi , Ueda Koichi
Published: October 2014

Objectives:

We compared the use of the pedicled temporoparietal fascial flap (TPFF) with the use of free deep temporal fascia (DTF) in soft-wall reconstruction after canal wall–down tympanoplasty.

Methods:

In the TPFF group (6 ears), the pedicled TPFF that includes the superficial temporal artery and vein was raised ipsilaterally and rotated into the eradicated mastoid cavity. The tympanic membrane and external auditory canal (EAC) were reconstructed by gluing one side of the TPFF to the mucosal layer of the tympanic membrane and the reverse side of the posterior EAC skin. In the DTF group (21 ears), reconstruction was performed similarly with free DTF. The postoperative period for epithelialization of the tympanic membrane and EAC skin, postoperative complications, and reaeration in the middle ear revealed by computed tomography were reviewed in both groups.

Results:

In the TPFF group, the mean (±SD) period to epithelialization was 25.5 ± 2.8 days versus 38.4 ± 12.0 days in the DTF group; the two groups differed statistically (Welch's t-test, p = 0.0002). No postoperative complications occurred in the TPFF group, whereas 2 patients in the DTF group underwent graft necrosis with infection. Three of the 6 patients in the TPFF group showed reaeration not only in the tympanic cavity, but also in the mastoid cavity. However, no statistical differences between the two groups were observed in terms of postoperative complications or reaeration of the mastoid cavity.

Conclusions:

Our preliminary findings suggest that the pedicled TPFF has positive effects on quick epithelialization. Further prospective studies are needed to reveal the superiority of the pedicled TPFF over free DTF with regard to postoperative infection and recovery of mastoid aeration.
Staged Surgical Management of Hypopharyngeal Traction Diverticulum
Authors: Alexander Ronda E. , Silber Jeffrey , Myssiorek David
Published: October 2014

A 50-year-old woman who had undergone cervical spine fixation 6 years earlier presented with dysphagia, regurgitation of undigested food, halitosis, and weight loss. Operative examination demonstrated a hypopharyngeal diverticulum with spinal hardware visible in a defect in the mucosa. She underwent an open cervical approach to removal of the hardware. Endoscopic staple diverticulotomy as described by Scher and Richtsmeier was performed 8 weeks later in the ambulatory surgical setting. After a period of enteral feeding via a nasogastric tube in the initial postoperative period, she was able to resume oral nutrition in the interim between the surgical procedures. After the second procedure, she was able to resume a normal diet immediately and she experienced minimal symptoms. It is established that traction diverticulum is appropriately treated by removing the inciting anatomic factor(s). We propose that staged surgical management begin with the removal of the nidus followed by marsupialization of the diverticulum pouch. Standard staple diverticulotomy is a viable option for the second stage. This technique allows the patient to minimize the length of, or avoid, the second hospitalization for diverticulum management.
Reflex Vocal Fold Adduction in the Porcine Model: The Effects of Stimuli Delivered to Various Sensory Nerves
Authors: Woo Jeong-Soo , Hundal Jagdeep S. , Sasaki Clarence T. , Abdelmessih Mikhail W. , Kelleher Stephen P.
Published: October 2014

Objectives:

The aim of this study was to identify a panel of sensory nerves capable of eliciting an evoked glottic closure reflex (GCR) and to quantify the glottic closing force (GCF) of these responses in a porcine model.

Methods:

In 5 pigs, the internal branch of the superior laryngeal nerve (iSLN) and the trigeminal, pharyngeal plexus, glossopharyngeal, radial, and intercostal nerves were surgically isolated and electrically stimulated. During stimulation of each nerve, the GCR was detected by laryngeal electromyography and the GCF was measured with a pressure transducer.

Results:

The only nerve that elicited the GCR in the 5 pigs was the iSLN. The average GCF was 288.9 mm Hg.

Conclusions:

This study demonstrates that the only afferent nerve that elicits the GCR in pigs is the iSLN, and that it should remain the focus of research for the rehabilitation of patients with absent or defective reflex vocal fold adduction.
Nijmegen Results with Application of a Bone-Anchored Hearing Aid in Children: Simplified Surgical Technique
Authors: de Wolf Maarten J. F. , Hol Myrthe K. S. , Huygen Patrick L. M. , Mylanus Emmanuel A. M. , Cremers W. R. J.
Published: October 2014

Objectives:

A retrospective analysis was performed to evaluate the clinical outcome of percutaneous bone-anchored hearing aid (BAHA) application in children with the outcome measures of fixture loss and skin reactions.

Methods:

An analysis was done of 93 of the 101 children 16 years of age or younger who underwent the simplified Nijmegen surgical technique between January 1994 and July 2007.

Results:

Twenty-one of 129 fixtures (16.3%) were lost or removed. In 12 cases, osseointegration failed. The majority of the fixture losses (86%) occurred within 1 year after surgery. No differences were found between 3 age groups or between fixture lengths (seven 3-mm implants versus fourteen 4-mm implants). The BAHA fixtures were less stable in children than in adults. In 8 cases, Holgers grade 4 skin reactions were noted at an average (±SD) of 5.5 ± 4.7 months after surgery, ie, significantly sooner than the milder reactions (p = 0.001). In 28 cases (22%), skin reactions of Holgers grades 2 to 4 were observed. Revision surgery to reduce subcutaneous scar tissue was necessary in 22 implants (17%).

Conclusions:

Fixture loss was more frequent in children than in adults. The age of the child and the length of the fixture did not appear to influence fixture stability. Children should undergo frequent checkups at the outpatient clinic.
Cystic Lymphatic Malformation of the Middle Ear
Authors: Tanna Neil , Sidell Douglas , Schwartz Arnold M. , Schessel David A.
Published: October 2014

Objectives:

We review the clinical, radiologic, and histopathologic features of cystic lymphangioma of the middle ear, and discuss the developmental etiology and management of such a lesion.

Methods:

We present an unusual location for the development of a cystic lymphangioma with emphasis on etiology, clinical implications, and current treatment.

Results:

A 10-year-old girl presented with a mass involving the medial surface of the right tympanic membrane. T2-weighted magnetic resonance imaging demonstrated a hyperintense lesion in the anterior-superior middle ear cavity without evidence of vascular abnormalities.

Conclusions:

To our knowledge, this is the only report of lymphangioma involving the middle ear represented in the English-language literature. Such a lesion has been demonstrated to arise from abnormalities in growth factors that contribute to the tightly regulated process of lymphangiogenesis. Lymphatic malformations can be diagnosed presumptively by virtue of magnetic resonance imaging in combination with a detailed physical examination. The treatment of choice for lymphangiomas located in the middle ear is surgical excision. Definitive diagnosis of the lesion is then made by identifying specific histopathologic characteristics. Although rare and histologically benign, middle ear lymphangiomas may produce significant patient discomfort and ultimately a conductive hearing loss. Therefore, these lesions warrant early recognition and treatment.
Performance of an Automated, Remote System to Detect Vocal Fold Paralysis
Authors: Wormald Robert N. , Moran Rosalyn J. , Reilly Richard B. , Lacy Peter D.
Published: October 2014

Objectives:

The aim of this project was to evaluate the diagnostic accuracy of an automated, remote system for correctly identifying vocal fold paralysis.

Methods:

Consecutive patients presenting for vocal analysis at the Beaumont Hospital Voice Clinic were enrolled in this prospective, blinded study. Control patients were enlisted from routine otolaryngology clinics. All patients were assessed by standard history, clinical examination, and flexible laryngoscopy or videostroboscopy. The subjects were blindly assessed by remote voice analysis. Sustained phonation was recorded over a standard telephone network. Each recording was subjected to automated, remote analysis of extracted features, including measures of pitch perturbation, amplitude perturbation, and harmonics-to-noise ratio. The presence or absence of a vocal fold paralysis as determined by the automated classifier was recorded and correlated with clinical findings.

Results:

Seventy-eight consecutive patients were enrolled in the study. The automated speech analysis system demonstrated 92% sensitivity and 75% specificity for detecting vocal fold paralysis.

Conclusions:

This pilot study, assessing an automated system that analyzes audiological data remotely over the standard telephone network, suggests that with further “training” it may become a reliable, simple, and convenient means for screening patients for voice disorders.
Contemporary Role of Endolymphatic Mastoid Shunt Surgery in the Era of Transtympanic Perfusion Strategies
Authors: Lee Lisa , Pensak Myles L.
Published: October 2014

Objectives:

Although there exist undisputed methods to permanently silence the aberrant end organ, controversy surrounds the durable efficacy of non-ablative interventions. This study provides a contemporary review of our institution's clinical experience in performing endolymphatic mastoid shunt surgery (EMSS) in patients with medically refractory endolymphatic hydrops, or Meniere's disease.

Methods:

Between 1984 and 2002, 1,612 patients were referred to our institution with a diagnosis of Meniere's disease. Of these referrals, 1,172 patients met the criteria for Meniere's disease. Although 553 patients responded to medical management, 486 patients underwent EMSS and 133 patients had refractory disease that required chemical or surgical obliterative interventions. The retrospective study utilizes data collected on 226 patients who were followed for a minimum of 5 years.

Results:

Overall, 78% patients responded favorably to EMSS, according to the functional level scale and class categories delineated by the American Academy of Otolaryngology-Head and Neck Surgery 1995 guidelines for control of vertigo. According to the Arenberg anatomic classification for endolymphatic sac location, EMSS achieved adequate control of vertigo in 86% of type I cases, 90% of type II cases, and 82% of type III cases.

Conclusions:

Endolymphatic mastoid shunt surgery is a relatively safe, effective procedure for the long-term control of vertigo in patients with medically refractory Meniere's disease.
Damage to Ciliated Epithelium in Chronic Rhinosinusitis: What is the Role of Bacterial Biofilms?
Authors: Galli Jacopo , Calò Lea , Ardito Fausta , Imperiali Micaela , Bassotti Ezio , Passali Giulio Cesare , La Torre Giuseppe , Paludetti Gaetano , Fadda Giovanni
Published: October 2014

Objectives:

We assess the association between the presence of biofilms and cilial damage in patients with chronic rhinosinusitis (CRS), describe the microorganisms associated with samples that exhibited cilial loss and biofilms, and demonstrate the absence of ciliary injury and biofilms in similarly prepared “normal” controls.

Methods:

We examined samples of ethmoid mucosa obtained from 24 patients who underwent functional endoscopic sinus surgery for CRS. Samples from a control group (20 healthy subjects) were also examined. The specimens were divided into 2 fragments; the first was processed for bacterial cultures, and the second was subjected to scanning electron microscopy. Statistical analysis was performed.

Results:

All CRS samples had positive bacterial cultures. The scanning electron microscopy analysis showed bacterial biofilms in 10 of the 24 specimens. A marked destruction of the epithelium was observed in samples positive for biofilms (p < 0.001), and the presence of Haemophilus influenzae was associated with ciliary abnormalities (partial damage in 55.6% and absence of cilia in 50%; p = 0.041).

Conclusions:

The high percentage of biofilms in our specimens confirms the association between biofilms and CRS. Our data support the hypothesis that biofilm formation represents the latter phase of an inflammatory process that leads to complete epithelial destruction.
Comparison of an Oropharyngeal pH Probe and a Standard Dual pH Probe for Diagnosis of Laryngopharyngeal Reflux
Authors: Golub Justin S. , Johns Michael M. , Lim Jae H. , DelGaudio John M. , Klein Adam M.
Published: October 2014

Objectives:

We compared the ability of an oropharyngeal (OP) aerosol-detecting pH probe and a standard dual pH probe in measuring laryngopharyngeal reflux (LPR).

Methods:

Fifteen subjects with LPR symptoms had 24-hour simultaneous placement of the OP probe and a standard dual pH probe. Acid exposure was defined as a 10% pH decrease below baseline for the OP probe or a pH of less than 4 at the upper esophageal sphincter (UES) probe of the dual pH probe.

Results:

The mean duration of acid exposure was 650 seconds (SD, 619) or 0.75% of the total time for the OP probe and 438 seconds (SD, 511) or 0.51% of the total time for the UES probe. When we excluded meals and sleep, the mean duration of acid exposure was 271 seconds (SD, 356) or 0.31% of the total time for the OP probe and 271 seconds (SD, 359) or 0.31% of the total time for the UES probe. The correlation coefficient (R) between the two probes for measurement of the duration of acid exposure was 0.50 (p < 0.05). When we excluded meals and the supine position, the R was notably higher, at 0.95 (p < 0.0001).

Conclusions:

The OP probe reliably documented LPR events when meals and sleep were eliminated and was better tolerated than the standard dual probe.
Advanced Oral Tongue Cancer in a 22-Year-Old Pregnant Woman
Authors: Cheung Esther J. , Wagner Henry , Botti John J. , Fedok Fred , Goldenberg David
Published: October 2014

Objectives:

Oral squamous cell carcinoma generally occurs in older men and is associated mostly with tobacco and alcohol as the primary risk factors. The incidence of oral squamous cell carcinoma in younger patients has increased. We report a case of a young woman, 25 weeks pregnant, who presented with stage IV carcinoma of the oral tongue.

Methods:

The following is a case presentation and literature review.

Results:

The patient presented with T4 N3 M0 oral tongue cancer. A team consisting of a head and neck surgeon, a radiation oncologist, a medical oncologist, and a maternal-fetal medicine specialist was assembled. The patient initially refused surgery. Chemotherapy was initiated until 32 weeks' gestation. After an infant boy was delivered via cesarean section, the patient began concurrent irradiation and chemotherapy, which induced complete regression of the primary tongue neoplasm with a partial response of the neck nodes. The patient underwent bilateral neck dissection followed by hemiglossectomy for recurrence.

Conclusions:

Management of advanced oral carcinoma in pregnancy presents a unique set of challenges. Few studies have described chemotherapy and radiotherapy during pregnancy, and long-term results are needed. Care must be taken to balance appropriate and adequate treatment of disease and to ensure the safety of the patient and the fetus.
Secondary Airway Lesions in Infants with Laryngomalacia
Authors: Dickson J. Matthew , Richter Gresham T. , Meinzen-Derr Jareen , Rutter Michael J. , Thompson Dana M.
Published: October 2014

Objectives:

We sought to determine the incidence of secondary airway lesions in infants with laryngomalacia and to compare the incidences of these concomitant airway lesions in infants with severe, moderate, and mild laryngomalacia; to determine whether infants with mild or moderate laryngomalacia have a higher incidence of surgical intervention when a secondary airway lesion is present; and to determine whether the incidence of gastroesophageal reflux disease (GERD) is affected by the presence of a secondary airway lesion.

Methods:

We performed a retrospective review of a database consisting of 201 infants with a diagnosis of laryngomalacia treated at a pediatric tertiary referral center between June 1998 and June 2003. Data pertaining to demographic information, severity of laryngomalacia, presence of secondary airway lesions, and diagnosis of GERD were collected and analyzed.

Results:

Of the 201 infants, 104 (51.7%) were found to have a secondary airway lesion. Subglottic stenosis was found in 38.8%, and tracheomalacia in 37.8%. Of the infants with severe laryngomalacia, 30 (79%) had a diagnosis of a secondary lesion, compared with 51 (61.5%) of those with moderate and 23 (28.8%) of those with mild disease. Among infants with mild or moderate disease, those with secondary airway lesions were more likely to require surgical intervention than were infants without secondary airway lesions (27% versus 5.6%; p = 0.0002). There was no difference in the rates of secondary airway lesions in infants managed with supraglottoplasty versus tracheotomy. The incidence of GERD in this patient population was 65.6%. Infants with a secondary airway lesion were more likely to have GERD than were those without a secondary airway lesion (84.6% versus 45.4%; p < 0.0001).

Conclusions:

The incidence of secondary airway lesions in our population of infants with laryngomalacia was higher than those previously reported. The severity of disease correlated with the diagnosis of a secondary airway lesion. Secondary airway lesions lead to an increased incidence of surgical intervention and GERD in infants with laryngomalacia.
Preserved Regeneration and Functional Recovery of the Injured Recurrent Laryngeal Nerve after Secondary Surgical Repair in Adult Rats
Authors: Hydman Jonas , Mattsson Per
Published: October 2014

Objectives:

Transection of the recurrent laryngeal nerve (RLN) is accompanied by poor functional recovery, despite primary repair, because of regeneration difficulties. Nimodipine can promote regeneration, but it is not yet clear whether preoperative treatment is necessary. It is also not clear whether surgical repair following RLN injury may be performed in a second procedure, with preserved regeneration. This study investigated the time window for secondary surgical repair of the transected RLN and the need for preoperative administration of nimodipine.

Methods:

In adult rats, the left RLN was transected and repaired at time intervals up to 3 weeks after transection, in combination with nimodipine treatment starting either before or after the operation. Regeneration and neuromuscular recovery were assessed by electrophysiology, retrograde tracing, and immunohistochemistry.

Results:

Similar (whether 0, 2, or 7 days) regenerative results were obtained when the RLN was repaired up to 1 week after injury, given nimodipine administration, whereas fewer motor neurons managed to regenerate after nerve repair at 3 weeks after the initial transection. No beneficial effect was detected from preoperative nimodipine administration.

Conclusions:

Provided that nimodipine is administered, surgical reconstruction of the RLN can be performed within 1 week after the initial nerve trauma, with preserved neuromuscular function. Nimodipine may be administered at the time of RLN transection injury.
Indirect Estimation of Laryngeal Resistance via Airflow Redirection
Authors: Rieves Adam L. , Hoffman Matthew R. , Jiang Jack J.
Published: October 2014

Objectives:

Our aim was to estimate aerodynamic parameters of laryngeal resistance (Rl) and aerodynamic power indirectly from a subglottal pressure (Ps) data trace obtained with the airflow redirection system.

Methods:

During airflow interruption, the airflow redirection tank fills capacitively with pressure until it reaches the subject's Ps. Therefore, a time constant, τ, can be extracted from the data trace and used to calculate Rl. The validity of applying this method to the estimation of RL was demonstrated with a computer model. Estimations were made for values of 10, 20, 30, 40, and 50 cm H2O per liter per second (L/s). Twenty subjects performed 10 trials on the experimental system designed to measure Ps. The values of RL and aerodynamic power were then calculated.

Results:

The computer model simulation yielded a maximum measurement error of 3.00% and a mean error of 1.78%. In human subject testing, the mean ± SD laryngeal resistance was 22.61 ± 8.65 cm H2O per L/s, the mean Ps was 6.91 ± 1.94 cm H2O, and the mean aerodynamic power was 0.247 ± 0.170 kPa × (L/s).

Conclusions:

The proposed method of data analysis enables a clinician to estimate Rl and aerodynamic power from a single experimental trial designed to measure Ps. This technique provides the clinician with an aerodynamic function report that can be used to analyze patient health and treatment efficacy.
Surgical Method to Create Vocal Fold Injuries in Mice
Authors: Yamashita Masaru , Bless Diane M. , Welham Nathan V.
Published: October 2014

Objectives:

The goal of this study was to develop a surgical method for the creation of vocal fold injuries in mice, as a precursor to the use of genetically engineered mouse models in the study of vocal fold wound healing and scar formation.

Methods:

Seven FVB strain mice were used in this study. A laryngoscope and 3 micro-instruments were designed and fabricated to facilitate endoscopic vocal fold visualization and the creation of vocal fold surgical injuries. The larynges were harvested 1 and 7 days after surgery, and the vocal fold injury sites were evaluated by routine hematoxylin and eosin staining. Additional immunohistochemical analysis of collagen type I and elastin distribution in the lamina propria was performed for an uninjured control larynx.

Results:

Endoscopic visualization and vocal fold stripping resulting in thyroarytenoid muscle exposure were successful in all animals. Histologic and immunohistochemical analyses revealed a simple lamina propria structure with relatively even collagen type I and elastin distribution in the control vocal fold, obliteration of vocal fold mucosa 1 day after surgery, and complete reepithelialization by 7 days.

Conclusions:

These results demonstrate the feasibility of creating reproducible vocal fold injuries via an endoscopic approach in mice. The observation that the mouse lamina propria may have a relatively simple histologic structure indicates that additional characterization should be performed and caution used in translating findings between this and other model systems.
Modulating Effects of Hypoxia and Hypercarbia on Glottic Closing Force
Authors: Sasaki Clarence T. , Hundal Jagdeep S. , Wadie Mikhail , Woo Jeong-Soo , Rosenblatt William
Published: October 2014

Objectives:

Aspiration has been identified as one of the independent risk factors for development of respiratory tract infections, the incidence of which varies from 10% to 65% in patients in intensive care units. The primary defense mechanism for protection of the lower airway is the glottic closure reflex (GCR), elicited by stimulation of the internal branch of the superior laryngeal nerve. This reflex, once considered highly stable, is now considered vulnerable to a growing number of clinical factors. This study was designed to explore the biomechanical effects of hypoxia and hypercarbia, common occurrences among critically ill patients, on the GCR.

Methods:

Five adult male Yorkshire pigs were used in the study. Both internal superior laryngeal nerves were simultaneously stimulated with bipolar platinum-iridium electrodes. The glottic closing force (GCF) was then measured by placing a pressure transducer between the adducting vocal folds under 3 different protocols: Protocol 1 (control), protocol 2 (hypoxia: Partial pressure of arterial oxygen [Pao2] levels of 90, 70, and 50 mm Hg), and protocol 3 (hypercarbia: Partial pressure of arterial carbon dioxide [Paco2] levels of 60 and 70 mm Hg). Six readings were recorded under each experimental paradigm, and Student's t-test was applied to calculate the statistical significance against the control.

Results:

Hypoxia reduced the GCF to 75%, 40%, and 29% of control for Pao2 levels of 90, 70, and 50 mm Hg, respectively, and hypercarbia reduced the GCF to 40% and 27% of control for Paco2 levels of 60 and 70 mm Hg, respectively.

Conclusions:

This is the first study that highlights the biomechanical impact of hypoxia and hypercarbia on the GCR, providing a unified explanation for the increased incidence of life-threatening aspiration in critically ill patients with such alterations.
Effect of Dehydration on Phonation Threshold Flow in Excised Canine Larynges
Authors: Witt Rachel E. , Regner Michael F. , Tao Chao , Rieves Adam L. , Zhuang Peiyun , Jiang Jack J.
Published: October 2014

Objectives:

The minimum airflow necessary to initiate stable vocal fold vibration — Phonation threshold flow (PTF) — May increase as exposure to dry air increases. A critical period of dehydration may exist after which phonation can no longer be initiated.

Methods:

We collected PTF data for 11 excised canine larynges mounted on a bench apparatus. Trials consisted of cycles of 10 seconds of phonation followed by 3 seconds of rest. During the experimental trials, subglottal flow of comparatively dry air was increased until phonation was initiated, and phonation was sustained for the remainder of the 10-second period. The subglottal flow was then decreased until phonation ceased. No saline solution was applied during the dehydration trials. During the control trials, subglottal airflow was humidified and saline solution was applied frequently to the vocal folds.

Results:

The PTF increased as exposure to dry air increased during the experimental trials (p = 0.010); this relationship was not statistically significant in control trials. A point existed after which phonation could not be initiated.

Conclusions:

Knowledge of the effect of exposure to dry air on PTF could be useful in the clinical assessment and prevention of dehydration. Further exploration of this relationship in vivo could be used to evaluate the effectiveness of current hydration therapies and provide theoretical support for the development of new ones.