bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Treatment of Subglottic and Tracheal Stenosis by Radial Laser Incision and Dilation
Authors: Shapshay Stanley M. , Hybels Roger L. , Beamis John F. , Bohigian R. Kirk
Published: October 2014

Five patients with severe fibrous subglottic and tracheal stenosis were treated by endoscopic radial laser incision and dilation using both carbon dioxide and neodymium:yttrium aluminum garnet lasers. Good results were noted without complications in all patients in a follow-up period of at least 1 year. Careful selection of patients, excluding those with tracheal collapse or tracheomalacia, and preservation of tracheal epithelium with minimal heat and mechanical trauma are considered essential for good results.
Laryngeal Electrode Platform: An Indwelling Device for Mobilizing the Vocal Cords
Authors: Kraus Warren M. , Aviv Jonathan E. , Sanders Ira , Biller Hugh F.
Published: October 2014

By passing electrical current across the laryngeal mucosa and esophageal wall, the recurrent laryngeal nerve can be stimulated, thereby mobilizing the vocal cords. In designing a device that would utilize this phenomenon, we theorized that stability, targeting, and mucosal contact could be maximized by an indwelling device that would conform precisely to the topography of the posterior larynx. In five dogs, molds of the hypopharynx and proximal esophagus were fashioned in vivo by injection of an alginate compound. From each mold was constructed a vinyl platform blanketed with electrodes. Each platform fit snugly in place, and could activate the nerve consistently in any of the dogs. With as little as 3 mA pulsatile current, use of specific electrodes enabled bilateral abduction, more than doubling the resting glottic aperture. Bilateral adduction was sometimes attainable. Such a platform may have use in visualizing subglottic lesions, diagnosing laryngeal movement disorders, and facilitating intubation and extubation.
Caustic Ingestions and Foreign Body Aspirations: An Overlooked Form of Child Abuse
Authors: Friedman Ellen M.
Published: October 2014

Caustic ingestions and foreign body aspirations are common occurrences in the pediatric population. The high association between caustic ingestions and foreign body aspirations and family stress with social problems may result in significant morbidity and mortality. It is the purpose of this article to increase physician awareness concerning the possibility that these events may be a form of child abuse. It is hoped that by recognizing the risk of child abuse in these cases the physician can make the appropriate referrals in order to avoid serious injury to the child.
Cholesteatoma Surgery: Canal Wall down Procedures
Authors: Sheehv James L.
Published: October 2014

We prefer the intact canal wall technique for tympanoplasty with mastoidectomy, but use a canal wall down procedure in up to 25 % of oases. Creating a round cavity with a large meatus is imperative if one is to obtain a trouble-free ear. The five types of canal wall down procedures are defined, as are our indications for using them. Results in 19 only hearing ears and 19 labyrinthine fistula cases are presented, along with 64 tympanoplasty cases.
Potentiation of Ototoxicity by Glutathione Depletion
Authors: Hoffman Douglas W. , Jones-King Kitty L. , Whitworth Craig A. , Rybak Leonard P.
Published: October 2014

The combination of 10 mg/kg ethacrynic acid (ETA) and 100 mg/kg kanamycin (KA) caused neither morphologic damage to the cochlea nor change in the auditory brain stem response of the chinchilla. However, after pretreatment with a single dose of buthionine sulfoximine (BSO; 800 mg/kg intraperitoneally) to reduce intracellular glutathione (γ-glutamylcysteinylglycine; GSH) levels, the above single administration of ETA and KA resulted in complete deafness and severe morphologic damage. The kidney, which has a rapid GSH turnover and is therefore especially susceptible to GSH depletion by BSO, also demonstrated severe damage after this treatment. A similar rapid turnover of GSH and resulting limited capacity to detoxify reactive metabolites and free radicals may determine cochlear and renal vulnerability to this toxicity. These findings may explain the clinical observations of enhanced ototoxicity in patients administered aminoglycoside antibiotics concomitantly with loop diuretics.
Eliminating the Toynbee Phenomenon in Patients with Nasal Packs
Authors: Finkelstein Yehuda , Zohar Yuval , Laurian Nelu
Published: October 2014

Nasal packing is a common procedure in otolaryngology, but is not a completely innocuous procedure. Besides aggravating mouth breathing, complete nasal obstruction results in an annoying Toynbee phenomenon. In patients with bilateral anterior nasal packing, we recorded high pressure gradients in the nasopharynx and, in consequence, in the middle ear. Patients in whom rubber tubes were inserted between the gauze layers of the anterior nasal packs suffered no such inconvenience and showed no such gradients. Our work proves the value of using these tubes for pressure equalization when nasal packs are necessary.
Airway Management of Acute Supraglottitis at the Children's Hospital, Boston: 1980–1985
Authors: Crockett Dennis M. , McGill Trevor J. , Healy Gerald B. , Friedman Ellen M.
Published: October 2014

A controversy has existed in recent years regarding the ideal method of establishing and maintaining an airway in the pediatric patient with acute supraglottitis. Nasotracheal intubation has been used as the sole method of airway management of acute supraglottitis at The Children's Hospital, Boston, since 1970. This paper reviews our experience with 80 children with acute supraglottitis presenting at our institution during the years 1980 to 1985.
Effects of Stripping and Laser Excision on Vocal Fold Mucosa in Cats
Authors: Leonard Rebecca J. , Charpied George , Gallia Louis J. , Kelly Andrew
Published: October 2014

We compared the effects of stripping and laser excision on vocal fold mucosa in cats. Of particular interest were the comparative effects of each procedure on the mucosa's sensory structures. Mucosa was stripped from one vocal fold in three cats, lased in three additional cats, and histologically examined at 1-, 2-, and 3-week intervals postoperatively. Results indicate that both procedures produce unique and degenerative effects that are still apparent 3 weeks after operation; however, nervous elements in lased tissue samples appeared less disrupted than in stripped tissue. Unique effects on the composition of epithelial tissue also were noted for the two procedures. Implications for voice quality in human patients undergoing similar procedures are discussed.
Acoustic Analysis of Voices of Patients with Neurologic Disease: Rationale and Preliminary Data
Authors: Ramig Lorraine A. , Titze Ingo R. , Scherer Ronald C. , Ringel Steven P.
Published: October 2014

This paper presents a rationale for acoustic analysis of voices of neurologically diseased patients, and reports preliminary data from patients with myotonic dystrophy, Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis, as well as from individuals at risk for Huntington's disease. Noninvasive acoustic analysis may be of clinical value to the otolaryngologist, neurologist, and speech pathologist for early and differential diagnosis and for documenting disease progression in these various neurologic disorders.
Abnormalities of Cilia in the Middle Ear in Chronic Otitis Media
Authors: Yeger Herman , Minaker Erma , Rubin Allen , Charles David , Sturgess Jennifer M.
Published: October 2014

We studied the fine structure of nasal and middle ear mucosa in 18 patients with chronic otitis media, comparing them with ten age-matched control patients. Electron microscopy revealed no single fundamental defect of cilia in the tissue samples; however, patients with chronic otitis media had a significantly higher incidence of abnormal cilia in the middle ear without correlating abnormalities of nasal cilia. These findings indicated that ciliary anomalies, including deletion of ciliary microtubules, presence of supernumerary tubules, and fusion of cilia, occur as a result of infection or inflammation. Such abnormalities would impair normal mucociliary clearance and exacerbate clinical complications.
Computerized Data Bank System for Temporal Bone Histopathology
Authors: Okuno Taeko , Wall Conrad , Sando Isamu
Published: October 2014

A computerized data bank system to store and analyze temporal bone histopathologic data is described. This system uses the University of Pittsburgh's Digital Equipment Corporation System 10 computer and the System 1022 data base management software. Data on histology cases are divided into five files: General information, otologic information, summary, histopathologic information about the external ear and middle ear, and histopathologic information about the inner ear. Eleven general terms are used to describe pathologic findings, surgery, postmortem degeneration, and artifacts. In addition, provision is made for the inclusion of more precise qualitative information to be entered as text.
Pathology Consultation Surgical Margins in Squamous Cell Carcinomas
Authors: Batsakis John G.
Published: October 2014

Positive or negative surgical margins of excision cannot predict the clinical course of patients with squamous cell carcinomas of the head and neck. Local recurrences are increased in frequency and number when invasive or in situ carcinoma or severe dysplasia is present at the margins. Histologic grade of the carcinoma has no influence. In patients with negative margins, 2- and 5-year survivals are dependent on the clinical stage and size of the primary tumor.
Technique for External Repositioning of the Paralyzed Vocal Cord with Silastic Implant
Authors: Escajadillo J. Ramón
Published: October 2014

A technique is introduced for vocal cord mobilization in which a tunnel is made through the inner perichondrium of the thyroid cartilage and a medical grade silicone is placed from the upper part of the thyroid cartilage and pulled out over the cricothyroid membrane. This technique was performed on six dogs, and results were compared to those of a modified laryngoplasty performed on another six dogs. The technique was refined on 20 cadavers and finally performed on five adult patients with more than 1 year of vocal cord paralysis. Results of this technique suggest that it constitutes a good alternative to Teflon injection; morbidity was minimal.
Protocol for Management of the Interposition Cartilage Graft Laryngotracheoplasty
Authors: Prescott C. A. J.
Published: October 2014

This report presents the results of laryngotracheoplasty surgery using both the Evans and Cotton techniques on 27 children with congenital or acquired subglottic stenosis. Failure to obtain early decannulation after surgery has resulted in the formulation of a new protocol for the operative and postoperative management of infants undergoing cartilage graft tracheoplasty. Excision and closure of the tracheostoma at surgery, with postoperative nasoendotracheal intubation providing the necessary support for the graft, now has reduced this period to approximately 2 weeks. A series of six infants for whom this protocol was followed is presented.
Effects of Elevated Intranasal Temperature on Subjective and Objective Findings in Perennial Rhinitis
Authors: Ophir Dov , Elad Yigal , Fishler Elza , Fink Aaron , Marshak Gabriel
Published: October 2014

The effects of elevated intranasal temperature on symptoms and signs of perennial rhinitis were studied in 78 patients by a double-blind, randomized, placebo-controlled clinical trial. Patients were subjected to two treatments separated by a 1-week interval. Each treatment consisted of three 30-minute sessions, during which the patient's intranasal temperature was raised by inhalation of saturated hot air (42°C to 44°C). Subjective response was recorded on a daily symptom score card during the week following treatment. Nasal patency was determined before and after treatment by measuring maximal nasal expiratory and inspiratory airflow and by measuring the area covered with vapor formed by the exhaled air on a plate. Highly reproducible results were obtained by using these three objective methods. Elevation of intranasal temperature resulted in amelioration of rhinitis symptoms and in objective evidence of increased nasal patency in a significant percentage of patients compared to the placebo-treated group.
Epithelial Distribution in the Human Fetal Larynx
Authors: Stafford Nicholas D. , Davies Stephen J.
Published: October 2014

Scanning and transmission electron microscopy and light microscopy were used to study the distribution of squamous epithelium and ciliated respiratory type epithelium in ten midtrimester human fetal larynges. Particular attention was paid to the subglottic region, where previous studies have reported areas of squamous metaplasia in neonates, infants, and nonsmoking adults. Both types of epithelium were found in different proportions in the supraglottic, glottic, and subglottic regions. There was considerable downward extension of squamous epithelium from the glottis into the subglottic region, with a wide transition zone where both types of epithelium were found in close association. These observations would suggest that such areas of squamous epithelium in the nonglottic larynx are normal, rather than always indicating a response to extrinsic trauma or irritation. Therefore, the term squamous metaplasia may be inappropriate when applied to such areas in the adult larynx.
Surgery for Congenital Conductive Deafness in Klippel-Feil Syndrome
Authors: van Rijn Peter M. , Cremers W. R. J.
Published: October 2014

A wide variety of anomalies of the middle and inner ear has been reported in association with congenital deafness in Klippel-Feil syndrome. Findings of six new exploratory tympanotomies are added to a review of 14 previously reported; for this entire group, better hearing was achieved in eight ears. When the only anomaly is a disconnection of the incudostapedial joint, good results can be expected from reconstruction of the ossicular chain. With the addition of the six newly reported stapedectomies, the success rate for this procedure now equals 50%. None of the fenestrations of the promontory performed for absence of the stapes and oval window have been successful. Since these results are encouraging, it is concluded that an exploratory tympanotomy should be considered during the course of hearing rehabilitation in cases of Klippel-Feil syndrome and a significant conductive hearing loss. Anomalies of inner ear structures established preoperatively may be a contraindication for stapedectomy.
Alternate and Simultaneous Binaural Bithermal Caloric Testing: A Comparison
Authors: Furman Joseph M. R. , Wall Conrad , Kamerer Donald B.
Published: October 2014

This study compares the results from simultaneous binaural bithermal and alternate binaural bithermal caloric testing of 652 patients with dizziness. Also compared are the abilities of these tests to distinguish between a population of healthy asymptomatic subjects and our patient population. Caloric testing used a closed-loop irrigation system. Eye movements were monitored with electro-oculography. The agreement between the results from the two tests was low. Also, while the simultaneous test was more sensitive, the alternate test was more specific. Using receiver-operator characteristic methodology, it was found that the ability of the alternate test to distinguish between a healthy population and a patient population was superior to that of the simultaneous test. There was no improvement in the ability to distinguish between a healthy population and a patient population when the results from the two tests were combined as compared to using the alternate caloric test alone.
Anatomic Findings and Management of Choanal Atresia and the Charge Association
Authors: Coniglio John U. , Manzione James V. , Hengerer Arthur S.
Published: October 2014

The CHARGE association is a collection of multisystem congenital anomalies including choanal atresia. A review of the literature failed to identify any specific findings that suggested the need to alter the management of choanal atresia in these patients. Our review of 24 patients with choanal atresia managed between 1974 and 1986 identified nine patients with the CHARGE criteria. These nine patients demonstrated a higher prevalence of surgical failures than the patients without the CHARGE association. The reasons are discussed, and computed tomographic scans demonstrate the anatomic findings of a more contracted nasopharynx and narrowed posterior choanal region. Thus, successful repairs require a more radical resection of the posterior nasal septum and lateral bony walls that can be achieved only with a transpalatal approach. The preoperative airways of CHARGE association patients are also at increased risk of obstruction and may require intubation or tracheotomy during the early life of the patient.
Dilation of Esophageal Strictures: Comparative Morbidity of Antegrade and Retrograde Methods
Authors: Hawkins Donald B.
Published: October 2014

A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were secondary to caustic ingestion and 89% of the dilations were in these patients. Antegrade dilations were performed 389 times and retrograde dilations were performed 298 times. Esophageal perforation occurred seven times with antegrade dilations. There were no perforations with retrograde dilations. The retrograde method using Tucker bougies is the safest and most successful method of dilating severe strictures.
Obstructing Tumors of the Subglottic Larynx and Cervical Trachea: Airway Management and Treatment
Authors: Shapshay Stanley M. , Bohigian R. Kirk , Ruah Carlos B. , Beamis John F.
Published: October 2014

A series of 11 patients presenting with airway obstruction secondary to tumors involving the subglottic larynx and cervical trachea was treated with either carbon dioxide or neodymium:yttrium aluminum garnet laser tumor ablation. Choice of ventilation varied according to the site of airway obstruction: Venturi jet with ventilation laryngoscope for glottic and subglottic tumors and a specially designed ventilation laser fiber tracheoscope for tumors obstructing the cervical trachea. All patients subsequently had definitive treatment of the tumor and were relieved of the compromised airway. No complications associated with ventilation and treatment techniques were recorded.
Mechanisms of Pneumothorax following Tracheal Intubation
Authors: Berg Lawrence F. , Campos Mario , Mafee Mahmood F. , Applebaum Edward L.
Published: October 2014

To investigate the mechanism by which pneumothorax may occur as a complication of tracheal intubation, we submitted four cats to tracheotomy and three to tracheal intubation. To simulate the dissection of air along fascial planes following tracheotomy, we placed catheters in either the pretracheal or subcutaneous plane and applied positive pressure to the catheters. The cats undergoing tracheal intubation were ventilated with excessive positive pressure. Computed tomography was used to document the progression of pneumothorax. High positive pressures during mechanical ventilation led to pneumothorax and pneumomediastinum, and the mechanism was primarily the dissection of air along the perivascular sheaths of the pulmonary arteries, presumably due to rupture of perivascular alveoli. Dissection of air along the pretracheal fascia following tracheotomy produced pneumomediastinum but not pneumothorax. This suggests that pneumothorax occurring clinically is more likely a complication of assisted ventilation than a complication of tracheotomy surgery.
Evaluation of Laryngeal Calcium Deposition: A New Methodology
Authors: Yerman Howard M. , Werkhaven Jay , Schild Joyce A.
Published: October 2014

Despite study for over 100 years, sites and patterns of laryngeal calcification and ossification are understood incompletely. Methodologies used in the past have included radiographic imaging and histologic staining with hematoxylin and eosin. Investigation of this subject offers potential application in the correlation of laryngeal disease with loss of normal calcification patterns. A technique for the detection of calcium deposition in human larynges, formerly used only in staining bony and cartilaginous tissue of small vertebrates, is described. This technique offers the advantage of whole organ staining and provides a sensitive means of determining degree and pattern of laryngeal calcification. The results of our pilot investigation with photographic examples are presented.
Hypocalcemia following Pharyngoesophageal Ablation and Gastric Pull-up Reconstruction: Pathophysiology and Management
Authors: Price John C. , Ridley Marion B.
Published: October 2014

Profound hypocalcemia has been observed following surgical ablation of malignancies in the hypopharynx, larynx, cervical trachea, and esophagus. Adequate control of these tumors may require extirpation of the visceral compartment of the neck and upper mediastinum. Preservation of parathyroid glands is sometimes inconsistent with good oncologic principles. Postoperative hypocalcemia develops rapidly, and high-dose intravenous calcium supplementation is required. Clinical observations indicated that requirements for calcium supplementation were reduced dramatically once oral feeding was instituted. It is postulated that dysfunction arising from surgical manipulation of the duodenum, the primary site for active calcium absorption, and bypass of that bowel segment by the feeding jejunostomy are primary contributors to the severity of hypocalcemia. A plan of management is proposed that includes early postoperative administration of 1,25-dihydroxyvitamin D or dihydrotachysterol, active vitamin D metabolites that promote the absorption of calcium. Early oral feeding is encouraged. Other mechanisms of calcium loss, appropriate calcium management, and parathyroid autotransplantation are discussed.
Laryngeal Framework Surgery in the Management of the Aged Larynx
Authors: Tucker Harvey M.
Published: October 2014

Laryngeal framework surgery as described by Isshiki, LeJeune, and Tucker offers the opportunity to adjust vocal fold tension. A modification of Isshiki's technique has been applied in ten patients exhibiting the breathiness and quavering voice typical of an “elderly” larynx, eight of whom have been followed long enough to be evaluated, and in two younger patients with similarly unexplained vocal fold flaccidity. Patient selection, technique, and results are reported. The procedure is of limited value in elderly patients because of eventual relaxation of tissues, but seems to provide significant long-term improvement in younger patients.
Pneumothorax as a Complication of Tracheoesophageal Voice Prosthesis Use
Authors: Odland Rick , Adams George
Published: October 2014

A previously unreported association of pneumothorax and the use of a tracheoesophageal voice prosthesis is presented. A review of 44 cases revealed that two patients developed a pneumothorax requiring chest tube placement. Pulmonary barotrauma is believed to be the cause of the injury. In those patients in whom the tracheoesophageal voice prosthesis has been effective, it has produced excellent results. However, certain pulmonary conditions may be considered a relative contraindication to the use of the tracheoesophageal voice prosthesis in patients who must generate significant force to produce voice. Patients using a voice prosthesis who present with symptoms of chest pain or dyspnea must be evaluated carefully for pulmonary rupture.
Adult Subglottiscope for Laser Surgery
Authors: Ossoff Robert H. , Duncavage James A.
Published: October 2014

A subglottiscope for use in adult men and women has been developed for microlaryngeal laser operations in the subglottic region of the larynx. The tip has been designed to facilitate exposure of the subglottis and upper trachea in both short-necked and long-necked individuals. A smoke evacuation channel has been included, as has a nonreflective finish. Finally, a port for jet ventilation has been added to facilitate use of this anesthetic technique when indicated. The authors have used the prototypes of these subglottiscopes on six patients, four women and two men, and have found the exposure of subglottic and upper tracheal lesions to be improved over that obtained with existing microlaryngoscopes.
Selective Lesions of the Vestibular Labyrinth
Authors: Kimura Robert S. , Iverson Nancy A. , Southard Rebecca E.
Published: October 2014

In attempts to decrease gentamicin ototoxicity, the round windows of guinea pigs were covered with fat before gentamicin was given through the middle ear cavity. Although ototoxicity to the cochlea was reduced, the desired effect on the vestibular sense organs also was reduced, because of the oval window's resistance to drug penetration. In another series of guinea pigs, simple opening of the lateral semicircular canal and covering it with a pledget of Gelfoam soaked with gentamicin was an excellent method for producing a selective vestibular lesion. It is expected to reduce the function of all vestibular sense organs without impairing cochlear function.
Middle Ear Implantable Hearing Device: Ongoing Animal and Human Evaluation
Authors: Hough Jack , Dormer Kenneth J. , Meikle Mary , Baker R. Stan , Himelick Tom
Published: October 2014

The first five patients have been permanently implanted with an electromagnetic middle ear implantable hearing device. Hearing tests were performed at the time of operation and at 8 weeks postoperatively with a coil held at the isthmus of the ear canal. All patients reported clear, high fidelity sound, as proven by speech discrimination scores. Improvements were seen in all frequencies, including 4,000 Hz. Improvement in pure tones as tested with an audiometer monitoring sounds amplified by a 3-V sound processor was as high as 50 dB sound pressure level. That which remains to be done is the final design of a compact, wearable sound processor with filtering and signal-processing capabilities to meet the needs of the sensorineural hearing-impaired population.
Surgical Treatment of Cholesteatoma: The Role of Staging in Closed Operations
Authors: Smyth Gordon D. L.
Published: October 2014

It has been proposed that closed operations on cholesteatomatous ears should be performed on a two-stage basis in order to detect disease left behind at the first operation and to correct developing retraction pockets. Two groups of patients who had closed operations performed in two stages, 100 combined approach tympanoplasties and 100 mastoid obliterations with tympanoplasty, were observed for 10 years after the second stage. A much greater than expected incidence of eventual cholesteatoma recurrence suggests that even with staging, closed techniques may provide a less than reliable outcome in surgical control of the disease, and long-term observation of ears thus treated is desirable.
Newer Techniques of Laryngeal Reinnervation
Authors: Maniglia Anthony J. , Dodds Brian , Sorensen Kelly , Kumar N. , Katirji M. B.
Published: October 2014

We relate the experience obtained in the use of the right superior laryngeal nerve (motor branch)–cricothyroid muscle pedicle flap in dogs in an attempt to reinnervate the right posterior cricoarytenoid muscle (PCA). The right vocal cord was paralyzed by severance and removal of 2.5 cm of the right recurrent laryngeal nerve. Evaluation 6 months postoperatively revealed the vocal fold remobilization on the right side to have an average of about one half the mobility of the left, normal side. After the recurrent laryngeal and superior laryngeal nerves on the left were severed, the vocal cord mobility dropped to only about one fourth. This suggests that the dogs had contralateral reinnervation. Nevertheless, the right vocal cord mobility, driven only by the right superior laryngeal nerve, was enough to secure an adequate airway without the need for a tracheotomy. This experiment was statistically significant on comparison with a control group. Electromyographic studies as well as PCA histochemistry were performed.
Video Nasopharyngoscopy: A Comparison of Fiberscopic, Telescopic, and Microscopic Documentation
Authors: Yanagisawa Eiji , Kmucha Steven T. , Isaacson Glenn , Hirokawa Ronald
Published: October 2014

Video nasopharyngoscopy is a most valuable method of documenting the anatomy and pathophysiology of the nasopharynx. Such a permanent record is useful for diagnosis, patient counselling, resident teaching, and the monitoring of therapy in nasopharyngeal disorders. To evaluate the various techniques for assessment of the nasopharynx, the authors have attempted to systematically compare flexible and rigid endoscopes and mirror examination during video recording. The pros and cons of 1) transnasal fiberscopic, 2) transnasal telescopic, 3) transoral telescopic, and 4) transoral microscopic mirror examination methods for video nasopharyngoscopy are discussed.
Squamous Cell Carcinoma of the Thyroid: A Diagnostic Dilemma
Authors: Korovin Gwen S. , Cho Hyun T. , Kuriloff Daniel B. , Sobol Steven M.
Published: October 2014

Four cases of primary squamous cell carcinoma of the thyroid gland are reported. Thorough evaluation confirmed these lesions to be of primary thyroid origin rather than from metastasis or direct invasion from contiguous structures. These cases illustrate the aggressive nature of the disease and the propensity for local and distant metastases. The clinicopathologic data presented here underscore the challenge in diagnosis and treatment of this rare entity.
Acute Management of Laryngeal Trauma Update
Authors: Schaefer Steven D. , Close Lanny G.
Published: October 2014

The management of 120 laryngeal injury patients at a major trauma center over 23 years is presented in the form of two patient populations. The first population consists of 52 previously analyzed and reported laryngeal trauma patients who served as the basis for the subsequent refinement of treatment of a second population of 68 patients. Collectively, these patients form a series unique in that 1) it comprises the largest number of such injuries treated at one institution, 2) the management principles remained the same throughout the entire 23 years, and 3) the majority of the patients were managed by one physician. The experience gained from these patients is examined in the hope of resolving prevailing controversies about the treatment of the acutely injured larynx.
Laser Surgery for Vocal Cord Carcinoma Involving the Anterior Commissure
Authors: Krespi Yosef P. , Meltzer Charles J.
Published: October 2014

Endoscopic laser surgery is an established means of treatment for benign laryngeal lesions. Laser surgery for early (stages I and II) squamous cell carcinoma is still being tested. Treatment of glottic tumors extending to the anterior commissure is in itself controversial. Approximately 20% of all glottic tumors involve the anterior commissure, with only 1% of these lesions being purely anterior commissure tumors. The anatomy of the anterior commissure is such that an apparent T1 lesion may actually be a T4 lesion if it involves the thyroid cartilage. The distance between the anterior commissure ligament and the thyroid cartilage is only 2 to 3 mm. A preoperative computed tomographic scan can aid us in evaluating this space. Therefore, tumors of the anterior commissure present as a therapeutic challenge. Radiation therapy has proven to be inadequate, with a high rate of recurrence and increased risk for radiochondronecrosis. The literature with regard to radiotherapy varies widely as to survival rates. Conservation surgery has consistently demonstrated an 80% survival in T1 lesions. Recently, it has been suggested that laser surgery in the region of the anterior commissure might offer satisfactory results. We have found the opposite. We will report on five patients who underwent endoscopic laser surgery on T1 vocal cord lesions involving the anterior commissure. All of these patients had tumor recurrence and subsequently have undergone salvage surgery and/or radiation therapy. The difficulties associated with endoscopic laser surgery of the anterior commissure will be discussed with a supporting animal study.
Choanal Atresia: Treatment Trends in 47 Patients over 33 Years
Authors: Ferguson Jonathan L. , Neel H. Bryan
Published: October 2014

From 1977 through 1985, 11 patients underwent surgical correction of choanal atresia. This group brings the total number of patients corrected at our institution since 1951 to 47. This review compares treatment and outcome in the most recent group with the previous series of 36 patients. Eight patients were female and three were male; their ages at the time of surgical treatment ranged from 1 day to 19 years. The atresia was bilateral in five patients and unilateral in six. Six patients had other physical or mental developmental problems. Mean follow-up was 5.6 years (range, 2 to 10 years). All five patients who had transnasal puncture as primary treatment required reoperation; this is a higher incidence of failure than in the previous group. None of the three patients who had transpalatal procedures needed further operation. In two of the eight patients who had transseptal repair, restenosis developed.
Effects of Cricothyroid Muscle Contraction on Laryngeal Resistance and Glottic Area
Authors: Woodson Gayle E. , Mathew Oommen , Sant'Ambrogio Franca , Sant'Ambrogio Giuseppe
Published: October 2014

To determine the functional significance of the cricothyroid muscle (CT) in respiration, laryngeal resistance was measured in anesthetized dogs, along with electromyographic activity of the posterior cricoarytenoid muscle (PCA) and CT. In two dogs the larynx was videotaped simultaneously via a telescope. Increased CT activity was induced by airway occlusion or hypercapnia. Observations were carried out before and during cold blockade of the recurrent laryngeal nerve (RLN) or the nerve to the CT (external branch of the superior laryngeal nerve [Ext SLN]). Paralysis of the CT had no effect on laryngeal resistance or glottic area, even at very high levels of CT activity. Blockade of the RLN increased inspiratory resistance, but did not have a significant effect on expiratory resistance. Electrical stimulation of the Ext SLN produced tetanic CT contraction, which increased laryngeal resistance in both inspiration and expiration. This was true even at very high levels of PCA activity. These results indicate that although artificially induced CT contraction markedly affects laryngeal resistance, physiologic levels of respiratory activity do not have a significant effect.
Pathology Consultation Low-Grade and High-Grade Adenocarcinomas of the Salivary Duct System
Authors: Batsakis John G. , Luna Mario A.
Published: October 2014

Adenocarcinomas of salivary glands are encountered less frequently than adenoid cystic or mucoepidermoid carcinomas. They fall into two well-defined clinicopathologic groups: 1) those arising from intercalated ducts and 2) those from the excretory and interlobular ducts. The former, designated terminal duct adenocarcinomas, are low-grade malignancies found preponderantly in the oral cavity, especially the palate. The latter, designated salivary duct carcinomas, are high-grade neoplasms and arise almost exclusively in major salivary glands, especially the parotid gland.
Obstructive Sleep Apnea Syndrome in Sickle Cell Disease
Authors: Maddern Bruce R. , Ohene-Frempong Kwaku , Reed Hollis T. , Beckerman Robert C.
Published: October 2014

We present a series of 21 children with obstructive sleep apnea syndrome and sickle cell disease (SCD). Thirteen patients underwent adenotonsillectomy with resolution of symptoms and improvement in alveolar hypoventilation. Adenotonsillectomy involves significantly increased risks in patients with SCD. We present our protocol for management of these difficult surgical patients, including vigorous hydration and transfusion therapy. Polysomnography has proven valuable both in diagnosis and in identifying severely affected patients. Increased end tidal alveolar carbon dioxide during sleep has proven to be a significant predictor of disease, while oxygen saturation monitoring was shown to be unreliable. The incidence of adenotonsillar hypertrophy (ATH) in SCD appears increased and not related to infectious diseases. We suggest that ATH represents a part of the natural course of compensatory lymphoid tissue enlargement in children with SCD.
G Syndrome and its Otolaryngologic Manifestations
Authors: Howell Laurene , Smith James D.
Published: October 2014

G syndrome is a familial constellation of congenital anomalies that include a distinctive facies, ocular hypertelorism, prominent occiput and forehead, short lingual frenulum, stridor, hoarse cry, and laryngotracheoesophageal (LTE) clefts, as well as hypospadias and cryptorchidism. Approximately one third of the reported cases have also involved cleft lip and/or palate. Thirty cases of this syndrome have been reported in the pediatric and genetic literature, with variable expression of the syndrome characteristics. The purpose of this article is to report two additional cases of G syndrome with LTE cleft. A technique for repair of LTE cleft via a lateral pharyngeal approach is described. Although G syndrome is rare, otolaryngologists should be aware of its association with LTE cleft and its potential life-threatening problems.
Definitive Radiotherapy in the Management of Stage I and II Carcinomas of the Glottis
Authors: Kelly Maria D. , Spaulding Cynthia A. , Constable William C. , Hahn Seung S. , Kersh C. Ronald , Cantrell Robert W.
Published: October 2014

Definitive radiotherapy for early glottic carcinoma continues to offer excellent control and the advantage of voice preservation. In the 13 years from January 1972 through December 1984, there were 187 patients diagnosed with squamous cell carcinoma of the glottis at the University of Virginia Medical Center. One hundred forty-eight patients were treated with definitive radiotherapy as the initial management. The 3-year disease-free survival for the irradiated population was 93.6% in stage I and 75.5% in stage II. Twenty patients had recurrences following radiotherapy, and 13 of 20 were successfully surgically salvaged for an overall determinate survival of 100% in stage I and 85.7% in stage II at 3 years. These statistics are comparable to those from our previous 16-year review of 147 patients from 1956 through 1971. Factors of prognostic significance were persistent hoarseness after radiotherapy, impaired cord mobility, subglottic extension, and multiple sites of involvement in stage I. We conclude that definitive radiotherapy offers excellent survival and that a majority of the small number of treatment failures can be managed with surgical salvage.
Hearing in Chronic Suppurative Otitis Media
Authors: Browning George G. , Gatehouse Stuart
Published: October 2014

In individuals with chronic otitis media, mixed hearing impairments are common but it is unclear whether the raised bone conduction thresholds are a reflection of the pathologic process affecting the inner ear or a combination of the high prevalence of sensorineural hearing impairments in the population along with the artificial elevation of bone conduction thresholds associated with a conductive defect. a total of 395 ears with chronic otitis media but without cholesteatoma were studied. In them, once the artificial elevation (Carhart effect) of the bone conduction thresholds, which occurs whenever there is an abnormality of the sound conduction mechanism, had been taken into account, there was no difference in the bone conduction thresholds compared with those in 920 control ears. In addition, in 100 instances, the contralateral ear was normal and there was no difference in the bone conduction thresholds between the diseased and the normal ears. Raised bone conduction thresholds in chronic otitis media are considerably likely to reflect both the Carhart effect and the high prevalence of sensorineural impairments, rather than disease damage to the inner ear.
Low Frequency Oscillatory Ventilation through the Suction Channel of a Pediatric Bronchoscope
Authors: Nutman Jacob , Carlo Waldemar A. , Chatburn Robert L.
Published: October 2014

To determine whether low frequency oscillatory ventilation (LFOV) may be safely applied through the suction channel of a pediatric fiberoptic bronchoscope, we devised a system using a combination of jet ventilation and constant air suction, both delivered with a single interface valve. The system was tested on an in vitro lung model and on rabbits. With tidal volumes of 12 mL, inadvertent increase in functional residual capacity (FRC) measured in the lung model was minimal. All rabbits experienced marked hypoventilation (PaCO2 62 ± 2 torr) on introduction of the bronchoscope, which promptly improved with administration of LFOV (PaCO2 41 ± 4 torr). That baseline FRC remained stable indicated that air trapping did not occur. We conclude that LFOV improves ventilation in rabbits during bronchoscopy without causing air trapping. A similar system might be applied during bronchoscopy in full-term and premature infants, thus facilitating safer and more complete visualization of their airways and preserving the possibility of obtaining samples by suction.
Quantitative Bacterial Cultures and Beta-Lactamase Activity in Chronic Suppurative Otitis Media
Authors: Brook Itzhak , Yocum Paula
Published: October 2014

Aspiration of the exudate through open perforation was performed in 54 children with chronic suppurative otitis media. Eighty aerobic and 81 anaerobic isolates were recovered. Aerobic bacteria only were involved in 20 patients (37%), and anaerobic organisms only in seven (13%). Mixed aerobic and anaerobic isolates were recovered from 27 patients (50%). The most common bacteria isolated were anaerobic gram-positive cocci, Bacteroides melaninogenicus group, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus. There were 45 β-lactamase–producing bacteria (BLPB), 30 aerobes, and 15 anaerobes recovered from 38 patients (70%). β-Lactamase activity was detected in 30 of the 38 ear aspirates (79%) that contained BLPB. All but one of these organisms were in excess of 104 colony-forming units/mL. The detection of β-lactamase activity in the ear aspirates provides evidence of the role of BLPB in the failure of penicillin therapy to eradicate chronic ear infection.
Increased Ciliary Beating Frequency of Nasal Mucosa following Immunotherapy for Allergy
Authors: Ohashi Yoshihiro , Furuya Hiroyuki , Nakai Yoshiaki , Esaki Yusuke , Ikeoka Hiroshi , Kato Shoko
Published: October 2014

The present study was designed to elucidate the effect of immunotherapy on the beating frequency of nasal cilia in patients with nasal allergy. Of 40 patients with nasal allergy due to Dermatophagoides farinae, 20 were treated with immunotherapy by the use of D farinae extracts, and 20 control patients were treated with antihistamine tablets. Mucosal pieces were taken from the right inferior turbinate before and 1 year after the initiation of treatment, and the ciliary beating frequency (CBF) was examined by a photoelectric method. The use of antihistamine tablets did not increase CBF even when it relieved the nasal symptoms. Immunotherapy, on the other hand, increased CBF in 66.7% of patients when it alleviated their nasal symptoms. The CBF before immunotherapy of patients who showed an increased CBF after treatment was statistically higher than that of patients who did not.
Evaluation of Pure Tone and Speech Discrimination Changes in Usher's Syndrome
Authors: Meyer Dianne H. , Piazza Lawrence , Fishman Gerald A.
Published: October 2014

Twenty-three adult patients with type 2 Usher's syndrome were evaluated for changes in pure tone average (PTA), discrete frequency thresholds, and speech discrimination scores. These patients were evaluated over a period of 5 years on the average (range, 2 to 9 years). Analyses of ear data showed a <10-dB change on PTA and discrete frequency thresholds for most ears. Of the ears that showed a threshold change ≥ 10 dB, statistical significance was reached only at 4,000 Hz (p < .01), where 11 ears representing ten patients dropped 10 to 15 dB. Speech discrimination data showed a ≥ 16% change in score for 18 ears (12 patients). Sixteen of those ears (ten patients) had a 16% to 52% decrease in score (p < .01), and the remaining two ears (two patients) showed a 20% and 30% improvement in score. These findings document little or no change in pure tone sensitivity for type 2 Usher's syndrome patients, but demonstrate the importance of monitoring their speech discrimination performance.
Prognosis of Secretory Otitis Media in Relation to Viscoelasticity of Effusions in Children
Authors: Takeuchi Kazuhiko , Morishita Atsuhito , Majima Yuichi , Hattori Masahiko , Hirata Keisuke , Sakakura Yasuo
Published: October 2014

Both elasticity (G′) and viscosity (η′) of middle ear effusions (MEEs) were measured with an oscillating sphere magnetic rheometer and compared with continuance of fluid retention in 93 ears of 69 children with otitis media with effusion (OME). The ears were divided into four groups according to the viscoelastic properties of MEEs at the first myringotomy. Eighty-four percent of the ears in group 2 were free from effusion within 4 months; the difference from the other groups was statistically significant. These results indicate that the mucociliary clearance function plays an important role in the process of recovery from OME.
Electrocochleographic Changes in Endolymphatic Hydrops Induced by Type II Collagen Immunization through the Stylomastoid Foramen
Authors: Ohashi Toru , Tomoda Koichi , Yoshie Nobuo
Published: October 2014

Changes in action potential (AP) and summating potential (SP) were investigated in guinea pigs immunized with type II collagen through the stylomastoid foramen. Endolymphatic hydrops could be induced in four of 11 guinea pigs. The striking feature of the electrocochleographic waveform in guinea pigs with endolymphatic hydrops was the negative SP recording in response to high frequency tone bursts. Furthermore, abnormal changes in AP were observed in three of four hydropic guinea pigs. Morphologic study of the cochleas in these three guinea pigs with light microscopy revealed spiral ganglion cell degeneration in addition to endolymphatic hydrops and almost normal sensory hair cells. These results suggest that guinea pigs with hydrops as produced by our procedure can serve as a useful model of Meniere's disease, that autoimmune response may play an important role in the etiopathogenesis of Meniere's disease, and that spiral ganglion cell degeneration together with endolymphatic hydrops seems to contribute to abnormal changes in AP.
Proteases and Protease Inhibitors in Immune Complex Otitis Media in Chinchillas
Authors: Hamaguchi Yukiyoshi , Morizono Tetsuo , Juhn Steven K. , Sakakura Yasuo
Published: October 2014

Using an immune complex–induced (IC) otitis media model in chinchillas sensitized with human serum albumin (HSA), we measured the levels of protease activity, protease inhibitors, and HSA in the middle ear fluid (MEF). The effect of a corticosteroid agent (triamcinolone) on the degree of IC otitis media also was studied. The levels of protease inhibitors α1-antitrypsin and α2-macroglobulin in the MEF were significantly higher than in nonsensitized animals. Fibrinolytic (plasminogen activator [PA]) activity was detected in the MEF; however, only a small level of activity of nonspecific proteases was detected because of the significant level of antitryptic activity in the MEF. The levels of protease inhibitors and PA activity were significantly reduced by the steroid treatment. It is concluded that protease inhibitors play an important role in the protection of the middle ear mucosa and that corticosteroid treatment can reduce the severity of IC otitis media.