bluuebunny/crossref_metadata_2025 huggingface dataset:
Adductor Spasmodic Dysphonia and Botulinum Toxin Treatment: The Effect on Well-Being
Authors: Langeveld Ton P. M. , Luteijn Frans , Drost Harm A. , van Rossum Maya , de Jong Robert J. Baatenburg
Published: October 2014

Adductor spasmodic dysphonia (AdSD) is a controversial and enigmatic voice disorder. It is generally accepted that it has a neurologic, although undetermined, cause, and it is accompanied by much psychological and physical distress. In this prospective study, standardized psychometric tests were used to assess the personality characteristics and psychological and somatic well-being of 46 patients with AdSD. Moreover, the effect of botulinum toxin (Botox) treatment on their well-being was evaluated. No significant differences could be detected between patients and a representative norm group concerning 7 personality characteristics. Nevertheless, before treatment, there were significantly more psychological and somatic complaints. After establishment of a normal to near-normal voice with Botox injections, these complaints were reduced to normal levels — a finding suggesting these phenomena to be secondary to the voice disorder. These findings, and the normal personality characteristics, do not support a psychogenic cause of AdSD.
Dynamic Assessment of Paranasal Sinus Ventilation Using Xenon-Enhanced Computed Tomography
Authors: Marcucci Catherine , Leopold Donald A. , Zinreich S. James , Cullen Michelle , Simon Brett A.
Published: October 2014

Disease of the paranasal sinuses is a common and costly condition. Evaluation of the efficacy of either medical or surgical methods of treatment is limited by the lack of quantitative methods to characterize sinus ventilation, which may be an important determinant of the baseline physiological state of the sinuses. Xenon-enhanced computed tomography (Xe-ct) measurement of sinus ventilation provides a noninvasive method of quantifying maxillary sinus ventilation using the nonradioactive, radiodense gas Xe as a tracer. Study subjects breathed a mixture of Xe gas and oxygen through a close-fitting nasal mask during serial ct imaging of a single radiographic plane through the maxillary sinuses — a generally well-tolerated protocol. Analysis of the sinus density–time curves allowed calculation of first-order exponential time constants from which specific ventilation rates could be determined for individual sinuses. Previously developed data analysis techniques were used to assess the statistical significance of the data and determine confidence intervals, allowing examination of the effects of noise in the data, and to demonstrate areas for further study protocol refinement. We conclude that Xe-ct measurement of sinus ventilation is a potentially valuable noninvasive technique for the diagnostic imaging of the human maxillary sinus.
Atypical Fibroxanthoma
Authors: Hakim Ishrat
Published: October 2014

This is the first case report of atypical fibroxanthoma in the otolaryngology literature. Atypical fibroxanthoma is a rare fibrohistiocytic tumor that occurs on actinically damaged skin. The typical presentation is a nodular lesion in sun-exposed areas of the head and neck in an elderly patient. Differentiating atypical fibroxanthoma from other soft tissue sarcomas, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, can be difficult. Treatment should be wide local excision with a 1-cm margin. In cosmetically important regions in which tissue preservation is important, Mohs' surgery should be considered.
Auricular Exostoses among the Prehistoric Population of Different Islands of the Canary Archipelago
Authors: Arnay-de-la-Rosa Matilde , González-Reimers Emilio , Velasco-Vázquez Javier , Santolaria-Fernández Francisco
Published: October 2014

It is generally believed that auricular exostoses are due to prolonged exposure to cold water, so their existence in ancient remains may inform us about economic activities in the past. This study was performed to analyze the prevalence of auricular exostoses among 150 pre-Hispanic individuals of different islands of the Canary archipelago. Individuals from Gran Canaria (6/26), Fuerteventura (1/15), and Tenerife (2/64), but not from El Hierro (0/45), showed auricular exostoses, thus supporting the hypothesis of a greater reliance on fishing and shellfishing in the former 3 islands.
Eustachian Tube Function in Children after Insertion of Ventilation Tubes
Authors: van Heerbeek Niels , Snik Ad F. M. , Ingels Koen J. A. O. , Zielhuis Gerhard A.
Published: October 2014

This study was performed to assess the effect of the insertion of ventilation tubes and the subsequent aeration of the middle ear on eustachian tube (ET) function in children. Manometric ET function tests were performed repeatedly for 3 months after the placement of ventilation tubes in 83 children with otitis media with effusion (OME). Opening and closing pressures (passive tubal function) and active tubal function were measured. Analysis of the results showed a significant increase in opening pressure over time, whereas the closing pressure did not change. The active tubal function did not change and remained at the same poor level. Therefore, the opening pressure and closing pressure and, especially, the poor active tubal function, were more likely to be a causal factor of OME than a result. Certain children may have poor intrinsic ET function that makes them more susceptible to OME.
Subglottic Stenosis Complicated by Allergic Esophagitis
Authors: Hartnick Christopher J. , Cotton Robin T. , Liu James H. , Rudolph Colin
Published: October 2014

Allergic esophagitis is a known entity that had been described in patients with dysphagia. It has not been previously described in association with subglottic stenosis. We report the case of a 2-year-old girl with symptoms suggestive of allergic esophagitis who suffered from subglottic stenosis that recurred despite surgical measures. Her esophageal pH monitoring results were normal, and she did not respond to antireflux medications. She did respond dramatically to corticosteroid therapy with improvement of both her esophageal and laryngeal symptoms. Allergic esophagitis as a clinical entity is discussed.
Median Cleft of the Lower Lip: Report of Two New Cases and Review of the Literature
Authors: Seyhan Tamer , Kýlýnç Hýdýr
Published: October 2014

Median clefts of the lower lip and mandible are rare craniofacial clefts. Couronné in 1819 was the first to describe the condition. The midline cleft of the lower lip was classified by Tessier as a type 30 craniofacial cleft. Recently, the total number of the reported cases had increased to about 66 in the world literature. In addition, 2 more patients are presented here. The first case involves only a small notch in the vermilion; the deformity was treated by Z-plasty. In the second case, a midline incomplete cleft of the lower lip, a sublingual abnormal frenulum, a complete cleft in the mandible, a bifid sternum, a presternal skin tag, and a ventricular septal defect in the heart were present. At operation, Z-plasty of the lingual frenulum released the normal-sized tongue. The lip cleft was corrected by a simple V excision followed by closure in 3 layers. The mandibular segments were “vitalized” with a bone rongeur and immobilized in the predetermined position with an interosseous stainless steel wire. Because the bone fusion was complete, the stainless steel wire was taken out after 3 months so that it would not prevent mandibular development. Our treatment methods and others are discussed.
Expression of Heat Shock Protein 70 in the Cochlea in Experimental Autoimmune Inner Ear Disease
Authors: Gong Shu-Sheng , Yan Zhen
Published: October 2014

To explore whether the immune response of the inner ear could induce heat shock protein 70 (hsp70) in the guinea pig cochlea, we established a model of autoimmune inner ear disease (AIED) by systemically immunizing guinea pigs with homologous crude inner ear antigen (CIEAg). The immunized cochleas and normal control cochleas were examined for the expression of hsp70 by immunohistochemical analysis and in situ hybridization. It was found that 10 of 28 ears showed significant increases in hearing thresholds after the animals had been sensitized with CIEAg, and 67.9% of the ears from the immunized animals had modiolar vasculitis. The hsp70-like proteins were basically expressed in the normal cochleas, but dramatically increased expressions of hsp70 (perhaps also including hsp70-like molecules) and its messenger RNA were observed in the cochleas of the AIED models. The results suggest that the immune response of the inner ear induced the expression of hsp70 in the guinea pig cochleas.
Induction of Mucous Cell Metaplasia by Tumor Necrosis Factor Alpha in Rat Middle Ear: The Pathological Basis for Mucin Hyperproduction in Mucoid Otitis Media
Authors: Haruta Atsushi , Schachern Patricia A. , Kawano Hirokazu , Tsuboi Yasuhiro , Paparella Michael M. , Kim Youngki , Lin Jizhen
Published: October 2014

Mucoid otitis media (MOM), one of the leading causes of acquired hearing loss in children, is characterized by mucous cell hyperplasia in the middle ear cleft associated with mucin accumulation in the middle ear cavity. The factors that stimulate mucous cell metaplasia-hyperplasia and mucin hyperproduction are poorly understood. Recent studies demonstrated that tumor necrosis factor a (TNF-α), present in human middle ear effusion, stimulated mucin production in vitro and up-regulated mucin gene expression in vivo. These findings suggest that TNF-α is important in the development of mucous cell metaplasia-hyperplasia. This study demonstrated that inoculation of TNF-α into the middle ear cavity followed by eustachian tube obstruction stimulated mucous cell metaplasia-hyperplasia in the middle ear cleft, accompanied by abundant mucin or mucin-like glycoproteins in the middle ear effusion — a phenotype of MOM in humans. This finding suggests that TNF-α plays a key role in the pathogenesis of MOM through induction of mucous cell metaplasia-hyperplasia and mucin production.
Extracapsular Spread in Ipsilateral Neck and Contralateral Neck Metastases in Laryngeal Cancer
Authors: Suoglu Yusufhan , Erdamar Burak , Karatay M. Can , Katircioglu O. Sami , Sunay Tayfun
Published: October 2014

We investigated the incidence of extracapsular spread (ECS) and the impact of ECS on contralateral neck metastasis in 67 patients with ipsilateral nodal metastasis (IpN+) whose records were extracted retrospectively from those of 155 laryngeal cancer patients. The incidence of ECS in association with variables was determined: T stage, N stage, tumor location, tumor extension, number of positive nodes, and contralateral neck status. The variables were evaluated to identify their impact on the rates of contralateral neck metastasis (CNM) and 3-year survival. Of the 67 patients, 30 (44.7%) had ECS. A significant relationship was found between ECS positivity and increased N stage, tumor extension up to the midline, number of positive nodes, and CNM (p = .04, p = .0001, p = .018, p = .0001, respectively). Multivariate analysis revealed that N stage (p = .002; odds ratio, 3.5517) and the presence of ECS (p = .0036; odds ratio, 7.7840) in IpN+ were associated with the greatest risk of CNM. The 3-year survival rate of patients with ipsilateral ECS was significantly lower than that of patients without ECS (43% versus 81%, p = .0002). Both CNM and presence of ECS in IpN+ emerged as significant independent predictors for survival with Cox multivariate analysis (p = .0086 and p = .0234, respectively). This result indicates the necessity of treating the contralateral NO neck in cases of IpN+ with ECS.
Isolated Congenital round Window Absence
Authors: Martin Christian , Tringali Stéphane , Pouget Jean-François , Bertholon Pierre , Prades Jean-Michel
Published: October 2014

Absence of the round window as a congenital defect is a rare entity that causes a conductive hearing loss. To the best of our knowledge, isolated and nonsyndromal round window absence has only been reported 3 times; the diagnoses were made during surgery. We are reporting on another case that was diagnosed before operation by virtual endoscopy of the middle ear during a high-resolution computed tomography scan. Although this new technique requires further validation, it may be an alternative to surgery as a means of confirming this rare diagnosis.
High-Dose Glucocorticoids Inhibit Proliferation of Rat Olfactory Epithelium
Authors: Ohta Yasushi , Marino Nobuko , Takanosawa Minako , Ishimoto Shinichi , Matumoto Chiori , Ichimura Keiichi
Published: October 2014

Glucocorticoids (GCs) are commonly prescribed for treatment of olfactory dysfunction. However, the effects of GCs on olfactory epithelium are not well known. We investigated the effects of high-dose GCs on proliferating cells of olfactory epithelium. Five adult male rats (300 g) received a single daily subcutaneous dose of vehicle containing 0.3 mg dexamethasone (DEX) for 9 days (DEX+ group), and a control group received vehicle alone (DEX– group). We compared sections from the Two groups for numbers of Ki67-positive cells. The mean number of Ki67-positive cells per 500 olfactory epithelial cells was 9.6 for the DEX+ group and 58 for the DEX– group (significant difference). We conclude that high-dose GC suppressed proliferation of olfactory epithelium. We suggest that high-dose GC suppresses cytokines and growth factors, resulting in secondary suppression of proliferating ability.
Treatment of Recurrent Respiratory Papillomatosis in Children with the Microdebrider
Authors: Patel Nalin , Rowe Mark , Tunkel David
Published: October 2014

The mainstay of treatment of children with recurrent respiratory papillomatosis has been CO2 laser laryngoscopy. Powered microdebriders allow precise removal of laryngeal lesions without thermal damage. The microdebrider may reduce costs by reducing operative time and limiting the need for expensive laser-related equipment. To compare the use of the microdebrider with that of the CO2 laser in children undergoing surgery for recurrent respiratory papillomatosis, we retrospectively reviewed the charts of 18 patients from 2 institutions covering a treatment period between December 1998 and October 2001. These patients were initially treated with the CO2 laser, but were switched to microdebrider resection during the review period. We recorded the number of procedures, the technique(s) of resection used, and the operative time for each procedure. We identified 18 patients, 11 male and 7 female, ages 18 months to 14 years. A total of 127 procedures were performed with the CO2 laser, and a total of 50 procedures were performed with the microdebrider. The mean number of procedures per patient was 10 (range, 2 to 17 procedures). The mean surgical time per procedure using the CO2 laser was 59.2 minutes (range, 8 to 130 minutes). The mean time per procedure with the microdebrider was 32 4 minutes (range, 12 to 47 minutes). This reduction in operative time was clinically and statistically significant (p = .0001, unpaired Student's t-test). We concluded that microdebrider resection of laryngeal papilloma in children allowed more rapid surgery with potentially reduced treatment costs. Other advantages of this technique include precise excision without thermal injury. Our report details useful refinements of technique with the microdebrider.
Rate of Recovery of Taste Function after Preservation of Chorda Tympani Nerve in Middle Ear Surgery with Special Reference to Type of Disease
Authors: Sakagami Masafumi , Sone Mieko , Fukazawa Keijiro , Tsuji Kojiro , Mishiro Yasuo
Published: October 2014

To study the recovery of function of the chorda tympani nerve, we examined by electrogustometry 79 patients (83 ears) with both preoperative normal function of the nerve and operative preservation of the nerve, every 2 days during hospitalization and at 6 months after surgery. For symptoms such as tongue numbness and taste disturbance, patients with noninflammmatory (NI) diseases (13/20 or 65.0%) showed a significantly higher rate of symptoms than did patients with chronic otitis media (COM; 13/35 or 37.1%) at 2 weeks after surgery (p = .032). The patients with NI diseases (5/20 or 25.0%) tended to show a higher rate of symptoms than did the COM patients (2/35 or 5.7%) or cholesteatoma patients (2/28 or 7.1%) at 6 months after surgery. The rate of recovery of the EGM threshold to normal at 2 weeks after surgery was significantly lower in NI disease patients (6/20 or 30.0%) than in COM patients (23/ 35 or 62.9%) or cholesteatoma patients (19/28 or 67.9%; p = .015 and .008, respectively). Thus, the patients with NI diseases had postoperative symptoms and elevation of EGM threshold more frequently than did the patients with inflammatory diseases.
Molecular Transformation of Recurrent Respiratory Papillomatosis: Viral Typing and P53 Overexpression
Authors: Go Cynthia , Schwartz Mary R. , Donovan Donald T.
Published: October 2014

Recurrent respiratory papillomatosis (RRP) is a histologically benign disease of the larynx, trachea, and bronchi. Here we report on the histologic and molecular characteristics of 7 cases of malignant transformation of RRP to squamous cell carcinoma (SCCA). The clinical histories of 7 patients with RRP who developed SCCA were carefully reviewed. Sequential biopsies were available from 5 of the 7 cases of spontaneous transformation of RRP to SCCA and were reviewed. In addition, p53 protein overexpression and human papillomavirus (HPV) typing for all cases was examined. The average age of patients with juvenile-onset RRP was 3 years, and that of patients with adult-onset RRP was 31 years. The average age of onset of transformation to SCCA was 28 years. All patients had laryngeal involvement with RRP, and 3 of the 7 patients had tracheal extension of disease. Five patients were tracheotomy-dependent. Four of the 7 patients developed SCCA of the lung, while 3 patients developed laryngeal SCCA. There was no consistent histologic progression from squamous papilloma to papilloma with dysplasia, and all but 1 of the SCCAs were well differentiated. The overexpression of p53 protein was variable in each of the 5 patients. We detected HPV types 6/11 in papillomas from 3 patients, and HPV types 6/11, 16/18, and 31/33/51 in a papilloma of a fourth patient. No HPV DNA was detected in papillomas of 2 patients. We found HPV 6/11 in 4 of the carcinomas. We conclude that the spontaneous transformation of RRP to SCCA is not characterized by a histologic progression through dysplasia over time. Transformation can result in the loss of HPV expression. It does not appear that p53 is a molecular marker for monitoring the transformation process. Thus, these cancers may be very difficult to diagnose histologically and clinically early in the course of the transformation of the disease.
Electromyographic Findings in Recurrent Laryngeal Nerve Reinnervation
Authors: Maronian Nicole , Robinson Lawrence , Waugh Patricia , Hillel Allen
Published: October 2014

Abductor, adductor, and combined reinnervation procedures have been explored with variable success rates. We describe the experience of a tertiary care center with adductor reinnervation procedures, including preoperative and postoperative videostroboscopy and electromyography (EMG) findings. A retrospective chart review was performed from 1997 to 2001 that included 9 patients. Preoperative and postoperative voice comparison was performed by 3 blinded speech pathologists. Clinical comparisons of videostroboscopy findings for vocal fold bulk, tone, position, presence of gap, and movement are elucidated. The preoperative and postoperative EMG findings are described. In all patients, preoperative EMG revealed a dense, complete denervation of the affected recurrent laryngeal nerve. No movement was noted on videostroboscopy with persistent glottic gap. Reinnervation involved a nerve-muscle pedicle or a direct neurorrhaphy of the ansa cervicalis to the recurrent laryngeal nerve. Voice improvement was noted between 60 days and 3 months after reinnervation. Four postoperative EMG studies were performed. An early postoperative EMG study at 5 months revealed activation of the lateral cricoarytenoid muscle and thyroarytenoid muscle with head-lift. Videostroboscopy showed excellent near-midline static positioning of the vocal fold. Late EMG studies, performed 12 to 16 months after reinnervation, revealed “learning” of these muscles, with new activation on “eee” phonation. We conclude that recurrent laryngeal nerve reinnervation procedures belong in the armamentarium of the laryngologist for the treatment of vocal fold paralysis. The EMG findings reported in this study suggest that ongoing reinnervation allows for activation with phonation in matured neuronal anastomoses. Overall, this procedure results in excellent patient acceptance and near-normal vocal quality.
Usher Syndrome Type III Can Mimic other Types of Usher Syndrome
Authors: Pennings Ronald J. E. , Deutman August F. , Fields Randall R. , Kimberling William J. , Huygen Patrick L. M. , Cremers W. R. J.
Published: October 2014

Clinical and genetic characteristics are presented of 2 patients from a Dutch Usher syndrome type III family who have a new homozygous USH3 gene mutation: 149–152delCAGG + insTGTCCAAT. One individual (IV: 1) is profoundly hearing impaired and has normal vestibular function and retinitis punctata albescens (RPA). The other individual is also profoundly hearing impaired, but has well-developed speech, vestibular areflexia, and retinitis pigmentosa sine pigmento (RPSP). These findings suggest that Usher syndrome type III can be clinically misdiagnosed as either Usher type I or II; that Usher syndrome patients who are profoundly hearing impaired and have normal vestibular function should be tested for USH3 mutations; and that RPA and RPSP can occur as fundoscopic manifestations of pigmentary retinopathy in Usher syndrome.
Value-Based Approach to Power-Assisted Adenoidectomy
Authors: Gillespie M. Boyd , Ingram Frank , Scarlett Matthew , Hoy Mark
Published: October 2014

A recognized disadvantage of power-assisted adenoidectomy (PAA) is the increased patient charge associated with the disposable instrumentation. The elimination of pathological review of routine adenoid specimens may provide a means of offsetting the increased charge, as 1) unsuspected findings are rare, and 2) PAA specimens are too traumatized to provide the microscopic detail necessary to make an unsuspected diagnosis. The pathology reports of all adenoidectomy specimens removed over a 10-year period were reviewed and combined with previously published reviews in order to estimate the prevalence of unsuspected disease. The estimated prevalence of unsuspected diagnoses found by routine pathological review of adenoid specimens is 37 per 100,000 cases (95% confidence interval, 26–51). In a separate analysis, a pathologist blinded to the technique of adenoid removal assessed the tissue effects of curette adenoidectomy versus PAA. Significant tissue damage at the microscopic level was identified in 6 of 11 specimens removed with the power-assisted technique as compared to 0 of 11 specimens removed by curette (p = .03). Eliminating histopathologic review of routine adenoidectomy specimens can potentially offset the increased patient charge of PAA by 62%. Power-assisted adenoidectomy, however, should be avoided in nonroutine cases in which the potential for occult disease exists.
Treatment of Inferior Turbinate Hypertrophy: A Randomized Clinical Trial
Authors: Passàli Desiderio , Passàli Francesco Maria , Passàli Giulio Cesare , Damiani Valerio , Bellussi Luisa
Published: October 2014

In the past 130 years, many surgical procedures for turbinate reduction have been developed. We analyzed the long-term efficacy of 6 of these surgical techniques (turbinectomy, laser cautery, electrocautery, cryotherapy, submucosal resection, and submucosal resection with lateral displacement) over a 6-year follow-up period. We randomly divided 382 patients into 6 therapeutic groups and surgically treated them at the Department of Otorhinolaryngology of the University of Siena. After 6 years, only submucosal resection resulted in optimal long-term normalization of nasal patency and in restoration of mucociliary clearance and local secretory IgA production to a physiological level with few postoperative complications (p < .001). The addition of lateral displacement of the inferior turbinate improved the long-term results. We recommend, in spite of the greater surgical skill required, submucosal resection combined with lateral displacement as the first-choice technique for the treatment of nasal obstruction due to hypertrophy of the inferior turbinates.
Processing of Fascia for Vocal Fold Injection
Authors: Rihkanen Heikki , Kaliste Eila , Leivo Ilmo
Published: October 2014

To evaluate the simplest and safest method to mince fascia for autologous vocal fold injection, we performed an in vitro study applying porcine fascia and a prospective study using a canine model. Six different surfaces were tested in the laboratory for mincing fascia. The ease of handling of tissue on each surface was noted. Minced fascia was studied by microscope under polarized illumination, and the number and nature of foreign particles were recorded. After the safest method to mince fascia was established, 2 dogs were operated on. The recurrent nerve was sectioned, and a piece of fascia lata was harvested and cut with scissors on a steel surface. Fascia injection deep into the thyroarytenoid muscle was performed. The dogs were painlessly sacrificed 6 months later, and the larynges were removed for histomorphological study. On cutting, all polymer surfaces released small amounts of particles. These were not evident when we used glass or steel plates, but their hard surfaces were difficult to work on. Cutting a piece of fascia with scissors was found to be effective and safe in terms of microscopic foreign particles. The two dogs suffered no perioperative or late complications. Six months later, a well-preserved, vascularized, collagen-rich tissue was in its place without any evidence of acute or chronic inflammation. The histomorphological findings were identical to those of our previous study, with the exception that this time, no foreign particles from the mincing surface were present. An autologous fascia graft proves to be well preserved and well tolerated in the augmentation of a paralyzed vocal fold, and scissors are simple and effective in mincing it for injection.
Tracheal Resection with Primary Anastomosis in Cadavers: The Effects of Releasing Maneuvers and Length of Tracheal Resection on Tension
Authors: Rosen Frederick S. , Pou Anna M. , Buford William L.
Published: October 2014

To determine the relationships among length of trachea resected, total tracheal length, and anastomotic tension when using various release maneuvers, we studied 10 adult human cadavers: 5 male and 5 female. The trachea was transected between rings 2 and 3. Precision, handheld spring tensiometers (Geneva Gage, LLC) were used to measure the tension required to approximate, and then overlap, the proximal segment relative to the distal segment, and the distal segment relative to the proximal segment after these maneuvers: no release, blunt dissection, neck flexion, suprahyoid release (SHR) without neck flexion, SHR with neck flexion, and right hilar release. After the tension measurements were recorded, the trachea was harvested and the total tracheal length was measured. Length-tension curves were plotted for both the superior and inferior tracheal segments after each release maneuver. The stiffness coefficient for the trachea and the resting load on the trachea following each release maneuver were calculated. An exponential length-tension relationship existed for the distal tracheal segment regardless of whether release maneuvers were performed. The proximal tracheal segment exhibited a linear length-tension relationship initially, but displayed an exponential relationship after SHR. We could resect 6.68 cm (range, 4.2 to 9.9 cm), 13.3 rings (range, 10 to 20 rings), or 65.5% (range, 42% to 100%) of the trachea without undue tension (< 1,000 g) on the anastomosis. We conclude that various tracheal release maneuvers are effective in increasing the length of trachea that can be relatively safely resected. However, these maneuvers are not uniformly effective across subjects.
Morphological and Functional Changes of Human Vocal Fold Fibroblasts with Hepatocyte Growth Factor
Authors: Hirano Shigeru , Bless Diane M. , Hartig Gregory K. , Massey Randall J. , Ford Charles N.
Published: October 2014

Fibroblasts produce extracellular matrix and play an important role in wound healing and scarring. Hepatocyte growth factor (HGF) has strong antifibrotic activity, and has been suggested to have therapeutic potential for treatment of fibrotic diseases. In the present in vitro study, morphological and functional changes of human vocal fold fibroblasts with HGF were examined by transmission electron microscopy and enzyme-linked immunosorbent assay to help clarify the potential use of HGF in the prevention or treatment of vocal fold scarring. The HGF stimulated the production of hyaluronic acid (HA) and decreased the production of collagen type I from the fibroblasts in Reinke's space (FbRS), whereas fibronectin production was not affected. The HGF also changed the shape of the FbRS from an oval shape toward a spindle and stellate shape, and developed Golgi apparatus (GA) and rough endoplasmic reticulum (rER) in the FbRS. The fibroblasts in the macula flava (FbMF) presented with much more production of HA and collagen type I than did FbRS, and were more frequently formed in a stellate shape with well-developed GA and rER. The HGF decreased the production of collagen type I from the FbMF, but barely affected the FbMF in terms of the shape of the cells, the development of GA and rER, or the production of HA. These results were interpreted to suggest that the FbMF are not as susceptible to HGF as are FbRS. On the contrary, HGF appeared to activate the FbRS and modify the function. The increased HA and decreased collagen type I production from the FbRS suggest that HGF may be useful in the prevention or treatment of fibrotic vocal fold scarring.
Effects of Glucocorticoids on Infiltrating Cells and Epithelial Cells of Nasal Polyps
Authors: Watanabe Kazumasa , Kanaizumi Etsuko , Shirasaki Hideaki , Himi Tetsuo
Published: October 2014

Glucocorticoids are known to be effective in the treatment of nasal polyps (NPs). To examine the mechanisms of their effect, we evaluated 1) the ability of glucocorticoids to induce the apoptosis of eosinophils and T lymphocytes in NPs, and 2) the ability of dexamethasone to down-regulate epithelial cell functions that relate to eosinophilic inflammation. In vitro and in vivo, glucocorticoids increased the apoptosis of both eosinophils and T lymphocytes in NPs. Dexamethasone inhibited the production of granulocyte-macrophage colony-stimulating factor (GM-CSF) from both NP epithelial cells that were unstimulated and NP epithelial cells that were stimulated with interleukin-4 or tumor necrosis factor a. These results suggest that the clinical efficacy of glucocorticoids on NPs may be due to 1) induction of apoptosis in both eosinophils and T lymphocytes that infiltrate NPs, and 2) down-regulation of epithelial GM-CSF production, which prolongs eosinophil survival.
Clinical and Experimental Investigations of Spontaneous Impedance Changes of the Middle Ear
Authors: Thiede Oliver , Stoll Wolfgang , Schmäl Frank
Published: October 2014

The major symptoms of glomus tympanicum tumors are pulsatile tinnitus and spontaneous impedance changes (SICs) of the middle ear. On the other hand, SICs often occur even in the absence of pathological findings. The aim of this study was to analyze the occurrence of SICs in patients and healthy volunteers. We retrospectively evaluated 184 patients with SICs and/or complaints of periodic tinnitus. Most of them (n = 134) showed pulse-synchronous SICs. Pathological findings were recorded in only 66 patients. Binaural SICs were registered significantly (p = .03) more frequently in patients with arterial hypertension (63% versus 18%). Because of the positive correlation between arterial hypertension and the occurrence of SICs, the influence of increasing blood pressure (systolic blood pressure > 160 mm Hg after physical activity) on the occurrence of SICs was investigated in a prospective trial in healthy test subjects (n = 42). In 17 of them, pulse-synchronous SICs occurred for the first time or were registered at a lower sensitivity level after an increase in blood pressure. In summary, only half of the patients with pulse-synchronous SICs showed pathological findings. a significant correlation between high blood pressure and binaural pulse-synchronous SICs was demonstrated in patients with arterial hypertension and healthy volunteers after physical activity.
Histologic Behavior of the Inflammatory Process in Autologous Fat Implantation in Rabbit Vocal Folds
Authors: de Campos Duprat André , Costa Henrique Olival , de Almeida Roberta Ribeiro , Lancelotti Carmem , Caron Renata
Published: October 2014

Fat implantation in the vocal fold is described as a method of repairing vocal fold histostructural lesions that correlate with mucosal wave abnormalities. The aim of this study was to evaluate the histologic behavior of autologous fat implants. A fat block was implanted in pockets surgically created in the vocal folds of rabbits, and the inflammatory process induced was compared to the status of the contralateral vocal fold. Twenty-four rabbits were allocated into 3 groups to be sacrificed 1 week, 3 weeks, and 3 months after the implantation. The fat autograft did not cause any unexpected fibrosis, and we consider it a relatively safe material for implantation, with a low tendency to induce epithelial reaction and the ability to repair the histostructure of the vocal fold.
Analysis of Recurrences in 322 TIS, T1, or T2 Glottic Carcinomas Treated by Carbon Dioxide Laser
Authors: Peretti Giorgio , Bolzoni Andrea , Parrinello Giovanni , Mensi Maria C. , Shapshay Stanley M. , Piazza Cesare , Rossini Manuela , Antonelli Antonino R.
Published: October 2014

An endoscopic approach to early glottic carcinoma is considered a sound treatment for both previously untreated lesions and selected recurrent lesions. Between January 1988 and December 2000, we treated 322 patients by CO2 laser at a single institution; 37 had Tis, 191 T1a, 55 T1b, and 39 T2 lesions (mean follow-up, 77 months; range, 6 to 180 months). Kaplan-Meier curves showed a 5-year overall survival rate of 88%, a determinate survival rate of 99%, a disease-free survival rate of 81%, a rate of ultimate local control with laser alone of 91%, and a laryngeal preservation rate of 97%. Univariate and multivariate analysis showed that the only factor that statistically affected endoscopic control was lateral extension of the tumor with involvement of the bottom of the ventricle (hazard risk ratio, 4.0; 95% confidence interval, 1.71 to 9.35). The 58 recurrences were classified according to their location compared with the site of the primary tumor as follows: 14 in the same area (group A), 27 in adjacent subsites with superficial spreading or multifocal distribution (group B), and 17 in adjacent sites by submucosal diffusion to the visceral spaces, cartilaginous framework, or extralaryngeal tissues (group C). For each group, we analyzed the rate of patients who underwent salvage by endoscopic or open neck procedures and the rate of laryngeal preservation. Recurrences in groups A and B were endoscopically treated in 86% and 74% of cases, respectively. By contrast, in group C no patient was endoscopically cured, and there was a low laryngeal preservation rate (47%). The pathways of spread in recurrent carcinoma are therefore the single most important factor in predicting its endoscopic curability.
Effect of Acid and Pepsin on Gene Expression in Laryngeal Fibroblasts
Authors: Ylitalo Riitta , Li Wenhua , Baugh Andrew , Thibeault Susan
Published: October 2014

The aim of this study was to determine changes that momentary low pH with or without pepsin causes in gene expression in laryngeal fibroblasts. Cell cultures were established from human false vocal fold (FVF) and postcricoidal (PC) mucosae. Using a real-time polymerase chain reaction, we analyzed messenger RNA gene expression of growth factors (transforming growth factor β1, vascular endothelial growth factor, fibroblast growth factor 2), matrix metalloproteinases (MMP-1, MMP-2), and decorin in normal media, pH 4 media, and pH 5 media with and without pepsin. The FVF fibroblast gene expression differed substantially from the PC fibroblast gene expression. No significant interaction effects for acid and pepsin were found in the FVF culture, but in PC cultures we found a significant overexpression interaction effect for vascular endothelial growth factor, fibroblast growth factor 2, MMP-1, MMP-2, and decorin. These results imply that PC tissue is more sensitive than FVF tissue to the noxious effects of gastric contents. Furthermore, there appears to be a synergistic effect for acid and pepsin exposure in the posterior larynx.
Effect of Daily Cod Liver Oil and a Multivitamin-Mineral Supplement with Selenium on Upper Respiratory Tract Pediatric Visits by Young, Inner-City, Latino Children: Randomized Pediatric Sites
Authors: Linday Linda A. , Tapia-Mendoza Juan , Shindledecker Richard D. , Dolitsky Jay N.
Published: October 2014

We studied the effect of daily supplementation with lemon-flavored cod liver oil and a children's multivitamin-mineral supplement containing selenium on the number of pediatric visits by young, inner-city, Latino children from late autumn of 2002 through early spring of 2003. Two private pediatric offices with similar demographics, located 1.1 miles apart in upper Manhattan, New York City, were randomized to a supplementation site and a medical records control site. Ninety-four children (47 at each site), 6 months to 5 years of age, were enrolled. The mean age of the supplementation group was 2.03 years (SD, ±1.04 years); that of the control group was 2.08 years (SD, ±1.10 years). Children ≥1 year of age in the supplementation group received 1 teaspoon of lemon-flavored cod liver oil per day and one half-tablet of a children's multivitamin-mineral; the starting dose was halved for children <1 year of age. The supplements were given from enrollment through May 1, 2003. The primary outcome measure was the number of upper respiratory tract pediatric visits during the follow-up/supplementation period. The supplementation group had a statistically significant decrease in the mean number of upper respiratory tract visits over time (p = .042; r = 0.893; y = 0.602 − 0.002x); the medical records control group had no change in this parameter (p = .999; r = 0.0006; y = 0.259 + 1.43 × 10−6x). The supplements were well tolerated; per parental report, 70% of children completed the 5- to 6-month course of cod liver oil. Use of these nutritional supplements was acceptable to the inner-city Latino families and their young children, and was associated with a decrease in upper respiratory tract pediatric visits over time; this approach therefore deserves further research and attention.
Effect of Antimicrobial Therapy with Amoxicillin and Cefprozil on Bacterial Interference and Beta-Lactamase Production in the Adenoids
Authors: Brook Itzhak , Foote Perry A.
Published: October 2014

To compare the effects on the bacterial flora of the adenoids of antimicrobial therapy with amoxicillin or cefprozil, we enrolled in a prospective randomized study 60 children scheduled for elective adenoidectomy because of recurrent otitis media. They were randomized before surgery into 3 groups of 20 patients each: a no-therapy group, and groups with 10 days of either amoxicillin or cefprozil therapy. Core adenoid materials were quantitatively cultured for aerobic and facultative bacteria. The in vitro ability of α-hemolytic streptococci (AHS) to inhibit the growth of non-type B Haemophilus influenzae and Streptococcus pneumoniae was determined. The number of organisms in adenoids obtained from patients treated with either antibiotic was reduced as compared to that in adenoids from controls. However, in patients treated with amoxicillin, a significant decline in the number of AHS, and an increase (in Staphylococcus aureus) or no change in the number of other β-lactamase-producing bacteria (BLPB) was noted. In contrast, in those treated with cefprozil, no change was noted in the frequency of recovery of AHS, and the number of BLPB decreased. Interfering AHS were more often recovered in patients treated with cefprozil. We conclude that the adenoids contain more interfering AHS after therapy with a second-generation oral cephalosporin (cefprozil) than after amoxicillin therapy. This study suggests a potential beneficial effect of using an antimicrobial that selectively spares interfering AHS while inhibiting BLPB.
Mandibular Reconstruction with Frozen Autologous Mandibular Bone and Radial Periosteal Fasciocutaneous Free Flap: Preliminary Report
Authors: Roselli Raffaele , Muscatello Luca , Pavan Graziano , Valdatta Luigi , Spriano Giuseppe
Published: October 2014

The authors present a new method of mandibular reconstruction with frozen autologous mandibular bone. Vascular supply to the neomandible is ensured by the periosteal layer of a microvascular radial periosteal fasciocutaneous free flap, placed so as to envelop the bone and cover the surgical defect. The use of the periosteal layer of the radius to provide new blood vessels to the frozen mandible is an original technical feature that we describe. We describe 2 cases of oral carcinoma involving the mandible, treated with mandibular resection and reconstruction. This technique allows good functional and aesthetic results, avoiding more serious complications related to the use of composite free flaps harvested from distant anatomic donor sites.
Frontolateral Vertical Partial Laryngectomy without Tracheotomy for Invasive Squamous Cell Carcinoma of the True Vocal Cord: A 25-Year Experience
Authors: Brumund Kevin T. , Babin Emmanuel , Gutierrez-Fonseca Raimundo , Hans Stéphane , Garcia Dominique , Laccourreye Ollivier
Published: October 2014

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T1N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p < .0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.
Acute External Laryngeal Trauma: Experience with 112 Patients
Authors: Butler Allen P. , O'Rourke Ashli K. , Wood Brennan P. , Porubsky Edward S.
Published: October 2014

The purpose of this report is to promote early recognition, expeditious evaluation, and judicious management of acute external laryngeal trauma. A retrospective chart review was performed of 112 cases that were managed at a Medical College of Georgia tertiary care hospital by the senior author (E.S.P.). Patients were classified by the time of their presentation, the severity of their injury, and the treatment protocol followed. The clinical outcomes of airway, voice quality, and deglutition were retrospectively reviewed. For voice outcomes, in the delayed treatment group, only 27.7% of patients had a good result, as compared to a 78.3% good result in the early treatment group. Similar differences were demonstrated regarding the airway. In the delayed treatment group, only 73.3% had good airway function, as compared to 93.3% who had good airway function in the early treatment group. Ninety-nine percent of all patients had a good result for deglutition. We conclude that expeditious diagnosis and intervention reduce the incidence of suboptimal clinical outcomes, and with timely and appropriate application of diagnostic and management protocols, the majority of patients will be successfully decannulated (97%) with functional speech (100%) and normal deglutition (99%).
Rat Model of Platelet-Activating Factor-Induced Rhinosinusitis
Authors: Jeon Sea-Yuong , Kim Jin-Pyeong , Ahn Seong-Ki , Kim Eun-Ah , Kim Beom-Gyu
Published: October 2014

Platelet-activating factor (PAF) is known to be a potent inflammatory mediator, especially in allergic inflammation. However, the exact role of PAF in the pathogenesis of rhinosinusitis has not been clearly established. To understand the role of PAF in the pathogenesis of rhinosinusitis, it is necessary to develop an animal model of PAF-induced rhinosinusitis. The aim of this study was to develop a rat model of rhinosinusitis induced by intranasally applied PAF. Fifty microliters of 16 μg/mL PAF was applied intranasally through each naris in 4-week-old Sprague-Dawley rats, and the same amount of vehicle was applied in control rats. At 1, 3, or 5 days, the animals were painlessly sacrificed, and the nasal cavity and sinuses were prepared for histologic investigation. The histologic sections were examined in a blind manner for the appearance of neutrophil clusters in the sinonasal air space, and the numbers of eosinophils, areas of epithelial loss, goblet cells, and inducible nitric oxide synthase (iNOS)–positive inflammatory cells in the mucosa. Neutrophil clusters were observed in the air space, and the number of eosinophils, areas of epithelial loss, goblet cells, and iNOS-positive inflammatory cells in the mucosa were increased significantly in the PAF-applied rats. The amount of inflammation varied according to the time interval, showing a peak at day 3. We conclude that intranasally applied PAF induces rhinosinusitis in rats. The histologic evidence of rhinosinusitis revealed the appearance of neutrophil clusters in the sinonasal air space, infiltration of eosinophils and iNOS-positive inflammatory cells in the mucosa, areas of epithelial loss, and goblet cell hyperplasia in the epithelium. This rat model of PAF-induced rhinosinusitis may be applied for better understanding of the role of PAF in the pathogenesis of rhinosinusitis.