bluuebunny/crossref_metadata_2025 huggingface dataset:
Concurrent Intra-Arterial Chemotherapy and Radiotherapy for Advanced Laryngeal Cancer
Authors: Yoshizaki Tomokazu , Kondo Satoru , Wakisaka Naohiro , Murono Shigeyuki , Kitagawa Noriko , Tsuji Akira , Nakashima Masashi , Sanada Jun-Ichiro , Matsui Osamu
Published: October 2014

Objectives:

An intra-arterial chemoradiotherapy regimen (RADPLAT) provides remarkable local control for head and neck cancer. This study evaluates the efficacy of a reduced RADPLAT protocol in patients who are candidates for total laryngectomy.

Methods:

Forty-three patients with advanced laryngeal cancer were treated with 2 courses of intra-arterial cisplatin infusion (100 mg per body) during 40-Gy irradiation. The patients who showed a greatly diminished tumor received sequential irradiation. The patients with obvious residual disease received chemotherapy during the sequential irradiation. Poor responders, with less than 50% tumor reduction, underwent total laryngectomy.

Results:

Forty-two patients completed the protocol. All surviving patients were followed for at least 3 years. Thirty-four patients were alive (80% of the supraglottic cases and 87.5% of the glottic cases). Local control was achieved in 27 patients (67.5% of the 11 glottic cases and 64.0% of the supraglottic cases). The glottic cohort showed better progression-free survival rates than did the supraglottic cohort (68.8% and 45.0%, respectively; p = 0.019). There were 2 cases of grade 3 neutropenia and 3 cases of grade 3 mucositis. No patients required tube feeding. One patient required tracheostomy 3 months after the completion of the treatment protocol.

Conclusions:

Concurrent chemoradiotherapy with a reduced dose of intra-arterial cisplatin is feasible for patients with advanced glottic cancer.
Prothrombotic Gene Mutations in Patients with Sudden Sensorineural Hearing Loss and Cardiovascular Thrombotic Disease
Authors: Capaccio Pasquale , Cuccarini Valeria , Ottaviani Francesco , Fracchiolla Nicola Stefano , Bossi Anna , Pignataro Lorenzo
Published: October 2014

Objectives:

Impaired cochlear perfusion seems to be an important event in sudden sensorineural hearing loss. Prothrombotic gene mutations have been related to vascular disorders and sudden hearing loss. We assessed the prothrombotic risk in 10 patients with sudden sensorineural hearing loss who had previously experienced cardiovascular events to support its vascular pathogenesis.

Methods:

Ten patients underwent hematologic tests (MTHFR C677T/A1298C, prothrombin G20210A, platelet GlyIIIaA1/A2, and V Leiden G1691A genotyping; fibrinogenemia; cholesterolemia; homocysteinemia; folatemia). The results were compared with those of 100 previously investigated patients with sudden hearing loss alone and those of 200 healthy controls. DNA was isolated from peripheral blood leukocytes, and the gene mutations were investigated by polymerase chain reaction and a LightCycler DNA analyzer.

Results:

Two patients had 2 mutant alleles, 6 had 3, and 2 had 4. The mean homocysteine, cholesterol, and fibrinogen levels were above the upper limit of normal; the mean folate levels were slightly above the lower limit of normal. Multiple mutations were more frequent in the patient group than in the previously analyzed patients and healthy controls.

Conclusions:

The association between inherited and acquired prothrombotic factors in patients with sudden sensorineural hearing loss and thrombotic diseases in other sites suggests that a multifactorial mechanism may underlie microvascular cochlear impairment. Hematologic investigation, including MTHFR, prothrombin, platelet, and V Leiden genotyping, may help to detect patients at potential risk of recurrent hearing loss and multiple microvascular diseases, and could be usefully performed in otherwise idiopathic sudden sensorineural hearing loss.
Use of Neuromuscular Electrostimulation in the Treatment of Dysphagia in Patients with Multiple Sclerosis
Authors: Bogaardt Hans , van Dam Danielle , Wever Nienke M. , Bruggeman Caroline E. , Koops Johan , Fokkens Wytske J.
Published: October 2014

Objectives:

We explored the possible effects of neuromuscular electrostimulation on the swallowing function of patients with multiple sclerosis and swallowing problems.

Methods:

Twenty-five patients (average age, 53.1 years; SD, 9.8 years) with multiple sclerosis and swallowing problems were treated for 3 weeks with 2 sessions per week of neuromuscular electrostimulation. The average time since the onset of multiple sclerosis was 16.5 years (SD, 10.2 years). Seventeen patients were examined with transnasal flexible endoscopy 1 week before treatment and 1 week after treatment.

Results:

After treatment, a significant decrease in pooling of saliva in the pyriform sinuses was seen in 6 patients (p = 0.03), and significantly less aspiration during swallowing of thin liquids (p < 0.01) was seen in 9 patients. Overall, the 25 patients reported that their swallowing had improved (p < 0.01), and in 20% of the patients, it had become less strenuous. No adverse effects of the treatment were reported.

Conclusions:

Our study showed that the treatment of swallowing problems with neuromuscular electrostimulation in patients with multiple sclerosis in this sample was successful in the reduction of pooling of saliva and in the reduction of aspiration.
Measurement of Cross-Sectional Dimensions of the Cricoid Cartilage: A Computed Tomographic Study
Authors: Shin Hyun-Woo , Ahn Youngjin , Sung Myung-Whun , Kim Kwang Hyun , Kwon Tack-Kyun
Published: October 2014

Objectives:

We measured the cross-sectional dimensions of the cricoid cartilage and degrees of ossification of the marrow space for designing a cricoid implant.

Methods:

We reviewed 100 age- and sex-matched neck computed tomography scans that were performed at Seoul National University Hospital from 2001 to 2005. Under a standardized computed tomography window setting, the height of the cricoid cartilage marrow and the thickness of the marrow space and the ossified inner and outer cortices were measured by one observer.

Results:

The mean height of the cricoid cartilage marrow was 13.6 mm (range, 5.5 to 20.5 mm) in women and 17.5 mm (range, 13.0 to 24.5 mm) in men. The mean thickness of the cricoid cartilage marrow was 3.17 mm (range, 1.22 to 4.75 mm) in women and 5.13 mm (range, 3.42 to 7.60 mm) in men. We also observed that women in general have a higher density of the cricoid marrow than men; 4 women and 1 man had a markedly denser marrow space. There were individual variations in size and density of the cricoid marrow.

Conclusions:

Human adult cricoid cartilages have sufficient marrow space for cricoid implantation. Preoperative evaluation of the size and density of the cricoid marrow is recommended for individual application of the cricoid implant.
Impact of Supraglottoplasty on Aspiration in Severe Laryngomalacia
Authors: Richter Gresham T. , Wootten Christopher T. , Rutter Michael J. , Thompson Dana M.
Published: October 2014

Objectives:

We examined the incidence and significance of aspiration in infants with severe laryngomalacia (LM) who undergo supraglottoplasty.

Methods:

We performed a 5-year retrospective review of a prospective database from 2 tertiary care pediatric institutions. The studied patients were 50 consecutive infants with severe LM who underwent supraglottoplasty (median age, 4.5 months) and functional endoscopic evaluation of swallowing (FEES) with or without laryngopharyngeal stimulation testing. The intervention was cold-knife microlaryngeal supraglottoplasty and reflux management. The main outcome measure was aspiration resolution.

Results:

Preoperative FEES identified laryngeal penetration in 44 infants (88%) with severe LM. Laryngeal penetration with aspiration beyond the vocal folds was noted in 36 infants (72%). Postoperative FEES (median follow-up, 3.8 months) indicated resolution of laryngeal penetration and aspiration in 36 (81.8%) and 31 (86.1%) of these patients, respectively. The 14 patients without preoperative aspiration showed no evidence of aspiration after supraglottoplasty. In patients with aspiration, the mean preoperative laryngopharyngeal stimulation test threshold was 8.45 mm Hg. This improved on average by 4.0 mm Hg after supraglottoplasty (paired t-test, p < 0.0001). Multiple medical comorbidities were present in the 5 patients who had persistent aspiration after supraglottoplasty, including congenital heart disease (all 5 patients), congenital syndromes (4 patients), neurologic disorders (2 patients), and a need for tracheostomy (2 patients).

Conclusions:

Laryngeal penetration and aspiration improve after cold-knife supraglottoplasty. Supraglottoplasty does not cause aspiration in patients who do not have preoperative aspiration. Supraglottoplasty may not improve aspiration in patients with multiple medical comorbidities.
Clinical Significance of the Summating Potential—Action Potential Ratio and the Action Potential Latency Difference for Condensation and Rarefaction Clicks in Meniere's Disease
Authors: Ohashi Toru , Nishino Hirohito , Arai Yoko , Hyodo Makoto , Takatsu Mitsuharu
Published: October 2014

Objectives:

This study was aimed to elucidate the diagnostic significance of the summating potential (SP)–action potential (AP) ratio and the AP latency difference between condensation and rarefaction clicks (AP con-rar difference) in Meniere's disease.

Methods:

The AP and SP were recorded transtympanically in 67 patients with definite Meniere's disease. The SP/AP ratio and the AP con-rar difference were assessed in terms of 1) their interrelationship, 2) their relationship to hearing level, and 3) the rate of occurrence of abnormal values according to the stages of Meniere's disease.

Results:

No correlation was found between the SP/AP ratio and the AP con-rar difference. Neither the SP/AP ratio in general nor the AP con-rar difference was correlated with the hearing level. However, enhanced values of the SP/AP ratio (0.35 or higher) were moderately correlated with the hearing level (r = 0.51), and their occurrence rate was 55.2%. An increased AP con-rar difference (0.13 ms or longer) was not correlated with the hearing level, and its occurrence rate was 50.2%; it appeared most frequently at stage 3 (p < 0.05).

Conclusions:

An enhanced SP/AP ratio might not always indicate the presence of endolymphatic hydrops associated with an increase in endolymphatic pressure. An increased AP con-rar difference might reflect the presence of a biased basilar membrane resulting from an increased endolymphatic pressure, and hence it is diagnostically essential to simultaneously evaluate the SP/AP ratio and the AP con-rar difference.
Mild and Variable Audiometric and Vestibular Features in a Third DFNA15 Family with a Novel Mutation in POU4F3
Authors: de Heer Anne-Martine R. , Huygen Patrick L. M. , Collin Rob W. J. , Kremer Hannie , Cremers W. R. J.
Published: October 2014

Objectives:

Cochleovestibular characteristics were investigated in a Dutch DFNA15 family with a novel POU4F3 mutation, L223P

Methods:

A 4-generation pedigree was constructed of the Dutch family with the novel L223P POU4F3 mutation. Pure tone audiometric data were collected and analyzed cross-sectionally in mutation carriers. Age-related typical audiograms were derived. Vestibular examination was performed in most of the mutation carriers. The results were compared to those obtained from previously identified 884del8 and L289F POU4F3 mutation carriers.

Results:

A novel mutation (L223P) in POU4F3 segregated with hearing impairment in the present family. Audiometric analysis generally showed an early-adult to midlife onset of hearing impairment. High-frequency hearing impairment was observed most frequently. Age-related typical audiograms showed a down-sloping configuration at ages of more than 30 years, with the fastest rate of progression at the high frequencies. Vestibular function tests revealed hypofunction of the vestibular labyrinth in 2 mutation carriers (not statistically significant).

Conclusions:

The clinical features in the present family with a POU4F3 mutation were fairly similar to those in the 2 previously described DFNA15 families, but the level of hearing impairment was milder, and there was no substantial vestibular dysfunction.
Three-Year Postimplantation Auditory Outcomes in Children with Sequential Bilateral Cochlear Implantation
Authors: Scherf Fanny , Van Deun Lieselot , van Wieringen Astrid , Wouters Jan , Desloovere Christian , Dhooge Ingeborg , Offeciers Erwin , Deggouj Naïma , De Raeve Leo , Wuyts Floris L. , Van de Heyning Paul
Published: October 2014

Objectives:

We report on the auditory abilities and speech performance in quiet and noise of 35 children with sequential bilateral cochlear implantation after 3 years of bilateral implant use.

Methods:

Testing was done in bilateral and both unilateral listening conditions. The assessments took place before the second implantation and at several time intervals after fitting. As different auditory tests were used, the children were categorized by their age at the second implantation: Younger or older than 6 years.

Results:

The pure tone averages for the bilateral condition were significantly better than those for either unilateral condition after 12 months of bilateral implant use and remained so from that test interval onward. The speech recognition outcomes in quiet and noise also improved significantly for almost all children after 36 months, although a linear regression analysis showed a beneficial effect of younger age at first implantation on the speech-in-noise results.

Conclusions:

Bilateral cochlear implantation offered advantages to all children in comparison with the first implant — Even the children who received the second implant after the age of 6 years. Compared to the younger children, the older children needed a longer adjustment period to gain bilateral benefit. However, they obtained similar results after 2 years of bilateral implant use.
Self-Reported Listening Habits and Enjoyment of Music among Adult Cochlear Implant Recipients
Authors: Migirov Lela , Kronenberg Jona , Henkin Yael
Published: October 2014

Objectives:

We sought to assess the associations between self-reported listening habits and enjoyment of music, and the following variables: Age at implantation, gender, prelingual versus postlingual deafness, duration of deafness, duration of cochlear implant (CI) use, type of CI, speech coding strategy, and speech perception abilities.

Methods:

A questionnaire on listening habits and enjoyment of music before the onset of deafness and after implantation was sent to 85 adult CI recipients who had been using the devices for at least 6 months.

Results:

Of the 53 responders, 39 (73.6%) listened to music after implantation. Listening to music was not significantly related to age at implantation, gender, duration of deafness, duration of CI use, type of CI device, speech coding strategy, or open-set speech perception abilities. The 14 nonlisteners were postlingually deafened. The ratings of enjoyment were the same for 22.6% of patients, improved for 26.4%, and worse for 50.9%. Only 2 of 13 patients who played a musical instrument and 14 of 24 patients who sang before the onset of deafness resumed their musical activities.

Conclusions:

Despite the decline in listening habits and in the enjoyment of music after cochlear implantation, most patients do listen to music. The changes in listening habits and enjoyment were not related to the selected background variables.
Human Papillomavirus—Associated Oropharyngeal Squamous Cell Carcinomas: Primary Tumor Burden and Survival in Surgical Patients
Authors: Ukpo Odey C. , Pritchett Cedric V. , Lewis Jean E. , Weaver Amy L. , Smith David I. , Moore Eric J.
Published: October 2014

Objectives:

We sought to determine whether the primary tumor burden in oropharyngeal squamous cell carcinoma is lower in tumors positive for human papillomavirus (HPV) or in tumors with a smoking- or alcohol-related cause.

Methods:

We retrospectively reviewed medical records of patients at our institution who had squamous cell carcinoma of the palatine tonsils, base of tongue, soft palate, or pharynx from 1995 through 2006. The patients underwent primary surgical therapy. The main outcome measures were the HPV status of tumors and nodes and the survival rates (categorized by HPV status).

Results:

Of 102 treated patients, 48 (47.1%) had HPV-positive carcinomas. Primary tumor size was not significantly different between HPV-positive and HPV-negative tumors (median, 2.5 versus 2.0 cm; p = 0.43). Patients with HPV had a higher prevalence of neck nodal metastases (35% versus 11%; p = 0.003) and high-grade lesions (83% versus 64%; p = 0.03).

Conclusions:

Primary tumor burden was not associated with HPV status. Patients with HPV-positive oropharyngeal squamous cell carcinomas had a higher prevalence of neck nodal metastases and high-grade lesions.
Clinicopathologic Features and Outcome of the Oncocytic Variant of Papillary Thyroid Carcinoma
Authors: Gross Menachem , Eliashar Ron , Ben-Yaakov Avraham , Weinberger Jeffrey M. , Maly Bella
Published: October 2014

Objectives:

The purpose of this study was to define the clinicopathologic features and outcome of the oncocytic variant of papillary thyroid carcinoma (OVPTC) with a review of the literature.

Methods:

Twenty-three patients with OVPTC over a 10-year period were studied. Demographic, clinical, and histopathologic features and outcome data were analyzed retrospectively.

Results:

Seventeen women and 6 men, ages ranging from 20 to 76 years (95% confidence interval, 43.0 to 54.48), were studied. Cervical lymph node involvement was found in 43.4% of the patients. Most of the recurrences were associated with thyroid masses greater than 2 cm in diameter. Evaluation of the overall survival data by the Kaplan-Meier method revealed that most recurrences took place earlier than 30 months, and the majority of patients (74%) were well, with no evidence of disease, up to 78 months after the last treatment. All of the OVPTC cases presented as nonencapsulated tumors, and 78.2% demonstrated extrathyroid stromal invasion.

Conclusions:

OVPTC is a unique variant of papillary thyroid carcinoma that has distinctive clinicopathologic features. Since OVPTC is often associated with local invasion and may involve cervical lymph nodes, it may require more extensive surgery than classic papillary thyroid carcinoma.
Radiographic and Micro—Computed Tomographic Imaging of Lipopolysaccharide-Mediated Bone Resorption
Authors: Nason Robert , Lee Dong H. , Jung Jae Y. , Chole Richard A.
Published: October 2014

Objectives:

Chronic otitis media and cholesteatomas cause hearing loss as a result of bony erosion. This bone resorption is known to be more aggressive when cholesteatomas become infected. The most common organism isolated from both diseases is the gram-negative bacterium Pseudomonas aeruginosa. Lipopolysaccharide (LPS), a major virulence factor found in the gram-negative bacterial cell wall, is well known to incite inflammatory bone resorption. The mechanisms underlying this process, however, are poorly understood. In this study, we developed a mouse model of calvarial osteolysis in which resorption was reliably imaged by plain radiography and micro–computed tomography (micro-CT).

Methods:

A murine calvarial model was developed to study bone resorption induced by P aeruginosa LPS. Calvariae from wild-type and knockout mice used in this model were imaged by plain radiography and micro-CT.

Results:

A high degree of correlation between plain radiography and micro-CT was identified (R2 = 0.8554). Furthermore, maximal LPS-induced bone resorption required functioning toll-like receptor (TLR) 2, TLR4, and myeloid differentiation factor 88 (MyD88).

Conclusions:

We have developed a successful model of inflammatory osteolysis in which plain radiography can reliably delineate induced bone resorption. In vivo, we have shown that P aeruginosa LPS signals via TLR2, as well as TLR4 through MyD88.
Dysplasia in Adults with Recurrent Respiratory Papillomatosis: Incidence and Risk Factors
Authors: Blumin Joel H. , Handler Ethan B. , Simpson C. Blake , Osipov Vladimir , Merati Albert L.
Published: October 2014

Objectives:

Recurrent respiratory papillomatosis (RRP) causes significant morbidity in laryngology. The incidence of dysplasia in adult patients with RRP has not been well described. In this study, the risk factors and incidence of RRP-associated dysplasia are investigated.

Methods:

Pathology specimens from patients with RRP over a 6-year period are reviewed, along with the patients' clinical and demographic information.

Results:

Fifty-two male and 21 female patients (mean, 50 years) with RRP were identified. Some degree of dysplasia was identified in 22 of 170 specimens (13%). Sixteen of the 73 patients (21.9%) were found to have dysplasia at some point during their clinical course. Although the patients with RRP-associated dysplasia were older (56.3 versus 48.3 years of age), this difference did not reach statistical significance (p < 0.09, unpaired t-test). There was a male preponderance in both dysplastic (10 of 16; 62.5%) and non-dysplastic (42 of 57; 73%) cases. The mean number of operations for RRP was 2.4 for patients without dysplasia and 3.2 for those with dysplasia; there was no significant difference between the groups. Seven of the 16 patients with dysplasia (44%) and 22 of the 57 patients without dysplasia (39%) had a history of tobacco use (p < 0.77, Fisher's exact test).

Conclusions:

Dysplasia was discovered in more than 20% of adult patients with RRP studied over a 6-year period. Age, gender, tobacco history, and operative frequency were not identifiable risk factors for the presence of dysplasia.
Diagnosis and Prognosis of Iatrogenic Injury of the Recurrent Laryngeal Nerve
Authors: Hydman Jonas , Björck Gunnar , Persson Jonas K. E. , Zedenius Jan , Mattsson Per
Published: October 2014

Objectives:

Following perioperative injury to a macroscopically intact recurrent laryngeal nerve (RLN), there are two possible intraneural injury types: 1) axonal injury, including disruption of axons, and 2) conduction block, only affecting the Schwann cells and the nodes of Ranvier. In this study, it was hypothesized that the functional outcome after RLN injury may depend on the type of nerve injury.

Methods:

Fifteen patients with acute postoperative unilateral RLN paralysis were prospectively studied. Electrophysiological examination (laryngeal electromyography) was used to differentiate between the two types of nerve injury. Vocal fold motions were monitored by repeated laryngoscopy during the study period (up to 6 months). Three of the patients with axonal injury were treated with the regeneration-promoting agent nimodipine.

Results:

The patients with conduction block all recovered normal vocal fold motion, whereas patients with axonal injury within the nerve had a significantly worse outcome. The 3 patients who were treated with nimodipine all recovered normal or near-normal vocal fold mobility despite the more severe axonal injury.

Conclusions:

In contrast to previous reports, our results show that laryngeal electromyography is a reliable tool for diagnosing the type of injury within the injured RLN, making it possible to predict the functional outcome in these patients. On the basis of the results, a future randomized study on nimodipine treatment for RLN axonal injury is suggested.
Recurrent Hoarseness Due to Inflammatory Vocal Fold Lesions in a Patient with Crohn's Disease
Authors: Hasegawa Naoko , Ishimoto Shin-Ichi , Takazoe Masakazu , Tsunoda Koichi , Fujimaki Youko , Shiraishi Aiko , Kinoshita Makoto , Okada Kazunari
Published: October 2014

Crohn's disease is a chronic inflammatory bowel disease characterized by discontinuous chronic inflammation that may affect virtually all organs, including the head and neck. Laryngeal involvement in Crohn's disease is very rare, and only 9 cases have been reported. All 9 patients complained of difficulty in breathing due to edema and ulceration from the larynx to the hypopharynx. The present patient was a 31-year-old woman who had experienced the intestinal symptoms of Crohn's disease starting 20 months earlier and complained of hoarseness, sore throat, and odynophagia. The hoarseness worsened gradually because of limited ulceration of the vocal fold without edema. We describe the first case in which limited ulceration occurred on the vocal fold without airway involvement.
Microlaryngoscopic and Office-Based Injection of Bevacizumab (Avastin) to Enhance 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis
Authors: Zeitels Steven M. , Lopez-Guerra Gerardo , Burns James A. , Lutch Matthew , Friedman Aaron M. , Hillman Robert E.
Published: October 2014

Objectives:

Photoangiolytic lasers effectively treat glottal papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avastin) were given to assess the effect on disease recurrence and phonatory function.

Methods:

A retrospective investigation was done in a pilot group of 10 adult patients with bilateral glottal papillomatosis who had prior angiolytic laser treatment with established patterns of recurrence. The patients underwent 5 bevacizumab injections (5 to 10 mg) into the diseased vocal folds along with 532-nm pulsed KTP laser photoangiolysis treatments 4 to 6 weeks apart. Their disease resolution was compared to findings from prior laser treatment alone, and objective measures of vocal function (acoustic, aerodynamic, Voice-Related Quality of Life survey) were obtained.

Results:

All 10 patients had a greater than 90% reduction in recurrence. Four of the 10 had resolution. Four of the 10 have limited recurrent or persistent disease, receive injections of bevacizumab at 8- to 12-week intervals, and have not required laser treatment. Two of the 10 have ongoing periodic office-based KTP laser treatment along with bevacizumab injections. No patient has required microlaryngeal surgery with general anesthesia, and all 10 have had substantial improvement in vocal function.

Conclusions:

This pilot investigation provides preliminary evidence that bevacizumab injections enhance photoangiolytic laser treatment of glottal papillomatosis while enhancing phonatory function. Coupling an antiangiogenesis agent with pulsed KTP laser photoangiolysis is conceptually promising, since the mechanisms of action are complementary.
Implantation of an Atelocollagen Sheet for the Treatment of Vocal Fold Scarring and Sulcus Vocalis
Authors: Kishimoto Yo , Hirano Shigeru , Kojima Tsuyoshi , Kanemaru Shin-Ichi , Ito Juichi
Published: October 2014

Objectives:

The management of vocal fold scarring and sulcus vocalis is challenging. These disorders are thought to be fibroplastic anomalies in the cover portion of the vocal fold that cause deterioration of the vibratory properties of the vocal fold mucosa. Histologic studies have revealed disorganization of extracellular matrix that needs to be addressed in the treatment of scarred vocal folds. Replacement of scar tissues with an appropriate implant may lead to regeneration of the vocal fold mucosa and its tissue properties. This retrospective case study examined the feasibility of using an atelocollagen sheet as a regenerative implant.

Methods:

Six patients with a post-cordectomy scar or sulcus vocalis underwent implantation of an atelocollagen sheet into the lamina propria of the vocal folds. The procedure consisted of elevation of a microflap, dissection and removal of scar tissue, implantation of the material, and wound closure. Vocal function was evaluated before and after surgery by stroboscopic examination and by aerodynamic and acoustic analyses.

Results:

The postoperative changes of aerodynamic and acoustic parameters varied among patients; however, gradual improvement was seen in most cases over a year. Stroboscopic findings also revealed gradual improvement of vibratory properties in most cases.

Conclusions:

Implantation of an atelocollagen sheet may have restorative effects on vocal fold scarring and sulcus vocalis in terms of tissue properties and function of the mucosa.
Sphenopalatine and Anterior Ethmoidal Artery Ligation for Severe Epistaxis
Authors: Asanau Alexander , Timoshenko Andrei P. , Vercherin Paul , Martin Christian , Prades Jean-Michel
Published: October 2014

Objectives:

We describe the surgical treatment of severe epistaxis and evaluate the recurrence of bleeding in a nonrandomized retrospective trial.

Methods:

We performed a retrospective study comparing bilateral endoscopic ligation of the sphenopalatine artery alone (ELSPA) and bilateral endoscopic ligation of the sphenopalatine artery with concomitant bilateral external ligation of the anterior ethmoidal artery (ELSPEA) in the management of persistent epistaxis. Clinical and hematologic information, preoperative and surgical care, and short- and long-term outcomes were analyzed. The main outcome measure was recurrence of epistaxis in the short- and long-term follow-up periods.

Results:

Forty-five patients were enrolled in the study. There were 20 patients in group A (ELSPA) and 25 in group B (ELSPEA). Three patients in group A and no patients in group B had long-term (more than 2 weeks after surgery) re-bleeding. The difference between the two groups was not statistically significant (p > 0.05).

Conclusions:

We conclude that ELSPA and ELSPEA are effective, well-tolerated, reliable procedures if performed by an experienced surgeon. Their failure can be explained by anatomic lateral nasal wall variations and perioperative technical difficulties. They can be appropriate methods to treat severe recurrent epistaxis refractory to repeated nasal packing.
Thyroid Lymphosonography: A Novel Method for Evaluating Lymphatic Drainage
Authors: Curry Joseph M. , Ezzat Waleed H. , Merton Daniel A. , Goldberg Barry B. , Cognetti David M. , Rosen David , Pribitkin Edmund A.
Published: October 2014

Objectives:

We evaluated lymphosonography, or contrast-enhanced, ultrasonography (US)–guided sentinel lymph node (SLN) detection, as a technique for demonstrating the lymphatic drainage of the thyroid gland.

Methods:

In this prospective animal study, four 50-kg Yorkshire swine underwent transcutaneous injection of a US contrast agent and methylene blue dye into the thyroid gland. Contrast-enhanced US was used to identify draining lymphatic channels and SLNs. Sentinel node biopsy was conducted. Subsequently, bilateral neck and upper mediastinal dissection was carried out.

Results:

In 3 of 4 cases, a blue dye–positive and US contrast–positive SLN was identified. We identified SLNs in level IV in 2 cases. One case revealed 2 adjacent nodes in the superior mediastinum. In 1 case, a lymphatic channel was identified traveling into the mediastinum, but exposure of the SLN could not be obtained. No residual blue dye–positive or US contrast–positive nodes were identified on subsequent dissection.

Conclusions:

Lymphosonography of the thyroid gland in a porcine model correlates well with blue dye–guided sentinel node biopsy and is technically feasible, although in some cases access to the SLN may be difficult. This technique could potentially enable a detailed analysis of thyroidal lymphatic drainage if applied to humans.
Clinical and Electrophysiological Characteristics of Larynx in Myasthenia Gravis
Authors: Xu Wen , Han Demin , Hou Lizhen , Hu Rong , Wang Lei
Published: October 2014

Objectives:

We investigated the clinical and electrophysiological characteristics of the larynx in patients with myasthenia gravis (MG).

Methods:

Thirty-two cases of MG were analyzed. The laryngeal behaviors and characteristics of laryngeal electromyography were evaluated, and voice assessment and repetitive nerve stimulation (RNS) tests were conducted.

Results:

The initial symptoms of patients were ptosis and/or diplopia in 28, dysphagia and slurred speech in 3, and limb weakness in 1. Only 8 patients had slight hoarseness and vocal fatigue, and 4 patients had positive laryngeal signs. When compared with normal subjects, the patients with MG had worse results on the acoustic analysis of shimmer, their normalized noise energy was greater, and the harmonics-to-noise ratio and maximum phonation time were significantly lower. The RNS findings were positive in 28 patients and negative in 4 patients. The average (±SD) amplitude decrement was 31.9% ± 19.1%. The mean number of involved laryngeal muscles was 2.22 ± 1.35. Cricothyroid muscles were involved in 26 cases, thyroarytenoid muscles were involved in 14 cases, posterior cricoarytenoid muscles were involved in 6 cases, and lateral cricoarytenoid muscles were involved in 2 cases.

Conclusions:

Although few patients presented with laryngeal symptoms as their initial symptoms, most patients with MG exhibited asymmetry and abnormal findings on laryngeal electromyography. The RNS test for laryngeal muscles is a more sensitive indicator for the diagnosis of MG, especially in the cricothyroid muscle
Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site
Authors: Rödel Ralph M. W. , Matthias Christoph , Blomeyer Barbara D. , Wolff Hendrik A. , Jung Klaus , Christiansen Hans
Published: October 2014

Objectives:

Treatment methods for patients with cervical cancer of an unknown primary site (CUP) are still under discussion. The purpose of this retrospective study was to analyze the oncological follow-up of 58 patients treated for cervical CUP.

Methods:

From 1986 to 2006, 58 patients with cervical CUP were treated at the authors' institution. Treatment consisted of neck dissection alone in 8, irradiation or chemoradiation in 5, combined surgery and radiotherapy in 28, and surgery and radiochemotherapy in 17.

Results:

The 3-year and 5-year overall survival rates for all patients were 52.9% and 40.9%, respectively. The 3-year and 5-year disease-specific survival rates were 50.9% and 39.7%, respectively. The 3-year and 5-year neck control rates were 73.7% and 67.3%, respectively. Neck dissection followed by radiochemotherapy was associated with the best 3-year and 5-year locoregional control rates. Extracapsular extension was a predictor of survival, but not of neck control. Distant metastases developed in about one third of all patients and were the most frequent cause of tumor-related death in cases of advanced neck disease.

Conclusions:

Despite the fact that regional control can be achieved in many cases, survival rates may be limited by distant metastasis, especially in patients with advanced neck disease.
Influence of Anxiety and Depression on the Predictive Value of the Reflux Symptom Index
Authors: Oyer Samuel L. , Anderson Lauren C. , Halum Stacey L.
Published: October 2014

Objectives:

Although the Reflux Symptom Index (RSI) is a validated laryngopharyngeal reflux (LPR) outcomes tool, its predictive value for LPR is controversial. Because psychiatric problems may lead to exaggerated patient-perceived symptoms and RSI values, the aim of this study was to determine whether the positive predictive value of the RSI for pH probe–documented LPR is influenced by anxiety and depression.

Methods:

We reviewed the charts of all patients who underwent pH probe testing for LPR between January 2006 and July 2008 at our institution. The RSI, Reflux Finding Score (RFS), medical history, and pH probe findings were recorded. Patients with anxiety or depression were included in the psychiatric disorder (+PSY) group, and those without anxiety or depression comprised the non–psychiatric disorder (–PSY) group. Predictive values of the RSI for pH probe–documented LPR were determined for each group.

Results:

We included 51 patients: 30 patients (59%) in the –PSY group and 21 patients (41%) in the +PSY group. The mean RSI of the +PSY group was higher than that of the –PSY group (p < 0.05), but the +PSY patients actually had a lower incidence of abnormal probe studies (p < 0.02). The positive predictive value of an elevated RSI for an abnormal pH probe study was poor in the +PSY patients (p = 0.495), but strong in the –PSY group (p = 0.004).

Conclusions:

The presence of anxiety and depression impairs the predictive value of the RSI for LPR. This finding potentially explains some of the controversy over the diagnostic utility of the RSI.
Safety of Ethmoid Sinus Drug-Eluting Catheter Insertion
Authors: Melroy Christopher T. , Kuhn Frederick A.
Published: October 2014

Objectives:

We sought to evaluate an instrument that allows a drug-eluting catheter to be inserted into the ethmoid sinuses and to demonstrate its safety and reproducibility in a cadaver model.

Methods:

A drug-eluting catheter was placed into 12 cadaveric anterior and posterior ethmoid sinuses by use of a trocar-based insertion device. The device's position was analyzed with computed tomographic scans, and postprocedural dissection was performed.

Results:

The drug-eluting catheter system was successfully inserted in all ethmoid sinuses without injury to the medial orbital wall, skull base, or sphenoid face. The final position of the distal tip of the catheter averaged 8.1 mm (root mean square [RMS], 3.3 mm) from the skull base, 5.6 mm (RMS, 3.5 mm) from the sphenoid face, and 5.0 mm (RMS, 3.5 mm) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1 mm (RMS, 3.5 mm) below the skull base.

Conclusions:

A trocar-based instrument can relatively safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without injuring the skull base, lamina papyracea, or sphenoid face. This device may allow safe topical drug delivery into the ethmoid sinuses and serve as a vehicle to treat chronic ethmoid sinusitis with direct and sustained topical therapy.
Effect of Peroxisome Proliferator—Activated Receptor Gamma Agonists on Myofibroblast Differentiation and Collagen Production in Nasal Polyp—Derived Fibroblasts
Authors: Lee Heung-Man , Kang Hee Jun , Park Hyo Hun , Hong Seok-Chan , Kim Jin-Kook , Cho Jae Hoon
Published: October 2014

Objectives:

We investigated the effect of transforming growth factor-β1 (TGF-β1) on the differentiation of nasal polyp–derived fibroblasts (NPDFs) and on their production of collagen, and investigated the effect of peroxisome proliferator-activated receptor γ (PPARγ) agonists on the effects of TGF-β1.

Methods:

Primary fibroblast lines were established from 5 human nasal polyp tissues. We activated the NPDFs with TGF-β1 and exposed them to the PPARγ agonists ciglitazone and 15-deoxy-A-prostaglandin J2. The expression of α-smooth muscle actin (α-SMA) and collagen was measured by reverse transcriptase–polymerase chain reactions, immunocytochemical staining, and collagen assays.

Results:

The treatment with TGF-β1 increased the expression of α-SMA and collagen, and expression was markedly attenuated by the PPARγ agonists.

Conclusions:

PPARγ agonists inhibit the differentiation of TGF-β1–activated NPDFs and their production of collagen.
Fusion as an Evolutionary Principle of the Vertebrate Labyrinth
Authors: Gacek Richard R.
Published: October 2014

Objectives:

This study was undertaken to demonstrate changes in the innervation of vestibular and auditory sense organs with the evolutionary ascent of the vertebrate labyrinth.

Methods:

Dissected labyrinths and their nerve supply prepared by the Sudan black B technique of Rasmussen were examined and photographed with a Canon A100 camera interfaced with a Zeiss operating microscope.

Results:

In lizards and alligators, the utricular sense organ is represented by 2 small maculae, each with a separate nerve branching off the ampullary nerves to the anterior and lateral canal cristae. These 2 maculae fuse into a bilobed macula with ascent in frogs and pigeons, eventually becoming a single large macula with its nerve supply from the superior vestibular division in guinea pigs, cats, lions, monkeys, and humans. Along with these changes, there is a fusion of the lateral and anterior canal ampullary nerves and of the bifurcating branches of the vertical canal ampullary nerves. The saccular macula is single, but receives a dual innervation from the superior division (anterior ramus) and the inferior division (posterior ramus) of the eighth nerve in alligators, pigeons, guinea pigs, cats, lions, monkeys, and humans. The main innervation is usually from the inferior division; however, saccular innervation is from the inferior division in lizards and from the superior division in frogs. The auditory sense organ is represented by a curved tube with a low-frequency receptor (lagena) at its distal end in lizards, alligators, and pigeons. In mammals, in which there is a coiled cochlea with a variable number of turns, low frequencies are recorded at the apical turn. This configuration may represent fusion of the lagena into the apical end of the auditory sense organ.

Conclusions:

Fusion of sense organs and of their nerve supply appears to be an evolutionary principle in the vertebrate labyrinth.
Study of Vestibular Evoked Myogenic Potentials in Patients Affected by Meniere's Disease Treated with Endolymphatic Mastoid Shunt
Authors: Salvinelli Fabrizio , Miele Angela , Rinaldi Vittorio , Pappacena Marco , Trivelli Maurizio
Published: October 2014

Objectives:

We recorded and compared the vestibular evoked myogenic potentials (VEMPs) before use of an endolymphatic mastoid shunt (EMS) and 1, 12, and 48 months after placement of the shunt.

Methods:

Air-conducted VEMPs were recorded in 28 patients affected by intractable Meniere's disease and treated with placement of an EMS.

Results:

One month and 12 months after the surgery, VEMPs were not detectable in the operated ear in 100% and 86% of the patients, respectively. Forty-eight months after the surgery, they were elicited in 79% of the patients.

Conclusions:

We conclude that VEMPs are a clinically useful tool in the postoperative follow-up of patients with an EMS.
Endoscopic Balloon Dilation Sinuplasty Including Ethmoidal Air Cells in Chronic Rhinosinusitis
Authors: Kutluhan Ahmet , Bozdemir Kazim , Çetin Hüseyin , Yalçiner Gökhan , Şalviz Mehti , Sari Neslihan , Deǧer Hasan Mervan , Bilgen Akif Sinan
Published: October 2014

Objectives:

We present the results of our experience with balloon catheter sinusotomy (BCS) in patients who had chronic rhinosinusitis.

Methods:

The medical records of 30 patients who were treated for chronic sinusitis with the BCS technique between April 2007 and February 2008 were reviewed retrospectively. Preoperative and postoperative assessments were performed by endoscopic endonasal examination and Lund-Mackay radiologic staging of paranasal sinus computed tomography scans. The symptom scoring was performed with the Sino-Nasal Outcome Test–20 (SNOT-20). The postoperative follow-up period was at least 12 months.

Results:

We performed BCS in 151 sinuses, excluding 2 maxillary and 2 frontal sinuses. No major complication attributable to BCS was observed. After operation, suctioning and crust removal was not needed in the area operated on in BCS patients. Revision surgery was needed in 2 patients after 6 months. From before to after operation, the SNOT-20 values and Lund-Mackay scores decreased significantly.

Conclusions:

We conclude that BCS helps to dilate the sinus ostia properly and effectively in the management of chronic rhinosinusitis. It can also be performed in the ethmoidal air cell area.
Voice Production Mechanisms following Phonosurgical Treatment of Early Glottic Cancer
Authors: Mehta Daryush D. , Deliyski Dimitar D. , Zeitels Steven M. , Quatieri Thomas F. , Hillman Robert E.
Published: October 2014

Objectives:

Although near-normal conversational voices can be achieved with the phonosurgical management of early glottic cancer, there are still acoustic and aerodynamic deficits in vocal function that must be better understood to help further optimize phonosurgical interventions. Stroboscopic assessment is inadequate for this purpose.

Methods:

A newly developed color high-speed videoendoscopy (HSV) system that included time-synchronized recordings of the acoustic signal was used to perform a detailed examination of voice production mechanisms in 14 subjects. Digital image processing techniques were used to quantify glottal phonatory function and to delineate relationships between vocal fold vibratory properties and acoustic perturbation measures.

Results:

The results for multiple measurements of vibratory asymmetry showed that 31% to 62% of subjects displayed higher-than-normal average values, whereas the mean values for glottal closure duration (open quotient) and periodicity of vibration fell within normal limits. The average HSV-based measures did not correlate significantly with the acoustic perturbation measures, but moderate correlations were exhibited between the acoustic measures and the SDs of the HSV-based parameters.

Conclusions:

The use of simultaneous, time-synchronized HSV and acoustic recordings can provide new insights into postoperative voice production mechanisms that cannot be obtained with stroboscopic assessment.
Supracricoid Partial Laryngectomy: Swallowing, Voice, and Speech Outcomes
Authors: Webster Kimberly T. , Samlan Robin A. , Jones Bronwyn , Bunton Kate , Tufano Ralph P.
Published: October 2014

Objectives:

The purpose of the study was to describe the swallowing and vocal function of patients after supracricoid partial laryngectomy (SCPL) as they changed over the first postoperative year.

Methods:

Ten patients with laryngeal carcinoma underwent SCPL at Johns Hopkins Hospital between August 2003 and May 2005. Clinical and videofluoroscopic swallowing examinations and perceptual, acoustic, aerodynamic, and videostroboscopic voice evaluations were completed before operation and at 3 weeks (swallowing only) and 2 (voice only), 6, and 12 months after operation.

Results:

The mean time to gastrostomy tube removal was 82 days. The patients tolerated an increased variety of foods over the first postoperative year. All patients initially used therapeutic strategies to swallow safely, and some still required them at 1 postoperative year. Over the year, the perceptual ratings of voice quality improved significantly. There were no consistent changes in acoustic or aerodynamic measures. The number of patients who used multiple vibratory sources to phonate increased over the year.

Conclusions:

The patients tolerated regular diets, yet continued to exhibit silent aspiration and a variety of decompensations. Their voices were breathy, rough, and strained. Their voice quality ratings improved over the year. Group changes were not captured, and it appears that the changes in speech and voice 2 months after surgery were subtle.
Négrevergne Otoplasty Technique
Authors: Songu Murat , Négrevergne Michel , Portmann Didier
Published: October 2014

Objectives:

More than 200 different otoplasty procedures have been described in the literature to treat patients with prominent ears. However, no simple “best” technique exists.

Methods:

The Négrevergne otoplasty technique was developed by Michel Négrevergne and adopted in the Georges Portmann Institute in France. The technique includes partial-thickness posterior scoring of the auricular cartilage by use of monopolar cutting diathermy.

Results:

A telephone survey was designed solely for this study, aimed to give general information about the technique's outcomes. The survey, conducted by the first author among his patients who were followed up for more than 1 year, revealed that most patients (46 of 52) were very to completely satisfied with the appearance and symmetry of their ears. Furthermore, evaluation according to the Global Aesthetic Improvement Scale was performed by a blinded nonparticipating observer using the medical photographs of 48 patients who consented to “medical photography” to evaluate the effect of treatment. All patients were rated as “improved” or better on the Global Aesthetic Improvement Scale at 52 weeks. There were no ratings of “no change” or “worse.”

Conclusions:

The Négrevergne otoplasty technique is a relatively simple and rapid procedure that maintains the natural contours of the auricle with little morbidity by addressing the poorly developed or absent antihelical fold, an abnormally large concha, and a prominent lobule.