bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Vibratory Characteristics of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia on High-Speed Digital Imaging
Authors: Patel Rita R. , Liu Li , Galatsanos Nikolaos , Bless Diane M.
Published: October 2014

Objectives:

The purpose of this study was to quantify disorder-specific signature kinematic disturbances of vibratory motion in adductor spasmodic dysphonia (AdSD) and muscle tension dysphonia (MTD), in voice disturbances of a severe nature, with the use of high-speed digital imaging (HSDI). A secondary hypothesis of the study was to investigate the sensitivity and specificity of the signature kinematic features obtained from HSDI, in differentiating between AdSD and MTD.

Methods:

We used vibratory features from automated extraction of vocal fold motion waveforms and glottal cycle montage analysis from HSDI for differential kinematic profiling of AdSD and MTD.

Results:

Novel features of motion irregularities and micromotions (as small as 27 ms) were greater in number for AdSD, whereas reduced motion irregularities, absence of oscillatory breaks, absence of micromotions, and increased hyperfunction characterized the MTD group. Oscillatory breaks (as small as 8 ms), although present only in the AdSD group, were not statistically significant because of their reduced number of occurrences compared to the other features. Further montage analysis of successive glottal cycles of oscillatory breaks in the AdSD group revealed 3 different kinematic patterns within the AdSD group, indicative of likely AdSD with: 1) possible predominant thyroarytenoid muscle involvement, 2) possible predominant cricothyroid muscle involvement, and 3) possible combined involvements of the thyroarytenoid and lateral cricoarytenoid muscles. Four consistent but unique kinematic patterns were identified within the MTD group: 1) diplophonia, 2) vocal fry, 3) breathy phonation, and 4) pressed phonation. Sensitivity and specificity analysis revealed that only motion irregularity was a significant predictor of the presence of AdSD.

Conclusions:

Fine kinematic analysis from HSDI can be used to aid detailed clinical profiling of the source characteristics of AdSD and MTD.
Several Mechanical Manipulations of the Wall of the Inner Ear Do Not Affect Air and Bone Conduction Auditory Thresholds
Authors: Perez Ronen , Adelman Cahtia , Sohmer Haim
Published: October 2014

Objectives:

According to classic theories, auditory stimulation, whether air- or bone-conducted, has been thought to begin with sound-induced relative motion between the cochlear shell and the stapes footplate, producing a passive mechanical traveling wave along the basilar membrane. This study was designed to assess the effect of experimental mechanical manipulations of the cochlea on the auditory thresholds to air-conducted and bone-conducted stimulation.

Methods:

The left ear of Psammomys obesus (highest auditory sensitivity between 0.5 and 5.0 kHz) was initially ablated in all animals studied. After baseline recording of auditory nerve–brain stem evoked response (ABR) thresholds to air- and bone-conducted broadband click stimulation from the right ear, a hole was drilled in the vestibule of that ear in 3 animals. In 2 other animals, the round window of the animals was immobilized. In 3 additional animals, the round window was widely perforated. Repeat ABR thresholds were then determined.

Results:

There was no change in ABR thresholds to both air- and bone-conducted stimulation following these manipulations. The ABR wave latency also did not change.

Conclusions:

It is likely that an alternative mode of cochlear excitation is possible.
Superior Mesotympanic Sinus
Authors: Holt James J.
Published: October 2014

Objectives:

This study of the posterior tympanum was performed to better define the anatomy of this complex area of the middle ear. A sinus previously not described was examined.

Methods:

The posterior tympanum of 49 temporal bones was studied by microscopic techniques. The sinus depth, the opening into the sinus, and the relationship of the facial nerve to the sinus were documented.

Results:

A sinus lying in the superior part of the posterior tympanum was discovered: The superior mesotympanic sinus. The depth of the sinus was from 0.5 to 2 mm, and it was present in 42 of the 49 specimens (86%). The superior border of the sinus is the facial nerve, which was dehiscent in 9 cases.

Conclusions:

The surgeon can remove disease with more confidence from the tympanum if he or she knows that disease may harbor in this sinus, and that injury to the facial nerve must be avoided.
Ten-Month Laryngeal Allograft Survival with Use of Pulsed Everolimus and Anti—αβ T-Cell Receptor Antibody Immunosuppression
Authors: Lott David G. , Russell Jonathon O. , Khariwala Samir S. , Dan Olivia , Strome Marshall
Published: October 2014

Objectives:

The risks of daily immunosuppression limit the use of laryngeal transplantation as a reconstructive option. Pulsed immunosuppressive dosing can lessen these risks. The study objective was to develop a long-term pulsing regimen that minimizes exposure to immunosuppressive agents.

Methods:

Rat laryngeal transplantation was performed. Everolimus (1 mg/kg per day) and anti–αβ T-cell receptor (TCR) antibodies (250 μg) were given for 7 days beginning 1 day before transplantation and for 5 days beginning on day 90 after transplantation. On day 180, group 1 (n = 5) received the initial regimen for 3 days, and group 2 (n = 5) received everolimus (1 mg/kg per day) until euthanization, which occurred when parathyroid hormone (PTH) levels dropped to less than 11 pg/mL or at 300 days.

Results:

Four of the 5 rats in group 1 had normal PTH levels at 300 days. The PTH level for 1 rat was less than 11 pg/mL at 270 days. In group 2, none of the 5 rats had normal PTH levels at 300 days. Two had PTH levels below 11 pg/mL at 270 days, and 3 had PTH levels below 11 pg/mL at 300 days. The allografts that survived beyond 300 days had an essentially normal histologic appearance.

Conclusions:

Pulsed immunosuppression prevented allograft rejection for 10 months and was more effective than daily everolimus. Short-term perioperative therapy followed by pulsed, tapered dosing is a viable alternative to traditional regimens and may decrease associated risks.
Response of Cricopharyngeus Muscle to Esophageal Stimulation by Mechanical Distension and Acid and Bile Perfusion
Authors: Chernichenko Natalya , Woo Jeong-Soo , Hundal Jagdeep S. , Sasaki Clarence T.
Published: October 2014

Objectives:

The aim of this study was to identify the response of the cricopharyngeus muscle (CPM) to esophageal stimulation by intraluminal mechanical distension and intraluminal acid and bile perfusion.

Methods:

In 3 adult pigs, electromyographic (EMG) activity of the CPM was recorded at baseline and after esophageal stimulation at 3 levels: Proximal, middle, and distal. The esophagus was stimulated with 20-mL balloon distension and intraluminal perfusion of 40 mL 0.1N hydrochloric acid, taurocholic acid (pH 1.5), and chenodeoxycholic acid (pH 7.4) at the rate of 40 mL/min. The EMG spike density was defined as peak-to-peak spikes greater than 10 μV averaged over 10-ms intervals.

Results:

In all 3 animals, the spike density at baseline was 0. The spike densities increased after proximal and middle distensions to 15.2 ± 1.5 and 5.1 ± 1.2 spikes per 10 ms, respectively. No change in CPM EMG activity occurred after distal distension. The spike density following intraluminal perfusion with hydrochloric acid at the distal level was 10.1 ± 1.1 spikes per 10 ms. No significant change in CPM EMG activity occurred after acid perfusion at the middle and proximal levels. No change in CPM EMG activity occurred after intraluminal esophageal perfusion with either taurocholic acid or chenodeoxycholic acid.

Conclusions:

Proximal esophageal distension, as well as distal intraluminal acid perfusion, appeared to be important mechanisms in generation of CPM activity. Bile acids, on the other hand, failed to evoke such CPM activity. The data suggest that transpyloric refluxate may not be significant enough to evoke the CPM protective sphincteric function, thereby placing supraesophageal structures at risk of bile injury.
Adaptation to Steady-State Electrical Stimulation of the Vestibular System in Humans
Authors: Guyot Jean-Philippe , Sigrist Alain , Pelizzone Marco , Kos Maria Izabel
Published: October 2014

Objectives:

Efforts are being made toward the development of a vestibular implant. If such a device is to mimic the physiology of the vestibular system, it must first be capable of restoring a baseline or “rest” activity in the vestibular pathways and then modulating it according to the direction and velocity of head movements. The aim of this study was to assess whether a human subject could adapt to continuous electrical stimulation of the vestibular system, and whether it was possible to elicit artificial smooth oscillatory eye movements via modulation of the stimulation.

Methods:

One bilaterally deaf patient with bilateral vestibular loss received a custom-modified Med-E1 cochlear implant in which one electrode was implanted in the vicinity of the left posterior ampullary nerve. This electrode was activated with biphasic pulse trains of 400-μs phase duration delivered at a repetition rate of 200 pulses per second. The resulting eye movements were recorded with 2-dimensional binocular video-oculography.

Results:

Successive “on-off” cycles of continuous electrical stimulation resulted in a progressively shorter duration of the nystagmic response. Once the adapted state was reached upon constant stimulation, amplitude or frequency modulations of electrical stimulation produced smooth oscillatory conjugated eye movements.

Conclusions:

Although this is a case study of one patient, the results suggest that humans can adapt to electrical stimulation of the vestibular system without too much discomfort. Once the subject is in the adapted state, the electrical stimulation can be modulated to artificially elicit smooth eye movements. Therefore, the major prerequisites for the feasibility of a vestibular implant for human use are fulfilled.
Objective Methods of Sample Selection in Acoustic Analysis of Voice
Authors: Olszewski Aleksandra E. , Shen Lisa , Jiang Jack J.
Published: October 2014

Objectives:

In acoustic voice analysis, the fact that reproducible methods of sample selection have not been defined impedes research study generalizability and clinical assessment of treatment efficacy. Because perturbation results differ along a single signal, this study sought to establish objective methods of sample selection by use of a moving window to determine the most stable regions of phonation.

Methods:

Voice signals obtained from 21 patients affected by laryngeal conditions associated with Parkinson's disease were analyzed to study jitter, shimmer, signal-to-noise ratio, and correlation dimension parameters when various sample selection procedures were used. Objectively selected voice samples were chosen based upon 5%, 10%, and 20% variance from a signal's minimum perturbation value. The stability of these samples, defined by the standard deviations of the acoustic measurements, was compared to the stability of unselected samples and subjectively selected samples.

Results:

A significant decrease in standard deviation values of acoustic parameters was found in comparing the objectively selected samples (particularly those selected with 5% and 10% variance) to the subjectively selected and unselected samples.

Conclusions:

These results suggest that the development of an objective sample selection method may have significant effects on the stability and reliability of acoustic voice measurements.
Acute Rhinosinusitis—Related Orbital Infection in Pediatric Patients: A Retrospective Analysis
Authors: Huang Shiang-Fu , Lee Ta-Jen , Lee Yun-Shien , Chen Chien-Cheng , Chin Shy-Chi , Wang Ning-Chia
Published: October 2014

Objectives:

Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling.

Methods:

In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan.

Results:

The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures.

Conclusions:

The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses.
Reconstruction of Tracheal Wall Defect with a Mesh Patch of Nickel-Titanium Shape-Memory Alloy
Authors: Luo Jia-Sheng , Cui Peng-Cheng , Gao Peng-Fei , Nan Hou , Liu Zhi , Sun Yong-Zhu
Published: October 2014

Objectives:

We explored the feasibility of reconstructing tracheal wall defects with a mesh patch fashioned from a nickel-titanium shape-memory alloy.

Methods:

A tracheal wall defect was first constructed surgically by resecting the anterior half of the tracheal wall between the second and sixth tracheal rings. The defect was reconstructed in 8 experimental animals by replacing the resected tracheal mucosa and tracheal cartilage with a pedicle skin flap, which was then enclosed in the mesh patch. In 4 control animals, only a pedicle skin flap with strap muscles was used in the reconstruction procedure. The performance of the animals was observed after surgery. At the end of the experiments, the reconstructed segment was harvested for anatomic evaluation.

Results:

In the experimental group, 1 animal died 5 days after the operation. Endoscopic and anatomic examination of the 7 animals that survived the observation period showed that the reconstructed trachea was stable, with sufficient airway space for breathing. All 4 control animals died after the operation. After observing successful completion of this operation in animals, we successfully used this method to repair a tracheal wall defect in a human victim of a traffic accident.

Conclusions:

Tracheal defects can be successfully reconstructed by use of a mesh patch of nickel-titanium shape-memory alloy as an extraluminal stent – a method that avoids complications associated with intraluminal stents.
Eustachian Tube Function in Adults without Middle Ear Disease
Authors: Swarts J. Douglas , Alper Cuneyt M. , Mandel Ellen M. , Villardo Richard , Doyle William J.
Published: October 2014

Objectives:

We sought to develop normative values for 5 eustachian tube function (ETF) test protocols in adults without otitis media (OM).

Methods:

Twenty adults (19 to 48 years of age) without a recent history of OM (5 had OM in childhood) underwent unilateral myringotomy and were evaluated for ETF by use of the forced response, inflation, deflation, forcible “sniff,” and Valsalva test protocols. When possible, these tests were repeated on a second day.

Results:

Normative values for the parameters of these protocols in adult subjects without a recent history of OM were developed. Between-day data for the forced response test were highly correlated. A percentage of these tests showed eustachian tube “constriction” during swallowing — An abnormal condition. The percent reduction in applied pressures for the inflation and deflation tests was high, indicative of good ETF. Few subjects had a positive “sniff” test, whereas most had a positive Valsalva test, and the results for both tests were effort-dependent.

Conclusions:

Results of ETF tests in adults with and without recent OM have not been published. Normative data are now available for comparison with ETF test results in adults with OM. These protocols will be used to evaluate the efficacy of surgical procedures designed to improve ETF.
Vibratory Asymmetry in Mobile Vocal Folds: Is it Predictive of Vocal Fold Paresis?
Authors: Simpson C. Blake , May Linda Seitan , Green Jill K. , Eller Robert L. , Jackson Carlayne E.
Published: October 2014

Objectives:

The purpose of this study was to determine whether the videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis. In addition, the ability of experienced reviewers to predict the distribution (left/right/bilateral) of the paresis was investigated.

Methods:

This is a retrospective chart review of all patients who presented to our clinic during a 3-year period with symptoms suggestive of glottal insufficiency (vocal fatigue or reduced vocal projection) accompanied by the videostroboscopic findings of bilateral normal vocal fold mobility and vibratory asymmetry. Twenty-three of these patients underwent diagnostic laryngeal electromyography of the thyroarytenoid and cricothyroid muscles to determine the presence of vocal fold paresis.

Results:

Nineteen of the 23 patients (82.6%) were found to have electrophysiological evidence of vocal fold paresis, either unilaterally or bilaterally, when videostroboscopic asymmetry was present in mobile vocal folds. However, the three expert reviewers' ability to predict the distribution (left/right/bilateral) of the paresis was poor (26.3%, 36.8%, and 36.8%, respectively).

Conclusions:

The videostroboscopic finding of vibratory asymmetry in mobile vocal folds is a reliable predictor of vocal fold paresis in most cases. However, the ability of expert reviewers to determine the distribution (left/right/bilateral) of the paresis using videostroboscopic findings is poor. This study highlights the value of laryngeal electromyography in arriving at a correct diagnosis in this clinical situation.
Facial Nerve Dehiscence and Cholesteatoma
Authors: Magliulo Giuseppe , Colicchio Maria Giovanna , Ciniglio Mario
Published: October 2014

Objectives:

We evaluated the incidence of facial nerve dehiscence in a group of patients with cholesteatoma who underwent otologic surgery.

Methods:

We performed a retrospective study in a tertiary referral hospital of 336 patients (298 adults, 38 children) with cholesteatoma who underwent surgery in the years 1998 to 2008. Using intraoperative findings, we assessed the incidence of facial nerve dehiscence in a group of patients with cholesteatoma. We quantified, in adult versus pediatric patients and in primary versus revision surgeries, the occurrence of facial nerve dehiscence, the predisposed anatomic sites, and the coexistence of semicircular canal fistula. In a selected group of 67 patients, preoperative 0.55-mm collimation computed tomography (CT) scans were compared with the intraoperative findings.

Results:

The frequency of facial nerve dehiscence in this group of patients was 27.1%. The dehiscence was detected in 29.5% of the adults, but in only 7.8% of the patients 16 years and younger. Dehiscence was present in 42.3% of the patients who underwent revision surgery. The most common site of dehiscence (92.3%) was the tympanic segment. The sensitivity and specificity of CT were 69% and 87%, respectively.

Conclusions:

Dehiscence of the facial nerve was found in 27.1% of patients with cholesteatoma, with a significant difference between patients of pediatric and adult ages. A dehiscent facial nerve was more commonly seen during revision surgery and more frequent in patients older than 16 years. The site of dehiscence most frequently involved by cholesteatoma was the tympanic segment. The presence of a semicircular canal fistula increases the risk of facial nerve dehiscence. Finally, the results of preoperative CT scans are encouraging for the use of CT in predicting facial nerve dehiscence.
Clinical Test of Gustatory Function Including Umami Taste
Authors: Mueller Christian Albert , Pintscher Karin , Renner Bertold
Published: October 2014

Objectives:

Assessment of gustatory function is a central part of the diagnosis of patients with chemosensory dysfunctions. The taste of monosodium glutamate was described as umami taste a century ago by Ikeda. The aim of this study was to extend a validated gustatory test with 4 concentrations of monosodium glutamate.

Methods:

The investigation included 96 subjects who reported having a normal sense of taste and smell. Taste function was assessed by 4 concentrations of sweet, sour, salty, bitter, and umami tastes (extended version) and compared to results obtained in a control group (n = 139) not presented with umami. In a subgroup of 46 participants, the complete test was repeated within 7 days to obtain retest values.

Results:

Group comparisons exhibited no differences in taste sensitivity for each of the 4 taste qualities (p > 0.3) and no deviation with regard to the sum of correctly identified tastants (p = 0.81). Test-retest data from the extended version revealed a high correlation of scores (r46 = 0.77; p < 0.001).

Conclusions:

The results indicate that the extended version of the gustatory test is applicable for experimental and clinical settings.
Malignant Carotid Body Tumor with Systemic Metastases
Authors: Nishijima Hironobu , Asakage Takahiro , Sugasawa Masashi
Published: October 2014

Carotid body tumors (CBTs) are rare neoplasms of the carotid body. Most CBTs are benign; however, some can show malignant behavior. Malignant CBTs have an unpredictable history; often, there is no correlation between the histologic findings and the clinical behavior. They are usually diagnosed by the development of local recurrence or lymph node metastasis following total resection of the primary mass, or by the detection of distant metastasis. There are few reports of histopathologic confirmation of malignant CBTs. We report a rare case of malignant CBT with distant metastases, in which the diagnosis was confirmed by histopathology, and present a review of the literature.
Implantation of an Atelocollagen Sponge with Autologous Bone Marrow—Derived Mesenchymal Stromal Cells for Treatment of Vocal Fold Scarring in a Canine Model
Authors: Ohno Satoshi , Hirano Shigeru , Kanemaru Shin-Ichi , Kitani Yoshiharu , Kojima Tsuyoshi , Tateya Ichiro , Nakamura Tatsuo , Ito Juichi
Published: October 2014

Objectives:

Vocal fold scarring remains a therapeutic challenge. A new regenerative approach is needed to restore disorganized extracellular matrix. Tissue regeneration requires appropriate cells and a scaffold. Bone marrow–derived mesenchymal stromal cells (BMSCs) are multipotent and secrete many kinds of growth factors to regenerate tissues. Atelocollagen sponges have many large pores that permit cell entry. The present study was performed to evaluate whether implantation of an atelocollagen sponge plus BMSCs is effective for the treatment of vocal fold scarring.

Methods:

Twelve beagles underwent implantation of an atelocollagen sponge or of an atelocollagen sponge with autologous BMSCs (1.0 × 106 cells) in the subepithelial pockets of scarred vocal folds. Six months after the operation, vibratory examinations and histologic examinations were performed.

Results:

Mucosal vibrations improved significantly for the atelocollagen sponge–implanted vocal folds. Histologic analyses revealed favorable restoration of the extracellular matrix in the lamina propria. Increased distribution of hyaluronic acid and decreased dense collagen deposition were also noted. These improvements were enhanced by implantation of BMSCs.

Conclusions:

Implantation of atelocollagen sponges with autologous BMSCs into scarred vocal folds significantly increased hyaluronic acid distribution and decreased dense collagen deposition in the lamina propria, leading to better mucosal vibration.
Differential Diagnosis of Cystic Neck Lesions
Authors: Sira James , Makura Zvoru G. G.
Published: October 2014

Objectives:

In patients less than 40 years of age who present with an upper anterior triangle cystic mass, branchial cyst is the presumed clinical diagnosis. Squamous cell malignancy is the important differential diagnosis in a patient more than 40 years of age. We sought to identify the range of lesions that can be clinically mistaken for, and removed as, branchial cysts.

Methods:

We performed retrospective reviews of 29 neck masses removed as branchial cysts and 47 solitary neck masses diagnosed as cancer between January 2003 and January 2008 across two teaching hospitals in Leeds, England.

Results:

Of the 29 lesions removed, 23 (79.3%) were confirmed to be branchial cysts. The remainder comprised 2 thyroid papillary carcinomas (6.9%) and 4 benign lesions (13.6%; laryngocele, neurilemmoma, parotid gland cyst, and cystadenoma). Of the 47 cases of metastatic cancer, 3 lesions (6.4%) were clinically mistaken as branchial cysts but were subsequently diagnosed as squamous cell carcinomas.

Conclusions:

When presented with a solitary lateral cystic mass, clinicians should consider the possibility of squamous cell carcinoma in patients more than 40 years of age, and thyroid papillary cancer should be considered particularly in the younger age groups. In our series, 30.8% of the neck lesions believed to be branchial cysts in patients over 40 were malignant, in contrast to 5.3% of those lesions in patients under 40.
Phenotype Analysis of an Australian DFNA9 Family with the I109N COCH Mutation
Authors: Pauw Robert J. , Huygen Patrick L. M. , Colditz Gordon M. , Cremers W. R. J.
Published: October 2014

Objectives:

We studied the clinical characteristics of an Australian family with an autosomal dominant sensorineural hearing impairment (DFNA9) caused by an I109N mutation in COCH.

Methods:

Retrospective analyses of audiometric data from 8 mutation carriers of an Australian DFNA9 family with the I109N COCH mutation were performed. Cross-sectional hearing levels related to age, age-related typical audiograms, and speech recognition scores related to age and to the level of hearing impairment were investigated. Data were compared to those obtained in previously identified DFNA9 families with P51S, V66G, G87W, G88E, I109T, and C542F COCH mutations.

Results:

Deterioration of hearing in the I109N mutation carriers started before the age of 40 years. The audiometric characteristics of the I109N mutation carriers are essentially similar to those previously established in I109T mutation carriers and, to a lesser extent, in P51S, G87W, and G88E mutation carriers.

Conclusions:

The phenotype associated with the I109N COCH mutation is largely similar to that associated with the I109T, P51S, G87W, and G88E mutation carriers. However, subtle differences seem to exist in terms of age of onset and rate of progression.
Nasal Nitric Oxide and Lifestyle Exposure to Tobacco Smoke
Authors: Zhou Haibo , Zou Baiming , Hazucha Milan , Carson Johnny L.
Published: October 2014

Objectives:

Nitric oxide (NO) is a reactive gas generated by inflammatory cells and mucosal epithelial cells of the nose and paranasal sinuses and is an important mediator in nonspecific host defense against infectious agents. However, NO also mediates physiologic events such as vasodilation, mucus hypersecretion, and mucosal disruption that are associated with inflammatory conditions, and it is a regulator of ciliary beat frequency. In the present study, we hypothesized that lifestyle exposure to tobacco smoke, whether through active smoking or by inadvertent exposure to secondhand tobacco smoke, would result in higher detectable levels of nasal NO (nNO) than are found in well-documented nonsmokers.

Methods:

Nasal NO measurements were obtained concomitant with assays of urine cotinine from well-documented nonsmokers, active smokers, and individuals exposed by lifestyle to secondhand smoke. These parameters were statistically analyzed to determine whether increasing levels of tobacco smoke exposure yield higher concentrations of nNO.

Results:

Our results and subsequent statistical analyses imply that active smokers who exhibit high urine cotinine levels exhibit significant increases in nNO levels in comparison to both nonsmokers and nonsmokers exposed to secondhand smoke.

Conclusions:

There is an increased level of nNO associated with tobacco smoke exposure that may contribute to the inflammatory processes characteristic of disease pathogenesis in smokers.
Observation of Cortical Activity during Speech Stimulation in Prelingually Deafened Adults with Cochlear Implantation by Positron Emission Tomography—Computed Tomography
Authors: Yoshida Haruo , Kanda Yukihiko , Takahashi Haruo , Miyamoto Izumi , Chiba Kenya
Published: October 2014

Objectives:

We evaluated the cortical activity of 2 successful prelingually deafened adult cochlear implant (CI) users who have been trained by auditory-verbal/oral communication since childhood.

Methods:

Changes in regional cerebral blood flow were measured by positron emission tomography using 18F-fluorodeoxyglucose while the subjects were receiving auditory language stimuli by listening to a story. Ten normal-hearing volunteers were observed as age-matched control subjects.

Results:

In both cases, the auditory-related regions, when compared to same regions in the control subjects, showed hypermetabolism in the left dorsolateral prefrontal cortex and the left precentral gyrus — Similar to that in successful CI users who are prelingually deafened children or postlingually deafened adults. Both subjects had the ability to activate these areas, and this ability might be one of the reasons that accounts for such exceptionally good performance in older prelingually deaf CI users. As for the visual-related regions, hypometabolism was observed in Brodmann areas 18 and 19, and this finding might be related to the intensive auditory-verbal/oral education that the subjects had received since childhood.

Conclusions:

Despite the limits imposed by the small sample size and the spatial resolution of positron emission tomography, this study yielded insights into the nature of the brain plasticity in prelingually deafened adults who are successful CI users.
Role of Rhinitis in Laryngitis: Another Dimension of the Unified Airway
Authors: Turley Richard , Cohen Seth M. , Becker Adam , Ebert Charles S.
Published: October 2014

Objectives:

We evaluated the prevalence of dysphonia and secondary laryngeal symptoms among patients with allergic rhinitis (AR), nonallergic rhinitis (NAR), and no rhinitis symptoms (controls).

Methods:

Patients with rhinitis symptoms with positive and negative allergy tests were recruited from allergy clinics, and patients without rhinitis symptoms were recruited from an orthopedic clinic. All groups completed the Voice-Related Quality of Life survey (VRQOL), the mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and the Reflux Symptom Index (RSI).

Results:

Completing the study were 134 patients with AR, 54 patients with NAR, and 62 controls. Both AR and NAR patients had an increased prevalence of dysphonia compared to controls (32.8% and 26.9% versus 8.1%, respectively; p = 0.001). When we controlled for confounding variables such as asthma, inhaled steroid use, and gastroesophageal reflux, patients with either AR or NAR had higher odds of dysphonia (odds ratio, 4.22; 95% confidence interval, 1.03 to 17.32). Patients with worse mini-RQLQ scores had lower VRQOL scores and higher RSI scores (Spearman correlation of −0.47 and p < 0.001 and Spearman correlation of 0.6 and p < 0.001, respectively).

Conclusions:

Patients with rhinitis (AR or NAR) had a higher prevalence of dysphonia than did controls. Patients with worse rhinitis symptoms had worse voice-related quality of life and more severe chronic laryngeal symptoms.
Microbiology of Acute and Chronic Maxillary Sinusitis in Smokers and Nonsmokers
Authors: Brook Itzhak , Hausfeld Jeffrey N.
Published: October 2014

Objectives:

We evaluated the microbiology of sinus aspirates of smokers and nonsmokers with acute and chronic maxillary sinusitis.

Methods:

Cultures were obtained from 458 patients, 244 (87 smokers and 157 nonsmokers) of whom had acute maxillary sinusitis and 214 (84 smokers and 130 nonsmokers) of whom had chronic maxillary sinusitis, between 2001 and 2007.

Results:

A greater number of Staphylococcus aureus, methicillin-resistant S aureus (MRSA), and beta-lactamase–producing bacteria (BLPB) were found in the 87 smokers with acute sinusitis than in the nonsmokers with acute sinusitis (p < 0.005, p < 0.025, and p < 0.05, respectively). A greater number of these organisms were found in the 84 smokers with chronic sinusitis than in the nonsmokers (p < 0.01, p < 0.025, and p < 0.001, respectively). Eighty-five BLPB isolates were recovered from 73 patients (30%) with acute sinusitis. These included Moraxella catarrhalis, S aureus, Haemophilus influenzae, Prevotella spp, and Fusobacterium spp; 40 BLPB isolates were found in smokers, and 45 in nonsmokers (p < 0.05). One hundred twenty-five BLPB isolates were recovered from 91 patients (43%) with chronic sinusitis, including M catarrhalis, Bacteroides fragilis group, S aureus, H influenzae, Prevotella spp. and Fusobacterium spp; 69 BLPB isolates were found in smokers, and 56 in nonsmokers (p < 0.001). Antimicrobial therapy had been administered in the past month to 130 patients (28%; 60 smokers and 70 nonsmokers; p < 0.025). Both MRSA and BLPB were isolated more often from these individuals (p < 0.025). However, the higher isolation rates of MRSA and BLPB in smokers were independent of previous antimicrobial therapy.

Conclusions:

These data illustrate a greater frequency of isolation of S aureus, MRSA, and BLPB in patients with acute and chronic sinusitis who smoke.
Management of Zenker's Diverticulum in the Endoscopic Age: Current Practice Patterns
Authors: Bock Jonathan M. , Van Daele Douglas J. , Gupta Nidhi , Blumin Joel H.
Published: October 2014

Objectives:

Zenker's diverticulum (ZD) is a common source of dysphagia with a well-established surgical treatment history. Variations may exist between practitioners in the preoperative, intraoperative, and postoperative management of patients with ZD because of recent evolutions in surgical approach toward an endoscopic technique.

Methods:

An online survey instrument was prepared and forwarded to the membership of the American Broncho-Esophagological Association (ABEA) to ascertain the current practice patterns of its members regarding numerous care parameters for patients with ZD.

Results:

Data on preoperative evaluation, operative care, postoperative management, and recalled incidence of complications, including mediastinitis, were evaluated. Subgroup analysis demonstrated significant differences in multiple care parameters for those surgeons who predominantly perform endoscopic operations (more than 80% willingness to perform endoscopic operations) compared to those who occasionally perform endoscopic operations (less than 80%), including average case number, advancement of oral intake, hospital discharge, use of antibiotics, and views on the efficacy of endoscopic surgical techniques. These changes were noted despite similar times since graduation from training for the two groups.

Conclusions:

These data present a contemporary snapshot of clinical care patterns of the ABEA membership for patients with ZD and suggest differences in care patterns for surgeons with a higher enthusiasm for endoscopic techniques and larger case volumes.
Expression of ABC Transporters is an Unfavorable Prognostic Factor in Laryngeal Squamous Cell Carcinoma
Authors: Shen Bin , Li Dawei , Dong Pin , Gao Shang
Published: October 2014

Objectives:

Two prominent and well-characterized representatives of adenosine triphosphate–binding cassette (ABC) transporter — Breast cancer resistance protein (BCRP or ABCG2) and P-glycoprotein (P-gp or ABCB1) — Are known to be membrane transporters associated with multidrug resistance. The aim of this study was to explore the correlation between ABC transporter expression and the clinicopathologic characteristics, proliferative index, and apoptotic index and their prognostic value in laryngeal squamous cell carcinoma (LSCC).

Methods:

Paraffin sections of 98 human LSCC specimens were investigated with immunohistochemical techniques. The relationship between ABCG2 and ABCB1 expression and clinicopathologic parameters, proliferative activities, and apoptotic activities and their prognostic value in patients' overall survival rate were subsequently analyzed.

Results:

Immunohistochemical analysis revealed positive expression of ABCG2 and ABCB1 in 52.0% and 41.8% of patients, respectively. There was a positive correlation between ABCG2 expression and ABCB1 expression. The presence of these two proteins was significantly related to clinical stage, lymph node metastasis, and overall survival in LSCC. Interestingly, up-regulation of ABCG2 expression was found to be associated with increased proliferation, but that of ABCB1 was not. Up-regulation of both ABCG2 expression and ABCB1 expression was associated with decreased apoptosis.

Conclusions:

The results of this study revealed that the presence of ABCG2 and/or ABCB1 is predictive for malignant progression and is an independent prognostic factor in LSCC. The mechanism of ABC transporters may contribute to chemotherapy resistance by promoting proliferation and/or suppressing apoptosis.
Endoscopic Assessment of Vocal Fold Movements during Cough
Authors: Britton Deanna , Yorkston Kathryn M. , Eadie Tanya , Stepp Cara E. , Ciol Marcia A. , Baylor Carolyn , Merati Albert L.
Published: October 2014

Objectives:

Little is known about the function of the true vocal folds (TVFs) during cough. The objective of this study was to determine the reliability of measuring TVF movements during cough and to obtain preliminary normative data for these measures.

Methods:

Sequential glottal angles associated with TVF adduction and abduction across the phases of cough were analyzed from laryngeal videoendoscopy records of 38 young healthy individuals.

Results:

The intraobserver and interobserver reliability of 3 experienced measurers was high (intraclass correlation of at least 0.97) for measuring sequential and maximum glottal angles. The TVF abduction velocity during expulsion was significantly higher than the precompression adduction velocity (p = 0.002), but there were no significant differences in maximum angle. No statistically significant differences were seen in maximum TVF angle and velocity when they were compared between the sexes and between the levels of cough strength. True vocal fold closure following expulsion occurred in 42% of soft coughs and in 57% of moderate to hard coughs.

Conclusions:

The TVF abduction angles during cough can be reliably measured from laryngeal videoendoscopy in young healthy individuals. The TVF movements are faster for expulsion abduction than for precompression adduction, but the extents of abduction are similar. To validly determine the cough phase duration, simultaneous measures of airflow are needed.
Chest Wall Kinematics during Speech Breathing in Tracheoesophageal Speakers
Authors: Bohnenkamp Todd A. , Forrest Karen , Klaben Bernice K. , Stager Joel
Published: October 2014

Objectives:

The purpose of the present study was to determine how tracheoesophageal (TE) speakers manipulate the chest wall (rib cage and abdomen) to speak and how respiratory compromise (chronic obstructive pulmonary disease; COPD) and task variables influence those behaviors.

Methods:

The chest wall movements of 11 male TE speakers (5 with COPD and 6 without COPD) were measured during tidal breathing, spontaneous speech, and reading. Repeated-measures multivariate analyses were used to compare breathing behaviors across speech tasks and by respiratory health. Additional repeated-measures multivariate analyses and 1-way analyses of variance were conducted on temporal, aerodynamic, and linguistic measures.

Results:

There was a significant main effect of task and a significant interaction effect of COPD and task on chest wall movements. Rib cage movements varied by task, whereas abdominal movements were as predicted. There was a significant difference in utterance length by task. There were no main effects of COPD on the chest wall and no significant group differences in utterance length, aerodynamic measures, or intelligibility. The TE speakers were generally accurate in inspiring at appropriate linguistic boundaries.

Conclusions:

The results suggest that there is robust control for speech breathing following laryngectomy, but that there is also increased effort within the chest wall. Implications for future research considerations are discussed.
Retrograde Sialendoscopy: A New Technique for Avoiding Retained Ductal Stones
Authors: Potash Andrea , Hoffman Henry T.
Published: October 2014

Objectives:

Recurrent infection from stones retained in Wharton's duct after submandibular gland resection warrants intraoperative attention to the duct remnant. Our hypothesis was that retrograde sialendoscopy would help ensure complete stone removal in submandibular gland removal for sialolithiasis.

Methods:

We reviewed 9 sequential cases of submandibular sialolithiasis treated surgically via open procedures at a tertiary care center by a single surgeon between November 2007 and December 2009. The review focused on the clinical history and intraoperative findings.

Results:

We identified successful application of a new technique of retrograde sialendoscopy performed to detect and remove stones that were retained in Wharton's duct at the time of submandibular gland resection. An index case of complications from a stone retained after submandibular gland resection is presented in a sequential series of cases in which retrograde sialendoscopy was developed.

Conclusions:

Retrograde sialendoscopy is a novel technique that is useful as an adjunct to standard submandibular gland resection in the management of sialolithiasis.
“Natural” Decannulation in Patients with Robin Sequence and Severe Airway Obstruction
Authors: Han Kevin D. , Seruya Mitchel , Oh Albert K. , Zalzal George H. , Preciado Diego A.
Published: October 2014

Objectives:

Airway management in infants with Robin sequence (RS) remains controversial, ranging from conservative to operative methods. In some centers, tracheostomy remains the mainstay for those infants with severe respiratory obstruction. The goals of this retrospective case cohort study were to determine the length of time to decannulation without further surgical intervention (ie, “natural” decannulation) in patients with severe RS who underwent tracheostomy and to investigate potential factors associated with successful decannulation.

Methods:

We reviewed all infants with RS treated at a large tertiary center from 1994 to 2010. Patients who had undergone tracheostomy were identified. Baseline demographics, complications, deaths, and time to “natural” decannulation were recorded. Statistical analysis was performed with univariate analysis and Kaplan-Meier log-rank tests.

Results:

Of 61 infants with RS with obstructive events, 25 infants (14 with isolated RS and 11 with syndromic RS) required tracheostomy. At a mean follow-up of 4 years, the rate of tracheostomy-specific complications was 52%; the tracheostomy-specific mortality rate was 12%. Overall, 13 of 25 infants (52%) were “naturally” decannulated, with a median time to decannulation of 97 months. Patients with syndromic RS had a significantly longer median time to decannulation than did those with isolated RS (more than 73 months versus 19 months, respectively; p = 0.019). In addition, patients with long-term tracheostomy dependence had significantly higher maximum carbon dioxide levels before tracheostomy than did patients who were successfully decannulated (82.4 versus 63.2 mEq/L, respectively; p = 0.02).

Conclusions:

Tracheostomy in infants with RS is associated with inordinately high rates of mortality, morbidity, and long-term tracheostomy dependence, particularly in patients with syndromic RS and in those with high maximum carbon dioxide levels before tracheostomy.
Short-Term Functional and Morphological Changes in Guinea Pig Cochlea following Intratympanic Application of Burow's Solution
Authors: Suzuki Mitsuya , Iwamura Hitoshi , Kashio Akinori , Sakamoto Takashi , Yamasoba Tatsuya
Published: October 2014

Objectives:

Burow's solution, comprising aluminum sulfate and acetic acid, is an otic drug formulation applied to the tympanic cavity. We characterized the relationship between the auditory brain stem response (ABR) thresholds and the area of the capillary basement membrane anionic sites in the stria vascularis after the application of Burow's solution.

Methods:

We used cationic polyethylenimine (PEI) to observe changes in the capillary basement membrane anionic sites in the stria vascularis. Burow's solution was dropped directly onto the round window membrane and retained for 2 hours. The ABRs were recorded at 4, 8, and 20 kHz immediately before surgery and before decapitation. The cochlea was extirpated immediately or 2 days after the surgery and immersed in cationic PEI solution. The PEI distribution associated with the capillary basement membrane anionic sites was measured in the basal and third turns.

Results:

The ABR threshold shifts at 4, 8, and 20 kHz were significantly increased immediately after the surgery, whereas those at 4 and 8 kHz, but not at 20 kHz, had recovered 2 days after the surgery. Further, the PEI distribution was significantly decreased immediately after the surgery and had recovered 2 days after the surgery.

Conclusions:

Although Burow's solution may cause an acetic low pH in the stria vascularis and a temporary ABR threshold shift at 4 and 8 kHz, the permanent ABR threshold shift at 20 kHz cannot be attributed to the acetic low pH.
Garlic-Supplemented Diet Attenuates Gentamicin-Induced Ototoxicity: An Experimental Study
Authors: Uzun Lokman , Balbaloglu Evrim , Akinci Harun
Published: October 2014

Objectives:

Gentamicin sulfate is a potent aminoglycoside antibiotic associated with serious side effects, including ototoxicity. Garlic, with its intrinsic antioxidant activity, may prove beneficial in prevention of ototoxicity. In this study, we investigated the effect of a 4% garlic–supplemented diet on the ototoxicity induced by gentamicin in rats by using brain stem evoked response audiometry.

Methods:

Eighteen male Wistar rats with an intact Preyer's reflex and an initial weight of 220 to 260 g were randomly assigned to a group with gentamicin injection and garlic supplementation, a group with gentamicin injection without garlic supplementation, or a control group (6 rats each group). Gentamicin was given by intraperitoneal injection at 120 mg/kg body weight once daily for 16 days. The garlic-supplemented diet was prepared by adding pulverized whole garlic cloves to standard chow in a 4% proportion. After 21 days, hearing thresholds were evaluated by use of brain stem evoked response audiometry at 10 kHz.

Results:

The mean (±SD) amplitudes of the auditory thresholds (sensation level) measured by use of brain stem evoked response audiometry for the group with garlic supplementation, the group without garlic, and the control group were 43.3 ± 8.16, 78.0 ± 4.47, and 16.7 ± 5.16 dB sensation level, respectively. The differences were statistically significant (p < 0.05).

Conclusions:

A garlic-supplemented diet seems to attenuate aminoglycoside-induced hearing loss.