bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Model of Fungal Sinusitis: A Pilot Study in Rabbits
Authors: Dufour Xavier , Goujon Jean-Michel , Rodier Marie-Helene , Kauffmann-Lacroix Catherine , Grollier Ghislaine , Klossek Jean-Michel
Published: October 2014

We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.
Histologic Characterization of Rat Vocal Fold Scarring
Authors: Tateya Tomoko , Sohn Jin Ho , Tateya Ichiro , Bless Diane M.
Published: October 2014

This study aimed to clarify the characteristics of rat vocal fold scarring by examining the alteration of key components in the extracellular matrix: hyaluronic acid, collagen, and fibronectin. Under monitoring with a 1.9-mm-diameter telescope, unilateral vocal fold stripping was performed, and larynges were harvested at 2, 4, 8, and 12 weeks after operation. The vocal folds were histologically analyzed with Alcian blue stain, trichrome stain, and immunofluorescence of collagen type I, collagen type III, and fibronectin. The scarred vocal folds showed less hyaluronic acid and more collagen types I and III than did the controls at all time points. Type III was stable for 12 weeks, while type I declined until 8 weeks and thereafter remained unchanged. Fibronectin increased for 4 weeks and then decreased; it was close to the control level at 8 and 12 weeks. These results suggest that the tissue remodeling process in scarred vocal folds slows down around 2 months after wounding.
Sudden Sensorineural Hearing Loss in Lupus Erythematosus Associated with Antiphospholipid Syndrome: Case Report and Review
Authors: Compadretti Giacomo Ceroni , Brandolini Cristina , Tasca Ignazio
Published: October 2014

Systemic lupus erythematosus is a disease of unknown cause that manifests with tissue and cellular alterations due to the deposition of antibodies and pathogenic immune complexes. The disease can be associated with anticardiolipin antibody syndrome, a disorder of recurrent vascular thrombosis and thrombocytopenia associated with a persistent anticardiolipin test positivity. In this report, we describe the case of a young woman affected by lupus erythematosus and positive for anticardiolipin antibodies who was brought to our observation for a sudden sensorineural hearing loss in the right ear. The patient was successfully treated with osmotic therapy and, 13 months after the initial symptom, is now in good clinical condition with no recurrence of the hearing loss and normal bilateral hearing. Together with a critical review of the pertinent literature, this rare clinical case led us to formulate some original comments.
Morphological and Radiologic Evaluation of the Human Nasopalatine Duct
Authors: Knecht Michael , Hüttenbrink Karl-Bernd , Kittner Thomas , Hummel Thomas , Beleites Thomas , Witt Martin
Published: October 2014

In several mammals, a direct connection between the nasal cavity and the oral cavity is a common finding. The structure is named the nasopalatine duct (NPD). It has been hypothesized to be functional in terms of transportation of odorants from the oral cavity to the nasal cavity. In humans, the NPD exists during embryological development. The connection between the nasopalatine infundibulum and the incisive fossa is typically closed at the time of birth. We present the case of a 24-year-old man who presented with a persistent NPD. By means of a thin, soft tube, it was possible to probe the NPD. Magnetic resonance imaging revealed a bony gap between the hard palate and the alveolar process of the maxillary bone with a length of 16 mm and a width of 6 mm. In light of the literature of the past 500 years, this represents a rare finding of a persistent NPD.
Use of Fibrin Glue as a Hemostatic in Endoscopic Sinus Surgery
Authors: Vaiman Michael , Shlamkovich Nathan , Eviatar Ephraim , Segal Samuel
Published: October 2014

Endoscopic sinus surgery (ESS), especially when combined with turbinectomy and/or with submucous resection of the septum, may involve postoperative bleeding that might end with nasal packing. Nasal packing causes pain, rhinorrhea, and inconvenience and may not stop the postoperative bleeding. The aim of our study was to compare the hemostatic properties of the second-generation surgical sealant Quixil (Crosseal) with those of nasal packing in ESS. We performed a prospective randomized trial in 64 consecutive patients who underwent ESS and presented excessive intraoperative and/or postoperative bleeding. They were allocated by the sealed-envelope method into two groups. A routine ESS procedure was ended with Merocel nasal packing in group 1, and with aerosol application of Quixil sealant at the operative site in group 2. The hemostatic effects were evaluated objectively in the clinic by anterior rhinoscopy and endoscopy and assessed subjectively by the patients at follow-up visits. In group 1, various types of postoperative bleeding occurred in 25% of patients. In group 2 there was no postoperative bleeding, except for 1 case of late hemorrhage (3.12%). Drainage and ventilation of the paranasal sinuses were not impaired. There were no allergic reactions to the glue. We conclude that aerosol application of fibrin glue can be readily performed in ESS, requires no special treatment (antibiotics), and appears to have an adequate hemostatic effect. The use of this second-generation glue in ESS appears to stop nasal bleeding well and to be relatively safe and convenient.
Role of Vascular Endothelial Growth Factor–A in Recurrent Respiratory Papillomatosis
Authors: Vargas Sara O. , Healy Gerald B. , Rahbar Reza , Folkman Judah , Tan Xiaolian , McGill Trevor J. , Brown Lawrence F.
Published: October 2014

Vascular endothelial growth factor–A (VEGF-A) is known to play an important role in the angiogenic response essential for tumor growth in a variety of human and experimental tumors. This study was designed to investigate whether VEGF-A may play a role in the pathogenesis of recurrent respiratory papillomatosis (RRP). A retrospective study with institutional review board approval was performed at a tertiary care medical center on 12 patients with a history of laryngeal RRP. Their ages at the time of initial diagnosis ranged from 19 to 96 months (mean, 56 months). All patients had involvement of right and left true vocal cords. All patients required multiple endoscopic procedures (range, 4 to 66; mean, 12). Normal pediatric larynx samples from 5 autopsy patients were used as controls. Formalin-fixed, paraffin-embedded sections of laryngeal squamous papillomas from the 12 patients with a diagnosis of RRP and the 5 control patients were examined by in situ hybridization for the presence of messenger RNA (mRNA) for VEGF-A and vascular endothelial growth factor receptor 1 (VEGFR-1) and vascular endothelial growth factor receptor 2 (VEGFR-2). The biopsy specimens were from the true vocal cord (N = 10) or subglottis (N = 2) in the patients with RRP and consisted of large sections of larynx including the true vocal cord in the control patients (N = 5). Strong expression of VEGF-A mRNA was noted in the squamous epithelium of papillomas of all 12 patients. Strong expression of VEGFR-1 and VEGFR-2 was noted in the endothelial cells of the underlying vessels in all 12 patients. Neither strong labeling of VEGF-A mRNA nor labeling of its receptors was noted in the control patients. We conclude that the angiogenic growth factor VEGF-A is strongly expressed in the epithelium of squamous papillomas in RRP. Also, VEGFR-1 and VEGFR-2 mRNAs are strongly expressed by underlying vascular endothelial cells, suggesting an important role in the pathogenesis of RRP.
Acute Histologic Effects of Extraesophageal Reflux on Vocal Fold Healing
Authors: Cohen Seth M. , Garrett C. Gaelyn , Huang Shan , Courey Mark S.
Published: October 2014

This study evaluates how extraesophageal reflux affects membranous vocal fold healing in a canine model. We created membranous vocal fold injuries in the animals and randomly assigned them to topical application of acid and pepsin at pH 2 or pH 6 or of normal saline solution every other day for 12 days. The experimental vocal folds were compared to uninjured, control vocal folds from animals painlessly sacrificed for other reasons. Hematoxylin and eosin, fibronectin, and procollagen I staining were performed for histologic analysis. The injured specimens had three times greater cellular infiltrate (p ≤ .001, analysis of variance) and twice as much fibronectin and procollagen I (p ≤ .001, analysis of variance) as did the specimens from the control animals. No significant differences or trends were identified for cellular infiltrate, fibronectin, or procollagen I within the injured groups (p > .05, Bonferroni t-test). Acute wound healing did not appear to be influenced by the presence of acid and pepsin at pH 2 or 6 as compared to saline solution.
Regeneration of Aged Vocal Folds with Basic Fibroblast Growth Factor in a Rat Model: A Preliminary Report
Authors: Hirano Shigeru , Tateya Tomoko , Nagai Hiromi , Ford Charles N. , Tateya Ichiro , Bless Diane M.
Published: October 2014

Aged vocal folds have been reported to have dense collagen deposition and decreased hyaluronic acid (HA) in the lamina propria. These characteristics are thought to contribute to vocal problems that occur with age (presbyphonia). To restore better viscoelasticity to aged vocal folds, an intervention that might increase HA and decrease collagen production from aged vocal fold fibroblasts would appear to be a potentially useful approach. Our previous in vitro study has revealed that basic fibroblast growth factor (bFGF) consistently stimulates HA production and decreases collagen production from aged rat vocal fold fibroblasts. The present in vivo study examined the effects of intracordal injection of bFGF into aged rats' vocal folds in terms of restoration of HA and collagen distribution in the lamina propria. We injected bFGF transorally into the lamina propria of (unilateral) vocal folds. The injection was repeated 4 times weekly, and rats were painlessly sacrificed 1 week, 1 month, and 2 months after the final injection. Histologic examination revealed that bFGF significantly increased the HA content of the lamina propria up to 2 months, but showed no effect on collagen, even after 2 months. Because it might take longer for excessive collagen to be degraded, further studies are necessary to clarify the long-term effect on collagen. A drug delivery system for bFGF also needs to be developed to maximize its effect in the future. The present study suggested at least a positive effect of bFGF in restoring the HA content in the aged vocal fold lamina propria.
Hearing Loss as a Late Complication of Radiotherapy in Children with Brain Tumors
Authors: Williams Glenn B. , Kun Larry E. , Gould Herbert J. , Thompson Jerome W. , Stocks Rose Mary S.
Published: October 2014

Late postirradiation hearing loss has been well described in the adult population. Few reports exist on the pediatric population. We conducted a retrospective review of 157 consecutive children with brain tumors treated exclusively with irradiation at St Jude Children's Research Hospital. Twenty-six patients developed a hearing loss, 74 did not, and 57 were excluded because of incomplete records. We report a statistically significant 27.41% cumulative risk of a stringent 20-dB hearing loss in the voice frequency range by the fifth year after radiotherapy. The right side demonstrated a significant frequency effect, with a higher incidence of loss in the higher-frequency region. We found no difference in cumulative incidence of hearing shift between the low-, middle-, and high-frequency ranges for either ear. This risk should be anticipated and managed as part of the treatment plan for radiotherapy for the treatment of malignancies. Radiation-induced hearing loss is important to acknowledge so that techniques of hyperfractionation, total dose, ports, preservative infusion medical therapy, or prolonged medical intervention (such as anticoagulants) can be developed that might reduce this disabling problem of postirradiation sensorineural hearing loss in future patients.
Midmembranous Vocal Fold Lamina Propria Proteoglycans across Selected Species
Authors: Hahn Mariah S. , Kobler James B. , Zeitels Steven M. , Langer Robert
Published: October 2014

Objectives:

We examined the proteoglycan (PG) and associated sulfated glycosaminoglycan (GAG) content of the midmembranous vocal fold lamina propria (LP) of humans, dogs, pigs, and ferrets.

Methods:

The LP PG levels were assessed indirectly by quantifying the associated sulfated GAGs, and immunohistochemical analyses of specific PGs and/or GAGs (PGs/GAGs) were conducted.

Results:

Sulfated GAGs constituted approximately (average ± SEM) 14.7 ±2.1 μg per milligram of tissue total protein in the human LP — similar to levels in canine, porcine, and ferret LPs (p > .05). Immunohistochemical analysis identified versican, chondroitin 4- and 6-sulfate, and heparan sulfate in the LP extracellular matrix — PGs/GAGs previously believed to be localized only intracellularly and in the basement membrane. Observations of PG/GAG staining patterns resulted in identification of microstructurally based subdivisions of canine, porcine, and ferret LPs.

Conclusions:

The sulfated GAG concentration in human LP was similar to that of dermis. In contrast to the interspecies similarity in LP sulfated GAG levels, immunohistochemical analysis indicated notable interspecies differences in specific PG/GAG distributions. Moreover, spatial variations in the presence of several PGs/GAGs were observed — variations that may be integral in maintaining normal LP physiology. Finally, the noted canine, porcine, and ferret LP subdivisions may yield insight into the adaptation of LP microstructure to the phonatory needs of each species.
Quality of Life following Small Fenestra Stapedotomy
Authors: Chandarana Shamir , Parnes Lorne , Agrawal Sumit , Fung Kevin
Published: October 2014

Objectives:

A cross-sectional observational study was designed to evaluate patient satisfaction after stapedotomy.

Methods:

Two validated questionnaires, the Psychosocial Impact of Assistive Devices Scale (PIADS) and the Hearing Handicap Inventory (HHI), were used to assess patients for whom audiometric data were available.

Results:

The response rate was 79%. The PIADS score showed that 96% of patients reported an improvement in quality of life. The HHI score, however, showed that 32% of patients still experienced a marked degree of handicap after surgery. The HHI scores correlated positively with postoperative audiometric data, and the PIADS scores correlated positively with the degree of change in audiometric data.

Conclusions:

The results of this study support the role of small fenestra stapedotomy as a primary treatment for otosclerosis. The study also identifies a certain subpopulation of patients with residual handicap who may require further aural rehabilitation.
Congenital Bilateral Vocal Cord Paralysis and the Role of Glycine
Authors: Berkowitz Robert G. , Sun Qi-Jian , Pilowsky Paul M.
Published: October 2014

Objectives:

We sought to modify normal laryngeal constrictor (LC) motoneuron activity to induce a pattern of aberrant LC muscle function that may serve as a model of congenital bilateral vocal cord paralysis.

Methods:

Single unit extracellular recordings of functionally identified LC motoneurons were made in anesthetized Sprague-Dawley rats, and the response to both intravenous and iontophoretic application of the glycine antagonist strychnine was studied.

Results:

The postinspiratory firing pattern of LC motoneurons became inspiratory after intravenous injection of strychnine (4 of 5 rats), but no change was recorded in response to strychnine iontophoresis (7 of 8 rats).

Conclusions:

Blockade of glycinergic inhibitory neurotransmission by strychnine, acting above the level of the LC motoneuron, causes LC motoneurons to fire during inspiration rather than after inspiration. This observation suggests that impaired glycine neurotransmission may be an underlying mechanism that explains the clinical manifestations of congenital bilateral vocal cord paralysis.
Vitamin A-Storing Stellate Cells in the Human Newborn Vocal Fold
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

Vocal fold stellate cells (VFSCs) in the newborn vocal fold were examined and compared with VFSCs in the adult vocal fold.

Methods:

Light and electron microscopic investigation of VFSCs was carried out on 5 human newborn larynges.

Results:

The VFSCs were distributed in human newborn maculae flavae. They were stellate or oval in shape, and possessed cytoplasmic processes. The VFSCs in some cells formed a gap junction with each other. A few lipid droplets were present in the cytoplasm, but they were much fewer than those of an adult. The nucleus-cytoplasm ratio was high, and the intracellular organelles were not very well developed. Free ribosomes were well developed in the cytoplasm. The VFSCs in some cells showed strong cytoplasm staining with periodic acid-Schiff stain and type III collagen. There were vesicles along the periphery of the cytoplasm of the VFSCs, and newly released amorphous materials were seen, but fewer were observed on the cell surface. The newborn VFSCs had started to synthesize extracellular matrices such as collagenous fibers, reticular fibers, elastic fibers, and glycosaminoglycan.

Conclusions:

The VFSCs in the newborn maculae flavae were immature, but had already started the synthesis of extracellular matrices essential for the viscoelastic properties of the vocal fold mucosa.
Endoscopic Treatment of cT2 Glottic Carcinoma: Prognostic Impact of Different pT Subcategories
Authors: Peretti Giorgio , Piazza Cesare , Mensi Maria C. , Magnoni Laura , Bolzoni Andrea
Published: October 2014

Objectives:

The cT2 glottic squamous cell carcinomas are a heterogeneous group of lesions in terms of superficial and deep extension. As a consequence, they differ greatly in treatment indications and prognosis. The aim of the present study was to divide cT2 glottic tumors into subcategories according to radiologic and postoperative histopathologic information, in order to identify risk factors connected with determinate survival, local-regional control, and laryngeal preservation rates.

Methods:

We retrospectively analyzed 55 cT2 glottic lesions treated at a single institution by carbon dioxide laser with at least 2 years of follow-up. Clinical, radiologic, surgical, and histopathologic data were reviewed, and the tumors were accordingly divided into 5 subcategories: I, or pT2 with lateral supraglottic extension (19 patients); II, or pT2 with lateral subglottic extension (6 patients); III, or pT2 with supracommissural and/or subcommissural extension (10 patients); IV, or pT2 with deep vocal muscle infiltration (14 patients); and V, or pT3, for superior and/or inferior paraglottic space invasion lateral to the thyroarytenoid muscle not detected before operation by computed tomographic scan (6 patients).

Results:

The disease-free survival, ultimate local control with laser alone, and laryngeal preservation rates were compared for each subcategory. Statistically significant differences were found only for the pT3 subgroup (2-year rates of 16.7%, 16.7%, and 16.7% for pT3 versus 5-year rates of 80.5%, 84.7%, and 93.3% for the entire pT2 group).

Conclusions:

Endoscopic treatment of cT2 glottic tumors can be considered effective when the pT2 stage has been confirmed. In cT2/pT3 patients, after the first endoscopic resection that allows the correct pT staging, additional treatment should always be considered.
Magnetic Resonance Imaging of Micronized Dermal Graft in the Larynx
Authors: Moonis Gul , Dyce Orville , Loevner Laurie A. , Mirza Natasha
Published: October 2014

Objectives:

This study was conducted to evaluate magnetic resonance imaging (MRI) as an objective measure of survival of micronized acellular human dermal graft (Cymetra, LifeCell Corporation) injected into the thyroarytenoid muscle for augmentation of unilateral vocal fold paralysis.

Methods:

We performed a retrospective review of MRI scans obtained in 6 patients in whom Cymetra was injected into the thyroarytenoid muscle. Gadolinium-enhanced MRI of the larynx was performed 3 days, 1 month, 8 months, 11 months, 15 months, and 21 months after injection. The survival of injected Cymetra was assessed according to information obtained from the MRI scan. Images were also obtained for 1 cm3 of reconstituted Cymetra paste.

Results:

The identification of Cymetra in the larynx is based on its proteinaceous content. T1-weighted images of the injected material in the true vocal fold showed hyperintense foci corresponding to injected Cymetra. Hyperintense signal was also present on the T2-weighted images. Persistence of the injected Cymetra was readily detectable by MRI for as long as 11 months.

Conclusions:

Cymetra is a viable treatment option for vocal fold augmentation. The duration of survival of Cymetra (as long as 11 months) makes it a good option in cases in which longer survival of the injectable material is needed.
Laser Microsurgical Bilateral Posterior Cordectomy for the Treatment of Bilateral Vocal Fold Paralysis
Authors: Olthoff Amo , Zeiss Daniel , Laskawi Rainer , Kruse Eberhard , Steiner Wolfgang
Published: October 2014

Objectives:

We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis.

Methods:

In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram).

Results:

After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment of voice quality was objectively documented with the Göttingen Hoarseness Diagram; the phonatory results measured with it correlated significantly with the subjective clinical evaluation of hoarseness. Aphonia did not occur.

Conclusions:

A bilateral approach for laser microsurgical posterior cordectomy combines excellent airway improvement and satisfactory voice preservation. In bilateral vocal fold paralysis, pretreatment and posttreatment clinical data should be evaluated by objective measures.
Adenovirus-Mediated Gene Transfer in Olfactory Epithelium and Olfactory Bulb: A Long-Term Study
Authors: Doi Kiyoshi , Nibu Ken-Ichi , Ishida Haruhiko , Okado Haruo , Terashima Toshio
Published: October 2014

Objectives:

We sought to study the spatiotemporal gene expression mediated by adenoviral vector in the olfactory pathways.

Methods:

The replication-defective adenoviral vector AxCALacZ, which encodes the enzyme Escherichia coli β-galactosidase, was applied to mouse olfactory epithelium by intranasal instillation.

Results:

The LacZ gene product, β-galactosidase, was expressed not only in the olfactory receptor neurons and their axons, but also in the olfactory bulbs. The first evidence of anterograde labeling was observed at postinfection day (PID) 2. At PID 3, β-galactosidase was strongly expressed in olfactory nerve axons, as well as their terminal glomeruli, in the olfactory bulbs. β-Galactosidase expression persisted up to PID 90, and there was a significant decrease in the number of labeled neurons at PID 30.

Conclusions:

These results suggest possible long-term effects of adenovirus-mediated gene transfer on the olfactory neurons, as well as the olfactory bulbs.
Diazepam Tolerance Effects on Vestibular Function Testing, Part II: Vestibulo-Ocular Reflex Parameters during Rotational Testing
Authors: Blau Patricia A. , Schwade Nathan , Roland Peter
Published: October 2014

Objectives:

The purpose of this prospective study was to determine whether clinical doses of diazepam (DZ; 10 mg/d) administered for 14 days result in tolerance as measured by the sinuosidal harmonic acceleration (SHA) rotational test. It has been shown that repeated dosing with DZ leads to accumulation and tolerance in outcome measures that assess memory, sedation, and psychomotor tasks.

Methods:

In a double-blinded, repeated-measures design, 30 normal male subjects who ranged in age from 20 to 36 years were randomly assigned to a placebo group or a DZ group and participated in 6 SHA rotational sessions over a 2-week period. Analysis of drug-placebo differences in percent change from baseline was performed with a 1-way analysis of variance.

Results:

Vestibulo-ocular reflex gain and phase frequencies at 0.01, 0.02, 0.04, and 0.08 Hz were significant (p < .05) for treatment group. No significant effect was observed for gain and phase frequency at 0.16 Hz — a finding that indicates selective effects on different central nervous system mechanisms. There was no statistical significance for time.

Conclusions:

Clinically, the DZ subjects' scores remained within the normal ranges for vestibulo-ocular phase and gain, suggesting that patients in whom drug cessation is problematic may not have to discontinue DZ before testing with the SHA rotational system.
Use of Silicone Hearing Aid Mold Material in Laryngotracheal Reconstruction
Authors: Heman-Ackah Yolanda D. , Sataloff Robert T.
Published: October 2014

Objectives:

Endolaryngeal stenting in patients with irregularly shaped larynges can be challenging. In such cases, the use of a moldable yet reasonably rigid endolaryngeal stent is desirable. The purpose of this report is to describe our experience with silicone hearing aid material as a moldable endolaryngeal stent in a patient with an atypically shaped larynx.

Methods:

A patient with relapsing polychondritis that resulted in complete stenosis of the subglottic airway underwent laryngotracheal reconstruction. Moldable silicone, commonly used to prepare ear canal molds for hearing aids, was molded into the neo-endolarynx to serve as a custom-made endolaryngeal stent.

Results:

The patient tolerated the moldable silicone stent well and had a patent airway with epithelialization 8 months after removal.

Conclusions:

Silicone mold material is a suitable substance for endolaryngeal stenting. It conforms to the configuration of the individual's airway, is tolerated well, can be removed relatively easily, and is a useful alternative to prefabricated stents in laryngotracheal reconstruction.
Angular Vestibulo-Ocular Reflex Gains Correlate with Vertigo Control after Intratympanic Gentamicin Treatment for Meniere's Disease
Authors: Lin Frank R. , Migliaccio Americo A. , Haslwanter Thomas , Minor Lloyd B. , Carey John P.
Published: October 2014

Objectives:

The objective of our study was to determine whether angular vestibulo-ocular reflex (aVOR) gains correlated with vertigo control after intratympanic gentamicin treatment for Meniere's disease.

Methods:

We conducted a prospective study of 18 subjects with unilateral Meniere's disease treated with intratympanic gentamicin injection and followed all subjects for 1 year. We measured the gain of the aVOR elicited by rapid rotary head thrusts in each of the canal planes for each subject before and after treatment with intratympanic gentamicin by using magnetic search coils to record eye movements.

Results:

During the follow-up period, 11 subjects (“single-treatment group”; 61%) had control of their vertigo with a single gentamicin injection. The remaining 7 subjects (“multiple-treatment group”; 39%) experienced recurrent vertigo that required a second injection of gentamicin at a mean of 6 months after the first treatment. The 11 subjects in the single-treatment group had significantly greater reduction of labyrinthine function after the first treatment, as measured by change in ipsilateral horizontal canal gain, than did the 7 subjects with vertigo recurrence. Changes in caloric asymmetry did not correlate with vertigo control.

Conclusions:

Our results suggest that successful treatment of Meniere's disease is closely related to attenuation of semicircular canal function as measured by horizontal canal aVOR gains.
Dose Response of Topical Anesthetic on Laryngeal Neuromuscular Electrical Transmission
Authors: Chitkara Ajay , Meyer Tanya , Cultrara Anthony , Blitzer Andrew
Published: October 2014

Objectives:

Our purpose was to determine the effect of a dose response to decreasing concentrations of topical anesthetic upon laryngeal neuromuscular electrical transmission.

Methods:

We performed a prospective study at a neurolaryngology referral center. Forty-three patients were divided into 5 groups. Each patient underwent laryngeal electromyography (EMG) of a thyroarytenoid muscle before and 60 seconds after topical laryngotracheal lidocaine hydrochloride, normal saline solution, or nothing was applied. The pretreatment and posttreatment measurements were recorded with the same indwelling EMG electrode. Group 1 (n = 12) received 4% lidocaine, group 2 (n = 9) received 2% lidocaine, and group 3 (n = 8) received 1% lidocaine. Group 4 (n = 5) received topical normal saline solution instead of lidocaine. A fifth group (group 5, n = 9) had 2 EMG recordings measured, each separated by 60 seconds, without topical anesthetic.

Results:

Groups 1, 2, and 3 showed significant decreases in the maximum peak-to-peak amplitude of the EMG recording (48.5%, 49.7%, 44.7%, respectively). Groups 4 and 5 failed to show a significant change in peak-to-peak amplitude after 60 seconds. There was no dose response change in EMG with decreasing lidocaine concentrations.

Conclusions:

All concentrations of lidocaine administered in this study decreased the laryngeal neuromuscular electrical transmission as measured by laryngeal EMG. This group of patients did not exhibit any dose response to anesthetic concentration. This finding is clinically significant for both diagnostic and therapeutic uses of laryngeal EMG preceded by administration of topical anesthetic.
Cidofovir Incorporation into Human Keratinocytes with Episomal HPV 16 Results in Nonselective Cytotoxicity
Authors: Spanos William C. , El-Deiry Mark , Lee John H.
Published: October 2014

Objectives:

Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV). Surgical excision is the mainstay of treatment; however, medical therapy including cidofovir, a cytosine analog, has been investigated. Human papillomavirus does not encode a viral DNA polymerase, which is the known target of cidofovir in cytomegalovirus infections.

Methods:

In an effort to better understand the usefulness of cidofovir in the treatment of HPV-related disease, we tested cidofovir's ability to inhibit growth, alter gene expression, and inhibit genome replication.

Results:

With the use of carbon 14-labeled cidofovir in episomal HPV 16-containing keratinocytes, there was a minimal increase in cidofovir incorporation into episomal DNA versus genomic DNA. Cidofovir decreased the copies of episomal HPV 16 in keratinocytes; however, the copies per cell returned to baseline levels once cidofovir was removed. Expression of a viral oncogene (HPV 16 E6) in transformed keratinocytes with episomal HPV 16 was not decreased by cidofovir. Cytotoxicity in head and neck squamous cell carcinoma lines exposed to cidofovir correlated with cell doubling time, and not with HPV status. Also, tonsil keratinocytes transformed with episomal HPV 16 did not exhibit greater cidofovir-mediated toxicity than did telomerase-transformed keratinocytes.

Conclusions:

These findings suggest that any potential in vivo benefit of cidofovir therapy results from non–viral-specific cell toxicity at the site of application.
C-C Chemokine Ligand 2 Gene Expression in Nasal Polyp Fibroblasts: Possible Implication in the Pathogenesis of Nasal Polyposis
Authors: Shun Chia-Tung , Lin Sze-Kwan , Hong Chi-Yuan , Kok Sang-Heng , Juan Yun-Hsiang , Wang Chih-Chiang , Hsu Ming-Che , Liu Chia-Ming
Published: October 2014

Objectives:

Recruitment of macrophages is essential to the pathogenesis of nasal polyps (NP), since this disease is inflammation-related. In this study, the effects of tumor necrosis factor α (TNF-α) on the expression of C-C chemokine ligand 2 (CCL2) in fibroblasts derived from nasal polyps (NPFs) were investigated. The roles of cyclooxygenase (COX) 2 and prostaglandins in the mediation of TNF-α–stimulated CCL2 gene expression were also investigated.

Methods:

Northern blot analysis was used to study the expression of CCL2 and c-Fos in cultured NPFs. An electrophoretic mobility shift assay was used to explore the interactions between activator protein 1 (AP-1) and DNA. Immunohistochemistry was used to explore the in vivo expressions of COX-2, CCL2, and CD68 in NPs.

Results:

The Northern blot analysis showed that TNF-α stimulated the expression of CCL2 and COX-2 genes, and the synthesis of CCL2 messenger RNA was COX-2-dependent. A transient elevation of c-Fos and c-Jun messenger RNAs was induced by TNF-α, whereas COX-2 inhibitors NS-398 and meloxicam abolished the up-regulation of c-Fos. The electrophoretic mobility shift assay revealed that TNF-α triggered AP-1 and DNA binding and again, NS-398 and meloxicam inhibited this reaction via reducing c-Fos synthesis. Curcumin (AP-1 inhibitor) markedly suppressed the TNF-α–induced CCL2 expression. The immunohistochemical staining of NP surgical specimens also revealed an intimate alignment between CCL2-positive fibroblasts and CD-68-positive macrophages.

Conclusions:

These data suggest that NPFs may contribute to NP development by synthesizing CCL2 to promote macrophage recruitment. Furthermore, COX-2 facilitates CCL2 transcription in NPFs via a c-Fos and AP-1 signaling pathway.
Efficacy of a Cochlear Implant Simultaneous Analog Stimulation Strategy Coupled with a Monopolar Electrode Configuration
Authors: Xu Li , Zwolan Teresa A. , Thompson Catherine S. , Pfingst Bryan E.
Published: October 2014

Objectives:

The present study was performed to evaluate the efficacy and clinical feasibility of using monopolar stimulation with the Clarion Simultaneous Analog Stimulation (SAS) strategy in patients with cochlear implants.

Methods:

Speech recognition by 10 Clarion cochlear implant users was evaluated by means of 4 different speech processing strategy/electrode configuration combinations; ie, SAS and Continuous Interleaved Sampling (CIS) strategies were each used with monopolar (MP) and bipolar (BP) electrode configurations. The test measures included consonants, vowels, consonant-nucleus-consonant words, and Hearing in Noise Test sentences with a +10 dB signal-to-noise ratio. Additionally, subjective judgments of sound quality were obtained for each strategy/configuration combination.

Results:

All subjects but 1 demonstrated open-set speech recognition with the SAS/MP combination. The group mean Hearing in Noise Test sentence score for the SAS/MP combination was 31.6% (range, 0% to 92%) correct, as compared to 25.0%, 46.7%, and 37.8% correct for the CIS/BP, CIS/MP, and SAS/BP combinations, respectively. Intersubject variability was high, and there were no significant differences in mean speech recognition scores or mean preference ratings among the 4 strategy/configuration combinations tested. Individually, the best speech recognition performance was with the subject's everyday strategy/configuration combination in 72% of the applicable cases. If the everyday strategy was excluded from the analysis, the subjects performed best with the SAS/MP combination in 37.5% of the remaining cases.

Conclusions:

The SAS processing strategy with an MP electrode configuration gave reasonable speech recognition in most subjects, even though subjects had minimal previous experience with this strategy/configuration combination. The SAS/MP combination might be particularly appropriate for patients for whom a full dynamic range of electrical hearing could not be achieved with a BP configuration.
Laryngeal Epithelial Defenses against Laryngopharyngeal Reflux: Investigations of E-Cadherin, Carbonic Anhydrase Isoenzyme III, and Pepsin
Authors: Gill Gulnaz A. , Johnston Nikki , Buda Andrea , Pignatelli Massimo , Pearson Jeffrey , Dettmar Peter W. , Koufman Jamie
Published: October 2014

Objectives:

This is the third annual report of an international research network studying the cellular impact of laryngopharyngeal reflux (LPR) on laryngeal epithelium. The objective of this study was to investigate the presence of E-cadherin (epithelial cadherin; the intercellular junctional complex protein) in relation to the presence of (intracellular) pepsin and carbonic anhydrase isoenzyme III (CAIII).

Methods:

Fifty-four laryngeal biopsy specimens from 18 LPR patients were studied by immunohistochemistry and Western blotting for pepsin, E-cadherin, and CAIII. These data were compared to those from normal control subjects analyzed in another research study.

Results:

Intracellular pepsin was detected in LPR patients, but not in controls. E-cadherin expression was reduced in patients with LPR. Carbonic anhydrase III expression was not found in the vocal fold or in the majority of samples taken from the ventricle of LPR patients and was inversely associated with E-cadherin membranous expression.

Conclusions:

The findings of depleted E-cadherin and CAIII and the presence of pepsin appear to correlate with LPR. The reduced protective response indicated by the reduced expression of CAIII may play an important role in the disruption of the intercellular barrier associated with the down-regulation of E-cadherin.
Radiation-Induced Petrous Internal Carotid Artery Aneurysm
Authors: Lau Wai Yip Stephen , Chow Chun Kuen
Published: October 2014

Iatrogenic internal carotid artery aneurysm is a rare complication of irradiation. There are few reported cases in the literature. A case of radiation-induced petrous internal carotid artery aneurysm in a patient with nasopharyngeal cancer treated with radiotherapy is reported. The approach to managing such an aneurysm is discussed.
Immunohistochemical Analyses of MUC5AC Mucin Expression in Sinus Mucosa of Children with Sinusitis and Controls
Authors: Peña Maria T. , Aujla Pawandeep K. , Patel Kantilal M. , Zalzal George H. , Rose Mary C.
Published: October 2014

Objectives:

The purpose of this study was to analyze MUC5AC protein expression in sinus mucosal specimens of children with and without chronic sinusitis.

Methods:

Morphometric, histologic, and immunohistochemical analyses were carried out on sinus mucosa of 7 children with chronic sinusitis and 6 children without sinusitis.

Results:

MUC5AC protein was expressed in a subset of goblet cells in the surface epithelium, but not in the submucosal glands in either pediatric population. The number of goblet cells that expressed MUC5AC mucin was not significantly different in patients with and without chronic sinusitis. All specimens had similar numbers of goblet cells in the surface epithelium.

Conclusions:

The data demonstrate that neither goblet cell hyperplasia nor increased MUC5AC expression occurs in the sinus mucosa of children with chronic sinusitis. This suggests that in contrast to asthma, in which goblet cell hyperplasia is present in the lower respiratory tract, mucus hypersecretion in pediatric chronic sinusitis may involve other secretory cells, eg, submucosal glandular cells, and mucins secreted by these glandular cells.
Seminar Series Recurrent Respiratory Papillomatosis
Authors: Derkay Craig S. , Darrow David H.
Published: October 2014

Recurrent respiratory papillomatosis is a frustrating and challenging disease for surgeons, patients, and patients' families. Although the voice and airway manifestations are managed surgically, a “cure” for this disease remains elusive. In this edition of the “Seminar Series,” we endeavor to review the current literature regarding the epidemiology, etiology, clinical manifestations, and surgical and medical treatments of this disorder. The key to future management of recurrent respiratory papillomatosis may lie in its prevention, if current efforts to develop an effective vaccine come to fruition.
Morphological and Histologic Examination of the Epiglottis: Implications for Improving Epiglottic Closure Technique
Authors: Yokoyama Shuji , Kano Makoto , Watanabe Mutsumi , Ogawa Hiroshi , Omori Koichi
Published: October 2014

Objectives:

We conducted a histologic examination and measured the tension on the epiglottis to determine how dehiscence of the epiglottis can be prevented after epiglottic closure surgery.

Methods:

We classified configurations of the epiglottis into flat, intermediate, and omega types and studied the histology of each type. We also measured the tension in each of these 3 morphological types on 4 regions of the epiglottis (upper, middle, and lower points, and the cuneiform tubercle) at 3 different times: before incision, after median incision, and after reversed-Y incision.

Results:

No histologic differences were evident among the epiglottic types. In the flat and intermediate types, the tension measured before incision decreased significantly upon completion of the median incision at every point. In these 2 types, the reversed-Y incision resulted in a further significant decrease in tension at the middle and lower points. In the omega type, the tension was low before incision and was not significantly reduced by either incision.

Conclusions:

We demonstrated that a median incision alone effectively decreased tension sufficiently to prevent dehiscence. The reversed-Y incision was even more effective for decreasing tension at the middle and lower points.
Preoperative Predictive Factors for Hearing Preservation in Vestibular Schwannoma Surgery
Authors: Rohit  , Piccirillo Enrico , Jain Yogesh , Augurio Angela , Sanna Mario
Published: October 2014

Objectives:

We performed a retrospective chart review to evaluate the various predictive factors for postoperative hearing preservation in the surgical management of vestibular schwannoma.

Methods:

Of 792 patients operated on for vestibular schwannoma between April 1987 and July 2002, 107 were candidates for hearing preservation surgery. These patients were divided into group 1 (hearing preserved) and group 2 (hearing not preserved), and both of these groups were evaluated for age, sex, pure tone average, sound discrimination score, tumor size, and auditory brain stem response parameters. A corrected χ2 test and a corrected t-test were used for statistical analysis. Multiple regression analysis was further done to evaluate independent predictive factors, either alone or in combination. The results were evaluated by use of the modified Sanna classification and the guidelines of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).

Results:

Preoperative pure tone average and tumor size were the 2 predictive factors in our study. A Pearson correlation test showed that there was no multicollinearity between the factors. On multiple regression analysis by backward elimination of nonsignificant factors, we found that tumor size is an independent predictive factor for postoperative hearing. According to the modified Sanna classification, postoperative hearing was preserved in 11.2% of patients (equivalent to class A of AAO-HNS guidelines).

Conclusions:

In our series, preoperative pure tone average and tumor size were found to be predictors of postoperative hearing levels.
Comparison of the Glottic Closure Reflex in Traditional “Open” versus Endoscopic Laser Supraglottic Laryngectomy
Authors: Sasaki Clarence T. , Leder Steven B. , Acton Lynn M. , Maune Steffen
Published: October 2014

Objectives:

Cancer of the supraglottic larynx may be surgically treated with either traditional “open” supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery.

Methods:

A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing.

Results:

All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later.

Conclusions:

Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.
Polydimethylsiloxane Particles for Permanent Injection Laryngoplasty
Authors: Sittel Christian , Echtemach Matthias , Federspil Philipp A. , Plinkert Peter K.
Published: October 2014

Objectives:

Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles.

Methods:

Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia.

Results:

The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4.

Conclusions:

Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.