bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency Stenting of Malignant Obstruction of the Upper Airways: Long-Term Follow-up with Two Types of Silicone Prostheses
Authors: Wassermann Klaus , Michel Olaf , Eckel Hans-Edmund , Müller Rolf-Peter
Published: October 2014

We report on 10 patients with severe malignant “mixed-type” obstruction of the proximal trachea or distal trachea plus both main stem bronchi. They had far-advanced inoperable tumors (esophageal cancer in 4 patients, lung cancer in 3, and recurrent laryngeal, uvular, and thyroid cancers in 1 each). Emergency treatment consisted of a dilating bougie maneuver followed by the insertion of a large one-way (4 patients) or Y-shaped (6) silicone prosthesis. Subsequent to the intervention, there was long-lasting clinical improvement. The median survival from stent insertion was 8 months for all patients irrespective of tumor type; it was 5 months for lung carcinoma patients and 8 months for those with esophageal cancer. The results are in accordance with those of other studies using different therapeutic modalities. Stent exchange proved necessary in 5 patients. The main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection. Patients died of pneumonia (4 patients), pulmonary lymphangitic spread (1), heart failure (2, one of whom also had pneumonia), and fatal hemorrhage (1). As of December 1995, 3 patients were still alive, 2, 5, and 8 months after stent implantation. As evidenced by clinical efficacy and length of palliation, endoscopic placement of silicone-based one-way and bifurcated prostheses in far-advanced tumor of the central airways is technically feasible and ethically justifiable.
Rate of Gas Exchange in the Middle Ear of Guinea Pigs
Authors: Mover-Lev Haya , Sadé Jacob , Ar Amos
Published: October 2014

Gas exchange between blood in the middle ear (ME) mucosa and ambient ME gas may be limited by diffusion through tissue or blood perfusion. In order to study the limiting factors in ME gas exchange, a hole was drilled in the bulla of 14 anesthetized guinea pigs through which a mass spectrometer probe was inserted and sealed in place. The rate at which oxygen (O2), carbon dioxide (CO2), nitrogen, and argon concentrations changed toward their steady state values was recorded. From the exponential fitted curves, gas rate constants (Kg) were calculated. The ratio KCO2/KO2 was 4:1, which is lower than expected from a diffusion-limited process in an aqueous compartment. The different rate ratios of CO2 and O2 indicate a diffusion-limited process. However, the deviation of the KCO2/KO2 ratio from that expected in aqueous solutions may indicate the involvement of a lipid compartment in gas exchange or other physiological mechanisms such as local acidity.
Expression of Acute Otitis Media after Receptor Blockade of Platelet Activating Factor, Thromboxane, and Leukotrienes in the Chinchilla
Authors: Diven Warren F. , Burckart Gilbert J. , Alper Cuneyt M. , Jaffe Ronald , Evans Rhobert W. , Doyle William J.
Published: October 2014

To determine the role of inflammatory products of phospholipid metabolism in acute otitis media (AOM), we infected 128 chinchillas with Streptococcus pneumoniae and randomly assigned them to one of four equal-sized treatment groups receiving intramuscular ampicillin sodium (control) or intramuscular ampicillin plus receptor blockers of platelet activating factor (WEB 2086, 5 mg/d orally), of leukotriene (MK 571, 0.5 mg/d orally), or of thromboxane A2 (GR 32191B, 5 mg/d orally). All treatments were begun on day 2 postinoculation and continued for 10 days. On days 3, 6, 9, and 12, 8 animals from each group were sacrificed. Effusions were recovered for biochemical assay, and the right middle ears were prepared for histologic study. Differences among groups in the number of ears with effusion or in effusion volume were not statistically significant. In comparison to the control group, mucosal thickness and the number of ears with histopathologic signs of inflammation were significantly less in the GR and WEB treatment groups, but not the MK group. Also, effusion concentrations of free fatty acids, protease, and hydrolytic enzymes were significantly less in those groups. These results show that the addition of a receptor blocker for either platelet activating factor and/or thromboxane to ampicillin in the treatment of AOM reduces mucosal inflammation and decreases the production of other inflammatory chemicals. The failure of a receptor blocker of leukotrienes to moderate disease expression suggests either a less important role for these chemicals in AOM or an insufficient bioavailability of the specific MK 571 inhibitor. These results confirm that platelet activating factor and thromboxane are active mediators of inflammation in AOM.
Increase of Mucous Glycoprotein Secretion by Tumor Necrosis Factor Alpha via a Protein Kinase C-Dependent Mechanism in Cultured Chinchilla Middle Ear Epithelial Cells
Authors: Lin Jizhen , Kim Youngki , Juhn Steven K.
Published: October 2014

Tumor necrosis factor α (TNF-α), originally defined by its antitumoral activity, is now recognized as a polypeptide mediator of inflammatory and cellular immune response. Recent studies have demonstrated that TNF-α exists in the fluid of otitis media with effusion and, therefore, suggested its possible role in the pathogenesis of mucus hypersecretion. In this study, the effects of TNF-α on mucous glycoprotein (MGP) secretion from cultured chinchilla middle ear epithelial cells were examined, and TNF-α was found to stimulate MGP secretion in a time- and concentration-dependent manner. The action of TNF-α on MGP secretion was significantly and dose-dependently inhibited by TNF-α monoclonal antibody; this finding is suggestive of its specificity on MGP secretion. The addition of the protein kinase C inhibitor 1-(5-isoquinolinylsulfonyl)-2-methylpiperidine (H-7) to the culture significantly blocked TNF-α-induced MGP secretion, while the calmodulin inhibitor N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (W-7) did not. This suggests that TNF-α stimulates MGP secretion via a protein kinase C—dependent mechanism.
Development of Cochlear Sensitivity to Aminoglycoside Antibiotics
Authors: O'Leary Stephen J. , Moore David R.
Published: October 2014

This study examined the temporal relationship between aminoglycoside ototoxicity and the onset of auditory function in the rat. A single dose of gentamicin sulfate (200 mg/kg) and furosemide (100 mg/kg) was administered on postnatal day 6 (P6), P7, P8, P9, or P10, just before the onset of auditory function. Ototoxicity was assessed by the elevation of auditory brain stem response (ABR) thresholds, recorded once the rats had matured. The ABRs were evoked by acoustic clicks and tone pips. The thresholds of control and P6- and P7-treated animals did not differ significantly from each other. Thresholds of some P8- and all P9-treated animals were elevated. The P10-treated animals were deafened, according to these ABR criteria. These data suggest that the potential for aminoglycoside ototoxicity develops rapidly between P8 and P10, just before the onset of auditory function.
Transient Vocal Fold Immobility
Authors: Postma Gregory N. , Shockley William W.
Published: October 2014

Temporary vocal fold immobility resolving in 4 weeks or less is considered a transient immobility. Many different disorders may lead to this type of laryngeal motion impairment. It is important for otolaryngologists to be familiar with the differential diagnosis for transient vocal fold immobility in order to optimize the management of these unusual cases.
Unilateral versus Bilateral Botulinum Toxin Injections in Adductor Spasmodic Dysphonia
Authors: Langeveld Ton P. M. , Drost Harm A. , de Jong Robert J. B Aatenburg
Published: October 2014

Thyroarytenoid injection of botulinum toxin is the therapy of choice in spasmodic dysphonia. However, there is no convincing evidence as to whether unilateral or bilateral injections are to be preferred. For this reason, a prospective study was designed in which voice quality, duration of effect, and side effects were assessed. Twenty-seven patients with adductor spasmodic dysphonia were treated with percutaneous injections of botulinum toxin. The first treatment consisted of injection of 5 units in the left thyroarytenoid muscle. The second treatment, 2.5 units in both sides, took place when the effect of the first procedure had completely ceased. All patients underwent both procedures. By means of self-rating scales, effects and side effects were assessed over at least 3 months. There was no difference between the procedures in duration of voice improvement, nor in the occurrence of breathy dysphonia. After a bilateral injection, statistically more patients reported swallowing problems. However, most patients preferred the bilateral injection, in spite of more and longer-lasting side effects.
Laryngeal Radionecrosis versus Recurrent Cancer: A Clinical Approach
Authors: McGuirt W. Frederick , Greven Kathryn M. , Keyes John W. , Williams Daniel W. , Watson Nat
Published: October 2014

A group of 38 patients was studied by positron emission tomography utilizing fluorine18-labeled deoxyglucose (FDG-PET) scanning to examine the ability to differentiate postirradiation laryngeal recurrent cancer from radionecrosis. The resulting 79% correct diagnosis showed the technique to be far superior to conventional computed tomography scanning (61%) and clinical examination (43%). An algorithmic approach to evaluating and treating patients with radionecrosis and/or recurrent cancer by utilizing FDG-PET scanning is presented.
Long-Term Excitability and Fine Tuning of Nerve Pedicles Reinnervating Strap Muscles in the Dog
Authors: Broniatowski Michael , Dessoffy Raymond , Strome Marshall
Published: October 2014

Contraction of paralyzed striated muscles has been restored by stimulating reinnervating pedicles with currents of low intensity. In order to allow clinical application, stable, long-term excitability must emulate the parameters necessary for the stimulation of normal motor nerves. In 6 dogs, the ansa hypoglossi nerve was implanted into the contralateral denervated sternohyoid muscle and surrounded with a bipolar cuff electrode. Three of the reinnervating pedicles were chronically paced with a Medtronic Itrel II Multiprogrammable Pulse Generator (0.5 V, 0.2 second on [30 pulses per second, 0.21-millisecond pulse width], 2.9 seconds off). At reexploration after 8 months (6 months for 1 dog), frank contraction confirmed by electromyography tracings occurred in all animals with currents in the range of 0.1 to 0.5 mA. Muscle force was further manipulated by selective release of blocking currents (600 Hz, 1.7 to 0.4 mA) superimposed over regular stimulation (50 Hz, 0.3 to 1.7 mA). Nerve and muscle vitality were histologically confirmed. Long-term, low-intensity conduction capabilities, fine tuning, good tolerance of implanted electrodes, and lack of fatigue suggest that reinnervating pedicles may be successfully used for pacing when clinically indicated.
Management of Unilateral Vocal Cord Paralysis by Injection Medialization with Teflon Paste
Authors: Harries Meredydd Lloyd , Morrison Murray
Published: October 2014

This paper prospectively analyzes eight patients who were selected for injection medialization of a unilateral vocal cord paralysis by a transcutaneous technique. Preoperative and postoperative videolaryngoscopic recordings of the position of the paralyzed cord were made with a scoring system correlated to the laryngeal airflow measurements. Quantitative acoustic recordings of the patient's voice were also taken and compared with the patient's own subjective analysis of his or her voice. Results indicate that Teflon injection by the transcutaneous method gives a statistically and clinically improved voice in the short term.
Effects of Head Rotation on Pharyngeal Function during Normal Swallow
Authors: Ohmae Yukio , Ogura Masami , Kitahara Satoshi , Karaho Takehiro , Inouye Tetsuzo
Published: October 2014

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.
FEESST: A New Bedside Endoscopic Test of the Motor and Sensory Components of Swallowing
Authors: Kim Ted , Goodhart Kathy , Aviv Jonathan E. , Sacco Ralph L. , Diamond Beverly , Kaplan Sarah , Close Lanny G.
Published: October 2014

We here introduce an office or bedside method of evaluating both the motor and sensory components of swallowing, called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal (LP) sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of LP sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 148 times on 133 patients with dysphagia over an 8-month period. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 94). Subsequent to LP sensory testing, a complete dysphagia evaluation was conducted. Various food and liquid consistencies were dyed green, and attention was paid to their management throughout the pharyngeal stage of swallowing. Evidence of latent swallow initiation, pharyngeal pooling and/or residue, laryngeal penetration, laryngeal aspiration, and/or reflux was noted. Recommendations for therapeutic intervention were based on information obtained during the FEESST and often involved the employment of compensatory swallowing strategies, modification of the diet or its presentation, placement on non-oral feeding status, and/or referral to other related specialists. All patients successfully completed the examination. In 111 of the evaluations (75%), severe (>6.0 mm Hg air pulse pressure [APP]) unilateral or bilateral LP sensory deficits were found. With puree consistencies, 31% of evaluations with severe deficits, compared to 5% of evaluations with either normal sensitivity or moderate (4.0 to 6.0 mm Hg APP) LP sensory deficits, displayed aspiration (p <.001, χ2 test). With puree consistencies, 69% of evaluations with severe deficits, compared to 24% with normal or moderate deficits, displayed laryngeal penetration (p <.001, χ2 test). FEESST allows the clinician to obtain a comprehensive bedside assessment of swallowing that is performed as the initial swallowing evaluation for the patient with dysphagia.
Point Prevalence of Secretory Otitis Media in Children in Southern Vietnam
Authors: Son Dang Hoang , Tri Le , Tien Vu Manh , Phuong Tran kim , Balle Viggo , Son Nhan trung , Mai Tran thi tuyet , Tos Mirko
Published: October 2014

Few reliable data exist on the prevalence of secretory otitis media (SOM) in the Third World. A large epidemiologic cross-sectional study was undertaken in two communes in southern Vietnam to study an urban and a rural community during two different climatic conditions: the dry and rainy seasons. The participants included 3,300 children (6,598 ears) ages 6 months to 10 years. Otolaryngological and medical histories were obtained, and an otolaryngological examination was carried out on 1,669 children in April 1995 (the dry season) and on 1,631 children in December 1995 (the rainy season). Tympanograms were obtained (n = 6,055), 429 of which were type B curves. The overall prevalence of SOM was 7.1%, the highest incidence was at the age of 2 years (with a prevalence of 22%), and there was a significantly higher prevalence of SOM during the rainy season than during the dry season. No significant difference in incidence was found in the urban district as compared to the rural district.
Site of Cortical Utricular Representation with Special Reference to the Somatosensory Barrel Field in the Gerbil
Authors: Ito Muneyuki , Seto-Ohshima Akiko
Published: October 2014

In mammals, the osseous semicircular canals of the vestibular labyrinths are usually embedded in the pyramis of the temporal bone. Thus, the osseous semicircular canals are a cavity system that can only be visualized by injection molding. Exceptionally, the walls of the osseous semicircular canals of the Mongolian gerbil are not embedded, but exposed in the hollow space in the temporal bone. Under urethane anesthesia, a window was made in the periotic capsule of the gerbil to reach this hollow space (semicircular canal triangle), and a pair of wire electrodes were inserted through an opening made in the horizontal semicircular canal toward the utricular nerve endings. Repetitive electric stimuli at 80 Hz were applied, and the direction of eye movements was noted. Subsequently, the stimulation frequency was reduced to 0.3 Hz, and evoked potentials were recorded from the neocortex. Positive surface potentials and negative deep potentials were recorded in the somatosensory area and, more specifically, in the vibrissa “barrel field,” as judged by later histochemical staining of the cortical specimens. This unique anatomic feature of the gerbil labyrinth offers an opportunity whereby the vestibular organ can be reached without any heavy surgical insult, and the presence of fine-grain vibrissa barrels in this species (seven rows instead of five rows in most rodents) will help elucidate functional interactions between vestibular and somatosensory sensations.
Medialization Laryngoplasty with Expanded Polytetrafluoroethylene
Authors: McCulloch Timothy M. , Hoffman Henry T.
Published: October 2014

Symptomatic unilateral laryngeal paralysis may be treated successfully by a wide variety of surgical techniques. These techniques share the concept that stabilization of the paralyzed vocal fold in a median position will improve glottic function. Medialization laryngoplasty with expanded polytetrafluoroethylene (ePTFE) incorporates the general principles of established medialization procedures, yet is unique in its simplicity. The technique does not require special instrumentation, employs incremental adjustment of vocal fold position, and utilizes an implantable material with a long history of patient safety. We describe this new technique and report on the outcome of our first 16 patients treated. No surgical or implant-related complications have occurred. Voice results were measured from preoperative and postoperative video and voice recordings by four independent observers using a standardized assessment tool. Voice grade and breathiness were evaluated on a four-point scale (0 = normal and 3 = abnormal, extreme). The mean overall grade improved from 2.3 ± 0.6 to 1.1 ± 0.6, and breathiness from 2.0 ± 0.8 to 0.4 ± 0.4. The technique is simple, the implant material has been in clinical use for decades, and the voice results are good to excellent.
Incidence of Frontal Sinusitis following Partial Middle Turbinectomy
Authors: Fortune D. Scott , Duncavage James A.
Published: October 2014

The role of partial middle turbinate resection as an adjunct to endoscopic sinus surgery is controversial. Recent literature suggests that middle turbinate resection may have a detrimental effect on the frontal sinus. A retrospective analysis of 155 consecutive patients undergoing partial middle turbinate resection utilizing the technique of the senior author (J.A.D.) for either sinusitis or nasal obstruction was conducted. The data reveal a low rate of frontal sinusitis following partial middle turbinectomy (10%). None of the patients undergoing partial middle turbinectomy for nasal obstruction developed frontal sinusitis postoperatively. No major complications were encountered. Frontal sinusitis following middle turbinectomy was often associated with preoperative comorbidity such as asthma, nasal polyps, severe disease score on computed tomography, or diseased middle turbinates. The authors conclude that partial middle turbinectomy for treatment of sinusitis and nasal obstruction has a low incidence of postoperative frontal sinusitis. Development of frontal sinusitis may be predictable on the basis of several comorbid factors.
Biomechanics of Arytenoid Adduction Surgery in an Ex Vivo Canine Model
Authors: Noordzij J. Pieter , Perrault Donald F. , Woo Peak
Published: October 2014

The biomechanics of arytenoid adduction surgery are not well understood. An excised canine larynx model was used to study the effects of variable suture tension on glottal configuration and on vocal fold tension (at the midfold and the vocal process). Arytenoid adduction both medializes the vocal fold and closes a posterior glottal chink. Vocal fold tension at the midfold did not vary significantly with suture tension. As suture tension increased to approximately 100 g, vocal fold tension at the vocal process also increased. Beyond 100 g of suture tension, vocal fold tension at the vocal process did not increase. We conclude that the effects of suture tension on the resistance to lateral movement are different at the midfold compared to the vocal process. Procedures for surgical rehabilitation of vocal fold paralysis should address the biomechanical subunits of the larynx individually in order to achieve optimum results.
Microvascular Lesions of the True Vocal Fold
Authors: Postma Gregory N. , Courey Mark S. , Ossoff Robert H.
Published: October 2014

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.
Comparative Evaluation of Culture and PCR for the Detection and Determination of Persistence of Bacterial Strains and DNAS in the Chinchilla Laniger Model of Otitis Media
Authors: Anderson Kenneth W. , Kingsley Larry A. , Aul Jerome J. , Wadowsky Robert M. , Post J. Christopher , Doyle William J. , Ehrlich Garth D.
Published: October 2014

This study was designed to determine the persistence of culturable bacteria versus DNA in the presence of a middle ear effusion in a chinchilla model of otitis media. Cohorts of animals were either infected with an ampicillin-resistant Haemophilus influenzae strain or injected with a tripartite inoculum consisting of freeze-thawed Streptococcus pneumoniae; pasteurized Moraxella catarrhalis; and DNA from H influenzae. The H influenzae-infected animals displayed culture positivity and polymerase chain reaction positivity through day 35. In the chinchillas infected with the low-copy number inocula of S pneumoniae, DNA was not detectable after day 1 from the co-inoculated pasteurized M catarrhalis bacteria or the purified H influenzae DNA; however, amplifiable DNA from the live low—copy number bacteria persisted through day 21 even though they were not culture-positive past day 3. These results demonstrate that DNA, and DNA from intact but nonviable bacteria, does not persist in an amplifiable form for more than a day in the presence of an effusion; however, live bacteria, while not culturable, persist in a viable state for weeks.
Wegener's Granulomatosis Presenting as Mastoiditis
Authors: Moussa Abd El-Mateen , Abou-Elhmd Kamal A.
Published: October 2014

Wegener's granulomatosis is an uncommon autoimmune disease. It has a peak incidence in the fifth decade of life, with a slight male predominance. Nasal problems are the predominant presentation, with rare otological manifestations. We report 2 cases of Wegener's granulomatosis presenting as mastoiditis in 2 young female patients. We conclude that young patients presenting with mastoiditis unresponsive to conventional medical and surgical therapy should be investigated for Wegener's granulomatosis.
Role of Substance P in the Laryngeal Chemoreflex
Authors: Wang Deqiang , McCulloch Timothy M. , Bauman Nancy M. , Jaffe Debra M. , Smith Richard J. H. , Porter Michael P. , Sandler Anthony D.
Published: October 2014

The laryngeal chemoreflex (LCR) is a potentially life-threatening reflex that is elicited in immature animals by the topical application of water to the laryngeal mucosa. The reflex response is characterized by immediate apnea and laryngeal adduction and delayed cardiovascular instability. The cardiorespiratory changes of the LCR may be life-threatening, particularly in very immature animals such as piglets under 2 weeks of age. The afferent and efferent limbs of the LCR are mediated through the vagus nerve, but the neuromediators responsible for the reflex changes have not yet been clearly elucidated. Previous agonist and antagonist studies in immature dogs demonstrated that substance P, a sensory tachykinin, mediates the life-threatening esophagolaryngeal adductor reflex elicited by distal esophageal sensory nerve stimulation. This study was conducted to determine if substance P also plays a role in mediating the LCR. The LCR response was compared before and after treatment with intravenous substance P antagonist (Pfizer CP-96,345–1) in eight piglets (mean 27.7 days of age). The laryngeal and cardiovascular responses of the animals following intravenous administration of the tachykinins substance P, neurokinin a, and neurokinin B were also assessed. Pretreatment with substance P antagonist did not alter the LCR's duration of apnea (p > .10), laryngeal adductor response, or early change in mean arterial pressure (p > .10), although the early maximal heart rate response was significantly altered (p < .01). Intravenous substance P, neurokinin a, and neurokinin B did not reproduce the laryngeal respiratory response of the LCR. We conclude that substance P, neurokinin a, and neurokinin B are not key neurotransmitters of the LCR.
Partial Vertical Laryngectomy in the Treatment of Early Glottic Cancer
Authors: Sheen Tzung-Shiahn , Ko Jenq-Yuh , Chang Yen-Liang
Published: October 2014

Treatment of early glottic cancer is still controversial. A retrospective study was conducted to analyze the results of 49 partial vertical laryngectomies in our department. All patients except 1 were successfully decannulated. The quality of voice was suboptimal but serviceable in all patients. Overall, there were 9 recurrences: 7 in the larynx and 2 in the neck. In the laryngeal recurrence group, 5 of 6 patients were successfully salvaged with total laryngectomy. One patient died of acute renal failure 1 month after salvage operation. Another patient survived 4.5 years after cisplatin-based chemotherapy. In the neck recurrence group, 1 patient was successfully salvaged with neck dissection; the other was lost to follow-up after neck dissection. The actuarial 5-year survival rate was 97.4% and the larynx preservation rate was 88%. The recurrence rate was 14%, when 2 of the 7 laryngeal recurrences were excluded because they occurred beyond 5 years. The results of this series were encouraging. We suggest that partial vertical laryngectomy is a good treatment modality for selected early glottic cancers, especially those of the T1 group.
Intracellular Calcium Changes and Chemosensitivities of Human Epidermoid Carcinoma Cell Lines after Exposure to Cisplatin
Authors: Tachikawa Takuya , Hori Yoshio , Yamashita Toshio , Harada Narinobu , Yodosawa Susumu , Kumazawa Hirobumi , Sai Shin-Ichi , Kawamoto Keiji
Published: October 2014

In order to elucidate the mechanisms of cisplatin (cis-diamminedichloroplatinum; CDDP)-resistant tumor cells, we previously established a CDDP-resistant KB cell line (KBrc cells) from a parental KB cell line derived from epidermoid carcinoma (KB cells). The KBrc cells were resistant to 5 kinds of platinum (Pt) drugs. Intracellular Pt concentrations in KBrc cells were lower than in KB cells. Decrease of intracellular Pt concentrations was one of the CDDP-resistant mechanisms. When we measured changes of intracellular calcium ion concentration ([Ca2+]i) during exposure to high-dose CDDP, a sustained elevation of the [Ca2+]i level was observed in the KB cells. These results suggest that the mechanisms underlying CDDP resistance involve changes in calcium channels and an alteration of calcium homeostasis in the tumor cell line.
Mucosal Melanomas of the Head and Neck
Authors: Batsakis John G. , Suarez Patricia , El-Naggar Adel K.
Published: October 2014

Mucosal melanomas of the head and neck, as a group, are rapidly lethal neoplasms with site-specific differences in survival. They are preponderantly thick melanomas and as a consequence can present with cervical lymph node metastasis with or without distant spread. Long-term survival is unusual to rare; 5-year survival is poor, and 10-year survival, dismal. Whether this life-consuming nature is due to a biologic characteristic or related to late discovery is unknown. Because of the accelerated course and obvious differences in epidemiology, mucosal melanomas should be considered separate from melanomas of the skin.
Cytokine Gene Expression in Nasal Polyps
Authors: Lee Chul Hee , Rhee Chae-Seo , Min Yang-Gi
Published: October 2014

Nasal polyps are the most common mass lesion of the nasal cavity. Various pathogenetic mechanisms have been proposed. However, the cause is still largely unknown, and treatment methods have not been changed for several hundred years. In order to investigate the role of cytokines in the pathogenesis of nasal polyps, expression of cytokine messenger RNAs (mRNAs) in nasal polyps was investigated. We performed reverse transcriptase-polymerase chain reaction and Southern blot to examine gene expression of the cytokines interleukin (IL)-1ß, IL-6, IL-8, transforming growth factor (TGF)-ß, IL-4, IL-5, and interferon (IFN)-Γ and compared the results with the gene expressions of these cytokines in normal nasal mucosa. Nasal polyp tissues were obtained from 14 patients undergoing polypectomy for nasal obstruction. Among them, 4 patients suffered from associated perennial allergic rhinitis. The mRNAs of IL-4 and IL-5 (Th2 cytokines) as well as IFN-γ (Thl cytokine) were expressed in all of the nasal polyps obtained from the 14 patients, irrespective of the presence or absence of allergy, while 2, 0, and 4 of 6 normal turbinate mucosae expressed IL-4, IL-5, and IFN-γ mRNAs, respectively. The mRNAs of IL-1ß, IL-6, IL-8, and TGF-ß were expressed in 6, 1, 2, and 3 of 6 normal turbinate mucosae, respectively, while the mRNAs of these cytokines were expressed in all of the 14 polyp tissues except IL-6 mRNA, which was expressed in 13 nasal polyp tissues. There were no differences in the mean density ratios of each cytokine band on Southern blot between polyp tissues with allergy and those without allergy. These results suggest that many cytokines are produced in nasal polyps, that they may play important roles in the pathogenesis of nasal polyps, and that allergy per se may not play a fundamental role in the pathogenesis of nasal polyps.
Isolated Epithelial Cysts of the Uvula in Children: A Report of Three Cases
Authors: Seshul Merritt , Wiatrak Brian J. , Tseng Ewen , Kelly David R.
Published: October 2014

Epidermoid cysts are unusual benign cysts that occur in the oral cavity less than 2% of the time. Epidermoid cysts isolated to the uvula are rare. A review of the literature has revealed only three confirmed cases of isolated uvular epidermoid cysts. We present a series of three such cases, two of which presented with significant symptomatology. The diagnosis and management of these unusual lesions will be discussed, as well as the differential diagnosis.
External Rhinoplasty Approach for Extirpation and Immediate Reconstruction of Congenital Midline Nasal Dermoids
Authors: Mankarious Leila A. , Smith Richard J. H.
Published: October 2014

Surgical extirpation is the treatment of choice for nasal dermoids in the pediatric population. Approaches include vertical-dorsal rhinotomy, lateral rhinotomy, transverse rhinotomy, and external rhinoplasty. While short-term results suggest that the last approach is cosmetically most acceptable, the required wide undermining of the nasal tip and dorsum may affect subsequent nasal growth. To assess long-term results, we reviewed our experience with 8 cases encountered over the past 10 years. Modifications of the technique to minimize midline dorsal depression are described.
Alveolar Soft Part Sarcoma of the Head and Neck Region
Authors: Hunter Brian C. , Ferlito Alfio , Devaney Kenneth O. , Rinaldo Alessandra
Published: October 2014

Alveolar soft part sarcoma is a soft tissue malignancy most often found in the extremities of young adults; when these tumors arise in the head and neck area, they usually appear in the orbit or the tongue. Their initial behavior is relatively indolent, but over time a sizable number of these tumors recur locally and metastasize; as such, they are best regarded as fully malignant neoplasms. The derivation of these tumors remains uncertain: while some have suggested that these are tumors of muscle origin and others have postulated a neuroendocrine origin, the evidence accumulated to date is conflicting, and so these neoplasms continue to be regarded as tumors of uncertain origin. Surgical excision is the mainstay of therapy.
Posterior Glottic Stenosis: A Canine Model
Authors: Courey Mark S. , Bryant Grady Lee , Ossoff Robert H.
Published: October 2014

Posterior glottic stenosis is a disabling disease in which the vocal folds are fixed near the midline. This allows adequate vocal fold adduction for voicing, but does not permit useful abduction for ventilation. The most common cause is prolonged endotracheal intubation for mechanical ventilation, and the incidence is estimated at 4% for intubations between 5 and 10 days. Currently, our understanding and treatment modalities are based on retrospective reviews of small, nonrandomized clinical experiences. The purpose of this project was to develop an animal model that would improve our understanding of histologic changes and allow future prospective randomized trials for therapeutic intervention. Twelve dogs, 15 to 25 kg, were randomly divided into three groups. Animals in group 1 had a superficial injury produced in the tissue over the right cricoarytenoid joint; animals in group 2 had a deep soft tissue injury produced; and animals in group 3 underwent joint opening. The animals were allowed to recover for 2 months. Morphometric analysis of the harvested larynges demonstrated clinically significant limitation in motion in the animals with deep soft tissue injury and in animals with joint disruption. Histologic analysis revealed various degrees of injury, from loss of subepithelial soft tissue to cartilaginous resorption and fusion of the arytenoid to the cricoid. These findings were directly related to the depth of the initial injury. It is possible to produce posterior glottic stenosis in the canine species. This will serve as a reliable animal model for future study.
Primary Aspergillosis of the Larynx and Squamous Cell Carcinoma
Authors: Beust Laurent , Godey Benoit , Grollier Régis , Le Gall François , Le Clech Guy
Published: October 2014

Primary laryngeal aspergillosis is exceptionally rare, and only five cases have been reported in the literature. We present here two cases of invasive laryngeal aspergillosis without tracheobronchopulmonary extension and without any generalized immune deficit. Aspergillosis developed after local radiotherapy for a squamous cell carcinoma and preceded a recurrence of the tumor. The relationships between the clinical features, the histopathology, and the etiology of laryngeal aspergillosis and squamous cell carcinoma are discussed. We recommend that following treatment of laryngeal aspergillosis, these rare patients should systematically be investigated for a squamous cell carcinoma or a recurrence thereof.
Treatment of Chronic Suppurative Otitis Media with Topical Ciprofloxacin
Authors: Alper Cuneyt M. , Casselbrant Margaretha L. , Dohar Joseph E. , Rose Elizabeth A. McI. , Kenna Margaret A. , Doyle William J. , Bluestone Charles D.
Published: October 2014

To date, only ofloxacin has been approved by the US Food and Drug Administration for treatment of ears with a nonintact tympanic membrane. The purpose of this study was to determine the safety and efficacy of topical ciprofloxacin hydrochloride in the treatment of experimental chronic suppurative otitis media caused by Pseudomonas aeruginosa infection in cynomolgus monkeys. Forty adult cynomolgus monkeys were divided into 4 equal groups, and their ears were challenged with P aeruginosa, drained for 3 weeks, then treated twice daily for 4 weeks with 1 of 4 randomly assigned agents: 1) ciprofloxacin, 2) saline, 3) Cortisporin, or 4) vehicle. The animals were followed up with auditory brain stem response testing, culture, otoscopy, and histopathology. Both ciprofloxacin and Cortisporin treatment resulted in a significantly more rapid rate of clearance of P aeruginosa as compared to treatment with saline (100% versus 20%). Eradication was not associated with resolution of otorrhea after a 4-week period of treatment. There were no significant changes in auditory brain stem response wave latencies for any of the treatment groups. Histopathologic data revealed that there was no statistically significant difference in the amount of outer hair cell loss for the ciprofloxacin group as compared to the control ear and other treatment groups. We conclude, therefore, that topical ciprofloxacin is not ototoxic and is effective in sterilizing the otorrhea, but does not promote resolution of the drainage, in this animal model.
Delayed Facial Palsy following Uneventful Middle Ear Surgery: A Herpes Simplex Virus Type 1 Reactivation?
Authors: Bonkowsky Viktor , Pere Paul , Kochanowski Bernd , Hosemann Werner , Strutz Jürgen , Arnold Wolfgang
Published: October 2014

In rare cases, a facial palsy appears a few days after uneventful middle ear surgery. The reason for this delayed palsy is unclear. One hypothesis is that it results from a reactivation of herpes simplex virus type 1 (HSV-1) in the geniculate ganglion of the facial nerve. From 1987 to 1996, in the course of over 1,800 middle ear operations, we observed 7 ipsilateral delayed facial palsies and investigated 5 of them using immunologic and virologic methods, including the polymerase chain reaction (PCR). We could detect HSV-1 genome with the nested primer PCR in the tongue swabs of 4 of the 5 examined patients with delayed facial palsy. The immunologic changes in these palsies are also compatible with a reactivation of HSV-1. We conclude that minimal stimulation of the facial nerve during middle ear surgery could result in a reactivation of HSV-1 in the geniculate ganglion, which may in turn lead to a facial palsy.
Correlation of Acoustic Threshold Measures and Spiral Ganglion Cell Survival in Severe to Profound Sensorineural Hearing Loss: Implications for Cochlear Implantation
Authors: Incesulu Armagan , Nadol Joseph B.
Published: October 2014

In a temporal bone study of 26 ears from 13 patients who, in life, had severe sensorineural hearing loss, the segmental and total spiral ganglion cell (SGC) counts were correlated with hearing thresholds and with the difference between hearing thresholds in the two ears, the age at death, the duration of deafness, and the duration of hearing loss. A statistically significant correlation was found between the interaural differences in total SGC counts and the interaural difference in pure tone averages for 3, 4, and 5 frequencies. The total SGC count was higher in the ear with the better residual hearing in 11 of 12 cases. Approximately 41% of the variability in interaural difference in pure tone average was explained by the difference in SGC counts. The findings would suggest that in a given individual, selection of the ear with better residual hearing for cochlear implantation is likely to result in accessing a higher number of residual SGCs. This, in turn, may result in better speech recognition with the implant.
Successful Prevention of Retrocochlear Hearing Loss in Murine Experimental Allergic Encephalomyelitis with T Cell Receptor Vβ8–Specific Antibody
Authors: Suzuki Mikio , Krug Marc S. , Cheng Kuang-Chuan , Yoo Tai-June
Published: October 2014

Experimental allergic encephalomyelitis is an animal model of a T cell—mediated autoimmune disease — for example, multiple sclerosis. We demonstrated that mice with experimental allergic encephalomyelitis developed retrocochlear hearing loss, and that the lesion of the auditory pathway might be related to T cell receptor Vß8–expressing T cells. To investigate whether anti-Vß8 antibody could prevent hearing loss, we carried out brain stem auditory evoked potential testing, histologic examinations, and flow cytometry in antibody-treated and control myelin basic protein—immunized B10.PL mice. The antibody was administered just before immunization of myelin basic protein. The disease incidence and severity were significantly reduced in the mice injected with the antibody. The results of brain stem auditory evoked potential testing, histologic examinations, and flow cytometry indicated that the depletion of Vß8-expressing T cells brings the prevention of hearing loss, as well as prevention of other neurologic deficits. The development of T cell receptor—specific antibody therapy might help treat retrocochlear hearing loss in multiple sclerosis.
Effect of Healed Tympanic Membrane Perforations on Umbo Velocity in the Rat
Authors: Bigelow Douglas C. , Kay David , Saunders James C.
Published: October 2014

Heterodyne laser interferometry was used to measure tympanic membrane (TM) velocity at the umbo during acoustic stimulation in 2 groups of rats. The control group had a normal TM, while in the other group the TM was perforated and then allowed to heal for at least 28 days. Umbo velocity functions for constant sound pressure level stimuli were obtained for test tones between 0.3 and 40.0 kHz in each animal. The results revealed that velocity was the same in the control and healed TMs below 3.0 kHz. Above 5.0 kHz, the velocity response in the healed ear was between 3 and 12 dB smaller than in the control ears. Histologic evaluation of the healed perforation revealed a thick fibrous reaction between the epidermal and lamina propria layers. The results indicated that the added mass of the scar tissue changed the middle- and high-frequency TM responses.
Evaluation of the Microbiology of Chronic Maxillary Sinusitis
Authors: Brown Carl A. , Paisner Hyman M. , Biel Merrill A. , Levinson Richard M. , Sigel Melvin E. , Garvis Gary E. , Tedford T. Michael
Published: October 2014

Chronic paranasal sinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. With the common use of multiple courses of broad-spectrum oral antibiotics to treat this condition, there is a possibility of an alteration in the pathogens that promote a persistence of chronic sinusitis. One hundred seventy-four consecutive patients with a diagnosis of chronic maxillary sinusitis requiring an endoscopic surgical procedure were prospectively evaluated. At the time of surgery, cultures of mucopus in the maxillary sinus were aseptically obtained endoscopically and cultured for aerobes, anaerobes, and fungus. Two hundred seventeen isolates from 174 patients were obtained. Coagulase-negative staphylococci were the most common isolates (36%), followed by Staphylococcus aureus (25%), Streptococcus viridans (8.3%), Corynebacterium (4.6%), and anaerobes (6.4%). Although coagulase-negative Staphylococcus is not considered a pathogen, of the 24 isolates that had sensitivity testing performed, 13 demonstrated resistance to multiple antibiotics, including cephalothin, erythromycin, oxacillin, sulfonamides, and clindamycin. This study demonstrates that aerobic rather than anaerobic bacteria are the more common pathogens in chronic sinusitis. In addition, coagulase-negative Staphylococcus may be a pathogen in the disease process, and sensitivities should be obtained of this isolate for evaluation and possible treatment.
Three-Dimensional Navigation in Otorhinolaryngological Surgery with the Viewing Wand
Authors: Gunkel Andreas R. , Kremser Christian , Freysinger Wolfgang , Bale Reto , Schön Gerald , Vogele Michael , Thumfart Walter F.
Published: October 2014

We report our experiences with the ISG Viewing Wand intraoperative 3-dimensional navigation device in endonasal endoscopic procedures of the paranasal sinuses, anterior skull base, and petrous bone. In the last 12 months we have routinely used the wand in 90 patients for treatment of polyposis nasi, for biopsies and removal of tumors in the nasal cavity and at the frontal skull base, for endocrine ophthalmopathy, and in 1 case for cholesteatoma. We present our computed tomography, magnetic resonance imaging, and clinical protocols that allow a precise routine use of the Viewing Wand. In all cases, the system was extremely helpful for intraoperative localization and helped to optimize surgery.
Partial Cricotracheal Resection for Severe Pediatric Subglottic Stenosis: Update of the Lausanne Experience
Authors: Monnier Philippe , Lang Florian , Savary Marcel
Published: October 2014

Until recently, severe pediatric subglottic stenosis (SGS) has been treated almost exclusively by laryngotracheoplasty procedures. Even in the most experienced centers, the results of single-stage operations for Cotton's grade III and IV stenoses have been disappointing. This paper reports our experience on 31 partial cricotracheal resections for severe SGS in infants and children. The stenosis was congenital in 6 cases and acquired after prolonged intubation in 25 cases. Twenty-seven patients were tracheotomy-dependent at the time of surgery. Twenty-two cases were classified as grade III and 9 cases as grade IV stenoses according to Cotton. The decannulation rate was 97% (30 of 31 cases) after an open procedure. There were no fatalities and no lesions to the recurrent laryngeal nerves, but there was 1 complete restenosis. Twenty-seven patients show no exertional dyspnea, 3 have a slight stridor with some dyspnea while exercising, and 1 patient is not decannulated. The voice is normal in 21 cases, a dysphonia is present in 9 cases, and the patient with complete restenosis acquired an esophageal voice. Postoperative follow-up is longer than 10 years in 8 cases and longer than 5 years in an additional 6 cases. All patients who reached adulthood show normal growth of the larynx and trachea. Considering the excellent results obtained in this consecutive series of 31 cases, partial cricoid resection with primary thyrotracheal anastomosis should be considered an important treatment option for severe SGS in infants and children.