bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Tumor Necrosis Factor Alpha Antagonist, Platelet Activating Factor Antagonist, and Nitric Oxide Synthase Inhibitor on Experimental Otitis Media with Effusion
Authors: Kim Dong-Hyun , Park Yong-Soo , Jeon Eun-Ju , Yeo Sang-Won , Chang Ki-Hong , Lee Seung Kyun
Published: October 2014

Objectives:

We studied the inflammatory responses in otitis media with effusion induced by lipopolysaccharide (LPS) in rats, and compared the preventive effects of tumor necrosis factor (TNF) soluble receptor type I (sTNFRI, a TNF-α antagonist), platelet activating factor antagonist, and the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME).

Methods:

We used 2 control groups of Sprague Dawley rats (untreated and saline-treated) and 4 experimental groups, which all received an intratympanic injection of LPS, followed in 3 groups by experimental treatment of the same ear. The LPS group had no additional treatment. The l-NAME group received intraperitoneal injection of L-NAME and was reinjected after 12 hours. The A-85783 group was first given an intraperitoneal injection of A-85783. The sTNFRI group was first given an intratympanic injection of sTNFRI. Twenty-four hours after the initial intratympanic injection of LPS, temporal bones from each group were examined histopathologically and the vascular permeability of the middle ear mucosa was measured by Evans blue vital dye staining.

Results:

The l-NAME, A-85783, and sTNFRI groups showed significantly reduced capillary permeability, subepithelial edema, and infiltration of inflammatory cells in comparison with the LPS group. There were no differences in capillary permeability, subepithelial edema, or infiltration of inflammatory cells between the A-85783 and sTNFRI groups. The l-NAME group showed no difference in vascular permeability or subepithelial edema in comparison with the A-85783 and sTNFRI groups, but showed more infiltration of inflammatory cells.

Conclusions:

We conclude that sTNFRI, A-85783, and l-NAME can be proposed as alternative future treatments for otitis media with effusion. However, l-NAME may be the least effective of these agents.
Pediatric Functional Endoscopic Sinus Surgery: Frequently Asked Questions
Authors: Cable Benjamin B. , Mair Eric A.
Published: October 2014

Pediatric endoscopic sinus surgery is a controversial procedure that has evolved considerably over the past 2 decades. We present a current review of the literature regarding the treatment of children with refractory sinusitis with a focus on the use of endoscopic sinus surgery. Preoperative evaluation, surgical technique, postoperative care, and unusual applications are discussed.
Evaluation of Recovery from Transient Facial Palsy following Canalplasty and Tympanoplasty for the Treatment of Congenital Aural Atresia
Authors: Ushio Munetaka , Takeuchi Naonobu , Kaga Kimitaka
Published: October 2014

Objectives:

Canalplasty is a surgical procedure of the external auditory canal. In this study we examined anatomic risk factors for facial nerve injury in aural atresia surgery, in addition to facial nerve outcomes and the time course of recovery in patients with facial nerve palsy following atresia surgery.

Methods:

Transient facial palsy was observed immediately after surgery in 6 of 99 ears (6 of 87 patients) after canalplasty and tympanoplasty for the treatment of congenital aural atresia. We assessed the course of recovery and mean scores using Jahrsdoerfer's grading system.

Results:

The rate of absence of the stapes and the rate of presence of positional anomalies of the facial nerve were significantly higher among cases with facial palsy, and Jahrsdoerfer total scores were significantly lower among cases with facial palsy. The mean recovery time in 5 cases with a minimum electroneurography value of 0% was 16.2 weeks (range, 14 to 18 weeks). No trends during recovery were detected for the nerve excitability test and R1 components of the blink reflex.

Conclusions:

The anatomic conditions that cause a predisposition to transient facial palsy include absence of the stapes and the presence of positional anomalies of the facial nerve. Although some patients displayed transient facial palsy after surgery, all patients fully recovered. Mechanisms of facial nerve injury are proposed.
Respiratory Retraining Therapy and Management of Laryngopharyngeal Reflux in the Treatment of Patients with Cough and Paradoxical Vocal Fold Movement Disorder
Authors: Murry Thomas , Tabaee Abtin , Owczarzak Vicki , Aviv Jonathan E.
Published: October 2014

Objectives:

We describe the outcome of patients with cough and paradoxical vocal fold movement disorder (PVFMD) treated with respiratory retraining therapy and management of laryngopharyngeal reflux (LPR).

Methods:

Twenty patients with the complaint of cough were given a diagnosis of PVFMD and treated with proton pump inhibitors for a minimum of 6 months followed by 3 to 5 sessions of respiratory retraining therapy. Pulmonary function testing (PFT) and subjective rating of cough and reflux (reflux symptom index; RSI) were performed. Also, PFT and rating of cough were performed on a group of 10 healthy volunteers with no complaint of cough.

Results:

The study group comprised 13 women and 7 men. The baseline cough rating and ratio of forced inspiratory volume at 0.5 second to forced inspiratory vital capacity (FIV0.5/FIVC) on PFT were significantly worse in the treatment group than in the control group. After therapy, 20 patients (100%) experienced improvement in cough, 19 patients (95%) experienced improvement on PFT, and 17 patients (85%) experienced improvement in the RSI score. The differences were statistically significant.

Conclusions:

Respiratory retraining therapy combined with management of LPR is an effective treatment for patients with cough and PVFMD when a single-modality treatment is not sufficient.
Development of the Human True Vocal Fold: Depth of Cell Layers and Quantifying Cell Types within the Lamina Propria
Authors: Boseley Mark E. , Hartnick Christopher J.
Published: October 2014

Objectives:

We sought to further describe the development of the 3-layered human vocal fold in children and to quantify macrophage and myofibroblast concentrations in each layer.

Methods:

We used an optical analysis software package to examine 8 longitudinally sectioned human vocal folds that had been fixed in formalin (ages 2 days to 14 years).

Results:

The 2-day-old vocal fold contained only a monolayer of cells. This became a bilayer by 5 months, and a trilayer began to become evident by 7 years. The percent of total depth represented by the superficial layer of the lamina propria (SLP) gradually decreased with age. The SLP made up 22% of the total lamina propria by age 7 years; this percentage approximates that in the adult vocal fold. Macrophages and myofibroblasts were predominately found in the SLP, and began to be apparent by 11 months of age.

Conclusions:

These results help describe the development of human voice and may have implications as to when phonosurgical therapy can be considered for children.
Airway Resistance and Airflow Dynamics after Fat Injection into Vocal Folds
Authors: Cantarella Giovanna , Fasano Valter , Maraschi Barbara , Mazzola Riccardo F. , Sambataro Giuseppe
Published: October 2014

Objectives:

The aim of this prospective study was to verify whether vocal fold fat augmentation (VFFA) modifies upper airway patency. To the best of our knowledge, this is the first study analyzing the impact of VFFA on laryngeal resistance to airflow.

Methods:

Twenty-one consecutive patients 16 to 74 years of age underwent 24 VFFA operations because of glottic incompetence due to laryngeal hemiplegia (13 patients) or vocal fold tissue defects (8 patients). Flow-volume loop spirometry and body plethysmography were performed before and 1 to 6 months after surgery.

Results:

There were no significant differences between preoperative and postoperative pulmonary volumes (FVC and FEV1), expiratory flows (PEF, FEF50), or inspiratory flows (PIF, FIF50), although a slight increase in inspiratory flows meant that FEF50/FIF50 slightly decreased. Specific airway resistance (sRaw) increased after VFFA, but not in a statistically significant manner (p = .078). None of the patients experienced postoperative stridor. One obese woman with laryngeal hemiplegia had postoperative effort dyspnea; her respiratory studies showed a reduction in inspiratory flows and an increase in sRaw, and demonstrated progressive improvement.

Conclusions:

Flow-volume loop spirometry showed that VFFA does not significantly modify respiratory airflows, although a slight increase of inspiratory airflows suggested an improvement in variable extrathoracic obstruction. Body plethysmography proved to be a sensitive procedure that highlighted the subtle increase in upper airway resistance. Hence, VFFA can be considered a relatively safe procedure for achieving vocal fold medialization, and spirometry and plethysmography can be useful for preoperative assessment and postoperative follow-up.
Histopathologic Changes in Laryngeal Mucosa of Extremely Low-Birth Weight Infants after Endotracheal Intubation
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

Advances in medicine have improved the survival of infants with increasingly lower birth weights. The histopathologic changes of intubation-related laryngeal injury in extremely low-birth weight infants (less than 1,000 g) have not been well known. We examined histopathologic changes in infant larynges, including extremely low-birth weight infants, after endotracheal intubation.

Methods:

Forty-four infants, including 21 extremely low-birth weight infants, who had been intubated for periods ranging from 10 minutes to 138 days, were examined in a whole organ serial section study.

Results:

As the duration of intubation increased, the ulceration was found to be larger and deeper. The injury at the subglottis and posterior glottis was greater than that at other portions. The perichondrium of the cartilage was exposed in many cases intubated longer than 8 days. Repaired epithelium that was composed of squamous epithelium was present in 6 of 7 larynges that had been intubated more than 20 days, indicating that not only injury but also the healing process occurred during long intubation. There were no obvious relationships between the degree of intubation injury and the birth weight of the infants.

Conclusions:

Prolonged intubation is better tolerated by infants than adults. The intubation-related laryngeal injuries of extremely low-birth weight infants were histopathologically the same as those of infants of other birth weights.
Radiofrequency Ablation in the Treatment of Idiopathic Bilateral Palatal Myoclonus: A New Indication
Authors: Aydin Omer , Iseri Mete , Ozturk Murat
Published: October 2014

Objectives:

We tested the effect of radiofrequency ablation in the treatment of palatal myoclonus refractory to other therapeutic regimens.

Methods:

A 20-year-old patient who presented with palatal myoclonus and annoying rhythmic objective clicking noise was treated with a radiofrequency generator with topical and local anesthesia in an outpatient setting.

Results:

The clicking noise was abolished within 3 to 4 days of the radiofrequency ablation. The rhythmic, jerky movements of the soft palate were confirmed to be absent 2 weeks later with electromyographic studies. The patient has been symptom-free for 6 months, and no side effects have occurred.

Conclusions:

As a new indication, radiofrequency ablation may effectively abolish abnormal movements of the soft palate and relieve associated tinnitus.
Relationship between Fluoroscopic and Manometric Measures of Pharyngeal Constriction: The Pharyngeal Constriction Ratio
Authors: Leonard Rebecca , Belafsky Peter C. , Rees Catherine J.
Published: October 2014

Objectives:

The gold standard objective measure of pharyngeal strength is pharyngeal manometry. We have developed an objective fluoroscopic measure of pharyngeal strength, the pharyngeal constriction ratio (PCR). A high PCR indicates poor pharyngeal constriction. The objective of the current study was to evaluate the correlation between the PCR and peak pressures on pharyngeal manometry.

Methods:

The charts of 20 consecutive individuals who underwent a dynamic fluoroscopic swallow evaluation and pharyngeal manometry at the Center for Voice and Swallowing of the University of California, Davis, were retrospectively reviewed. Information regarding patient demographics, diagnoses, PCR, and manometric pharyngeal peak pressures was abstracted. The correlation between the PCR and pharyngeal pressure was determined with the Pearson correlation coefficient.

Results:

The mean (±SD) age of the cohort was 63 ± 11 years. Fourteen of the 20 patients (70%) were male. The most common diagnoses were reflux (7 of 20) and cerebrovascular accident (4 of 20). The mean PCR was 0.26 ± 0.31. The mean pharyngeal pressure was 83 ± 43 mm Hg. The correlation between the PCR and pharyngeal pressure was −0.70 (p <.01).

Conclusions:

There was a high inverse correlation between the PCR and the peak pharyngeal pressure on manometry (-0.70). The PCR appears to be a valid objective surrogate measure of pharyngeal strength.
Transoral Approach to Laser Thyroarytenoid Myoneurectomy for Treatment of Adductor Spasmodic Dysphonia: Short-Term Results
Authors: Su Chih-Ying , Chuang Hui-Ching , Tsai Shang-Shyue , Chiu Jeng-Fen
Published: October 2014

Objectives:

The surgical technique for the resection of the recurrent laryngeal nerve for adductor spasmodic dysphonia (ASD) has high late failure rates. During the past decade, botulinum toxin has emerged as the treatment of choice for ASD. Although effective, it also has significant disadvantages, including a temporary effect and an unpredictable dose-response relationship. In this study we investigated the effectiveness of a new transoral approach to laser thyroarytenoid myoneurectomy for treatment of ASD.

Methods:

Fourteen patients with ASD underwent transoral laser myoneurectomy of bilateral thyroarytenoid muscles. Under general anesthesia, an operating microscope and a carbon dioxide laser were used to perform myectomy of the mid-posterior belly of bilateral thyroarytenoid muscles together with neurectomy of the terminal nerve fibers among the deep muscle bundles. Care was taken not to damage the vocalis ligaments, arytenoid cartilages, and lateral cricoarytenoid muscles. Preoperative and postoperative videolaryngostroboscopy and vocal assessments were studied.

Results:

The 13 patients who completed more than 6 months follow-up were enrolled in this study. Moderate and marked vocal improvement was achieved in 92% of the patients (12 of 13) after laser surgery during an average follow-up period of 17 months (range, 6 to 31 months). No vocal fold atrophy or paralysis was observed in any patient. None of the patients had a recurrence during the follow-up period.

Conclusions:

Transoral laser myoneurectomy of bilateral thyroarytenoid muscles is a relatively simple, effective, and valuable technique for the treatment of ASD. The durability of outcome achieved with this procedure is encouraging.
Polymorphism between Loci for Human Leukocyte Antigens DR and DQ in Patients with Nasal Polyps
Authors: Zhai Lijie , Sun Yiqing , Tang Linghao , Liu Hui
Published: October 2014

Objectives:

We explored a potential association between nasal polyps (NPs) and polymorphism at loci for human leukocyte antigen (HLA) DR and HLA-DQ.

Methods:

Polymorphism at loci HLA-DR and HLA-DQ were examined in 30 patients with NPs and in 81 healthy subjects by use of the polymerase chain reaction-sequence specific primer method.

Results:

HLA-DR16, HLA-DQ8, and HLA-DQ9 were found to be significantly associated with NPs. HLA-DR16, HLA-DQ8, and HLA-DQ9 specificities were found at higher frequencies in patients with NPs than in control subjects (5% versus 0.62%, RR = 8.9, p = .03; 10% versus 2.47%, RR = 4.81, p = .01; and 20% versus 6.18%, RR = 4.73%, p = .001; respectively). In contrast, HLA-DQ7 was found at lower frequencies in patients with NPs than in controls (10% versus 20.37%, RR = 0.36, p = .04).

Conclusions:

We conclude that HLA-DR16, HLA-DQ8, and HLA-DQ9 represent potential susceptibility determinants and that HLA-DQ7 might confer resistance in nasal polyps.
Administration of Esmolol in Microlaryngeal Surgery for Blunting the Hemodynamic Response during Laryngoscopy and Tracheal Intubation in Cigarette Smokers
Authors: Louizos Antonios A. , Hadzilia Sophie J. , Davilis Dimitrios I. , Samanta Evangelia G. , Georgiou Loucas G.
Published: October 2014

Objectives:

Cigarette smokers constitute a group of patients with an increased hemodynamic response to tracheal intubation. We studied the dose-response and side effects of bolus administration of esmolol hydrochloride in cigarette smokers undergoing elective microlaryngeal surgery, when esmolol was used for reducing the intense hemodynamic response to laryngoscopy and tracheal intubation.

Methods:

We randomly allocated 165 patients (American Society of Anesthesiologists physical status classes I to III) to receive placebo (Eplac) or esmolol 1 mg/kg (E1) or 2 mg/kg (E2). The esmolol was given 2 minutes before laryngoscopy and tracheal intubation. The same anesthetic technique was used in all patients. Cardiovascular parameters were recorded every minute for the first 5 minutes and thereafter every 3 minutes. Bronchospasm, other side effects, and rescue esmolol treatment were noted during anesthesia.

Results:

In group Eplac, significant increases (p < .05) in arterial blood pressure and heart rate were observed in the first 3 minutes after tracheal intubation. In group E1, significant increases (p < .05) in diastolic blood pressure were observed in the first 2 minutes after intubation. In group E2, no significant fluctuations were recorded in cardiovascular parameters after intubation. During surgery, 17% of the patients in group Eplac showed an increase in blood pressure and tachycardia.

Conclusions:

We conclude that esmolol administration of 2 mg/kg during induction of anesthesia in smokers provides hemodynamic stability after laryngoscopy and tracheal intubation with no severe side effects.
Endoscopic Management of Blunt Pediatric Laryngeal Trauma
Authors: Elmaraghy Charles A. , Tanna Neil , Wiet Gregory J. , Kang D. Richard
Published: October 2014

Objectives:

Blunt laryngeal trauma in the pediatric population is an uncommon but unique entity that can be potentially life-threatening. Given the infrequency of these events, its management can pose a clinical dilemma. The authors review the evaluation and treatment of blunt pediatric laryngeal trauma.

Methods:

We present a case report and a review of the literature.

Results:

We describe the case of a 3-year-old boy who presented with laryngeal injury following blunt trauma. The patient sustained endolaryngeal hematomas and mucosal lacerations with exposed cartilage. After mucosal approximation, the patient was successfully managed in a critical care setting without a tracheostomy.

Conclusions:

With an appropriate and thorough evaluation of the pediatric patient, endoscopic management without a surgical airway may be considered as a viable alternative for blunt laryngeal trauma.
Value of Temporal Bone Density Measurements in Otosclerosis Patients with Normal-Appearing Computed Tomographic Scan
Authors: Tringali Stéphane , Pouget Jean-François , Bertholon Pierre , Dubreuil Christian , Martin Christian
Published: October 2014

Objectives:

Previous studies demonstrated that otosclerosis diagnosis benefits from temporal bone density measurements. We sought to assess bone density measurements of the fissula ante fenestram (FAF) in normal patients, in patients with otosclerosis, and in patients with cholesteatoma. We discuss the value of temporal bone density measurements in patients with otosclerosis who have a normal-appearing computed tomographic (CT) scan.

Methods:

This was a prospective case-control study in which 219 temporal bones (123 adults, 18 to 84 years of age) were included between November 1, 2002, and April 30, 2004. All patients underwent a CT scan of the temporal bones. Axial views were obtained with density measurement of the FAF.

Results:

The FAF density was significantly different (p < .0001) in the otosclerosis group (n = 119) compared to the control group (n = 100). There was no significant difference between the otosclerosis group with a normal-appearing CT scan and the control group (p = .64).

Conclusions:

From our results, it may be suggested that 1) temporal bone density measurements seem not to be strictly comparable between CT scan devices; and 2) temporal bone density measurements of the FAF did not allow the diagnosis of otosclerosis when the CT scan appeared normal.
Multifocal Extranodal Mucosa-Associated Lymphoid Tissue Lymphoma Affecting the Larynx
Authors: Arndt Susan , Veelken Hendrik , Schmitt-Gräff Annette , Aschendorff Antje , Maier Wolfgang , Richter Bernhard
Published: October 2014

Objectives:

Extranodal marginal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) accounts for about 7% to 8% of all B-cell lymphomas and 50% of all gastric lymphomas. Long-term localized growth is typical of MALT lymphoma. Multifocal manifestations are possible in advanced stages. MALT lymphoma of the larynx is a very rare disease; only 15 cases have been reported in the literature.

Methods:

We report a case of multifocal MALT lymphoma affecting the larynx associated with extraesophageal reflux, chronic laryngitis, and gastric Helicobacter pylori infection. The staging revealed a recurrent tumor of MALT lymphoma in the stomach and an involvement of the right conjunctiva.

Results:

Following recent reports on successful treatment of MALT lymphoma with antibiotics, initial empirical therapy with doxycycline calcium led to a subjective clinical symptom improvement but no objective response as assessed by laryngoscopy, magnetic resonance imaging of the larynx, and esophagogastroduodenal endoscopy. Because of the advanced stage and multiple extranodal manifestations of the MALT lymphoma, the patient received 3 cycles of chemoimmunotherapy according to the FCR protocol (fludarabine phosphate-cyclophosphamide-rituximab). No evidence of disease was observed after a 6-month follow-up.

Conclusions:

In the rare diagnosis of MALT lymphoma of the larynx, comprehensive staging is indispensable to exclude multifocal involvement. In contrast to the treatment of primarily localized MALT lymphoma, multifocal disease warrants systemic therapy.
Clinical and Pathological Analysis of Recurrent Inverted Papilloma
Authors: Oikawa Keita , Furuta Yasushi , Itoh Tomoo , Oridate Nobuhiko , Fukuda Satoshi
Published: October 2014

Objectives:

We analyzed the clinical characteristics, pathological findings, and treatment outcomes of patients with recurrent sinonasal inverted papilloma (IP).

Methods:

This retrospective study consisted of 13 patients with recurrent IP. Patient data were collected on prior treatment, sites of recurrence, surgical procedures, pathological findings, and postoperative time to recurrence.

Results:

Eleven of the 13 patients (85%) had recurrence in the ethmoid sinus, particularly at the lamina papyracea (n = 8; 62%). Inverted papilloma with severe dysplasia (SD) was observed in 4 patients, 3 of whom showed malignant transformation of the recurrent tumor. Craniofacial resection was performed in 2 of the 4 patients, resulting in no further recurrence. However, the tumor was not managed in the remaining 2 patients. In the 9 patients without SD, lateral rhinotomy was performed in 6 patients and endoscopic sinus surgery was selected in 3 patients who had a small tumor without scar formation. No further recurrence was observed in the 9 patients.

Conclusions:

Careful management of IP around the lamina papyracea is essential during initial surgery. Recurrent IP without SD can be successfully managed by lateral rhinotomy in most cases, and by endoscopic sinus surgery in selected cases. However, more aggressive treatment, including craniofacial resection, should be considered in IP with SD, which is associated with a high rate of recurrence and malignant transformation.
Analysis of Human Glottal Velocity Using Hot-Wire Anemometry and High-Speed Imaging
Authors: Kataoka Hideyuki , Arii Shiro , Ochiai Yoshitaka , Suzuki Toyohiko , Hasegawa Kensaku , Kitano Hiroya
Published: October 2014

Objectives:

The aim of this study was to analyze glottal velocity and glottal opening and closure. For this purpose, we developed a miniature, flexible, hot-wire probe that can make truly instantaneous measurements of the human larynx in vivo.

Methods:

A miniature hot-wire tip was inserted into a flexible transnasal endoscope. Fiberscopic examination was performed transnasally so that we could observe glottal vibration using high-speed imaging. The tip of the hot-wire probe was placed just above the glottis. The position of the probe was carefully monitored and checked with another flexible endoscope.

Results:

Changes in velocity were recorded periodically. The velocity was higher in close proximity to the vocal folds. High-speed motion pictures were taken at a rate of 2,000 frames per second with an auxiliary light source.

Conclusions:

Quantitative analysis of glottal velocity is required to improve our understanding of the relationship between laryngeal physiology and acoustics in humans. To solve the problem of synchronization inaccuracy, glottal velocity was captured instantaneously in the high-speed imaging system's processor memory.
Streptococcus Viridans Has a Leading Role in Rhinosinusitis Complications
Authors: Hwang Siew Yoong , Tan Kun Kiaang
Published: October 2014

Objectives:

We sought to determine whether the bacteria in complicated rhinosinusitis were the typical acute rhinosinusitis triad of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. We also compared the difference in yield between infection sites and blood cultures.

Methods:

We performed a retrospective review of all patients who had required surgical intervention for rhinosinusitis complications over 7 years at a tertiary care pediatric hospital.

Results:

There were a total of 28 patients during the review period. Twenty-five organisms were isolated from 21 patients, of which Streptococcus viridans formed 44% of the isolates (11 of the 25). The typical triad of bacteria only formed 20% of the isolates (5 of the 25), and none of these bacteria were found in the group with intracranial complications. Infection site cultures had a superior yield compared to blood cultures (p <.001). Ninety-six percent of the bacteria were sensitive to a combination of amoxicillin-clavulanate and cloxacillin.

Conclusions:

In distinction to the typical bacteria of acute rhinosinusitis, S viridans is the leading cause of rhinosinusitis complications. It is not merely a commensal organism of the upper respiratory tract.
Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis
Authors: Ling Zhi-Qiang , Mukaisho Ken-Ichi , Hidaka Miyoko , Chen Kuan-Hao , Yamamoto Gaku , Hattori Takanori
Published: October 2014

Objectives:

The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial.

Methods:

We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen.

Results:

In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals.

Conclusions:

Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.
Relationship between Sinusitis and Adenoid Size in Pediatric Age Group
Authors: Berçin A. Sami , Ural Ahmet , Kutluhan Ahmet , Yurttaş Veysel
Published: October 2014

Objectives:

We sought to examine the relationship between adenoid volume and the stage of rhinosinusitis, as well as the relationship between age and adenoid size.

Methods:

Forty-two children complaining of nasal discharge, whose paranasal sinus computed tomographic scans had been obtained, were involved in the study. The patients with adenoid enlargement underwent adenoidectomy. The volumes of adenoid vegetation were measured in square centimeters, and paranasal sinus computed tomographic scans were classified according to the Lund-Mackay staging system.

Results:

No statistically significant difference existed between patients whose Lund-Mackay scores were 0 and those with scores greater than 0. There seems to be no correlation between the Lund-Mackay score and the degree of adenoid vegetation.

Conclusions:

Adenoid vegetation may cause nasal discharge that is not necessarily due to sinusitis. We could not find any supportive data for the statement “The greater the adenoid tissue, the more extensive the sinusitis.”
Measuring Edema in Irradiated Head and Neck Cancer Patients
Authors: Patterson Joanne M. , Hildreth Anthony , Wilson Janet A.
Published: October 2014

Objectives:

Edema is a common side effect of radiotherapy for head and neck cancer. Systems have been developed to record and monitor changes that occur after radiotherapy. These lack the sensitivity to record edema in specific laryngopharyngeal structures. The aim of this study was to develop a rating scale to measure edema in the larynx and pharynx.

Methods:

This was an exploratory study to develop a new measure, with the help of an expert panel, assessing interrater and intrarater reliability. A consensus group developed the rating scale. Eleven structures and 2 spaces were identified as areas sensitive to the development of edema. The terms no, mild, moderate, and severe were used to describe the degrees of edema. The scale was piloted and then tested for interrater and intrarater reliability on 5 speech and language therapists. They viewed 25 nasendolaryngoscopic images (23 patients who had had radiotherapy and 2 healthy volunteers). The images were rated with the scale. This process was repeated 1 week later.

Results:

Images were taken from patients with oral, oropharyngeal, nasopharyngeal, or laryngeal cancer. All had had radiotherapy or chemoradiotherapy. All raters were experienced in viewing larynges via nasendolaryngoscopy. The interrater reliability for scoring the edema rating scale was moderate (weighted kappa, 0.54). Lower levels of agreement were found for the tongue base, valleculae, pharyngeal walls, and anterior commissure. The intrarater reliability was very good (weighted kappa, 0.84).

Conclusions:

The edema rating scale can be scored with very good test-retest reproducibility and moderate levels of agreement between clinicians. Modifications to the method are suggested to increase interrater reliability.
Age-Related Changes in the Murine Larynx: Initial Validation of a Mouse Model
Authors: Abdelkafy Wael M. , Smith Johnathon Q. , Henriquez Oswaldo A. , Golub Justin S. , Xu Jianguo , Rojas Mauricio , Brigham Kenneth L. , Johns Michael M.
Published: October 2014

Objectives:

Changes in voice are commonly associated with aging (presbyphonia). Age-related voice change significantly impairs elderly individuals' ability to communicate meaningfully with others and affects their quality of life. With changing age demographics in our society and increasing emphasis on quality of life, treatment of presbylaryngis is becoming more paramount.

Methods:

We used 9 aged and 9 young mice to validate a mouse model for the aging larynx. We stained the larynges with Alcian blue to determine the hyaluronic acid content, trichrome stain to determine the collagen content, and immunohis-tochemical stain for α smooth muscle actin to determine the myofibroblast content. Morphometric measurements were performed for muscle area, muscle thickness, and muscle fiber diameter.

Results:

Statistically significant differences in the density measurements of hyaluronic acid and collagen reflected decreased hyaluronic acid and increased collagen content in the aging larynx. We found α smooth muscle actin–labeled myofibroblasts only in the aged larynges. No statistically significant differences were found in the morphometric measurements.

Conclusions:

Aged mice may make a practical model for the age-related changes in the vocal folds that can be used further in studies aiming to correct these changes.
Monitoring Tracheal Tube Cuff Pressures in the Intensive Care Unit: A Comparison of Digital Palpation and Manometry
Authors: Morris Lue G. , Zoumalan Richard A. , Roccaforte J. David , Amin Milan R.
Published: October 2014

Objectives:

Tracheal tube cuff overinflation is a recognized risk factor for tracheal injury and stenosis. International studies report a 55% to 62% incidence of cuff overinflation among intensive care unit (ICU) patients. However, there are no data on tracheotomy tubes, and no recent data from ICUs in the United States. It is unknown whether routine cuff pressure measurement is beneficial. We sought to determine the incidence of cuff overinflation in the contemporary American ICU.

Methods:

We performed an Institutional Review Board-approved, prospective, observational study of endotracheal and tracheotomy tubes at 2 tertiary-care academic hospitals that monitor cuff pressure differently. At hospital A, cuff pressures are assessed by palpation; at hospital B, cuff pressures are measured via manometry. We audited cuff pressures in an unannounced fashion at these hospitals, using a handheld aneroid manometer. Cuffs were considered overinflated above 25 cm H2O.

Results:

We enrolled 115 patients: 63 at hospital A and 52 at hospital B. Overall, 44 patients (38%) were found to have overinflated cuffs. The incidence of overinflation was identical at the 2 hospitals (38%; p = .99). Of the endotracheal tubes, 43% were overinflated, as were 32% of the tracheotomy tubes (p = .24).

Conclusions:

Despite increasing awareness among intensivists and respiratory therapists, the incidence of tracheal tube overinflation remains high, with both endotracheal and tracheotomy tubes. Our finding that the use of manometry to assess cuff pressures did not reduce the incidence of overinflation suggests that a more vigilant management protocol may be necessary.
Injectable Form of Cross-Linked Hyaluronan is Effective for Middle Ear Wound Healing
Authors: Angeli Simon , Connell Sarah , Gibson Brian , Ozdek Ali , McElveen John T. , Van De Water Thomas R.
Published: October 2014

Objectives:

Two studies were designed to investigate a hyaluronan (HA) gel for middle ear (ME) wound healing.

Methods:

We used a guinea pig model of ME wound healing. In a long-term study, we performed a comparison of hearing and ME inflammation in 3 groups. Group 1 (n = 8) underwent bilateral wounding of ME mucosa and unilateral packing of the ME with HA gel (Sepragel). Group 2 (n = 6) was the same as group 1 except that the packing was absorbable bovine collagen sponges (Gelfoam). Group 3, the control group (n = 14), had operated, unpacked ears. In a short-term study, we investigated ME retention of HA gel at 1 and 2 weeks (n = 16).

Results:

At 1 week, all ears showed decreased distortion product otoacoustic emissions (DPOAEs) and auditory brain stem responses (ABRs) secondary to ME packing and postsurgical inflammation. The controls recovered preoperative DPOAEs and ABRs by week 2. Group 1 had decreased low-frequency DPOAEs at weeks 2 and 6, but their high-frequency DPOAEs and ABRs recovered to preoperative values by week 6. Group 2 had hearing losses that persisted throughout the study. Group 1 showed normal ME and inner ear histologic characteristics. Group 2 showed inflammatory cells within the ME and cochleas. Group 1 showed less packing retention than did group 2 at week 6 (p = 016). Eighty-five percent of the HA packing remained at 1 week, and 73% at 2 weeks.

Conclusions:

Hyaluronan gel was a relatively safe and effective ME packing material in our animal model.
Preoperative Staging and Surgical Approaches for Sinonasal Inverted Papilloma
Authors: Oikawa Keita , Furuta Yasushi , Nakamaru Yuji , Oridate Nobuhiko , Fukuda Satoshi
Published: October 2014

Objectives:

We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs).

Methods:

Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery.

Results:

Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches.

Conclusions:

Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.
Carcinosarcoma of the Parotid Gland: Report of a Case with Immunohistochemical Findings
Authors: Liess Benjamin D. , Hirschi Scot , Zitsch Robert P. , Frazier Shellaine , Konrad Angela
Published: October 2014

Objectives:

Carcinosarcoma (true malignant mixed tumor) of the parotid gland is an extremely uncommon tumor composed of both carcinomatous and sarcomatous components. An understanding of this manifestation is crucial to guide management and treatment of this disease.

Methods:

A patient who presented with facial nerve weakness and a painful mass of the parotid gland underwent fine needle aspiration, laboratory testing, and computed tomography of the neck that demonstrated a large parotid malignancy. The patient underwent surgical treatment followed by radiotherapy. Histologic and immunohistochemical examination of the specimen was performed.

Results:

This report of a slow-growing parotid mass with otalgia and facial nerve weakness was treated with radical parotidectomy, supraomohyoid neck dissection, and cable graft repair of the excised facial nerve, which was completely encircled by tumor. Postoperative radiotherapy was administered. Histologic and immunohistochemical evaluation demonstrated carcinosarcoma.

Conclusions:

Carcinosarcoma is an unusual tumor of the parotid gland. Treatment generally involves surgery with subsequent radiotherapy. Long-term close follow-up is recommended, for this tumor has a high propensity for both local and regional recurrence and metastasis.
Results, Hearing Rehabilitation, and Follow-up with Magnetic Resonance Imaging after Tympanomastoid Exenteration, Obliteration, and External Canal Overclosure for Severe Chronic Otitis Media
Authors: Ketelslagers Katrien , Somers Thomas , De Foer Bert , Zarowski Andrzej , Offeciers Erwin
Published: October 2014

Objectives:

We sought to evaluate the results, auditory rehabilitation, and follow-up with magnetic resonance imaging (MRI) after tympanomastoid exenteration with obliteration of the mastoid cavity and overclosure of the external ear canal in patients with severe chronic otitis media that was resistant to medical therapy and conventional surgery and was associated with a profound sensorineural or severe conductive hearing loss.

Methods:

Twenty-nine patients were analyzed and underwent this surgical technique. Twelve patients had, during the same or later stage, either cochlear implantation, fixture implantation for a bone-anchored hearing aid, or middle ear implantation. For follow-up control of the obliterated cavity, delayed gadolinium-enhanced, T1-weighted MRI in combination with non-echo planar imaging diffusion weighted sequences were used.

Results:

No patient had recurrent otorrhea after an average follow-up period of 4.75 years. One patient had a residual cholesteatoma as shown by new MRI techniques, and this was successfully resected. One patient developed complications 6 months after 1-stage tympanomastoid exenteration and cochlear implantation.

Conclusions:

This technique is very useful in selected patients with severe chronic otitis media that is resistant to medical therapy and surgery and is associated with a profound sensorineural or severe conductive hearing loss. New sequences in MRI are used for postoperative follow-up of these obliterated cavities and seem reliable for the detection of residual or recurrent cholesteatoma. Middle ear implantation and cochlear implantation can be relatively safely performed in these patients in a second stage.
Drug Delivery System of Hepatocyte Growth Factor for the Treatment of Vocal Fold Scarring in a Canine Model
Authors: Ohno Tsunehisa , Hirano Shigeru , Kanemaru Shin-Ichi , Yamashita Masaru , Umeda Hiroo , Suehiro Atsushi , Tamura Yoshihiro , Nakamura Tatsuo , Ito Juichi , Tabata Yasuhiko
Published: October 2014

Objectives:

Vocal fold scarring remains a therapeutic challenge. Previous studies have indicated that hepatocyte growth factor (HGF), a strong antifibrotic element, has therapeutic potential for restoring scarred vocal folds. To enhance the effect of HGF in vivo, we developed a novel drug delivery system (DDS) in which HGF is embedded in gelatin hydrogel and continuously released over a period of 2 weeks. In the present study we investigated the therapeutic efficacy of the HGF DDS on vocal fold scarring by using a canine model.

Methods:

The vocal folds of 8 beagles were unilaterally scarred by stripping the entire layer of the lamina propria. The contralateral vocal folds were kept intact as normal controls. One month after the procedure, hydrogels (0.5 mL) containing 1 μg of HGF were injected into the scarred vocal folds of 4 dogs (HGF-treated group), whereas hydrogels containing saline solution were injected in the other 4 dogs (sham group). Histologic and vibratory examinations were completed for each group 6 months after the initial surgery.

Results:

The excised larynx experiments showed significantly better vibration in terms of mucosal wave amplitude and glottal closure in the HGF-treated group compared to the sham group. Histologic evaluation of the vocal folds indicated remarkable reduction in collagen deposition and tissue contraction, with favorable restoration of hyaluronic acid and elastin in the HGF-treated group.

Conclusions:

The present findings suggest that the novel HGF DDS may provide favorable effects in restoring the vibratory properties of scarred vocal folds.
Impact of Treatment of Gastroesophageal Reflux on Obstructive Sleep Apnea-Hypopnea Syndrome
Authors: Friedman Michael , Gurpinar Berk , Lin Hsin-Ching , Schalch Paul , Joseph Ninos J.
Published: October 2014

Objectives:

We test the hypothesis that treatment of gastroesophageal reflux disease (GERD) can improve obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods:

One hundred forty-six patients with OSAHS underwent a complete history-taking, physical examination, and laboratory testing, including questions related to GERD symptoms. Full-night attended polysomnography, 24-hour wireless pH study at the upper esophagus, snoring level evaluation, Epworth Sleepiness Scale, and quality-of-life surveys were completed for each patient. Patients who tested positive for GERD were treated with esomeprazole magnesium 40 mg once daily for 2 to 12 months. The 24-hour pH study was repeated, and those patients with elimination of GERD were reevaluated by polysomnography, snoring level evaluation, Epworth Sleepiness Scale, quality-of-life surveys, and subjective data collection.

Results:

Forty-one patients completed single-dose treatment with esomeprazole, but the repeat 24-hour pH study showed that 9 patients had persistent GERD. In the 29 patients who completed phase 2 with normal pH study findings, the snoring level decreased from 9.7 ± 0.5 to 7.9 ± 1.3 (p < .0001), the Epworth Sleepiness Scale score decreased from 14.2 ± 2.5 to 11.1 ± 2.4 (p < .0001), the apnea-hypopnea index decreased from 37.9 ± 19.1 to 28.8 ± 11.5 (p = .006), and the minimum saturation of oxygen increased from 84.1% ± 7.8% to 86.9% ± 5.0% (p = .055).

Conclusions:

Treatment of GERD had a significant impact on the reduction of the apnea-hypopnea index, snoring, and daytime sleepiness. Elimination of GERD should be part of a comprehensive treatment plan for patients with OSAHS.
Auditory Skills Checklist: Clinical Tool for Monitoring Functional Auditory Skill Development in Young Children with Cochlear Implants
Authors: Meinzen-Derr Jareen , Wiley Susan , Creighton Jodi , Choo Daniel
Published: October 2014

Objectives:

The Auditory Skills Checklist© (ASC) was developed to address the need for tools to evaluate functional auditory skill progress in very young children with sensorineural hearing loss. We describe the development, validation, and utility of the ASC for use in young children with cochlear implants.

Methods:

Using the ASC, we measured auditory skills in 37 subjects who received cochlear implants at no more than 36 months of age. Repeated measures analysis was conducted to determine expected auditory skill development after implantation. Interrater reliability was tested on a small subset. The ASC was compared to the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) to determine its validity in measuring functional auditory skills.

Results:

The ASC had excellent internal consistency (Cronbach's alpha, 0.98) and interrater reliability (intraclass correlation coefficient, 0.99), and was highly correlated with the IT-MAIS (r = 0.90). According to the repeated measures analysis, children who received a cochlear implant at 36 months of age or earlier were expected to increase their ASC score by 8 points every 3 months (beta coefficient, 8.3; p < .001).

Conclusions:

The ASC is a clinically relevant and easily administered tool for assessing the functional auditory skills of young children with a cochlear implant. By assessing auditory skill development over time with the ASC, we can better realize expectations for a particular child based on his or her age, hearing loss level, and management strategies in place.