bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Trends in the Success Rate of Anterior Cricoid Split
Authors: Rotenberg Brian W. , Berkowitz Robert G.
Published: October 2014

Objectives:

We determined the historical trends at our institution in the extubation success rate, defined as avoiding tracheostomy, for infants with acquired laryngotracheal stenosis (LTS) who undergo anterior cricoid split (ACS) as primary treatment.

Methods:

We performed a retrospective chart review of all neonates with acquired LTS treated with ACS between 1989 and 2005. Successful extubation rates were assessed over the study's time period. Student's t-test was used to compare identified subgroups.

Results:

Thirty-one neonates (14 male, 17 female) were identified, with an average gestational age of 27.6 weeks. During 1989 to 1995, a successful cumulative extubation rate of 71.4% was achieved in 14 children. By 2005, though, following a further 17 children, the successful cumulative extubation rate had dropped to 54.8%. The extubation rate in the time period 1996 to 2005 specifically was only 41.2%. The factor identified that most significantly correlated with this change was the difference in average duration of preoperative intubation. Relatively higher numbers of significant neurologic, respiratory, and cardiac comorbidities were identified both in the 1996 to 2005 grouping and in the ACS failure grouping.

Conclusions:

The success rate of ACS as a means of avoiding neonatal tracheostomy appears to have declined over the past 10 years at our institution. A prolonged period of preoperative intubation, as well as associated increasingly significant comorbidities, may be explanatory for this change. Revising the accepted selection criteria for ACS, or broadening the indications for alternative techniques, may be warranted.
Selective Neck Dissection in Patients with Upper Aerodigestive Tract Cancer with Clinically Positive Nodal Disease
Authors: Simental Alfred A. , Duvvuri Umamaheswar , Johnson Jonas T. , Myers Eugene N.
Published: October 2014

Objectives:

We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease.

Methods:

We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease.

Results:

Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination.

Conclusions:

The application of selective neck dissection and postoperative irradiation in patients with clinically N1 and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures.
Stapedotomy with Microdrill or Carbon Dioxide Laser: Influence on Inner Ear Function
Authors: Somers Thomas , Vercruysse Jean-Philippe , Zarowski Andrzej , Verstreken Margriet , Offeciers Erwin
Published: October 2014

Objectives:

A prospective randomized audiological analysis of 336 otosclerosis operations was conducted to compare the evolution of bone conduction thresholds after primary stapedotomy with Two different techniques to open the footplate: microdrill and carbon dioxide laser stapedotomy.

Methods:

To monitor the inner ear function, we compared the preoperative bone conduction thresholds with the postoperative levels at day 2, week 2, week 6, and month 6. Evolution of the bone conduction was compared for the Two studied groups (laser versus microdrill).

Results:

An average bone conduction loss of 1.8 dB was measured at day 2 for the middle frequencies (0.5, 1, and 2 kHz). At 4 kHz, a bone conduction loss of 7 dB was found. The bone conduction thresholds measured in the first and second months after surgery showed a gradual recovery with overclosure as the end result.

Conclusions:

Our results confirm the transient depression of inner ear function in the immediate postoperative period, with recovery within the first weeks after surgery. In the studied population, no statistically significant difference was found between the Two techniques that were used to make the calibrated hole (laser versus microdrill). These results demonstrate that both techniques possess the same early effect regarding inner ear function. The authors hypothesize that an early inflammatory reaction could be the cause of the transient bone conduction shift.
Transient Evoked Otoacoustic Emissions in Vestibular Neuritis
Authors: Gouveris Haralampos , Victor Anja , Mann Wolf
Published: October 2014

Objectives:

Partial or total degeneration of the vestibulocochlear anastomosis at its takeoff from the saccular ganglion and regenerating efferent neural buds under the cochlear outer hair cells (OHCs) have been found in the temporal bones of human patients with a history of vestibular neuritis (VN). We sought to test whether VN has any functional impact on the ipsilateral OHCs by means of transient evoked otoacoustic emission (TEOAE) testing.

Methods:

We retrospectively analyzed prospectively collected TEOAE data of 28 patients (19 female, 9 male; age range, 21 to 60 years; median age, 42.5 years). The pure tone air conduction hearing thresholds at each standard audiometric frequency (0.125 to 8 kHz) and the amplitudes of the TEOAEs at the 1-, 2-, 3-, and 4-kHz frequency bands were compared between the lesional and contralateral sides by use of the nonparametric sign test for 2 paired samples.

Results:

No significant difference was found in the pure tone air conduction hearing thresholds between the lesional and contralateral ears at any of the 11 standard tested frequencies. No significant difference was found between the TEOAE amplitudes of the lesional and contralateral sides.

Conclusions:

Subclinical OHC functional impairment is not present in VN. Moreover, no apparent significant changes in medial olivocochlear bundle resting activity accompany VN.
Microbiology of Intracranial Abscesses Associated with Sinusitis of Odontogenic Origin
Authors: Brook Itzhak
Published: October 2014

Objectives:

The unique microbiology of sinusitis of dental origin that is associated with intracranial abscesses (IAs) and the correlation between the organisms at the Two sites has not been reported before. This report describes the author's experience during a 30-year period in studying the microbiology of 8 IAs and their corresponding sinusitis of dental origin.

Methods:

Aspirates of pus from 8 infected sinuses associated with odontogenic infections and their corresponding IAs were studied for aerobic and anaerobic bacteria. Polymicrobial flora was found in all 8 sinuses and 7 IAs, and the number of isolates varied from 1 to 5.

Results:

Anaerobic bacteria were isolated from all sinuses and IAs. A total of 28 isolates (3.5 isolates per site; 25 strict anaerobic, 1 aerobic or facultative, and 2 microaerophilic) were recovered from the sinuses, and 20 isolates (2.5 isolates per site; 16 strict anaerobic, 1 aerobic or facultative, and 3 microaerophilic) were found in the IAs. The bacterial isolates were Fusobacterium spp (14), Prevotella spp (11), Peptostreptococcus spp (13), microaerophilic streptococci (5), Veillonella parvula (3), and β-hemolytic streptococci group F (2). Concordance in the microbiological findings between the sinus and the IA was found in all instances; however, certain organisms were only present at one site.

Conclusions:

These data illustrate the concordance in the organisms recovered from sinusitis of dental origin and their associated IAs and confirm the importance of anaerobic bacteria in sinusitis and IAs of dental origin.
Characterization of Rat Spiral Ligament Cell Line Immortalized by Adenovirus 12-Simian Virus 40 Hybrid Virus
Authors: Yian Christopher , Moon Sung K. , Jin Sunji , Webster Paul , Rhim Johng S. , Andalibi Ali , Lim David J.
Published: October 2014

Objectives:

Spiral ligament fibrocytes play an important role in inner ear ion homeostasis and are classified into several subtypes according to expression of specific enzymes such as Na+,K+-ATPase, Ca++-ATPase, and carbonic anhydrase. Although our understanding of the cell and molecular biology of spiral ligament fibrocytes has increased over time, access to these cells still remains a significant hurdle hindering future studies. In this study, we aimed to establish a rat spiral ligament cell line with minimal disruption of the original characteristics.

Methods:

The primary spiral ligament fibrocytes were exposed to adenovirus 12-simian virus 40 hybrid virus for immortalization. Karyotypic analysis was performed after stabilization of the infected cells, and the population doubling time was compared to that of the primary cell. The cell line was characterized by immunolabeling and electron microscopy.

Results:

We describe the establishment and characterization of a line of type I spiral ligament fibrocytes immortalized with an adenovirus 12-simian virus 40 hybrid virus.

Conclusions:

This cell line can be a useful research tool for investigating the role of spiral ligament fibrocytes in homeostasis and inflammation of the inner ear.
Asymmetric Hearing Loss in a Random Population of Patients with Mild to Moderate Sensorineural Hearing Loss
Authors: Segal Nili , Shkolnik Mark , Kochba Anat , Segal Avichai , Kraus Mordechai
Published: October 2014

Objectives:

We evaluated the correlation of asymmetric hearing loss, in a random population of patients with mild to moderate sensorineural hearing loss, to several clinical factors such as age, sex, handedness, and noise exposure.

Methods:

We randomly selected, from 8 hearing institutes in Israel, 429 patients with sensorineural hearing loss of at least 30 dB at one frequency and a speech reception threshold not exceeding 30 dB. Patients with middle ear disease or retrocochlear disorders were excluded. The results of audiometric examinations were compared binaurally and in relation to the selected factors.

Results:

The left ear's hearing threshold level was significantly higher than that of the right ear at all frequencies except 1.0 kHz (p < .05). One hundred fifty patients (35%) had asymmetric hearing loss (more than 10 dB difference between ears). In most of the patients (85%) the binaural difference in hearing threshold level, at any frequency, was less than 20 dB.

Conclusions:

Age, handedness, and sex were not found to be correlated to asymmetric hearing loss. Noise exposure was found to be correlated to asymmetric hearing loss.
Somatic Modulation of Tinnitus: Test Reliability and Results after Repetitive Muscle Contraction Training
Authors: Sanchez Tanit Ganz , Lima Adriana da Silva , Brandão Ana Laura , Lorenzi Maria Cecília , Bento Ricardo Ferreira
Published: October 2014

Objectives:

We sought to study the reliability of tinnitus modulation by muscle contractions and to observe the effect of their prolonged repetition.

Methods:

Thirty-eight patients with tinnitus underwent 9 maneuvers of muscle contractions in test and retest situations. After a 2-month training period of repeating the maneuvers, tinnitus modulation and daily perception were evaluated.

Results:

There was no difference between the occurrence of tinnitus modulation in test (57.9%) and retest (63.2%) situations. After 2 months, the occurrence of modulation during the maneuvers was similar (55.3%), but a new pattern showed an increase in tinnitus improvement and a decrease in tinnitus worsening. The daily perception of tinnitus was unchanged.

Conclusions:

Maneuvers of head and neck muscle contractions evoked tinnitus modulation in a frequent and reliable manner. Also, the repetition of such maneuvers for 2 months altered the pattern of modulation.
Cost Savings of Unsedated Office-Based Laser Surgery for Laryngeal Papillomas
Authors: Rees Catherine J. , Postma Gregory N. , Koufman Jamie A.
Published: October 2014

Objectives:

Unsedated office-based laryngeal laser surgery (UOLS) is now an effective alternative to traditional operating room-based suspension microdirect laryngoscopy under general anesthesia. This procedure includes pulsed dye laser (PDL) treatment of recurrent respiratory papillomas, granulomas, leukoplakia, and polypoid degeneration. The objective of this study was to determine the magnitude of the cost savings derived by moving these types of procedures from the operating room to the office setting.

Methods:

Retrospective cost-identification analysis was performed by comparing the billing records of patients who underwent surgical laser treatment for recurrent respiratory papillomatosis in the operating room to the costs and charges for patients who underwent similar procedures with the in-office PDL.

Results:

In performing surgery with the PDL in the office, the average cost savings was more than $5,000 per case. Current reimbursement rates do not cover the cost of performing UOLS.

Conclusions:

The potential cost savings of UOLS are tremendous; however, at present significant financial disincentives prevent proliferation of this technology.
Strobokymographic and Videostroboscopic Analysis of Vocal Fold Motion in Unilateral Superior Laryngeal Nerve Paralysis
Authors: Mendelsohn Abie H. , Sung Myung-Whun , Berke Gerald S. , Chhetri Dinesh K.
Published: October 2014

The clinical diagnosis of superior laryngeal nerve paralysis (SLNp) is infrequently made, because of the heterogeneity of clinical presentations and laryngoscopic findings. Laryngeal electromyography (LEMG) can provide the definitive diagnosis of this abnormality. With increasing use of LEMG in clinical practice, this condition is now more frequently appreciated by otolaryngologists. A characteristic, but infrequently reported, videostroboscopic vocal fold motion termed Gegenschlagen (“dashing-against-each-other”) has previously been described to occur in unilateral SLNp. We encountered such motion in a clinical case, which we subsequently verified as unilateral SLNp by means of LEMG. This characteristic glottic motion was then verified in an in vivo canine model of phonation after unilateral SLNp. Videostrobokymography was performed to generate kymograms that illustrated this vocal fold motion clearly. Kymograms of both human and canine subjects with SLNp demonstrated an undulating motion of the horizontally shifting glottic space as the medial edges of the vocal folds chased each other 90° out of phase. As one vocal fold mucosal edge was opening, the other was closing, and this repeated motion appeared as vocal folds chasing or dashing against each other. Although not uniformly seen in all cases, this vocal fold motion appears to be unique to SLNp.
Treatment of Squamous Cell Carcinoma of the Tongue Base: Irradiation, Surgery, or Palliation?
Authors: Jones Andrew S. , Rafferty Mark , Fenton John E. , Jones Terence M. , Husband David J.
Published: October 2014

Objectives:

Squamous cell carcinoma of the tongue base has a poor prognosis, and treatment is accompanied by a number of major problems. In view of this, it is important to recognize which patients will benefit from treatment with curative intent and which treatment method to use.

Methods:

One hundred sixty-five patients with squamous cell carcinoma of the tongue base were identified on our database. Eighty-two patients were treated by radical irradiation, and 41 by surgery. A further 42 patients were considered unsuitable for curative treatment.

Results:

The 5-year cause-specific survival rate was 41% for those treated by irradiation, 58% for those treated by surgery, and 9% for untreated patients. There was no difference in the efficacy of treatment methods (p = .5362), but a highly significant difference was seen in survival rate between treated and untreated patients (p = .0028). The decision regarding administration of curative treatment was based on the extent of locoregional involvement at the primary site (p = .0139; odds ratio, 0.43) and in the neck (p = .0078; odds ratio, 0.23). No factors affected the decision to treat by irradiation or surgery. When the observed survival rate was calculated, there was no significant difference in 5-year survival rate between treated and untreated patients (p = .2762). Those with early (T1-2) disease at the primary site had an improved survival rate from 0.5 to 4 years compared with those who were untreated (T3-4; p = .0081; odds ratio, 2.2). In addition, those with early (T1-2) disease had a better survival rate than those with advanced cancers (p = .0139; odds ratio, 2.09). There was, however, no difference in survival rate at 5 years. Those with early disease compared with those with advanced disease were twice as likely to be alive at 2 years; however, all survival advantages had disappeared by 5 years.

Conclusions:

In terms of observed survival, treating tongue base squamous cell carcinoma that is locally advanced (T3-4) at presentation offers no survival advantage over palliation alone. Treating early disease (T1-2) doubles the survival rate for up to 4 years, but by 5 years this survival advantage is lost. The present study finds radiotherapy and surgery to be equivalent at controlling this disease.
Features of Muscle Tension Dysphonia before and after Correction of Unilateral Vocal Cord Paralysis
Authors: Su Wan-Fu , Hsiao Yu-Che , Hung Chung-Ching
Published: October 2014

Objectives:

We performed a retrospective, longitudinal study to compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP).

Methods:

Eighty-six patients with UVCP who had a successful surgical correction were enrolled. Preoperative and postoperative videolaryngostroboscopy images were analyzed, and the muscle tension patterns (MTPs) were rated according to the Morrison-Rammage classification. A 4-item glottal closure index was used for each patient on study entry and for 40 normal subjects as the control group.

Results:

There was no significant difference in MTP prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals.

Conclusions:

Persistence of MTPs after correction of UVCP may be due to intractable vocal habits or psychogenic factors.
Artificial Voice Modulation in Dogs by Recurrent Laryngeal Nerve Stimulation: Electrophysiological Confirmation of Anatomic Data
Authors: Broniatowski Michael , Grundfest-Broniatowski Sharon , Tucker Harvey M. , Tyler Dustin J.
Published: October 2014

Objectives:

We hypothesized that voice may be artificially manipulated to ameliorate dystonias considered to be a failure in dynamic integration between competing neuromuscular systems.

Methods:

Orderly intrinsic laryngeal muscle recruitment by anodal block via the recurrent laryngeal and vagus nerves has allowed us to define specific values based on differential excitabilities, but has precluded voice fluency because of focused breaks during stimulation and the need to treat several neural conduits. Such problems may be obviated by a circuit capable of stimulating some axons while simultaneously blocking others in the recurrent laryngeal nerve, which carries innervation to all intrinsic laryngeal muscles, including the arguably intrinsic cricothyroideus. In 5 dogs, both recurrent laryngeal nerves received 40-Hz quasi-trapezoidal pulses (0 to 2,000 μA, 0 to 2,000 μs, 0 to 500 μs decay) via tripolar electrodes. Electromyograms were matched with audio intensities and fundamental frequencies recorded under a constant flow of humidified air. Data were digitized and evaluated for potential correlations.

Results:

Orderly recruitment of the thyroarytenoideus, posterior cricoarytenoideus, and cricothyroideus was correlated with stimulating intensities (p < .001), and posterior cricoarytenoideus opposition to the thyroarytenoideus and cricothyroideus was instrumental in manipulating audio intensities and fundamental frequencies.

Conclusions:

Manipulation of canine voice parameters appears feasible via the sole recurrent laryngeal nerve within appropriate stimulation envelopes, and offers promise in human laryngeal dystonias.
Adductor Spasmodic Dysphonia versus Muscle Tension Dysphonia: Examining the Diagnostic Value of Recurrent Laryngeal Nerve Lidocaine Block
Authors: Roy Nelson , Smith Marshall E. , Allen Brynn , Merrill Ray M.
Published: October 2014

Objectives:

Differentiating adductor spasmodic dysphonia (ADSD) from muscle tension dysphonia (MTD) can be difficult. This investigation examined the precision of response to unilateral lidocaine block of the recurrent laryngeal nerve (RLN block) as a potential diagnostic test to discriminate ADSD from MTD.

Methods:

Patients with ADSD (n = 23) and MTD (n = 20) were audio-recorded before and during RLN block. The patients completed self-ratings of dysphonia severity, vocal effort, and laryngeal tightness, and blinded listeners completed auditory-perceptual ratings of overall severity, breathiness, and strain of voice samples before and during the block.

Results:

Repeated-measures analysis of variance, with “group” (ADSD/MTD) as the between-subjects variable and “time” (before block/during block) as the within-subjects variable, confirmed significant “time” effects, but no significant “group-by-time” interaction effects, indicating that both disorder groups responded favorably to RLN block, according to patient- and listener-based ratings. Furthermore, low estimates of sensitivity and specificity and weak receiver operating characteristic curves confirmed that a positive response to the RLN block test did not distinguish ADSD from MTD.

Conclusions:

We conclude that RLN block offers little discriminatory value in the differential diagnosis of ADSD versus MTD, and a positive response to RLN block should not be considered confirmatory of ADSD.
Risk Factors for Adult Laryngotracheal Stenosis: A Review of 74 Cases
Authors: Koshkareva Yekaterina , Gaughan John P. , Soliman Ahmed M. S.
Published: October 2014

Objectives:

We sought to identify risk factors for and review our experience in the management of adult acquired laryngotracheal stenosis (LTS) at an academic urban medical center.

Methods:

A retrospective review of all patients given a diagnosis of acquired LTS between 1997 and 2005 was performed. Seventy-four patients with LTS were identified. Demographic information, medical and surgical history, surgical procedures performed, and outcomes were collected. A control group of 106 patients admitted over the same time period with respiratory distress but without LTS was identified. The data collected for both groups were analyzed by Fisher's exact test and logistic regression analysis.

Results:

Demographically, the control group was not significantly different from the LTS group. Patients who had a previous tracheostomy were 10.99 times more likely to develop LTS than control patients (95% confidence interval [CI], 4.68 to 25.80). Patients irradiated for carcinomas of the oropharynx and larynx were 5.95 times more likely to develop LTS than control patients (95% CI, 1.87 to 18.91). Those previously intubated for more than 48 hours were 3.91 times more likely to develop LTS than control patients (95% CI, 1.91 to 8.02). Finally, patients who were intubated for any non-airway surgery were found to be 2.07 times more likely to develop LTS (95% CI, 1.09 to 3.93).

Conclusions:

Prolonged intubation, tracheostomy, previous non-airway surgery, and irradiation for oropharyngeal and laryngeal tumors are risk factors for LTS. Multiple surgical procedures are often required for treatment. Mitomycin C did not significantly improve decannulation rates.
Endoscopic Lysis of Anterior Glottic Webs and Silicone Keel Placement
Authors: Edwards John , Tanna Neil , Bielamowicz Steven A.
Published: October 2014

Objectives:

Acquired anterior glottic webs occur most commonly after endoscopic resection of laryngeal papilloma involving the anterior vocal folds. Treatment of anterior glottic webs has included a tracheotomy with laryngofissure and placement of a laryngeal stent or keel. We have used an endoscopic technique of web lysis and placement of a laryngeal keel without tracheotomy over the past 7 years.

Methods:

A retrospective chart review was conducted of all cases of endoscopic web lysis and keel placement performed by the senior author (S.A.B.).

Results:

Over the past 7 years, 10 patients underwent the procedure, with a mean follow-up of 18 months. The length of the anterior web was up to two thirds of the membranous vocal fold. Outcomes analysis revealed a recurrence in 1 patient and 2 minor complications necessitating treatment.

Conclusions:

Endoscopic web lysis and keel placement offers superior results with less morbidity compared to open techniques.
H-Type Congenital Tracheoesophageal Fistula: University of Iowa Experience 1985 to 2005
Authors: Brookes James T. , Smith Mark C. , Smith Richard J. H. , Bauman Nancy M. , Manaligod Jose M. , Sandler Anthony D.
Published: October 2014

Objectives:

We review the diagnostic workup, associated disorders, surgical technique, and postoperative course of patients who underwent repair of H-type tracheoesophageal fistulas.

Methods:

We performed a retrospective chart review of patients who received a diagnosis of tracheoesophageal fistula at the University of Iowa.

Results:

Seven patients with an H-type tracheoesophageal fistula and a single patient with a missed proximal fistula associated with esophageal atresia were identified. Their symptoms included coughing with feeding, recurrent pneumonia, and episodic cyanosis. A delay in diagnosis was seen in 4 patients and ranged from 2.5 months to 5.9 years. In all patients, the diagnosis was made with an esophagogram. The level of the fistulas was between C5 and T3, and all were successfully repaired via a right cervical approach.

Conclusions:

A high index of suspicion for an H-type tracheoesophageal fistula should be maintained in the presence of neonatal respiratory symptoms, as the condition can be associated with a delay in diagnosis. Repeat esophagograms and bronchoscopy may be required for diagnosis. In the postoperative period, airway obstruction is a potential risk; however, long-term difficulty with swallowing, respiration, and phonation was not observed.
Eye Movements in Response to Electric Stimulation of the Human Posterior Ampullary Nerve
Authors: Wall Conrad , Kos Maria Izabel , Guyot Jean-Philippe
Published: October 2014

Objectives:

The concept of a vestibular implant to restore balance, similar to that of a cochlear implant to restore hearing in deaf patients, has been investigated in animal models. It remains to be shown, however, that electric stimulation of the human end organ or its vestibular nerve branches is capable of eliciting a nystagmic eye movement response.

Methods:

Three subjects were given electric stimulation of their posterior ampullary nerve, which was surgically exposed under local anesthesia, by a procedure developed by Gacek. The stimulus was a multiphasic, charge-balanced train of electric pulses.

Results:

In all subjects, a pulse repetition rate of 200 pulses per second produced a robust vertical nystagmus without any apparent change in the slow component velocity of the preexisting horizontal nystagmus.

Conclusions:

We have been able to replicate in humans a finding somewhat similar to that of Suzuki and Cohen in monkeys for electric stimulation of the posterior semicircular canal. The similarity is an eye movement with a large, predominant vertical component. The difference is that we saw no horizontal response component, and were not able to measure a torsional response, because we used 2-dimensional video methods. In addition, we found a robust nystagmus with slow component velocities that are large enough to compensate for vertical head movements. This is an essential step in demonstrating the feasibility of a vestibular prosthesis using electric stimulation.
Posterior Sinus of the Middle Ear
Authors: Holt James J.
Published: October 2014

Objectives:

This study defines the anatomy of the posterior sinus of the middle ear and its relationship with the sinus tympani.

Methods:

Fifty-one temporal bone plugs harvested from human cadavers were studied. The depth and width of the posterior sinus, its relationship to surrounding structures, and the structure that separates it from the sinus tympani were studied.

Results:

The posterior sinus, positioned just posterior to the oval window, was 1 mm or less in depth, and the width of the opening 1.5 mm or less. A ridge of bone from the floor of the middle ear separated the posterior sinus from the sinus tympani in 82% of specimens. In 10% a sheet of bone separated the two sinuses, and in 8% the sinus tympani and posterior sinus formed one confluent recess.

Conclusions:

This is the first study that describes the anatomy of the posterior sinus of the middle ear. This sinus is separated from the more inferiorly located sinus tympani by a ridge of bone, not by the ponticulus as was previously thought, and it is no larger than 1 mm in depth and 1.5 mm in width. The results from this study give the otologic surgeon knowledge of middle ear anatomy that he or she can use when removing cholesteatoma, granulation tissue, or retracted epithelium from the posterior tympanum.
Clinical Investigation and Mechanism of Air-Bone Gaps in Large Vestibular Aqueduct Syndrome
Authors: Merchant Saumil N. , Nakajima Hideko H. , Halpin Christopher , Nadol Joseph B. , Lee Daniel J. , Innis William P. , Curtin Hugh , Rosowski John J.
Published: October 2014

Objectives:

Patients with large vestibular aqueduct syndrome (LVAS) often demonstrate an air-bone gap at the low frequencies on audiometric testing. The mechanism causing such a gap has not been well elucidated. We investigated middle ear sound transmission in patients with LVAS, and present a hypothesis to explain the air-bone gap.

Methods:

Observations were made on 8 ears from 5 individuals with LVAS. The diagnosis of LVAS was made by computed tomography in all cases. Investigations included standard audiometry and measurements of umbo velocity by laser Doppler vibrometry (LDV) in all cases, as well as tympanometry, acoustic reflex testing, vestibular evoked myogenic potential (VEMP) testing, distortion product otoacoustic emission (DPOAE) testing, and middle ear exploration in some ears.

Results:

One ear with LVAS had anacusis. The other 7 ears demonstrated air-bone gaps at the low frequencies, with mean gaps of 51 dB at 250 Hz, 31 dB at 500 Hz, and 12 dB at 1,000 Hz. In these 7 ears with air-bone gaps, LDV showed the umbo velocity to be normal or high normal in all 7; tympanometry was normal in all 6 ears tested; acoustic reflexes were present in 3 of the 4 ears tested; VEMP responses were present in all 3 ears tested; DPOAEs were present in 1 of the 2 ears tested, and exploratory tympanotomy in 1 case showed a normal middle ear. The above data suggest that an air-bone gap in LVAS is not due to disease in the middle ear. The data are consistent with the hypothesis that a large vestibular aqueduct introduces a third mobile window into the inner ear, which can produce an air-bone gap by 1) shunting air-conducted sound away from the cochlea, thus elevating air conduction thresholds, and 2) increasing the difference in impedance between the scala vestibuli side and the scala tympani side of the cochlear partition during bone conduction testing, thus improving thresholds for bone-conducted sound.

Conclusions:

We conclude that LVAS can present with an air-bone gap that can mimic middle ear disease. Diagnostic testing using acoustic reflexes, VEMPs, DPOAEs, and LDV can help to identify a non?middle ear source for such a gap, thereby avoiding negative middle ear exploration. A large vestibular aqueduct may act as a third mobile window in the inner ear, resulting in an air-bone gap at low frequencies.
Successful Treatment of Autophonia with Botulinum Toxin: Case Report
Authors: Olthoff Arno , Laskawi Rainer , Kruse Eberhard
Published: October 2014

Objectives:

We sought to treat autophonia due to a patulous eustachian tube using botulinum toxin.

Methods:

Because we assumed that the patulous eustachian tube was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscles and salpingopharyngeus muscle), paralysis was performed via injection of botulinum toxin type A in a 45-year-old female professional musician who had had chronic unilateral autophonia for 20 years. In addition to a patient interview, an endoscopic examination of the nasopharynx (posterior rhinoscopy), ear microscopy, and impedance audiometry were performed to verify the diagnosis and the outcome after treatment.

Results:

The autophonia disappeared 1 week after treatment. Normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months.

Conclusions:

The administration of botulinum toxin type A provides a new option in the treatment of patulous eustachian tube. The reliability of this method and the effect of repeated injections remains to be proved in future studies.
Paranasal Sinus Osteomas and Gardner's Syndrome
Authors: Alexander Alan A. Z. , Patel Alpen A. , Odland Rick
Published: October 2014

Objectives:

Osteomas are common benign tumors of the paranasal sinuses. The origin of these lesions is uncertain. Although most are asymptomatic, symptoms can include headaches, facial pain, rhinorrhea, and sinusitis. Osteomas are also seen as part of Gardner's syndrome, an autosomal dominant disease characterized by intestinal polyposis, osteomas, and cutaneous and soft tissue tumors. In affected individuals, the risk of developing colon cancer approaches 100%. On average, osteomas are detected 17 years before colon polyps appear.

Methods:

Three patients with maxillary or ethmoid osteomas and chronic sinusitis are presented.

Results:

One of the patients had evidence of Gardner's syndrome, based on the presence of gastrointestinal symptoms and a positive family history of polyposis.

Conclusions:

Otolaryngologists should be aware of the possibility of Gardner's syndrome in patients with paranasal sinus osteomas. Suspected patients should have a complete workup for Gardner's syndrome, including lower gastrointestinal tract endoscopy, barium enema imaging, and DNA testing.
Cognitive Behavioral Therapy for Functional Dysphonia: A Pilot Study
Authors: Daniilidou Paressa , Carding Paul , Wilson Janet , Drinnan Michael , Deary Vincent
Published: October 2014

Objectives:

We sought to investigate whether a brief period of training in cognitive behavioral therapy (CBT) can improve the treatment of functional dysphonia by a speech and language therapist and ameliorate the psychological distress associated with this condition.

Methods:

In a consecutive cohort design, a speech and language therapist treated a small cohort (n = 15) of dysphonic patients with voice therapy alone. After a brief period of CBT training, she treated the next cohort of dysphonic patients (n = 13) with CBT-enhanced voice therapy. Pretreatment and posttreatment measures were taken of voice quality and voice-related quality of life. The General Health Questionnaire 28 and the Hospital Anxiety and Depression Scale were used to assess psychological distress and general well-being.

Results:

All voice measures improved significantly in both cohorts. Both groups improved significantly on the General Health Questionnaire 28, with the CBT group improving significantly more than the control group. Only the CBT group improved significantly on the Hospital Anxiety and Depression Scale (depression subscale).

Conclusions:

Despite limitations of size, design, and between-group baseline differences, the results support the hypothesis that the addition of CBT skills to existing voice therapy is both feasible and clinically effective in the treatment of functional dysphonia.
Analysis of Intracochlear New Bone and Fibrous Tissue Formation in Human Subjects with Cochlear Implants
Authors: Li Peter M. M. C. , Somdas Mehmet A. , Eddington Donald K. , Nadol Joseph B.
Published: October 2014

Objectives:

In this study we aimed to evaluate new bone and new fibrous tissue formation in the inner ear following cochlear implantation.

Methods:

Twelve temporal bones from patients who underwent cochlear implantation during life were prepared for histologic study. The specimens were reconstructed by both 2-dimensional and 3-dimensional methods. These reconstructions were used to calculate the total volume and distribution of new bone and new fibrous tissue in the cochlea, the number of spiral ganglion cells, and other histopathologic parameters. Clinical data, including the last-recorded word recognition scores, were obtained from the patients' medical records.

Results:

New bone and new fibrous tissue were found in all 12 specimens, particularly at the site of cochleostomy. There was a significant correlation between overall damage to the lateral cochlear wall and the total volume of intracochlear new tissue (Spearman rho = .853; p = .0004). The total volume of new tissue did not correlate with word recognition scores or spiral ganglion cell counts.

Conclusions:

These preliminary results suggest that the degree of damage to the lateral cochlear wall may play an important role in influencing the amount of new tissue formation following cochlear implantation. Intracochlear new tissue does not appear to be an important determinant of performance as measured by word recognition scores or the total number of remaining spiral ganglion cells.
Objective Assessment of Temporal Bone Drilling Skills
Authors: Zirkle Molly , Taplin Michael A. , Anthony Richard , Dubrowski Adam
Published: October 2014

Objectives:

There is great interest in training surgeons in the technical aspects of their craft through simulation and laboratory-based exercises. However, there are as yet only a few objective tools to assess technical performance in a laboratory setting. This study assesses three potential objective assessment tools for a traditional otolaryngology laboratory exercise, temporal bone drilling.

Methods:

We performed a validation study in an academic training program. Nineteen otolaryngology residents performed a cortical mastoidectomy on a cadaveric temporal bone. The participants were divided into two groups, experienced and novice, based on previous temporal bone drilling experience. Performance was rated by two independent, blinded experts using four different assessments, the Global Rating Scale (GRS), the Task-Based Checklist (TBC), the final product analysis (FPA), and expert opinion (EO).

Results:

The interrater reliability for all four assessments was good. Two potential objective assessments, the GRS and the TBC, and the traditional assessment tool of EO, correlated with trainee experience. The FPA, however, did not correlate with trainee experience. A logistic regression analysis of all assessments showed that the TBC correlates with EO.

Conclusions:

This study validates EO, the GRS, and the TBC as measures of temporal bone drilling performance. Of these measures, the TBC correlates best with EO according to logistic regression and can be reliably used as an objective assessment of temporal bone drilling.
Ex Vivo Perfused Larynx Model of Phonation: Preliminary Study
Authors: Berke Gerald S. , Neubauer Juergen , Berry David A. , Ye Ming , Chhetri Dinesh K.
Published: October 2014

Objectives:

Although excised laryngeal models and physical models of the larynx are important in the study of laryngeal dynamics, they cannot be used to study the influence of neuromuscular contraction on vocal fold vibration, especially with regard to the thyroarytenoid muscle. Our aim was to develop an ex vivo larynx model of phonation, and combine the benefits of the in vivo and excised laryngeal models to the ex vivo situation.

Methods:

Three canine larynges were surgically removed and perfused ex vivo with modified Krebs-Henseleit reperfusion solution. The laryngeal nerves were stimulated, and an assessment of neuromuscular viability, phonation, and vocal fold vibration was made.

Results:

Neuromuscular stimulation, phonation, and experimental manipulation were possible for several hours after the onset of ex vivo perfusion. Repeatable periodic phonation in short bursts was achieved. Perfusion appears critical to maintain ex vivo viability, as adductory force was almost immediately lost upon cessation of ex vivo perfusion.

Conclusions:

The ex vivo larynx model has the potential to facilitate the measurement of glottal variables in a neuromuscularly correct model. We propose that the further development of this laryngeal model may be useful in the study of laryngeal dynamics, particularly when invasive measurements, such as that of glottal exit flow, are required.
Efficacy of Additional Injection Laryngoplasty after Framework Surgery
Authors: Umeno Hirohito , Chitose Shun-Ichi , Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

The purpose of this study was to clarify the efficacy of additional injection laryngoplasty (AIL) after framework surgery (FS), while also trying to identify which patients or procedures were more likely to require AIL to obtain optimal results and to clarify why.

Methods:

Fifty-two patients with unilateral vocal fold paralysis underwent FS (thyroplasty [TP], 23; arytenoid adduction [AA], 18; and AA with TP, 11). The numbers of patients who required AIL were calculated for each type of FS. The voice function after AIL was investigated. Thereafter, the width and the bowing ratios on phonation were measured in patients who underwent AA.

Results:

The patients who underwent AA required AIL more frequently than did patients who underwent TP. Use of AIL provided better voice function for all patients. The width ratio after AA decreased in all cases, but the bowing ratio increased after AA in 44% of cases.

Conclusions:

These results indicate that AIL is an effective treatment for patients who still have a glottal gap after undergoing FS. In particular, patients who had AA frequently required AIL, in comparison to patients who had TP, because of the high frequency of an increased bowing ratio after AA.
Vestibular Evoked Myogenic and Periocular Potentials after Vestibular Schwannoma Surgery
Authors: Magliulo Giuseppe , Parrotto Donato , Gagliardi Mario
Published: October 2014

Objectives:

We analyzed the behavior of preoperative and postoperative vestibular evoked myogenic potentials (VEMPs) and vestibular evoked periocular potentials (VEPPs) in 3 patients who had vestibular schwannoma and underwent modified translabyrinthine surgery.

Methods:

We compared VEMPs and VEPPs, measured with both air-conducted (AC) and bone-conducted (BC) stimulations. Vestibular evoked potentials were measured both in the immediate postoperative period and some months later.

Results:

At the immediate postoperative examination, VEPPs were preserved in all 3 patients with both AC and BC stimulations. The VEMPs showed stable or improved parameters in 2 of our patients and were absent in the third patient. At the follow-up examination, VEMPs did not show any significant change with respect to the previous evaluation. In contrast, VEPPs were absent in 2 of our patients with AC stimulation and in 1 patient with BC stimulation.

Conclusions:

Our results seem to indicate a greater stability and reproducibility of VEMPs compared with VEPPs. In 1 patient, who had a schwannoma of the inferior vestibular nerve, the preservation of VEPPs and the absence of VEMPs in the immediate postoperative period confirm that the saccule represents the origin of VEMPs. Furthermore, these results suggest that not only the saccule, but also the utriculus, could be implicated in the origin of VEPPs.
Large Concha Bullosa Mucopyocele Replacing the Anterior Ethmoid Sinuses and Contiguous with the Frontal Sinus
Authors: Cohen Samuel D. , Matthews Brian L.
Published: October 2014

Concha bullosa, a pneumatized middle turbinate, is a common anatomic variant found in the paranasal sinuses. When a concha bullosa becomes obstructed, it can form a mucocele and, eventually, a mucopyocele if it becomes secondarily infected. This is a rare phenomenon; only 9 concha bullosa mucopyoceles have been previously reported in the English-language literature. We present the case of a large concha bullosa mucopyocele in a pediatric patient in which the concha bullosa replaced the anterior ethmoid sinuses and was contiguous with the frontal sinus.
Do Anxiety and Depression Confound Symptom Reporting and Diagnostic Accuracy in Chronic Rhinosinusitis?
Authors: Bhattacharyya Neil , Wasan Ajay
Published: October 2014

Objectives:

We sought to determine the impact of psychiatric comorbidity on symptom reporting and diagnostic accuracy in chronic rhinosinusitis (CRS).

Methods:

A prospective cohort of patients presenting for evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed with respect to paranasal sinus computed tomography (CT) Lund score. The degree of correlation between sinonasal symptoms and CT scan stage adjusting for anxiety and depression was determined. The relationships between symptoms, psychiatric comorbidity, and the presence of radiographic CRS were determined with multivariate logistic regression.

Results:

There were 230 patients (mean age, 43.4 years) enrolled. High levels of anxiety and depression were noted in 23.5% and 13.0%, respectively. According to CT criteria, 61.3% to 71.3% of patients had true CRS. Even adjusting for anxiety and depression, only the nasal symptom domain severity had a statistically significant correlation with Lund score (r = 0.240; p = .001); facial, oropharyngeal, systemic, and total symptoms did not correlate with CT score. Similarly, multivariate analysis revealed that even with adjustment for anxiety and depression, sinus symptom domains failed to predict radiographic positivity. Individually, only dysosmia, dental pain, and fatigue were predictive for CRS (odds ratios, 1.29 [p = .032], 1.69 [p = .001], and 0.70 [p = .023], respectively).

Conclusions:

Although anxiety and depression are prevalent in patients with CRS, they do not influence the correlation between nasal symptoms and CT findings. Markers of psychiatric comorbidity do not correlate with CRS symptoms. The presence of anxiety or depression does not cloud symptom reporting in CRS and should not bias clinical decision-making.