bluuebunny/crossref_metadata_2025 huggingface dataset:
Reversible Lateralization of the Paralyzed Vocal Cord without Tracheostomy
Authors: Lichtenberger György
Published: October 2014

The initial management of bilateral abductor vocal cord paralysis is usually tracheostomy. It is proposed that a reversible endoscopic vocal cord lateral fixation would avoid this morbid procedure. The operation is performed by laryngoscopy utilizing the endo-extralaryngeal suture technique of Lichtenberger. Two polypropylene sutures are looped over one of the paralyzed vocal cords and brought out through the neck skin. A small incision is made, and the sutures are secured in the sternohyoid muscle. If movement of one or both vocal cords returns, the sutures are removed. Sixty-one of 63 cases were successful. In 53 cases, the airway became stable, without return of function. In 8 cases, one or both of the vocal cords became mobile 3 to 4 months after the operation. The reversible endo-extralaryngeal lateralization of the vocal cord using the above suture technique ensures a stable airway immediately. This technique avoids the need for tracheostomy in cases of bilateral abductor vocal cord paralysis.
Expression of Glucocorticoid Receptors and Cyclooxygenase-2 in Nasal Polyps from Nonallergic Patients
Authors: Yun Chang-Bae , Lee Byung-Heon , Jang Tae-Jung
Published: October 2014

Glucocorticoid treatment has been widely used to suppress inflammatory and immune responses. However, from a clinical point of view, its efficacy in the treatment of nasal polyposis seems to vary individually from patient to patient. In the present study, we examined the presence of glucocorticoid receptors (GRs) and cyclooxygenase-2 (COX-2) in the nasal polyps of nonallergic patients as compared with normal controls. Reverse transcription-polymerase chain reaction analyses revealed the presence of both GR messenger RNA and COX-2 messenger RNA expression in nasal polyps from nonallergic patients, as well as in normal nasal mucosa from controls. Consistent with this finding, immunohistochemical analysis demonstrated that GRs and COX-2 were labeled in both tissues. In nasal polyps, GR labeling was associated with the cytoplasm and nucleus of surface mucosa, submucosal glands, endothelial cells, and inflammatory cells. Importantly, COX-2 labeling was seen in the cytoplasm of surface mucosa, submucosal glands, and the vascular wall in nasal polyps. In contrast, in normal nasal tissues, COX-2 labeling was only found in the vascular wall, and the expression was weaker — a finding demonstrating that COX-2 is upregulated in nasal polyps. Therefore, 1) the presence of GRs and COX-2 in nasal polyps from nonallergic patients, as well as upregulation of COX-2 expression, suggests that inflammation may play an important role in the pathophysiology of nasal polyps; and 2) glucocorticoid could be a potential treatment method for suppressing inflammatory processes.
Audiological Assessment in Ramsay Hunt Syndrome
Authors: Kaberos Antonis , Balatsouras Dimitrios G. , Kandiloros Dimitrios , Korres Stavros G. , Economou Constantinos
Published: October 2014

Ramsay Hunt syndrome is known to cause symptoms and signs of vestibulocochlear dysfunction, including sensorineural hearing loss. The present study investigates the audiological features of a group of 15 patients with this syndrome. A complete otolaryngological, neurologic, and audiological workup was performed in every patient, including auditory brain stem response measurements and recording of transiently evoked otoacoustic emissions. In most patients, some degree of hearing loss was evident, and abnormal latencies and interpeak latencies of the auditory brain stem response, or even absence of the waves, were observed. Transiently evoked otoacoustic emissions were present in only 6 cases, and caloric tests showed unilateral weakness in the majority of the patients. In all of the performed tests, abnormalities were present only on the affected side. The audiological data suggested cochlear or retrocochlear involvement or involvement at more than one site along the auditory pathway.
The Three Faces of Vestibular Ganglionitis
Authors: Gacek Richard R. , Gacek Mark R.
Published: October 2014

We present temporal bone and clinical evidence that common syndromes of recurrent vertigo are caused by a viral infection of the vestibular ganglion. In the present series, histopathologic and radiologic changes in the vestibular ganglion and meatal ganglion were consistent with a viral inflammation of ganglion cells in cases of Meniere's disease, benign paroxysmal positional vertigo, and vestibular neuronitis. Clinical observations of multiple neuropathies involving cranial nerves V, VII, and VIII on the same side in patients with recurrent vertigo are best explained by a cranial polyganglionitis caused by a neurotrophic virus, which is reactivated by a stressful event later in life. The reactivation of the latent virus may manifest as one of the above vertigo syndromes, depending on the part of the vestibular ganglion that is inflamed, the type and strain of the virus, and host resistance.
Antimicrobial Defensin Peptides of the Human Nasal Mucosa
Authors: Lee Sang Hag , Kim Jung Eun , Lee Heung Man , Lim Hyun Ho , Choi Jong Ouck
Published: October 2014

Defensins, a prominent group of antimicrobial peptides, are an important component of the innate immune response, particularly at mucosal surfaces that are vulnerable to colonization by potential pathogens. The present study was undertaken to investigate the expression of defensins in inferior turbinate mucosa of normal subjects and inferior turbinate mucosa and nasal polyps of patients with chronic sinusitis. Expression of β-defensin 1 and 2 and α-defensin 5 and 6 messenger RNAs (mRNAs) was investigated by reverse transcriptase–polymerase chain reaction, and their expression level was semiquantitatively evaluated by dot blot hybridization. Immunohistochemical analysis was used for detection of α-defensins 1, 2, and 3 in tissue sections. β-Defensin 1 mRNA was expressed in all tissue samples, at levels that did not differ significantly. β-Defensin 2 mRNA was detected in the turbinate mucosa and nasal polyps of patients with chronic sinusitis, but not in normal mucosa. Its expression level was significantly higher in nasal polyps than in turbinate mucosa. α-Defensin 5 and 6 mRNAs were not expressed in any tissues, but α-defensins 1, 2, and 3 were detected in all tissue samples obtained from patients with chronic sinusitis. These results suggest that β-defensin 1 may play a constitutive role in nasal defenses, whereas α-defensins 1, 2, and 3 and β-defensin 2 may be induced in response to local infection or inflammation.
Acute Tonsillitis as the First Manifestation of Post-Transplant Lymphoproliferative Disorder
Authors: Nouwen Johan , Smets Françoise , Hamoir Marc , Rombaux Philippe , Sokal Etienne Marc
Published: October 2014

Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication that may follow orthotopic liver transplantation (OUT) in children. The first symptoms are often in the ear, nose, or throat (ENT) area. This abnormal proliferation of lymphoid cells is related to Epstein-Barr virus (EBV) infection in immunocompromised children. The incidence of PTLD, EBV status before OLT and at the diagnosis of PTLD, delay between OLT and PTLD, localization, pathological investigations, and the treatment and evolution of PTLD were prospectively evaluated in 77 pediatric liver transplant recipients. Eight patients (10%) developed PTLD, all with an ENT presentation. Seven had acute nonbacterial tonsillitis (with a negative throat swab), and 1 had a pharyngolaryngeal localization at the time of the diagnosis. Four patients had associated involvement outside the ENT area. All patients were EBV-seronegative at the time of OLT; 6 underwent seroconversion at the time of diagnosis, and 2 within 9 and 20 months of diagnosis. All patients presented with low-grade PTLD. All patients with acute tonsillitis associated with EBV seroconversion underwent immediate tonsillectomy, and immunosuppression was decreased as much as tolerated. This therapeutic protocol led to complete recovery in all patients. After OLT in children, nonbacterial tonsillar inflammation or hypertrophy associated with an EBV infection is often the first manifestation of PTLD. Tonsillectomy combined with tapering of immunosuppression offers the best chance for a complete recovery.
Functional Neck Dissection for the Clinically Negative Neck: Effectiveness and Controversies
Authors: Lassaletta Luis , García-Pallarés Marta , Morera Eduardo , Salinas Silvia , Bernáldez Ricardo , Patrón Mercedes , Gavilán Javier
Published: October 2014

This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cNO) neck, focusing on recurrences in the pathologically negative (pNO) neck and the role of extracapsular spread in the cNO neck. A series of 172 patients (253 dissected fields) treated for cNO laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pNO necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cNO neck. The accurate prognostic significance of extracapsular spread in cNO necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pNO necks.
Complications of Intranasal Prescription Narcotic Abuse
Authors: yewell Jason , Archer Sanford , Haydon Richard , Manaligod Jose M.
Published: October 2014

The abuse of drugs via an intranasal route is an increasingly prevalent pattern of behavior. In the past year, a number of patients received care at our institution for complications resulting from the previously unreported phenomenon of intranasal prescription narcotic abuse. This report describes the clinical manifestations of this form of drug abuse in 5 patients. Their symptoms consisted of nasal and/or facial pain, nasal obstruction, and chronic foul-smelling drainage. Common physical findings were nasal septal perforation; erosion of the lateral nasal walls, nasopharynx, and soft palate; and mucopurulent exudate on affected nasal surfaces. In addition, 2 of the 5 patients had invasive fungal rhinosinusitis, which appears to be a complication unique to intranasal narcotic abuse.
Membranous Tracheal Rupture in Children following Minor Blunt Cervical Trauma
Authors: Corsten Gerard , Berkowitz Robert G.
Published: October 2014

Injuries to the tracheobronchial tree are well-recognized sequelae of massive blunt or penetrating injuries of the neck or chest. They may also occur as a rare complication of endotracheal intubation. We present 2 cases of a less well-recognized clinical entity, rupture of the membranous trachea following minimal blunt trauma to the neck in children. The case histories and management of this disorder are discussed. Recognition and treatment of this problem requires a high index of suspicion for the lesion and timely investigations. Open repair of the trachea to secure a stable airway is recommended for this injury, unless the wound is small and the wound edges are well approximated.
Vascular Occlusion in the Endolymphatic Sac in Meniere's Disease
Authors: Friberg Ulla , Rask-Andersen Helge
Published: October 2014

In 2 patients with severe Meniere's disease (MD), there was histologic evidence of occlusion of the vein of the vestibular aqueduct (VVA). This finding coincided with total or partial occlusion of numerous small vessels around the endolymphatic sac (ES), flattening of epithelium, extensive perisaccular fibrosis, and signs of new bone formation. Ultrastructural analysis of the occluding material showed foci with dense connective tissue, calcification, lipid deposits, and layers of basement membrane, sometimes concentrically arranged. The exact nature of the occluding material was unknown. In another 2 MD patients, the VVA was not visualized, and the ES vessels showed no signs of occlusion. Seven controls with acoustic schwannoma or meningioma had normal vasculature. The presence of vascular impairment in the ES in MD patients indicated that altered hemodynamics may contribute to the pathogenesis of endolymphatic hydrops and MD.
Estimated Locations of the Narrowest Portion of the Eustachian Tube Lumen during Closed and Open States
Authors: Miura Makoto , sando isamu , Takasaki Kenji , Balaban Carey D. , Haginomori Shin-Ichi
Published: October 2014

To morphologically evaluate the location of the narrowest portion of the eustachian tube (ET) lumen during closed and open states, we used computer-assisted 3-dimensional reconstruction methods to investigate 13 normal human temporal bone–ET specimens obtained from 13 individuals 3 months to 81 years old. On the basis of recent endoscopic observations, we assumed that the site of minimum circumference of the ET lumen represents the site of minimum cross-sectional area during the open state. We tested the hypothesis that the location of the narrowest site of the ET lumen in the closed state is not identical to the site of minimum circumference of the ET lumen. Confirmation of this hypothesis would imply that the site of greatest constriction shifts with contraction of the tensor veli palatini muscle. In 11 of 13 cases, both the site of minimum cross-sectional area and the site of minimum circumference of the ET lumen were located in the cartilaginous portion of the ET, near the anterior margin of the junctional portion. In the 2 remaining cases, the site of minimum circumference was located in the junctional portion of the ET, whereas the site with the narrowest cross-sectional area stayed in the cartilaginous portion. The site of minimum circumference shifted significantly in the direction of the tympanic orifice of the ET, relative to the site of minimum cross-sectional area (p < .01). The average distance between these sites was 2.01 ± 1.75 mm. There was no significant difference between children (n = 6) and adults (n = 7). The so-called isthmus portion of the ET, located between the cartilaginous and bony portions, has been considered traditionally as the narrowest site through the entire ET. However, our results suggest that the narrowest portion of the ET lumen is located in the cartilaginous portion in both closed and open states.
Metallic Tracheal Stents: Complications Associated with Long-Term Use in the Upper Airway
Authors: Burningham Alan R. , Wax Mark K. , Andersen Peter E. , Everts Edwin C. , Cohen James I.
Published: October 2014

The use of metallic airway stents for the treatment of benign airway stenosis is increasingly advocated; however, the long-term safety and efficacy of these devices has not been established. Three case studies involving late but significant proximal tracheal stent complications are reported; 1 related to proximal mechanical stent failure and 2 related to obstructing granulation tissue and stenosis at the proximal stent orifice. Placement of these stents in close proximity to the cricotracheal junction is thought to be primarily responsible for these complications as a result of the excess shearing forces created at the stent-mucosal interface by the differential motion of the stent relative to the rigid subglottic airway and the more distensible trachea. Although the use of metallic stents remains appropriate in cases in which there is a defined and relatively short-term end point for treatment, caution is urged in using them in the proximal trachea for long-term management of benign airway disease.
Genotypic and Phenotypic Expression of Vocal Fold Polyps and Reinke's Edema: A Preliminary Study
Authors: Thibeault Susan L. , Ford Charles N. , Gray Steven D. , Smith Marshall E. , Li Wenhua , Davis R. Kim
Published: October 2014

Although a great deal of research exists regarding lamina propria composition, no report exists that relates gene expression in benign laryngeal lesions to phenotypic markers. In this study, messenger RNA profiles for extracellular matrix proteins — procollagen I, collagenase, elastase, fibronectin, fibromodulin, decorin, hyaluronic acid synthase 2, and hyaluronidase — were completed on 5 polyps and 4 Reinke's edema specimens. These genotypic profiles were correlated to a videostroboscopic parameter of mucosal wave stiffness, which was used as a measurement of phenotypic expression. Polyps, characterized by stiffer mucosal waves, had higher levels of gene expression, whereas stiffer mucosal wave scores for Reinke's edema were associated with lower gene activity levels. This study supports the hypothesis that there is a relationship between genotypic expression found in polyps and Reinke's edema and phenotype as defined by a loss of or a decreased mucosal wave. The study also gives clues as to the proteins responsible for the phenotype.
Does Endogenous or Exogenous Adenosine Facilitate the Functional Recovery of the Cochlea after Ischemia?
Authors: Tabuchi Keiji , Ito Zenya , Tsuji Shigeki , Hara Akira , Asaka Yasutoshi , Kusakari Jun
Published: October 2014

The present study was undertaken to determine whether adenosine attenuates cochlear dysfunction induced by transient ischemia. Adenosine or erythro-9-(2-hydroxy-3-nonyl)adenine (EHNA), an adenosine deaminase inhibitor, was administered by perilymphatic perfusion to albino guinea pigs that were subjected to cochlear ischemic episodes of 30-minute duration. The threshold shift of the compound action potential (CAP) from the preischemic value was significantly reduced in the animals perfused with EHNA 1 hour after the onset of reperfusion. However, perfusion of adenosine at concentrations of 100 μmol/L to 10 mmol/L did not reduce the postishemic CAP threshold shift by either 1 hour or 4 hours after the onset of reperfusion. These results suggest that the elevation of the adenosine concentration did not exert a protective effect on the cochlear ischemia-reperfusion injury, and that the protective action of EHNA is unrelated to elevating the adenosine concentration.
Is Hearing Preservation Useful in Vestibular Schwannoma Surgery?
Authors: Levo Hilla , Blomstedt Göran , Pyykkö Ilmari
Published: October 2014

The goal of our study was to examine the usefulness of preserved hearing after unilateral vestibular schwannoma removal. The patients were assessed by clinical evaluation, preoperative and postoperative audiometric evaluation, operative findings, and postoperative functional results. Hearing was preserved in 47 of 119 patients. The postoperative hearing was better than 30 dB in 10 patients. During the follow-up, the hearing decreased 5 dB on average, and almost all of the decrement occurred during the first 6 months. Subjectively, the preserved hearing assisted in understanding of speech in 62% of the patients. Tinnitus did not interfere with understanding of speech. The age of the patients was the most significant factor associated with preserved hearing. Sixty-six percent of the patients with hearing preservation rated their preserved hearing as valuable. Neither tinnitus nor speech distortion reduced the appreciation for hearing preservation. We conclude that efforts to preserve hearing are worthwhile.
Extraesophageal Reflux in Patients with Contact Granuloma: A Prospective Controlled Study
Authors: Ylitalo Riitta , Ramel Stig
Published: October 2014

The aim of this study was to compare the incidences of extraesophageal reflux in patients with contact granuloma and healthy controls. A 24-hour ambulatory pH monitoring technique was used to measure reflux parameters in the pharynx and distal esophagus. Pharyngeal acid reflux events occurred in 17 of 26 granuloma patients (1 to 20 episodes per patient) and 5 of 19 controls (1 to 8 episodes per subject). The reflux episodes were typically short and occurred predominantly in an upright position. A comparison between the groups showed a significant difference in the number of pharyngeal reflux episodes (p = .009) and in the total time of pH below 4 (p = .006). On the other hand, we found no significant differences in any esophageal reflux parameters, except for the percentage of distal esophageal reflux episodes that reached the pharynx (p = .006). In this study, pharyngeal acid exposure was significantly more prevalent in patients with contact granuloma than in healthy controls.
Cricothyroid Approximation to Elevate Vocal Pitch in Male-to-Female Transsexuals: Results of Surgery
Authors: Yang Caroline Y. , Palmer Andrew D. , Meltzer Toby R. , Murray Karen Drake , Cohen James I.
Published: October 2014

Functional changes in voice production, including pitch elevation, may help male-to-female transsexuals assume a new gender identity. To date, there has been a paucity of objective data on the effectiveness of pitch-raising methods. Acoustic data were gathered with regard to preoperative and postoperative changes in pitch, pitch range, and perturbation in 20 patients after cricothyroid approximation. Subjective data were gathered by means of a mailed questionnaire. The mean follow-up time was 22 months. The speaking fundamental frequency was raised by half an octave without any significant changes in perturbation. The lower and upper limits of pitch range both increased by an average of 4 semitones. There was some decline over time of the lower pitch range toward preoperative levels, but the upper pitch range remained elevated. The majority of the patients were satisfied with the results of surgery and felt their voices to be more feminine.
Videostrobolaryngoscopy of Mucus Layer during Vocal Fold Vibration in Patients with Laryngeal Tension-Fatigue Syndrome
Authors: Hsiao Tzu-Yu , Liu Chia-Ming , Lin Kai-Nan
Published: October 2014

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.
Dendritic Cell Influx Differs between the Subglottic and Glottic Mucosae during Acute Laryngotracheitis Induced by a Broad Spectrum of Stimuli
Authors: Jecker Peter , McWilliam Andrew S. , Mann Wolf J. , Holt Patrick G.
Published: October 2014

Clinically, the subglottic and glottic mucosae may react differently, eg, during acute laryngotracheitis. In healthy rats, we showed previously that the composition of the mucosal immune system of the larynx also differs between these areas. Neutrophils, lymphocytes, and dendritic cells (DCs) are part of this mucosal immune system. In particular, DCs occupy a key function. They migrate into inflamed mucosae during the early phase of the immune response, which is normally characterized by an influx of neutrophils. Thus, they help to overcome the time lag between the innate and the adaptive immune responses. In the present study, the influx of DCs, neutrophils, and T lymphocytes into the subglottic and glottic mucosae of rats was examined at different time points after challenge with a broad spectrum of stimuli such as dead Moraxella catarrhalis, viable Bordetella pertussis, viable Sendai virus, and the soluble protein ovalbumin. The number of DCs increased rapidly after the application of the antigens. This increase was as rapid as the increase in neutrophils. Depending on the kind of antigen, their number in the mucosa increased up to 1,000 cells per 0.1 mm2 (Sendai virus). The comparison of different mucosal areas shows that an overwhelming number of immunocompetent cells entered the subglottic mucosa, whereas only a few cells migrated into the adjacent glottic mucosa. In conclusion, after inhalation of different kinds of antigens, the subset of immunocompetent cells investigated in this study entered the laryngeal mucosa in high numbers. The number of DCs entering the laryngeal mucosa was higher than the numbers of the other immune cells investigated. This finding underlines their function as first-line sentinels of the mucosal immune system of the larynx. The observation that the number of cells entering the laryngeal mucosa is location-dependent indicates the ability of adjacent laryngeal regions to react differently. This is similar to the clinical observation of a selective subglottic reaction during acute laryngotracheitis.
Morphology of the Cricopharyngeal Muscle in Zenker and Control Specimens
Authors: Schulze Stacey L. , Danielson Susan K. , Rhee John S. , Toohill Robert J. , Kulpa Judith I. , Jaradeh Safwan S.
Published: October 2014

The cricopharyngeal muscle (CPM) is essential for normal deglutition. Pharyngeal dysphagia commonly results from impaired or uncoordinated CPM dilation. Dysfunction of the CPM has also been implicated in the genesis of Zenker's (pharyngoesophageal) diverticulum. Despite the CPM's significance, little is understood about its morphology. We studied CPM biopsy specimens from 20 patients with Zenker's diverticulum and from 5 fresh cadaver patients with detailed histologic techniques to include fiber size and shape and adenosine triphosphatase, reduced nicotinamide adenine dinucleotide, trichrome, succinate dehydrogenase, cytochrome C oxidase, periodic acid-Schiff reaction, oil red O, acid phosphatase, Congo red, crystal violet, and monoadenylate deaminase stains. The normal CPM has unique morphological characteristics, with some myofibers having staining properties that are a hybrid between striated muscle and muscle spindle. The variable orientation of the muscle fibers is also different from that of most other striated musculature. Of the 20 Zenker CPM specimens, 4 specimens did not reveal any significant differences from controls (2 of which had insufficient amounts of tissue for complete analysis). In the remaining 16 specimens, several abnormalities existed, including excessive size variation (16/16), grouping of atrophic fibers (9/16), target or targetoid formations (4/16), cores (2/16), and ragged red fibers (2/16). The final pathological pattern of the 16 specimens was neurogenic in 7, myopathic in 4, and mixed (with neurogenic predominance) in the remaining 5. Two specimens contained significant lymphocytic inflammatory infiltrates. We conclude that the unique neuromuscular function of the CPM in deglutition is likely due to its fiber orientation and the hybrid nature of some of the myofibers. Morphological disturbances of the CPM impair its dilation and may account for the development of Zenker's diverticulum. This disturbance is most often due to progressive denervation of the CPM.
Neuromuscular Junction Changes in Aged Rat Thyroarytenoid Muscle
Authors: Connor Nadine P. , Suzuki Tatsutoshi , Sewall Gregory K. , Lee Kyungah , Heisey Dennis M.
Published: October 2014

Dynamic remodeling of neuromuscular junction (NMJ) structure is postulated as a cause of age-related muscular atrophy. Direct study of NMJ morphology in laryngeal muscles is important to our understanding of age-related decrements in voice and swallowing. The morphology of NMJs was studied in a rat model to compare young and old specimens of thyroarytenoid muscle — a muscle critical to airway protection and phonation. Fluorescent, triple-label immunohistochemical analysis and confocal microscopic visualization were used to analyze the structure of NMJs. We found that laryngeal NMJs underwent significant changes that were similar to those observed after denervation. Specifically, the axon terminal area was significantly reduced, there were a number of postsynaptic acetylcholine receptor areas unoccupied by nerve terminals, and there was increased variability in end plate architecture in the old muscles. The results of this study increase our understanding of the age-related morphological changes in the larynx, and may serve as a baseline to test the effectiveness of future interventions.
Immunohistochemical Localization of Subtypes of Muscarinic Receptors in Human Inferior Turbinate Mucosa
Authors: Nakaya Muneo , Yuasa Takafumi , Usui Nobuo
Published: October 2014

The regulation of glandular secretions and vasomotor tone in human nasal mucosa implicates muscarinic receptors. There are 5 recognized classes (m1 through m5) of muscarinic receptor subtypes, and the aim of our study was to localize muscarinic receptor subtypes (m1 through m5) in human inferior turbinate mucosa by an immunohistochemical method. We found m1 and m2 receptors distributed on glands, arteries, veins, and epithelia; m4 receptors were found around arteries; and m5 receptors were identified on glands and arteries. We found m3 receptors to be the most extensively distributed on glands, arteries, and veins of all of the muscarinic receptor subtypes. The m3 receptor is probably important in the physiology of the human inferior turbinate. This study may help identify the best target for more selective muscarinic drugs and guide the treatment of allergic and nonallergic rhinitis.
Histopathologic Study of the Temporalc Bones and Eustachian Tubes of Children with Cholesterol Granuloma
Authors: Miura Makoto , Orita Yorihisa , Sando Isamu , Hirsch Barry E.
Published: October 2014

Six temporal bone-eustachian tube (ET) specimens with cholesterol granuloma (CG), obtained from 6 children 6 months to 15 years of age, were studied histopathologically to obtain further information about the pathogenesis of CG. We observed CG in the mastoid air cells in 5 ears, the mastoid antrum in 1 ear, the aditus ad antrum in 2 ears, and the epitympanum in 1 ear. All 6 cases exhibited a large amount of remaining mesenchyme that was in continuity with the hematopoietic bone marrow in the locations in which CG was present. All cases demonstrated otitis media with effusion and inflammation of the ET. Apparent morphological abnormalities of the ET and its associated structures, including hypoplastic ET cartilage and an abnormal tensor veli palatini muscle, were noted in 3 of the 6 cases. Furthermore, the posterior cartilaginous portion of the ET that includes its narrowest portion was completely filled with effusion in 2 of the 3 cases with the ET anomaly. The findings obtained were compared with data from age-matched control cases. Our results suggest that the source of erythrocytes in the remaining mesenchyme is the hematopoietic bone marrow. The pathogenesis of CG in children is likely promoted by ET dysfunction resulting in failure of ventilation of the middle ear.
Pathophysiology of Facial Nerve Paralysis Induced by Herpes Simplex Virus Type 1 Infection
Authors: Hato Naohito , Kisaki Hisanobu , Honda Nobumitu , Takahashi Hirotaka , Murakami Shingo , Wakisaka Hiroyuki , Gyo Kiyofumi
Published: October 2014

Herpes simplex virus type 1 (HSV-1) has been proven to be a cause of Bell's palsy; however, the underlying pathophysiology of the facial nerve paralysis is not fully understood. We established a mouse model with facial nerve paralysis induced by HSV-1 infection simulating Bell's palsy and investigated the pathophysiology of the facial nerve paralysis. The time course of the R1 latency in the blink reflex tests paralleled the recovery of the facial nerve paralysis well, whereas electroneurographic recovery tended to be delayed, compared to that of the paralysis; these responses are usually seen in Bell's palsy. On histopathologic analysis, intact, demyelinated, and degenerated nerves were intermingled in the facial nerve in the model. The similarity of the time course of facial nerve paralysis and the electrophysiological results in Bell's palsy and the model strongly suggest that the pathophysiological basis of Bell's palsy is a mixed lesion of various nerve injuries.
Hepatocyte Growth Factor and its Receptor C-Met in Rat and Rabbit Vocal Folds
Authors: Hirano Shigeru , Thibeault Susan , Ford Charles N. , Bless Diane M. , Kanemaru Shin-Ichi
Published: October 2014

Vocal fold fibrotic scar is characterized by fibrosis of the lamina propria and epithelium, and is difficult to treat. Hepatocyte growth factor (HGF) has antifibrotic activity and has received attention as a possible therapeutic alternative to treat fibrosis. In this study, in order to clarify whether HGF can be involved in vocal fold scarring, we examined the existence of HGF and its receptor, c-Met, in rat vocal folds, and then the activity of HGF in rabbit injured vocal folds, using immunohistochemistry and enzyme-linked immunosorbent assay. We found HGF and c-Met on epithelial cells and gland cells of the rat vocal folds. On the injured vocal folds of rabbits, little HGF was observed immediately after injury, but prominent activity occurred simultaneously with reepithelialization of the vocal fold mucosa on days 10 to 15. The activity of HGF was observed on fibroblasts in the lamina propria, as well as the epithelium. It is suggested that HGF in the vocal folds is produced by the fibroblasts and delivered to the epithelium. The implication of these findings is that HGF is involved in wound healing of the vocal fold, and may provide an alternative approach in preventing and treating vocal fold scarring.
Laryngeal-Respiratory Kinematics are Impaired in Aged Rats
Authors: Suzuki Tatsutoshi , Connor Nadine P. , Leverson Glen , Lee Kyungah , Ford Charles N.
Published: October 2014

Fatigue and weakness in the elderly are the functional consequences of underlying neuromuscular decline. However, little is known about the manifestations of aging in the larynx. This study evaluated the manner in which laryngeal senescence affects laryngeal-respiratory kinematics by videorecording laryngeal motion in both young and old rats. Recorded images were digitized, and glottal displacement and movement rate were measured. The results indicated that the amplitude of change in glottal angle was significantly diminished, and laryngeal movement durations were prolonged in the old animals. These findings may be due to functional constraints on the respiratory system, impaired laryngeal-respiratory interactions, or decrements in vocal fold tension with age. Because of the serious and pervasive nature of dysphagia and communicative impairments in the elderly, research that specifically examines the manifestations and causes of these impairments is of great importance.
Washout of 133-Xenon as an Objective Assessment of Paranasal Sinus Ventilation in Endoscopic Sinus Surgery
Authors: Paulsson BO , Lindberg Sven , Ohlin Per
Published: October 2014

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1–Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neo-ostia, as rapid washout may lead to no activity remaining at the time of measurement.
Clinical Note Granular Cell Tumor of the Pituitary Fossa
Authors: Rhee John S. , Wackym Phillip A. , Wolfe David , Hague Karin , King Wesley A.
Published: October 2014

Although granular cell tumors are relatively common in the head and neck, symptomatic granular cell tumors of the neurohypophysis are extremely rare. Ophthalmologic symptoms are most common, followed by endocrinologic manifestations. We report a case of a granular cell tumor of the pituitary fossa that was surgically treated. The clinical manifestations, radiographic appearance, and surgical management of granular cell tumors of the pituitary fossa are reviewed, as well as the unique histopathology and electron microscopy of this uncommon neoplasm.
Receptive and Expressive Language Skills of Children with Five Years of Experience Using a Cochlear Implant
Authors: Young Gretchen A. , Killen Deanne H.
Published: October 2014

The language of 7 children who had used a cochlear implant for 5 years was evaluated by means of the Clinical Evaluation of Language Fundamentals-3, the Peabody Picture Vocabulary Test-Revised, and the Expressive Vocabulary Subtest of the Test of Word Knowledge. All subjects demonstrated impaired skills relative to normal-hearing children on 1 or more subtests. Variability in performance occurred between subjects and within subjects across subtests. Strengths in semantic skills were evident compared to weaker syntactic and morphological abilities. The nature of the subjects' language impairments is considered with reference to language delay and specific language impairment. The findings support the need for further evaluation of the rate and course of development of language subskills. Investigation of the influences of information processing, and learning styles and strategies, on children's outcomes is also warranted. These findings have implications for implementation of optimal habilitation and education programs for children with cochlear implants.
Noncontact Three-Dimensional Laser Measuring Device for Tracheoscopy
Authors: Müller Andreas , Schubert Mario , Beleites Eggert
Published: October 2014

Luminal dimension measurements are still an unsolved problem in endoscopy. The goal of our study was to develop a 3-dimensional (3-D) measuring device for endoscopic applications. For this purpose, a fiber probe projecting a ring of laser light (laser diode, 675 nm) was integrated in a position registration system. Software was developed for image analysis, distortion correction, and export of data for 3-D display. Experimental evaluation of measuring accuracy employing plastic tubes and 15 postmortem pig trachea preparations with artificial stenosis indicated a high level of method precision (Pearson's correlation coefficients, r = 0.99 for normal tracheal lumen and r = 0.97 for high-grade stenosis; p < .0001). Our clinical experience with the technique in 10 patients with tracheal stenosis revealed no side effects and encourages us to recommend this method for other endoscopic applications. The method enhances our 3-D grasp of endoscopically examined lesions.
Meningioma Involving Meckel's Cave: Transpetrosal Surgical Anatomy and Clinical Considerations
Authors: Choo Daniel I. , Steward David L. , Pensak Myles L.
Published: October 2014

Meningiomas originating in Meckel's cave (MC) are uncommon lesions that represent 1% of all intracranial meningiomas. Innovations in skull base surgery have enabled resection of these lesions with less morbidity, but require an intimate knowledge of both lesional pathology and regional microneuroanatomy. To review the surgical and clinical considerations involved in the management of MC meningiomas, we retrospectively reviewed data from patients who underwent transpetrosal resection of primary MC meningiomas between 1984 and 1998. Of 146 patients who underwent transpetrosal removal of meningiomas, 7 were believed to have tumors originating in MC. All 7 patients presented with trigeminal dysfunction, facial pain, and/or headache. Complete tumor removal was achieved in 5 of the 7 patients. Facial hypoesthesia or anesthesia, paralysis of cranial nerve VI, and ophthalmoplegia were among the postoperative complications encountered. Meningiomas of MC represent treatable lesions whose diagnosis requires prompt imaging of patients with trigeminal dysfunction and symptoms of facial pain and headache.
Soft Tissue Response of the Rabbit Larynx to Gore-Tex Implants
Authors: Cashman Steve , Simpson C. Blake , McGuff H. Stan
Published: October 2014

The use of Gore-Tex (expanded polytetrafluoroethylene) for medialization laryngoplasty has recently been described. Clinically, this laryngeal implant has performed well, but no animal studies evaluating the use of this implant in the larynx have been published. This study examines the gross and histologic response of the rabbit larynx to the Gore-Tex implant. Five rabbits underwent bilateral medialization with the Gore Thyroplasty Device. The vocal folds were left innervated and mobile. After 6 months, the rabbits were painlessly sacrificed and the implants were evaluated by gross inspection and histologic examination. No gross changes to the glottis occurred, and the implants were easily removed with gentle traction. A modest inflammatory response with a thin fibrous capsule was present around the implant. Foreign body giant cells were observed at the interface of the implant with the tissue. No migration or extrusion of the implant was observed. These results suggest that Gore-Tex is biocompatible in the rabbit larynx.
Economic Benefit of Tonsillectomy in Adults with Chronic Tonsillitis
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: October 2014

To determine the economic impact of adult chronic tonsillitis and the economic improvement from adult tonsillectomy, we studied patients who underwent adult tonsillectomy for chronic tonsillitis with the Glasgow Benefit Inventory and a questionnaire for disease severity parameters before and after tonsillectomy. The economic impact of chronic tonsillitis and adult tonsillectomy were computed with a break-even time analysis model. Eighty-three adult patients (average age, 27.3 years) completed the study with an average duration of follow-up of 37.7 months. The patients exhibited a mean improvement in quality of life of +27.54 ± 4.63 after tonsillectomy according to the Glasgow Benefit Inventory. In the 12 months following the procedure, tonsillectomy resulted in yearly mean decreases in number of weeks on antibiotics by 5.9 weeks, number of workdays missed because of tonsillitis by 8.7 days, and physician visits for tonsillitis by 5.3 visits. In considering the medical costs of tonsillectomy only, the break-even point was found to be 12.7 years, whereas considering the overall economic impact of tonsillectomy resulted in a break-even point of 2.3 years after the procedure. We conclude that tonsillectomy results in significant improvement in quality of life, decreases health-care utilization, and diminishes the economic burden of chronic tonsillitis in the adult patient population.
Atrial Natriuretic Peptide Receptor Upregulation in the Rat Inner Ear
Authors: Dornhoffer John L. , Zhou Lin , Danner Christopher , Li Shulin
Published: October 2014

The purpose of this study was to further examine whether fluid homeostasis in the endolymphatic system could be regulated by a locally effective paracrine system involving atrial natriuretic peptides (ANPs) and their receptors. We assessed the biologic activity of the 3 ANP receptors (ANP-A, ANP-B, ANP-C) in the rat inner ear by measuring receptor upregulation after inner ear administration of ANPs. After appropriate anesthesia, female Lewis rats were injected with ANP via the round window. The animals were sacrificed 24 hours later, and RNA was isolated for reverse transcription–polymerase chain reaction (RT-PCR). Electrophoresis of RT-PCR products showed the presence of all 3 ANP receptor genes in both injected and control animals. Gene expression was significantly higher 24 hours after injection. These findings demonstrate that ANP receptors in the inner ear can be upregulated after injection of ANPs.
Functional Anatomy of the Tensor Veli Palatini Muscle and Ostmann's Fatty Tissue
Authors: Takasaki Kenji , Balaban Carey D. , Sando Isamu , Miura Makoto
Published: October 2014

This study examined morphological features of the tensor veli palatini muscle (TVPM) and Ostmann's fatty tissue that may be important for eustachian tube (ET) ventilation. Histologic sections through the midcartilaginous ET from 17 human temporal bone-ET specimens (age range, 3 months to 88 years) were used to assess 1) the presence or absence of attachment of the TVPM fibers to either the perichondrium of the ET cartilage lateral lamina (LL) or a tendinous membrane along the medial margin of the TVPM, 2) the angular relationship between the TVPM fibers and the vertical axis of the ET lumen, and 3) the location of the TVPM and Ostmann's fatty tissue. The TVPM fibers were attached to the LL perichondrium in 14 cases; an attachment was absent in 3 cases because of fatty atrophy of the TVPM. However, the TVPM fibers were inserted into the tendonlike membrane in all cases. The angle of insertion of TVPM fibers into the membrane was significantly more acute (relative to the vertical ET axis) in the inferior aspect than in the superior aspect of the membrane both in young children (3 months to 4 years; mean ± SD, 39.0° ± 15.1° superiorly to 23.8° ± 17.0° inferiorly) and in older subjects (8 to 88 years, 30.4° ± 11.6° superiorly to 15.7° ± 11.2° inferiorly; t-test, p < .001). The location of Ostmann's fatty tissue accompanied the TVPM throughout the cartilaginous ET. These data suggest that contraction of the TVPM moves the LL inferolaterally to open the superior aspect more than the inferior aspect of the lumen and that Ostmann's fatty tissue will limit the opening of the ET lumen, especially that of its inferior aspect.
Intramuscular Hemangioma of the Posterior Belly of the Digastric Muscle Failing to Highlight on Magnetic Resonance Imaging
Authors: Clement W. Andrew , Graham Iain , Rawlings David , Ablett Mark , Dempster John H.
Published: October 2014

Intramuscular hemangiomas of the digastric muscle are rare. We present the fifth case reported and the second to be imaged in vivo with magnetic resonance imaging. Accurate preoperative diagnosis of these lesions is difficult, but may be facilitated by a high degree of clinical suspicion and imaging. Magnetic resonance imaging using T2-weighted sequencing has been reported to effectively highlight these lesions. We present a case in which magnetic resonance imaging failed to highlight an intramuscular hemangioma of the posterior belly of the digastric muscle. Possible reasons for this failure are discussed.