bluuebunny/crossref_metadata_2025 huggingface dataset:
Algorithm Analysis of Lectin Glycohistochemistry and Feulgen Cytometry for a New Classification of Nasal Polyposis
Authors: Decaestecker Christine , Pasteels Jean Lambert , Hassid Sergio , Hermans Christine , Danguy André , Salmon Isabelle , Kiss Robert
Published: October 2014

The aim of this study is to present a new classification of nasal polyps. This classification is based both on morphologic criteria relating to morphonuclear features from isolated Feulgen-stained nuclei and on glycohistochemical characteristics from histologic slides submitted to three lectins (peanut, wheat germ, and gorse seed agglutinins) and one neoglycoconjugate glycohistochemical stain. While the morphonuclear features (including 30 variables) relate essentially to chromatin pattern, the glycohistochemical stains (including 16 variables) are linked to the presence of specific carbohydrate moieties in cell membranes and cytoplasm. Forty-nine nasal polyps, including single polyps, diffuse polyposis, cystic fibrosis-related polyposis, and aspirin idiosyncracy-related polyposis associated with asthma, were thus characterized. All the variables were obtained quantitatively by means of computer-assisted microscopy. Two complementary methods of data classification were used to determine the actual diagnostic value contributed by each quantitative variable, namely, discriminant analysis, which forms part of multifactorial statistical analysis, and the decision tree technique, which is an artificial intelligence-related algorithm. The data so obtained show that our morphologic classification of nasal polyps fits in with the classification of nasal polyps defined on the basis of clinical criteria.
Changes in Myosin Expression in Denervated Laryngeal Muscle
Authors: Delgaudio John M. , Sciote James J.
Published: October 2014

The effects of chronic denervation on the myosin heavy chain (MyHC) content and muscle fiber type composition of rat laryngeal muscles are described. The posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were removed 3 weeks, 3 months, and 6 months after recurrent laryngeal nerve sectioning. Myofibrillar adenosine triphosphatase staining of cryostat sections was performed, and fiber type percentages were determined. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to separate MyHC isoforms, and densitometry was subsequently used for quantitative analysis. Unoperated animals served as controls. In the PCA muscle, denervation resulted in a progressive reduction in type I MyHC (the slow-contracting isoform) to an almost complete loss at 6 months, with a concomitant increase in type II MyHCs (fast-contracting isoforms, excluding type IIL). Type IIL MyHC (laryngeal-specific isoform) remained relatively constant up to 6 months after denervation. The myosin expression in the TA muscle, which contained only type II MyHCs, remained relatively constant with denervation. Changes in fiber type composition of the muscles described from tissue staining correlated with MyHC content. These findings in laryngeal muscle confirm the dependence of type I MyHC expression upon neural input, as has been found previously in limb skeletal muscles. Since the expression of all MyHCs except the IIL was modified after denervation in the PCA muscle, it is possible that the IIL isoform is maintained by factors that differ from those in the other skeletal myosins.
Relationship of Endotoxin to Tumor Necrosis Factor–α and Interleukin-1β in Children with Otitis Media with Effusion
Authors: Willett Darryl N. , Rezaee Rod P. , Billy John M. , Tighe Mary B. , DeMaria Thomas F.
Published: October 2014

Sixty-five middle ear effusions and paired sera from 41 children with chronic otitis media with effusion were assayed for endotoxin and for tumor necrosis factor–α (TNF-α) and interleukin-1β (IL-1β) in order to establish whether a correlation exists between the concentrations of endotoxin and of these cytokines. Endotoxin concentration was determined by means of a chromogenic limulus amebocyte lysate assay, and the cytokine concentration by means of a quantitative enzyme-linked immunosorbent assay. Forty percent of the effusions had detectable levels of endotoxin, with a mean concentration of 2.9 ± 7.8 endotoxin units per milligram of total protein. The mean concentration of TNF-α was 1.24 ± 3.1 pg/mg total protein, and that of IL-1β was 18.79 pg/mg total protein. A strong, statistically significant correlation exists between the concentrations of endotoxin and TNF-α (r =.89) and IL-1β (r =.72). The data indicate that endotoxin may contribute to the pathogenesis of chronic otitis media with effusion by stimulating the sustained production of TNF-α and IL-1β in the middle ear.
Effects of Nitric Oxide on Blood Flow and Mucociliary Activity in the Human Nose
Authors: Runer Thomas , Lindberg Sven
Published: October 2014

In an animal model, nitric oxide (NO) has been shown to increase mucociliary activity in vivo and ciliary beat frequency in vitro. The aim of the present study was to investigate the effects of NO on blood flow and mucociliary activity in the human nose. The concentration of NO in nasal air was measured with a chemiluminescence technique after nebulizing the NO donor sodium nitroprusside (SNP) at a dose of 3.0 mg into the nose in six volunteers, and was found to increase by 50.1% ± 10.0% (mean ± SEM; p <.001) after the SNP challenge. Blood flow measured by laser Doppler flowmetry increased by 67.3% ± 15.5% (p <.05) after challenge with SNP at 1.0 mg, and by 75.4% ± 18.5% at 3.0 mg (p <.01; n = 6). The higher dose, which produced no subjective side effects, was then used in the mucociliary experiments. The maximum increase in nasal mucociliary activity was 57.2% ± 6.7% at 3.0 mg of SNP (n = 5). The findings support the view that NO regulates mucociliary activity and blood flow in the human nasal mucosa.
Osteosarcoma of the Larynx
Authors: Myssiorek David , Patel Mahendra , Wasserman Patricia , Rofeim Omid
Published: October 2014

About 11,600 cases of laryngeal cancer were reported in the United States in 1995, accounting for 1% of all reported cancers. Fewer than 1% of laryngeal cancers are sarcomas, osteosarcoma being the rarest type. Twelve cases of laryngeal osteosarcoma have been cited in the literature. A 47-year-old man presented with hoarseness following a benign vocal polypectomy. The entire larynx appeared swollen, although both vocal folds moved well. Biopsies did not reveal pathologic tissue. Computed tomographic imaging revealed a destructive, expansile lesion of the thyroid cartilage. A computed tomography-guided biopsy of this cartilage revealed a high-grade sarcoma. Laryngeal osteosarcoma was diagnosed following total laryngectomy. Laryngeal osteosarcoma is a highly malignant neoplasm with early hematogenous spread. Survival statistics for peripheral osteosarcoma are poor. Limited experience reveals that a combination of surgery and radiotherapy with adjuvant chemotherapy can offer some palliation. The literature and published cases of laryngeal osteosarcoma are reviewed.
Experimental Models of Aural Cholesteatomas in Mongolian Gerbils
Authors: Kim Hyung-Jong , Chole Richard A.
Published: October 2014

Mongolian gerbils have a remarkable propensity for the development of aural cholesteatoma; canal cholesteatomas develop spontaneously in aged animals. In the present study, cholesteatomas were produced in a single species, Meriones unguiculatus, by three different methods of induction: 1) external canal ligation (ECL), 2) eustachian tube obstruction (ETO) by electrocautery, and 3) application of propylene glycol (PG) into the middle ear. Each method of induction resulted in cholesteatomas with characteristic features and success rates. With ECL, cholesteatomas could be induced in all ligated ears; stage III and IV cholesteatomas were seen in 4 of 12 ears after 8 weeks. With ETO, cholesteatomas were seen in 7 of 9 animals 8 weeks after induction. With PG, cholesteatomas developed in 2 of 7 animals 4 weeks after induction, although keratin accumulation in the external auditory canal could be found in all animals injected. Although epithelial hyperplasia of the external auditory canal was most prominent in the ECL group, it was also seen in the ETO and PG groups. Keratin accumulation in the ECL or PG group was much greater than that in the ETO group. Thickening of the tympanic membrane, which was most prominent in the PG group, was quite variable in the other groups. Adhesions of the tympanic membrane began at the prominence of the cochlea in the ECL group. In contrast, adhesions in the PG group usually began at the superior bulla, the area in which PG was applied. Each of the three methods of inducing cholesteatoma may be helpful in investigating different clinical aspects of this disease.
Effects of Surgery on Mucosal Pathologic Changes following Experimental Sinusitis in Rabbit
Authors: Forsgren Karin , Fukami Masaya , Westrin Karl Magnus , Stierna Pontus
Published: October 2014

In the present investigation, the regenerative capacity of the infected maxillary sinus mucosa following surgical procedures was studied in a rabbit model. Sinusitis was induced by occluding the ostium with and without the addition of Staphylococcus aureus or Bacteroides fragilis, or by provoking a prolonged bacterial infection with both pathogens. The surgical procedures performed were 1) widening of the natural sinus ostium (middle meatal antrostomy; MMA) and 2) removal of sinus mucosa without ostial interference (modified radical operation; MRO). The histologic features of the entire nose-sinus complex were studied, graded semiquantitatively, and compared with findings in untreated sinusitis, or after surgery only. Whereas MMA and MRO both led to a decrease of the inflammatory features of the sinus mucosa in induced sinusitis, persistent local histopathology was observed in the ostial region following MMA surgery. This indicates the importance of local pathologic changes resulting from interactions of bacterial colonization, inflammation, and surgery in chronic sinusitis.
Synchronous and Metachronous Multiple Primary Laryngeal Malignancies
Authors: Ferlito Alfio , Devaney Kenneth O. , Rinaldo Alessandra , Hunter Brian C.
Published: October 2014

The article reviews the literature on synchronous and metachronous multiple primary malignant laryngeal tumors of the same phenotype, of different phenotypes, and of different histogenesis.
Electrosurgery in the Head and Neck
Authors: Sajjadian Ali , Isaacson Glenn
Published: October 2014

Electrosurgery is widely used in the practice of otolaryngology—head and neck surgery. Despite its popularity, few training programs give formal education in the optimal use of electrosurgical instruments. This article reviews the history, physics, and tissue effects of these commonly used devices. Armed with this knowledge, the head and neck surgeon can take full advantage of electrosurgery's ability to dissect tissues with precision and minimal blood loss.
Airflow and Pressure Characteristics of Three Different Tracheostoma Valves
Authors: Grolman Wilko , Grolman Eric , Van Steenwijk Reindert P. , Schouwenburg Paul F.
Published: October 2014

Tracheoesophageal speakers can achieve speech without digital occlusion by using a tracheostoma valve. Laryngectomized patients who are successful with this device can regain considerable freedom. However, little is known about which valve suits the patient best. Valve aerodynamics may give a guideline for its use. Three major tracheostoma valves, each divided into four subtypes, were repeatedly measured in this study. Dynamic pressure and airflow rate signals were sampled through an analog-digital interface into a computer. Considerable aerodynamic differences were observed between the tested valves. The maximum airflow rates, closing pressures, and resistances at low velocities were compared. The presented data may help increase the successful use of tracheostoma valves in tracheoesophageal speakers. Patient factors and additional valve factors should always be taken into account. Further clinical study to validate the clinical relevance of the data is needed.
Loss of Cochlear Nucleus Neurons following Aminoglycoside Antibiotics or Cochlear Removal
Authors: Moore David R. , Rogers Nina J. , O'Leary Stephen J.
Published: October 2014

This study compared the effects of aminoglycoside ototoxicity and surgical ablation of the cochlea in infancy on the survival of neurons in the rat cochlear nucleus (CN). Ototoxicity was induced by a single, systemic dose of gentamicin sulfate and furosemide on postnatal day 6 (P6), P7, or P10, and assessed by the elevation of auditory brain stem response thresholds, as described in a companion paper. Unilateral cochlear removals were performed under Saffan anesthesia on P6, P9, and P12. Rats were painlessly sacrificed in adulthood, and the formalin-perfused brains and cochleas were embedded in wax, sectioned, and stained. Ototoxic treatment at P6 through P10 did not reduce neuron counts in the CN. Cochlear removal at P6 resulted in a 40% loss of CN neurons, but removal at P12 did not result in CN neuron loss. These data suggest that the critical period for the dependence of CN neurons on afferent input from the cochlea ends at the same time that susceptibility to aminoglycoside ototoxicity begins.
Modifications of Airway Reconstruction in Children
Authors: Ward Robert F. , Rabkin Dimitry , Gordon Michael , April Max M.
Published: October 2014

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. AH patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.
Neuromuscular Organization of the Human Upper Esophageal Sphincter
Authors: Mu Liancai , Sanders Ira
Published: October 2014

The upper esophageal sphincter (UES) is a key component of swallowing, and yet, its anatomy and function are still incompletely understood. The UES is a functional entity that is composed of three muscles: the cricopharyngeal (CP) muscle, the inferior pharyngeal constrictor (IPC) muscle, and the upper esophageal (UE) muscle. This study compared the anatomy of the three muscles of the UES in nine human autopsy specimens. The variables examined included the pattern of motor end plates (acetylcholinesterase stain), the proportion of fast- and slow-twitch muscle fibers (myofibrillar adenosinetriphosphatase), and the details of their nerve supply (Sihler's stain). The results demonstrated that each variable is different in the three muscles. For example, the IPC muscle is innervated by the pharyngeal plexus, the CP muscle by both the pharyngeal plexus and the recurrent laryngeal nerve (RLN), and the UE muscle by the RLN. The IPC and CP muscles showed distinct motor end plate bands, while the horizontal part of the CP muscle also contained small and randomly scattered end plates. This latter pattern was present throughout the UE muscle. Analysis of the muscle fiber types of the UES revealed a type I (slow) predominance (89%) in the CP and UE muscles and a type II (fast) predominance (62%) in the IPC muscle. However, the IPC muscle is composed of two layers: a fast, thick, outer layer (90% type II) and a slow, thin, inner layer (85% type I). The implications of these findings for the diagnosis and treatment of UES dysfunction will be discussed.
Characterization of the Eosinophil Chemokine Rantes in Nasal Polyps
Authors: Allen Jerilyn S. , Eisma Roselle , Leonard Gerald , Lafreniere Denis , Kreutzer Donald
Published: October 2014

Previous studies have demonstrated that the cytokine RANTES (Regulated And Normal T cell Expressed and Secreted) has been shown to be a potent mediator of eosinophil Chemotaxis in vitro and of leukocyte recruitment. Because eosinophils are the hallmark cells in nasal polyposis, we hypothesize that RANTES is locally produced within the nasal polyp microenvironment and is responsible for the eosinophil recruitment seen in nasal polyposis. To begin to test this hypothesis, we evaluated nasal polyps from 17 patients and 3 control specimens for distribution and content of RANTES using immunohistochemical techniques and enzyme-linked immunosorbent assay technology. Our immunohistochemical studies demonstrated that in nasal polyposis, RANTES antigen staining occurred predominantly within eosinophils and epithelial cells. To quantify the relative levels of RANTES in normal and nasal polyp specimens, tissue homogenates were prepared, quantified, and normalized to protein levels. We detected RANTES in all 17 nasal polyp tissue homogenates (566 ± 16 pg/mg total protein). The RANTES levels in nasal polyp homogenates were nearly 40-fold higher man the RANTES levels in normal tissue (15.7 ± 28.2 pg/mg total protein). Thus, it appears that increased expression of RANTES by eosinophils and epithelial cells within the nasal polyp microenvironment promotes eosinophil recruitment and activation within nasal polyps. We hypothesize that RANTES induces increased recruitment and activation of eosinophils, presumably contributing to the increased tissue changes associated with nasal polyposis.
Increased Density of Olfactory Receptor Neurons Immunoreactive for Apolipoprotein E in Patients with Alzheimer's Disease
Authors: Yamagishi Masuo , Takami Shigeru , Getchell Marilyn L. , Getchell Thomas V.
Published: October 2014

Immunolocalization of apolipoprotein E (apoE) was investigated in human olfactory mucosa in which olfactory receptor neurons (ORNs) were identified with antiserum to protein gene product (PGP) 9.5. Tissue was obtained at autopsy from 10 nondemented middle-aged or elderly subjects and 9 patients with Alzheimer's disease (AD). Double-labeling immunofluorescence established that apoE immunoreactivity was colocalized in a subpopulation of PGP 9.5-immunoreactive ORNs. The mean number of apoE-immunoreactive ORNs per unit epithelial length in AD patients was about 3.5 times greater than that in nondemented patients, although the mean number of PGP 9.5-immunoreactive ORNs was similar. The apoE-immunopositive Schwann cells in olfactory nerve bundles were the probable source of apoE in the ORNs. The increased numbers of apoE-immunoreactive ORNs in AD patients compared to nondemented subjects demonstrates another manifestation of AD-related neuropathology, in addition to cytoskeletal changes, β-amyloid deposition, and changes in immunoreactivity for other neuroproteins, that parallels changes in neurons in the AD brain.
Wegener's Granulomatosis of the Head and Neck
Authors: Devaney Kenneth O. , Ferlito Alfio , Devaney Stephanie L. , Hunter Brian C. , Rinaldo Alessandra
Published: October 2014

Among the more puzzling non-neoplastic necrotizing lesions of the head and neck area is Wegener's granulomatosis. This is a condition of unknown cause that may present (in the head and neck area) with ulceration of the nasal septum, sinus mucosa, oral mucosa, or external ear canal, or even destruction of the vocal cord. Diagnosis depends on the pathologic finding of a characteristic inflammatory reaction pattern (which, in its best-developed form, includes necrosis, granulomatous inflammation, and vasculitis) and the serum finding of an elevated antinuclear cytoplasmic antigen. Treatment is principally medical, with the use of powerful immunosuppressive agents. Distinction from other conditions that may mimic Wegener's granulomatosis (such as malignant lymphoma and infections) is of critical importance in constructing an appropriate treatment strategy.
Cervicomedullary Compression: An Unrecognized Cause of Vocal Cord Paralysis in Rheumatoid Arthritis
Authors: Link Dana Thompson , McCaffrey Thomas V. , Link Michael J. , Krauss William E. , Ferguson M. Troy
Published: October 2014

Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto-axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral-transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.
Tracheal Reconstruction with a Vascularized Cartilage Flap in Rabbits
Authors: Tan Ergin N. , Demirhan Beyhan , Koç Can , Dal Teoman
Published: October 2014

The relative merits of a vascularized autogenous cartilage flap (VACF) are discussed in reconstruction of tracheal defects in rabbits. Sixteen albino Vienna rabbits were divided into two groups of eight animals each. In all rabbits, a rectangular tracheal defect was created. In the experimental group, a VACF was designed on the left auricle. This island flap was then transposed through a subcutaneous tunnel to the trachea and used to repair the defect. In the control group, tracheal defects were reconstructed with free cartilage grafts. In histologic evaluations, it was found that the reconstructed site showed a greater degree of vascularization when a VACF was used, and the gap between the trachea and flap was filled with new cartilage tissue, to a much greater extent than with the free cartilage grafts. It is concluded that use of the VACF is a relatively safe and effective procedure for repairing tracheal defects.
Skull Metastasis from Renal Cell Carcinoma Case Report and Literature Review
Authors: Koutnouyan Hrair A. , Rumore Gregory J. , Kahn Jonathan M.
Published: October 2014

Metastatic tumors to the head and neck are uncommon. We report a case of renal cell carcinoma that presented as an epidermal inclusion cyst on the forehead. The forehead is an exceedingly uncommon site for renal cell metastases. We review the biology of tumor metastases and explore the pathways by which infraclavicular tumors spread to the head and neck. We then discuss the clinical appearance and management of metastatic renal cell carcinoma.
Age-Related Changes in Cochlear Blood Flow Response to Occlusion of Anterior Inferior Cerebellar Artery in Mice
Authors: Suzuki Toru , Nuttall Alfred L. , Ren Tianying , Miller Josef M.
Published: October 2014

Previous studies suggest that autoregulation of cochlear blood flow (CBF) may be impaired by aging. In this study, we quantified the capacity of CBF autoregulation in young adult (6-month-old) and aged (21-month-old) CBA mice, to examine the effect of aging on CBF autoregulation. The technique of anterior inferior cerebellar artery (AICA) occlusion was employed to manipulate cochlear perfusion pressure. The CBF was measured by laser Doppler flowmetry during intermittent occlusion of the AICA with a microvascular clamp, which causes an initial decrease in CBF. The autoregulation of CBF was evaluated by quantifying the CBF increase (compensatory dilatory response in the cochlear vessels) during AICA occlusion. Our results demonstrated that autoregulation of CBF was significantly reduced and that collateral vascular function supplying CBF was significantly lower in the aged group. These findings suggest that the aged ear has less capacity to maintain stable blood flow and thus may be more vulnerable to stress factors that affect cochlear function.
Examining the Safety of Nasogastric Tube Placement after Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil , Gopal Harsha V.
Published: October 2014

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.
Laryngomucocele as an Unusual Late Complication of Subtotal Laryngectomy
Authors: Carrat Xavier , François Jean-Marc , Devars François , Carles Dominique , Traissac Louis
Published: October 2014

We report an unusual case of laryngomucocele occurring after subtotal laryngectomy. Laryngoceles generally have a congenital origin in a long-preexisting saccule, and their association with laryngeal carcinoma is well known. Laryngocele is usually favored by the increase of intraglottic pressure caused by the laryngeal carcinoma. However, an iatrogenic secondary laryngomucocele occurring after a surgical procedure is uncommon. We report in detail the physiopathologic conditions leading to the creation of this lesion.
Cytokine Evaluation in Throat Infections
Authors: Deutsch Elimelech , Nisman Benjamin , Kaufman Michal , Barak Vivian
Published: October 2014

Inflammatory cytokines have been shown to play an important role in the pathogenesis of various inflammatory processes. In throat infections, intracellular inflammatory cytokines have been detected from the sites of inflammation. The present study aimed to evaluate serum cytokine levels of patients with throat infections and correlate them to the inflammatory parameters and type of inflammation. Significantly higher inflammatory cytokine levels (interleukin [IL]–6 >7 pg/mL, IL-1 >1β pg/mL, tumor necrosis factor a >1 pg/mL) were detected in most of the patients as opposed to healthy controls. Clinical parameters of infection (fever >38°C, leukocytosis >11,000 white blood cells per cubic millimeter, polymorphonuclear neutrophils >75%) were significantly correlated with high levels of inflammatory cytokines: mainly IL-6 and tumor necrosis factor α, and to a lesser degree with IL-1β. No correlation, however, was found between the type of inflammation and cytokine levels. The present study indicates a role of inflammatory cytokines in the pathogenesis of throat infections and the need for an anti-inflammatory and anticytokine therapeutic approach.
Lateral Laryngotomy for the Removal of Teflon Granuloma
Authors: Netterville James L. , Rainey Cheryl L. , Coleman John R. , Reinisch Lou , Chang Susan , Ossoff Robert H.
Published: October 2014

Teflon injection has been used for vocal fold medialization following paralysis. Recently, numerous articles have discussed the complications of Teflon injection, including overinjection, airway obstruction, Teflon granuloma, and an abnormal mass effect creating a decreased vibratory character of the true vocal fold. Multiple techniques for Teflon removal have been described. This report details our experience with complete Teflon granuloma removal via a lateral laryngotomy under local anesthesia. Microscopic dissection of the entire granuloma and the paraglottic space was accomplished in all patients. Due to extensive destruction caused by the granuloma, the vocal ligament was resected in 3 patients; it was partially resected and reanastomosed in 1 case, and spared in 6 patients. Laryngeal reconstruction was accomplished with an inferiorly based sternohyoid muscle rotation flap and arytenoid adduction. Effortful speech secondary to pressed vocal quality resolved in all patients. Near-normal to normal vocal quality was obtained in 4 patients, with the average “voice desirability” improving 60% and the effective glottic width increasing 29%. Factors that contributed to a successful outcome included noninvolvement of the vocal ligament and sparing of the mucosal cover.
Recording from Afferents in the Intact Recurrent Laryngeal Nerve during Respiration and Vocalization
Authors: Clark Keith F. , Farber Jay P.
Published: October 2014

The goal of this study was to determine whether sensory fibers in an intact recurrent laryngeal nerve (RLN) are influenced by respiration or vocalization. Patterns of RLN afferent activity were examined during respiration and evoked vocalization by means of midbrain electrical stimulation in cats anesthetized with α-chloralose. Nerve bundles were dissected from an intact RLN, with motor function preserved. The bundles were cut and the laryngeal end was placed on floating bipolar electrodes. Fifteen right RLNs were examined. A total of 9 single and multiunit afferent fibers from 4 cats were isolated and examined during respiration. Four units, analyzed from 3 fibers, showed respiratory phase modulation. Eight units, analyzed from 4 fibers in 1 cat, were observed during vocalization and showed no vocalization phase modulation. The RLN afferents could contribute to reflex modulation of the respiratory cycle, but more extensive sampling would be necessary to preclude effects from vocalization.
Effect of Penicillin on Formation of Fibrous Adhesions in Acute Otitis Media
Authors: Cayé-Thomasen Per , Tos Mirko
Published: October 2014

Fibrous middle ear adhesions are occasionally encountered in middle ear surgery and may cause a hearing impairment. Although usually associated with chronic otitis media, adhesions are also found following a single episode of experimental acute suppurative otitis media, suggesting a pathogenesis based on the inflammatory process engaging acute infection. In a well-established rat model of pneumococcal acute otitis media, we report on the effect of penicillin V on formation of fibrous middle ear adhesions. Previous studies have shown marked impact of penicillin on mucosal goblet cell density and other histopathologic features. Number, anatomic localization, and histopathologic morphology of adhesions were assessed in a longitudinal study of 25 normal, 25 untreated, and 25 treated rats. Although penicillin administration induced a slight tendency toward fewer ears with adhesions and fewer adhesions per ear, these changes were nonsignificant. Histomorphology and the general pattern of anatomic localization of adhesions were unaffected by penicillin administration. We conclude that administration of penicillin has an inconspicuous effect on the formation of fibrous adhesions in experimental acute otitis media caused by Streptococcus pneumoniae.
Tracheal Neoplasms in Children
Authors: Desai Devang P. , Holinger Lauren D. , Gonzalez-Crussi Frank
Published: October 2014

Primary tracheal neoplasms are extremely rare lesions in the pediatric age group. This study reviews the English-language literature to better characterize these lesions in children and reports 2 additional patients. Reports of only 36 infants and children through adolescence with primary tracheal neoplasms were discovered after an exhaustive literature review of the last 30 years. The data are analyzed with regard to pathology, demographics, symptomatology, site, and percent luminal obstruction. We report 2 additional patients with photographic documentation, imaging studies, and histopathology. Of the 36 previously reported lesions, 64% were characterized as benign and 36% as malignant. Fifty-six percent of all lesions were initially misdiagnosed as asthma. The most common site was the posterior membranous wall of the cervical trachea. In 14 (39%) of the 36 patients, the lesions obstructed more than 50% of the lumen at the time of diagnosis. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion and conducting an efficient workup, including definitive evaluation by bronchoscopy. The evaluation and the differential diagnosis of tracheal neoplasms in the pediatric population is discussed.
Significance of DNA Ploidy and Cell Proliferation in Juvenile Respiratory Papillomatosis
Authors: Stern Yoram , Hurtubise Paul E. , Cotton Robin T.
Published: October 2014

The clinical course of recurrent respiratory papillomatosis (RRP) in children is variable and unpredictable. At present there is no way to identify patients at risk for aggressive disease. The objective of this study was to evaluate whether DNA ploidy and cell proliferation analyses can predict the clinical course in children with RRP. Two different methods of estimating proliferation activity were compared. Nonembedded papilloma biopsy specimens from 18 pediatric patients were analyzed by flow cytometry providing DNA content with cell cycle analysis. The expression of the proliferative marker Ki-67 in papilloma tissue was quantified by immunohistochemistry. The patients were prospectively observed for 12 to 18 months. DNA content analysis and Ki-67 expression were compared to clinical information regarding number of disease sites, distal tracheobronchial spread, number of recurrences, need for tracheostomy, and disease remission. High S-phase fraction, proliferative index, and Ki-67 expression correlated with an aggressive clinical course. DNA ploidy analysis and immunodetection of proliferative markers may assist in predicting prognosis in children with RRP.
Results of Near-Total Laryngectomy
Authors: Pearson Bruce W. , Olsen Kerry D. , Desanto Lawrence W. , Salassa John R.
Published: October 2014

The clinical records of 225 patients undergoing primary or salvage near-total laryngectomy (NTL) for laryngeal and pyriform cancer were analyzed for local control and morbidity. If the primary cancer was laryngeal in origin, patients underwent a simple NTL; if it was pyriform, a minor modification called near-total laryngopharyngectomy (NTLP) was used. When NTLP was extended to include necessary portions of the tongue base or posterior pharyngeal wall, pharyngeal reconstructions were added. The principal outcomes studied were 1) 5-year local control of the primary cancer, 2) achievement of lung-powered shunt speech, and 3) incidence of aspiration. The local control of cancer was similar to that expected with total laryngectomy or laryngopharyngectomy. Conversational voice was achieved in 85% of patients surviving beyond 1 year. Some patients required additional surgery for voice — Usually endoscopic dilation. Aspiration was absent if primary healing was achieved. It was troublesome in wound breakdown if the shunt was directly affected. Secondary anti-aspiration procedures were required in 9% of our patients — usually preserving shunt speech.
Effects of Platelet Activating Factor on the Tubotympanic Mucosa and Inner Ear in the Guinea Pig
Authors: Ohno Yoshiharu , Ohashi Yoshihiro , Okamoto Hideki , Sugiura Yoshikazu , Nakai Yoshiaki
Published: October 2014

The effect of platelet activating factor (PAF) was studied to elucidate its role in the pathogenesis of otitis media and sensorineural hearing loss. The PAF alone did not induce a reduction of ciliary activity of the cultured middle ear mucosa. However, a dose-dependent decrease in ciliary activity was observed in the presence of the medium containing both PAF and macrophages. Intravenous injection of PAF did not induce dysfunction of the mucociliary system or morphologic changes of epithelium in the tubotympanum, but cytoplasmic vacuolization and ballooning were observed in the inner ear within 1 hour after injection of PAF. In contrast, intratympanic injection of PAF induced mucociliary dysfunction and some pathologic changes in the tubotympanum. Intratympanic inoculation of PAF induced no pathologic findings in the inner ear. These results suggest that PAF is at least partially involved in the pathogenesis of certain middle ear diseases such as otitis media with effusion. Additionally, PAF might be involved in the pathogenesis of some types of unexplained sensorineural hearing loss.
Keratinocyte Growth Factor and its Receptor Messenger RNA Expression in Nasal Mucosa and Nasal Polyps
Authors: Ishibashi Toshio , Tanaka Tadashi , Ishimoto Shin-Ichi , Nibu Ken-Ichi , Kaga Kimitaka
Published: October 2014

To examine the potential biologic role of fibroblast growth factors (FGFs) in nasal polyps and nasal mucosa during chronic inflammatory conditions, we investigated messenger RNA (mRNA) expression of three members of the FGF family — Acidic FGF, basic FGF, and keratinocyte growth factor (KGF) — in nasal polyp tissues, as well as in hyperplastic nasal mucosa. Using the sensitive method reverse transcription-polymerase chain reaction (RT-PCR), we demonstrated that of the examined FGFs, KGF had the most abundant mRNA expression in nasal polyps and nasal mucosa. We also found that significantly higher levels of KGF mRNA were expressed in nasal polyps than in nasal mucosa, whereas mRNA expression of acidic FGF and basic FGF was relatively low in these tissues. In addition, we showed that KGF receptor mRNA was present in most of the nasal mucosa; however, none or little was expressed in nasal polyps. These results suggest that KGF might play an important role in nasal epithelial proliferation and that excessive synthesis of KGF in nasal polyp stroma may contribute to hypertrophy of the nasal mucosa in patients with chronic sinusitis associated with nasal polyposis.
Calcium Pyrophosphate Deposition Disease of the Temporal Bone
Authors: Jordan Jennifer A. , Lindberg Guy , Roland Peter , Mendelsohn Dianne
Published: October 2014

Massive calcium pyrophosphate crystal deposition is a rare disorder that may affect the temporomandibular joint and temporal bone. The diagnosis is difficult, and misdiagnosis as malignancy, particularly chondrosarcoma, is frequent. This can lead to unnecessarily aggressive management. The clinical, radiographic, and pathologic features of this entity are reviewed, and treatment options are discussed.
Otological Manifestations of Charge Association
Authors: Dhooge Ingeborg , Standaert Lieve , Lemmerling Mark , Govaert Paul , Lagache Muriel , Mortier Geert
Published: October 2014

The combined findings of abnormalities of the incus and stapes, absence of the oval window, absence of the stapedius muscle (with absent pyramidal eminence and tympanic sinus in most cases), and abnormalities of different parts of the inner ear (dysplastic cochlea, hypoplastic or dysplastic vestibule, and absent semicircular canals) are characteristic of the CHARGE association. Computed tomography and magnetic resonance imaging using 1-mm-thick contiguous slices proved useful in demonstrating the broad spectrum of temporal bone abnormalities in patients with the CHARGE association.
Management of Chronic Sinusitis in the Adult Cystic Fibrosis Patient
Authors: Halvorson David J. , Dupree John R. , Porubsky Edward S.
Published: October 2014

Cystic fibrosis (CF) is an autosomal recessive disorder affecting exocrine gland function. Although CF was formerly a deadly disease of infants and children, recent improvements in antibiotics, nutritional therapy, and supportive care have extended the median survival to adulthood. Patients with CF often present with sinusitis and nasal polyposis in addition to recurrent pulmonary infections. Although the effectiveness of endoscopic sinus surgery in children with CF has been documented, the treatment guidelines and efficacy in the adult CF patient are unknown. We present a series of 16 adult patients with CF and chronic sinusitis. The majority of patients presented with nasal polyposis and concomitant pulmonary complications. Endoscopic findings are reviewed, with an emphasis on improving pulmonary function following endoscopic sinus surgery. Preliminary findings suggest that endoscopic sinus surgery improves symptoms of sinusitis and exercise tolerance and may delay the progressive respiratory failure that often affects the adult CF patient.
Pregnancy and Malignant Neoplasms of the Head and Neck
Authors: Devaney Stephanie L. , Devaney Kenneth O. , Ferlito Alfio , Carbone Antonino , Rinaldo Alessandra , Maio Michele , Friedmann Imrich
Published: October 2014

This paper, based on a literature review, deals with the occasional development of a head and neck neoplasm in the pregnant woman. This rare event makes for some challenging problems in patient management, insofar as the otolaryngologist is actually responsible for taking care of 2 patients — the mother and her unborn child. In particular, 4 tumor types have figured prominently among those head and neck tumors arising in pregnant women: cancer of the larynx, cancer of the thyroid, malignant melanomas, and malignant lymphomas of the head and neck. Of these, the most common appear to be melanomas, followed by lymphomas, thyroid carcinomas, and, finally, laryngeal carcinomas. The thyroid tumors, lymphomas, and laryngeal carcinomas do not appear to behave more aggressively in pregnant than in nonpregnant patients; there is, however, some anecdotal evidence to suggest that melanomas in pregnant women may be more aggressive neoplasms than similar-stage tumors in nonpregnant women. One difficulty in treating any of these tumor types in this clinical setting is the limitation that may be imposed on the use of adjuvant therapy by the presence of the unborn child, which may put the attending physicians in the difficult position of balancing less aggressive therapy for the mother against the potential for harming the baby through use of toxic systemic therapy.
Reticular Fibers in the Vocal Fold Mucosa
Authors: Sato Kiminori
Published: October 2014

Light and electron microscopic investigations of the reticular fibers (RFs) in the vocal fold mucosa were carried out on excised human adult larynges. The results are summarized as follows. Reticular fibers were found in the superficial and intermediate layers of the lamina propria of the vocal fold mucosa. They were most abundantly discovered around the vocal fold edge, and they decreased toward the superior and inferior portions of the vocal folds. The RFs were composed of slender fibrils, about 40 nm in diameter, and having cross-bands with a periodicity of about 67 nm. They were found in close association with the basal lamina of the epithelium and blood vessels. The slender fibrils of the RFs did not form any bundles, but branched and anastomosed. The RFs formed delicate 3-dimensional networks, and the spaces among the fibers were relatively large. Glycoprotein and glycosaminoglycan (proteoglycan) were situated around the RFs and in the spaces among the fibers. Elastic fibers were located in the spaces among the RFs. The 3-dimensional structure of the RFs in the vocal fold mucosa, first demonstrated in this study, appears to be one of the key components of the structural maintenance and viscoelasticity of the vibrating vocal fold tissue.
Endoscopic Transseptal Sphenopalatine Artery Ligation for Intractable Posterior Epistaxis
Authors: El-Guindy Ahmed
Published: October 2014

The rigid nasal endoscope was used through a transseptal approach to reach the sphenopalatine foramen and to ligate its artery in 9 patients with intractable posterior epistaxis. Immediate and complete cessation of the bleeding uniformly occurred, except in 1 case, in which there was persistent bleeding on endoscopic examination of the nasal cavity at the end of the procedure. The ligature was checked and the artery was reclipped. Thereafter, the patient's recovery was uncomplicated and free of further epistaxis. Endoscopic transseptal sphenopalatine artery ligation offers a reliable option in the treatment of intractable posterior epistaxis. The submucoperiosteal dissection reduces bleeding, shortens operation time, and allows relatively easy identification of the sphenopalatine foramen. The procedure allows direct positive control of the major vessel supplying the posterior nasal cavity. It avoids the complications associated with transantral and pterygopalatine fossa surgery.
TNM Glottic: Role of the Vocal Muscle, Arytenoid Cartilage, and Inferior Paraglottic Space in Impaired Vocal Cord Mobility (T2)
Authors: Rucci Lucio , Simonetti Laura , Gammarota Lucio , Cirri Maria Bruna Borghi
Published: October 2014

The TNM classification is unsatisfactory regarding the impaired mobility of the vocal cord and/or the arytenoid. The authors have studied the intrinsic laryngeal musculature, with particular attention to the medial thyroarytenoid muscle, the lateral thyroarytenoid muscle, and the inferior paraglottic space. The study was conducted on serial sections of 4 embryonal and 9 fetal larynges at different stages of development. The embryological observations showed that the lateral and medial thyroarytenoid muscles have different maturation times and probably different functions: phonatory and sphincteric. The authors have found that the inferior paraglottic space is situated between these 2 muscles. It would represent a path of diffusion for glottic cancer and play a central role in impaired vocal cord and/or arytenoid mobility, according to the degree of diffusion. Embryological observations have suggested the existence of laryngeal morphofunctional units belonging to the subsites of the glottic region and related to tumoral spreading.
Speech and Voice Characteristics after Near-Total Laryngectomy
Authors: Laccourreye Ollivier , Hans Stéphane , Crevier-Buchman Lise , Ménard Madeleine , Muscatello Luca , Brasnu Daniel
Published: October 2014

Selected characteristics were prospectively compared in the speech and voice of 10 patients managed with near-total laryngectomy. Tape-recorded speech samples were measured for durational features with a stopwatch. Acoustic features were analyzed with the Computerized Speech Lab and the Multidimensional Voice Program from Kay Elemetrics. Speech and voice parameters recorded preoperatively were compared with the parameters recorded postoperatively. Our data corroborate the prior reported good quality of the voice and speech after near-total laryngectomy.