bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Carbon Dioxide Laser Zenker's Diverticulotomy Revisited
Authors: Kos Martijn P. , David Eric F. , Mahieu Hans F.
Published: October 2014

Objectives:

We assessed the efficacy of endoscopic Zenker's diverticulotomy with the carbon dioxide (CO2) laser and Acuspot and compared it with the historical results of using a CO2 laser without Acuspot and electrocautery diverticulotomy.

Methods:

Between 1976 and 2005, a total of 229 endoscopic Zenker's diverticulotomies in 189 patients were performed in our institution. Since 1995, micro-endoscopic diverticulotomy with the CO2 laser and Acuspot (MEDCO2A) has been performed in 61 cases. Between 1984 and 1995, micro-endoscopic diverticulotomy with the CO2 laser (MEDCO2) was performed in 113 cases. Before 1984, endoscopic diverticulotomy with electrocautery (EDE) was performed in 55 cases. All patients had radiologically proven Zenker's diverticula. We recorded preoperative and postoperative complaints of dysphagia, the frequency of recurrence in long-term follow-up, postoperative tube feeding, non-oral intake, days of admission, and complications.

Results:

After operation, dysphagia was absent in 84.6% of MEDCO2A cases, 78.4% of MEDCO2 cases, and 72.0% of EDE cases. Repeat surgery was required in 13.0% of MEDCO2A cases, 19.6% of MEDCO2 cases, and 24.3% of EDE cases. Five patients developed mediastinitis (2 MEDCO2 cases and 3 EDE cases); none died as a consequence. In 1 patient, squamous cell carcinoma was found in the diverticulum.

Conclusions:

The technological improvement of the CO2 laser with Acuspot has further increased the efficacy of its use over that of methods previously used in our institution. The results and complications rate are comparable to those reported for endoscopic stapler diverticulotomy in the literature.
Biofilm Density in the Pediatric Nasopharynx: Recurrent Acute Otitis Media versus Obstructive Sleep Apnea
Authors: Zuliani Giancarlo , Carlisle Michael , Duberstein Aaron , Haupert Michael , Syamal Mausumi , Berk Richard , Du Wei , Coticchia James
Published: October 2014

Objectives:

We compared the biofilm surface density of adenoids removed from children with recurrent acute otitis media (RAOM) to that of adenoids removed from children with a diagnosis of obstructive sleep apnea (OSA).

Methods:

We performed a comparative microanatomic study of adenoid mucosa using scanning electron microscopy in patients with diagnoses of RAOM and OSA (27 female and 41 male; age range, 3 months to 15 years).

Results:

The adenoids removed from patients with RAOM had dense, mature biofilms covering nearly their entire mucosal surfaces. More specifically, the adenoids removed from patients with RAOM had an average of 93.53% of their mucosal surface covered, versus an average of 1.01% coverage on the adenoids removed from patients with OSA. These differences were statistically significant (p < 0.0001).

Conclusions:

The adenoids removed from patients with RAOM had almost their entire mucosal surface covered with biofilms, versus scant coverage for patients with OSA. Recurrent acute otitis media is notoriously resistant to antibiotic treatment, and aspirates of middle ear fluid repeatedly yield negative cultures. It is these properties that have led biofilms to become increasingly implicated in the pathogenesis of RAOM. Thus, the resistance of biofilms to antimicrobials, together with their planktonic shedding of organisms, may be an important mechanism in the development of RAOM.
Endoscopic Approach for Pituitary Surgery Improves Rhinologic Outcomes
Authors: Graham Scott M. , Iseli Tim A. , Karnell Lucy H. , Clinger John D. , Hitchon Patrick W. , Greenlee Jeremy D. W.
Published: October 2014

Objectives:

We hypothesized that the endoscopic approach to pituitary surgery improves rhinology-specific quality of life and has satisfactory tumor outcomes compared with the open approach.

Methods:

Cases of pituitary surgery from the Department of Neurosurgery database included an inception cohort of all patients who had endoscopic procedures and consecutive patients who had open procedures between January 1998 and February 2008. The Sino-Nasal Outcome Test-22 was mailed.

Results:

Since January 1998, 71 endoscopic and 122 open pituitary surgeries had been performed. The mean follow-up was longer for open procedures (49.3 months) than for endoscopic procedures (18.8 months). Recurrence was more common after open surgery (28.4%) than after endoscopic surgery (18.2%; p = 0.219). The most common diagnosis was macroadenoma (77.1% of endoscopic procedures and 93.4% of open procedures). The mean hospital stay was shorter for endoscopic procedures (4.1 days) than for open procedures (6.0 days; p < 0.001). Of patients who presented with visual deterioration, 53.8% with endoscopic surgery and 46.7% with open surgery had improvement. Among patients with normal preoperative hormonal function, 27.5% of patients in the endoscopy group and 29.4% of patients in the open group required medication for more than 2 months after surgery. Complications occurred in 33.3% of endoscopic procedures and 43.4% of open procedures. Cerebrospinal fluid leaks were more common in the endoscopy group (p = 0.035), and diabetes insipidus lasting more than 30 days was more common in the open group (p = 0.017). The mean Sino-Nasal Outcome Test-22 score was lower for patients in the endoscopy group (20.4) than for those in the open group (23.2; p = 0.41). Patients in the endoscopy group had a significantly lower rhinology-specific mean score (6.5) than did patients in the open group (9.2; p = 0.03).

Conclusions:

The endoscopic approach to pituitary surgery offers tumor outcomes comparable to those of open surgery, with no greater incidence of complications and an improved rhinology-specific quality of life.
Delayed Cerebrospinal Fluid Leak following Septoplasty
Authors: Thakar Alok , Lal Priti , Verma Rohit
Published: October 2014

We report on the clinical syndrome of delayed cerebrospinal fluid leak following septoplasty. We describe 2 such cases that we treated, and 1 other case described in the literature. A review of these 3 cases indicates a characteristic clinical and radiologic presentation and a consistent site of cerebrospinal fluid leak. All cases presented with cerebrospinal fluid leak 12 to 22 weeks after septoplasty and had slit-shaped dehiscences at the horizontal lamella of the cribriform plate. Endoscopic repair was successful in all. Delayed cerebrospinal fluid leaks may occur as a consequence of septal surgery. It is probable that uncontrolled twisting and rocking manipulations of the perpendicular plate of the ethmoid bone are transmitted to, and injure, the cribriform plate.
Additional Disease Burden from Hay Fever and Sinusitis Accompanying Asthma
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: October 2014

Objectives:

We sought to determine the additional disease burden imparted by sinusitis and hay fever (allergic rhinitis) to patients with asthma.

Methods:

Patients with a diagnosis of asthma, hay fever, or sinusitis were extracted from the National Health Interview Survey for the 1997 to 2006 adult sample. Disease groups consisting of patients with asthma alone, asthma + hay fever, asthma + sinusitis, and asthma + hay fever + sinusitis were assembled. Disease groups were then compared according to total health-care visits per year, emergency room visits per year, health-care spending per year, and number of workdays lost per year to determine the disease burden.

Results:

We identified 11,813 patients (mean age, 45.5 years) who reported active asthma with or without hay fever or sinusitis comorbidity. Of these, 5,931 patients (50%) were identified with asthma alone, 1,134 (10%) with combined asthma + hay fever, 2,461 (21%) with asthma + sinusitis, and 2,287 (19%) with combined asthma + hay fever + sinusitis. Patients with asthma + sinusitis and those with asthma + sinusitis + hay fever had more total health-care visits and emergency room visits than did those with asthma alone (p < 0.001). All three groups with comorbidities had higher health-care expenditures than did the group with asthma alone (p ≤ 0.002). Patients with asthma + sinusitis and those with asthma + hay fever + sinusitis missed more workdays than did patients in the group with asthma alone (10.0 and 13.1 versus 7.2, respectively; p < 0.001). Comorbid hay fever alone did not increase workdays lost (6.6 days; p = 0.983).

Conclusions:

The additional disease burden of sinusitis on asthma is greater than that of hay fever. These data highlight the importance of identifying comorbid diagnoses with asthma.
Locus for Familial Migrainous Vertigo Disease Maps to Chromosome 5q35
Authors: Bahmad Fayez , DePalma Steven R. , Merchant Saumil N. , Bezerra Roberta L. , Oliveira Carlos A. , Seidman Christine E. , Seidman Jonathan G.
Published: October 2014

Objectives:

Migrainous vertigo (episodic vertigo associated with migraine) is sometimes inherited as an autosomal dominant trait. However, neither disease genes nor loci that might be responsible have been reported. We sought to map the genetic locus for familial migrainous vertigo in a 4-generation family and to define the progression of disease in this family.

Methods:

We studied 23 members in a family in whom migrainous vertigo was inherited as an autosomal dominant trait. Clinical information obtained included case histories and results of otolaryngological, neurologic, audiometric, and imaging evaluations. Genome-wide linkage analysis was performed with Affymetrix Genechip Human Mapping 10K microarrays. Genotyping of family members' DNA with microsatellite markers was used to further assess candidate loci identified from the whole-genome scan.

Results:

Of 23 family members, 10 suffered from migrainous vertigo beginning after 35 years of age. Migraine headaches usually preceded the onset of vertigo by 15 to 20 years. Longitudinal audiometric studies over 12 years showed stable, high-frequency sensorineural hearing loss consistent with presbycusis. Low-frequency or fluctuating hearing loss was not observed. The results of vestibular testing and imaging studies were unremarkable. Genetic analysis defined a 12.0 MB interval on chromosome 5q35 between loci rs244895 and D5S2073 that contained the disease gene (logarithm of odds score, 4.21).

Conclusions:

We report the first locus for familial migrainous vertigo, which mapped to 5q35.
Pepsin in Nonacidic Refluxate Can Damage Hypopharyngeal Epithelial Cells
Authors: Johnston Nikki , Wells Clive W. , Samuels Tina L. , Blumin Joel H.
Published: October 2014

Objectives:

Studies using combined multichannel intraluminal impedance with pH monitoring reveal a role for nonacidic reflux in laryngopharyngeal symptoms and injury. We have discovered that pepsin is taken up by laryngeal epithelial cells by receptor-mediated endocytosis. This finding reveals a novel mechanism by which pepsin could cause cell damage, potentially even in nonacidic refluxate. The objective of this study was to determine whether pepsin, at pH 7.4 and thus in nonacidic refluxate, causes cell damage.

Methods:

Cultured hypopharyngeal epithelial (FaDu) cells were exposed to human pepsin (0.1 mg/mL) at pH 7.4 for either 1 hour or 12 hours at 37°C and analyzed by electron microscopy, cytotoxicity assay, and SuperArray.

Results:

We report mitochondrial and Golgi complex damage in cells exposed to pepsin at neutral pH, observed by electron microscopy. We also report cell toxicity of pepsin at pH 7.4, measured by a cytotoxicity assay. Furthermore, using SuperArray, we found that pepsin at pH 7.4 significantly alters the expression levels of multiple genes implicated in stress and toxicity.

Conclusions:

These findings are perhaps the first to explain why many patients have symptoms and injury associated with nonacidic reflux, and could have important implications for the development of new therapies for reflux, such as pepsin receptor antagonists and/or irreversible inhibitors of peptic activity.
Profound Mixed Hearing Loss: Bone-Anchored Hearing Aid System or Cochlear Implant?
Authors: Verhaegen Veronique J. O. , Mulder Jef J. S. , Mylanus Emmanuel A. M. , Cremers W. R. J. , Snik Ad F. M.
Published: October 2014

Objectives:

We evaluated 5 patients who were changed over from a Baha Cordelle to a cochlear implant (CI). Moreover, the level of phoneme score was determined at which a Baha Cordelle user was better helped with a CI.

Methods:

We offer descriptive case reports and a retrospective evaluation of speech recognition in Baha Cordelle users and CI users.

Results:

In the CI users with noncompromised cochleas, the 10th percentile of the aided phoneme score in quiet at 65 dB sound pressure level (PS65) was 42%. We consider this PS65 as the cutoff level for switching from a Baha Cordelle to a CI. When patients with mixed hearing loss were using the Baha Cordelle, the PS65 of 42% was obtained at a mean sensorineural hearing loss component of about 70 dB hearing level (HL). This 70–dB HL component was used to consider Baha Cordelle users for cochlear implantation. The results of the 5 patients support these transition criteria.

Conclusions:

A CI is a valuable option in patients with mixed hearing loss when the sensorineural hearing loss component exceeds 70 dB HL or when the PS65 with a Baha Cordelle is less than about 40%. In such patients, the implantation procedure should be individualized on the basis of the clinical findings in the middle ear and mastoid cavity.
Anatomic Study of Middle Fossa Approach Landmarks Using an Image Guidance System
Authors: Pons Yoann , Lombard Bertrand
Published: October 2014

Objectives:

We sought to verify the relevance and reliability of the main temporal bone anatomic landmarks commonly used for the middle fossa approach and to test the use of digital technology to perform an accurate analysis of these landmarks.

Methods:

Ten fresh cadaveric temporal bones (5 heads) were analyzed by both computed tomographic imaging and dissection procedures, with the help of an image guidance system (DigiPointeur). Eight landmarks, which were selected for their wide citation in the otoneurosurgical literature, were studied.

Results:

Of the 8 landmarks studied, we obtained results similar to previously published data for 2 (the distance between the temporal squama and the internal auditory meatus [IAM] fundus, and the distance between the top of the anterior semicircular canal [ASCC] arch and the IAM fundus), but divergent measurements for the other 6 (the distance between the temporal squama and the arcuate eminence; the distance between the top of the ASCC arch and the cochlear promontory; the IAM roof thickness; the angle formed by the ASCC arch plane orientation and the IAM axis; the angle formed by the head of the malleus, the geniculate ganglion, and the IAM fundus; and the correspondence between the arcuate eminence and the top of the ASCC arch).

Conclusions:

The use of an image guidance system allowed us to make sharp and precise measurements of the main anatomic landmarks used during a middle fossa approach. We found 6 measurements to be different from those reported in previously published data out of the 8 landmarks studied.
Age-Associated Changes in the Expression and Deposition of Vocal Fold Collagen and Hyaluronan
Authors: Ohno Tsunehisa , Hirano Shigeru , Rousseau Bernard
Published: October 2014

Objectives:

We investigated age-associated changes in the expression and deposition of collagen and hyaluronan (hyaluronic acid; HA) in aged vocal folds.

Methods:

Thirty Sprague-Dawley rats were involved in this study. For gene expression analyses, 15 animals were divided into 3 age groups of young (2 month), adult (9 month), and elderly (18 month) rats. Real-time polymerase chain reaction testing was used to quantify the messenger RNA expression of procollagen types I and III, matrix metalloproteinases 2 and 9, and HA synthases 1, 2, and 3. The remaining 15 animals were divided into 3 similar age groups and underwent histologic analyses designed to investigate age-associated changes in the deposition of collagen and HA.

Results:

The results revealed down-regulated expression of procollagen types I and III, matrix metalloproteinases 2 and 9, and HA synthases 1, 2, and 3 in adult and elderly vocal folds, compared to young vocal folds. Histologically, staining of collagen was dense in the vocal folds of adult and elderly rats, and HA was less dense in the vocal folds of adult and elderly rats than in young rats.

Conclusions:

A slowdown in the expression of procollagens and matrix metalloproteinases was associated with dense collagen in aged vocal folds, as observed in elderly humans. A similar decrease in the expression of genes that code for HA synthase was consistent with a low density of extracellular matrix HA in the vocal folds of elderly rats.
Prevalence, Morphology, and Prognosis of Human Papillomavirus in Tonsillar Cancer
Authors: Luginbuhl Adam , Sanders Melinda , Spiro Jeffrey D.
Published: October 2014

Objectives:

We sought to identify the prevalence of human papillomavirus (HPV) in tonsillar squamous cell carcinoma, and to examine the relationship of HPV to prognosis and tumor morphology.

Methods:

We performed in situ hybridization for HPV and retrospective clinical outcome analysis.

Results:

Of the 48 patients with tonsillar carcinoma, in situ hybridization identified 35% as HPV-positive tumors. Age-matched controls had no evidence of HPV. There was no significant difference between HPV-positive and HPV-negative patients regarding age (p = 0.34), tobacco consumption (p = 0.59), alcohol consumption (p = 0.91), or treatment method (p = 0.39). Forty-four patients were eligible for outcome analysis. The overall rate of recurrence in this population was 25%, and the disease-specific survival rate was 84%. There was no significant difference between the two groups either in the incidence of recurrence (p = 0.14) or in the disease-specific survival rate (p = 0.19). HPV-associated tumors developed from the tonsillar crypts significantly more frequently than did HPV-negative tumors (p = 0.01).

Conclusions:

As previously described, HPV is significantly associated with squamous cell carcinoma of the tonsil; however, HPV status in our series did not correlate with clinical outcome. Morphologically, we found that HPV-positive tumors had their origin in the tonsillar crypts, whereas HPV-negative tumors arose from the surface epithelium.
Superior Thyroid Cornu Syndrome: An Unusual Cause of Cervical Dysphagia
Authors: Mortensen Melissa , Ivey Chandra M. , Iida Minoru , Woo Peak
Published: October 2014

Objectives:

Ossification of a superior thyroid cornu in men may cause pharyngeal airway impingement and result in cervical dysphagia. We report on a clinical case series of this rare condition, called superior thyroid cornu syndrome. This is the first report of a case series of this entity as a possible cause of cervical dysphagia that was successfully treated with an endoscopic procedure.

Methods:

A clinical case series of 12 patients were identified as having superior thyroid cornu syndrome (years 2001 to 2006). Eleven patients were male and 1 was female; their mean age was 54.6 years. They complained of unresolved throat pain, difficulty swallowing, and/or pain on swallowing. On flexible laryngoscopy, there was an asymmetric indentation of the pharynx due to a prominent superior thyroid cornu. Laryngeal manipulation produced the pain and exposed the prominent cornu in the airway. Computed tomographic evidence of calcification of the superior thyroid horn without other abnormality was noted.

Results:

After maximal medical treatment with proton pump inhibitors, anti-inflammatory agents, nasal steroids, antihistamines, and/or other allergy treatments, 8 of the patients who had persistent symptoms were treated by transoral pharyngotomy and resection of an approximately 2.0 × 0.5-cm segment of a thyroid cornu. Vast improvement in symptoms occurred in 6 patients, and complete symptom resolution occurred in 3 of those 6. Two of 8 patients reported improvement in swallowing, but persistent pain. The follow-up duration was between 2 and 15 months from the time of surgery.

Conclusions:

Superior thyroid cornu syndrome may be a rare cause of cervical dysphagia. It may be diagnosed by careful laryngoscopy with laryngeal palpation followed by a computed tomography scan. Surgical resection of the affected superior thyroid cornu by transoral pharyngotomy appears to be effective in relief of symptoms.
Surgical and Medical Treatment of Hearing Loss in Mixed Otosclerosis
Authors: Félix-Trujillo Manuel Martín , Valdez-Martínez Edith , Ramírez Jorge Eduardo , Lozano-Morales Ramón
Published: October 2014

Objectives:

We assessed the effect of using preoperative sodium fluoride (NaF) on the difficulty of working with the footplate during stapedectomy and its effect on the postsurgical hearing gain in patients with mixed otosclerosis (ie, otosclerosis and/or otospongiosis).

Methods:

There were 2 groups of patients with mixed otosclerosis. The experimental group was made up of patients with an active focus of the disease; they received NaF for 6 months and then underwent stapedectomy. The control group was made up of patients with an inactive focus of the disease; they underwent stapedectomy without administration of NaF.

Results:

The difference between the study groups in the degree of difficulty in extracting the footplate was not found to be statistically significant. Both groups had hearing gains in bone and air conduction. The level of posttreatment hearing gain in the group exposed to NaF was greater than that in the nonexposed group.

Conclusions:

Sodium fluoride administered to patients with mixed otosclerosis and an active focus of disease does not increase the difficulty of working with the footplate during stapedectomy, and it increases the hearing gain after the procedure.
Subarcuate Supralabyrinthine Approach for Supralabyrinthine Petrosal Cholesteatoma
Authors: van Dinther Joost J. S. , Vercruysse Jean-Philippe , De Foer Bert , Somers Thomas , Zarowski Andrzej , Casselman Jan , Offeciers Erwin
Published: October 2014

Congenital cholesteatomas of the petrosal apex account for 1% to 3% of all cholesteatomas and often present an important surgical challenge. This report describes an exceptional case of a “nondestructive” translabyrinthine surgical approach to a large congenital petrosal cholesteatoma that threatened the vestibulum, superior semicircular canal, facial nerve, and internal auditory canal. We applied a nonconventional transmastoid subarcuate supralabyrinthine approach in a 20-year-old patient by accessing the lesion through the center of the superior semicircular arch without damaging the integrity of the canal. This led to a complete removal of the petrosal cholesteatoma with preservation of hearing and vestibular function. Follow-up imaging performed 1 and 2 years after operation by means of non—echo-planar diffusion-weighted imaging did not show residual cholesteatoma. This report describes the first successful use of a subarcuate supralabyrinthine approach through the arches of the superior semicircular canal in a case of petrosal cholesteatoma.
Relaxation Thyroplasty for Mutational Falsetto Treatment
Authors: Remacle Marc , Matar Nayla , Verduyckt Ingrid , Lawson Georges
Published: October 2014

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty was proposed by Isshiki to shorten the vocal folds and release tension by incising and depressing the anterior segment of the thyroid cartilage. This procedure is called relaxation thyroplasty by a medial approach (anterior commissure retrusion) in the European Laryngological Society classification system. It results in a lowering of the vocal pitch. The surgery can be performed under local or general anesthesia. It should only be considered for cases not improved by speech therapy and psychological counseling. Our series included 7 male patients with a mean age of 21 years who underwent modified relaxation thyroplasty after failure of behavioral management. The assessment of outcomes was based on changes in the fundamental frequency of the voice and the Voice Handicap Index. The mean fundamental frequency was lowered from 187 Hz to 104 Hz (p < 0.001), and the mean Voice Handicap Index was improved from 70 to 21. There were no postoperative complications. The voice results were consistent over a mean follow-up of 17 months. Modified relaxation Isshiki (type III) thyroplasty is a successful treatment option for lowering vocal pitch in cases of mutational falsetto voice recalcitrant to conservative therapy.
Glottal Reconstruction with a Tissue Engineering Technique Using Polypropylene Mesh: A Canine Experiment
Authors: Yamashita Masaru , Kanemaru Shin-Ichi , Hirano Shigeru , Umeda Hiroo , Kitani Yoshiharu , Omori Koichi , Nakamura Tatsuo , Ito Juichi
Published: October 2014

Objectives:

The larynx must be resected in some cases of cancer or stenosis, and various techniques are generally employed to fill the resulting defect. No ideal way, however, has been established to restore vocal function after this form of insult. The aim of this preliminary feasibility study in a canine model was to investigate the effectiveness of a polypropylene-based tissue engineering approach to repair a partial glottal defect.

Methods:

Eight dogs were used in this study. A laryngeal defect involving resection of the left vocal fold was created through a thyroid cartilage window. A scaffold made of polypropylene and collagen was preclotted and wrapped with autologous fascia lata, inserted through the window, and sutured to the laryngeal defect in 5 dogs. The defect was reconstructed with an adjacent sternohyoid muscle flap in 3 control dogs. The surgical site was evaluated 3 months after operation by fiberscopic examination, computed tomographic imaging, histologic evaluation, and study of excised larynges.

Results:

On fiberscopic examination, the experimental group implants were completely covered with regenerated mucosa in all cases, and a favorable vocal fold contour was found in 4 of the 5 cases. One case was characterized by a concave vocal fold shape and red granulation. In the control group, the muscle flap was replaced by scarred mucosa with a concave vocal fold contour in 2 cases, and there was soft white granulation at the anterior resected edge in the third case. The histologic data revealed the regeneration of lined epithelium, subepithelial tissue, and muscle structure in both groups. The excised larynx phonatory data revealed reduced vibratory amplitude in the experimental group compared with the control group; however, excised phonation was not achieved in 2 of the 3 cases in the control group.

Conclusions:

This polypropylene-based tissue engineering technique appears to be a viable tool for glottal reconstruction; however, additional refinement is required to maximize long-term phonatory function.
Multiparameter Analysis of Titanium Vocal Fold Medializing Implant in an Excised Larynx Model
Authors: Witt Rachel E. , Hoffman Matthew R. , Friedrich Gerhard , Rieves Adam L. , Schoepke Benjamin J. , Jiang Jack J.
Published: October 2014

Objectives:

We evaluated the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) on the basis of acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup.

Methods:

Measurements were recorded on 8 excised canine larynges with simulated UVFP before and after medialization with a TVFMI.

Results:

The phonation threshold flow (p < 0.001) and phonation threshold power (p = 0.008) decreased significantly after medialization. The phonation threshold pressure also decreased, but this difference was not significant (p = 0.081). Jitter (p = 0.005) and shimmer (p = 0.034) decreased significantly after medialization. The signal-to-noise ratio increased significantly (p = 0.05). Differences in mucosal wave characteristics were discernible but not significant. The phase difference between the normal and paralyzed vocal folds (p = 0.15) and the amplitude of the paralyzed vocal fold (p = 0.78) decreased. The glottal gap decreased significantly (p = 0.004).

Conclusions:

The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with UVFP.
Arytenoid Adduction for Correcting Vocal Fold Asymmetry: High-Speed Imaging
Authors: Kimura Miwako , Imagawa Hiroshi , Nito Takaharu , Sakakibara Ken-Ichi , Chan Roger W. , Tayama Niro
Published: October 2014

Objectives

We hypothesized that high-speed digital imaging provides a quantitative method to evaluate the effect of arytenoid adduction for the correction of asymmetric and irregular vocal fold vibration in unilateral vocal fold paralysis.

Methods

Six subjects with unilateral vocal fold paralysis participated in the study (4 male, 2 female; mean [±SD] age, 52.5 ± 21.3 years). Videokymographic and laryngotopographic methods for image analysis were performed for highspeed recordings of vocal fold vibration for visualizing the glottal vibratory patterns, and for quantifying the frequency of vibration of each vocal fold, respectively. Comparisons of the paralyzed and the normal vocal folds were made before and after arytenoid adduction.

Results

Analysis of the laryngotopographs revealed 2 distinct frequencies of vibration for the paralyzed and the contralateral vocal folds for all subjects before surgery. After arytenoid adduction, the vibration frequencies became identical or nearly identical in all subjects.

Conclusions

Asymmetric vibration in vocal fold paralysis was exemplified by differences in vibration frequency between the vocal folds. The present data showed that after arytenoid adduction the vibration frequencies and the vibratory patterns of the contralateral vocal folds approached symmetry. This surgical procedure could improve the functional symmetry of the larynx for phonation.
Vocal Function Exercises for Presbylaryngis: A Multidimensional Assessment of Treatment Outcomes
Authors: Sauder Cara , Roy Nelson , Tanner Kristine , Houtz Daniel R. , Smith Marshall E.
Published: October 2014

Objectives

Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis.

Methods

Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images.

Results

After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures, and laryngeal images did not reveal significant changes.

Conclusions

These preliminary data suggest that vocal function exercises produce significant functional and perceptual improvements in voice, and deserve further attention as a treatment for elderly patients with presbylaryngis.
Hemoglobin Monitoring in Head and Neck Cancer Patients Undergoing Radiotherapy
Authors: Montgomery Jennifer , Syed Mohammed Iqbal , Rana Indu , Singh Jatinder , Clark Louise J.
Published: October 2014

Objectives

Anemia is a well-recognized factor for local recurrence and decreased survival in cancer patients undergoing radiotherapy. Additionally, lower hemoglobin (Hb) levels have a negative impact on radiotherapy efficacy and response rates. The objective of this audit was to investigate how frequently Hb levels were observed in head and neck cancer patients receiving radiotherapy within a multidisciplinary team setting.

Methods

We performed a retrospective first-cycle audit in a university hospital in Glasgow that is a tertiary referral center for head and neck cancer. Included were 78 patients with head and neck cancer who were undergoing radiotherapy. Online laboratory services and clinical case sheets were checked for each patient to monitor the frequency of observation of Hb levels before, during, and after radiotherapy.

Results

Of these 78 patients, only 49 had their Hb level checked before radiotherapy treatment, only 9 during radiotherapy, and only 27 after completion of radiotherapy treatment (p < 0.0001). Of the 49 patients with preradiotherapy Hb levels available, 24% were found to be anemic; none of these patients had their Hb monitored during radiotherapy, and only 4 had Hb levels recorded after completion of treatment.

Conclusions

This audit has highlighted that despite evidence emphasizing that anemia in cancer is an independent prognostic factor for recurrence, there is no formal protocol for Hb monitoring in head and neck cancer patients undergoing radiotherapy. The audit has also demonstrated that Hb monitoring is infrequently performed and that subsequent observation of the Hb level is suboptimal.
Congenital Cholesteatoma: Posterior Lesions and the Staging System
Authors: Inokuchi Go , Okuno Taeko , Hata Yuko , Baba Miyuki , Sugiyama Daisuke
Published: October 2014

Objectives

We described the characteristics of congenital cholesteatoma in Japanese patients and assessed whether the staging system is useful for predicting the rate of residual disease, the need for reexploration, and surgical outcomes.

Methods

We performed a retrospective chart analysis of 23 consecutive patients with congenital cholesteatoma.

Results

The proportion of cases with anterior-superior quadrant involvement was significantly lower in the Asian group than in Western patients. The total residual rate was 26%, and there was a positive association between stage and residual rate, ranging from 0% in stage I and II to 44% in stage IV. Canal wall–up tympanomastoidectomy was the most frequent procedure (57%), and 61% had reexploration.

Conclusions

Congenital cholesteatoma in Asia is less likely to involve the anterior-superior quadrant than in Western patients. The 4-stage system was useful for predicting residual rates, even in patients in whom anterior-superior quadrant involvement was less common. Postoperative hearing was significantly related to the stages. A routine second-look procedure may be unnecessary in the early stages, whereas reexploration would be better performed in advanced stages. Endoscopy might reduce residual disease and the need for reexploration in the near future.
Multicenter Evaluation of the Digisonic SP Cochlear Implant Fixation System with Titanium Screws in 156 Patients
Authors: Guevara Nicolas , Sterkers Olivier , Bébéar Jean-Pierre , Meller Renaud , Magnan Jacques , Mosnier Isabelle , Amstutz Isabelle , Lerosey Yannick , Triglia Jean-Michel , Roman Stéphane , Gahide Ivan
Published: October 2014

Objectives:

We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws.

Methods:

The characteristics of this implant allow cochlear implantation using a minimal incision, a subperiosteal pocket, and fixation with two titanium screws, without drilling a custom-fitted seat or creating suture-retaining holes in the skull. The fixation system relies on two tailfins for use of osseo-integratable screws, incorporated into the cochlear implant housing. The first version of this fixation system was modified after a case of device migration: The size of the titanium insert inside the silicone tailfin was increased. Data on 156 patients (8 months to 86 years of age) from a 4-year period in 6 cochlear implantation centers were retrospectively evaluated. Ten patients have undergone bilateral implantation.

Results:

Of 166 implantations, 4 postoperative infections and 1 device failure after head trauma were reported. No cerebrospinal fluid leaks or epidural hematomas were reported. One device migration was observed in the first series; no device migrations occurred in the second series.

Conclusions:

The fixation system with screws embedded in the Digisonic SP involves a fast and simple surgical technique that seems to efficiently prevent implant migration.
Do Viscid Secretions Have a Role in Nasal Polyp Formation?
Authors: Sayed Ramadan Hashem , Abu-Dief Eman E. , Mohamed Doha S.
Published: October 2014

Objectives:

We compared histologic findings on light microscopy of viscid secretions found in association with nasal polyps with those found in patients with chronic sinusitis without polyposis (CSWP). The differences might further understanding of nasal polyp pathogenesis.

Methods:

In a prospective controlled study, viscid secretions found in association with nasal polyps were collected at endoscopic sinus surgery. Retained secretions in patients with CSWP acted as a control group. Both were fixed in 10% formalin, processed, and examined with a light microscope.

Results:

Viscid secretions were encountered among nasal polyps in 25 of 132 patients (18.9%). Polyps containing multiloculated cysts filled with viscid secretions were found in 2 of them. Histologic examination of viscid secretions showed variable histologic pictures, ranging from a homogeneous material infiltrated with inflammatory cells, newly formed blood vessels, and bundles of collagen fibers to a well-developed connective tissue core covered with a respiratory epithelium in some areas. Histologic examination of retained secretions in patients with CSWP revealed amorphous material infiltrated with inflammatory cells with no further maturation or epithelial coverage.

Conclusions:

Viscid secretions, originating from ruptured mucosal cysts, might represent the initial step in nasal polyp pathogenesis. The variable histologic pictures detected possibly reflect different stages in nasal polyp formation from these secretions. Factors postulated in nasal polyp etiopathogenesis might trigger maturation and changes in the morphological structure of these secretions.
Bone Marrow Stem Cell Transplantation to Olfactory Epithelium
Authors: Ochi Naoki , Doi Kiyoshi , Uranagase Masahiro , Nishikawa Tasuku , Katsunuma Sayaka , Nibu Ken-Ichi
Published: October 2014

Objectives:

We sought to develop a new therapeutic strategy for degeneration of olfactory receptor neurons (ORNs).

Methods:

We transplanted into Balb/C mice, locally by transnasal injection and systemically via the tail vain, BrdU-labeled bone marrow stem cells, also known as NRGs, which have the ability to differentiate into neural cells. Bone marrow stem cells engrafted into the olfactory epithelium were examined immunohistochemically.

Results:

Compared with previous studies, in which bone marrow was transplanted rather than bone marrow stem cells, migration of transplanted bone marrow stem cells into the olfactory epithelium was observed earlier, and engraftment rates were significantly higher. However, migrated bone marrow stem cells were positive for GAP43 but not for olfactory marker protein.

Conclusions:

These results suggest that engrafted cells had differentiated into premature, but not mature, ORNs. Further experiments using autologous bone marrow stem cells in combination with various growth factors and/or neurotrophic factors should aid the development of new therapeutic methods for degenerated ORNs.
How Does the Absence or Presence of Subglottal Medialization Affect Glottal Airflow?
Authors: Grisel Jedidiah , Khosla Sid , Murugappan Shanmugam , Lakhamraju Raghava , Aubry James , Gutmark Ephraim , Huntress Gordon
Published: October 2014

Objectives:

Our previous work has shown that the symmetric, smooth, convergent shape of the subglottis reduces turbulent airflow at the glottal entrance. Medialization thyroplasty may alter the glottal shape and is very likely to introduce some degree of glottal asymmetry, which could result in increased turbulence and a reduction in voice quality. This study reports the effects of medializing and not medializing the subglottis in silicone models of human cadaveric larynges.

Methods:

In experiment 1, silicone models of 4 human cadaveric larynges were created. The subglottis was then completely medialized in all 4 models. Hot-wire anemometry was used to measure velocity and turbulence profiles at the entrance and exit of the subglottis. In experiment 2, 1 model was created to accommodate incremental medialization of the glottis without any medialization of the subglottis. Airflow characteristics were likewise measured.

Results:

In experiment 1, the average maximum turbulence intensity (TI) at the exit of the larynx was less than the TI of incoming tracheal airflow for all 4 larynges. In experiment 2, incremental medialization of the glottis did not affect the TI for medialization up to 35%. However, the TI significantly increased for medialization of 53%.

Conclusions:

Medialization of the subglottis does not significantly affect the turbulence reduction properties of the subglottis, even though subglottal asymmetry is introduced. On the other hand, large amounts of medialization of the glottis only (with no subglottal medialization) can introduce significant amounts of turbulence.
Computed Tomography and Otosclerosis: A Practical Method to Correlate the Sites Affected to Hearing Loss
Authors: Wycherly Benjamin J. , Berkowitz Frank , Noone Anne-Michelle , Kim H. Jeffrey
Published: October 2014

Objectives:

We present a practical method for correlating computed tomography (CT) scans with hearing loss in otosclerosis.

Methods:

We reviewed the CT scans of 18 patients (34 ears) with clinical otosclerosis who were seen between 2007 and 2008. The scans were reviewed by an otologist in a clinical office setting, followed by a blinded radiologist working at an imaging workstation. The 5 most commonly affected sites in otosclerosis were evaluated for evidence of otospongiosis and then correlated with the degree of air-bone gap and sensorineural hearing loss.

Results:

Positive CT findings were noted in 70.5% of ears, with a 94% concordance between readings. The sites affected included the ante fenestram (21 ears), round window niche (12), cochlear promontory (4), cochlear apex (3), and posterior fenestram (2). The average air-bone gap increased with each additional site of involvement within an otic capsule (p = 0.004). The bone conduction threshold also increased, on average, with each additional affected site (p = 0.047).

Conclusions:

Most patients with clinical evidence of otosclerosis have evidence of otosclerosis on CT that is readily detected in the office setting. Ears with more affected sites have a significantly greater degree of air-bone gap and sensorineural hearing loss.
Analysis of Pepsin in Tracheoesophageal Puncture Sites
Authors: Bock Jonathan M. , Brawley Mary K. , Johnston Nikki , Samuels Tina , Massey Becky L. , Campbell Bruce H. , Toohill Robert J. , Blumin Joel H.
Published: October 2014

Objectives:

Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association.

Methods:

Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate–polyacrylamide gel electrophoresis Western blot analysis.

Results:

Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy.

Conclusions:

Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.
Clinical Presentation and the Presence of Hearing Impairment in Branchio-Oculo-Facial Syndrome: A New Mutation in the TFAP2A Gene
Authors: Thomeer Henricus G. X. M. , Crins Tom T. H. , Kamsteeg Erik J. , Buijsman Wendy , Cruysberg Johannes R. M. , Knoers Nine V. A. M. , Cremers W. R. J.
Published: October 2014

We report on the clinical presentation of branchio-oculo-facial (BOF) syndrome in 2 patients with mutations in the TFAP2A gene (OMIM 107580). This TFAP2A gene was recently shown to be involved in the causation of BOF syndrome. An overview of the literature on BOF syndrome is given based on clinical reports written in the period during which mutation analysis was not yet available for BOF syndrome. We also give descriptions of the mutations in the TFAP2A gene in our 2 new patients with BOF syndrome. Congenital conductive hearing impairments are described, including hearing rehabilitation and the results of ear surgery.
Effects of Nerve-Muscle Pedicle on Immobile Rat Vocal Folds in the Presence of Partial Innervation
Authors: Aoyama Takashi , Kumai Yoshihiko , Yumoto Eiji , Ito Takaaki , Miyamaru Satoru
Published: October 2014

Objectives:

We investigated whether implantation of an ansa cervicalis nerve (ACN)–muscle pedicle into the thyroarytenoid (TA) muscle is efficacious in the presence of partial recurrent laryngeal nerve (RLN) innervation.

Methods:

We studied a total of 36 rats. Twelve of the rats served as positive and negative control animals. In the remaining 24 rats, the left RLN was transected, a 1-mm piece of nerve was removed, and the stumps were abutted in silicone tubes (STs), inducing partial RLN regeneration. Twelve of the ST-treated rats underwent this procedure alone, and the other 12 rats had a nerve-muscle pedicle (NMP) implanted into the left TA muscle 5 weeks after ST treatment. At 15 weeks, reinnervation was assessed by histologic evaluation of the TA muscle and by electromyography with stimulation of the RLNs and ACNs.

Results:

The muscle area, the number of nerve terminals, the number of acetylcholine receptors, and the ratio of nerve terminals to acetylcholine receptors were significantly greater (p < 0.05) in the NMP group than in the ST group. Electromyography elicited TA muscle compound action potentials upon stimulation of the RLNs and ACNs.

Conclusions:

In rats, NMP implantation is efficacious for reducing atrophic changes in the TA muscle in the presence of partial RLN innervation.