bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Recurrent Laryngeal Nerve Transection and Vagotomy on Respiratory Contraction of the Cricothyroid Muscle
Authors: Woodson Gayle E.
Published: October 2014

The cricothyroid muscle (CT) appears to be an accessory muscle of respiration. Phasic inspiratory contraction is stimulated by increasing respiratory demand. Reflex activation of the CT may be responsible for the paramedian position of the vocal folds, and hence airway obstruction, in patients with bilateral recurrent laryngeal nerve (RLN) paralysis. Previous research has demonstrated the influence of superior laryngeal nerve (SLN) afferents on CT activity. The present study addresses the effects of vagal and RLN afferents. Electromyographic activity of the CT and right posterior cricoarytenoid muscle was monitored in anesthetized cats during tracheotomy breathing and in response to tracheal or upper airway occlusion in the intact animal. This was repeated following left RLN transection, bilateral vagotomy, and bilateral SLN transection. Vagotomy abolished CT response to tracheal occlusion and markedly reduced the response to upper airway occlusion. Vocal fold position following RLN transection appeared to correlate with CT activity; however, observed changes were minor.
Effects of Nitrogen Mustard-N-Oxide on Ionic Activities of Inner Ear Fluid and Ionic Permeabilities of the Cochlear Partition in the Guinea Pig
Authors: Ikeda Katsuhisa , Takasaka Tomonori , Kusakari Jun , Saito Yoshitaka
Published: October 2014

The effect of nitrogen mustard-N-oxide (NMO) on the endocochlear potential (EP) was investigated from the aspect of the ion concentrations and permeabilities in the cochlea. Compared with the untreated animals, in NMO-treated animals 20 to 30 hours after administration, the EP was decreased (30.8 ± 3.5 mV in NMO versus 82.4 ± 1.6 mV in control), the K+ concentration in perilymph of the scala tympani was increased (8.2 ± 1.0 m M versus 5.3 ± 0.7 m M), the K+ concentration in endolymph was decreased (128.5 ± 10.6 m M versus 157.9 ± 7.9 m M), and the Na+ concentration in endolymph was increased (9.6 ± 3.6 m M versus 2.5 ± 0.4 m M). The permeability coefficient for Na+ of the cochlear partition in the NMO-treated animals significantly decreased, while that for Cl− significantly increased. The negative EP, which presumably exists in the normal state, diminished further (−2.7 mV versus −27.8 mV), and the calculated electrogenic potential of the EP was depressed remarkably (33.5 mV versus 110.2 mV). The results suggest that the effects of NMO involved changes in ion permeabilities of the partition and the inhibition of electrogenic transport processes in the cochlea.
Immunohistochemical Analysis of the Olfactory Mucosa by Use of Antibodies to Brain Proteins and Cytokeratin
Authors: Yamagishi Masuo , Hasegawa Satoshi , Nakano Yuichi , Takahashi Sugata , Iwanaga Toshihiko
Published: October 2014

The present study deals with the immunohistochemical detection of four brain-derived proteins and cytokeratin in the normal olfactory mucosa of humans and guinea pigs. Neurofilament protein immunoreactivity was found in the olfactory vesicles, dendrites, and perikaryon of receptor cells, and in thick nerve bundles located deep in the lamina propria. The antiserum to neuron-specific enolase (NSE) selectively stained olfactory receptor cells throughout the length of the bundles. The NSE immunoreactivity also was recognized in nerve bundles of various sizes throughout the lamina propria. Glia-specific S-100 protein immunoreactivity was present in Bowman's glands as well as in all nerve bundles in the lamina propria, but not in any cellular elements constituting the olfactory epithelium. Immunoreactivity for spot-35 protein, which was considered to be specific for cerebellar Purkinje cells, was found in flasklike cells (microvillar cells) occurring near the free surface of the epithelium. The basal cells in the olfactory and respiratory epithelium were stained positively with a cytokeratin antiserum.
Primary Intravestibular Lipoma
Authors: Huang Tsun-Sheng
Published: October 2014

An intravestibular lipoma was discovered during destructive surgery for disabling vertigo in a case diagnosed as delayed endolymphatic hydrops. The author recommends that in cases that resemble Meniere's disease but have unusual symptoms, the existence of other lesions within the inner ear should be suspected.
Bacteriology of Chronic Maxillary Sinusitis in Adults
Authors: Brook Itzhak
Published: October 2014

Aspirates of 72 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. Bacterial growth was present in 66 of the 72 specimens (92%). Anaerobic bacteria were isolated in 58 of the 66 culture-positive specimens (88%). Anaerobes only were recovered in 37 cases (56%) and in 21 (32%) they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in eight cases (12%). A total of 185 isolates (2.8 per specimen) — 131 (2.0 per specimen) anaerobes and 54 (0.8 per specimen) aerobes or facultatives — were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides sp, and the predominant aerobes or facultatives were Streptococcus sp and Staphylococcus aureus. Twelve of the 27 Bacteroides sp that were tested for β-lactamase (44%) produced the enzyme. These findings indicate the major role of anaerobic organisms in chronic sinusitis.
Antigen-Specific Immune Response in the Inner Ear
Authors: Tomiyama Shunichi , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2014

The specificity of inner ear immune responses was investigated by challenging each inner ear of presensitized animals with different antigens. Animals presensitized systemically with keyhole limpet hemocyanin (klh) and bovine serum albumin (BSA) were challenged with klh in the right and BSA in the left inner ears. Two weeks later perilymph anti-klh levels were increased significantly in the right inner ears compared to the levels in the left inner ears. In contrast, perilymph anti-BSA levels were increased significantly in the left inner ears compared to the levels in the right inner ears. These results suggested that the rise in perilymph antibody following inner ear antigen challenge was predominantly the result of an antigen-specific immune response in the inner ear and not simply the result of an increase in vascular permeability or serum contamination from the experimental procedure itself.
Cylindrical Cochlear Electrode Array for Use in Humans
Authors: van der Puije Patrick D. , Pon Carlos R. , Robillard Hugh
Published: October 2014

This report describes the fabrication of a flexible multichannel electrode array suitable for use in humans. The conductors, pads, and stimulating tips are made of platinum on a polyimide substrate. Photolithographic techniques are employed in the fabrication of the electrode on a planar surface in the form of a film. The film is rolled subsequently into a cylinder of diameter 0.50 mm and the cylinder is filled with medical grade silicone rubber. The stimulation pads then form rings around the cylinder. In vitro and in vivo tests are ongoing with good results so far.
Role of Perilymphatic Fistula in Sudden Hearing Loss: An Animal Model
Authors: Oshiro Eric M. , Shelton Clough , Lusted Hugh S.
Published: October 2014

The electrophysiologic response of the guinea pig cochlea was monitored after sequential lesions to Reissner's membrane and the round window (RW). Action potential (AP) responses to click stimuli were recorded from the RW before and after discrete puncture-type lesions were created in the cochlear partition of the second turn. Observed decrements were typically minor, comparable to no greater than 10 dB attenuation of stimulus intensity. The RW membranes then were perforated to create perilymphatic fistulas. Further monitoring demonstrated a rapid (within 5 to 10 minutes), severe decrement in AP amplitude and latency, with complete loss of the AP within 1 hour. Control animals with RW perforations alone did not show these decrements. Correct placement of the second turn lesions was documented by histology. We conclude that discrete lesions in the cochlear duct are not reflected in the AP input-output functions unless there is a fluid leak from the RW, and thus present a possible model for idiopathic sudden hearing loss.
Sclerosing Orbital Pseudotumor: A Unique Clinicopathologic Entity
Authors: Weissler Mark C. , Miller Eydie , Fortune Michael A.
Published: October 2014

A case of orbital pseudotumor is presented that histologically showed dense fibrosis invading bone and adjacent sinuses, and failed to respond to either steroids or radiation therapy. “Orbital pseudotumor” remains a sobriquet for a variety of clinical and histopathologic entities including a monomorphous lymphocytic benign or malignant neoplasm; a polymorphous reactive inflammatory lesion; and a densely fibrosing sclerotic variant that appears to behave more aggressively, often locally invades adjacent structures, and may be related to a multifocal fibrosclerosis that also includes retroperitoneal fibrosis, Riedel's sclerosing thyroiditis, mediastinal fibrosis, and sclerosing cholangitis. This “sclerosing orbital pseudotumor” is felt to represent a unique clinicopathologic entity, and an approach to its treatment is described.
Congenital Anomalies of the Eustachian Tube in down Syndrome
Authors: Shibahara Yoshihiro , Sando Isamu
Published: October 2014

Congenital anomalies of the eustachian tube (ET) that may play an important role in the cause of otitis media with effusion should be investigated histopathologically. One such anomaly, which has not been thoroughly investigated to date, is that accompanying Down syndrome. This report describes histopathologic findings in a temporal bone obtained from a 26-weeks' gestation male fetus with Down syndrome. As compared to a control specimen, its ET was extremely small, mostly collapsed in the midcartilaginous, isthmus, and tympanic portions, and had poorly developed lateral cartilage in the midcartilaginous portion. This is the first case report of such ET anomalies, which appear to be due to an insult to the ET that occurs earlier in fetal life than the 16th gestational week. This insult is possibly a causative factor in postnatal ET dysfunction.
Phonosurgery: Indications and Pitfalls
Authors: Maves Michael D. , McCabe Brian F. , Gray Steven
Published: October 2014

Twenty-five patients underwent type 1 thyroplasty (external medialization of abducted true vocal cord) during a 2-year period (1986 to 1988) at the University of Iowa. The most common indication for thyroplasty was post-thyroidectomy vocal cord paralysis. Eighteen patients (72%) had either a good or an excellent initial result. Five patients were revised. Postrevision, 21 patients (84%) had achieved either a good or an excellent result. Complications were limited to one case of significant vocal cord edema and another instance of vocal cord hemorrhage. No patient required a tracheotomy. No prosthesis extruded. We feel that phonosurgery has the advantages over traditional Teflon injection of allowing the patient's head to be in a neutral position during the operation; of allowing local anesthesia; of permitting a predictable, graduated end point of the procedure; and of being infinitely adjustable, with preservation of the vocal cord mucosal wave.
Bedside Videolaryngoscopic Assessment of Intubation Trauma
Authors: Alessi David M. , Hanson David G. , Berci George
Published: October 2014

Telescopic laryngoscopic examination was performed at the bedside after extubation in 29 consecutive surgical intensive care unit patients who required endotracheal intubation for more than 16 hours. The examinations were documented with a portable video recording system. The majority of patients exhibited evidence of acute endolaryngeal trauma. Vocal fold ulceration and vocal fold motion abnormalities were the most common lesions. Patients with abnormal larynges were followed up after discharge from the intensive care unit. Most of the identified injuries resolved without intervention. However, silent aspiration was identified frequently in patients with vocal fold paresis and was thought to be a significant factor in postoperative pulmonary complications. Early identification of significant laryngeal trauma and/or vocal fold paresis in critically ill patients is important for both postoperative pulmonary care and voice rehabilitation. This pilot study demonstrated that documentation of the laryngeal examination is feasible in critically ill patients in an intensive care unit setting.
Endoscopic Problems Due to Cervical Vertebral Diseases
Authors: Welsh Louis W. , Welsh John J. , Chinnici Joanne C.
Published: October 2014

The authors draw attention to cervical spine disorders that limit mobility of the vertebrae and thereby interfere with esophagoscopy. Four orthopedic disorders that either fuse the cervical spine or produce massive osteophytes are discussed and exemplified by specific cases, and appropriate techniques for endoscopy are recommended.
Auditory Brain Stem Response Monitoring during Middle Ear Surgery
Authors: von Scheel Jobst , Mrowinski Dieter , Gerull Günther , Thoma Josef
Published: October 2014

Conductive hearing loss can be determined in the course of middle ear surgery by sound probe stimulation and simultaneous recording of auditory brain stem responses. Mechanical properties of the ossicular chain, usually judged subjectively by the surgeon's visual and tactile senses, can be quantified objectively. Thus, disarticulation of ossicles can be localized precisely, and fixation of the head of the malleus can be differentiated from stapes fixation. Moreover, the function of the reconstructed ossicular chain or prosthesis may be ascertained.
Large Pituitary Adenomas with Extension into the Nasopharynx
Authors: van der Mey Andel G. L. , van Krieken Johan H. J. M. , van Dulken Hans , van Seters Arnoud P. , Vielvoye Jan , Hulshof Jan H.
Published: October 2014

Three cases of pituitary adenoma with extension into the nasopharynx and nasal cavity are reported. The occurrence of this rare tumor underscores the need to consider a pituitary tumor whenever a patient presents with rhinologic complaints and destruction of the sellar floor. Epistaxis, although exceptional, may be the first manifestation of a pituitary tumor. Immunohistochemical analysis combined with staining for the pituitary hormones proved to be essential for reaching a definite diagnosis. Magnetic resonance imaging seems to be the modality of choice for differentiation between tumorous and nontumorous sinus obstruction.
Cytokeratin Patterns of Tissues Related to Cholesteatoma Pathogenesis
Authors: Grote Jan J. , Out Coby J. , van Blitterswijk Clemens A. , Lutgert Rik W. , van Muijen Goos N. P. , Hesseling Saco C. , Fransen Jack A. M.
Published: October 2014

Specimens of cholesteatoma matrix, meatal epidermis, and middle ear epithelium were removed during surgery, and immunohistochemical techniques were used to investigate cytokeratin expression. The use of five chain-specific anticytokeratin monoclonal antibodies and one broad specific anticytokeratin monoclonal antibody showed the divergent behavior of middle ear epithelium compared with the cytokeratin expression of the other two types of epithelium. Middle ear epithelium was characterized by the presence of cytokeratins 4, 8, 18, and 19, whereas in both cholesteatoma and meatal epidermis cytokeratin 10 predominated. Furthermore, cholesteatoma showed an infrequent focal presence of cytokeratins 4, 18, and 19. The similarity between cholesteatoma and meatal epidermis with respect to morphology, and the presence of cytokeratin 10 support an epidermal origin of cholesteatoma. However, a metaplastic origin cannot be excluded, because of the infrequent occurrence of a small amount of cytokeratins 4, 18, and 19 in cholesteatoma matrix that was not found in meatal epidermis but was a component of the cytokeratin pattern of middle ear epithelium.
Type II Collagen Distribution in the Ear of the Guinea Pig Fetus
Authors: Ishibe Tsukasa , Cremer Michael A. , Yoo T. J.
Published: October 2014

By using monoclonal antibodies to type II collagen and immunohistochemical techniques, we studied the distribution of type II collagen in the developing guinea pig ear. Type II collagen appearance and disappearance corresponded to cartilage development and resorption. Type II collagen was identified in Meckel's and Reichert's cartilages, the cartilage plate of the auricle and external acoustic meatus, the ossicles, eustachian tube cartilage, and the otic capsule. Type II collagen also appeared with the development of structures in noncartilaginous parts including the tympanic membrane, tympanic annulus, basilar membrane, spiral limbus, spiral ligament, and osseous spiral lamina, Rosenthal's canal, the maculae of the utricle and saccule, and the semicircular canal membrane, crista ampullaris, and endolymphatic duct. Type II collagen is distributed widely in the ear after the early stages of development. Thus, type II collagen should be considered an important structural component of the ear.
Phonosurgical Studies: Fat-Graft Reconstruction of Injured Canine Vocal Cords
Authors: Wexler David B. , Gray Steven D. , Jiang Jiaqi , Titze Ingo R.
Published: October 2014

Damage to the vocal cords can result in scarring and impaired vibration and can manifest clinically as hoarseness and loss of vocal power. If the vibratory characteristics could be restored in these scarred vocal cords, the vocal intensity and efficiency of phonation also should improve. In an effort to enhance the vibration of damaged vocal cords, we implanted a submucosal fat autograft within the injured vocal cord cover layer of dogs 6 weeks after unilateral mucosal excision had been performed. Three months postoperatively these animals were compared to normal dogs and those with mucosal excision but no fat-grafting. Acoustic and biomechanical measures of phonation were collected from an excised larynx preparation. We found that the fat-augmented vocal cords had lower threshold pressures for phonation, greater vocal intensity, and more efficient acoustic output than injured vocal cords without the fat-grafting. These results provide a foundation for further research on reconstructive surgery of damaged vocal cords.
Long-Term Results of Nerve-Muscle Pedicle Reinnervation for Laryngeal Paralysis
Authors: Tucker Harvey M.
Published: October 2014

Between 1976 and 1986, 214 patients with bilateral vocal fold paralysis and 73 patients with unilateral vocal fold paralysis were managed by the author using the nerve-muscle pedicle technique for reinnervation. Follow-up of at least 2 years has been obtained on 202 of the bilaterally and 70 of the unilaterally involved patients. Long-term success has been achieved in 74% of the bilateral group and 88% of the unilateral group. Successful reinnervation of unilateral paralyses usually maintains voice correction indefinitely, but there is late (2 to 5 years postsurgery) deterioration of successful airway restoration in approximately 17% of bilateral cases, which appears to be due to development of cricoarytenoid arthritis.
Congenital Subglottic Stenosis: The Elliptical Cricoid Cartilage
Authors: Holinger Lauren D. , Oppenheimer Randy W.
Published: October 2014

Various malformations of the cricoid cartilage produce congenital subglottic stenosis. The elliptical cricoid cartilage first was demonstrated histopathologically in horizontal sections of six postmortem specimens and now has been identified clinically in ten patients. The clinical diagnosis of the elliptical cricoid cartilage, suggested by anteroposterior soft tissue neck films, is confirmed at direct laryngoscopy. Delineation of the precise location, extent, and histopathology of subglottic stenosis provides the basis for rational management.
Red Blood Cell Scan in Cavernous Hemangioma of the Larynx
Authors: Finkelstein David M. , Noyek Arnold M. , Kirsh Joel C.
Published: October 2014

Cavernous hemangioma of the larynx is an uncommon, difficult-to-diagnose vascular tumor for which there is no significant imaging literature to date. The possibility of improved diagnosis through RBC scanning might obviate injudicious biopsy and potential hemorrhage within the airway. Utilizing the radionuclide RBC scan, which labels the patient's own RBCs initially with cold pyrophosphate, and subsequently with technetium 99m as pertechnetate, we have identified successfully four patients with cavernous hemangioma of the larynx. All presented with a supraglottic mass involving at least the aryepiglottic fold and arytenoid region unilaterally. This report describes our satisfactory diagnostic imaging experience with the radionuclide RBC scan and suggests both its imaging specificity and its role in the management of this lesion.
Hydroxylapatite for Laryngotracheal Framework Reconstruction
Authors: Hirano Minoru , Yoshida Tetsuji , Sakaguchi Shinji
Published: October 2014

Hydroxylapatite plates and rings were employed for reconstruction of the laryngotracheal framework in 12 patients. The cause of the framework defect was surgery for stenosis in nine cases and removal of malignancy in the other three. The trough method associated with a two-stage procedure was tolerated in all 12 cases. Hydroxylapatite plates or rings were used to reconstruct the framework during the second stage. The implant was well taken in all cases, without any infection or rejection. Nine of the 12 cases resulted in excellent airways.
Acute Airway Obstruction Due to Necrotizing Tracheobronchial Aspergillosis in Immunocompromised Patients: A New Clinical Entity
Authors: Berlinger Norman T. , Freeman Todd J.
Published: October 2014

Two immunocompromised patients with severe neutropenia developed acute airway obstruction due to Aspergillus mycetoma formation in the trachea and main bronchi. The mycetomas caused transmural necrosis of the airway. In one patient, the necrosis extended through the bronchus intermedius into the pulmonary artery, resulting in a fatal hemorrhage during bronchoscopy.
Nerve Fiber Analysis of the Facial Nerve
Authors: Fujii Mayumi , Goto Noboru
Published: October 2014

Nerve fiber analyses were conducted on the human facial nerve with use of a new staining method (Luxol-PAS-hematoxylin stain; discriminative staining method) that permits simultaneous observation of the axon and surrounding myelin sheath. The following combination of equipment was employed in the study: An image-analyzing digitizer, a microscope with a drawing tube, and a computer for storing the data and performing statistical analyses. The numbers, transverse areas, and circularity ratios of axons were measured in 11 cases. The average number of axons composing one facial nerve was 6,254, and the average size of the axons was 6.23 μm2. The results indicated that although the numbers of axons became reduced with age, the transverse areas and circularity ratios of the axons did not change with age.
Posttracheotomy Granulation Tissue Managed by Carbon Dioxide Laser Excision
Authors: Werkhaven Jay , Maddern Bruce R. , Stool Sylvan E.
Published: October 2014

The problem of accumulation of granulation tissue and scar at the superior edge of the tracheostoma is a frequent problem in the management of chronic tracheotomy patients. This traditionally has been managed by cup forceps excision or by eversion through the tracheostoma with a skin hook and blind resection. These methods often lead to hemorrhage, and incomplete removal in a bloody field. We have used the carbon dioxide laser via a bronchoscope for ablation of the granulation tissue and/or scar at the stomal edge and at the tracheotomy tube proximal tip without morbidity in 13 pediatric cases. With experience, removal with the laser often proceeds more quickly than conventional methods. The scar and granulation tissue are excised under direct vision with minimal hemorrhage. We believe this to be a reasonable alternative in the management of this recurring problem.
Osteomyelitis of the Frontal Bone
Authors: Montgomery William W. , Cheney Mack L. , Jacobs Edward E.
Published: October 2014

Osteomyelitis of the frontal bone and its complications remain a diagnostic and therapeutic challenge to the head and neck surgeon. This paper will deal with the etiology, pathogenesis, diagnosis, and treatment of osteomyelitis of the frontal bone, and its complications and sequelae. Special emphasis is placed on techniques for repair of forehead defects.
Treatment of Depressed Tinnitus Patients with Nortriptyline
Authors: Sullivan Mark D. , Sakai Connie S. , Dobie Robert A. , Katon Wayne J.
Published: October 2014

Patients disabled by tinnitus show a high prevalence of major depression. Furthermore, tinnitus produces patterns of disability similar to those produced by major depression. To explore further this link between tinnitus and depression, and to investigate the efficacy of treating depression in the treatment of tinnitus, a single-blind, placebo-washout, nonrandomized pilot study of the tricyclic antidepressant nortriptyline (hydrochloride) was undertaken in disabled tinnitus patients who also met diagnostic criteria for major depression. Nineteen patients began the study, two responded to placebo, and two dropped out prior to completion. Fourteen considered their tinnitus improved, and 12 chose to continue taking nortriptyline after the study. Depression severity decreased, on the average, by 65% (p<.0001). Tinnitus loudness measured by audiometric matching decreased by a mean of 10 dB or 50% (p<.02). Self-reports of tinnitus loudness and severity, somatic and psychologic symptoms, and psychosocial dysfunction all showed significant improvement with treatment. These results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability.
Meniere's Syndrome and Endolymphatic Hydrops
Authors: Rauch Steven D. , Merchant Saumil N. , Thedinger Britt A.
Published: October 2014

A systematic double-blind assessment of case histories and histopathologic findings in temporal bones in the collection at the Massachusetts Eye and Ear Infirmary was performed to test the hypothesis that clinical Meniere's syndrome is associated with endolymphatic hydrops demonstrated histopathologically at death. Thirteen of 13 cases of clinical Meniere's syndrome were found to have endolymphatic hydrops not attributable to other causes. However, some patients with idiopathic endolymphatic hydrops did not exhibit clinical Meniere's syndrome as revealed in their medical records. These results challenge the dogma that endolymphatic hydrops per se generates the symptoms of Meniere's syndrome.
Newer Technique of Laryngeal Reinnervation: Superior Laryngeal Nerve (Motor Branch) as a Driver of the Posterior Cricoarytenoid Muscle
Authors: Maniglia Anthony J. , Dodds Brian , Katirji M. B. , Sorensen Kelly , Rosenbaum Mary L.
Published: October 2014

This report analyzes the experience gained using two different techniques to reinnervate the paralyzed vocal cord. In the neurotization group, the superior laryngeal nerve (SLN) motor branch–cricothyroid muscle pedicle was used to reinnervate the posterior cricoarytenoid muscle. In the direct nerve anastomosis group, the SLN was anastomosed to the abductor branch of the recurrent laryngeal nerve (RLN), and the ansa hypoglossi (AH) to the adductor branch of the RLN. A third group of animals (control) had the right RLN sectioned without any anastomosis. About 5 to 6 months postoperatively the animals were killed painlessly and evaluated. The neurotization group revealed vocal fold mobilization on the right side to have an average of about half of the mobility of the left, normal side. After the RLN and SLN on the left were severed as well as the AH bilaterally, the vocal cord mobility was reduced to about one fourth. The direct nerve anastomosis group showed about fourfold less vocal cord mobility than the neurotization group. After the SLN, RLN, and AH were severed bilaterally, the control group showed no vocal cord mobility. The neurotization technique has been selected for further experimentation in human adults.
Basaloid-Squamous Carcinomas of the Upper Aerodigestive Tracts
Authors: Batsakis John G. , El Naggar Adel
Published: October 2014

Basaloid-squamous carcinoma is a new addition to the lexicon of variants of squamous cell carcinoma. The carcinoma is distinctive histologically, is biologically high grade, and manifests a predilection for the base of tongue, hypopharynx, and supraglottic larynx.
Applications of the Voice Prosthesis during Laryngectomy
Authors: Singer Mark I. , Blom Eric D. , Hamaker Ronald C. , Yoshida Glen Y.
Published: October 2014

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented. Eighty percent of the population achieved a durable voice, and the complications were infrequent. The results support the primary use of tracheoesophageal phonation as a relatively safe and reliable alternative to total laryngectomy alone.
Carbon Dioxide Laser Posterior Cordectomy for Treatment of Bilateral Vocal Cord Paralysis
Authors: Dennis Donald P. , Kashima Haskins
Published: October 2014

Upper airway obstruction due to bilateral vocal cord paralysis was successfully relieved by carbon dioxide laser posterior cordectomy. All patients achieved satisfactory airway and decannulation. Flow-volume loop spirograms obtained preoperatively and postoperatively documented improved flow rates on inspiration and expiration. Final voice quality was subjectively good in all patients. Follow-up has ranged from 1 year 10 months to 5 years 8 months, and initial improvement has been sustained in all cases. Carbon dioxide laser posterior partial cordectomy is an alternative management option for relief of upper airway obstruction due to bilateral vocal cord paralysis. The procedure can be performed without prophylactic tracheotomy. Subjectively good voice quality is preserved.
Surgical Implantation and Biocompatibility of Central Nervous System Auditory Prostheses
Authors: Niparko John K. , Altschuler Richard A. , Wiler James A. , Xue Xiaolin , Anderson David J.
Published: October 2014

As part of a program to determine the feasibility of a CNS auditory prosthesis, the tissue reaction to electrodes chronically implanted in the cochlear nucleus (CN) of the guinea pig was examined. Varied open operative approaches and microelectrode designs were utilized. Silicon substrate thin film and platinum-iridium wire electrodes, tethered and untethered, were placed successfully in different divisions of the CN. Implantation through a posterior suboccipital approach was most successful. Histologic examinations demonstrated a glial cell proliferation confined to the area of the electrode track that never exceeded 15 μm in width. No neuronal loss or significant effect on cell morphology was seen, and reactive cells were absent. Electrode migration was apparent in a minority of animal preparations. Although potential problems were identified, our findings lend support to the feasibility of implanting a neuroprosthesis in the CN and have helped to establish methods for future studies of chronic intranuclear stimulation.
Round Window Membrane and Perilymph in Experimental Otitis Media with Effusion
Authors: Suzuki Masashi , Fujiyoshi Tatsuya , Kawauchi Hideyuki , Mogi Goro
Published: October 2014

To investigate the influence of middle ear effusion (MEE) on perilymph (PL), an experimental otitis media with effusion (OME) was manufactured in chinchillas by injecting the tympanic cavity with immune complexes. The presence of MEE lasted for up to 9 days after the injection of immune complexes. Perilymph was aspirated on the fourth, tenth, and 21st days after the inoculation. The mean concentrations of albumin, immunoglobulin G, histamine, and prostaglandin E2 (PGE2) were significantly greater in PL from ears with induced OME than in that from normal control ears. The 3H-PGE2 placed on the round window membrane of pathologically affected ears passed into PL in significantly greater amounts than in normal control ears. The findings indicate that the immune complexes placed in the middle ear cavity affect the biochemical milieu of PL, and that MEE is a result of immune complexes.
Clinical Diagnosis of Anterior Inferior Cerebellar Artery Thrombosis
Authors: Hinojosa Raul , Kohut Robert I. , Harker Lee A.
Published: October 2014

A patient having the diagnosis of an anterior inferior cerebellar artery insufficiency died 36 hours after the onset of the symptoms that allowed this diagnosis. The special features of this study include a known symmetric 40-dB hearing loss 1 year prior to the onset of the symptoms, the noted decrease in hearing and severe vertigo heralding the vascular accident, the ensuing neurologic deficits, and the short duration of the patient's life after the onset of her symptoms. The patient's clinical course and the histopathologic findings of the brain stem involved the vestibular nuclei, facial nerve, nuclei of nerve V, restiform body and middle cerebellar peduncle and labyrinth including loss of sensory epithelium of the cochlea and vestibular system and the ganglion cells of Scarpa's ganglion. These findings are correlated with previous animal studies and those of Reye's syndrome. To the authors' knowledge this is the first report of a temporal bone histopathologic study from a patient having had the diagnosis of a labyrinthine arterial vascular accident.
Prevention of Aspiration in Infants and Young Children: Federal Regulations
Authors: Reilly James S.
Published: October 2014

Aspiration of and asphyxiation from small objects is a well-known danger to young infants and children. At present, there are three different federal regulations that address this problem, by specifying different dimensions of height, width, and length. The Small Parts Regulation, which affects toy size, is the least stringent and is being challenged. The anatomic and physiologic concepts behind these important regulations are analyzed and discussed. The idea of a single generic standard is also reviewed.
Neck Dissection for Laryngeal Adenoid Cystic Carcinoma: Is it Indicated?
Authors: Ferlito Alfio , Barnes Leon , Myers Eugene N.
Published: October 2014

The authors report six cases of adenoid cystic carcinoma with a view to evaluating the validity of neck dissection in this tumor. Adenoid cystic carcinoma may invade regional lymph nodes by direct extension, but true embolic lymph node metastases are so rare, if they exist at all, that neck dissection may be considered an overtreatment.
Ventral Cleft of the Larynx: A Rare Congenital Laryngeal Defect
Authors: Cohen Seymour R. , Thompson Jerome W.
Published: October 2014

An anterior cleft of the larynx is apparently extremely rare. Only two patients with this defect have been reported in the American literature. The purpose of this paper is to present a child who was aphonic at birth and who was later found to have a congenital anterior cleft of the larynx. The diagnosis is established by the clinical symptoms, direct laryngoscopic examination, and radiographic studies. While severe voice change is the most prominent symptom of this defect, chronic aspiration is also a disquieting symptom, albeit controllable. The literature is reviewed, and the patient's symptoms and radiographic findings are documented. The clinical course over a period of almost 4 years is discussed.
Middle Ear Gas Generation in Myringoplasties
Authors: Buckingham Richard A.
Published: October 2014

No Gelfoam was used to support the vein in 10 simple underlay vein graft myringoplasties. Computed tomographic studies 24 hours postoperatively showed gas filling 75% to 100% of the middle ears in three ears. The epitympanum and mastoid were also evaluated. Apparently, in some ears the middle ear generates gas in the immediate postoperative period to support fresh vein grafts.
Middle Ear Mucosa in Ramsay Hunt Syndrome
Authors: Fujiwara Yasuo , Yanagihara Naoaki , Kurata Takeshi
Published: October 2014

We report two patients with Ramsay Hunt syndrome, together with histopathologic findings of the middle ear mucosa near the facial canal. An attempt was made to find specific antigens of varicella zoster virus (VZV) and herpes simplex virus (HSV) by an immunofluorescence method. Histopathologic examination revealed inflammation of the middle ear mucosa. Specific VZV antigens were demonstrated in the cytoplasm and nucleus of elliptically shaped cells and round cells, but no specific antigens of HSV were found. The findings suggest a pathogenetic relationship between VZV infection and inflammatory changes in the middle ear mucosa.
Endotoxin and Lysosomal Protease Activity in Acute and Chronic Otitis Media with Effusion
Authors: Sakakura Kenji , Hamaguchi Yukiyoshi , Yamagiwa Mikikazu , Harada Teruhiko , Sakakura Yasuo
Published: October 2014

Endotoxin levels and lysosomal protease (collagenase, cathepsin B, and lysozyme) activity were measured in 104 middle ear effusions (MEEs) from patients with otitis media with effusion (OME). The MEE samples were classified into four groups: Pediatric serous, mucoid, and acute, and adult serous. Endotoxin levels and lysosomal protease activity in MEEs were significantly different in the following order: Adult < serous < mucoid < acute groups, indicating that both endotoxin and lysosomal proteases are more closely related to the pathogenesis of pediatric chronic OME than to adult OME. In pediatric serous and mucoid effusions, endotoxin level had a significant correlation with activity of the lysosomal proteases. In conclusion, endotoxin enhances leukocyte infiltration into the middle ear, and lysosomal proteases released from leukocytes damage the middle ear mucosa and thereby prolong mucosal inflammation, which may be responsible for delayed recovery from acute OME.
Prospective Study of Subglottic Stenosis in Intubated Neonates
Authors: Grundfast Kenneth M. , Camilon Felizardo S. , Barber Colin S. , Pransky Seth , Fink Robert
Published: October 2014

Although numerous retrospective studies have attempted to investigate the incidence, etiology, and pathogenesis of subglottic stenosis, there have been few prospective studies. The retrospective studies focused initially on diagnosed cases, then drew inferences regarding incidence and causality based upon data obtained from review of patient records. In contrast, this prospective study accrued data on all neonates intubated for 48 hours or longer during the 1-year intake period. There were 195 neonates entered in the study; then 36 were excluded, leaving 159 for data analysis. Parameters assessed included age at intubation (mean, 5.7 days), duration of intubation (mean, 12.3 days), and number of times reintubated (mean, 0.79). Results of this prospective study are compared to results from previous retrospective studies.
Cadaver Middle Ears as Models for Living Ears: Comparisons of Middle Ear Input Immittance
Authors: Rosowski John J. , Davis Paul J. , Donahue Kathleen M. , Merchant Saumil N. , Coltrera Marc D.
Published: October 2014

In vitro measurements of the middle ear input immittance in temporal bones extracted from human cadavers were directly compared with similar in vivo measurements from clinically normal subjects. The results of this comparison indicate that most otoscopically normal unfixed cadaver ears have middle ear input immittances that are indistinguishable from those of live subjects in the 0.1- to 2-kHz range — As long as they have been kept from drying and the static pressures on either side of the tympanic membrane are equal. The effects of the middle ear muscles on the measured input immittance are generally small and the cadaver ears can be maintained in the frozen state for several months with little change. Tympanometry appears to be a reliable indicator of normal middle ear immittance. Cadaver middle ears are useful models of human middle ear function.
Supracricoid Laryngectomy with Cricohyoidoepiglottopexy: A Partial Laryngeal Procedure for Glottic Carcinoma
Authors: Laccourreye Henri , Laccourreye Ollivier , Menard Madeleine , Weinstein Gregory , Brasnu Daniel
Published: October 2014

The partial horizontal supracricoid laryngectomy with cricohyoidoepiglottopexy consists of resection of the whole thyroid cartilage and paraglottic space. The cricoid cartilage, the hyoid bone, most of the epiglottis, and at least one arytenoid cartilage are conserved. Thirty-six patients with squamous cell carcinoma of the glottis who underwent this procedure from 1974 through 1986 are presented. All 36 recovered physiologic deglutition and phonation. None required a permanent tracheotomy. The 3-year actuarial survival rate was 86.5%. The local recurrence rate was 5.5%. The indications for the procedure are carcinomas of the glottis that 1) spread beyond the confines of the membranous portion of the true vocal cord or 2) present with limitation of true vocal cord mobility. The procedure is presented as a useful alternative to radiotherapy, partial vertical laryngectomy, and total laryngectomy in select cases of glottic carcinoma.
Electromyography of the Inferior Constrictor and Cricopharyngeal Muscles during Swallowing
Authors: Elidan Joseph , Gonen Benjamin , Shochina Mara , Gay Isaac
Published: October 2014

Electromyography (EMG) of the inferior pharyngeal constrictor (IC) and the cricopharyngeal (CP) muscle was recorded in 18 patients with swallowing and/or aspiration problems who were candidates for cricopharyngeal myotomy. The EMG recordings were compared to those of 13 “normal” subjects who did not suffer from such problems. Differences in EMG activity between the control group and the patient group were considered with respect to the clinical symptoms in the patient group. Recording of EMG in the CP and IC muscles is relatively safe, useful, and easily mastered. The technique may provide important information regarding the function of some of the muscles involved in deglutition.
Experimental Endolymphatic Hydrops: Are Cochlear and Vestibular Symptoms Caused by Increased Endolymphatic Pressure?
Authors: Böhmer Andreas , Dillier Norbert
Published: October 2014

The correlation between inner ear pressure and cochlear function was investigated in guinea pigs with unilaterally obliterated endolymphatic sacs and ducts. In 11 animals that developed endolymphatic hydrops, auditory thresholds as monitored by auditory evoked action potentials had increased with recruitment. Most of these animals also experienced episodes of spontaneous nystagmus. In control ears endolymphatic pressure did not differ more than 0.5 cm H2O from perilymphatic pressure. In six of 11 hydropic ears, endolymphatic pressure was more than 0.5 cm H2O higher than perilympathic pressure; auditory thresholds in all these ears had deteriorated within 2 weeks before pressure recording. No further hearing deterioration within this period was noted in five hydropic ears with endolymphatic pressure equal to or lower than perilymphatic pressure. Endolympathic-perilymphatic pressure gradients may contribute to auditory threshold increase in endolymphatic hydrops, but are not its only cause.
Imbalance and Chronic Secretory Otitis Media in Children: Effect of Myringotomy and Insertion of Ventilation Tubes on Body Sway
Authors: Jones Nick S. , Prichard Andrew J. N. , Radomskij Paul , Snashall Susan E.
Published: October 2014

We studied balance in 34 children with chronic secretory otitis media and compared them with 34 age- and sex-matched control children between the ages of 3 and 5 years. In addition to history and examination, objective measurements were obtained by use of a fixed force plate body sway platform in both the control group and the group with chronic secretory otitis media. We took measurements in both groups at an interval of 4 months to ensure that any improvement in body sway could not be attributed to normal maturation. Eight parameters of body sway were compared, including three new parameters not described elsewhere (mean squared velocity, the number of intersections, and velocity moment). Our study showed that balance is significantly worse in children with chronic secretory otitis media compared to a control group. Furthermore, the increased body sway of children with chronic secretory otitis media was returned to the normal range by myringotomy and insertion of ventilation tubes.
Osteogenic Sarcoma of the Frontal Sinus
Authors: Gupta Deepak , Vishwakarma S. K.
Published: October 2014

Occurrence of osteogenic sarcoma in the craniofacial bones is limited. The case presented here is only the second reported case of osteogenic sarcoma of the frontal sinus, occurring in an 80-year-old woman who presented with proptosis and developed neurologic symptoms. The radiographic appearance was of a diffuse opacity with thickening of the calvaria. Tumor tissue was adherent to the dura, and there was a fairly good initial response with the methotrexate sodium–cisplatin combination chemotherapy used, but the outcome was fatal.
Jejunal Interposition for Repair of Stricture or Fistula after Laryngectomy
Authors: de Vries Egbert J. , Johnson Jonas T. , Petruzzelli Guy J. , Myers Eugene N. , Shestak Kenneth , Jones Neil F. , Schusterman Mark A. , Wagner Robin
Published: October 2014

Complications following total laryngectomy may include pharyngocutaneous fistula or pharyngeal stricture. Traditional techniques of repair of fistula and stricture with local or regional flaps lead to a high rate of failure. In this study, we report 18 patients treated by secondary jejunal interposition (JI) to rehabilitate swallowing following recalcitrant postlaryngectomy stricture or fistula. All patients had undergone total laryngectomy with or without partial pharyngectomy for treatment of squamous cell carcinoma of the larynx (8) or hypopharynx (10). Four were stage II; 5, stage III; and 9, stage IV. Thirteen patients (72%) regained swallowing function. Complications of secondary JI included perioperative death (2), flap loss (1), and persistent fistulas (3). Jejunal interposition may be the best modality in the rehabilitation of swallowing in patients with persistent fistula or stricture that fails to respond to traditional management.
Use of the Nasogastric Tube after Total Laryngectomy: Is it Truly Necessary?
Authors: Aprigliano Flavio
Published: October 2014

The nasogastric tube has been routinely used to feed the patient during the first postoperative days after a total laryngectomy. In the last 21 years the author has performed 625 total laryngectomies without using the feeding tube. With this procedure oral feeding could be started during the third postoperative day, making the patient more comfortable and confident. In addition, the hospital stay was shortened. It was also observed that the incidence of pharyngeal fistulas (9%) was comparable to that of other reports in the literature.
Bilateral Endolymphatic Hydrops in Meniere's Disease: Review of Temporal Bone Autopsies
Authors: Yazawa Yoshiro , Kitahara Masaaki
Published: October 2014

The wide range in incidence rates reported for bilateral Meniere's disease results mainly from the lack of established clinical criteria for bilaterality, and from follow-ups of varying duration. In order to help determine a reasonable bilateral involvement rate, we examined histologic reports of temporal bones with endolymphatic hydrops. We reviewed the literature on temporal bone autopsies from 1938 to 1988, and selected 72 cases for histologic examination. Of the 72 cases, 67 (93%) showed endolymphatic hydrops, 2 (2.8%) showed collapse, and 3 (4.2%) showed membranous labyrinths of normal appearance. Twenty of the 67 endolymphatic hydrops cases (29.9%) displayed bilateral involvement, suggesting a rate of bilaterality in Meniere's disease of approximately 30%.