bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological, Neural, Endocrine, and Immune Study of Stress in Tinnitus Patients: Any Correlation between Psychometric and Biochemical Measures?
Authors: Savastano Marina , Aita Maria , Barlani Federico
Published: October 2014

Objectives:

The present study was carried out in tinnitus patients in order to study the psychological distress and the biochemical measures of this stressful condition. Psychological features were compared to immune and neuroendocrine parameters in order to verify in these subjects the possible presence of psychological and somatic responses to stress.

Methods:

We studied 85 tinnitus patients who underwent hematochemical immune tests: Lymphocyte subpopulations (CD3; CD4; CD3+CD4; CD8; CD19; CD16NK; CD3+CD16+CD56; and CD4/CD8), cortisol, adrenocorticotropic hormone, β-endorphin, prolactin, and urinary catecholamine.

Results:

Clinically, significant scores were obtained for hysteria, depression, paranoia, hypochondrias, and social introversion; and high scores were obtained for anxiety, depression, care for health, difficulty of treatment, low self-esteem, family and work difficulties, and social discomfort. There was a low to medium level of self-perception of stress. The less a subject felt stressed, the higher was his or her satisfaction level in the areas of psychological and physical functioning. The scores on the tests and the biochemical measures did not show a significant correlation, but there was a tendency to correlation for the lymphocytes CD19 and CD16NK and for adrenocorticotropic hormone.

Conclusions:

The comparison between the psychometric and biochemical variables did not reveal any significant correlation among stress perception, daily satisfaction, and the biochemical parameters of stress.
Branchial Cyst Side Predilection: Fact or Fiction?
Authors: Doshi Jayesh , Anari Shahram
Published: October 2014

Objectives:

It is a common teaching that two thirds of branchial cysts occur on the left side of the neck. We reviewed the evidence behind this statement and assessed whether they actually do present twice as often on the left side.

Methods:

Our study comprised two parts: 1) a historical review of branchial cysts and 2) a retrospective review of 91 histologically confirmed cases operated on at two British hospitals in the years 1999 to 2005. The side of the branchial cyst was recorded.

Results:

Early studies on branchial cysts did not always rely upon histologic diagnosis; the definition of a branchial cyst has varied throughout medical history. The statement “two thirds of branchial cysts occur on the left” is based upon these early studies in which the definition was variable. In our study, right-sided branchial cysts were actually more common than left-sided branchial cysts (53.8% versus 45%; χ2 test, p = .399). One percent were bilateral.

Conclusions:

Ours is the largest single study in the past 50 years to look at the side predilection of branchial cysts in terms of histologic proof. We propose that branchial cysts may not present more commonly on the left side of the neck, as is commonly taught in medical schools.
Immunocompetency in Children with Recurrent Respiratory Papillomatosis: Prospective Study
Authors: Stern Yoram , Felipovich Alexandra , Cotton Robin T. , Segal Karl
Published: October 2014

Objectives:

We sought to investigate the immunologic status of children with recurrent respiratory papillomatosis and to evaluate possible correlations between the patients' immunocompetency and the clinical course of the disease.

Methods:

Twenty children with recurrent respiratory papillomatosis underwent immunologic evaluation every 6 months for determination of complete blood count, serum immunoglobulin levels, lymphocyte subpopulations, lymphocyte response to mitogen stimulation, and natural killer cell function. The patients were observed prospectively (42 to 56 months), and their clinical course was recorded. The findings were compared with those in healthy age-matched controls.

Results:

The CD4/CD8 ratio and the lymphocyte response to mitogen stimulation were significantly reduced in the study children compared to normal controls. A reduction in lymphocyte response to mitogen stimulation was significantly correlated to a high number of papilloma sites and more frequent recurrences. Abnormal natural killer cell function was significantly correlated to more frequent recurrences.

Conclusions:

A compromised cell-mediated immune response may be associated with repeated or persistent human pap-illomavirus infections, leading to the development of recurrent respiratory papillomatosis. Patients with an aggressive clinical course may have underlying cell-mediated immunodeficiency. Long-term prospective investigations are needed to establish the role of the host immune system in the pathogenesis of recurrent respiratory papillomatosis in children.
Histopathology of Ossicular Grafts and Implants in Chronic Otitis Media
Authors: Bahmad Fayez , Merchant Saumil N.
Published: October 2014

Objectives:

We describe the histopathology of ossicular grafts and implants so as to provide insight into factors that may influence functional results after surgery for chronic otitis media.

Methods:

Histopathologic observations were made on 56 cases: 50 surgical specimens and 6 temporal bone cases in which the graft was sectioned in situ.

Results and Conclusions:

Autogenous malleus, incus, and cortical bone grafts behaved in a similar manner and maintained their morphological size, shape, and contour for extended periods of time, at least up to 30 years. These histopathologic observations support the continued use of autograft ossicular and cortical bone grafts for middle ear reconstruction. Cartilage grafts developed chondromalacia with resulting loss of stiffness and showed a tendency to undergo resorption. Synthetic prostheses made of porous plastic (Plastipore, Polycel) elicited foreign body giant cell reactions with various degrees of biodegradation of the implants. Prostheses made of hydroxyapatite and Bioglass were enveloped by a lining of connective tissue and mucosal epithelium. The Bioglass material was broken down into small fragments and partially resorbed by a host response within the middle ear. These results warrant caution in the use of prostheses made of porous plastic or Bioglass.
Human Lung Mucous Glands Manifest Evidence of the H+/K+-ATPase Proton Pump
Authors: Altman Kenneth W. , Waltonen Joshua D. , Tarjan Gabor , Radosevich James A. , Haines G. Kenneth
Published: October 2014

Objectives:

The H+/K+-ATPase proton pump has been demonstrated in human laryngeal submucosal glands, and is not solely present in the parietal cells of the stomach. Although proton secretion is present in the lung, a variety of mechanisms have been elucidated. The hypothesis of this study is that the H+/K+-ATPase proton pump is one additional pathway of proton secretion in the human lung.

Methods:

Fourteen surgical lung specimens from 10 subjects were retrospectively obtained after approval from our Human Subjects Committee. Banked human stomach tissue was used for comparative positive and negative controls. Sections were immunostained with 2 monoclonal antibodies selectively reactive with alpha or beta subunits of the H+/K+-ATPase proton pump.

Results:

In the human lung, consistent staining for both subunits was present in the mucous gland cells and ducts in all specimens in which mucous glands were present (6 specimens from 5 subjects). Overall, weak to strong staining was present in focal areas within the multicellular mucous glands. There was only scant focal staining in the respiratory epithelium in 4 specimens. Stomach parietal cells exhibited strongly positive staining for both subunits of the proton pump. There was no staining in stomach cells that were not morphologically consistent with parietal cells.

Conclusions:

The H+/K+-ATPase proton pump is present in mucous cells and ducts in the human lung, with some variable expression noted. Proton pump inhibitor pharmacotherapy may have a site of action in the human lung, explaining some of the controversies otherwise attributable to interrelatedness of aerodigestive tract disease.
Intratympanic Steroids for Idiopathic Sudden Sensorineural Hearing Loss
Authors: Fitzgerald Dennis C. , McGuire John F.
Published: October 2014

Objectives:

We undertook to evaluate the effectiveness of intratympanic (IT) steroid injections for treating idiopathic sudden sensorineural hearing loss (ISSHL) by performing a retrospective case series study in a private otology practice.

Methods:

A total of 21 eligible patients with ISSHL were included. We defined ISSHL as a hearing loss of 20 dB or more at at least 3 consecutive audiometric frequencies that develops within 72 hours or less and cannot be attributed to any commonly identifiable cause of sudden hearing loss. Three IT injections of 0.4 mL of 62.5 mg/mL methylprednisolone solution were administered 1 week apart. The end point for the study was a clinically significant change in audiometric values, with a positive response determined to be a 10-dB or greater improvement in the 4-tone pure tone average and/or a 15% or greater improvement in the word discrimination score. Audiometric data were recorded just before therapy and 1 week after the last IT treatment. The potentially confounding variables recorded included age, sex, “prompt treatment” (defined as treatment within 14 days from onset), concurrent or prior treatment with oral steroids, and severity of hearing loss.

Results:

The overall response rate to the IT steroid protocol was 67% (14 of 21 patients), with a 95% confidence interval of 43% to 85%. Backward stepwise logistic regression identified “prompt treatment” as the only variable that significantly affected the outcome. The response rate of the “prompt treatment” cohort was 91% (10 of 11 patients), with a 95% confidence interval of 59% to 100%.

Conclusions:

These findings support the use of IT steroids as an early intervention in the treatment of ISSHL.
Late Displacement of a Montgomery Thyroplasty Implant following Endotracheal Intubation
Authors: Ayala Marco A. , Patterson Matthew B. , Bach Kevin K.
Published: October 2014

Objectives:

We document a late displacement of a thyroplasty implant following endotracheal intubation.

Methods:

A 66-year-old man was referred to our clinic with a chief complaint of breathy dysphonia immediately following an elective inguinal hernia repair under general endotracheal anesthesia. The patient's medical history was significant for a medialization laryngoplasty with a Montgomery implant 14 years earlier.

Results:

Examination and computed tomographic scanning of the neck confirmed displacement of the implant. The patient underwent revision medialization laryngoplasty with successful restoration of his voice quality.

Conclusions:

This case report illustrates a potential complication of endotracheal intubation in patients who have previously undergone vocal fold medialization procedures.
Solitary Fibrous Tumors in the Head and Neck: New Insights and Implications for Diagnosis and Treatment
Authors: Ridder Gerd Jürgen , Kayser Gian , Teszler Christian Barna , Pfeiffer Jens
Published: October 2014

Objectives:

The solitary fibrous tumor (SFT) is a potentially malignant spindle cell neoplasm of mesenchymal origin that was originally described as a thoracic lesion originating from pleural tissue. Recently, numerous extrapleural sites of origin have been described, frequently affecting the head and neck region. The purpose of this article is to focus on a formerly underestimated neoplasm and to highlight its appearance in the head and neck region.

Methods:

The authors present 2 illustrative cases, including what is probably the first reported case of an SFT arising in the human tonsillar fossa, and give a clinical and pathological literature review.

Results:

The clinical, histologic, and radiologic features are presented, and the surgical treatment is described. The international medical literature concerning SFTs in general and SFTs of the head and neck in particular is reviewed, and the changing concept of SFTs and hemangiopericytomas is discussed on the basis of the updated World Health Organization classification of soft tissue tumors.

Conclusions:

It is nowadays recognized that the large majority of lesions formerly classified as hemangiopericytomas are, in fact, variants of SFTs. Although still a rare occurrence, SFTs have become increasingly recognized, and clinicians should be aware of their presentation.
Effect of Uvulopalatopharyngoplasty on Work of Breathing during Wakefulness in Obstructive Sleep Apnea Syndrome
Authors: Lin Ching-Chi , Lee Kuo-Sheng , Wang Ying-Piao , Hsieh Wen-Yeh , Shen Sheng-Yeh , Chiu Chung-Hsin , Liaw Shwu-Fang
Published: October 2014

Objectives:

We evaluated the effects of uvulopalatopharyngoplasty (UPPP) on the work of breathing (WOB) in obstructive sleep apnea syndrome (OSAS).

Methods:

Fifteen healthy subjects and 30 subjects with OSAS who desired UPPP were prospectively enrolled. All underwent measurement of WOB while awake as well as in a sleep study. These studies were repeated 3 months after UPPP in the patients with OSAS.

Results:

In OSAS before UPPP, the WOB while supine was increased above that of normal subjects. After UPPP, the WOB while supine remained elevated in those whose OSAS did not respond to surgery, and it returned to normal levels in patients whose OSAS improved after UPPP.

Conclusions:

Abnormal WOB in patients with OSAS returns to normal if UPPP results in amelioration of OSAS.
Alström Syndrome: Progressive Deafness and Blindness
Authors: Welsh Louis W.
Published: October 2014

Alström syndrome is a very rare, genetically transmitted disorder that affects special sense functions, resulting in progressive visual and auditory impairment. The diagnostic criteria for this disorder are presented, and the differential issues between it and other, similar syndromal forms of sensory and multisystem dysfunction are discussed. A report of 2 siblings so involved is summarized. The disability of other organs is considered, namely, the kidney, the heart, and the metabolic and endocrine systems.
Upper Mediastinal Node Dissection for Hypopharyngeal and Cervical Esophageal Carcinomas
Authors: Hirano Shigeru , Nagahara Kunihiko , Moritani Sueyoshi , Kitamura Morimasa , Takagita Shin-Ichi
Published: October 2014

Objectives:

Hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce) are aggressive tumors with a poor prognosis. Multiple lymph node metastases often occur in the upper mediastinum, as well as in the neck, and thus upper mediastinal dissection (MD) is crucial to improving the cure rate. However, excessive MD can increase postoperative morbidity and mortality, making it important to employ the proper technique and appropriate extent of dissection. In the present retrospective study we aimed to determine the proper extent of upper MD according to tumor site and stage. The benefit and risk of upper MD are also discussed.

Methods:

Chart review was completed for patients who underwent upper MD, including 64 patients with HPC, 21 patients with Ce, and 9 patients with Ce extending to involve the upper thoracic esophagus (Ce/Ut). The incidence and distribution of lymph node metastases in the upper mediastinum were assessed by postoperative histopathologic examination. Postoperative complications of upper MD, as well as the impact on survival and locoregional control, were also reviewed.

Results:

Upper mediastinal metastases were detected in 7.8% of HPC patients, 33.3% of Ce patients, and 55.6% of Ce/Ut patients. In HPC patients, mediastinal metastases were usually associated with T4 primary tumors (80%), whereas positive nodes in the upper mediastinum were detected regardless of T stage in both Ce and Ce/Ut. Only 1 Ce/Ut patient with a T4 tumor developed late nodal metastasis in the lower mediastinum. The 5-year disease-specific survival and locoregional control rates were 58.6% and 90.2% in HPC, 45.5% and 94.1% in Ce, and 38.9% and 77.7% in Ce/Ut, respectively. Rupture of the greater vessels after MD was observed in 5 cases (5.3%).

Conclusions:

The present results indicate excellent locoregional control rates following upper MD, while major complications such as arterial breakdown were rare. It is suggested that upper MD may be an essential and adequate procedure for patients with Ce or Ce/Ut tumors, and may also be required for cases of HPC with a T4 primary to improve locoregional control of the disease.
Laryngoscopies in the Obese: Predicting Problems and Optimizing Visualization
Authors: Hekiert Adrianna M. , Mandel Jeff , Mirza Natasha
Published: October 2014

Objectives:

This pilot study was designed to 1) identify predictors of difficult laryngeal exposure in obese patients, 2) develop strategies for efficient intubation and intraoperative visualization of the glottis, and 3) devise perioperative protocols for difficult laryngoscopies.

Methods:

We undertook a retrospective study over a 1-year period of 14 consecutive patients with a body mass index of more than 30 kg/m2 who underwent elective direct laryngoscopy under general anesthesia. Measurements of height, weight, neck circumference, Mallampati score, and Cormack-Lehane classification of the airway were recorded. Problems encountered during anesthesia induction and emergence were also noted. The laryngologist recorded on a visual analog scale the degree of difficulty encountered in obtaining a binocular stereoscopic view and magnification, illumination, and suspension.

Results:

Anatomic challenges during difficult laryngoscopy included decreased neck extension, redundant folds of tissue in the oropharynx and hypopharynx, and upper airway collapsibility. Overall, there was an association between the incidence of difficult laryngeal exposure and the Cormack-Lehane score (r = .57; p = .03), but the Mallampati score was of limited utility to the laryngologist. Neck size in female patients correlated with the Cormack-Lehane score (p = .02). Neither weight nor body mass index were predictive of a difficult laryngeal exposure. Straight blade laryngoscopes with a distal flange allowed greater depth of insertion and provided the best visualization of the glottis.

Conclusions:

An appropriate clinical examination may help predict a difficult airway. However, further studies are warranted to fully characterize the anatomic predictors of a difficult laryngeal exposure.
Phenotype Description of a Novel DFNA9/COCH Mutation, I109T
Authors: Pauw Robert J. , Huygen Patrick L. M. , Collin Rob W. J. , Cruysberg Johannes R. M. , Hoefsloot Lies H. , Kremer Hannie , Cremers W. R. J.
Published: October 2014

Objectives:

This is a report of the audiological and vestibular characteristics of a Dutch DFNA9 family with a novel mutation, I109T, in the LCCL domain of COCH.

Methods:

From the family with the novel I109T COCH mutation, audiometric data were collected and analyzed longitudinally. Results were compared to those obtained in previously identified P51S, G88E, and G87W COCH mutation carriers. Special attention was also given to a comparison of age-related features such as progressive hearing loss and vestibular impairment.

Results:

A novel mutation (I109T) in COCH segregates with hearing impairment and vestibular dysfunction in the present family. Pure tone thresholds, phoneme recognition scores, and vestibular responses of the I109T mutation carriers were essentially similar to those previously established in P51S, G87W, and G88E mutation carriers. Deterioration of hearing in the I109T mutation carriers started at 43 years of age, and vestibular function deteriorated at least 7 years later.

Conclusions:

The phenotype associated with the novel COCH (I109T) mutation is largely similar to that associated with P51S and G88E mutation carriers. However, subtle differences in terms of onset age and rate of progression seem to exist.
Comparative Neuromuscular Histopathology of Cricopharyngeal Achalasia Patients with and without Previous Botulinum Toxin Treatment
Authors: Merati Albert L. , Tseng Jeffrey , Blumin Joel H. , Toohill Robert J. , Jaradeh Safwan
Published: October 2014

Objectives:

Botulinum toxin injection (BTX) and cricopharyngeal (CP) myotomy are performed in the treatment of CP achalasia (CA). The objective of this study was to examine the effects of BTX on neuromuscular histopathologic findings and to make direct comparisons between specimens of muscle from CA patients who had received BTX to the upper esophageal sphincter and from CA patients who had no previous exposure to BTX.

Methods:

We performed a retrospective review (2001 to 2005) of CP muscle specimens from all patients who underwent myotomy for CA. Cases of Zenker's diverticulum were excluded. Patient demographics, clinical course, and neuromuscular pathology findings were noted from the chart.

Results:

Nineteen patients with CA were identified: 10 male and 9 female, with a mean age of 57 years. Eleven had no prior BTX (6 male and 5 female; mean age, 62 years); 8 had previous treatment with BTX (4 male and 4 female; mean age, 51 years). Eight of the 11 BTX-naive patients revealed predominantly myopathic changes on histology. Those with previous BTX tended to be younger; 6 of the 8 had a clinical benefit from their BTX and ultimately went on to myotomy. The CP muscle specimens featured both mixed and neurogenic pathologic changes in 5 of the 8 patients with BTX. Although these findings suggest some impact of BTX on the CP muscle, the difference between the groups was not statistically significant (p < 20, x2 test).

Conclusions:

Treatment with BTX may have some clinical and histopathologic impact on the upper esophageal sphincter of patients with CA. Although neuropathic changes were noted in the CP muscle of previously injected patients at the time of their CP myotomy, the neuromuscular pathologic findings overall were not significantly different from those of BTX-naive patients.
Microbiology of Acute Sinusitis of Odontogenic Origin Presenting with Periorbital Cellulitis in Children
Authors: Brook Itzhak
Published: October 2014

Objectives:

This study was undertaken to evaluate the aerobic and anaerobic microbiology of acute maxillary sinusitis of odontogenic origin presenting with periodontal infection in children.

Methods:

Aspirates of 18 acutely infected maxillary sinuses that were associated with odontogenic infection in children who presented with periorbital cellulitis were processed for aerobic and anaerobic bacteria.

Results:

A total of 54 isolates were recovered (3.0 per specimen): 13 aerobic and facultative (0.7 per specimen) and 41 anaerobic (2.3 per specimen). The number of isolates per specimen varied from 1 to 4. Aerobic and facultative organisms alone were recovered in 2 specimens (11%), anaerobes only in 7 (39%), and mixed aerobic and anaerobic bacteria in 9 (50%). The predominant aerobic and facultative organisms were α-hemolytic streptococci (4), microaerophilic streptococci (3), and Streptococcus pyogenes and Staphylococcus aureus (2 each). The predominant anaerobic bacteria were anaerobic gram-negative bacilli (17), Peptostreptococcus spp (11), Fusobacterium spp (8), and Propionibacterium acnes (2). Twelve β-lactamase-producing bacteria were recovered from 9 specimens (50%).

Conclusions:

This study demonstrates the unique aerobic and anaerobic microbiological features of acute maxillary sinusitis of odontogenic origin presenting with periorbital cellulitis in children.
Reliability of the Pharyngeal Squeeze Maneuver
Authors: Rodriguez Kimsey H. , Roth Carole R. , Rees Catherine J. , Belafsky Peter C.
Published: October 2014

Objectives:

Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver.

Methods:

Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal squeeze maneuver were assessed with the kappa coefficient.

Results:

The mean age of the cohort was 58 years. Fifty-eight percent (23 of 40) were male. When the clinicians were instructed to rate each side of the pharynx as normal, diminished, or absent, the interobserver and intraobserver reliabilities were poor (63% to 68% agreement; kappa = 0.18 to 0.67). When the clinicians were asked to rate the pharyngeal squeeze maneuver as normal or abnormal, both interobserver and intraobserver reliabilities were excellent (85% to 98% agreement; kappa = 0.75 to 0.95).

Conclusions:

The pharyngeal squeeze maneuver displayed poor reliability when motor function was classified into unilateral or bilateral normal, diminished, and absent categories. The pharyngeal squeeze maneuver was very reliable when simply graded as normal or abnormal. Clinicians could not reliably distinguish between diminished and absent pharyngeal motor functions.
Creation and Validation of the Singing Voice Handicap Index
Authors: Cohen Seth M. , Jacobson Barbara H. , Garrett C. Gaelyn , Noordzij J. Pieter , Stewart Michael G. , Attia Albert , Ossoff Robert H. , Cleveland Thomas F.
Published: October 2014

Objectives:

We developed and validated a disorder-specific health status instrument (Singing Voice Handicap Index; SVHI) for use in patients with singing problems.

Methods:

Prospective instrument validation was performed. Of 81 original items, those with poor statistical validity were eliminated, resulting in 36 items. The ability to discriminate dysphonic from normal singers, test-retest reliability, internal consistency, and construct validity were assessed.

Results:

We included 112 dysphonic and 129 normal singers, professional and nonprofessional, of classical, country, rock, choral, and gospel repertoire. Dysphonic singers had worse SVHI scores than normal singers (p ≤ .001, rank sum test). Test-retest reliability was high (Spearman correlation, 0.92; p ≤ .001). Internal consistency demonstrated a Cronbach's α of 97, and the correlation between the SVHI and self-rated singing voice impairment was .63 (p ≤ .001, Spearman correlation).

Conclusions:

The SVHI is a reliable and valid tool for assessing self-perceived handicap associated with singing problems.
Bilateral Sudden Profound Hearing Loss and Vertigo as a Unique Manifestation of Bilateral Symmetric Inferior Pontine Infarctions
Authors: Bovo Roberto , Ortore Rocco , Ciorba Andrea , Berto Anna , Martini Alessandro
Published: October 2014

Objectives:

We present a case of sudden bilateral profound deafness and vertigo, without any accompanying neurologic signs, secondary to bilateral infarctions of the cochlear and vestibular nuclei.

Methods:

Vertigo, vomiting, tinnitus, and bilateral profound deafness suddenly developed in a 65-year-old woman without any accompanying neurologic signs. In particular, she did not present dysarthria, numbness, cranial nerve palsies, or visual or cerebellar signs.

Results:

Magnetic resonance imaging of the brain revealed 2 fresh infarctions of 8 to 10 mm symmetrically localized in the posterolateral bulbopontine junction. Angiography revealed a complete occlusion of the basilar artery, with a well-represented backward flow of its distal portion from the carotid artery via posterior communicating arteries. Excluding a transient ischemic attack that occurred 16 days after the acute episode, the patient had had no other neurologic events at 8 months of follow-up.

Conclusions:

Acute vertigo and sudden deafness in a patient with known cerebrovascular occlusive disease may represent the warning signs of an impending brain stem or cerebellar infarction, even when other neurologic signs are absent. These events are fortunately very rare, but should be considered by clinicians who see patients with vertigo.
Liposarcoma of the Larynx
Authors: Powitzky Rosser , Powitzky Eric S. , Garcia Rafael
Published: October 2014

Objectives:

The objective was to review the presentation, diagnosis, treatment, and prognosis of patients with laryngeal liposarcoma (LLS). A case is reported, and a retrospective review of the English-language literature is presented.

Methods:

All published cases of LLS with adequate histopathologic documentation and clinical information were included for review.

Results:

Thirty cases of LLS have been reported. A majority of these patients are men between 40 and 70 years of age. The most common location of the tumor is the supraglottis, and the presenting complaints are similar to those of other laryngeal neoplasms. Although these neoplasms recur often and can cause significant morbidity, they are typically of low grade and rarely metastasize. The outcomes of this disease are generally good when it is treated with wide surgical excision.

Conclusions:

Cases of LLS are extremely rare. Because the histologic changes are frequently subtle, LLS can be easily mistaken for a benign tumor. As a result, the diagnosis requires a high index of suspicion and diligence in examining biopsy specimens. Computed tomography and magnetic resonance imaging can assist in the diagnosis and surgical approach. Genetic and immunostaining analysis techniques may also prove to have valuable prognostic, diagnostic, and therapeutic implications for this disease. Wide surgical excision is the mainstay of treatment. The use of radiotherapy and chemotherapy in treating this cancer remains experimental, but might be considered on a case-to-case basis for palliation or to treat aggressive variants of the disease.
Role of Vascular Endothelial Growth Factor a in Children with Acquired Airway Stenosis
Authors: Rahbar Reza , Brown Lawrence F. , Folkman Judah , McGill Trevor J. , Healy Gerald B. , Liu Guanmei , Vargas Sara O.
Published: October 2014

Objectives:

Vascular endothelial growth factor A (VEGF-A) is important in the angiogenic response for wound healing. This study investigated whether VEGF-A may play a role in the pathogenesis of acquired airway stenosis.

Methods:

Eight lesions from 5 pediatric patients with subglottic stenosis after airway reconstruction (N = 4) or prolonged intubation (N = 1) and normal laryngeal tissue from 5 autopsy patients were included. Formalin-fixed sections of subglottic tissue from each patient were examined by in situ hybridization for the presence of messenger RNA (mRNA) for VEGF-A, vascular endothelial growth factor receptor 1 (VEGFR-1), and vascular endothelial growth factor receptor 2 (VEGFR-2).

Results:

Strong expression of VEGF-A mRNA was noted in hyperplastic squamous epithelium overlying granulation tissue. Strong expression of VEGFR-1 and VEGFR-2 was noted in the endothelial cells within granulation tissue. No strong labeling of VEGF-A mRNA or its receptors was noted in 2 specimens with mature scar tissue or in the control specimens.

Conclusions:

The angiogenic growth factor VEGF-A is strongly expressed in hyperplastic epithelium overlying granulation tissue in airway stenosis. Also, VEGFR-1 and VEGFR-2 mRNAs are strongly expressed in the endothelial cells of granulation tissue. This finding suggests an important role of VEGF-A in the pathogenesis of airway scar formation and stenosis.
Upper Displacement of the Anterior Commissure: Experimental Study of a New Phonosurgical Approach to Raising Vocal Pitch
Authors: Chung Daniel , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara , Imamura Rui
Published: October 2014

Objectives:

The present study assessed the effects of a unique pitch-raising surgical technique designated upper displacement of the anterior commissure (UDAC), comparing the results with those obtained through cricothyroid approximation (CTA).

Methods:

Vocal fold vibration was artificially evoked in 20 excised human larynges through tracheal injection of compressed air. Vocal fold length, fundamental frequency, and videokymography parameters were determined preoperatively, post-CTA, and post-UDAC. In UDAC, a bilateral incision was made between the middle and anterior thirds of the thyroid cartilage. The inferiormost portion of the anterior thyroid cartilage (anterior to the cartilaginous incision) was sutured to the superiormost portion of the posterior thyroid cartilage (posterior to the cartilaginous incision). The anterior commissure was thus moved upward and forward, ensuring increased vocal fold tension.

Results:

The mean vocal fold length was 16.88 mm preoperatively, 20.02 mm post-CTA, and 18.67 mm post-UDAC (p < .05). The mean fundamental frequency was 151.60 Hz preoperatively, 271.10 Hz post-CTA, and 239.30 Hz post-UDAC (p < .05). The post-CTA and post-UDAC vibration amplitudes were significantly lower than the preoperative values (p < .05).

Conclusions:

Vocal fold length and fundamental frequency increased significantly after UDAC (p < .05), although to a lesser degree than after CTA.
Association of Anxiety and Depression with Reported Disease Severity in Patients Undergoing Evaluation for Chronic Rhinosinusitis
Authors: Wasan Ajay , Fernandez Ephrem , Jamison Robert N. , Bhattacharyya Neil
Published: October 2014

Objectives:

We sought to determine the impact of psychiatric comorbidity on symptom density and resource utilization in chronic rhinosinusitis (CRS).

Methods:

A prospective cohort of patients who sought evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed to determine the interactions among psychiatric comorbidity, symptom reporting, and resource utilization in CRS.

Results:

We studied 143 patients (mean age, 43.4 years). Low, moderate, and high levels of anxiety were reported by 48.3%, 25.9%, and 25.9% of patients, respectively. Low, moderate, and high levels of depression were reported by 76.2%, 9.1%, and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% had low, moderate, and high levels. Patients with high anxiety levels reported significant elevations of oropharyngeal symptoms (p = .013) and total symptoms (p = .030) in comparison with the low group. Patients with high depression levels reported higher oropharyngeal (p = .003), systemic (p = .001), and total symptom (p = .003) scores than did the low group. High combined psychopathology scores were associated with elevated facial, oropharyngeal, and systemic scores (p < .05). Regarding medical utilization, high anxiety levels or high combined psychopathology scores were associated with more frequent physician visits (p < .05). A high level of depression was associated with increased antibiotic use, missed workdays, and physician visits (p < .05).

Conclusions:

High levels of anxiety and depression are common in patients who undergo evaluation for CRS. Psychiatric comorbidity is associated with increased symptoms in CRS and increased health-care utilization. Anxiety and depression should be identified in these patients to structure appropriate treatment.
Effects of Cochlear Implantation on Gustatory Function
Authors: Mueller Christian A. , Khatib Saher , Temmel Andreas F. P. , Baumgartner Wolf-Dieter , Hummel Thomas
Published: October 2014

Objectives:

Because of the anatomic position of the chorda tympani in the tympanic cavity, the nerve is at risk during cochlear implantation. The aim of this study was to assess changes in taste sensitivity and in self-ratings of gustatory function after surgery.

Methods:

Twenty-four patients (mean age, 54 years) who underwent cochlear implantation were investigated. Taste function was tested with a validated test for regional quantitative assessment of sweet, sour, salty, and bitter tastes on each side of the tongue before and 4 days after surgery.

Results:

The mean taste score was 10.0 (SD, 4.0) before and 8.0 (SD, 4.1) after surgery on the side of the tongue ipsilateral to the operated ear (p = .004). However, only 1 patient reported subjective taste loss due to surgery. Taste testing of the side of the tongue contralateral to the operated ear yielded a score of 10.0 (SD, 4.1) before and 10.9 (SD, 4.5) after surgery (p = .037). Self-ratings of gustatory function did not change significantly as a consequence of the procedure.

Conclusions:

Our results indicate that cochlear implantation is a relatively safe procedure regarding taste function. Preoperative testing of gustatory function is recommended, at least in those patients who already have undergone operation on the contralateral ear.
Paraneoplastic Syndromes in Patients with Cancer of the Larynx and Hypopharynx
Authors: Ferlito Alfio , Rinaldo Alessandra
Published: October 2014

Paraneoplastic syndromes may be the first sign of a malignancy. They are systemic, nonmetastatic manifestations associated with a variety of malignant neoplasms and occurring in a minority of cancer patients. These associations of symptoms and signs are not directly related to the site or local manifestations of a malignant tumor or its metastases, but their recognition may facilitate the detection of malignancies or recurrences. Paraneoplastic syndromes are categorized into 6 types: Dermatologic or cutaneous, endocrine, hematologic, neurologic, osteoarticular or rheumatologic, and ocular. Different oncotypes have rarely been associated with paraneoplastic syndromes in patients with cancer of the larynx and hypopharynx. The world literature has been reviewed.
Sphenoid Sinus Fungal Balls
Authors: Bowman James , Panizza Benedict , Gandhi Mitesh
Published: October 2014

Objectives:

We sought to examine the nature of fungal balls of the sphenoid sinus, in particular the exposure of adjacent skull base structures and the potential for surgical morbidity.

Methods:

We retrospectively reviewed our series of 17 cases of sphenoid sinus fungal balls seen between 1998 and 2005 with reference to their diagnosis, radiologic changes, histopathology, and surgical management.

Results:

Exposed structures included the pituitary fossa, cavernous sinus, and cavernous internal carotid artery, but this exposure did not result in an increase in perioperative complications. Sclerotic thickening of the sinus walls persisted, probably representing a chronic osteitis in response to concurrent bacterial infection. This appeared to be protective against further sinus wall erosions. Wall erosions did not heal. One patient demonstrated what appeared to be invasive fungal disease from a fungal ball.

Conclusions:

Sphenoid sinus fungal balls can occur with minimal symptoms in a mainly elderly population and require surgical removal. Sphenoid sinus fungal balls have a low rate of operative morbidity and should be effectively managed by transnasal endoscopic sphenoidotomy alone.
Thermal Welding versus Cold Dissection Tonsillectomy: A Prospective, Randomized, Single-Blind Study in Adult Patients
Authors: Stavroulaki Pelagia , Skoulakis Charalampos , Theos Evangelos , Kokalis Nikolaos , Valagianis Dimitrios
Published: October 2014

Objectives:

We performed a single-blind, prospective, randomized, controlled clinical study to compare the rates of postoperative morbidity in adults undergoing thermal welding tonsillectomy versus cold dissection tonsillectomy.

Methods:

Thirty-two adults with recurrent tonsillitis who were scheduled for elective tonsillectomy were randomized to either thermal welding or cold dissection tonsillectomy groups. The main outcome measures included intraoperative blood loss, intensity of postoperative pain expressed on a 10-cm visual analog scale (with 0 representing no pain and 10 representing the worst possible pain), day of cessation of significant pain (ie, a pain score of at least 7), and presence of postoperative hemorrhage estimated on a 3-point scale (with 0 representing no bleeding, 1 representing minor bleeding, and 2 representing major bleeding). Additional outcome measures included total analgesic requirements, last day of receipt of analgesics, presence of nausea and/or vomiting, and wound healing after 10 days of surgery.

Results:

The rate of intraoperative blood loss was significantly lower in the thermal welding group (p < .0001). Patients who had thermal welding tonsillectomy also showed a general trend toward lower pain scores, and this difference was statistically significant from the first to the fourth postoperative days (p < .05). Cessation of significant pain also occurred 3 days earlier in this group (p < .05). No significant difference was observed regarding pain medication, nausea and/or vomiting, postoperative hemorrhage, or wound healing.

Conclusions:

Thermal welding tonsillectomy is a relatively safe and reliable method with significantly less postoperative morbidity than cold dissection tonsillectomy.
Value of Laryngeal Electromyography in Diagnosis of Vocal Fold Immobility
Authors: Xu Wen , Han Demin , Hou Lizhen , Zhang Li , Zhao Gongwei
Published: October 2014

Objectives:

We sought to determine the value of laryngeal electromyography (LEMG) and evoked LEMG in the diagnosis of vocal fold immobility.

Methods:

We analyzed 110 cases of vocal fold immobility by their clinical manifestations and LEMG characteristics, including spontaneous potential activity, motor unit potential measurement, recruitment pattern analysis, and evoked LEMG signals.

Results:

With LEMG, we identified 87 patients with neuropathic laryngeal injuries. Neurogenic vocal fold immobility showed a wide variety of abnormal activity. Fibrillation potentials and positive sharp waves were found in patients with laryngeal nerve injuries. For laryngeal paralysis, there was no reaction with LEMG and evoked LEMG. For incomplete laryngeal paralysis, decreased evoked LEMG signals were also seen with delayed latency (thyroarytenoid muscle, 2.2 ± 1.0 ms, p < 01; posterior cricoarytenoid muscle, 2.4 ± 1.0 ms, p < .05) and lower amplitude (thyroarytenoid muscle, 0.9 ± 0.7 mV, p < .05; posterior cricoarytenoid muscle, 1.2 ± 1.0 mV, p < .01). Nineteen patients with vocal fold mechanical limitations generally had normal LEMG and evoked LEMG signals. Four patients with neoplastic infiltration of the laryngeal muscles demonstrated abnormal LEMG signals but nearly normal evoked LEMG signals.

Conclusions:

We conclude that LEMG and evoked LEMG behavior plays a crucial role in the diagnosis of vocal fold immobility. The decreased recruitment activities on LEMG and the decreased evoked LEMG signals with longer latency and lower amplitude reflect the severity of neuropathic laryngeal injury.
Neuromuscular Specializations within Human Pharyngeal Constrictor Muscles
Authors: Mu Liancai , Sanders Ira
Published: October 2014

Objectives:

At present it is believed that the pharyngeal constrictor (PC) muscles are innervated by the vagus (X) nerve and are homogeneous in muscle fiber content. This study tested the hypothesis that adult human PCs are divided into 2 distinct and specialized layers: A slow inner layer (SIL), innervated by the glossopharyngeal (IX) nerve, and a fast outer layer (FOL), innervated by nerve X.

Methods:

Eight normal adult human pharynges (16 sides) obtained from autopsies were studied to determine 1) their gross motor innervation by use of Sihler's stain; 2) their terminal axonal branching by use of acetylcholinesterase (AChE) and silver stain; and 3) their myosin heavy chain (MHC) expression in PC muscle fibers by use of immunocytochemical and immunoblotting techniques. In addition, the specialized nature of the 2 PC layers was also studied in developmental (newborn, neonate, and senescent humans), pathological (adult humans with idiopathic Parkinson's disease [IPD]), and comparative (nonhuman primate [adult macaque monkey]) specimens.

Results:

When nerves IX and X were traced from their cranial roots to their intramuscular termination in Sihler's-stained specimens, it was seen that nerve IX supplied the SIL, whereas branches of nerve X innervated the FOL in the adult human PCs. Use of AChE and silver stain confirmed that nerve IX branches supplying the SIL contained motor axons and innervated motor end plates. In addition to distinct motor innervation, the SIL contained muscle fibers expressing slow-tonic and α-cardiac MHC isoforms, whereas the FOL contained muscle fibers expressing developmental MHC isoforms. In contrast, the FOL became obscured in the elderly and in the adult humans with IPD because of an increased proportion of slow muscle fibers. Notably, distinct muscle fiber layers were not found in the human newborn and nonhuman primate (monkey), but were identified in the 2-year-old human.

Conclusions:

Human PCs appear to be organized into functional fiber layers, as indicated by distinct motor innervation and specialized muscle fibers. The SIL appears to be a specialized layer unique to normal humans. The presence of the highly specialized slow-tonic and α-cardiac MHC isoforms, together with their absence in human newborns and nonhuman primates, suggests that the specialization of the SIL may be related to speech and respiration. This specialization may reflect the sustained contraction needed in humans to maintain stiffness of the pharyngeal walls during respiration and to shape the walls for speech articulation. In contrast, the FOL is adapted for rapid movement as seen during swallowing. Senescent humans and patients with IPD are known to be susceptible to dysphagia, and this susceptibility may be related to the observed shift in muscle fiber content.
Large Jugular Bulb Diverticulum Invading the Internal Auditory Canal
Authors: Fujimoto Chisato , Ito Ken , Ishimoto Shin-Ichi , Iwasaki Shinichi
Published: October 2014

Objectives:

We report, with neuro-otologic findings, a very rare case of a large jugular bulb diverticulum eroding the internal auditory canal (IAC).

Methods:

We present the imaging and functional studies of a 29-year-old woman in whom a large jugular bulb diverticulum on the left side was found incidentally.

Results:

Imaging studies revealed a normal external auditory canal, middle ear, and inner ear, but a large jugular bulb diverticulum extending superiorly on the left side had eroded the IAC from below and behind with destruction of the petrous bone. Caloric responses and facial movements were normal. Vestibular evoked myogenic potentials with bone conduction stimuli were absent on the left, indicating dysfunction of the left inferior vestibular system.

Conclusions:

This is the first report in the English-language literature of detailed imaging and functional findings in a very large diverticulum invading the IAC. Vestibular evoked myogenic potentials were useful in uncovering subclinical inferior vestibular system dysfunction in the jugular bulb diverticulum invading the IAC.