bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Rhinosinusitis with Nasal Polyps: A Proteomic Analysis
Authors: Upton David C. , Welham Nathan V. , Kuo John S. , Walker Jeffery W. , Pasic Thomas R.
Published: October 2014

Objectives:

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe subtype of chronic rhinosinusitis that can affect patients despite medical and surgical interventions. The purpose of this study was to utilize the techniques of proteomics to investigate differences in protein abundance within the sinonasal mucosa of patients with CRSwNP compared to healthy controls.

Methods:

In a case-control study at a tertiary-care academic medical center, sinonasal mucosa was harvested from 3 patients with CRSwNP and 3 control patients undergoing transsphenoidal excision of pituitary tumors. Two-dimensional gel electrophoresis was used to identify proteins with elevated or reduced abundance in CRSwNP patients compared to controls. The proteins showing the greatest abundance differences were characterized by mass spectrometry.

Results:

More than 300 differentially abundant proteins (p ≤ 0.05) were identified. Many of these protein species were involved in the host inflammatory response. Proteins up-regulated in CRSwNP patients included eosinophil lysophospholipase by a ratio (R) of 18.13, RHO-GDP dissociation inhibitor 2 (R = 2.80), and apolipoprotein A-1 (R = 1.73). Down-regulated proteins in CRSwNP patients included catalase (R = −5.87), annexin A1 (R = −6.27), and keratin II-8 (R = −6.73). A detailed analysis of additional protein species is outlined.

Conclusions:

The proteomic approach allows detection of significant differences in protein abundance in CRSwNP and provides unique insight into the pathophysiology of this common disease.
Vocal Fold Stellate Cells in the Human Macula Flava and the Diffuse Stellate Cell System
Authors: Sato Kiminori , Umeno Hirohito , Nakashima Tadashi
Published: October 2014

Objectives:

Hepatic stellate cells (HSCs) are desmin-positive cells with perinuclear vitamin A droplets that play important roles in liver fibrogenesis. Morphologically similar cells have been found at many extrahepatic sites. Consequently, the concept of a diffuse stellate cell system has been proposed. Vocal fold stellate cells (VFSCs) in the human maculae flavae (MFs) are starlike in shape and possess lipid droplets and store vitamin A. In this study, the relationship between the VFSCs in the human MFs and the diffuse stellate cell system was investigated.

Methods:

Light and electron microscopic investigations and immunohistochemical studies were performed in 5 samples of human adult vocal fold mucosa.

Results:

The VFSCs showed the morphological features of the HSCs (ie, they were desmin-positive cells with perinuclear vitamin A droplets). Glial fibrillary acidic protein and vimentin were identified in the VFSCs in the MFs.

Conclusions:

The VFSCs in the human adult MFs express the neural and muscle-associated proteins seen in HSCs. Our present and previous investigations suggest that the VFSCs in the human MFs are a member of the diffuse stellate cell system. The VFSCs are considered a new category of cells in the human vocal fold. The MFs are proposed to be special microenvironments, known as niches, that nurture a pool of VFSCs.
Prognosis Tool Based on a Modified Children's Implant Profile for Use in Pediatric Cochlear Implant Candidacy Evaluation
Authors: O'Brien Lynne C. Graham , Valim Clarissa , Neault Marilyn , Kammerer Betsy , Clark Terrell , Johnston Jennifer , Culver Stacey , Zhou Jing , Kenna Margaret A. , Licameli Greg R.
Published: October 2014

Objectives:

We developed a prediction tool to assist in evaluation of pediatric candidates for cochlear implantation (CI) and to help plan for preoperative and postoperative support.

Methods:

Between 1995 and 2005, 277 patients underwent CI at Children's Hospital Boston. Of these 277 patients, 250 had at least 2 years of post-CI follow-up and adequate pre-CI information for rating by our prediction tool. Of the 250, 106 were randomly selected for inclusion. The patients were divided into group A (auditory/oral communicator); group B (auditory/oral communicator with visual assistance), group C (visual/manual communicator with auditory/oral skills assistance), and group D (will not derive communicative benefit from implant). Predictions were performed with clinical assessment and two statistical techniques: Regression modeling and classification and regression tree (CART) analysis.

Results:

Among patients who became auditory/oral communicators (group A), clinical assessment predicted that outcome accurately 65% of the time, CART analysis had intermediate sensitivity (79%), and regression modeling was the most sensitive (95%). Groups B through D were predicted 45% of the time by regression modeling, 90% of the time by clinical assessment, and 100% of the time by CART analysis.

Conclusions:

A combination of speech-language, medical, and educational constructs can provide a reliable prediction of the communication outcome. Our goal for the prognosis tool is to make it part of the overall candidacy process in supporting decision-making about CI and planning for post-CI therapy.
Evaluation of Volitional and Reflexive Swallowing in Elderly Patients with a History of Pneumonia
Authors: Kiyohara Hideyuki , Umezaki Toshiro , Sawatsubashi Motohiro , Matsumoto Nozomu , Komune Shizuo
Published: October 2014

Objectives:

Precise assessment of the risk of aspiration is critical in older patients with a history of pneumonia. However, the currently popular videofluoroscopic and videoendoscopic examinations of swallowing only evaluate volitional swallowing. A method for quantitative analysis of reflexive swallowing is not yet available.

Methods:

We evaluated volitional swallowing in the sitting position by videoendoscopic examination and then measured the volume of injected water that triggered reflexive swallowing in the supine position in 54 patients with a history of pneumonia and 24 control patients of a similar age who had no history of pneumonia.

Results:

The volume of injected water that triggered reflexive swallowing was larger in the pneumonia group than in the control group (mean, 1.64 ± 0.61 mL versus 0.71 ± 0.28 mL; p < 0.001). Both impaired volitional swallowing and impaired reflexive swallowing independently correlated with a history of pneumonia.

Conclusions:

The endoscopic supine swallow-evoking test (“ESSET”) may detect previously omitted risk factors for aspiration in patients who can volitionally swallow.
Language Development, Interpersonal Communication, and Academic Achievement among Japanese Children as Assessed by the ALADJIN
Authors: Sugishita Syuuhei , Fukushima Kunihiro , Kasai Norio , Konishi Takayuki , Omori Kana , Taguchi Tomoko , Fujiyoshi Akie , Ojima Toshiyuki
Published: October 2014

Objectives:

Japanese-speaking children in a standard sample were subjected to a test battery (ALADJIN: Assessment Package for Language Development in Japanese Hearing-Impaired Children) to evaluate the effect of language development on both interpersonal communication skills and academic achievement.

Methods:

A total of 414 preschool and school-age children without hearing impairment were included in this study. The following tests make up the ALADJIN: The Test of Question-Answer Interaction Development (TQAID), the Japanese Language by Criterion Referenced Test–II (CRT-II) for measuring academic achievement, the Picture Vocabulary Test–Revised (PVT-R), the Standardized Comprehension Test of Abstract Words (SCTAW), both parts of the Syntactic Processing Test for Aphasia (STA), and the Word Fluency Test (WFT). Means and standard deviations at each academic grade level were calculated, and a multiple regression analysis was performed.

Results:

A ceiling effect was observed for the TQAID and the STA in children in grade 3 of elementary school, and the scores for the PVT-R, SCTAW, and WFT increased incrementally according to grade level. Multiple regression analysis revealed that the PVT-R, WFT, and STA (production) have predictive power for the results of the TQAID (R = 0.59; R2 = 0.58; p < 0.0001), whereas the SCTAW and STA (comprehension) have predictive power for the results of the CRT-II.

Conclusions:

Both vocabulary and syntax are important in communication development among children. The results of our multiple regression analysis suggest that different language domains may play different roles in the development of interpersonal communication skills and in academic achievement. The development of interpersonal communication skills is largely based on productive vocabulary and syntax abilities, whereas academic achievement is largely based on comprehensive vocabulary and syntax abilities. Children who have difficulties in either area should be evaluated with detailed language assessment tools such as the ALADJIN in an effort to aid in the selection of appropriate intervention.
VTMR, a New Speech Audiometry Test with Verbal Tasks and Motor Responses
Authors: Di Berardino Federica , Forti Stella , Cesarani Antonio
Published: October 2014

Objectives:

The aim of this study was to design a complementary speech audiometry test using verbal tasks and motor responses (VTMR) to assess the ability of a subject to understand and perform simple motor tasks with 3-dimensional objects, to describe its construction, and to show the preliminary results of a pilot study on the Italian version of the test.

Methods:

The items used in the test setting included 1 base, 1 hammer, 1 wooden structure with 4 sticks, and 5 rings of different colors and 20 lists with 5 verbal tasks per list. The VTMR test and bisyllabic speech audiometry were evaluated in normal-hearing subjects with and without cognitive impairment and in subjects with sensorineural hearing loss.

Results:

All normal-hearing subjects without cognitive impairment performed the VTMR tasks (100%) correctly at 35 dB sound pressure level. In subjects with sensorineural hearing loss, the percentage of correct answers was significantly higher for the VTMR test than for bisyllabic speech audiometry above 50 dB sound pressure level. This percentage was higher for the VTMR also in normal-hearing subjects with poor cognitive skills.

Conclusions:

The VTMR might make it easier to check patients' ability to understand verbal commands than does traditional speech audiometry, in particular in those patients with poor test-taking skills.
Tolerability of Sialendoscopy under Local Anesthesia
Authors: Luers Jan Christoffer , Stenner Markus , Schinke Michael , Helmstaedter Victor , Beutner Dirk
Published: October 2014

Objectives:

We sought to investigate patients' tolerance of sialendoscopy of the parotid and submandibular glands with local anesthesia.

Methods:

In a retrospective case series of 84 adult patients who underwent sialendoscopy with local anesthesia at an academic tertiary referral hospital, we analyzed patients' demographic data, American Society of Anesthesiologists (ASA) status score, perioperative cardiovascular parameters, and results on a 2-question survey.

Results:

Of the 84 patients, 44 were female and 40 were male (mean age, 48.6 years). The patients had a mean ASA status score of 1.57. On average, 2.16 mL of local anesthetic was used. The mean systolic blood pressure was 137 mm Hg, and the mean diastolic blood pressure was 80 mm Hg. The duration of the procedure showed a significant correlation with the maximum systolic blood pressure (r = 0.35; p = 0.001), the mean systolic blood pressure (r = 0.25; p = 0.02), the maximum diastolic blood pressure (r = 0.37; p = 0.001), and the mean diastolic blood pressure (r = 0.31; p = 0.005). The mean heart rate was 77 beats per minute. The majority of patients considered the procedure to be tolerable. In this series, the indications for conducting sialendoscopy under general anesthesia were procedures of greater invasiveness and complex situations with multiple sialolithiases, difficult anatomic preconditions, or a very long expected operation time.

Conclusions:

Sialendoscopy performed with local anesthesia is well tolerated, provided that the patient has a good general health status and the operative procedure is not expected to be complex or long-lasting.
Comparative Analysis of Primary and Secondary Rhinoplasties According to Surgeon's Perspective, Patient Satisfaction, and Quality of Life
Authors: Cingi Cemal , Eskiizmir Görkem , Çaklı Hamdi
Published: October 2014

Objectives:

We sought to analyze and compare the problems and technical difficulties related to surgical intervention, patient satisfaction, and quality of life after primary and secondary rhinoplasties.

Methods:

A total of 168 cases of rhinoplasty were grouped as primary or secondary according to the patient's history of rhinoplasty. The type of nasal deformity, the surgical approach, and the difficulty of the surgery were recorded. The levels of patient satisfaction and the quality of life were assessed before and after the operation with the Rhinoplasty Outcomes Evaluation (ROE) and European Quality of Life–5 Dimension (EQ-5D) questionnaires. A quantitative and statistical analysis was performed.

Results:

Thirty-three patients had secondary rhinoplasty, and 135 patients had primary rhinoplasty. Relatively high rates of saddle nose deformity, crooked nose, and tip asymmetry were observed in the secondary rhinoplasty group. The preoperative and postoperative scores on the ROE and EQ-5D questionnaires demonstrated statistically significant differences in both the primary and secondary rhinoplasty groups. The comparison of postoperative change between the primary and secondary rhinoplasty groups did not demonstrate a statistically significant difference.

Conclusions:

The surgical difficulty of secondary rhinoplasty is approximately twice that of primary rhinoplasty because of the high rate of major deformities. However, the levels of patient satisfaction and improvements in quality of life are similar after primary and secondary rhinoplasties.
Musical Pitch Discrimination by Cochlear Implant Users
Authors: Ping Lichuan , Yuan Meng , Feng Haihong
Published: October 2014

Objectives:

The main goal of this study was to investigate the effects of acoustic characteristics, including timbre and fundamental frequency (F0), on the musical pitch discrimination of cochlear implant users.

Methods:

Eight postlingually deafened cochlear implant users were recruited, along with 8 control subjects with normal hearing. Pitch discrimination tests were carried out using test stimuli from 4 musical instruments plus synthetic complex stimuli. Three reference tones with different F0s were used.

Results:

The mean difference limens were 1.8 to 10.7 semitones in the just-noticeable difference task and 2.1 to 13.6 semitones in the pitch-direction discrimination task for different timbre and F0 combinations. Three-way analysis of variance showed that the acoustic characteristics of the musical stimuli, such as timbre and F0, significantly influenced pitch discrimination performance.

Conclusions:

Acoustic characteristics determine the complexity of the electrical stimulation pattern, which directly affects performance in pitch discrimination. A place pattern with a clear and regular low-order harmonic structure is most important for good pitch discrimination. A clear F0-related temporal pattern is also useful when the F0 is low. Pitch perception performance will worsen when there is interference in the high-frequency channels.
Effects of Sleep-Disordered Breathing on Physical Traits, School Performance, and Behavior of Korean Elementary School Students in the Upper Grade Levels
Authors: Kim Jin Kook , Lee Ji Hye , Lee Seung-Hoon , Hong Seok-Chan , Cho Jae Hoon
Published: October 2014

Objectives:

We investigated the physical traits, school performance, and behavior of Korean children with sleep-disordered breathing (SDB).

Methods:

We recruited 679 students from an elementary school in Seoul, Korea. We used a survey to collect information on the absence or presence of SDB at both the child's preschool age and his or her current age and on the degree of behavioral disturbance. Physical traits and examination scores were also analyzed. We divided the children into 4 groups: Non-SDB group, past SDB group, recent SDB group, and continuous SDB group. Comparisons between these four groups were conducted.

Results:

Sixty-one students were excluded because of incomplete information. The current body mass index was significantly higher in the past (19.7 ± 3.6), recent (21.2 ± 3.6), and continuous SDB groups (20.7 ± 3.9) than in the non-SDB group (18.8 ± 3.2), but only for male students (p < 0.001). The examination scores were not different among the four groups, but the behavioral disturbance scores were much higher in the past, recent, and continuous SDB groups than in the non-SDB group for both genders.

Conclusions:

Among these Korean elementary school students in the upper grade levels, the presence of current or past SDB appeared to influence the current body mass index in boys and the presence of behavioral disturbances in both genders. However, SDB was not associated with school performance.
Adhesion of a Monolayer of Fibroblast Cells to Fibronectin under Sonic Vibrations in a Bioreactor
Authors: Titze Ingo R. , Klemuk Sarah A. , Lu Xiaoying
Published: October 2014

Objectives:

We examined cell adhesion to a surface under vibrational forces approximating those of phonation.

Methods:

A monolayer of human fibroblast cells was seeded on a fibronectin-coated glass coverslip, which was attached to either the rotating part or the stationary part of a rheometer-bioreactor. The temperature, humidity, carbon dioxide level, nutrients, and cell seeding density were controlled. The cell density was on the order of 1,000 to 5,000 cells per square millimeter. Target stresses above 1 kPa at an oscillatory frequency of 100 Hz were chosen to reflect conditions of vocal fold tissue vibration.

Results:

Fibronectin coating provided enough adhesion to support at least 2 kPa of oscillating stress, but only about 0.1 kPa of steady rotational shear. For stresses exceeding those limits, the cells were not able to adhere to the thin film of fibronectin.

Conclusions:

Cells will adhere to a planar surface under stresses typical of phonation, which provide a more stringent test than adherence in a 3-dimensional matrix. The density of cell seeding on the coverslip played a role in cell–extracellular matrix adhesion, in that the cells adhered to each other more than to the fibronectin coating when the cells were nearly confluent.
Novel Device for Tissue Cooling during Endoscopic Laryngeal Laser Surgery: Thermal Damage Study in an Ex Vivo Calf Model
Authors: Koo Hae Jin , Burns James A. , Kobler James B. , Heaton James T. , Zeitels Steven M.
Published: October 2014

Objectives:

Minimizing collateral thermal damage during endoscopic laryngeal laser surgery remains a priority, and tissue cooling is one way to achieve this goal. Cooling systems utilizing compressed air have been shown to reduce the extent of thermal trauma on the vocal folds, but these units are not ideal for endoscopic applications because cooling is inefficient at the low airflows needed. We examined whether a novel vortex cooling device that generates cooled air at low flow rates would provide a cooling benefit beyond that which could be obtained by using room-temperature air for cooling tissue or by using no cooling during simulated laryngeal laser surgery.

Methods:

A continuous-wave thulium laser was used to incise glottic tissue in 12 calf vocal folds. Cooling was achieved with a prototype vortex cooler (9°C air output; flow rate, 3 L/min), and tissue temperature measurements were compared to those with room-air cooling and no cooling. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase inactivation surrounding the mucosal incision. The cooling conditions were tested during time-constant cuts (8 seconds) and depth-constant cuts (into the thyroarytenoid muscle).

Results:

During time-constant cuts, comparison between vortex cooling and room-air cooling revealed that vortex cooling resulted in a thermal damage zone that was 14% smaller (519 versus 603 μm; p < 0.05). During depth-constant cuts, vortex cooling created a thermal damage zone that was 32% smaller than that created with no cooling (p < 0.01) and 9% smaller than that created with room-air cooling (p < 0.01).

Conclusions:

Vortex cooling reduces thermal damage more effectively than room-air cooling or no cooling during both time-constant and depth-constant thulium laser cuts.
Bioactive Glass S53P4 in Mastoid Obliteration Surgery for Chronic Otitis Media and Cerebrospinal Fluid Leakage
Authors: Sarin Jussi , Grénman Reidar , Aitasalo Kalle , Pulkkinen Jaakko
Published: October 2014

Objectives:

We evaluated the results of cases of chronic otitis media treated with mastoid obliteration surgery using bioactive glass S53P4.

Methods:

Twenty-five patients with chronic otitis media and 1 patient with cerebrospinal fluid leakage without chronic infection were treated with bioactive glass S53P4. Twenty patients had had previous surgery because of chronic otitis media with or without cholesteatoma. A mastoid obliteration was performed with bioactive glass S53P4 granules and a musculoperiosteal flap with or without bone paté. In 2 patients with a bony dehiscence at the middle cranial fossa, a bioactive glass plate was used to support the protruding dura. In addition, in 3 patients, occlusion of a dural fistula was needed. The median follow-up period was 34.5 months (range, 1 to 182 months).

Results:

Excluding the 2 patients with only 1 month of follow-up at our department, 96% of the patients had a dry, safe ear or only intermittent otorrhea. In 92% of the patients, the objective of achieving a smaller or nonexistent cavity was achieved.

Conclusions:

Bioactive glass S53P4 is a noteworthy material in mastoid obliteration surgery.
Streptococcal Tonsillitis and Acute Streptococcal Myocarditis: An Unusual Combination Assessed by Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsy
Authors: Mavrogeni Sophie , Bratis Konstantinos , Kitsiou Anastasia , Kolovou Genovefa
Published: October 2014

Objectives:

Acute streptococcal tonsillitis is occasionally combined with myocarditis. Our aim was to examine patients with tonsillitis in whom myocarditis was suspected by using cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy.

Methods:

After prospective evaluation of 200 patients with tonsillitis, 17 men (median age, 23 years; age range, 18 to 29 years) were recruited for cardiac MRI because of a suspicion of myocarditis. Chest pain 3 to 5 days after tonsillitis was the main complaint in 15 patients, and atypical chest discomfort in 2 patients. We performed cardiac MRI including short TI inversion recovery T2-weighted scanning and T1-weighted scanning with early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE). The left ventricular ejection fraction and the presence of myocarditis were evaluated by the standard protocol. A T2 ratio of greater than 2 and an EGE value of greater than 4 were considered abnormal. Heart biopsy was suggested for patients with a reduced left ventricular ejection fraction.

Results:

Cardiac enzyme levels were increased in 8 of the 17 patients. Increased T2 ratio values (median, 2.8; range, 2.5 to 4.0) were documented in 16 patients. The EGE values were increased (median, 12; range, 8 to 19) in 16 patients. Positive LGE was identified in 13 patients. Endomyocardial biopsy in 4 patients revealed acute myocarditis, and polymerase chain reaction analysis identified streptococcal genomes. Re-evaluation by cardiac MRI 3 months later showed normal results in 14 patients.

Conclusions:

Acute streptococcal tonsillitis can be occasionally complicated by myocarditis with either a typical or an atypical presentation. Cardiac MRI can facilitate the diagnosis in both forms and allow a noninvasive follow-up.
Analysis of the Roles of Smoking and Allergy in Nasal Polyposis
Authors: Görgülü Orhan , Özdemir Süleyman , Canbolat Emre Polat , Sayar Çağdaş , Olgun Mustafa Kemal , Akbaş Yücel
Published: October 2014

Objectives:

Recent studies on the etiopathogenesis of nasal polyps have shown that smoking and nonallergenic inhalants such as occupational dust exposure cause chronic inflammation of the nasal mucosa. These factors may be associated with nasal polyps. The aim of this study was to use laboratory tests to investigate the effects of smoking and allergens on the development of nasal polyps.

Methods:

The study included 60 consecutive patients with a diagnosis of nasal polyposis who were treated with functional endoscopic sinus surgery at our clinic and 25 smoker and 25 nonsmoker participants who constituted a control group.

Results:

In the patient and control groups, the mean absorbance value for cotinine in smokers was found to be statistically significantly lower than that in nonsmokers. There was a significant difference between the groups with respect to blood cotinine positivity. No significant difference was found between the groups in terms of allergy parameters. In the regression model, smoking was found to be the only significant risk factor for the development of nasal polyps, independent of smoking duration, absorbance value, or cotinine positivity.

Conclusions:

Smoking restriction and avoiding exposure to cigarette smoke by patients with nasal polyps may be an important strategy in the prevention and recurrence of nasal polyposis. No direct relationship was determined between allergy and nasal polyposis.
Transcervical Approach to Benign Parapharyngeal Space Tumors
Authors: Chang Steven S. , Goldenberg David , Koch Wayne M.
Published: October 2014

Objectives:

We describe our experience with the postoperative sequelae, complications, and recurrences associated with resection of a series of parapharyngeal space (PPS) tumors via a transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy.

Methods:

We performed a retrospective review of 51 cases, 40 of which were pleomorphic adenomas and 11 of which were lipomas or schwannomas.

Results:

Of 30 fine-needle aspirations performed, 24 indicated pleomorphic adenoma before operation. Twenty-eight of the 30 fine-needle aspirations yielded diagnoses that were consistent with the final pathologic diagnoses. The average hospital stay was 1.05 days. After operation, there were 9 cases of trismus, 4 cases of “first bite” pain, and 7 cases of transient marginal nerve weakness. There were no recurrences over an average follow-up of 115 months.

Conclusions:

The majority of PPS tumors are benign. It is important to use an approach that allows complete tumor excision but does not impart undue postoperative morbidity. We demonstrate that the transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy is ideal for benign PPS tumors.
Experimental Exploration of the Soft Tissue Conduction Pathway from Skin Stimulation Site to Inner Ear
Authors: de Jong Marrigje A. , Perez Ronen , Adelman Cahtia , Sohmer Haim
Published: October 2014

Objectives:

Auditory sensation can be elicited by air conduction (AC) and by bone conduction (BC). It is also possible to elicit such responses by applying the standard clinical bone vibrator to the skin over soft tissue sites on the head, neck, or thorax of humans and animals. This mode of auditory stimulation has been called soft tissue conduction (STC). This study was designed to investigate the pathway between soft tissue sites and the ear.

Methods:

The air in the middle ear was replaced with saline solution in an animal with unique anatomy — The fat sand rat, in which about 70% of a thin-walled inner ear bulges into the middle ear bulla cavity — While we recorded the auditory brain stem responses (ABRs) to AC, BC, and STC stimulation.

Results:

This replacement of air with saline solution led to a significant improvement in STC threshold. With AC stimulation, the ABR threshold was elevated and the latency of the first ABR wave was prolonged. Consistent changes were not seen with BC stimulation.

Conclusions:

When the air (which has a very low acoustic impedance) that normally surrounds most of the inner ear is replaced with saline solution (which has an acoustic impedance similar to that of soft tissues), the STC threshold is improved. This improvement may be due to improved transmission of acoustic energy from the soft tissues to the inner ear.
Diagnosis and Management of New-Onset Hoarseness: A Survey of the American Broncho-Esophagological Association
Authors: Paul Benjamin C. , Branski Ryan C. , Amin Milan R.
Published: October 2014

Objectives:

The recently published Clinical Practice Guideline raised issues related to the value and timing of laryngoscopy in patients with hoarseness. We sought to determine the extent to which these guidelines concur with clinical practice among members of the American Broncho-Esophagological Association (ABEA).

Methods:

A web-based survey was distributed to ABEA members, composed of four sections: 1) background and demographics; 2) information regarding the appropriate length of time that new-onset dysphonia may be managed before laryngeal visualization, given particular comorbidities; 3) the frequency and risks of office-based flexible transnasal laryngoscopy; and 4) the overall value of laryngoscopy and stroboscopy.

Results:

Seventy-one ABEA members completed the survey; they had a combined 1,468 years of post-residency experience. Approximately 75% of respondents were involved in a fully academic practice. Across all respondents, an average of 11 patients with new voice complaints were seen per week. Overall, 98.6% of respondents believe that laryngoscopy is very valuable. Stridor in a neonate and potential foreign bodies were both conditions necessitating laryngoscopy on the day of presentation. In patients with no serious underlying condition(s), the mean duration until laryngoscopy was 12.96 days (range, 0 to 30 days).

Conclusions:

These data suggest that the current practice patterns among experts in the field are divergent from the recently published Guideline.
Functional and Oncological Outcomes of Primary versus Salvage Transoral Laser Microsurgery for Supraglottic Carcinoma
Authors: Hutcheson Katherine A. , Jantharapattana Kitti , Barringer Denise A. , Lewin Jan S. , Holsinger F. Christopher
Published: October 2014

Objectives:

We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment.

Methods:

We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up.

Results:

Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 (“usually understandable”) in the salvage group and 100 (“always understandable”) in the previously untreated group.

Conclusions:

Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.
Benign Paroxysmal Positional Vertigo Associated with Meniere's Disease: Epidemiological, Pathophysiologic, Clinical, and Therapeutic Aspects
Authors: Balatsouras Dimitrios G. , Ganelis Panayotis , Aspris Andreas , Economou Nicolas C. , Moukos Antonis , Koukoutsis George
Published: October 2014

Objectives:

We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease.

Methods:

The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group.

Results:

Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence.

Conclusions:

The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.
Hemodynamic Changes during Otolaryngological Office-Based Flexible Endoscopic Procedures
Authors: Morrison Michele P. , O'Rourke Ashli , Dion Gregory R. , Eller Robert L. , Weinberger Paul , Postma Gregory N.
Published: October 2014

Objectives:

A preponderance of literature supports the safety of office-based flexible endoscopic procedures of the upper aerodigestive tract; however, until recently there were no data regarding hemodynamic stability during these procedures. A recent study showed intraprocedure changes in patients' hemodynamic parameters, raising the concern that perhaps patients should be monitored during these procedures. The aim of our study was to determine whether physiologically significant alterations in vital signs occur during office-based flexible endoscopic procedures.

Methods:

We performed a retrospective review of 100 consecutive patients who underwent office-based flexible endoscopic procedures of the upper aerodigestive tract from July 2010 to October 2011. Baseline values and the maximal changes in systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded and compared.

Results:

One hundred consecutive patients were included in the study. Twenty-one patients (21%) had severe hypertension and 40 patients (40%) had tachycardia during the procedure. The mean change overall in systolic blood pressure was 26.2 mm Hg (p < 0.001), the mean change in diastolic blood pressure was 13.9 mm Hg (p < 0.001), the mean change in heart rate was 16.6 beats per minute (p < 0.001), and the mean change in oxygen saturation was 1.6% (p < 0.001). These changes were significant. On further breakdown into groups, patients over 50 years of age and patients who were undergoing esophageal or laser procedures had significant elevations in heart rate (p = 0.01 and p = 0.04, respectively). An elevation in diastolic blood pressure was also significant in patients who were undergoing esophageal or laser procedures (p = 0.04 for both).

Conclusions:

These data concur with those of the previous report that found potentially significant hemodynamic changes during office-based procedures. Although preliminary, our findings suggest that it may be wise to monitor vital signs in patients over 50 years of age and patients who are undergoing an esophageal or laser procedure who are at risk for complications that could arise from tachycardia and hypertension.
Is Obesity Truly a Risk Factor for Mortality after Tracheotomy?
Authors: Meacham Ryan , Vieira Francisco
Published: October 2014

Objectives:

We sought to determine the short-term and long-term overall mortality rates in obese and non-obese patients after tracheotomy and to evaluate which factors, including the Charlson Comorbidity Index (CCI), predict mortality rates among obese patients.

Methods:

We performed a retrospective chart review of patients who underwent open tracheotomy in the operating room at a single hospital from 2005 to 2010.

Results:

Of 200 patients reviewed, 146 were non-obese and 54 were obese. The rate of mortality was higher at 30 days (p = 0.02) and at 1 year (p = 0.04) in obese patients (35.1% and 59.2%, respectively) than in non-obese patients (19.2% and 42.5%, respectively). The need for tracheotomy due to ventilator-dependent respiratory failure (VDRF) was much higher (p < 0.001) in obese patients (83.3%) than in non-obese patients (56.8%), and the rate of mortality was significantly higher (p < 0.001) in those who required tracheotomy for VDRF (32.8% at 30 days and 57% at 1 year) than in those who required tracheotomy for all other indications (4.2% at 30 days and 25% at 1 year). The mortality risk increased with higher CCI scores at both 30 days (p = 0.08) and 1 year (p = 0.009).

Conclusions:

The overall mortality rate is higher in obese patients after tracheotomy than in non-obese control subjects in the short and long terms. This increased rate of mortality is due to the heightened incidence of tracheotomy for VDRF among obese patients. The mortality rates after tracheotomy correlate well with the CCI.
Is Preoperative Computed Tomographic Density Measurement of Soft Tissues Helpful in the Diagnosis of Cholesteatoma?
Authors: Lee Dong-Hee , Kim Choung-Soo , Park Chang-Woo , Chung Dae-Young
Published: October 2014

Objectives:

We undertook to verify the usefulness of computed tomography Hounsfield units (HU) in differentiating cholesteatoma from inflammatory tissue.

Methods:

In 91 enrolled cases, the lesions were classified according to the gross pathology, and the specific locations of each lesion were documented by 1 surgeon within 1 day after the operation. The densities in HU of cholesteatoma and non-cholesteatoma lesions were retrospectively measured 3 times by the same examiner, and the difference between the two groups was analyzed. The interobserver reliability among the 3 examiners was assessed to verify the confidence level of the HU measurements in preoperative detection of cholesteatoma.

Results:

The mean HU values of cholesteatoma were 35.7 to 66.6 HU, and those of non-cholesteatoma lesions were 32.9 to 51.3 HU. A general linear model–repeated-measures analysis of variance did not show any significant difference between the cholesteatoma and non-cholesteatoma lesions (p = 0.305). The general linear model–repeated-measures analysis of variance showed a significant difference of the measured HU levels among the 3 examiners (p = 0.021).

Conclusions:

This study showed that the HU values on preoperative computed tomography did not suffice for the detection of cholesteatoma lesions. A clinician's physical examination together with an interpretation of computed tomography is still the “gold standard” method.
Use of Diced Cartilage Grafts Wrapped with Amniotic Membrane in Soft Tissue Augmentation: Experimental Study
Authors: Ozturk Murat , Aydin Omer
Published: October 2014

Objectives:

Correcting nasal dorsal deformities and irregularities often requires biological or alloplastic materials. In rhinoplasty, a frequent postoperative problem is a rough and rigid nasal dorsum. The purpose of this experimental study was to investigate the feasibility of using diced cartilage grafts wrapped in amniotic membrane for soft tissue augmentation.

Methods:

Diced cartilage grafts wrapped with amniotic membrane were transplanted to a subcutaneous tunnel that was made in the back in 20 rats. After 2 months, the histopathologic changes that occurred in the grafts were examined by light microscopy.

Results:

When the diced cartilage grafts wrapped in amniotic membrane were examined, each graft displayed different viability rates.

Conclusions:

In soft tissue augmentation, especially in the nasal dorsum, amniotic membrane can be used to keep the diced cartilage viable and adjoined.
Vestibular Schwannoma in the Only Hearing Ear: Role of Cochlear Implants
Authors: Di Lella Filippo , Merkus Paul , Di Trapani Giuseppe , Taibah Abdelkader , Guida Maurizio , Sanna Mario
Published: October 2014

Objectives:

We sought to delineate the role of cochlear implantation in the management of vestibular schwannoma or other cerebellopontine angle tumors in the only hearing ear.

Methods:

We performed a retrospective analysis in a quaternary referral skull base center of all patients who were affected by vestibular schwannoma (or other lesions of the cerebellopontine angle) in the only hearing ear and received a cochlear implant before or after tumor treatment (surgery or radiotherapy) or during the wait-and-scan follow-up. We also performed a systematic review of the English-language literature.

Results:

The clinical and audiological results of 10 patients are reported. All patients were managed with contralateral cochlear implantation. In 7 patients, cochlear implantation was performed before tumor removal, while hearing in the ear with the tumor was still present. In 3 patients, the implant was placed after curative surgery. Nine of the 10 patients routinely use their implant with subjective benefit and fairly good auditory performance (median disyllabic word recognition, 90%; median sentence comprehension, 75%). The literature search retrieved no major series with assessment of the long-term efficacy of cochlear implantation in this rare clinical scenario.

Conclusions:

Patients affected by vestibular schwannoma in their only hearing ear may significantly benefit from a cochlear implant on the contralateral side prior to tumor removal. Recent and significant hearing deterioration and tumor growth represent the main indications for cochlear implantation.
Rhabdomyosarcoma of Stensen's Duct in Children
Authors: Le Treut Claire , Rome Angélique , Cassagneau Pierre , Fernandez Carla , Triglia Jean-Michel , Nicollas Richard
Published: October 2014

Objectives:

Stensen's duct is a very uncommon location for rhabdomyosarcoma. The purpose of this article was to review the clinical history of 2 patients who had rhabdomyosarcoma of Stensen's duct.

Methods:

We reviewed the clinical history, imaging studies, histologic analysis, and treatment of 2 patients with rhabdomyosarcoma of Stensen's duct.

Results:

An 8-year-old boy (case 1) and a 17-year-old boy (case 2) presented with nonspecific facial swelling. In both patients, imaging studies showed a tumor at Stensen's duct, and biopsy showed embryonal rhabdomyosarcoma. Both patients were treated with preoperative chemotherapy, parotidectomy, and resection of Stensen's duct and postoperative chemotherapy and radiation therapy. Follow-up at 9 years (case 1) and 2 years (case 2) after surgery showed that the patients were free of disease.

Conclusions:

Stensen's duct rhabdomyosarcoma is rare and may have a better prognosis than rhabdomyosarcoma in other locations in the head and neck.
Subacute Rhinitis in Infants: Gastroesophageal Reflux Must Be Considered
Authors: Zagólski Olaf
Published: October 2014

Objectives:

The study sought to evaluate the influence of gastroesophageal reflux disease (GERD) and allergy on subacute rhinitis in infants.

Methods:

Mothers of 74 infants with subacute rhinitis completed the Infant Gastroesophageal Reflux Questionnaire Revised. Participants with GERD were randomized to undergo one of the following regimens for 10 days: Use of fluorometholone nasal drops with positional and feeding changes; positional and feeding changes; or a placebo.

Results:

The daily amount of nasal secretion decreased by 75.9% (p < 0.001), the intensity of swallowing difficulty by 79.2% (p < 0.001), and the incidence of uneasiness by 92.0% (p < 0.001) in infants treated with nasal glucocorticoid and positional and feeding changes; and the percentage differences in the amount of nasal secretion (p < 0.001), feeding difficulty (p < 0.001), and uneasiness (p < 0.001) were greater than those in the group treated with positional and feeding changes. The infants treated with placebo did not improve. The influence of nasal allergy was nonsignificant.

Conclusions:

Gastroesophageal reflux disease might contribute to aggravation of subacute rhinitis in infants.
Caffeic Acid Phenethyl Ester Inhibits Diesel Exhaust Particle—Induced Inflammation of Human Middle Ear Epithelial Cells via NOX4 Inhibition
Authors: Jo Sun-Young , Lee Naree , Hong Sung-Moon , Jung Hak Hyun , Chae Sung-Won
Published: October 2014

Objectives:

Otitis media is one of the most common diseases in pediatric populations. Recent research on its pathogenesis has focused on air pollution. Chronic exposure to particulate air pollution is associated with the impairment of middle ear function. However, the mechanisms and the underlying inhibitory pathways, especially in the human middle ear, remain unknown. Caffeic acid phenethyl ester (CAPE) is a biologically active ingredient of propolis, a product of honeybee hives, which has anti-oxidative and anti-inflammatory activities. The aim of this study was to evaluate the inhibitory effect of CAPE on diesel exhaust particle (DEP)–induced inflammation of human middle ear epithelial cells and to determine the underlying pathway of the action of CAPE.

Methods:

The inflammatory damage caused by DEPs and the anti-inflammatory effects of CAPE were determined by measuring the levels of tumor necrosis factor α and nicotinamide adenine dinucleotide phosphate oxidase (NOX) 4 with real-time reverse transcription polymerase chain reaction and Western blot analysis. The oxidative stress induced by DEPs and the anti-oxidative effects of CAPE were directly evaluated by measuring reactive oxygen species production by use of flow cytometric analysis of 2′,7′-dichlorofluorescein diacetate. The effects of CAPE were compared with those of N-acetyl-L-cysteine, which has anti-oxidative and anti-inflammatory effects.

Results:

Use of CAPE significantly inhibited DEP-induced up-regulation of tumor necrosis factor α and NOX4 expression in a dose- and time-dependent manner. The accumulation of reactive oxygen species induced by DEPs was decreased by pretreatment with CAPE. The anti-inflammatory and anti-oxidative effects of CAPE were similar to those of N-acetyl-L-cysteine.

Conclusions:

The inflammation induced by DEP is reduced by CAPE via the inhibition of NOX4 expression. These findings suggest that CAPE might be used as a therapeutic agent against DEP-induced inflammation of human middle ear epithelial cells.
Rapid Development of a Simple Ranula in a Child
Authors: Sathanantham Dinesh Kumar , Shah Gopi B. , Ulüalp Seckin
Published: October 2014

Objective:

A simple ranula is a gradually progressive, benign condition of the salivary gland. The report here describes a very rare case of a simple ranula enlarging in an acute fashion, resulting in airway obstruction.

Case Report:

A 7-year-old girl presented with swelling in the floor of the mouth, pushing the tongue upward and backward, requiring immediate nasotracheal intubation. Magnetic resonance imaging suggested a simple ranula requiring urgent surgery. The patient was followed up 4 weeks after discharge, at which time she was doing well.

Conclusion:

To the best of the authors’ knowledge, this is the first case reported of a simple ranula presenting in an acute fashion, leading to airway compromise in a pediatric patient. The literature is reviewed and features of diagnosis and treatment are presented.