bluuebunny/crossref_metadata_2025 huggingface dataset:
Rat Laryngeal Transplant Model: Technical Advancements and a Redefined Rejection Grading System
Authors: Lorenz Robert R. , Dan Olivia , Nelson Marc , Fritz Michael A. , Strome Marshall
Published: October 2014

The rat laryngeal transplant model, introduced in 1992, laid the basic science foundation that contributed to the first successful human larynx transplant in 1998. Over 1,500 rat transplants later, numerous modifications have improved the model, increasing the initially reported evaluability rate of 50% to almost 100%. The observed histologic rejection process has been altered, as well. We report the technique modifications, as well as the results of a new study using nonimmunosuppressed, allogenic transplantations, in order to define a new rejection grading system. Using the updated model, we performed 50 transplantations between LBN(fl) donor rats and Lewis recipients. Larynges from 8 groups of 5 to 10 animals were harvested at intervals between 1 and 20 days after transplantation. The larynges were examined grossly and microscopically in a blinded manner for evidence of rejection. A multivariable linear regression model was used to define a new rejection grading scale. All 50 animals survived their assigned posttransplantation period. No animals exhibited vascular thromboses, for an evaluability rate of 100%. Histologic criteria in 7 categories and gross criteria in 5 categories demonstrated increased rejection proportional to the amount of time after transplantation. The equation [Group = −2.209 + 0.465 × (Size) + 0.901 × (VAFlow) + 0.613 × (Muscle) + 1.040 × (Thyroid)] reproducibly grades rejection on the basis of gross and histologic findings. New modifications to the rat laryngeal transplant model have conferred greatly improved animal survival rates and anastomotic patency rates. Additionally, the observed rates of rejection have been reduced in comparison to those of initial studies. This updated rejection staging system will be used to compare immunosuppressive regimens in future rat laryngeal transplant studies.
Modeling Measured Glottal Volume Velocity Waveforms
Authors: Verneuil Andrew , Gerratt Bruce R. , Berry David A. , Ye Ming , Kreiman Jody , Berke Gerald S.
Published: October 2014

The source-filter theory of speech production describes a glottal energy source (volume velocity waveform) that is filtered by the vocal tract and radiates from the mouth as phonation. The characteristics of the volume velocity waveform, the source that drives phonation, have been estimated, but never directly measured at the glottis. To accomplish this measurement, constant temperature anemometer probes were used in an in vivo canine constant pressure model of phonation. A 3-probe array was positioned supraglottically, and an endoscopic camera was positioned subglottically. Simultaneous recordings of airflow velocity (using anemometry) and glottal area (using stroboscopy) were made in 3 animals. Glottal airflow velocities and areas were combined to produce direct measurements of glottal volume velocity waveforms. The anterior and middle parts of the glottis contributed significantly to the volume velocity waveform, with less contribution from the posterior part of the glottis. The measured volume velocity waveforms were successfully fitted to a well-known laryngeal airflow model. A noninvasive measured volume velocity waveform holds promise for future clinical use.
From the Roots of Rhinology: The Reconstruction of Nasal Injuries by Hippocrates
Authors: Lascaratos John G. , Trompoukis Constantinos C. , Segas John V. , Assimakopoulos Dimitrios A.
Published: October 2014

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine.
Treatment of Ranula with Intracystic Injection of the Streptococcal Preparation Ok-432
Authors: Fukase Shigeru , Inamura Kazutoshi , Ohta Nobuo , Aoyagi Masaru
Published: October 2014

Intracystic injection of OK-432 was developed as a therapy for operatively difficult lymphangioma (cystic hygroma) and is currently becoming a treatment of first choice for this disease. We tried this therapy in 32 patients with ranula (oral floor type in 21 cases and plunging type in 11 cases). Disappearance or marked reduction of the lesion was observed in 31 patients (97%) who had this therapy, and local scarring did not occur in any patient. As side effects, local pain at the injection site and fever (37°C to 39°C) were observed in almost half of the patients who had this therapy, but such problems resolved within a few days. We treated the initial 4 cases in the hospital for 4 to 5 days, but after the safety of this method had been confirmed, we treated the other 28 cases on an outpatient basis. Thus, we confirmed that intracystic injection therapy with OK-432 is relatively safe and can be used as a substitute for surgery in the treatment of ranulas.
Multiplex Nested Reverse Transcription-Polymerase Chain Reaction for Respiratory Viruses in Acute Otitis Media
Authors: Ishibashi Toshio , Monobe Hiroko , Shinogami Masanobu , Nomura Yuka , Yano Jun
Published: October 2014

Because respiratory viruses play an important role in the causation and pathogenesis of acute otitis media (AOM), determining which virus has infected a child is important with respect to vaccines and antiviral drugs. In some instances, this information might be used to prevent the occurrence of AOM. We used a rapid, economical, and sensitive diagnostic system involving a multiplex nested reverse transcription–polymerase chain reaction (RT-PCR) assay to detect various respiratory viruses in clinical specimens of middle ear fluid (MEF) from children with AOM in our hospital. Multiplex RT-PCR was completed on 40 MEF samples from 28 infants and children less than 6 years old with AOM. Viral RNA was detected in 17 MEF samples (43%). Respiratory syncytial virus type A was present in 12 samples, adenovirus in 3, rhinovirus in 2, and influenza A (H3N2) in 1. The multiplex RT-PCR assay is recommended to clinical laboratories that are considering adoption of a molecular technique for viral diagnosis.
Cicatricial Pemphigoid in the Upper Aerodigestive Tract: Diagnosis and Management in Severe Laryngeal Stenosis
Authors: Boedeker Carsten Christof , Staats Richard , Termeer Christian Carl , Ridder Gerd Jürgen
Published: October 2014

Pemphigoid is a group of rare, acquired, autoimmune subepithelial blistering diseases. The condition has been subclassified into bullous pemphigoid and cicatricial pemphigoid (CP). Diagnosis is based on clinical presentation, evidence of subepithelial vesicles or bullae on routine histologic analysis, and direct and indirect immunofluorescence studies. Cicatricial pemphigoid is characterized by linear deposition of immunoreactants, principally IgG and complement factor 3, along epithelial basement membranes. Cicatricial pemphigoid usually leads to mucosal scarring. We present a case of severe CP that led to laryngeal and subglottic stenosis and involvement of both eyes and the oral, nasal, and nasopharyngeal mucosae. Treatment with dapsone, corticosteroids, azathioprine sodium, cyclosporine A, cyclophosphamide, methotrexate sodium, and mycophenolate mofetil between 1997 and 2001 only resulted in temporary disease control. The patient has been treated with leflunomide for the past 8 months, and there have been no relapses. Treatment of CP with leflunomide has not been described in the literature until now.
Fixation of the Anterior Mallear Ligament: Diagnosis and Consequences for Hearing Results in Stapes Surgery
Authors: Huber Alexander , Koike Takuji , Nandapalan Vel , Wada Hiroshi , Fisch Ugo
Published: October 2014

In the search for possible causes of unfavorable results after stapes surgery, the study reported here focused on the anterior mallear ligament, since it has been previously reported that partial mallear fixation (PMF) leads to functional failure in 38% of cases of stapes revision surgery. The aims of the study were to identify effective methods for the diagnosis of PMF and experimentally assess the conductive hearing loss that results from PMF. The study included vibration amplitude measurements of the ossicles by laser Doppler interferometry (LDI) in 19 patients and 5 fresh human temporal bone (TB) specimens. Analysis of their dynamic behavior was performed by finite element modeling (FEM). Similar, significant changes of manubrium vibration patterns for PMF were found by FEM calculations, in TB experiments, and in patients. We could identify PMF either before operation, using LDI, or during operation, by manual palpation. In the TB experiments and FEM calculations, the attenuation of the stapes displacement due to an isolated PMF was approximately 10 dB and frequency-dependent. Untreated anterior mallear ligament fixation produced a persistent air-bone gap of approximately 10 dB after stapedioplasty.
Isolated Inflammatory Sphenoid Sinus Disease in Children
Authors: Uren Brent A. , Berkowitz Robert G.
Published: October 2014

Isolated inflammatory disease of the sphenoid sinus is very uncommon in the pediatric population. A 10-year review of all patients at our institution 16 years of age or younger with inflammatory sphenoid sinus disease found 8 patients with isolated sphenoid sinusitis and 3 with sphenoid mucoceles. The most common symptoms were headache and visual disturbance. Five patients with uncomplicated sinusitis were successfully managed medically, while 3 with either complicated sinusitis or sinusitis not responding to antibiotics were treated by endoscopic sphenoidotomy. All patients with a mucocele were treated surgically. Isolated inflammatory sphenoid sinusitis should be considered in children age 7 years or older who present with headache that does not respond to simple analgesia. Delayed diagnosis and advanced disease may lead to life-threatening complications.
Reduction of Postural Sway by Use of a Vibrotactile Balance Prosthesis Prototype in Subjects with Vestibular Deficits
Authors: Kentala Erna , Vivas Jason , Wall Conrad
Published: October 2014

To evaluate the effectiveness of a prototype vibrotactile balance prosthesis in maintaining balance during dynamic posturography, we studied 6 subjects with unilateral or bilateral vestibular deficit by means of Equitest computerized dynamic posturography (CDP). Their anterior-posterior (AP) sway at the small of the back was measured with a micromechanical rate gyroscope and a linear accelerometer. The resulting tilt estimate was displayed by a vibrotactile array attached to the torso. The vibration served as tilt feedback to the subject. Subject performance was evaluated with the tilt performance index (TPI), which is the inverse of the root-mean-square of tilt. We found that the balance prosthesis reduced the subjects' AP sway. The subjects' results without the balance prosthesis on CDP sensory organization tests (SOTs) 5 and 6 were compared to results with the prosthesis. The average TPI increased significantly (p < .05) when vibrotactile feedback was used as compared to the unaided condition. This finding was true for both SOTs 5 and 6. We conclude that vibrotactile feedback of estimated AP body tilt improved the subjects' ability to perform selected CDP tests. Some of the subjects were able to stand throughout the test with the device turned on, whereas they otherwise constantly fell.
Detection of Recurrent Nasopharyngeal Carcinomas with Technetium-99m Methoxyisobutylisonitrile Single Photon Emission Computed Tomography in Patients with Indeterminate Magnetic Resonance Imaging Findings after Radiotherapy
Authors: Tsai Ming H. , Lin Cheng C. , Shiau Yu C. , Lee Cheng C. , Tai Chih J. , Kao Albert
Published: October 2014

The aim of this study was to evaluate the effectiveness of technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) single photon emission computed tomography (SPECT) for detecting recurrent nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. Twenty-eight NPC patients who had received radiotherapy and had indeterminate MRI findings were included in the study. We performed MRI, Tc-99m MIBI SPECT, and biopsy at least 4 months after radiotherapy and within 1 week. The final results were based on histopathologic findings and clinical follow-up after 6 or more months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m MIBI SPECT were 85.7%, 92.9%, and 89.3%, respectively. Our findings suggest that Tc-99m MIBI SPECT may be an effective tool for detecting recurrent NPC when MRI findings are indeterminate.
Extracellular Matrix as a Scaffold for Laryngeal Reconstruction
Authors: Huber Jessica E. , Spievack Alan , Ringel Robert L. , Simmons-Byrd Abby , Badylak Stephen
Published: October 2014

Porcine-derived xenogeneic extracellular matrix (ECM) has been successfully used as a scaffold for tissue repair and reconstruction in numerous preclinical animal studies and human applications. These scaffolds are completely and rapidly degraded and replaced by host-derived tissues that frequently mimic the original tissue composition and architecture. The purpose of the present study was to examine the morphology of ECM scaffolds after their use for laryngeal reconstruction. Thirty adult female dogs were subjected to a partial hemilaryngectomy. The right thyroid cartilage and vocal fold were replaced with ECM scaffold, and the dogs were painlessly sacrificed from 1 week to 12 months after surgery. Histologic examination of the reconstructed tissue showed the presence of a simple squamous epithelial lining, organized glandular structures within the submucosa, reconstructed thyroid cartilage, and bundles of skeletal muscle by 3 months after surgery. We conclude that ECM scaffolds are promising templates for constructive remodeling of laryngeal tissue.
Hammer-Chisel Technique in Endoscopic Dacryocystorhinostomy
Authors: Cokkeser Yasar , Tercan Mustafa , Evereklioglu Cem , Hepsen Ibrahim F.
Published: October 2014

We performed a prospective evaluation of endoscopic hammer-chisel dacryocystorhinostomy (DCR) procedures on 62 eyes of 44 patients (40 female and 4 male) with chronic epiphora or dacryocystitis (26 unilateral and 18 bilateral). The technique included chisel removal of bone over the lacrimal sac. The follow-up period was 12 to 54 months (mean, 28 months), and the patients' ages ranged from 17 to 67 years (mean, 35.5 years). The success rate of the consecutive endoscopic hammer-chisel DCR procedures was 87%. During operation, 8 patients had mild mucosal hemorrhage, which did not prevent the successful completion of the operation. Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic hammer-chisel DCR is less traumatic, is less time-consuming, and is practical and cosmetically convenient, with minimal perioperative and postoperative complications. It also allows the simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.
Laser Surgery of the Inferior Turbinate for Allergic Rhinitis with Seasonal Exacerbation: An Acoustic Rhinometry Study
Authors: Takeno Sachio , Ishino Takashi , Osada Rika , Yajin Koji
Published: October 2014

Laser surgery has been used to successfully treat patients with perennial allergic rhinitis. We examined whether the numbers and types of sensitized allergens influence the effects of surgery. Two different groups (those allergic to house dust mites only, and those allergic to house dust mites and Japanese cedar pollen) prospectively underwent the same course of laser turbinectomy during the pollen dispersion season. The symptom scores for nasal obstruction significantly decreased in both groups, but the improvement of sneezing and rhinorrhea was less pronounced in the pollen group. We used acoustic rhinometry to measure postoperative changes in the nasal dimensions. Four months after treatment, the minimum cross-sectional area and nasal cavity volume had increased, respectively, by 61.7% and 30.7% in the house dust group, and by 30.7% and 16.2% in the pollen group. We conclude that laser surgery can be successfully applied to patients whose allergies show seasonal exacerbation by airborne pollen.
Effects of Bacterial Toxins on Air-Exposed Cultured Human Respiratory Sinus Epithelium
Authors: Nell Marja J. , Grote Jan J.
Published: October 2014

The present study was designed to investigate the effects of the bacterial toxins lipopolysaccharide (LPS) and lipoteichoic acid (LTA) on air-exposed cultured human respiratory sinus epithelium. The morphological changes, proliferation, and differentiation of sphenoid sinus mucosa were examined after incubation with different LPS or LTA concentrations. Air-exposed cultured sinus mucosa differentiated from pseudostratified respiratory epithelium to squamous ciliated epithelium with few goblet cells. High concentrations of bacterial toxins induced a significant increase in mucus production and a decrease in ciliated cells. Ki67 immunostaining showed an increased cell proliferation after incubation with moderate levels of LPS or LTA. High concentrations of bacterial toxins, on the other hand, induced a decreased proliferation. Involucrin expression was clearly altered by incubation with high levels of bacterial toxins, indicating an increased degree of terminal differentiation. These results indicate that the bacterial toxins LPS and LTA both induce comparable dose-dependent morphological changes in sinus epithelium.
Pediatric Endoscopic Transnasal Adenoid Ablation
Authors: Shin Jennifer Joan , Hartnick Christopher J.
Published: October 2014

We describe a technique in which suction diathermy is used for adenoid ablation through a solely endoscopic transnasal approach in the older pediatric population. This procedure has proved to be both effective and convenient during other transnasal endoscopic procedures, as it provides excellent visualization of both the superior and inferior parts of the nasopharynx and results in minimal to no bleeding in the adenoid bed. In all cases to date, there has been complete resolution of preoperative problems of infection, pain, and bleeding. All patients had good control of postoperative pain. There has been no evidence of postoperative nasopharyngeal stenosis and no velopharyngeal insufficiency. Although transnasal adenoid ablation is not appropriate for the entire pediatric population, this procedure has multiple benefits when another endoscopic sinonasal procedure is planned, when there is neck instability, or when enhanced visualization of the nasopharynx is desired.
Rupture Pressures of the Porcine Tympanic Membrane
Authors: Thamrin Cindy , Eikelboom Robert H.
Published: October 2014

The mean rupture pressure of the porcine tympanic membrane (TM) was measured in 9 specimens. Pressure was delivered gradually into the external ear canal of an excised piece of temporal bone, via a syringe and polyurethane tubing attached to the canal. Tympanometry was used to ascertain the structural integrity of the TM before pressure delivery. Rupture pressure was defined to be that point at which a sudden drop occurred in the overpressure in the ear canal, as measured by a pressure gauge. From the results, we concluded that the mean rupture pressure for the porcine TM is 1.2 ± 0.3 atm. This is of the same order of magnitude as and slightly less than pressures obtained for the human TM.
First Forty-Eight Hours of Developing Otitis Media: An Experimental Study
Authors: Eriksson Per Olof , Mattsson Cecilia , Hellström Sten
Published: October 2014

The early inflammatory changes in the tympanic membrane were explored in 2 rat models. Acute otitis media was induced by instillation of Streptococcus pneumoniae type 3 into the middle ear cavity, and otitis media with effusion was induced by blockage of the eustachian tube. Otomicroscopic examination was performed before the rats were painlessly sacrificed at 3, 6, 9, 12, 18, 24, or 48 hours after initiation of the otitis media conditions. The tympanic membrane was studied by light and electron microscopy. Both acute otitis media and otitis media with effusion caused early inflammatory changes of the tympanic membrane, and the pars flaccida was the portion that reacted first. The inflammatory alterations were most pronounced in the acute otitis media model. The course of inflammation showed a bimodal pattern with an early deposition of a filamentous material with a band pattern, typical of fibrin. Despite a fluid-filled middle ear cavity, the inflammatory changes in the otitis media with effusion model were moderate, as was consistent with the clinical appearance of the tympanic membrane.
Malignant Peripheral Nerve Sheath Tumor of the Parotid Gland
Authors: Imamura Shun-Ichi , Suzuki Haruko , Usami Shin-Ichi , Koda Eiki , Yoshizawa Akihiko
Published: October 2014

Malignant peripheral nerve sheath tumor (MPNST) has been defined as any malignant tumor arising from or differentiating toward cells of the peripheral nerve sheath. We treated a case of MPNST arising from the right parotid gland that showed a highly aggressive course. We reviewed the English-language literature published since 1990 and found 142 cases of head and neck MPNST reported within the past 13 years. The results of the review suggested that MPNSTs may arise from any organs of the head and neck. Immunohistochemical analysis of various neural markers plays a significant role in the evaluation of the histologic diagnosis. Curative treatment based on radical resection of MPNSTs of head and neck origin is more difficult than treatment of MPNSTs of other origins.
Incompetent Circle of Willis and Vertebrobasilar Insufficiency
Authors: Welsh Louis W. , Lewin Bernard , Welsh John J. , Dragonette Joseph E.
Published: October 2014

An analysis of the vascular basis of vertebrobasilar insufficiency was derived from the examination of 135 subjects by magnetic resonance imaging and angiography. The data from this cohort were compared to those from normal, ie, asymptomatic, individuals. We concluded that there is a significant difference in the potential for intracerebral collateralization and regional perfusion due to structural defects such as stenosis or developmental absence of the posterior communicating arteries in this symptomatic group. In addition, an occlusion of one or more of the source vessels, the internal carotid and vertebral arteries, in conjunction with an incomplete circle of Willis increased the potential for hindbrain perfusion deficits. Clinical cases illustrate the relationship between failure of internal shunting and the myriad symptoms of hindbrain dysfunction.
Intravenous Infusion of Recombinant Tissue Plasminogen Activator for the Treatment of Patients with Sudden and/or Chronic Hearing Loss
Authors: Mora Renzo , Barbieri Marco , Mora Massimilliano , Mora Francesco , Yoo T. J.
Published: October 2014

Seventeen patients with sudden hearing loss and 10 patients with chronic hearing loss were treated with intravenous infusion of tissue plasminogen activator. For sudden hearing loss, the recombinant tissue plasminogen activator was used, and 3 mg (in 3 mL of diluent) was diluted into 250 mL of physiological saline solution and given intravenously every 12 hours. Sixteen patients of the sudden hearing loss group and all 10 patients of the chronic hearing loss group showed an improvement after this treatment. No patients had side effects from the treatment. The results indicate that this would be an excellent mode of therapy for patients with hearing loss.
Restoration of Hearing Loss with Tissue Plasminogen Activator
Authors: Mora Renzo , Mora Francesco , Barbieri Marco , Mora Massimilliano , Yoo T. J.
Published: October 2014

A 59-year-old man with a 2-year history of sudden onset of hearing loss in the left ear was treated with tissue plasminogen activator (tPA) for myocardial infarction. The patient had 50 dB of hearing recovery after the full dose (100 mg of tPA followed by 3 mg/d of tPA for 2 weeks).
Effect of Tensor Veli Palatini Muscle Paralysis on Eustachian Tube Mechanics
Authors: Ghadiali Samir N. , Swarts J. Douglas , Doyle William J.
Published: October 2014

Several physiological functions, such as regulating middle ear (ME) pressure and clearing ME fluid into the nasopharynx, require an opening of the collapsed eustachian tube (ET). The ability to perform these functions has been related to several mechanical properties of the ET: opening pressure (Popen), compliance (ETC), and hysteresis (η). These global properties may be influenced by the mechanics of the surrounding tissue and/or the mucosa-air interface. In this study, we investigated the influence of tissue mechanics by paralyzing the right tensor veli palatini (TVP) muscle in 12 cynomolgus monkeys via botulinum toxin injection. A previously developed modified forced-response protocol was used to measure Popen, ETC, and η under normal conditions and after muscle paralysis. The loss of muscle tone and/or stiffness resulted in a significant decrease in Popen (p < .01) and a significant increase in ETC (p < .01). In addition, muscle paralysis reduced the viscoelastic properties of the TVP muscle and therefore resulted in a significant decrease in η (p < .05). A comparison with previous measurements on the influence of surface tension mechanics indicates that the ET's compliance is primarily determined by tissue elastic properties. The ET hysteresis, however, is equally affected by viscoelastic tissue properties and surface tension hysteretic properties. Knowledge of how these physical components affect the global mechanical environment may lead to improved treatments for ET dysfunction that target the underlying mechanical abnormality.
Postnatal Changes in the Connective Tissue in the Region Lateral to the Eustachian Tube: Possible Relationship to Tube Function
Authors: Orita Yorihisa , Miura Makoto , Sando Isamu , Hasebe Seishi
Published: October 2014

In order to delineate the possible role of connective tissue (CT) in the region lateral to the eustachian tube (ET) between the ET lumen and the tensor veli palatini muscle (TVPM), we studied the postnatal changes in the CT in histologic sections of human ET. In fetuses and neonates, the lateral region was filled with mesenchyme. Loose collagenous CT appeared first at 2 weeks of age, and in subjects older than 4 years of age, the collagen formed dense, meshlike structures attaching to both the subepithelial CT layer of the ET and the tendonlike membrane of the TVPM. Along the long axis of the ET, those attachments were distributed mainly in the region at the posterior part of the cartilaginous portion of the ET. Attachments to the subepithelial CT layer of the ET were distributed mainly in the upper half of the region. The dense, meshlike collagenous CT might help the ET to be opened by drawing the lateral wall of the ET lumen through inferolateral movement of the tendonlike membrane of the TVPM when the TVPM contracts. It may work to open mainly the parts that include the narrowest portion of the ET, and also the upper aspect of the ET lumen. Incomplete development of this structure in infants may be one of the factors associated with dysfunction in ET opening.
Successful Treatment of Idiopathic Laryngotracheal Stenosis by Resection and Primary Anastomosis
Authors: Grillo Hermes C. , Mathisen Douglas J. , Wright Cameron D. , Ashiku Simon K. , Wain John C.
Published: October 2014

We studied the early and long-term response of idiopathic laryngotracheal stenosis (ILTS) to treatment by 1-stage laryngotracheal or tracheal resection and reconstruction in 73 patients. Nineteen of the 72 (26%) noted no difference in their voices or any difficulty in breathing after reconstruction. Forty-seven (64%) described loss of ability to project their voices as loudly as before or noted some difficulty in singing as well as they did before. Five (7%) had various degrees of dyspnea or stridor on effort. One needed continued dilation. The median follow-up was 8 years. Surgical treatment gave good or excellent results in 90% of these patients with ILTS. Recurrence or progression of stenosis was not evident.
Decannulation and Survival following Tracheostomy in an Intensive Care Unit
Authors: Leung Randal , Campbell Donald , MacGregor Lachlan , Berkowitz Robert G.
Published: October 2014

We investigated the long-term outcome of patients requiring tracheostomy in an intensive care unit (ICU) in an attempt to identify risk factors that would indicate a low probability of early decannulation. A retrospective study was conducted of a consecutive series of 106 patients who underwent tracheostomy in the period between January 1, 2001, and December 31, 2001, during their admission to the ICU at the Royal Melbourne Hospital, Melbourne, Australia. There were 61 male and 39 female patients with a median age of 65 years. The indications for tracheostomy were prolonged mechanical ventilation (47), tracheobronchial toilet or risk of aspiration (45), and an unstable or obstructed airway (8). Thirty-seven patients died during the study period. All surviving patients were successfully decannulated (median cannulation time, 25 days). Patients with tracheostomies inserted for an unstable or obstructed airway had a significantly shorter cannulation time (median time of 13 days) as compared to the other two indications (mechanical ventilation, 25 days; risk of aspiration, 33 days; log-rank test, χ2(2) = 14.62 and p = .0007). Multivariate analysis showed that the effect of an unstable or obstructed airway was independent of the remaining group variables. We conclude that ICU patients who need a tracheostomy have a high mortality rate. Only the indication for tracheostomy insertion predicts early decannulation, and other patient variables are not significant predictors.
Benign Paroxysmal Positional Vertigo in Older Women May be Related to Osteoporosis and Osteopenia
Authors: Vibert Dominique , Kompis Martin , Häusler Rudolf
Published: October 2014

Benign paroxysmal positional vertigo (BPPV), so-called canalolithiasis and cupulolithiasis, usually occurs after head trauma or viral vestibular neuritis. In many cases, the cause remains obscure, and it often affects women more than 50 years old. The goal of this work was to study a possible relationship between BPPV and osteopenia or osteoporosis. Thirty-two women, whose ages ranged from 50 to 85 years (median age, 69 years), who had BPPV and were free of any other otoneurologic history, were selected. The diagnosis of osteopenia or osteoporosis was confirmed by a bone mineral density measurement made with dual x-ray absorptiometry of spine and hip (T-score). The BPPV was unilateral in 26 patients and bilateral in 6 patients. Our results showed osteopenia or osteoporosis in 24 of the 32 patients (75%) with BPPV. The T-scores were compared in 3 age groups to those of 83 healthy women. The patients with BPPV had a significantly lower (p < .026) T-score in all groups. Possible pathophysiological mechanisms are discussed to explain the apparent correlation between BPPV and osteopenia or osteoporosis.
Expression of Nitric Oxide Synthases in Nasal Mucosa from a Mouse Model of Allergic Rhinitis
Authors: Oh Seung Jun , Min Yang-Gi , Lee Seung-Ju , Kim Jeong-Whun , Jarin Peter R.
Published: October 2014

Nitric oxide (NO), which is produced by nitric oxide synthase (NOS), has been recently identified as a multifunctional mediator. As for nasal tissue, however, the distribution and expression patterns of 3 isoforms of NOS, including neuronal NOS (nNOS, type I NOS), inducible NOS (iNOS, type II NOS), and endothelial NOS (eNOS, type III NOS), are still unclear. To evaluate the function of NO in the pathophysiology of nasal allergy, we investigated the distribution of NOSs in the nasal mucosa of C57BL/6 mice with allergic rhinitis to the house dust mite, Dermatophagoides farinae. Immunoreactivity to each isoform of NOS was immunohisto-chemically observed. In the allergic nasal mucosa, many eosinophils had infiltrated. Immunoreactivity to NOS types I and III was localized to the surface epithelial and vascular endothelial cells in both allergic and control groups without a statistically significant difference. In contrast, the type II NOS immunoreactivity was weak in normal mice and increased after allergic sensitization. The type II NOS expression of the surface epithelial and vascular endothelial cells was significantly elevated in the allergic group as compared with the control group. These findings suggest that a large amount of NO may be produced in the nasal mucosa of mice by type II NOS after allergic sensitization and that type II NOS may play an important role in the pathogenesis of allergic rhinitis.
Endolaryngeal Extrusion of Expanded Polytetrafluoroethylene Implant after Medialization Thyroplasty
Authors: Laccourreye Ollivier , Hans Stéphane
Published: October 2014

Various nonresorbable implants are currently used worldwide for medialization thyroplasty in patients with unilateral vocal cord paralysis. The Gore-Tex (expanded polytetrafluoroethylene) implant was introduced in the late 1990s. At our institution, 27 patients with unilateral laryngeal nerve paralysis had medialization thyroplasty with a Gore-Tex implant during the years 1998 to 2002. The current report documents our first case of endolaryngeal extrusion of a Gore-Tex implant.
Development of a Canine Model for Recurrent Respiratory Papillomatosis
Authors: Jahan-Parwar Babak , Chhetri Dinesh K. , Bhuta Sunita , Hart Steven , Berke Gerald S.
Published: October 2014

A canine model for recurrent respiratory papillomatosis (RRP) was developed with canine oral papillomavirus (COPV) inoculated into the buccal mucosa and supraglottic larynx of 5 beagles. The animals received systemic immunosuppression with daily oral prednisone at doses of 0, 1, 2, 3, and 4 mg/kg. Buccal papillomata developed at 6 weeks in all animals and regressed by 10 weeks in the animals that received 0 and 1 mg/kg. The other animals had continuous growth of their buccal papillomata for 26 weeks. The animal that received 2 mg/kg developed papillomata on the lingual surface of the epiglottis that continued to grow through 26 weeks. Systemic oral prednisone successfully maintained COPV-induced oral and laryngeal papillomata in beagles. Thus, COPV-induced oral and laryngeal papillomata that are prednisone-maintained may have utility as a model for RRP.
Intraoperative Electrically Elicited Stapedius Reflex Threshold is Related to the Dosage of Hypnotic Drugs in General Anesthesia
Authors: Beger Frank Andreas , Niclaus Oliver , Schultz Arthur , Weber Benno Paul , Lüllwitz Ekkehard , Grouven Ulrich , Schultz Barbara
Published: October 2014

Today cochlear implantation is a widely used means of treatment in deafness and severe hearing disorders in adults, children, and infants. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. However, especially in infants and young children, this fitting process can be difficult because of limited communication capabilities. The use of intraoperatively obtained stapedius reflex thresholds has been proposed for postoperative speech processor fitting, but the influence of anesthetics on threshold values needs to be taken into account. In a retrospective study with 20 patients between 3 and 43 years of age, a highly significant correlation between the dosage of methohexital and the mean stapedius reflex threshold value could be shown (r = 0.65, p = .002). We conclude that more reliable threshold values can be obtained by reducing the dosage of hypnotics to achieve a lighter level of hypnosis during stapedius reflex measurement. To achieve a light, but still sufficient level of hypnosis, electroencephalographic monitoring including automatic interpretation of the complex raw signal should be used.
Lymphocele after Neck Dissection
Authors: Nouwen Johan , Halimi Philippe , Hans Stéphane , Laccourreye Ollivier
Published: October 2014

The current report documents a case of lymphocele after neck dissection and reviews the management and treatment options.
Sudden Sensorineural Hearing Loss after Rapid Reduction of Blood Pressure in Malignant Hypertension
Authors: Chao Ting-Kuang
Published: October 2014

Although circulatory impairment of the cochlea would be intuitively a possible cause of sudden sensorineural hearing loss (SSHL), definite proof is lacking. A 46-year-old man developed bilateral SSHL immediately after rapid reduction of the blood pressure in malignant hypertension. Vertigo and left-sided hearing impairment and tinnitus resolved spontaneously a few hours after onset. The right-sided hearing loss and tinnitus persisted, and the hearing loss improved only 17 dB after 3 months of treatment. This case may provide an in vivo human model of SSHL caused by ischemia. Bilateral involvement is possible in SSHL if the circulatory disturbance is systemic. In addition, a poorer prognosis is anticipated on the side with the more severe initial attack.
Tolerability of N-Chlorotaurine in the Guinea Pig Middle Ear: A Pilot Study Using an Improved Application System
Authors: Nagl Markus , Brown Nadine , Neher Andreas , Prieskorn Diane , Schrott-Fischer Anneliese , Mitchell Alice , Miller Josef M.
Published: October 2014

The tissue tolerance of N-chlorotaurine (NCT), a mild endogenous antimicrobial oxidant, has been investigated by application to the guinea pig middle ear. The animals were implanted with a novel cannula system that allows chronic external drug delivery to the round window niche. In the first part of the study, 3 animals each received 100 μL of 0.1% NCT (5.5 mmol/L) and 1% NCT, respectively, in aqueous solution twice daily for 8 days. In the second part, NCT was dissolved in phosphate-buffered saline solution to 300 milliosmolar (isotonic), and 27 μL was injected in 3 additional animals twice daily for 7 days. The guinea pigs injected with 100 μL of NCT developed immediate dizziness and nystagmus and did not thrive. Other reactions included mucosal thickening in the middle ear, rupture of the tympanic membrane, and blood and gelatinous material in the cochlea accompanied by hair cell loss and a 10- to 90-dB elevation of the hearing threshold as determined by auditory brain stem responses. The effects seemed to be dose-dependent, but the rate of variability was high across animals. In contrast, the guinea pigs treated with 27 μL of isotonic NCT showed no signs of discomfort, no or only moderate thickening of the middle ear mucosa, no shift of the hearing threshold, and no hair cell loss. Positive control animals injected with 10% neomycin sulfate developed extensive hair cell loss. Provided that the membranes of the inner ear are intact and that low single-dose volumes are used to avoid increased middle ear pressure, isotonic NCT seems to be well tolerated in the tympanic cavity. The new drug delivery system proved to be advantageous for ototoxicity studies.
Autologous Fat Injection Laryngohypopharyngoplasty for Aspiration after Vocal Fold Paralysis
Authors: Sato Kiminori , Umeno Hirohito , Nakashima Tadashi
Published: October 2014

Injection laryngoplasty is one of the procedures for treating unilateral vocal fold paralysis. This is a preliminary report on modified injection laryngoplasty, ie, injection of liposuctioned autologous fat into the larynx and hypopharynx of patients who have aspiration and voice disorders after vocal fold paralysis. Lipoinjection was performed in 3 patients with these complaints with the endolaryngeal microsurgical technique under general anesthesia. The locations of fat injection were the vocal fold, the false vocal fold, the aryepiglottic fold of the larynx, and the medial wall of the pyriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold strengthened laryngeal closure. Lipoinjection, performed into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage, made arytenoid cartilage rotation possible, and consequently strengthened laryngeal closure. Lipoinjection into the medial wall of the pyriform sinus of the hypopharynx reduced its capacity; consequently, the amount of residual food retained in it was reduced and pharyngeal clearance on the affected side was improved. The longest follow-up among the 3 patients has been 24 months. Their aspiration and glottal incompetence have been improved by this operation. We conclude that modified injection laryngoplasty (laryngohypopharyngoplasty) is one of the surgical options for preventing aspiration after vocal fold paralysis.
Anatomy and Fiber Type Composition of Human Interarytenoid Muscle
Authors: Tellis Cari M. , Thekdi Apurva , Rosen Clark , Sciote James J.
Published: October 2014

Intrinsic laryngeal muscle investigations, especially those of the interarytenoid (IA) muscle, have been primarily Ideologically based. We determined IA muscle anatomy and histochemical and immunohistochemical classification of extrafusal and intrafusal (muscle spindle) fibers in 5 patients. Extrafusal fibers were oxidative type I and glycolytic types IIA and IIX. Intrafusal fibers of muscle spindles were identified by the presence of tonic and neonatal myosin. The results demonstrate that the IA muscle has a phenotype similar to that of limb skeletal muscle. Myosin coexpression, the absence of intrafusal fibers, and fiber type grouping were unusual features found previously in the thyroarytenoid and posterior cricoarytenoid muscles, but they were not present in the IA muscle. These findings lead to the conclusion that the IA muscle has functional significance beyond its assumed importance in maintaining vocal fold position during phonation. The presence of spindles demonstrates differences in motor control as compared to the thyroarytenoid and posterior cricoarytenoid muscles. Further, extrafusal fiber characteristics implicate IA muscle involvement in muscle tension dysphonia and adductor spasmodic dysphonia. Given the unique physiologic characteristics of the human IA muscle, further research into the role of the IA muscle in voice disorders is warranted.
Herpes Zoster Laryngis with Prelaryngeal Skin Erythema
Authors: Wu Chin-Lung , Linne Oan-Che , Chiang Ching-Wen
Published: October 2014

A 74-year-old man came to our hospital with complete left vocal cord paralysis and erythema of the prelaryngeal skin. The patient also had mucosal swelling and erosions in the left arytenoid cartilage, aryepiglottic fold, and pyriform sinus. Herpetic vesicles developed over the prelaryngeal erythema 4 days after admission. An increase in the varicella-zoster immunoglobulin G level to 3,294 IU/mL confirmed varicella-zoster virus infection of the larynx and prelaryngeal skin. The patient was treated with acyclovir without marked effect. Nevertheless, in cases of unilateral vocal cord paralysis and erythema of the ipsilateral prelaryngeal skin, we advise that herpes zoster laryngis must be considered and treatment with early intravenous acyclovir started.
Image-Guided Surgical Drainage of Medial Parapharyngeal Abscesses in Children: A Novel Adjuvant to a Difficult Approach
Authors: Cable Benjamin B. , Bauman Nancy M. , Brenner Pryor , Mair Eric A.
Published: October 2014

Surgical drainage of localized infections in deep neck spaces in children is often completed without a high degree of technical difficulty. However, abscess drainage within the superior parapharyngeal space medial to the great vessels is particularly challenging for otolaryngologists. Drawbacks to both the intraoral and external approaches to this area have led us to develop a new adjunctive technique that utilizes intraoperative image-guided technology to augment the intraoral approach. Here we present a case series of 12 children in whom this technique was successfully used.
Videolaryngostroboscopy following Frontolateral Laryngectomy with Sternohyoid Flap
Authors: Cruz Walter Paiva , Rapoport Abrão , Dedivitis Rogério Aparecido , Guimarães André Vicente
Published: October 2014

We conducted a retrospective study to analyze the videostroboscopic findings in a group of 21 patients who underwent vertical frontolateral laryngectomy with reconstruction by use of the sternohyoid muscle flap. They had T1b and T2 glottic tumors and a follow-up of more than 1 year. Three observers analyzed the recorded videostroboscopic data. The cases in which the stroboscopic evaluation of the vocal folds was incomplete were studied in regard to the clinical staging, the supraglottic hyperfunction, and the vibratory site; the Fisher exact test was applied. The glottic closure was complete in 15 individuals, and 6 had irregular vocal gaps. The site of vibration was glottic in 10 cases, supraglottic in 7, and mixed in 4. The amplitude was normal on 4 and slightly diminished on 9 preserved sides, whereas it was moderately or severely diminished on 16 and absent on 5 reconstructed sides. The mucosal wave vibratory pattern was always totally present on 15 preserved and 5 reconstructed sides: normal or slightly diminished in the preserved vocal folds, and moderately or severely diminished in the reconstructed ones. The reconstructed vocal folds had a nonvibrating portion in 5 cases. The movement extent of the preserved side was larger than that of the other side in 8 cases, and the sides were similar in 13 cases. The symmetry was regular in 18 cases. The periodicity was always or generally regular in 9 cases. There was supraglottic hyperadduction in 16 cases, with a lateral constriction predominance. The mucosal appearance was normal in 15 patients and wet in 6 patients. The epiglottis was straight in 14 cases and crescent in 7. Mucus formation was observed in 1 patient in the posterior vibratory portion. Videolaryngostroboscopy allowed thorough evaluation of the vibratory pattern of the vocal folds in 52.4% of the patients. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic in 33.3%, and mixed in 19.1% of the cases. The vibratory pattern was diminished on both sides, but mainly on the reconstructed one.
Mucosal Changes in Rhinitis Medicamentosa
Authors: Lin Chun-Yu , Cheng Po-Hsu , Fang Sheen-Yie
Published: October 2014

To evaluate the nasal mucosal changes in rhinitis medicamentosa (RM), especially those related to goblet cells and subepithelial glands, we studied specimens of the inferior turbinate mucosa from 8 patients with RM, 8 patients with chronic hypertrophic rhinitis (CHR), and 5 patients with normal nasal mucosa. All specimens were assessed by electron microscopy and immunohistochemical study. Under a scanning electron microscope, hyperplasia of goblet cells was most prominent in the RM group, and an increased number of gland openings was evident in the RM and CHR groups. In addition, the immunoreactivity of epidermal growth factor receptor staining was strongest in the hyperplastic epithelium of the RM group. According to our results, it is feasible that the mucosa of patients with RM is in a chronic inflammatory, hypersecretory state. Degenerative changes in the secretory elements may cause impairment of mucociliary transport and may be responsible for the nasal obstruction and posterior nasal drip in RM.