bluuebunny/crossref_metadata_2025 huggingface dataset:
Immortalization of Normal Adult Human Middle Ear Epithelial Cells Using a Retrovirus Containing the E6/E7 Genes of Human Papillomavirus Type 16
Authors: Moon Sung-Kyun , Brackmann Derald E. , chun Young-Myoung , Lee Haa-Yung , Rhim Johng S. , Webster Paul , Lim David J.
Published: October 2014

A human middle ear epithelial cell line (HMEEC-1) was established using human papillomavirus E6/E7 genes. HMEEC-1 has remained morphologically and phenotypically stable, even after 50 passages. The cells are anchorage-dependent and nontumorigenic when injected into nude mice. This cell line thus provides a new tool for the study of normal cell biology and the pathological processes associated with the epithelial cells of the middle ear in otitis media. HMEEC-1 will also be useful in the search for new drugs and biological agents for the treatment of otitis media.
Results of Fascial Augmentation in Unilateral Vocal Fold Paralysis
Authors: Reijonen Petri , Lehikoinen-Söderlund Sari , Rihkanen Heikki
Published: October 2014

The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.
Functional Anatomy of Levator Veli Palatini Muscle and Tensor Veli Palatini Muscle in Association with Eustachian Tube Cartilage
Authors: Ishijima Ken , Sando Isamu , Miura Makoto , Balaban Carey D. , Takasaki Kenji
Published: October 2014

The anatomic relationships among the levator veli palatini muscle (LVPM), the tensor veli palatini muscle (TVPM), and the eustachian tube (ET) cartilage were investigated by computer-aided 3-dimensional reconstruction and measurement methods. The study used 13 normal temporal bone–ET specimens obtained from 13 individuals (range of age at death, 3 months to 88 years). This study revealed several anatomic features of the anterior cartilaginous portion of the ET First, the LVPM is always located inferolateral to the inferior margin of the medial lamina (ML) of the ET cartilage. Second, the LVPM has a large cross-sectional area throughout the extent of the anterior cartilaginous portion of the ET. Third, although the LVPM lies close to the ML of the ET cartilage (0.44 ± 0.16 mm in children and 1.02 ± 0.58 mm in adults), there is no region of attachment. Finally, the TVPM is not attached to the lateral lamina (LL) of the ET cartilage of the anterior quarter of the cartilaginous portion. Accordingly, it could be assumed that the most anterior cartilaginous portion of the ET is opened primarily by the contraction of the LVPM, which causes a superior-medial rotation of the ML. Furthermore, since the contraction time of the LVPM is reported to be longer than that of the TVPM, the anterior cartilaginous portions of the ET may remain open, even after the middle to posterior cartilaginous portions are closed after relaxation of the TVPM. This process would produce a pumping action of the ET in the direction from the middle ear to the pharyngeal side. The pumping function may be beneficial to clearance of the middle ear.
Otologic Facial Palsy: Etiology, Onset, and Symptom Duration
Authors: Kvestad Ellen , Kværner Kari J. , Mair Iain W. S.
Published: October 2014

To estimate the occurrence of otogenic facial palsy, we performed a retrospective case record study of all patients hospitalized for otogenic facial palsy in the period 1989 to 1999 at Ullevål University Hospital, which is the only referral hospital for patients with otologic sequelae in Oslo. The facial palsy was a complication of acute otitis media in 10 patients (56%), of acute mastoiditis in 3 patients (17%), of secretory otitis media in 3 patients (17%), and of chronic otitis media in 2 patients (11%). In half of the patients, complete facial palsy was found at the time of diagnosis. Sixteen patients (89%) reported a gradual onset of the facial palsy. The mean duration of otologic symptoms before the onset of facial palsy was 3 days (range, 1 to 9 days), and the median time to remission was 9 weeks (range, 2 to 96 weeks). Total remission was achieved in all patients who received follow-up. Although most patients recover within a few weeks, some patients have long-lasting facial palsy. Multicenter studies are needed to increase the sample size and to identify predictors of facial palsy duration.
Exposure to 200 PPM of Methanol Increases the Concentrations of Interleukin-1β and Interleukin-8 in Nasal Secretions of Healthy Volunteers
Authors: Mann Wolf J. , Klimek Ludger , Muttray Axel , Faas Michael , Schaefer Dirk , Konietzko Johannes
Published: October 2014

This study was designed to investigate subclinical irritating effects of methanol on functional and immunologic parameters in human respiratory epithelia. Twelve healthy, nonsmoking individuals were exposed to concentrations of 20 and 200 ppm of methanol in an exposure chamber. The concentrations of interleukin (IL)-8, IL-1β, IL-6, and prostaglandin E2 (PGE2) were monitored. The saccharin transport time test was used to evaluate mucociliary transport. Video interference contrast microscopy was used to determine the ciliary beat frequency of nasal epithelial cells. Subjective symptoms were assessed with a questionnaire. The median concentrations of IL-8 and IL-1β were significantly elevated after exposure to 200 ppm of methanol as compared to exposure to 20 ppm (IL-1β, 21.4 versus 8.3 pg/mL, p = .001; IL-8, 424 versus 356 pg/mL, p = .02). The release of IL-6 and PGE2 did not change significantly (IL-6, 10.3 versus 6.5 pg/mL, p = .13; PGE2, 13.6 versus 13.4 pg/mL), nor did the ciliary beat frequency or the saccharin transport time. Both IL-8 and IL-1β proved to be sensitive indicators for subclinical irritating effects of methanol in vivo. The German threshold limit of 200 ppm of methanol does not prevent subclinical inflammatory reactions of the nasal respiratory mucosa.
Type I Thyroplasty for Acute Unilateral Vocal Fold Paralysis following Intrathoracic Surgery
Authors: Abraham Manoj T. , Bains Manjit S. , Korst Robert J. , Downey Robert J. , Kraus Dennis H.
Published: October 2014

Patients who undergo intrathoracic operative procedures for malignancy may require sacrifice of a recurrent laryngeal nerve. Postoperative vocal fold paralysis may lead to diminished cough with secretion retention, aspiration, and life-endangering pneumonia. This study retrospectively reviews our institution's experience of 23 patients who underwent type I thyroplasty within the 2-week (acute) period after thoracic surgery. Primary lung cancer (n = 16) was the most common disease. Upper lobectomy (n = 9) and pneumonectomy (n = 7) were the most frequent surgical procedures. Silicone medialization alone (n = 11) or with arytenoid adduction (n = 12) was performed. There were no significant postoperative complications. Improvements in hoarseness (86%), dyspnea (72%), dysphagia (50%), and aspiration (79%) were noted. Pulmonary status improved after vocal fold medialization, as reflected by decreased need for therapeutic bronchoscopy in the majority of patients in the postoperative period. Type I thyroplasty for vocal fold paralysis in the acute phase following thoracic surgery is well tolerated and is associated with improved patient outcome with no postoperative deaths in this high-risk patient population.
Contribution of Speech Rate to Speech Perception in Multichannel Cochlear Implant Users
Authors: Iwasaki Satoshi , Nagura Mitsuyoshi , Ocho Shuji , Hoshino Tomoyuki
Published: October 2014

This study describes the effect of speech rate (fast, 11 syllables per second; medium, 9 syllables per second; slow, 6 syllables per second) on speech perception in 10 cochlear implant users. The speech perception performance was evaluated on the basis of the percentage score of syllables that were correctly recalled in sentences composed of 4 to 6 words. The percentage scores at the fast, medium, and slow speech rates were 15.7%, 39.0%, and 56.0%, respectively. The effect of speech rate slowing was significant (p < .0001). Variations in the effect of speech rate slowing were observed in the cochlear implant users. The improvement of speech perception by speech rate slowing was significantly (p < .005) related to the word test score and the score at the fast speech rate. The results reveal that the rate of speech is an important factor in improving the speech perception of cochlear implant users.
Vascular Permeability to Fluorescent Substance in Human Cranial Nerves
Authors: Tabuchi Tomizo , Sakihama Noriyuki , Nakao Yoshiaki , Kobayashi Toshimitsu
Published: October 2014

It has recently been reported that in the facial canal, the facial nerve shows enhancement on gadolinium-enhanced magnetic resonance imaging in patients with clinically normal facial nerves. However, the mechanism of this enhancement has not yet been sufficiently clarified. The present study investigated the permeability of blood vessels in human cranial nerves that were obtained from surgically treated patients. The patients received an intravenous injection of sodium fluorescein 45 minutes before nerve resection. For histologic observation, the nerves were removed and frozen at −70°C, and the sections were then cut at 4-μm thickness with a freezing microtome. The localization of the tracers was examined with a fluorescence microscope. Fluorescence was observed in the external nerve sheath and slightly in the endoneurium of these nerves, but was not observed within nerve fibers. These findings indicate that the vascular barrier in human peripheral nerves is incomplete.
Multiple and Synchronous Peripheral Giant Cell Granulomas of the Gums
Authors: Junquera Luis M. , Lombardia Eduardo , Lupi Ettore , Fresno Manuel F.
Published: October 2014

The presence of multiple giant cell lesions in the maxillofacial region is suggestive of hyperparathyroidism or neurofibromatosis. A case of synchronous, multiple peripheral giant cell granulomas is reported, bilaterally affecting the mandibular gums and also the upper right maxillary gingival mucosa, without concomitant systemic disease. Only 2 cases of central giant cell granulomas, and no cases of peripheral giant cell granulomas exhibiting similar characteristics, have been reported in the literature to date.
Spontaneous Intracranial Hypotension: A Rare Cause of Labyrinthine Hydrops
Authors: Portier Frédéric , De Minteguiaga Carlos , Ba Huy Patrice Tran , Racy Emmanuel , Herman Philippe
Published: October 2014

Spontaneous intracranial hypotension should be considered as a possible cause of cochlear hydrops. We report a case of unilateral hearing loss attributed to spontaneous intracranial hypotension on the basis of characteristic abnormalities seen on magnetic resonance imaging. The diagnostic gold standards for intracranial hypotension are lumbar measurement of cerebrospinal fluid pressure and magnetic resonance imaging. The usual treatment is an autologous blood injection into the peridural spaces. The mechanism of hearing loss is thought to involve secondary perilymph depression due to a patent cochlear aqueduct. This perilymph depression would induce a compensatory expansion of the endolymphatic compartment, with a subsequent decrease in basilar or Reissner's membrane compliance. Endolymphatic hydrops can occur in the course of intracranial hypotension, and not only because of abnormal endolymph production or resorption. Hydrops can thus be classified into 1) syndromes of endolymphatic origin and 2) syndromes of perilymphatic origin, in which loss of perilymph induces compensatory expansion of the endolymphatic space.
Postnatal Development of Static Volume of the Eustachian Tube Lumen
Authors: Ishijima Ken , Balaban Carey D. , Sando Isamu , Takasaki Kenji , Miura Makoto , Sudo Masaharu
Published: October 2014

Eleven human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals (ages, 3 months to 88 years) were studied to investigate the static volume of the ET lumen. The volumes were measured by computer-aided 3-dimensional reconstruction and measurement methods. Four of the 11 individuals were children, and the remaining 7 were adults. The total volume of the ET lumen was significantly larger in the adults than in the children (p < .01). This difference was produced by significant growth of the volume of the cartilaginous and junctional portions (p < .01). The lumen of the bony portion, by contrast, did not change with age. Increased volume of the ET lumen, especially of the cartilaginous and junctional portions, would be expected to increase both ventilation and clearance. Therefore, the small volume of ET lumen of the cartilaginous and junctional portions in children may be a predisposing factor for otitis media.
Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment
Authors: Djalilian Hamid R. , Smith Sharon L. , King Timothy A. , Levine Samuel C.
Published: October 2014

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.
Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging
Authors: Speyer Renée , Kempen Pieter A. , Wieneke George , Kersing Willem , Hosseini Elham Ghazi , Dejonckere Philippe H.
Published: October 2014

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.
Laryngeal Tuberculosis: A Report of 15 Cases
Authors: Nishiike Suetaka , Irifune Morihiro , Sawada Toru , Doi Katsumi , Kubo Takeshi
Published: October 2014

Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis. Recent studies have described a change in the clinical features of laryngeal tuberculosis. We present 15 cases of laryngeal tuberculosis treated at the Osaka Prefectural Habikino Hospital between 1993 and 2000. The results showed a mean age of 51 years, a male predominance by 2.75 to 1, and a 20% incidence (n = 3) of negative chest radiographic findings. The prominent presenting symptom was hoarseness (73.3%), and systemic symptoms were relatively rare. Seven patients showed ulcerative lesions, 5 showed granulomatous lesions, and the remaining 3 showed nonspecific inflammatory lesions in the larynx. Laryngeal lesions did not show any predilection for specific laryngeal sites in our series. In contrast to earlier studies, our study shows variations in clinical features of laryngeal tuberculosis. Physicians should consider tuberculosis in the differential diagnosis of laryngeal disease.
Prospective Study on the Incidence of Chronic Ear Complaints Related to Gastroesophageal Reflux and on the Outcome of Antireflux Therapy
Authors: Poelmans Johan , Tack Jan , Feenstra Louw
Published: October 2014

Over a 2-year period (1997 to 1999), 5 consecutive adult patients with chronic refractory secretory otitis media (CSOM) and 16 with a chronic refractory feeling of pressure in the ear(s) (CRFP) thought to be related to concomitant eustachian tube dysfunction were prospectively studied for coexisting gastroesophageal reflux (GER). All patients underwent an extensive standardized otorhinolaryngological examination, ambulatory 24-hour dual-probe esophageal pH monitoring with a distal pH probe 5 cm and a proximal probe 20 cm above the lower esophageal sphincter, and upper gastrointestinal endoscopy. Most of them also underwent esophageal manometry. All patients with CSOM and 12 of the 16 patients with CRFP had evidence of GER. Only 5 patients experienced heartburn or regurgitation. All patients responded very well to antireflux therapy with omeprazole 20 mg twice per day (40 mg twice per day in 2 patients) accompanied by conservative antireflux measures, ie, complete cessation of their middle ear complaints. This study demonstrates the role of GER in the pathogenesis of refractory CSOM and CRFP and the effectiveness of sustained antireflux therapy.
Blood Flow Measurements in the Ears of Patients Receiving Cochlear Implants
Authors: Nakashima Tsutomu , Hattori Taku , Sato Eisuke , Sone Michihiko , Tominaga Mitsuo
Published: October 2014

We measured cochlear blood flow in 12 patients who received cochlear implants, using a laser-Doppler probe with an outer diameter of 0.8 mm. The subjects had congenital deafness, idiopathic progressive sensorineural hearing loss, Waardenburg's syndrome, narrow internal auditory canal, or sudden deafness. Putting the probe tip to the site of drilling for cochlear implantation, we measured blood flow before, during, and after the cochlear bony wall was opened. The laser-Doppler output was confirmed even after the tip of the probe was inserted into the perilymphatic space in all cases. Our results revealed that blood flow was maintained in all cochleas, although there was a probability of reduction in blood flow volume. We conclude that laser-Doppler flowmetry is both relatively safe and useful for measuring blood flow in the ears during cochlear implantation procedures.
Internet Resources Available to Otolaryngologists
Authors: Balatsouras Dimitrios G. , Kandiloros Dimitrios , Kaberos Antonis , Ferekidis Eleftherios , Korres Stavros G. , Economou Constantinos
Published: October 2014

During recent years, the Internet has evolved into the largest computer network in the world, allowing access to vast amounts of information and services. Medical information is increasingly available to both patients and professionals, and ever more biomedical resources are becoming available on-line to assist in research, clinical medicine, and education. The Internet has always provided useful resources to otolaryngologists, implemented at various academic departments and national organizations or by specialists or specific medical web sites offering technical, scientific, and biomedical information. The purpose of this article is to provide as complete a list as possible of the World Wide Web sites accessible through the Internet that are of interest to otolaryngologists. It summarizes different types of resources available, including educational material, audiology sites, outcomes research, discussion lists, research laboratories, publications, medical libraries, news and medical conferences, organizations, academic departments, otolaryngological and medical resources, medical and surgical equipment and suppliers, and miscellaneous other sites of interest to otolaryngologists. This review is intended to present the wealth of the accessible information on the Internet and to promote the use of the network to otolaryngologists who do not have extensive experience in computers or telecommunications.
Surgery for Pediatric Vocal Cord Paralysis: A Retrospective Review
Authors: Hartnick Christopher J. , Brigger Matthew T. , Cotton Robin T. , Willging J. Paul , Charles M. Myer
Published: October 2014

To determine the outcome of surgical procedures for bilateral vocal cord paralysis in children, we performed a retrospective review of children under 18 years of age with bilateral vocal cord paralysis and a previous tracheotomy who underwent a primary procedure at a single tertiary care institution with an aim of decannulation. The primary outcome measure was the operation-specific decannulation rate (OSDR). The overall decannulation rates, as well as morbidity rates, were also recorded. Fifty-two children met the inclusion criteria (mean age at time of primary surgery, 6.2 years; SD, 5 years). Vocal cord lateralization procedures combined with a partial arytenoidectomy achieved the highest OSDR (17/24 or 71%). This OSDR was statistically higher than the OSDRs for CO2 laser cordotomy or arytenoidectomy procedures (OSDR, 5/17 or 29%, p = .008), for isolated arytenoidopexy procedures (OSDR, 1/4 or 25%, p = .000004), or for posterior costal cartilage graft procedures (OSDR, 3/5 or 60%, p = .0004). Neither of the 2 children who underwent isolated arytenoidectomy achieved primary decannulation. The incidence of aspiration following posterior cartilage graft procedures was 15% (2/15). Subanalysis by age failed to reveal differences in OSDR. We conclude that vocal cord lateralization procedures with partial arytenoidectomy afford the highest OSDR among primary procedures for pediatric vocal cord paralysis. The CO2 laser procedures, while having limited success as a primary procedure, are effective for revision.
Passive Marker Computer-Aided Sinonasal and Cranial Base Surgery: Observations from a Learning Curve
Authors: Rassekh Christopher H. , Nauta Haring J.
Published: October 2014

To assess the feasibility of passive marker computer-aided surgery in a single institution, we performed 22 procedures in 21 patients with disorders including sinonasal tumors (n = 9), fungal sinusitis (n = 4), recurrent polyps (n = 3), chronic sinusitis (n = 3), and cerebrospinal fluid rhinorrhea (n = 2). Passive marker computer-aided surgery was successful in 19 of the 21 patients. The accuracy was on the order of 1.35 mm. Probe conversion, rotation, and cordlessness were helpful in all 19 cases. The system helped with landmarks (n = 14), margins (n = 7), skull base (n = 6), orbit (n = 5), and approach (n = 4). Computer-aided surgery accurately confirmed the location of an instrument and demonstrated tumor-normal tissue interfaces. It aided the surgeon in procedures on the sinonasal area and cranial base. The potential advantages of a passive marker system as compared with other available technologies center around the ability to convert and/or rotate virtually any instrument to a cordless imaging probe on demand during the operation.
Olfactory Changes at Threshold and Suprathreshold Levels following Septoplasty with Partial Inferior Turbinectomy
Authors: Damm Michael , Jungehülsing Markus , Eckel Hans E. , Hummel Thomas
Published: October 2014

Partial inferior turbinectomy with septoplasty is routinely carried out for airway obstruction. However, its effects on the sense of smell have not been systematically evaluated. The aim of this prospective study was to evaluate the influence of septoplasty with partial inferior turbinectomy on threshold and suprathreshold olfactory acuity. The subjects were 30 patients undergoing septoplasty including partial inferior turbinectomy. Olfactory function was determined by the “Sniffin' Sticks,” which allow the assessment of odor thresholds, odor discrimination, and odor identification. The patients rated both olfactory function and nasal airflow using visual analog scales. Nasal airflow was measured by anterior rhinomanometry. Multivariate analyses of variance for repeated measures were used to analyze the results before and after surgery (mean interval, 9.1 weeks). After operation, 87% of the patients had increased airflow, 80% had improved olfactory function in terms of odor identification, and in 70% odor discrimination was found to be improved — but only 54% had improved olfactory function in terms of odor thresholds. Surgery increased ratings of nasal airflow in 93%, and those of olfactory function in 77% (p < .001). Similarly, bilateral inspiratory nasal flow increased (p < .001) and olfactory function was improved (p < .001) after surgical treatment. However, this increase was most pronounced for suprathreshold tests, while it was moderate for odor thresholds (interaction “surgery” × “olfactory test,” p = .001). The present investigation suggests that septoplasty in combination with inferior turbinectomy has a beneficial effect on olfaction, mainly on suprathreshold olfactory functions. This effect may be partly due to interactions between the increased perception of nasal airflow and cognitive factors involved in olfactory sensitivity. According to the present results and data from the literature, a moderate decrease of olfactory function appears to occur in as many as 20% of patients. However, anosmia seems to be an extremely rare complication of septoplasty and partial turbinectomy.
Monitoring of Laryngopharyngeal Reflux: Influence of Meals and Beverages
Authors: Smit Conrad F. , Mathus-Vliegen Lisbeth M. H. , van Leeuwen Justin A. M. J. , Devriese Pieter P. , Semin Astrid
Published: October 2014

Ambulatory 24-hour double-probe pH monitoring seems to be the best test to measure reflux. Artifacts caused by intake of acid foods and beverages have to be excluded, necessitating a time-consuming manual review of the 24-hour data. Dietary restrictions used to bypass these artifacts would interfere with the normal daily life situation. Therefore, the influence of food and beverages ingested during the monitoring period was studied. Data from 252 patients who underwent double-probe pH monitoring were analyzed, first by visual inspection of the 24-hour tracing and second by leaving out the intake periods. As to the registration of gastroesophageal reflux, the inclusion or omission of meals and beverages hardly influenced the data. However, the registration of laryngopharyngeal reflux was severely biased by intake of food and beverages and other artifacts. Leaving out meals and beverages did not correct for all artifacts. Therefore, we recommend review of each laryngopharyngeal pH drop.
Expression of Epidermal Growth Factor Receptor and its Ligands in Chronic Sinusitis
Authors: Lee Heung-Man , Choi Jin Ho , Hwang Soon Jae , Chae Sung Won , Lee Sang Hag
Published: October 2014

The epidermal growth factor receptor (EGF-R) system plays a crucial role in mucus production in vitro and in rats. However, the role of the EGF-R system in humans is not known. We compared the localization of EGF-R and its ligands (epidermal growth factor and transforming growth factor α) in the epithelia of sinuses with chronic sinusitis and in those of healthy controls. Immunohistochemical techniques were employed to identify the presence of EGF-R and its ligands in the sinus mucosa. We found EGF-R in goblet cells, basal cells, and submucosal gland cells, but not in ciliated cells. Immunoreactivity for both epidermal growth factor and transforming growth factor α was found in the epithelial cells and inflammatory cells and in some submucosal gland cells. There was stronger staining of EGF-R and its ligand proteins in chronic sinusitis specimens than in controls. The interrelated localization of EGF-R and its ligands suggests a role in mucus production in the epithelium of the sinus mucosa.
Medialization Laryngoplasty with Gore-Tex for Voice Restoration Secondary to Glottal Incompetence: Indications and Observations
Authors: Zeitels Steven M. , Mauri Marcelo , Dailey Seth H.
Published: October 2014

Gore-Tex has been used as an effective implant for medialization laryngoplasty in the management of paralytic dysphonia; however, reporting of large patient cohorts has been limited. Furthermore, the use of Gore-Tex in the treatment of glottal incompetence secondary to soft tissue defects has not yet been described. Finally, a number of the procedural nuances of using Gore-Tex have not been elucidated. A prospective investigation was done on 142 patients who underwent 152 Gore-Tex medialization laryngoplas-ties in 183 vocal folds from December 1997 to March 2002. The primary diagnoses prompting the 152 procedures were paralysis in 94, paresis in 18, cancer reconstruction in 14, sulcus vocalis in 6, atrophy in 3, trauma defect in 5, arytenoid dislocation in 3, bilateral paralysis in 3, bilateral paresis in 1, parkinsonism in 4, and neurologic aerodynamic dissociation in 1. One patient who underwent reconstruction of a complex cancer defect required endoscopic removal of the Gore-Tex because of persistent granulation. Clinical observations reveal that Gore-Tex is a versatile implant that is ideally suited for phonosurgical reconstruction of aerodynamic glottal incompetence secondary to a variety of causes. Gore-Tex was especially useful for medialization of complex anatomic soft tissue defects such as those resulting from cancer resection, trauma, atrophy, and sulcus vocalis. There was superior ease in handling, placement, and in vivo adjustability.
Outcome of Treatment with Valacyclovir and Prednisone in Patients with Bell's Palsy
Authors: Axelsson Sara , Lindberg Sven , Stjernquist-Desatnik Anna
Published: October 2014

Idiopathic facial paralysis, or Bell's palsy, shows a nonepidemic pattern that might indicate reactivation of a latent microorganism such as herpes simplex type I as a causative agent. Thirty percent of patients with Bell's palsy given no treatment will not recover completely, and 5% will have severe sequelae. The aim of this study was to find out whether treatment with an antiviral drug in combination with corticosteroids is more effective than no medical treatment at all in patients with Bell's palsy. Fifty-six consecutive adult patients attending the otorhinolaryngology department of the University Hospital of Lund from 1997 to 1999 were treated with 1 g of valacyclovir hydrochloride 3 times per day for 7 days and 50 mg of prednisone daily for 5 days, with the dose being reduced by 10 mg daily for the next 5 days. Fifty-six adult patients with Bell's palsy attending the same department between 1995 and 1996 who were given no medical treatment were studied retrospectively and used as the control group. Forty-nine patients (87.5%) in the treatment group recovered completely, as compared with 38 patients (68%) in the control group (p <.05). One patient (1.8%) in the treatment group displayed severe sequelae, defined as a House-Brackmann score of IV or worse, as compared with 10 of 56 patients (18%) in the control group (p <.01). Among patients over 60 years old, 10 of 10 in the treatment group had complete recovery, as compared with 5 of 12 patients in the control group (p <.01). The present study showed a significantly better outcome in patients with Bell's palsy treated with valacyclovir and prednisone as compared with patients given no medical treatment. This difference in outcome was especially pronounced among elderly patients.
Cell Kinetics and Apoptosis in Laryngeal Carcinoma Patients
Authors: Georgiou Anastasia , Gomatos Ilias P. , Giotakis John , Pararas Nikolaos B. , Ferekidis Eleutherios
Published: October 2014

Cellular proliferation and apoptosis are both implicated in the process of carcinogenesis. The objective of this study was to access the prognostic significance of the expression of proliferating cell nuclear antigen (PCNA) and the apoptosis-related genes (bax, bcl-2, and p53) in laryngeal carcinoma patients. Thirty consecutive patients with stage I to IV squamous cell laryngeal carcinoma were treated in our department from 1992 to 1994. We immunohistochemically studied the expression of PCNA and bax, bcl-2, and p53 genes in their tumor specimens. Five healthy men were used as the control group. The staining results were correlated with clinicopathologic data. The PCNA protein expression was correlated with a significantly worse survival in those patients who were bax-negative (0% versus 42.86%, p =.0445). Similarly, the presence of PCNA led to an unfavorable clinical outcome in those patients who were bax-negative, bcl-2-negative, and p53-negative (0% versus 50%, p =.0278). Expression of bcl-2 protein was found to be an independent prognostic factor related to an unfavorable clinical outcome (p =.0262). The expression of bcl-2 protein appears to predict survival in laryngeal carcinoma patients. Furthermore, the combined study of proliferation markers and apoptosis-related genes helped us to identify a high-risk group of patients who may benefit from a more aggressive treatment protocol.
Traumatic Perilymphatic Fistula
Authors: Rajan Gunesh P. , Huber Alexander M.
Published: October 2014

We present the case of a patient with a traumatic perilymphatic fistula and discuss the most reliable diagnostic sign in detecting this challenging disorder.
Acute Peripheral Vestibular Deficits after Whiplash Injuries
Authors: Vibert Dominique , Häusler Rudolf
Published: October 2014

We report 3 patients who had acute peripheral vestibular dysfunction minutes to hours after a car collision with whiplash injury without head trauma. The accident was a frontal collision in 1 case, a rear impact in the second, and lateral in the third. All patients complained immediately of cervicalgia, headache, acute vertigo with a sensation of erroneous body movements, and slipping of image with head movements. A sudden sensation of tilting of the environment when driving, tinnitus, and hyperacusis were also described. The otoneurologic findings showed bilateral canalolithiasis in 1 patient and an acute peripheral vestibular deficit in 2 patients. Tilt of the subjective visual vertical was measured in all patients. Cerebral magnetic resonance imaging yielded normal findings. As angular and linear accelerometers, the vestibular organs are directly exposed to high forces generated by whiplash mechanisms. Vertigo generated by peripheral vestibular lesions is probably underestimated in whiplash injuries and may often be incorrectly attributed to cervical or cerebral lesions.
Recovery of Swallowing Disorders in Patients Undergoing Supracricoid Laryngectomy with Botulinum Toxin Therapy
Authors: Marchese-Ragona Rosario , Staffieri Alberto , De Grandis Domenico , Marioni Gino , Restivo Domenico A. , Pastore Antonio
Published: October 2014

In recent decades, functional laryngeal surgery has become a widespread method of treating glottic and supraglottic neoplasms, since it ensures an oncological outcome comparable to that of radical surgery and functional results that are conducive to a good quality of life. The most common postoperative complaints for this type of surgery are swallowing disorders, which can thwart good surgical results, especially when severe. Five supracricoid laryngectomees with swallowing disorders unresolved by speech therapy were treated by percutaneous injection of botulinum toxin under electromyographic control. All patients presented marked improvement in their complaints. A single session of botulinum toxin type A treatment resolved the dysphagia in all cases.
Cepstral Peak Prominence: A More Reliable Measure of Dysphonia
Authors: Heman-Ackah Yolanda D. , Michael Deirdre D. , Baroody Margaret M. , Ostrowski Rosemary , Hillenbrand James , Heuer Reinhardt J. , Horman Michelle , Sataloff Robert T.
Published: October 2014

Quantification of perceptual voice characteristics allows the assessment of voice changes. Acoustic measures of jitter, shimmer, and noise-to-harmonic ratio (NHR) are often unreliable. Measures of cepstral peak prominence (CPP) may be more reliable predictors of dysphonia. Trained listeners analyzed voice samples from 281 patients. The NHR, amplitude perturbation quotient, smoothed pitch perturbation quotient, percent jitter, and CPP were obtained from sustained vowel phonation, and the CPP was obtained from running speech. For the first time, normal and abnormal values of CPP were defined, and they were compared with other acoustic measures used to predict dysphonia. The CPP for running speech is a good predictor and a more reliable measure of dysphonia than are acoustic measures of jitter, shimmer, and NHR.
Histology of Nerves and Muscles in Adductor Spasmodic Dysphonia
Authors: Chhetri Dinesh K. , Vinters Harry V. , Blumin Joel H. , Berke Gerald S.
Published: October 2014

To elucidate the etiology and pathophysiology of spasmodic dysphonia, we examined the adductor branch of the recurrent laryngeal nerve and the lateral cricoarytenoid muscle from 9 consecutive patients with this disorder who were previously treated with botulinum toxin. Histologic examination revealed average muscle fiber diameters ranging from 21 to 57 μm. Botulinum toxin treatment-related muscle atrophy was observed up to 5 months after injection. Endomysial fibrosis was present in all samples. Histochemical analysis in 8 patients revealed type 2 fiber predominance in 7 patients and fiber type grouping in 2. Type-specific muscle fiber size changes were not present. Nerve samples were examined in plastic sections. In 8 patients the nerves contained homogeneous, large-diameter myelinated nerve fibers and sparse small fibers. One patient had a relatively increased proportion of small myelinated nerve fibers. Overall, the nerve fiber diameter was slightly larger in patients than in controls. These findings may implicate the central nervous system in the pathophysiology of adductor spasmodic dysphonia.
Laryngocele Resection by Combined External and Endoscopic Laser Approach
Authors: Ettema Sandra L. , Carothers Daniel G. , Hoffman Henry T.
Published: October 2014

Options in the management of laryngoceles include observation, endoscopic resection, and resection via an external approach. We introduce a combined endoscopic and external approach that we have employed on several occasions to ensure complete removal of the laryngocele and the saccule from which it originated. A case is presented to help define the technique.
Scuba Diving with Cochlear Implants
Authors: Kompis Martin , Vibert Dominique , Vischer Mattheus W. , Senn Pascal , Häusler Rudolf
Published: October 2014

We report on a patient with bilateral cochlear implants (a Med-El Combi40 and a Med-El Combi40+), as well as considerable experience in scuba diving with both of his implants. After having been exposed to 68 and 89 dives, respectively, in depths of up to 43 m, both cochlear implants are in working order and the patient continues to receive excellent speech recognition scores with both cochlear implant systems. The presented data show that scuba diving after cochlear implantation is possible over a considerable number of dives without any major negative impact on the implants.
Botulinum Toxin Management of Adductor Spasmodic Dysphonia after Failed Recurrent Laryngeal Nerve Section
Authors: Sulica Lucian , Brin Mitchell F. , Blitzer Andrew , Stewart Celia F.
Published: October 2014

This study examined botulinum toxin type A (BTX-A) treatment of adductor spasmodic dysphonia patients who had previously undergone recurrent laryngeal nerve section that failed to control symptoms. Information was retrieved from records of patients treated by our group between 1984 and 1999. Complete records with standardized outcome measurements were available for 181 BTX-A injection sessions in 16 patients who had had nerve section. These were compared to previously published information regarding 4,621 sessions in 639 adductor spasmodic dysphonia patients also treated by our group. Treatment with BTX-A resulted in significant improvement in voice function in the studied patients (change, 38.2% ± 24.5%; p < .0001). The onset of effect took place approximately 2.3 days after treatment, and the peak effect about 10.0 days after treatment. The therapeutic effect lasted 14.1 weeks on the average. These features were not significantly different from those observed in adductor spasmodic dysphonia patients as a whole. The incidence of complications was also comparable. However, lower baseline and peak posttreatment perceptions of voice function in the nerve section group were statistically significant (baseline, 45.6% ± 23.0% versus 52.4% ± 22.0%; peak, 83.8% ± 16.4% versus 89.7% ± 13.0%; both p < .001). We conclude that BTX-A is effective in the treatment of adductor spasmodic dysphonia in patients who have had recurrent nerve section. However, nerve section may adversely affect perceived voice function and may make botulinum toxin therapy less satisfactory. Because of this finding, and because of the unusual pathological features of the focal dystonias, irreversible means of treating adductor spasmodic dysphonia should be approached with caution.
Stomal Recurrence following Total Laryngectomy: Clinical and Molecular Analysis of a Series
Authors: Santoro Roberto , Franchi Alessandro , Sardi Iacopo , Tempesti Claudia , Polli Gianni
Published: October 2014

The aim of the present study was to analyze the risk features and to discuss the preventive measures and treatment of stomal recurrence (SR) after total laryngectomy (TL), and to investigate the clonal relationship between the primary and recurrent lesions. We reviewed a series of 25 patients affected by SR after TL for laryngeal squamous cell carcinoma. A subset of 7 coupled primary and recurrent carcinomas were examined for microsatellite alterations that were used as a marker of genetic lineage. The incidence of SR was higher in patients with initial subglottic lesions (subglottic, transglottic, or glottic-subglottic tumors) than in those with other locations of laryngeal cancer (p = .013). In addition, the frequency of SR was significantly higher in patients who underwent preoperative tracheotomy, performed 48 hours or more before the TL, than in the group of patients who did not receive preoperative tracheotomy (23.3% versus 0.46%, p < .001). According to microsatellite analysis, of the 5 informative patients, 2 demonstrated discordant alterations in the recurrent tumor indicative of clonal heterogeneity, 2 demonstrated identical alterations, and 1 showed an additional alteration in the recurrent tumor. Our analysis supports the hypothesis that a subset of SRs after TL may be second primary tumors, genetically unrelated to the primary laryngeal lesion.
Functional Treatment of a Large Laryngeal Chondrosarcoma by Tracheal Autotransplantation
Authors: Delaere Pierre R. , Vertriest Rudolph , Hermans Robert
Published: October 2014

Chondrosarcoma of the cricoid cartilage poses difficult therapeutic challenges. The tumor necessitates resection of parts of the cricoid cartilage with a resulting defect that is difficult to repair. We wanted to improve the functional outcome after resection of a lateralized chondrosarcoma by applying the technique of tracheal autotransplantation. The technique involves a 2-stage procedure, because the trachea needs at least 2 weeks for revascularization. Tracheal revascularization is the first stage, and is accomplished by wrapping the trachea in vascularized fascia (radial forearm). The second stage, performed after 14 days, consists of a hemilaryngectomy with tracheal autotransplantation. A case of a large unilateral chondrosarcoma of the cricoid cartilage with involvement of 1 cricoarytenoid joint is reported. The tumor was removed by hemicricohemilaryngectomy. After 2 weeks of tracheal revascularization, the cervical trachea was used to repair the laryngeal defect. The tumor was completely resected, and all laryngeal functions (swallowing, voice, respiration without tracheostomy) were restored. The patient remains tumor-free after a follow-up period of 3 years. Tracheal autotransplantation improves the functional treatment of lateralized chondrosarcomas of the cricoid cartilage.
Preoperative and Postoperative Voice in Tis-T1 Glottic Cancer Treated by Endoscopic Cordectomy: An Additional Issue for Patient Counseling
Authors: Peretti Giorgio , Mensi Maria C. , Piazza Cesare , Rossini Manuela , Balzanelli Cristiano , Antonelli Antonino R.
Published: October 2014

Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.
Worldwide Distribution of Waardenburg Syndrome
Authors: Nayak Chetan S. , Isaacson Glenn
Published: October 2014

To clarify the multiracial occurrence of Waardenburg syndrome, we present a case series and literature review. A computerized review of the English-language literature was conducted to assess the distribution of reported occurrences of Waardenburg syndrome in populations around the world. We detail the clinical features of 2 family cohorts: one of Western European origin and the other from South Asia. A computerized literature review found sporadic cases of the syndrome in many ethnic groups, including Japanese, Taiwanese, and Middle Eastern families. The highest reported incidence is among Kenyan Africans. Waardenburg syndrome accounts for between 2% and 5% of cases of congenital deafness. It was first described in Northern European cohorts and is widely identified in fair-skinned populations. We hope to raise awareness of the worldwide distribution of this important cause of hearing loss.
Thyroarytenoid Muscle Responses to Air Pressure Stimulation of the Laryngeal Mucosa in Humans
Authors: Bhabu Priyanka , Poletto Christopher , Bielamowicz Steven , Mann Eric , Ludlow Christy L.
Published: October 2014

Others have observed glottic adduction in response to air puff stimuli and suggested that this is a reliable indicator of laryngeal sensation. We undertook to determine whether the same thresholds are found if one uses either thyroarytenoid (TA) muscle responses or subjects' reports of laryngeal sensation. We also studied the characteristics of TA responses to unilateral air pressure stimulation of the mucosa overlying the arytenoid cartilages. Ten normal volunteers provided button press responses to air pressure stimuli during bilateral TA electromyography. Similar thresholds were determined by reports of sensation as by electromyographic responses (p < .0005). The early TA responses occurred either around 80 ms or around 125 ms after onset of the air puff, with equal frequency on the ipsilateral and contralateral sides. The TA muscle responses to air pressure stimulation differ in physiological characteristics from the laryngeal adductor reflex that occurs in response to electrical stimulation of the superior laryngeal nerve.