bluuebunny/crossref_metadata_2025 huggingface dataset:
Melker Cricothyrotomy Kit: An Alternative to the Surgical Technique
Authors: Melker Jeremy S. , Gabrielli Andrea
Published: October 2014

Emergent cricothyrotomy is a potentially lifesaving procedure central to acute airway algorithms. In most cases in which cricothyrotomy is indicated, the acuteness of the airway precludes subspecialty consultation before performance of the procedure. The academic environment is an exception, in which the responsibility of securing a “difficult” cricothyroid airway may fall upon junior otolaryngology residents. Described here is the use of the Melker Emergency Cricothyrotomy Kit, a prepackaged kit that uses a wire-guided percutaneous dilational technique (the Seldinger technique) and a procedure-specific polyvinylchloride airway catheter. The wire-guided technique may add a margin of safety for a relatively inexperienced resident performing cricothyrotomy. Furthermore, a newly released version of the kit includes instrumentation for insertion of the Melker airway catheter by the classic surgical technique in addition to that required for the Seldinger technique, which may enable even a seasoned surgeon to secure the airway faster and more safely.
Bilateral Pharyngoceles (Branchial Cleft Anomalies?) and Endoscopic Surgical Considerations
Authors: Chang Christopher Y. , Furdyna Julia A.
Published: October 2014

A case report of bilateral pharyngoceles without a history of elevated intrapharyngeal pressures is used to support the hypothesis that pharyngoceles may be an adult manifestation of an internal branchial sinus anomaly. The development of a pharyngocele from a branchial sinus origin would suggest a predictable relationship to the hypoglossal, glossopharyngeal, and superior laryngeal nerves, which may influence the choice of surgical approach (open versus endoscopic) and the counseling of patients who are considering surgical correction.
Audiologic Features of Norrie Disease
Authors: Halpin Chris , Owen Grace , Gutiérrez-Espeleta Gustavo A. , Sims Katherine , Rehm Heidi L.
Published: October 2014

Objectives:

Norrie disease is an X-linked recessive disorder in which patients are born blind and develop sensory hearing loss in adolescence. The hearing loss associated with Norrie disease has been shown in a genetically altered knockout mouse to involve dysfunction of the stria vascularis; most other structures are preserved until the later stages of the disease. The objective of this study was to characterize the audiologic phenotype of Norrie disease for comparison with the pathophysiologic mechanism.

Methods:

The design combined two series of clinical audiologic evaluations, with special attention to speech intelligibility.

Results:

The audiologic results for 12 affected individuals and 10 carriers show that patients with Norrie disease retain high speech intelligibility scores even when the threshold loss is severe.

Conclusions:

The cochlear mechanism — failure of the stria vascularis — accounts for some of the higher values in the wide distribution of speech scores in cases with similar pure tone audiograms.
Extensive Acquired Cholesteatoma in Children: When the Penny Drops
Authors: Semple Craig W. , Mahadevan Murali , Berkowitz Robert G.
Published: October 2014

Objectives:

To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center.

Methods:

We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period.

Results:

There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid.

Conclusions:

Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.
Cochlear Wall Erosion after Cochlear Implantation
Authors: Cervera-Paz Francisco J. , Linthicum Frederick H.
Published: October 2014

Objectives:

Cochlear implantation is a clinically satisfactory procedure, but it is associated with a variable degree of histologic intracochlear trauma. We report a new histologic finding in a cochlear implant specimen from the House Ear Institute collection.

Methods:

An analysis of 34 temporal bones with single-channel (n = 23) or multichannel (n = 11) cochlear implants was performed. All temporal bones had been fixed for a month in 10% buffered formalin, progressively decalcified in ethylenediaminetetraacetic acid, and embedded in celloidin. After electrode removal, the bones were cut into 20-μm sections and stained.

Results:

In 1 specimen, the implanted electrode had caused erosion of the bone through the endosteum into the marrow spaces, at the superior-anterior portion of the basal turn. This area showed an intense lymphocytic infiltration surrounded by some new bone formation.

Conclusions:

Trauma may provoke an inflammatory reaction due to the presence of the foreign body after violation of the endosteum.
Tuberculous Parotitis: Case Report and Literature Review
Authors: Lee Ing-Kit , Liu Jien-Wei
Published: October 2014

Objectives:

Our aim was to better understand the rarely encountered tuberculous (TB) parotitis.

Methods:

A case of TB parotitis is reported, and the literature is reviewed.

Results:

Forty-nine patients (27 men, 22 women; mean age, 38.3 ± 16.4 years) were enrolled. The median duration of symptoms before these patients sought medical help was 6 months. Except for 1 patient with bilateral TB parotitis, all had unilateral involvement; complications included draining sinuses in 4 patients (8%) and facial palsy in 2 patients (4%). Twenty-one of 36 patients (58%) had a painless parotid mass, 12 of 19 (63%) had cervical lymphadenitis, 8 of 11 (73%) had fever, and 11 of 44 (25%) had pulmonary tuberculosis (4 active and 7 inactive cases). Neoplasm was the most common presumptive diagnosis. The diagnosis of TB parotitis in most cases was made on the basis of cytologic analysis of the fine-needle aspirate or histopathologic analysis of the excised tissue. Forty-six patients with TB parotitis who had a traceable outcome survived after 6 to 10 months of antituberculosis chemotherapy.

Conclusions:

Physicians should have a high index of suspicion for TB parotitis in patients with a chronic parotid lump, even if the chest radiographs appear normal. Fine-needle aspiration should be performed first for diagnosis, and TB parotitis should be medically treated.
Radiographic and Endoscopic Measurements of Esophageal Length in Pediatric Patients
Authors: Yang Grace S. , Bishop Warren P. , Smith Brian J. , Goudy Steven L. , Sato Yutaka , Bauman Nancy M.
Published: October 2014

Objectives:

Knowledge of the length between the upper esophageal sphincter (UES) and the lower esophageal sphincter (LES) in pediatric patients is essential for intraluminal impedance and dual pH probe recordings.

Methods:

We measured the vertical distance between the true vocal cords (TVCs) and the LES in chest x-rays (CXRs) of 118 children (ages, 6 weeks to 13 years) and measured the vertical distance between the UES and the LES during endoscopy in 31 patients (ages, 14 months to 17 years) and correlated the measurements to height, weight, and age.

Results:

Esophageal length correlated best with patient height (R = 0.96 by CXR, R = 0.88 by endoscopy) and less well with weight (R = 0.87, R = 0.67) and age (R = 0.94, R = 0.86). Linear regression analyses using radiographic measurements revealed that esophageal length (TVC to LES) can be estimated from a patient's height by the following equation: 1.048 + 0.167 × height (in centimeters). With the upper pH probe placed in the hypopharynx at the TVC level and the inferior probe placed in the esophagus 3 to 6 cm above the LES, the patients were divided into 6 groups corresponding to the currently available number of sizes of dual pH-impedance probes. With the patients' heights between 71.5 and 161.3 cm, 64.7% to 100% of patients were within 1 cm of the desired location with preselected probes. Confirmation of placement was performed with CXR.

Conclusions:

A pediatric patient's height can be used to estimate the esophageal length (TVC to LES) and facilitate the selection of dual pH—impedance probes. Our method decreases the risk of morbidity while increasing the accuracy of the study of extraesophageal reflux disease.
Prediction of Difficult Laryngeal Exposure in Patients Undergoing Microlaryngosurgery
Authors: Roh Jong-Lyel , Lee Yong-Won
Published: October 2014

Objectives:

Although difficult laryngeal exposure (DLE) is a common problem encountered during microlaryngosurgery, reliable predictors of DLE and grading systems of laryngeal exposure have been scarcely suggested in the field of laryngology. We propose a new classification of laryngeal exposure focusing on the extent of glottic visualization.

Methods:

We investigated physical parameters that could predict DLE; 73 patients underwent a physical examination including 15 parameters. During endotracheal intubation and suspension laryngoscopy, Cormack-Lehane and laryngeal exposure scores were obtained for each patient and compared with the parameters.

Results:

The patients' ages ranged from 23 to 77 years. The laryngeal exposure score was correlated with the Cormack-Lehane score (p < .001, r = 0.469). Of all parameters, body mass index, neck circumference, thyroid-mental distance, and horizontal thyroid-mental distance showed significant correlation with the laryngeal exposure score (p < .05). From analysis of the candidate parameters in 13 patients with DLE and the non-DLE group, we found that the cutoff values for predicting DLE were a body mass index of >25.0 kg/m2, a neck circumference of >39.5 cm, a thyroid-mental distance of <5.5 cm, and a horizontal thyroid-mental distance of <4.0 cm.

Conclusions:

According to the proposed classification of laryngeal exposure, patients with obesity, a muscular neck, or retrognathia are likely to present DLE, and preoperative measurement of the predictors may be useful in preparing for microlaryngosurgery.
Effect of Climate on the Bacteriology of Chronic Suppurative Otitis Media
Authors: Yildirim Altan , Erdem Hakan , Kilic Selim , Yetiser Sertac , Pahsa Alaaddin
Published: October 2014

Objectives:

We evaluated the correlation between the microbial content of chronic suppurative otitis media (CSOM) and regional climatic parameters.

Methods:

We assessed the interrelations between monthly mean records of temperature, maximum temperature, atmospheric pressure, and humidity and the aerobic microbial flora in CSOM.

Results:

Forty-three bacteria of Enterobacteriaceae, 67 staphylococcal spp, 51 Pseudomonas aeruginosa, 9 Streptococcus pneumoniae, 1 α-hemolytic Streptococcus, 1 Enterococcus sp, and 2 Edwardsiella tarda strains were recovered from 173 patients with CSOM. There was a good relationship between enteric bacteria and monthly mean temperature (r = 0.501) and significant colonization rates due to increasing monthly mean temperature (p = .040) and monthly mean maximum temperature values (p = .048).

Conclusions:

When the weather warmed, the frequency of isolation of enteric bacteria increased significantly. Temperature changes may affect the enteric bacterial colonization of CSOM.
Immune Stimulation for the Treatment of Papilloma
Authors: Poetker David M. , Kerschner Joseph E. , Patel Nalin J. , Bauman Nancy M. , Sandler Anthony D.
Published: October 2014

Objectives:

There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV).

Methods:

Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development.

Results:

Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional weeks of observation. There was no difference between the groups in papilloma size at the site of the injections, nor was there eradication of papillomas at remote sites in either group. No new papillomas developed in any of the 8 animals that were rechallenged.

Conclusions:

We have reproduced an effective mammalian papilloma model for preclinical immunotherapeutic testing. Despite the potency of CpG in triggering host immunity, CpG oligodeoxynucleotide did not show a therapeutic effect against the large papilloma burdens tested in this study. The lack of effect suggests that either enhanced papilloma antigen presentation or targeting of immune-evasive mechanisms used by the papillomas is needed to treat bulky disease with an immunotherapeutic strategy.
Imaging the Mucosa of the Human Vocal Fold with Optical Coherence Tomography
Authors: Burns James A. , Zeitels Steven M. , Anderson R. Rox , Kobler James B. , Pierce Mark C. , de Boer Johannes F.
Published: October 2014

Objectives:

Discerning the layered microstructure of the vocal folds is critical for effective phonomicrosurgery. Optical coherence tomography (OCT), a noncontact, noninvasive technology that provides cross-sectional images by means of backscattered light, offers the potential for delineating these layers in vivo.

Methods:

The glottal mucosa of 3 human cadaver larynges was imaged with conventional OCT and polarization-sensitive OCT (PS-OCT). Images were obtained through the epithelium and lamina propria.

Results:

Although the superficial layer of the lamina propria appeared quite homogeneous, the outer surface of the superficial lamina propria was correlated with an increase in backscatter with OCT. The superficial lamina propria and vocal ligament were correlated with a marked increase in tissue birefringence with PS-OCT.

Conclusions:

This preliminary study demonstrates the capacity of OCT and PS-OCT for visualizing the layered microstructure of the vocal fold mucosa. We believe that these imaging techniques will have applications in the exploration of solutions to vocal fold scarring and in imaging vocal fold disorders in the clinic and operating room.
Cortical Adaptation following Partial Glossectomy with Primary Closure: Implications for Reconstruction of the Oral Tongue
Authors: Mosier Kristine , Liu Wen-Ching , Behin Babak , Lee Christopher , Baredes Soly
Published: October 2014

Objectives:

The considerable variability in functional outcomes for speech and swallowing with different reconstruction techniques following partial glossectomy may reflect the ability of patients to adapt to altered tongue structure. The purpose of this study was to determine mechanisms of cortical adaptation in swallowing to partial glossectomy reconstructed with primary closure.

Methods:

Four patients treated with partial glossectomy and primary closure underwent functional magnetic resonance imaging at a mean of 6 months after operation, and the data were compared to those from 8 healthy controls.

Results:

Statistically significant increases in activity occurred predominately in the parietal cortices and the cerebellum. The volume of the resection was most highly correlated with activity in the premotor and parietal cortices and cerebellum.

Conclusions:

The adaptive changes in the cortex following partial glossectomy with primary closure reflect adaptation to the biomechanics of tongue movement during swallowing, and not altered sensation in the tongue.
Silent Sinus Syndrome: A Case Presentation and Comprehensive Review of All 84 Reported Cases
Authors: Numa William A. , Desai Urmen , Gold Daniel R. , Heher Katrinka L. , Annino Donald J.
Published: October 2014

Objectives:

The term silent sinus syndrome has been used to describe the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical chronic maxillary sinusitis. Currently, it is believed to occur as a result of the sequence of events following maxillary sinus hypoventilation due to the obstruction of the ostiomeatal complex.

Methods:

In this study, we present a case of true silent sinus syndrome. In addition, we highlight the previously published cases of silent sinus syndrome, as well as provide a review of the etiology, pathophysiology, radiologic diagnosis, surgical treatment, and pitfalls to avoid in the management of patients with silent sinus syndrome.

Results:

Eighty-three previously published cases of silent sinus syndrome were reported in the literature and are summarized in this review.

Conclusions:

A well-defined set of criteria is needed to classify a patient under the diagnosis of silent sinus syndrome, which include enophthalmos and/or hypoglobus in the absence of clinically evident sinonasal inflammatory disease.
Tissue Maturation Correlating to Clinical Manifestations in Juvenile Angiofibroma
Authors: Sennes Luiz U. , Fortes Felipe S. G. , Butugan Ossamu , Saldiva Paulo H. , Bernardi Fabiola C.
Published: October 2014

Objectives:

Juvenile nasopharyngeal angiofibroma is a rare benign tumor that affects young male patients and shows a characteristic development from its origin. It is not a true neoplasm, but shows features of vascular processes, developing into a more fibrous condition. The aim of this study was to correlate the clinical manifestations and the histologic findings of the tumor.

Methods:

Thirty-six patients without previous treatment were studied. We correlated the incidence and duration of the clinical manifestations (nasal obstruction, epistaxis, nasal and/or pharyngeal tumor, and facial deformity) and morphometric histologic analyses of the central region of the tumor (number, caliber, and presence of muscle cells in the vessel wall, and tissue maturity and cellularity).

Results:

The duration of nasal obstruction, the presence of nasal and/or pharyngeal tumor, and facial deformity were significantly correlated with the number of vessels, the tissue maturation, and the cellularity of the tumor. Epistaxis showed a strong correlation with the presence of muscle fibers in the vessels.

Conclusions:

There are correlations between the duration of the clinical manifestations and histologic maturation in the central portion of the tumor.
HspE7 Treatment of Pediatric Recurrent Respiratory Papillomatosis: Final Results of an Open-Label Trial
Authors: Derkay Craig S. , Smith Richard J. H. , McClay John , van Burik Jo-Anne H. , Wiatrak Brian J. , Arnold James , Berger Bruce , Neefe John R.
Published: October 2014

Objectives:

We sought to evaluate the effectiveness of HspE7, a recombinant fusion protein of Hsp65 from Mycobacterium bovis BCG and E7 protein from human papillomavirus 16, to improve the clinical course of pediatric patients with recurrent respiratory papillomatosis.

Methods:

An open-label, single-arm intervention study was conducted in 8 university-affiliated medical centers. Twenty-seven male and female patients with recurrent respiratory papillomatosis, ages 2 to 18 years, were enrolled and followed up to 60 weeks. Before enrollment, these patients required surgery on average every 55 days. After a baseline debulking surgery, the patients received HspE7 500 μg subcutaneously monthly, for 3 doses over 60 days. The primary end point was the length of the interval from the last surgery during the treatment period until the first debulking surgery in the posttreatment period, compared with the median intersurgical interval (ISI) of the 4 surgeries before the treatment.

Results:

The mean of the first posttreatment ISI increased 93% (from 55 days to 106 days; p < .02). The median ISI for all surgeries after treatment was similarly prolonged (mean, 107 days; p < .02), indicating a sustained treatment effect, and was associated with a significant decrease in the number of required surgeries (p < .003). Unexpectedly, the treatment effect was most striking in the 13 female patients, who had statistically significant increases in both the first posttreatment ISI (142%; p < .03) and the median ISI (147%; p < .03). The most common adverse events were mild-to-moderate injection site reactions.

Conclusions:

Treatment with HspE7 appears to significantly improve the clinical course in pediatric patients with RRP insofar as it reduces the frequency of required surgeries. These results warrant a confirmatory phase III trial.
Prognosis of Inner Ear Periphery and Central Vestibular Plasticity in Sudden Deafness with Vertigo
Authors: Kitahara Tadashi , Takeda Noriaki , Nishiike Suetaka , Okumura Shin-Ichi , Kubo Takeshi
Published: October 2014

Objectives:

We sought to elucidate the clinical problems and otopathology of patients with sudden deafness with vertigo (SDV).

Methods:

In 24 patients with SDV who had significant canal paresis (CP) at their first visit to our hospital between 1997 and 2001, we examined pure tone audiograms, caloric tests, and several questionnaires twice, at the first visit within 5 days after the onset and around 2 years after steroid therapy.

Results:

These examinations revealed that improvements of auditory and vestibular function in patients with SDV tended to be correlated with one another. Sixteen of the 24 patients (66.7%) still had CP. This rate in SDV was significantly worse than that reported previously for vestibular neuritis (VN). On the other hand, patients with SDV with long-lasting CP had a faster reduction of head-shaking afternystagmus and of handicaps in their everyday life due to dizziness than did patients with VN and CP.

Conclusions:

These findings suggest that SDV may deteriorate the inner ear function more severely but accelerate the central vestibular compensation more effectively than VN after the lesion. It is well known that vestibular neurectomy causes much more severe motion-induced dizziness after surgery than does labyrinthectomy. Taken together, these findings suggest different regions of damage in SDV (mainly the labyrinth, as in labyrinthectomy) and VN (mainly the ganglion, as in vestibular neurectomy).
Phonetic Effects of Paralytic Dysphonia
Authors: Hartl Dana M. , Crevier-Buchman Lise , Vaissière Jacqueline , Brasnu Daniel F.
Published: October 2014

Objectives:

This study was performed to determine whether and how unilateral vocal fold paralysis (UVFP) affects the production and perception of voiced stop consonants as compared with unvoiced stops, and to analyze the phonetic effects of UVFP on the voicing feature.

Methods:

Phonetic constructs pronounced by 7 male patients with UVFP and 5 normal male subjects were recorded. The 432 speech tokens consisted of intervocalic, prevocalic, and postvocalic stop consonants (/p/, /t/, /k/, /b/, /d/, /g/) in the vowel contexts / a/ and /i/. Perceptual consonant identification testing was performed with 5 voice and speech professionals as listeners. The type and frequency of errors made in consonant identification were analyzed. Spectrographic analysis was used to analyze acoustic cues.

Results:

The rate of correct consonant identification was significantly lower for tokens pronounced by patients with UVFP (77.3% versus 97.6%, p =.0001) because of incorrect identification of the voiced consonants, frequently perceived as their unvoiced homologues. Confusion between dental and alveolar place of articulation for unvoiced stops was also noted.

Conclusions:

Unilateral vocal fold paralysis alters the voiced-unvoiced stop consonant distinction and the dental-palatal stop consonant distinction in an experimental nonspeech context. This finding implies the existence of a phonetic handicap for patients with UVFP. Further studies should determine the effects of UVFP on global speech intelligibility.
Alterations in Contractile Properties of Tongue Muscles in Old Rats
Authors: Ota Fumikazu , Connor Nadine P. , Konopacki Richard
Published: October 2014

Objectives:

Fatigue and weakness are well-known signs of aging that are related to sarcopenia, or loss of skeletal muscle mass, organization, and strength. Sarcopenia may affect swallowing. The tongue plays a vital role in swallowing, but there is limited knowledge regarding age-related changes in lingual muscle contractile properties. Our purpose was to determine whether alterations in tongue force, temporal features of tongue muscle contraction, and fatigability are manifested as a function of aging in old rats.

Methods:

We evaluated tongue muscle contractile properties in young and old Fischer 344/Brown Norway rats. Contractions were elicited via bilateral electrical stimulation of the hypoglossal nerves.

Results:

Maximum tongue forces and fatigability were not significantly altered in old animals, but aging was associated with significantly longer twitch contraction time and longer half-decay recovery time intervals (p <.01).

Conclusions:

The results indicated that old animals generated sufficient maximum tongue forces, but were slower in achieving these forces than young animals. These findings are consistent with reports of altered temporal parameters of tongue actions during swallowing in humans, and suggest that a disruption in the timing of muscle contraction onset and recovery may contribute to the altered tongue kinetics observed with aging.
Individual Subject Laryngeal Dimensions of Multiple Mammalian Species for Biomechanical Models
Authors: Hunter Eric J. , Titze Ingo R.
Published: October 2014

Objectives:

This report provides a detailed knowledge base of individual subject laryngeal cartilage dimensions across multiple species to assist researchers in creating subject-specific biomechanical laryngeal models.

Methods:

The raw data from previous laryngeal cartilage studies were grouped by species (for human, canine, and ovine) and by cartilage (arytenoid, thyroid, and cricoid) by means of a previously reported labeling scheme. No animals were sacrificed specifically for the present study.

Results:

More than 1,500 measurements from 37 subjects are presented in 15 tables. No comparisons of the average measures were attempted, as they were done in previous studies.

Conclusions:

By means of a database of individual subject dimensions, a laryngeal model could be designed and tested to morph from one subject to the next, predicting subject-specific results of laryngeal function. Eventually, this would lead to modeling patient-specific laryngeal disorders and the prediction of therapeutic outcomes. An electronic downloadable version of the database is made available to assist in this effort.
Clinical Characteristics of Eosinophilic Esophagitis in Children
Authors: Dauer Eileen H. , Freese Deborah K. , El-Youssef Mounif , Thompson Dana M.
Published: October 2014

Objectives:

The role of eosinophilic esophagitis (EE) in aerodigestive tract disorders in children is underestimated and overlooked, primarily because of a lack of understanding of this disorder by otolaryngologists. We sought to better characterize the clinical presentation of EE in order to increase awareness among otolaryngologists.

Methods:

We retrospectively reviewed 71 children with biopsy-proven EE to determine the most common symptoms and laboratory findings that should increase the clinical suspicion of EE.

Results:

Dysphagia, food impaction, and emesis were the most common symptoms in children with EE. Asthma was the most common airway diagnosis. Rhinosinusitis was the most common otolaryngological diagnosis. Food allergy was present in 60% of the children tested. Eighty-three percent of the children with elevated immunoglobulin E levels had thick linear streaking or patchy white exudate of the esophagus seen on esophagoscopy. Other major medical comorbidities existed in more than half of the children with EE, of which psychiatric disorders and other disorders of the aerodigestive tract were the most common.

Conclusions:

Eosinophilic esophagitis may contribute to treatment failure in patients with common and complicated aerodigestive tract disorders. To encourage clinicians to avoid overlooking the diagnosis, we present an evaluative algorithm to increase the suspicion of this entity.
Influence of Vocal Fold Scarring on Phonation: Predictions from a Finite Element Model
Authors: Berry David A. , Reininger Haven , Alipour Fariborz , Bless Diane M. , Ford Charles N.
Published: October 2014

Objectives:

A systematic study of the influence of vocal fold scarring on phonation was conducted. In particular, phonatory variables such as fundamental frequency, oral acoustic intensity, and phonation threshold pressure (PTP) were investigated as a function of the size and position of the laryngeal scar.

Methods:

By means of a finite element model of vocal fold vibration, the viscoelastic properties of both normal and scarred vocal fold mucosae were simulated on the basis of recent rheological data obtained from rabbit and canine models.

Results:

The study showed that an increase in the viscoelasticity of the scarred mucosa resulted in an increase in fundamental frequency, an increase in PTP, and a decrease in oral acoustic intensity. With regard to positioning of the scar, the PTP increased most significantly when the scar was within ±2 mm of the superior-medial junction of the vocal folds.

Conclusions:

The systematic data obtained in this investigation agree with the general clinical experience. In the future, these findings may be further validated on human subjects as newly emerging technologies such as linear skin rheometry and optical coherence tomography allow the histologic and viscoelastic properties of the normal and scarred vocal fold mucosae to be measured in the clinic.
Radiology of the Cochlear Aqueduct
Authors: Migirov Lela , Kronenberg Jona
Published: October 2014

Objectives:

We sought to determine normative data for the radiologic presentation of the cochlear aqueduct (CA), hypothesizing that increasing the scanner's resolution could enhance detection capability.

Methods:

Axial sections of 502 high-resolution computed tomography (CT) images of temporal bones (488 patients) were reviewed. A type 1 CA was visualized on CT scans up to the vestibule, and its portion in the otic capsule segment could be seen as a thin (<1 mm) streak. In type 2, we were able to detect the medial Two thirds of the structure, but we failed to see the whole otic capsule portion. In type 3, only the external aperture of the aqueduct and/or the medial third was seen. We defined undetectable CAs as type 4.

Results:

We obtained CT scans with 0.6-, 1.1-, or 1.3-mm-thick slices through the petrous bones in 9.5%, 58.8%, and 31.7% of cases, respectively. The CA was visible and bilaterally symmetric in 49% of the images, and type 2 was the most commonly detected CA type (36%). The CA was invisible on either side in 21.9% of scans, irrespective of CT resolution, and was asymmetric in 53 of the 502 images. The CA types varied with changes in resolution, although type 3 appeared unchanged independent of alterations in resolution in most cases.

Conclusions:

There was no significant difference in CT detection capability between CA types at different resolutions. Computed tomography failed to demonstrate any CAs ≥1 mm in width in the otic capsule segment.
Predicting Outcome in Aged and Severely Ill Patients with Prolonged Respiratory Failure
Authors: Baskin Jonathan Z. , Panagopoulos Georgia , Parks Christine , Komisar Arnold
Published: October 2014

Objectives:

Consultations for tracheotomy are often sought on aged and severely ill patients with respiratory insufficiency. This patient population has high short-term mortality rates and is difficult to stratify on the basis of expected outcome. We examined whether APACHE III (Acute Physiology and Chronic Health Evaluation III) scores or neurologic status assessment (NSA) scores in sedated individuals are predictive of outcome.

Methods:

We performed a retrospective study examining aged patients who underwent tracheotomy for respiratory insufficiency and prolonged intubation. The APACHE III scores (n = 30) and NSA (based on a modified Glasgow Coma Scale) scores (n = 37) were calculated before tracheotomy. All patients were mildly sedated. Using APACHE III and NSA scores as predictor variables and using death and ability to be weaned from the ventilator as outcome variables, we performed a Kaplan-Meier survival analysis and a Cox proportional hazard regression.

Results:

The APACHE III was not significantly predictive of either outcome. Higher NSA scores were associated with increased survival rates (log rank = 19.7, p < .0001) and longer median survival (88 days versus 16 days for lower scorers). Higher NSA scores also predicted a higher rate of ventilator independence.

Conclusions:

Neurologic function in sedated patients (and not APACHE III scores) can be used to stratify aged individuals with respiratory insufficiency on the basis of expected outcome.
Comparative Study of the Daily Lifestyle of Patients with Meniere's Disease and Controls
Authors: Onuki Junichi , Takahashi Masahiro , Odagiri Kyoko , Wada Ryoko , Sato Ririko
Published: October 2014

Objectives:

This study was performed to investigate the possibility that daily lifestyle may have a causal relationship with Meniere's disease.

Methods:

We conducted a questionnaire study of daily lifestyles among groups of patients with Meniere's disease and those with low-frequency hearing loss, and compared the results with those of control groups of local residents matched individually by gender and age.

Results:

The Meniere's disease group diverged most widely from the control groups in their behavior patterns. Significant divergence was especially indicated in their engrossed, self-inhibiting, and time-constrained behaviors. Although the low-frequency hearing loss group also exhibited similar tendencies toward engrossment and in their feeling pressed for time, their self-inhibiting behavior was less pronounced. There was no major difference between the endolymphatic hydrops patient groups and the control groups on other items in the study such as daily lifestyle, environmental stress, and means of relaxation.

Conclusions:

The results of the present study strongly suggest that there may be a link between an individual's specific behavior patterns and the onset of Meniere's disease.
Conservative Management of Stapler Failure in Zenker's Endoscopic Diverticulotomy
Authors: Van Daele Douglas J.
Published: October 2014

The endoscopic stapler has achieved widespread use in the management of Zenker's diverticulum owing to its ease of use and safety. However, complications associated with its use can and do occur. This study details the treatment course of 2 patients who underwent an endoscopic stapler approach to their Zenker's diverticulum complicated by the stapler's not sealing the mucosal edges. Although the patients' hospital stays were extended as a result, they suffered no long-term morbidity as a result of the complication.
Acoustic Rhinometry: Accuracy and Ability to Detect Changes in Passage Area at Different Locations in the Nasal Cavity
Authors: Cakmak Ozcan , Tarhan Erkan , Coskun Mehmet , Cankurtaran Mehmet , Çelik Huseyin
Published: October 2014

Objectives:

To evaluate the accuracy of acoustic rhinometry (AR) measurements, and to assess how well AR detects obstructions of various sizes at specific sites in the nasal cavity, we created a cast model from an adult cadaver nasal cavity.

Methods:

The actual cross-sectional areas of the cast model nasal passage were determined by computed tomography and compared with the corresponding areas measured by AR. To assess how nasal obstruction affects the AR results, we placed small wax spheres of different diameters at specific sites in the model (nasal valve, head of the inferior turbinate, head of the middle turbinate, middle of the middle turbinate, choana, and nasopharynx).

Results:

The AR-derived cross-sectional areas in the first 6.5 cm of the cast model nasal cavity were very close to the corresponding areas calculated from computed tomographic sections perpendicular to the presumed acoustic axis. However, AR overestimated the passage areas at locations posterior to the 6.5-cm point. Acoustic rhinometry gave an accurate indication of the passage area of the nasal valve and its distance from the nostril. The nasal valve and the choana were indicated by significant dips on the AR area-distance curve, whereas the curve was smooth throughout the region that included the head of the inferior turbinate, the head of the middle turbinate, the middle of the middle turbinate, and the nasopharynx. In other words, AR did not discretely identify these latter sites. Acoustic rhinometry detected the different-sized inserts (obstructions) more accurately at the nasal valve than at sites posterior to this location.

Conclusions:

The results of the study show that AR is a valuable method for assessing the anterior nasal cavity. This technique is sensitive for detecting changes in passage area at the nasal valve region; however, the sensitivity is lower at sites posterior to this. The findings suggest that when there is substantial narrowing of the nasal valve, AR will not identify an obstruction at any location posterior to the nasal valve. In such situations, AR measurements beyond the abnormal nasal valve may easily lead to misinterpretation of the patient's nasal anatomy or condition.
Can Ki-67 Predict Recurrence of N0 Squamous Cell Carcinoma of the Tongue?
Authors: Davies Louise , Hardin Nicholas J. , Beatty Barbara G.
Published: October 2014

Objectives:

Ki-67 is a molecular marker of cellular proliferation that predicts prognosis of some head and neck tumors. Studies of Ki-67 in oropharyngeal cancer have yielded conflicting findings. This study was designed to test Ki-67 as a marker for poor prognosis in N0 tongue squamous cell carcinoma.

Methods:

We examined 29 cases in a retrospective cohort to test the hypothesis that a high rate of tumor cell proliferation (high levels of Ki-67 staining) at the invasive edge of N0 squamous cell carcinoma of the tongue correlates with increased risk of recurrence.

Results:

There were 14 cases of recurrence. The average age of the patients with recurrence was 58 years. The average time to recurrence was 13.1 months. A 0% to 33% uptake of Ki-67 at the tumor's leading edge was associated with a 6-times-greater risk of recurrence. The mean length of survival for the group with 0% to 33% uptake was 21 months; for the group with >33% uptake, it was 33 months. Overall uptake of Ki-67 and histologic grade did not correlate with risk of recurrence.

Conclusions:

In this sample, low rates of Ki-67 staining at the invasive edge of the tumor predicted a risk of recurrence. These results need to be confirmed before Ki-67 can be used for predicting recurrence of tongue squamous cell carcinoma.
Tongue Paresthesia and Dysgeusia following Operative Microlaryngoscopy
Authors: Tessema Belachew , Sulica Lucian , Yu Guo-Pei , Sessions Roy B.
Published: October 2014

Objectives:

This study was performed to assess the overall incidence and duration of alterations in tongue sensation and taste after operative microlaryngoscopy, and the relation of these symptoms to operative time.

Methods:

We performed a retrospective review of information regarding tongue symptoms in patients who completed standard post-microlaryngoscopy follow-up at 1 week, 1 month, and 3 months.

Results:

One hundred patients (54 male and 46 female; mean age, 46 years; age range, 14 to 83 years) met the inclusion criteria. Eighteen patients had positive findings at 1 week: 15 complained of paresthesia and 3 of dysgeusia. The symptoms decreased over time without treatment (4% of patients at 1 month and 1% of patients at 3 months). Only 1 case of dysgeusia persisted past 3 months. Gender was found to be a significant independent risk factor for the development of symptoms (odds ratio, 5.63; 95% confidence interval, 1.36 to 31.29; p = .013). Patients whose operations lasted longer than 1 hour were almost 4 times more likely to develop tongue-related symptoms than those with an operative time less than 30 minutes, although these findings did not achieve statistical significance (odds ratio, 3.91; 95% confidence interval, 0.62 to 30.95; p = .182).

Conclusions:

Alterations in tongue sensation and taste, most likely due to lingual nerve injury, are common after microlaryngoscopy, especially in female patients. They also tend to be associated with longer operative times. Although transient in nearly every case, lingual paresthesia and dysgeusia should form part of the preoperative discussion with the patient.
Redefining Parapharyngeal Space Infections
Authors: Sichel Jean-Yves , Attal Pierre , Hocwald Eitan , Eliashar Ron
Published: October 2014

Objectives:

Our intent was to review the clinical signs, computed tomography (CT) scans, treatment, and outcome of parapharyngeal space infections (PPIs), and to define 2 types of infections of the parapharyngeal space (PPS) according to the location of the infectious process.

Methods:

We performed a retrospective analysis of patients hospitalized in a tertiary university hospital with a diagnosis of PPI, abscess, or deep neck abscess between 1988 and 2004. Files and CT scans were reviewed after classification into 2 groups: 1) infection located in the posterior part of the PPS (PostPPI); and 2) infection located in the anterior part of the PPS(AntPPI).

Results:

Twenty-two patients had a PostPPI; their ages ranged from 10 months to 24 years. Five patients underwent surgical drainage, and 17 others were treated solely with intravenous antibiotic therapy. No pus was found during surgery in 2 patients. The average time of hospitalization was 10 days. Only 1 complication (aspiration pneumonia) was observed. Seven patients had an AntPPI; their ages ranged from 1.5 years to 65 years. All patients underwent surgical drainage, and pus was detected in all cases. The average time of hospitalization was 35 days. Complications (septic shock, respiratory arrest, mediastinitis, pleural empyema, pericarditis) were observed in 4 patients.

Conclusions:

The term “parapharyngeal abscess” was assigned long before the CT scan era, and was based on physical examination and plain film radiology. In essence, the entity PPS “abscess” or “infection” is composed of 2 different disorders. Infection located in the posterior part of the PPS with no invasion into the parapharyngeal fat and with no extension into other cervical spaces except the adjacent retropharyngeal space may be termed posterior parapharyngeal infection or parapharyngeal lymphadenitis. This is a relatively benign condition, and nonsurgical treatment should be considered. Infection involving the parapharyngeal fat may be termed parapharyngeal abscess or deep neck abscess. Diffusion into the mediastinum and other severe complications are frequent. Urgent surgical drainage is therefore mandatory.
Quality-of-Life Impact of Non-Neoplastic Voice Disorders: A Meta-Analysis
Authors: Cohen Seth M. , Dupont William D. , Courey Mark S.
Published: October 2014

Objectives:

We undertook to explore the relationship between non-neoplastic voice disorders and patients' quality of life.

Methods:

A PubMed search (1966 to 2003) for the terms Voice Handicap Index (VHI), Short Form-36 (SF-36), voice disorders, voice quality, treatment outcome, voice outcome, quality of life, and questionnaires was performed. Raw data were obtained whenever possible. Studies were analyzed by meta-analysis techniques.

Results:

Of 54 VHI studies identified, 11 were excluded, and of 21 SF-36 studies, 7 were excluded for incomplete data, non-English language, measuring malignant disease, or duplicate publication. Patients with neurologic and inflammatory or traumatic laryngeal disease had worse VHI scores than controls, and those with neurologic laryngeal disease had the most severe impairment (p <.001, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Those with neurologic laryngeal disease had worse SF-36 subdomain scores than did controls in 6 of 8 subdomains (p <.03, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Both patients with neurologic disease and patients with inflammatory or traumatic laryngeal disorders had changes in SF-36 subdomains similar to those of patients with other chronic disease states.

Conclusions:

Non-neoplastic voice disorders adversely impact patients' voice-related and general quality of life, and neurologic voice disorders have the greatest impact.
Cell Production in Injured Vocal Folds: A Rat Study
Authors: Tateya Ichiro , Tateya Tomoko , Lim Xinhong , Sohn Jin Ho , Bless Diane M.
Published: October 2014

Objectives:

Fibroblasts are reported to play an important role in producing the extracellular matrix of the vocal fold. However, no reports have focused on how and where these cells are generated in the vocal fold after injury. To reveal the characteristics of vocal fold cell production, we investigated cell proliferation in the acute phase of wound healing.

Methods:

Using a telescope for guidance, we made an incision in the middle region of the vocal fold tissue in 24 rats and performed immunohistochemical staining for vimentin, α-smooth muscle actin, and 5-bromo-2-deoxyuridine.

Results:

After injury, epithelialization occurred with a peak at day 1, and fibroblasts proliferated in the lamina propria with a peak at day 3, whereas those in the macula flava did not show any increased proliferation.

Conclusions:

It is suggested that the fibroblasts in the macula flava have functions different from those of fibroblasts in the lamina propria and that the macula flava does not serve as a cell source for the vocal fold in response to injury.