bluuebunny/crossref_metadata_2025 huggingface dataset:
Ancillary Instruments for the Video Microlaryngoscope
Authors: Kantor Edward A. , Partlow Eric , Berci George , Paz-Partlow Margaret
Published: October 2014

Two years of experience with the video microlaryngoscope has identified the need for ancillary instrumentation to take full advantage of the system's potential. The authors developed the following additions to video microlaryngoscopy: 1) a hinged mirror that may be articulated from its pistol grip handle: 2) a 4-mm 30° or 70° angled telescope for examination of subglottic areas not accessible by mirror examination; and 3) angulated laryngeal instrumentation that permits operation on previously obscured anterior anatomy. The authors also find that the video microlaryngoscope's distal view eliminates interference with visualization caused by the syringe during vocal cord injection.
Fungal Sinusitis in Immunocompromised Children with Neoplasms
Authors: Kavanagh Kevin T. , Parham David M. , Hughes Walter T. , Chanin Louis R.
Published: October 2014

This paper reviews the treatment and diagnosis of immunocompromised patients with fungal sinusitis at St Jude Children's Research Hospital. Sinusitis of all types was found to be more common in patients with hematopoietic neoplasms than in patients with solid tumors; 42% of patients with leukemia had abnormal sinus radiographs. Eight cases of pathologically proven fungal sinusitis were identified. All patients were undergoing chemotherapy for either acute myeloblastic leukemia or acute lymphoblastic leukemia and had neutrophil counts less than 100 cells/mm3. The most common findings were fever, facial pain, and abnormal sinus radiographs. Surveillance cultures of the upper aerodigestive system did not reliably predict sinus pathogens. An aggressive treatment approach consisting of early administration of amphotericin B (intravenously and via catheter irrigations of the sinuses) and surgical drainage is advocated. There was an 80% survival rate in patients in remission who were undergoing maintenance chemotherapy. All patients undergoing chemotherapy for relapse died.
Leiomyosarcoma of the Trachea
Authors: Thedinger Britt A. , Montgomery William W. , Cheney Mack L. , Goodman Max
Published: October 2014

Leiomyosarcoma of the trachea is a rare primary tumor of the upper airway. Twelve cases have been reported in the English-language literature. Our experience with a patient with leiomysarcoma of the cervical trachea is presented. The classic symptoms, diagnosis, and surgical management of this case are contrasted with those of the previously reported cases. The surgical technique used for our patient, primary tumor resection with skin grafting and placement of a Montgomery® Laryngeal Stent, is a unique and effective treatment.
Syndrome of Inappropriate Antidiuretic Hormone Secretion in Cancer of the Head and Neck
Authors: Zohar Yuval , Talmi Yoav P. , Nobel Michael , Finkelstein Yehuda , Gafter Uzi
Published: October 2014

The syndrome of inappropriate secretion of arginine vasopressin (AVP) known as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia that results from water retention attributable to persistent AVP release. It may occur in a variety of malignant and nonmalignant lesions, with small cell or oat cell carcinoma of the lung by far responsible for the largest number of these cases. Cancer of the head and neck may be a rare cause of SIADH, and only a few such cases have been reported. We describe four patients with advanced cancer of the head and neck region with coexisting SIADH. Diagnosis and treatment are reported and the literature is reviewed. The possible occurrence of SIADH in the head and neck surgical practice should be kept in mind. Since SIADH is usually transient, water restriction and parenteral sodium chloride may be sufficient in overcoming the acute phase.
Early Biochemical Events in Pneumococcal Otitis Media: Arachidonic Acid Metabolites in Middle Ear Fluid
Authors: Nonomura Naobumi , Giebink G. Scott , Harada Teruhiko , Zelterman Daniel , Juhn Steven K.
Published: October 2014

The concentrations of four arachidonic acid metabolites, prostaglandin E2, 6-keto-prostaglandin F1α, leukotriene B4, and leukotriene C4, were measured in middle ear fluid of chinchillas 6 to 72 hours after middle ear inoculation of log-phase, heat-killed encapsulated Streptococcus pneumoniae organisms. Compared with saline-inoculated ears, significant increases in the mean concentrations of all four metabolites were observed in the pneumococcus-inoculated ears 24 hours after inoculation, but not after 6, 48, or 72 hours. Since pneumococcus inoculation caused an influx of inflammatory cells as early as 6 hours after inoculation, before the increase in arachidonate metabolites, the initial stimulus for inflammatory cell chemotaxis is probably not metabolic products of arachidonic acid such as leukotriene B4. These metabolites may, however, amplify the subsequent inflammatory response.
Distribution of Mast Cells in the Tubotympanum of Guinea Pigs
Authors: Watanabe Tetsuo , Fujiyoshi Tatsuya , Kawauchi Hideyuki , Mogi Goro
Published: October 2014

The distribution pattern of mast cells in the middle ear mucosa and eustachian tube was examined histologically in adult and developing guinea pigs. The aim was to better understand the role of mast cells in the middle ear defense mechanism. The density of mast cells was highest in the pharyngeal orifice of the eustachian tube, and decreased in the direction of the tympanic orifice. The density was higher in adults than in developing animals. Mast cells were also found in the tubotympanic membrane of the fetal guinea pig. Mast cells in the middle ear mucosa appeared in areas covered by ciliated epithelia or areas richly vascularized. Almost all mast cells found in the middle ear and eustachian tube mucosa were the connective tissue type. The results of this investigation suggest that mast cells distribute in the tubotympanum in response to continuous stimuli to the tubotympanic cavity.
Epiglottoplasty for Reconstruction of Posttraumatic Laryngeal Stenosis
Authors: Delaere Pierre R. , Segers Alex , Ostyn Frans , VanDyck Ward
Published: October 2014

Laryngeal stenosis secondary to blunt laryngeal trauma is mostly localized at the supraglottic and glottic levels. The epiglottis is ideally suited to reconstruct the defect after excision of supraglottic and glottic scar tissue and anterior thyroid cartilage. It is the conclusion of the authors that epiglottic reconstruction is an effective procedure for repair of laryngeal stenosis at the supracricoid level. Two case reports are given.
Laser Uvulopalatoplasty in Treatment of Habitual Snoring
Authors: Carenfelt Christer
Published: October 2014

Velopharyngeal sonorous snoring is best treated with uvulopalatopharyngoplasty (UPPP). To reduce surgical risks and minimize the morbidity, a simplified carbon dioxide laser uvulopalatoplasty (LUPP) was performed under local anesthesia. Among a total of 146 patients who had a LUPP performed, there was no significant bleeding or postoperative episodes of asphyxia. The procedure was well tolerated even by those patients with strong vomiting reflexes. The operation time was halved, as was the convalescence. Two patients (1.4%) developed scarring with nasal obstruction, but the impact of factors other than the laser approach itself seemed to be the cause. By scored questionnaires the effect on snoring, family complaints, and daytime somnolence was evaluated in two comparable random groups of patients. Sixty-three patients had LUPP procedures, and 37 had UPPP. The short-term results showed that about 90% of the patients considered themselves essentially improved as regarded snoring and that most patients felt more alert, irrespective of the surgical method used.
Pharyngeal Ulceration in AIDS Patients Secondary to Cytomegalovirus Infection
Authors: Lalwani Anil K. , Snyderman Nancy L.
Published: October 2014

Cytomegalovirus (CMV) infections in patients with acquired immunodeficiency syndrome are common and may present as retinitis, encephalitis, esophagitis, gastritis, enterocolitis, adrenalitis, or pneumonitis. Three patients are presented with pharyngeal ulcerations secondary to CMV. Similar cases have not been previously described in the literature. Symptoms, physical findings, and the treatment of this clinical entity are discussed. Although pharyngeal CMV ulcers are not life-threatening, they may herald multisystemic CMV infection that may require prompt antiviral chemotherapy.
Modifications of the Nasal Cycle in Patients with Hypothalamic Disorders: Kallmann's Syndrome
Authors: Galioto Giovanbattista , Fornasari Gabriele , Mevio Emilio , Cisternino Mariangela , Galioto Pietro , Fraietta Lorenzo
Published: October 2014

The nasal cycle is a phenomenon characterized by cyclic changes in the airflow resistance of each nasal fossa from congestion or constriction of the nasal erectile tissue. This phenomenon is caused by alterations in the influence exerted by the autonomic nervous system and is believed to be regulated by a hypothalamic center. In order to verify this hypothesis on the hypothalamic regulation of the nasal cycle, the authors studied a group of subjects with Kallmann's syndrome. This disorder is characterized by coexisting hypothalamic hypogonadism and hyposmia or anosmia due to hypothalamic and olfactory center hypoplasia. An anomalous nasal cycle was found in all the subjects with Kallmann's syndrome. This disorder might be related to hypothalamus atrophy.
Effects of Preoperative Electrical Stimulability and Historical Factors on Performance with Multichannel Cochlear Implant
Authors: Kileny Paul R. , Kemink John L. , Zimmerman-Phillips Susan , Schmaltz Stephen P.
Published: October 2014

We investigated the relationship between results of preoperative transtympanic electrical promontory stimulation, duration of deafness, postoperative implanted psychophysical results, and postoperative speech and speech sound recognition as indicated by a battery of five tests. Our subjects were 10 patients implanted with the Cochlear Corporation multielectrode implant, 1 year postimplantation, with a minimum of 17 active electrodes programmed in the bipolar + 1 mode. The results indicated that preoperative promontory thresholds, the slope of the threshold function, and the duration of auditory deprivation are excellent predictors of postoperative speech and speech sound recognition in the auditory (processor alone) mode. These results have significant implications for patient selection and counseling.
Intracavernous Carotid Artery Aneurysm Presenting as Recurrent Epistaxis
Authors: Goleas John , Paige Milton L. , Mikhael Michael A. , Wolff Allan P.
Published: October 2014

Massive epistaxis from a leaking intracavernous carotid artery aneurysm is a rare occurrence. Such an unusual case is presented with appropriate imaging and a successful treatment program.
Pacing Parameters of the Canine Posterior Cricoarytenoid Muscle
Authors: Kano Shigeru , Sasaki Clarence T.
Published: October 2014

The electrical pacing of laryngeal tissue consists of many uncharted parameters. We carried out several acute experiments in the canine model to narrow parametric ranges to serve future research and development in this field. Our findings were as follows. Stimulation intensities greater than 6 V caused tissue damage. Optimum stimulation frequency ranged from 60 to 90 Hz. Optimum pulse duration was 2.0 milliseconds. Biphasic stimulation reduced accumulation of electrical charge at the electrodes.
Middle Ear Fluid Lysozyme Source in Experimental Pneumococcal Otitis Media
Authors: Nonomura Naobumi , Giebink G. Scott , Harada Teruhiko , Zelterman Daniel , Juhn Steven K.
Published: October 2014

Middle ear infection with Streptococcus pneumoniae is important in the pathogenesis of acute and chronic otitis media, and lysozyme in middle ear fluid (MEF) is an important inflammatory mediator in this disease. To determine the source of lysozyme during the early period of acute pneumococcal otitis media, chinchillas were irradiated to induce neutropenia, and their middle ears were inoculated with heat-killed, encapsulated pneumococci. The number of inflammatory cells and concentration of lysozyme were measured in MEF between 6 and 72 hours after inoculation. In pneumococcus-inoculated ears, the mean number of inflammatory cells but not lysozyme was significantly lower in MEF from irradiated animals than that from nonirradiated animals at 6 hours. Since lysozyme accumulated in MEF before the influx of inflammatory cells in irradiated animals, the initial release of this inflammatory mediator is most likely not from inflammatory cells; and mucosal epithelial cells, the only other known source of lysozyme in the middle ear environment, were the probable source induced by the direct stimulation of pneumococci. Inflammatory cells may contribute lysozyme later in the inflammatory response, since cellular and lysozyme concentrations in irradiated and nonirradiated animals were similar between 24 and 72 hours. These results suggest that future therapeutic interventions to limit middle ear inflammation in acute otitis media may need to recognize the direct action of pneumococcal cells or their envelope components on middle ear epithelium.
Stapes Surgery: Complications and Airway Infection
Authors: Pedersen Christian Brahe , Felding Jens Ulrik
Published: October 2014

From a group of 1,111 patients who had stapedectomy or stapedotomy performed in a 10-year period, a thorough investigation was made of 11 patients who had a total hearing loss and 8 patients who developed a partial sensorineural hearing loss after operation. The data obtained indicate that postoperative infection with influenza virus may be responsible for unexpected complications following stapedectomy. A close relation was found between the appearance of complications and periods of epidemics of influenza.
Nasopharyngeal Flora in the First Three Years of Life in Normal and Otitis-Prone Children
Authors: Faden Howard , Brodsky Linda , Waz Mary Jane , Stanievich John , Bernstein Joel M. , Ogra Pearay L.
Published: October 2014

Nasopharyngeal carriage of the three major middle ear pathogens ( Streptococcus pneumoniae, nontypeable Hemophilus influenzae, and Moraxella catarrhalis) was evaluated prospectively in a group of 110 children followed up for the first 3 years of life. The findings suggested that nasopharyngeal carriage of middle ear pathogens increases significantly during respiratory illness among the general population of young children; however, otitis-prone children demonstrated a tendency to carry nontypeable H influenzae at an unusually high rate even during health. This propensity to carry nontypeable H influenzae might explain why nontypeable H influenzae is a major cause of recurrent or chronic otitis media.
Chlamydia Trachomatis in the Etiology of Acute Otitis Media
Authors: Weber Peter Cy , Koltai Peter J.
Published: October 2014

In an effort to show that Chlamydia trachomatis (CT) may be involved in the causation of acute otitis media (AOM), we performed three experiments. In the first, we inoculated the tympanic bullae of 6 chinchillas with CT. Five of the 6 inoculated animals developed CT AOM. In the second experiment, we sprayed the nasopharynx of 10 chinchillas with CT. Of these, 8 developed both pharyngitis and AOM, and in 6, live CT was cultured from the middle ear and pharynx. In the third experiment, 5 chinchillas had their conjunctiva inoculated with CT. Three developed CT conjunctivitis. Of these, 2 developed CT pharyngitis and 1 developed CT AOM. We concluded that CT will cause AOM in the chinchilla by direct inoculation into the middle ear as well as indirectly by infection of the nasopharynx and conjunctiva.
Tetanic Response of the Cricothyroid Muscle
Authors: Alipour-Haghighi Fariborz , Perlman Adrienne L. , Titze Ingo R.
Published: October 2014

Tetanic response of canine cricothyroid muscle tissue was investigated through a series of experiments conducted in vitro. Two separate portions of the cricothyroid muscle, namely the pars recta and pars oblique, were studied. Samples of the muscle were dissected from dog larynges excised a few minutes before death and kept in Krebs-Ringer solution at a temperature of 37°±1°C and a pH of 7.4±0.05. Tetanic contraction of the muscle samples was obtained by field stimulation to the muscle through a pair of parallel-plate platinum electrodes and with a train of square pulses of 0.1-millisecond duration and 85-V amplitude. Isometric force responses of the pars recta and pars oblique muscles were obtained electronically with a dual servo system (ergometer). The effect of tissue elongation on the active and passive responses was quantified by stimulation of the sample during cyclic elongation. Both active and passive responses as a function of elongation were obtained on the same sample.
Distribution of Immunocompetent Cells in Normal Nasal Mucosa: Comparisons among Germ-Free, Specific Pathogen-Free, and Conventional Mice
Authors: Ichimiya Issei , Kawauchi Hideyuki , Tanaka Takahiro , Fujiyoshi Tatsuya , Mogi Goro
Published: October 2014

To better understand the role of immunocompetent cells in the defense mechanism of the upper respiratory tract against microbial invasions, the distribution patterns of those cells were investigated in nasal mucosa of mice maintained in three different conditions: Germ-free (GF), specific pathogen-free (SPF), and conventional (CV) conditions. Immunostaining by the indirect peroxidase method and toluidine blue staining were employed for the detection of immunocompetent cells and mast cells. For immunostaining, anti-IgG, -IgA, and -IgM polyclonal antibodies and anti-Lyt-1, -Lyt-2, and -Mac-1 monoclonal antibodies were used as primary antibodies. In nasal mucosa of CV mice, Mac-1+ cells, mast cells, and all cell types of lymphocyte subsets were present. In nasal mucosa of SPF mice, all cell types were also positive, but fewer in number than those of CV mice. In nasal mucosa of GF mice, IgG+, IgA+, and Lyt-2+ cells were rare, although IgM+ and Lyt-1+ cells were present in small numbers. An electron microscopic study revealed that follicle-like lymphocyte aggregates with high endothelial venules were present in nasal mucosa close to the mucosal epithelia. These findings suggest that lymphocytes are mobilized to nasal mucosa, responding to continuous antigenic stimuli, and play an important role in the local defense mechanism of the upper respiratory tract.
Pressure Chamber Tympanometry in Diving Candidates
Authors: Shupak Avi , Ostfeld Ervin , Sharoni Zohara , Doweck Ilana
Published: October 2014

The currently recommended examination for diving fitness ascertains middle ear autoinflation ability only under surface pressure conditions. The purpose of our study was to document and quantify middle ear pressure equalization failure during simulated dives among diving candidates who had otherwise met the otologic criteria for diving fitness. Forty-two candidates for regular naval diving activity were included in the study. Tympanograms of both ears at 1 and 1.1 absolute atmospheres (ATA) were taken inside a pressure chamber with the subjects in two positions: Seated and supine. At a pressure of 1 ATA, type A tympanograms were found in all 84 ears examined. At a pressure of 1.1 ATA, with subjects in the upright position, 19 (22.9%) of the ears had type C and 2 (2.4%) type B tympanograms, while with subjects recumbent during descent, 6 of the ears (7.2%) had type C and 7 (8.4%) type B. Our results suggest that successful autoinflation at surface ambient pressure does not necessarily reflect middle ear pressure equalization ability during descent in a dive.
Endoscopic and Videofluoroscopic Evaluations of Swallowing and Aspiration
Authors: Schatz Kenneth , Langmore Susan E. , Olson Nels
Published: October 2014

A new procedure for evaluating oropharyngeal dysphagia utilizing fiberoptic laryngoscopy was compared to the videofluoroscopy procedure. Twenty-one subjects were given both examinations within a 48-hour period. Results of the fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy examinations were compared for presence or absence of abnormal events. Good agreement was found, especially for the finding of aspiration (90% agreement). The FEES was then measured against the videofluoroscopy study for sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity was 0.88 or greater for three of the four parameters measured. Specificity was lower overall, but was still 0.92 for detection of aspiration. It was concluded that the FEES is a valid and valuable tool for evaluating oropharyngeal dysphagia. Some specific patients and conditions that lend themselves to this procedure are discussed.
Salivary-Type Neoplasms of the Sinonasal Tract
Authors: Manning John T. , Batsakis John G.
Published: October 2014

Salivary-type neoplasms of the nasal cavity and paranasal sinuses are numerically dominated by adenoid cystic carcinomas and pleomorphic adenomas. All others, benign or malignant, are rarely encountered and are usually biologically and histologically low-grade. Sites of origin in the sinonasal tract conform to the density and distribution of the seromucous glands and hence are most often nasal (septum and turbinates) or ostial
Bilateral Arteriovenous Malformation of the Mandible
Authors: Sofferman Robert A. , Summers Gordon W.
Published: October 2014

Spontaneous bleeding from the molar gingiva may reflect the presence of a life-threatening vascular malformation. Sporadic reports of exsanguinating hemorrhage in the dental literature warn of the dangers of extraction, although deaths from unrecognized lesions or secondary to mandibular fracture still occur. Arteriovenous malformation (AVM) may be either unilateral or, less commonly, bilateral, and should be suspected in individuals with large lower facial hemangiomata. Two cases of near-exsanguinating hemorrhage from bilateral AVMs are discussed with the long-term management over a 3- to 20-year follow-up. The report underscores the failure of therapeutic embolization and the need for computed tomographic scanning as a corollary to angiography. A newer treatment with direct removal of the AVM and obliteration methods solves the hemorrhagic complications, reduces the potential for steal syndromes, and reduces the potential for recurrence.
Preepiglottic Space Invasion in “Early” Epiglottic Cancer
Authors: Zeitels Steven M. , Vaughan Charles W.
Published: October 2014

The tendency of epiglottic cancer to invade the preepiglottic space and the significance of this invasion was evaluated in 36 surgical specimens of epiglottic carcinoma originally staged T1 or T2. None of the 9 lesions originating above the hyoepiglottic ligament invaded the preepiglottic space. Twenty-four of the 27 (89%) lesions originating below the hyoepiglottic ligament showed invasion of the preepiglottic space and were clinically understaged. Of the 3 infrahyoid lesions showing no invasion of the preepiglottic space, 1 was a verrucous carcinoma and another was a mucoepidermoid carcinoma arising on the petiole. All other lesions were squamous cell carcinoma. In 12 of the 24 patients (50%) with preepiglottic space invasion, cervical node metastasis was present despite the preoperative staging of T1 or T2.
Psychological Predictors of Audiological Outcomes of Multichannel Cochlear Implants: Preliminary Findings
Authors: Knutson John F. , Gantz Bruce J. , Hinrichs James V. , Schartz Helen A. , Tyler Richard S. , Woodworth George
Published: October 2014

The purpose of this research was to determine whether psychological variables were associated with the variability that characterizes the audiological performance of recipients of multichannel cochlear implants. Twenty-nine consecutive recipients of multichannel implants participated in a preoperative psychological assessment and audiological follow-up assessments after 18 months of implant use. Experimental cognitive measures that assess an ability to rapidly detect and respond to features imbedded in sequentially arrayed information accounted for up to 30% of the variance in implant outcome, suggesting the importance of cognitive abilities in implant outcome. Standardized measures of intellectual ability, however, were not predictive of outcome. The Health Opinion Survey, a measure of participatory engagement, was also a significant predictor of audiological outcome. Overall, the results implicated the importance of several specific psychological factors in the audiological outcome of cochlear implants in postlingually deafened adult recipients.
Cerebral Autoregulation in Patients with Orthostatic Hypotension
Authors: Ohashi Naoki , Yasumura Satsuki , Shojaku Hideo , Nakagawa Hajime , Mizukoshi Kanemasa
Published: October 2014

The present study was conducted to determine the relationship between autonomic nervous function and cerebral autoregulation in 17 patients with vertigo or dizziness. Autonomic nervous function was examined by measuring systolic blood pressure response and dynamic electrocardiogram R-peak to R-peak response upon standing up. Regional cerebral autoregulation was examined by comparing cerebral blood flow in both supine and standing positions with single photon emission computed tomography. Moreover, the relationship of each of these three measures to postural provocation of symptoms was studied. The findings indicated that autonomic nervous dysfunction does not influence cerebral autoregulation, but autonomic nervous dysfunction was related to postural provocation of symptoms. This might indicate that impaired autoregulation in the brain stem or the peripheral vestibule, which could not be detected by the single photon emission computed tomography, played a role in inducing vertigo or dizziness in patients with orthostatic hypotension.
Psychological Change following 18 Months of Cochlear Implant Use
Authors: Knutson John F. , Tyler Richard S. , Schartz Helen A. , Hinrichs James V. , Gantz Bruce J. , Woodworth George
Published: October 2014

Consecutive recipients of multichannel cochlear implants participated in preimplant as well as 9-month and 18-month psychological evaluations. Before receiving a cochlear implant, psychological tests indicated that the implant recipients were more depressed, suspicious, socially isolated, lonely, and socially anxious than was the general population. After 18 months of implant use, there was a significant reduction in depression, loneliness, social anxiety, social isolation, and suspiciousness. These changes in psychological state did not correlate with improved performance on audiological measures. The data suggest that although cochlear implants can have a positive effect on the emotional and behavioral status of persons with acquired postlingual profound deafness, the psychological outcome of implants is not simply a function of the audiological benefit assessed with standardized speech-based audiological tests.
Round Window versus Promontory Stimulation: Assessment for Cochlear Implant Candidacy
Authors: Shipp David B. , Nedzelski Julian M.
Published: October 2014

Electrical stimulation of the cochlea is a part of the preliminary evaluation protocol for cochlear implant candidacy at many centers. Typically, a transtympanic needle electrode is placed on the promontory of the ear under consideration and electrical current is presented to measure auditory percepts and psychophysical-electrophysiologic measures. Since 1984, we have used a ball electrode placed directly on the round window (via a tympanotomy) for stimulation, with 27 subjects being so tested to date. Nine additional subjects have had stimulating electrodes placed on both the round window and the promontory. Seven of these subjects yielded complete data. For measurements of threshold, maximum acceptable loudness level, and dynamic range, promontory testing mean values were higher than round window measurements. However, the differences were not significant.
Evaluation of the Temporal Bones of a Multichannel Cochlear Implant Patient
Authors: Zappia John J. , Niparko John K. , Kemink John L. , Oviatt Dana L. , Altschuler Richard A.
Published: October 2014

In this report we detail the temporal bone findings of a 57-year-old patient who underwent placement of a Nucleus 22-channel electrode 7 months prior to his death. Audiometric testing postoperatively demonstrated suprasegmental speech cue discrimination only. Histologic evaluation of the cochleas revealed significant sensorineural survival except in the region of the basal turn of the implanted cochlea adjacent to the implant. There was no significant pathologic condition attributable to the operation or the electrode in areas remote from the basal turn of the cochlea.
Airway Obstruction and High-Frequency Jet Ventilation during Laryngoscopy
Authors: Desruennes Eric , Mamelle Gérard , Bourgain Jean-Louis , Luboinski Bernard
Published: October 2014

High-frequency jet ventilation has been reported as an effective method of ventilation during laryngoscopy, but may expose the patient to the risks of barotrauma or alveolar hypoventilation. The aim of the study was to evaluate the determining factors of pulmonary complications under high-frequency jet ventilation in 83 patients undergoing laryngoscopy for upper airway cancer. Pulmonary distention was mainly influenced by upper airway obstruction score (p = .0001), while patients with chronic obstructive pulmonary disease (COPD) did not suffer from gas trapping. Impaired gas exchange was predicted by increased weight (p = .0001), smaller injector diameter (p = .02), and lower airway obstruction (p = .001). Hypercapnia occurred in both upper and lower airway obstruction, while hypoxemia was principally observed in COPD patients. Emphasis is placed on monitoring by pulse oximetry, end-expiratory pressure, and PCO2 measurement, especially in patients with obesity, COPD, or upper airway obstruction.
Salivary Neoplasms of the Jaw Bones with Particular Reference to Central Mucoepidermoid Carcinomas
Authors: Bruner Janet M. , Batsakis John G.
Published: October 2014

Intragnathic salivary-type neoplasms are few in number, are of debated histogenesis, and are most often classified as mucoepidermoid carcinomas. Two generating tissues have been proposed for the origin of these central (intraosseous) tumors: enclaves of salivary tissue and a metaplasia of the linings of odontogenic cysts. They are not mutually exclusive. Although most mucoepidermoid carcinomas have been low grade, these neoplasms nonetheless have a very respectable recurrence rate and can be fatal.
Hearing Gain after Stapedotomy, Partial Platinectomy, or Total Stapedectomy for Otosclerosis
Authors: Cremers W. R. J. , Beusen Jan M. H. , Huygen Patrick L. M.
Published: October 2014

The differences in hearing gain 1 year after stapedectomy, partial platinectomy, or total stapedectomy for otosclerosis were studied separately at 0.5, 1, 2, 4, and 8 kHz with the data available from 311 consecutive primary operations performed between 1980 and 1982 in the University of Nijmegen Department of Otorhinolaryngology. Three groups of patients were matched for age, sex, clinical type of otosclerosis, and type of 0.6-mm all-Teflon piston. The hearing gain for air conduction was significantly better by an average of 7.4 dB for all frequencies combined after either stapedotomy or partial platinectomy compared to total stapedectomy.
Tullio Phenomenon and Postural Stability: Experimental Study in Normal Subjects and Patients with Vertigo
Authors: Ishizaki Hisayoshi , Aalto Heikki , Pyykkö Ilmari , Starck Jukka
Published: October 2014

The effect of low-frequency sound (LFS) on postural stability was studied in 55 healthy volunteers and in 152 patients with vertigo due to different types of inner ear disease. The sound pressure levels ranged from 130 to 132 dB and were given at frequencies of 25, 50, and 63 Hz. The duration of each stimulation lasted 30 seconds. The postural responses were measured with a force platform. The LFS stimulation improved the postural stability of the healthy subjects through the alerting response. We did not observe any difference in the body sway according to whether the LFS was delivered with monaural or binaural stimulation. Twenty-six percent of the patients with Meniere's disease, 40% with chronic otitis media with vertigo, and 26% with vertigo of peripheral origin experienced significant postural instability at least at two of the three test frequencies during stimulation with LFS. The results demonstrate that in subjects with different types of inner ear disease the vestibular system starts to respond to LFS. The activation of vestibulospinal responses by LFS seems to be an expression of the Tullio phenomenon.
Cochlear Bone Erosion: Effects on Cochlear Hair Cells
Authors: McGinn Michael D. , Chole Richard A.
Published: October 2014

Cochleae from gerbils with normal middle ears were compared with cochleae from gerbils with experimentally induced cholesteatomas that were in contact with the cochlear wall (stage III cholesteatomas). Cochleae from gerbils with stage III cholesteatomas were further divided into two groups: one without erosion of cochlear bone, and one with cholesteatoma-induced bone erosion but without cochlear fistulae. The cochleae with bone erosion showed significant loss of outer hair cells in the middle and apical turns, but not in the basal turn. The cochleae with stage III cholesteatomas but without bone erosion did not differ from normal controls. These results suggest that an ototoxic agent, involved in the process of bone erosion, acts through the bony cochlear wall.
Effect of Viruses and Interferon on Chick Embryo Otocyst Cultures
Authors: Shikani Alan H. , Richtsmeier William J.
Published: October 2014

Chick embryo otocyst organ cultures were subjected to live vesicular stomatitis virus and rubella virus preparations, to interferon (IFN), and to a combination of both virus and IFN, and compared to control untreated otocysts, We observed morphologic and microscopic changes suggestive of individual cell death and delayed organ differentiation in the virus-treated groups, along with an appreciable decrease in size of the otocyst. Low-dose IFN treatment prior to virus inoculation appeared to partially prevent these effects. The addition of IFN alone did not seem to affect the differentiation process. Time-lapse videophotography further confirmed the above findings. This study suggests that the peripheral component of congenital deafness associated with viral infections is likely to be an effect of the virus itself, and not of the IFN. Interferon provides a partial protective effect against the insult from the virus in vitro and does not seem to be toxic to the developing otocyst.
Factors Contributing to Phoneme Recognition Ability of Users of the 22-Channel Cochlear Implant System
Authors: Honda Kiyoshi , Yukawa Kumiko , Shiroma Masae , Yamanaka Noboru , Kumakawa Kozo , Kawano Jun , Funasaka Sotaro
Published: October 2014

A study was carried out to determine which factors contributed to the vowel and consonant recognition ability of recipients of the 22-channel cochlear implant system. On the basis of the statistical analysis, no isolated factor showed a strong correlation with vowel recognition score. On the other hand, negative correlations were found between patients' consonant recognition scores and postoperative psychophysical percepts such as threshold levels and maximum comfortable loudness levels. However, multiple regression analysis also showed that the combination of lower threshold levels, a larger number of usable electrodes, and wider dynamic ranges contributed to higher consonant recognition scores.
Model for Understanding the Influence of Some Parameters in Cochlear Implantation
Authors: Berger-Vachon Christian , Djedou Bachir , Collet Lionel , Morgon Alain
Published: October 2014

Considering the recognition performance obtained by an implanted patient, the authors have developed models to explain the decrease in performance when the number of open channels on the prosthesis is increased. The French cochlear implant Chorimac was used in this experiment. Two models have been developed. The first is monodimensional and the second is multidimensional. They respectively represent an increase in information and its superposition. Results suggest that for the patient, the superposition factor prevails and is detrimental to recognition. Its elimination should be a major goal. A good selection of electrodes in a relatively small number seems to be the best policy. This is already done in some cochlear implants. Some other parameters in the signal that seem worth being analyzed are introduced.
Lower Complication Rates Associated with Bronchial Foreign Bodies over the Last 20 Years
Authors: Inglis Andrew F. , Wagner David V.
Published: October 2014

A retrospective comparison of all endoscopic bronchial foreign body (BFB) removals performed at Children's Hospital and Medical Center, Seattle, Washington, during two separate 5-year periods is reported. There were 54 patients between July 1, 1964, and June 30, 1969, and 119 patients between July 1, 1984, and June 30, 1989. Bronchoscopic removal of foreign bodies in the late cohort was performed almost exclusively with Hopkins telescope—guided foreign body graspers as opposed to traditional forceps guided by the naked eye in the first group. There were no differences in the average age, foreign body type, anesthetic technique, operative length, or anatomic distribution between cohorts. There were significantly fewer complications in the late cohort than the early. Complication rates increased with the duration of the BFB in situ. There were significantly fewer missed BFBs at initial bronchoscopy in the late cohort (4) than the early (10). Inability to endoscopically remove the BFB resulted in thoracotomy in 3 patients in the early cohort and 1 patient in the late cohort. There was one instance in which foreign body migration from right to left main stem occurred during the delay between diagnosis and operation, resulting in the necessity for emergent bronchoscopy with the patient in extremis. Prompt endoscopy in patients with suspected BFBs using the Hopkins rod bronchoscopic system will result in fewer complications and fewer missed foreign bodies.
Multichannel Electromyographic Observations in Spasmodic Dysphonia Patients and Normal Control Subjects
Authors: Roark Rick M. , Freeman Frances J. , Schaefer Steven D. , Watson Ben C. , Butsch Rorert W. , Kondraske George V. , Pohl John
Published: October 2014

Spasmodic dysphonia is primarily a disorder of vocalization. Increasing evidence, however, suggests that individuals with this disorder comprise a heterogeneous population characterized by abnormal motor control throughout the vocal tract. Multichannel simultaneous electromyography was performed on 11 spasmodic dysphonia patients and 10 normal awake subjects to investigate both the distribution of neuromotor abnormality within the vocal tract (eg, intrinsic and extrinsic laryngeal muscles, tongue, and palate) and the contribution of activation of higher central nervous system centers to observed abnormality. Experimental tasks ranged from vegetative (quiet breathing) to simple linguistic (short sentences). Digitized electromyographic signals were analyzed to compute the amplitude envelope and extract a set of parameters that represent amplitude characteristics. Electrode insertions were cross-validated by quantitative analysis of patterns of activation across selected reference tasks and by traditional qualitative methods. Between-group differences were found for measures of normalized median and peak token amplitudes. These differences are both task- and measure-dependent. Results highlight the complex and interactive effects of muscle, task, and quantitative measures on between-group differences.
Stable Internal Fixation of Fractures of the Partially Mineralized Thyroid Cartilage
Authors: Austin John R. , Stanley Robert B. , Cooper Donald S.
Published: October 2014

Thyroid cartilage fractures due to external blunt trauma have typically been thought to occur in patients over the age of 40. Lack of mineralization of the cartilage has been considered to be the protective mechanism. Our experience with laryngeal injuries has demonstrated that younger persons are indeed at risk for thyroid cartilage fractures, and that these injuries may be easily overlooked. Although these fractures do not lead to laryngeal stenosis if untreated, they may cause noticeable phonatory changes. Fixation of these fractures is difficult because of the usual soft character of the unmineralized cartilage, prompting us to adopt a wire-tube fixation technique. This technique has been uniformly successful in restoring the anatomic contour of the thyroid cartilage, and our results appear to justify open reduction of these moderately displaced or angulated thyroid cartilage fractures.
Injection and Removal of Teflon for Unilateral Vocal Cord Paralysis
Authors: Dedo Herbert H.
Published: October 2014

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.
Effect of Prior Antibiotic Treatment on Middle Ear Disease in Children
Authors: Faden Howard , Bernstein Joel , Stanievich John , Brodsky Linda , Ogra Pearay L.
Published: October 2014

The effect of prior antibiotic treatment on the course of otitis media was assessed in a group of 62 children who experienced 83 episodes of ear infection during 3 years of observation. Bacterial quantitation in middle ear fluids demonstrated a significantly higher colony count in symptomatic children (3.9 × 104 ± 12 bacteria per milliliter) compared to asymptomatic children (6.3 × 103 ± 10 bacteria per milliliter; p = .05). Bacterial counts similarly tended to be higher in children with Streptococcus pneumoniae (4.0 × 106 ± 16 bacteria per milliliter) and Hemophilus influenzae (2.0 × 106 ± 16 bacteria per milliliter), who were more often symptomatic (73% and 55%, respectively, versus 38 %) than children with Moraxella catarrhalis (7.9 × 103 ± 2). Antibiotic therapy between 3 and 30 days prior to bacterial diagnosis was associated with a reduction in symptoms from 70% to 38% (p< .025). However, prior treatment did not statistically reduce bacterial colony counts, although S pneumoniae decreased 90% in the previously treated group. Resistance to ampicillin occurred in 0% of S pneumoniae, 39 % of nontypeable H influenzae, and 80% of M catarrhalis subjects without prior treatment and in 0%, 46%, and 100%, respectively, of subjects previously treated (p< .025). These data suggest that prior treatment has a significant impact on the subsequent course of otitis media in children.
Meta-Analysis of Second Malignant Tumors in Head and Neck Cancer: The Case for an Endoscopic Screening Protocol
Authors: Haughey Bruce H. , Arfken Cynthia L. , Gates George A. , Harvey Joseph
Published: October 2014

A meta-analysis was performed on data from the Washington University Department of Otolaryngology Head and Neck Tumor Registry and 24 studies reporting synchronous and metachronous malignancies in head and neck cancer patients. The overall second malignant tumor (second primary) prevalence was 14.2% in 40,287 patients, the majority of tumors being metachronous. Site relationships between index tumors and second primaries revealed significantly high risks along the digestive tract axis or the respiratory tract axis, although lung second primaries were prevalent in all groups. Head and neck second primaries were the largest group, being significantly more common in the oral cavity, oropharynx, and hypopharynx than in the larynx. Oral cavity index tumors showed the highest overall rate of second primary formation. Half of all aerodigestive tract second primaries are detected by 2 years from index tumor presentation, but non-aerodigestive tract tumors are common beyond 5 years. A significantly higher detection rate was proven for the prospective panendoscopy studies. We recommend routine interval endoscopic intervention within 2 years of treatment for optimum detection of second primaries in head and neck cancer patients. Also, a lifetime of clinical surveillance is suggested for aerodigestive tract second neoplasms in oral cavity, oropharynx, and hypopharynx cancer patients and for lung and non-aerodigestive tract neoplasms in larynx cancer patients.
Pediatric Transbronchial Lung Biopsy
Authors: Muntz Harlan R. , Wallace Mark , Lusk Rodney P.
Published: October 2014

A retrospective review of 25 transbronchial lung biopsies in 19 pediatric patients is reported. Nineteen of these procedures used a rigid ventilating bronchoscope and a small cup biopsy forceps. The indications included diffuse pulmonary infiltrates in the immunocompromised patient, severe hyaline membrane disease, tumor, and lung transplant. In 84 % of the procedures, adequate tissue was obtained. There was a 12.5% incidence of pneumothorax and no significant pulmonary hemorrhage.
Open Tube versus Flexible Esophagoscopy in Adult Head and Neck Endoscopy
Authors: Bacon Charles K. , Hendrix Robert A.
Published: October 2014

Open tube esophagoscopy is the mainstay of otolaryngic esophageal examination. Over the last 30 years flexible endoscopes have become popular and are challenging the open tube esophagoscope for use in otolaryngic practice. This study examines all open tube esophagoscopies performed on adult patients at the University of Pennsylvania over an 8-year period for the diagnosis and treatment of foreign bodies, strictures, functional disorders, and carcinoma. Open tube esophagoscopy is most useful for foreign body extraction, examination of the cervical esophagus, and dilation of pliable strictures. For most other indications flexible esophagoscopy provides improved visualization with lower morbidity. For patients with squamous cell carcinoma of the head and neck we found a 1.4% incidence of secondary esophageal malignancies and a 28% incidence of false-negative barium swallow studies. We recommend esophagoscopy for all patients with carcinoma of the upper aerodigestive tract. The otolaryngologist should be adept at both flexible and open tube esophagoscopy in order to allow optimal examination of and therapeutic intervention in the upper aerodigestive tract.