bluuebunny/crossref_metadata_2025 huggingface dataset:
Overexpression of Fas-Ligand in Human Nasal Polyps
Authors: Fang Sheen-Yie , Yang Bei-Chang
Published: October 2014

Apoptosis mediated through the Fas/Fas-L system is essential in regulating immune function, developing organs, and conferring immune privilege. To illustrate the role of the Fas/Fas-L system in the pathogenesis of human nasal polyps, we investigated the transcripts and protein level of the Fas-L gene in 8 human nasal polyp tissues and 7 nasal turbinate mucosa specimens using reverse transcription—polymerase chain reaction and Western blotting. Localization of Fas-L was performed with immunohistochemistry. The transcripts of the Fas-L gene were detected at similar levels in both polyps and nasal mucosa. There was a significant overexpression of Fas-L protein on nasal polyps compared to nasal mucosa. Fas-L—positive cells were localized on the epithelial layers of cystically dilated glands and the down-growing epithelium of nasal polyps. Fas-L may play an important role in the pathogenesis of human nasal polyps, including cystic degeneration of submucosal glands and conferring of immune privilege to nasal polyp formation.
Glottographic Phase Difference in Recurrent Nerve Paralysis
Authors: Jiang Jack , Lin Emily , Hanson David G.
Published: October 2014

Phase measures with simultaneously recorded electroglottography (EGG) and photoglottography (PGG) signals have been studied in canine models and found to be sensitive to the effect of recurrent laryngeal nerve (RLN) paralysis on vocal fold vibration. This study examined the usefulness of this type of measure in clinical application. The combined glottographic signals were obtained from 5 men with a diagnosis of unilateral RLN paralysis and 5 age-matched controls. In the patient group, EGG waveforms were found to have a consistent phase delay in relation to PGG. A measure of the overall glottographic phase difference (GPD) was found to significantly distinguish the control group (mean GPD = 0.2371 ms) from the patient group (mean GPD = −0.2765 ms). A validity analysis performed on 19 subjects with or without unilateral RLN paralysis confirmed that the GPD test had a relatively high efficiency (91.7%) in detecting unilateral RLN paralysis in the male population.
Fourth Branchial Cyst Presenting with Neonatal Respiratory Distress
Authors: Hwang Tzer-Zen , Lin Yuh-Jyh , Tsai Sen-Tien
Published: October 2014

Fourth branchial cysts are quite rare. a neonate with a left lateral neck mass and respiratory distress was found to have a fourth branchial cyst, which was diagnosed with computed tomography and endoscopy. The characteristic computed tomography findings included an air-containing neck cyst, which was located at the anteromedial site of the common carotid artery with mediastinal extension. Endoscopic examination revealed an internal opening at the apex of the pyriform sinus, communicating with the cyst. Total excision of the cyst was performed, and the specimen, which showed ciliated columnar epithelium with a subepithelial lymphoid infiltrate, thyroid follicles, and thymic tissue, histologically confirmed the diagnosis.
Pyriform Sinus Fistula: Management with Chemocauterization of the Internal Opening
Authors: Kim Kwang Hyun , Sung Myung-Whun , Oh Seung Ha , Koh Tae-Yong , Kim In-Sang
Published: October 2014

A branchial remnant originating in the pyriform sinus causes a recurrent fistula or abscess in the neck. In spite of excision, recurrence may result from inadequate removal of the fistula tract. We attempted chemocauterization of the internal opening of the fistula tract with trichloroacetic acid (TCA) on direct endoscopy. This is a 6-year review of 18 patients with pyriform sinus fistula. Medical history, barium esophagography, computed tomography scans, operative findings, and treatment results were analyzed. By direct endoscopy, all patients were found to have a fistula opening in the pyriform sinus, exclusively on the left side. In only 9 patients, the fistula tract was identified by barium esophagography before operation. Computed tomography revealed a suspicious fistula tract originating from the pyriform sinus in 8 of 10 patients. Sixteen patients were initially managed by TCA chemocauterization. There were no serious intraoperative or postoperative complications. Four patients had recurrent masses, which were managed by simple excision in 2 patients and repeated TCA cauterization in the other 2 patients with unobliterated internal openings. We recommend barium swallow study and direct endoscopy for all patients presenting with a recurrent lateral neck abscess, especially on the left side. Our results suggest that initial chemocauterization of the internal opening can be a reasonable alternative procedure for the management of pyriform sinus fistula.
Laryngeal Radionecrosis and Hyperbaric Oxygen Therapy: Report of 18 Cases and Review of the Literature
Authors: Filntisis George A. , Farmer Joseph C. , Moon Richard E. , Scher Richard L. , Kraft Kevin L. , Piantadosi Claude A.
Published: October 2014

Laryngeal radionecrosis is a difficult late complication of radiotherapy. It is associated with hoarseness, edema, pain, weight loss, and upper airway obstruction. The medical treatment options are limited, and in severe cases, the patient may require tracheostomy or laryngectomy. We report clinical results in 18 patients treated with adjunctive hyperbaric oxygen (HBO) therapy for severe radionecrosis of the larynx. Of these 18 patients, 2 had grade 3 and 16 had grade 4 radionecrosis. The patients received a mean number of 41 HBO treatments (range, 6 to 80) at 2 atmospheres absolute for 2 hours, twice a day, 6 days a week. Thirteen patients (72.2%) had a major improvement after HBO therapy, and none of them required total laryngectomy. All patients preserved their voice and deglutition in good or normal condition. Five patients (27.8%) failed to have a good response to HBO and underwent total laryngectomy. One of these patients had local recurrence of his cancer 4 months later, and the other 3 had significant concurrent medical problems. The remaining patient received only 6 HBO treatments because of emergency heart surgery. These encouraging results are comparable to those of smaller previous studies suggesting that HBO has a beneficial effect in the management of advanced laryngeal radionecrosis.
Cervical versus Thoracic Epidural Morphine for the Treatment of Head and Neck Cancer Pain
Authors: Georgiou Loucas , Sklavou Christina , Yiotakis Ioannis , Louizos Antonios , Manolopoulos Leonidas , Adamopoulos Georgios
Published: October 2014

We studied 29 patients in the final stage of head or neck cancer who were suffering pain that was not relieved by oral morphine. Cervical or thoracic epidural morphine was administered to relieve the pain. The quality of analgesia was equally good for both techniques. However, cervical epidural administration appeared to be superior, because much smaller doses of morphine were required in order to induce more rapid and longer analgesia.
Pediatric Laryngopharyngeal Sensory Testing during Flexible Endoscopic Evaluation of Swallowing: Feasible and Correlative
Authors: Link Dana Thompson , Willging J. Paul , Cotton Robin T. , Miller Claire Kane , Rudolph Colin D.
Published: October 2014

Laryngopharyngeal sensory testing can predict aspiration risk in adult patients. Its feasibility and potential role in the evaluation of pediatric swallowing is undetermined. The goals of this study were to determine the feasibility of performing laryngopharyngeal sensory testing in awake pediatric patients and to assess whether the sensory testing results correlated with aspiration during a feeding assessment or correlated with a history of pneumonia. Fiberoptic endoscopic evaluation of swallowing with sensory testing was performed in 100 pediatric patients who were evaluated for feeding and swallowing disorders. The swallowing function parameters evaluated were pooled secretions, laryngeal penetration, and aspiration. The laryngopharyngeal sensory tests were performed by delivering a pressure-controlled and duration-controlled air pulse to the aryepiglottic fold through a flexible laryngoscope to induce the laryngeal adductor response (LAR). The air pulse stimulus ranged in intensity from 3 to 10 mm Hg. The patients tested ranged from 1 month to 24 years of age, with a median age of 2.7 years. Sensory testing was completed in 92% of patients. Patients who had an LAR at less than 4 mm Hg rarely if ever had episodes of laryngeal penetration or aspiration. Those with an LAR at 4 to 10 mm Hg had variable amounts of aspiration and laryngeal penetration. The LAR could not be elicited at the maximum level of intensity (10 mm Hg) in 22 patients, who demonstrated severe laryngeal penetration and/or aspiration. Elevated laryngopharyngeal sensory thresholds correlated positively with previous clinical diagnoses of recurrent pneumonia, neurologic disorders, and gastroesophageal reflux, and correlated positively with findings of pooled secretions, laryngeal penetration, and aspiration. Laryngopharyngeal sensory testing in children is feasible and correlative.
Function of a Hearing Aid under Stressful Conditions
Authors: Welsh Louis W. , Welsh John J. , Rosen Laurie F.
Published: October 2014

The auditory function of individuals with normal hearing was compared with that of hearing-aided subjects of similar age to determine whether amplification remediates hearing impairment under stressful auditory situations. The specific tests of listening in a competitive noise environment and identifying moderately compressed speech were introduced to adequately aided individuals. The data indicate that noise had an impact on auditory function to a much greater degree in aided individuals than in matched counterparts with normal hearing. The data derived from acceleration of simple sentences delivered to the aided group suggested that contrary to basic tonal sensitivity, the capacity to understand the stimulus was greatly compromised. The authors discuss cochlear damage and central auditory impairment as they relate to the limitations of amplification for sensorineural hearing loss.
Recurrent Laryngeal Nerve Transposition in Guinea Pigs
Authors: Heaton James T. , McMahon Thomas A. , Kobler James B. , Barry Daniel T. , Goldstein Ehab A. , Hillman Robert E.
Published: October 2014

Improved control of prosthetic voice aids for laryngectomees might be possible to obtain with residual laryngeal motor nerve signals. We were able to recover motor signals from the recurrent laryngeal nerve (RLN) by transposing it into the ipsilateral denervated sternohyoid muscle (SH) in 8 guinea pigs. Reinnervation was monitored by electromyographic recordings from surface and intramuscular needle electrodes in awake animals. Within 4 to 14 weeks after surgery, all animals demonstrated laryngeal-like motor activity in the reinnervated SH, including activity during respiration, sniffing, swallowing, and/or vocalizing. After 3 to 6 months, the animals were reanesthetized, and nerve stimulation and section experiments confirmed the RLN as the source of reinnervation in all cases. In several animals, activity of the RLN-innervated SH was demonstrated to be correlated with that of contralateral laryngeal muscles. Histochemical analysis of the SH indicated a unilateral transformation from mostly fatigable to mostly fatigue-resistant fiber types ipsilateral to the RLN transposition, a phenotype more typical of laryngeal muscles. Thus, RLN transposition at the time of laryngectomy may be a method for salvaging laryngeal control signals that could be used to control prosthetic voice devices.
Word Deafness after Resection of a Pineal Body Tumor in the Presence of Normal Wave Latencies of the Auditory Brain Stem Response
Authors: Masuda Sawako , Takeuchi Kazuhiko , Ukai Kotaro , Tsuruoka Hiromi , Sakakura Yasuo
Published: October 2014

We studied the case of a 48-year-old woman who had resection of a pineal body tumor in terms of postoperative audiological function. Postoperative magnetic resonance imaging disclosed partial inferior colliculi destruction and medial geniculate body degeneration. A pure tone audiogram revealed only moderate sensorineural hearing loss, but her speech perception was totally impaired. The binaural sound localization function was also impaired. The auditory brain stem response (ABR) showed waves I, III, and V to have normal latencies. The amplitude of wave III was larger than that of wave V. These results support the view that the waves of the ABR are elicited from multiple sources in the auditory brain stem nuclei and tracts. This case suggests a substantial role for the inferior colliculus and medial geniculate body in the processing of speech perception and sound localization.
Laser Partial Epiglottidectomy as a Treatment for Obstructive Sleep Apnea and Laryngomalacia
Authors: Goldenberg David , Netzer Aviram , Golz Avishay , Westerman S. Thomas , Westerman Liane M. , Catalfumo Frank J. , Joachims H. Zvi
Published: October 2014

Obstructive sleep apnea (OSA) and laryngomalacia are two different entities. Occasionally, they may have a common etiology: an elongated, flaccid, and lax epiglottis that is displaced posteriorly during inspiration causing airway obstruction. Twenty-seven adults with a diagnosis of airway obstruction or OSA of various degrees, and 12 infants with severe stridor associated with frequent apneas due to laryngomalacia, who on fiberoptic examination were found to have a posteriorly displaced epiglottis, underwent partial epiglottidectomy with a CO2 laser. Their postoperative recovery was uneventful. Polysomnographic studies performed after operation in the adult patients demonstrated statistically significant improvement in 85% of the patients. In all the cases of laryngomalacia, stridor ceased permanently after surgery, together with complete cessation of the apneic episodes. This study demonstrates that similar pathophysiological mechanisms may be involved in both laryngomalacia and in OSA. Effective and relatively safe treatment can be achieved by partial resection of the epiglottis with a microlaryngoscopic CO2 laser.
Local Recurrences following Transoral Laser Surgery for Early Glottic Carcinoma: Frequency, Management, and Outcome
Authors: Eckel Hans Edmund
Published: October 2014

Although transoral laser surgery (TLS) for the treatment of early stage glottic carcinoma is now widely used, the patterns of local recurrences, related re-treatment methods, and results have not been documented comprehensively. Two hundred fifty-two patients with glottic carcinoma stage I or II were treated for cure with TLS alone and followed up for 24 to 139 months (mean, 62 months). Their charts were retrospectively reviewed to identify local recurrence patterns. Thirty-five patients (13.9%) presented with local recurrences or second laryngeal primaries 4 to 84 months (mean, 23 months) after initial treatment. Of the 161 patients classified T1N0M0, 21 (13.0%) suffered local recurrences, and in the 91 classified T2N0M0. 14 (15.4%) tumors recurred. If tumors recurring more than 60 months after initial treatment are considered second primary tumors rather than recurrences, then only 18 (11.2%) of 161 patients classified T1N0M0 would have had a recurrence. However, the difference in local control between patients with stage I versus stage II disease would still not be significant (p = .41). Of the 35 patients with local recurrences, 16 (45%) were managed with total laryngectomy, 10 (28.6%) with further TLS, 4(11.4%) with partial laryngectomy, and 2 (5.7%) with radiotherapy, and 3 (8.6%) had no curative treatment. Accordingly, 16 patients (45.7%) with local treatment failure could be treated with further organ-sparing treatment methods. The actuarial overall survival, disease-specific survival, and organ preservation rates 5 years after the diagnosis of recurrent disease were 43.6%, 74.6%, and 33.7%. Transoral laser surgery leads to local control rates that are comparable to those found after radiotherapy for lesions classified T1 and leads to slightly better control rates for lesions classified T2, but the results are inferior to those achieved with conventional partial laryngectomy. However, if local recurrence occurs, then more re-treatment options are available after TLS as compared to initial radiotherapy or open surgery.
Further Experience with Tracheojejunal Shunt Speech after Pharyngolaryngoesophagectomy
Authors: Kinishi Minoru , Amatsu Mutsuo , Tahara Shinya
Published: October 2014

Over the past 10 years, 16 patients have undergone the tracheojejunal shunt operation for voice reconstruction after undergoing pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. For the purpose of voice reconstruction, a 2-cm inferiorly based tracheal flap is obtained from the membranous part of the trachea by removing 4 cartilaginous tracheal rings. After the establishment of digestive continuity with the jejunal graft, a side-to-side anastomosis is created by approximating the incised margin of the jejunal mucosa to that of the tracheal flap. The tracheal flap is tubed to construct the tracheojejunal shunt. In addition, the incised margin of the jejunal serosa is sutured to the lateral wall of the shunt to reinforce the approximation of the shunt to the jejunal graft. Thirteen of the 16 patients (81%) were initially capable of voice production. The length of time during which tracheojejunal speech has been used ranges from 18 to 122 months, with a mean of 55 months. During follow-up. 12 of the 13 patients (92%) have been able to swallow without aspiration.
Immunohistochemical Analysis of Small Cell Carcinoma of the Head and Neck: A Report of Four Patients and a Review of Sixteen Patients in the Literature with Ectopic Hormone Production
Authors: Mineta Hiroyuki , Miura Katsutoshi , Ueda Yoh , Takebayashi Satoru , Harada Hidekazu , Araki Keisuke , Misawa Kiyoshi
Published: October 2014

Small cell carcinoma (SCC) occurs mostly in the lung, and in some patients is accompanied by production of ectopic hormones. Small cell carcinoma of the head and neck is very rare. We report 4 patients with SCC of the head and neck (larynx, tonsil, maxillary sinus, and parotid gland). The patient with SCC of the maxillary sinus demonstrated a high level of plasma serotonin and overexpression of parathyroid hormone; however, he did not show any related symptoms. The patient with SCC of the tonsil showed the syndrome of inappropriate secretion of antidiuretic hormone associated with antidiuretic hormone hyperproduction at the terminal stage. In the literature, 16 patients with SCC of the head and neck with ectopic hormone production have been reported. Antidiuretic hormone and adrenocorticotropic hormone were the hormones that caused clinical symptoms (paraneoplastic syndromes). We believe that the evaluation of hormonal syndromes is valuable for diagnosis and treatment.
Poly(Adenosine Diphosphate-Ribose) Synthetase Inhibitor 3-Aminobenzamide Alleviates Cochlear Dysfunction Induced by Transient Ischemia
Authors: Ito Zenya , Serizawa Fujiko , Tabuchi Keiji , Tsuji Shigeki , Hara Akira , Nakagawa Akiko , Kusakari Jun
Published: October 2014

The present study was undertaken to determine the possible deleterious role played by poly(adenosine diphosphate—ribose) synthetase (PARS) in cochlear ischemia-reperfusion injury. Transient ischemia of the cochlea was induced in albino guinea pigs for 15, 30, or 60 minutes by pressing the labyrinthine artery at the porus acusticus internus. The animals were given intravenous 3-aminobenzamide (a PARS inhibitor) or physiological saline solution 1 minute before the onset of reperfusion. The compound action potential thresholds were measured before the onset of ischemia and 4 hours after the onset of reperfusion. A statistically significant reduction in the postischemic compound action potential threshold shift was observed in the animals treated with 3-aminobenzamide after 15 or 30 minutes of ischemia, whereas no statistical difference was found after 60 minutes of ischemia. These results suggest that excessive activation of PARS exerts deleterious effects on the cochlear injury induced by transient ischemia.
Aneurysmal Bone Cyst in the Sphenoid Bone: Treatment with Minimally Invasive Surgery
Authors: de Minteguiaga Carlos , Portier Frédéric , Heitzmann Patrick , Guichard Jean Pierre , Ba Huy Patrice Tran , Racy Emmanuel , Herman Philippe
Published: October 2014

Aneurysmal bone cysts are vascular lesions that destroy and expand bone. We report a recently treated case of an aneurysmal cyst of the sphenoid bone. A 14-year-old girl presented with frontal headaches, bouts of nausea, and vomiting. Computed tomography and magnetic resonance imaging showed typical features of an aneurysmal bone cyst. Arterial embolization was undertaken before surgery. The endoscopic transnasal procedure used allowed the complete removal of the aneurysmal bone cyst. This use of minimally invasive surgery makes this case of interest to surgeons of the skull base and sinuses.
Malignant Melanoma Arising within a Burn Scar Case Report and Review of the Literature
Authors: Spring Paul M. , El-Naggar Adel K. , Myers Jeffrey N. , Langstein Howard N.
Published: October 2014

Burn scar carcinomas, also called Marjolin's ulcers, are uncommon tumors that arise from an antecedent burn. Most burn scar carcinomas are diagnosed about 30 years after the burn, and most are well-differentiated squamous cell carcinomas. We report a case in which a squamous cell carcinoma developed within a burn scar on the cheek and then a malignant melanoma arose within the burn scar after the squamous cell carcinoma had been excised. We also review the available literature on burn scar carcinoma, covering the demographics, pathogenesis, diagnosis, prognosis, and treatment of the disease. Given the multifocality of this disease process, we advocate aggressive resection of the entire burn scar, as well as the tumor, to prevent the development of further cancers within the wound.
Bone Conduction Impairment in Chronic Ear Disease
Authors: Linstrom Christopher J. , Rosen Arie , Silverman Carol A. , Meiteles Lawrence Z.
Published: October 2014

The preoperative and postoperative bone conduction (BC) thresholds were prospectively investigated in 24 patients with chronic ear disease in the form of cholesteatoma, chronic suppurative otitis media, or adhesive otitis media. All underwent tympanoplasty with mastoidectomy. Ossicular reconstruction was performed in 14, and the remaining 10 were still awaiting second-stage ossicular reconstruction at the time of this investigation. In each group, the postoperative results were compared with the preoperative results by the paired-samples t-test. In the ossicular reconstruction group, the results revealed a significant improvement in the postoperative BC thresholds, as compared with the preoperative BC thresholds, at 250, 1,000, and 2,000 Hz, with the largest mean improvement observed at 2,000 Hz. No significant improvement was observed at any frequency for the group without ossicular reconstruction. Postoperative improvement of at least 10 dB at 2 or more frequencies was observed in 71% of the ossicular reconstruction group, as compared with 0% of the group that did not undergo ossicular reconstruction. The results support the theory that the elevated BC thresholds of patients with chronic ear disease result from the elimination, due to disease, of the middle ear contribution (from the inertial ossicular component and ossicular resonance) to the BC response. The results also suggest that the middle ear contribution to the BC response is restored with ossicular reconstruction.
Cheilitis Granulomatosa Miescher: Treatment with Clofazimine and Review of the Literature
Authors: Ridder Gerd Jürgen , Fradis Milo , Löhle Erwin
Published: October 2014

Cheilitis granulomatosa Miescher is a rare condition of unknown cause characterized by intermittent lip swelling that gradually persists and causes cosmetic deformity. We report the case of a young woman with cheilitis granulomatosa as a monosymptomatic manifestation of Melkersson-Rosenthal syndrome successfully treated by the antileprosy agent clofazimine, and propose clofazimine as an alternative treatment in cases refractory to corticosteroids. The differential diagnosis and current methods of treatment are summarized, and the literature is reviewed and discussed.
Electroglottographic and Acoustic Changes following Type Ithyroplasty or Autologous Fat Injection
Authors: Shaw Gary Y. , Searl Jeffrey P.
Published: October 2014

This study identified the electroglottographic (EGG) and acoustic measures that were most predictive of change in the glottic gap size of patients undergoing type I thyroplasty or autologous fat injection. Simultaneous EGG and acoustic recordings were made before and after autologous fat injection in 23 patients and type I thyroplasty in 45 patients. Relative measures of glottic gap size were obtained before and after operation from videostroboscopic images. Regression and correlation analysis was used to determine the strength of associations between the EGG or acoustic measures and glottic gap changes. A significant regression equation for both patient groups was constructed. The strongest predictors of glottic gap size change were changes in the EGG open quotient, signal-to-noise ratio, and mean fundamental frequency. Glottography provided a clinically useful means of evaluating glottic gap changes in patients undergoing vocal fold medialization procedures. Preoperative-postoperative differences in signal-to-noise ratio and mean fundamental frequency also were correlated to glottic gap size changes, but to a lesser degree.
Deep Neck Abscess: A Retrospective Review of 210 Cases
Authors: Parhiscar Afshin , Har-El Gady
Published: October 2014

This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998. Peritonsillar abscesses and limited intraoral abscesses were excluded. Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has replaced S aureus and β-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Tracheotomy is indicated in patients with Ludwig's angina.
Instability of Extracellular Matrix Gene Expression in Primary Cell Culture of Fibroblasts from Human Vocal Fold Lamina Propria and Tracheal Scar
Authors: Thibeault Susan L. , Gray Steven D. , Li Wenhua , Chen Zhong
Published: October 2014

Primary fibroblast cell cultures were established from lamina propria of human vocal fold and tracheal scar. There exists a crucial need to provide new tools for studying voice biology, and one of the first steps is the development of a human primary laryngeal cell culture bank. Because cell lines can lose their differentiated phenotype in culture across passages, documentation of gene expression must be determined for passage populations, for us to have knowledge of cell behavior in vitro. Comparison of messenger RNA gene expression of extracellular matrix proteins (procollagen I, collagenase, elastin, hyaluronic acid synthase 2, hyaluronidase, fibronectin, cd44, fibromodulin, anddecorin) across cell passages (3, 4, 5, 6, 10, and 12 for normal lamina propria and 3, 4, 5, 6, and 10 for tracheal scar) revealed varied growth patterns. Cytogenetic analysis demonstrated relative stability of the karyotypes across passages for the tracheal scar cell cultures, whereas the karyotypes of the normal lamina propria fibroblasts showed instability in in vitro cultures. Recommendations for use of primary cell cultures for further studies of gene expression are made.
Near-Total Laryngectomy in Advanced Cancers of the Larynx and Pyriform Sinus: A Comparative Study of Morbidity and Functional and Oncological Outcomes
Authors: Shenoy Ashok M. , Sridharan Suja , Anand V. T. , Srihariprasad A. V. , Premalatha B. S. , Reddy B. K. M. , Nanjundappa
Published: October 2014

This prospective study, performed from 1991 to 1996, analyzes the differences in oncological safety, functional utility, and surgical morbidity in 14 advanced lesions of the larynx (10 T3 and 4 T4; 7 N+) and 40 pyriform sinus lesions (1 T2, 20 T3, and 19 T4; 29 N+) subjected to Pearson near-total laryngectomy. The laryngeal cancer patients healed much faster, with a minimal wound complication rate of 28%, in comparison to the 68% rate encountered in the pyriform sinus cases (p <.05). The 3-year disease-free survival rate for the laryngeal cancers was 74%, while the 5-year survival rates for pyriform sinus cases were 66% for medial wall lesions and 54% for lateral wall lesions. Lung-powered shunt speech deemed qualitatively superior by acoustic analysis was obtained in 81% of the individuals (93% in laryngeal cases and 76% in pyriform sinus cases). Aspiration-free deglutition was achieved by 90% over periods ranging from 15 to 30 days. This study conclusively attests to the therapeutic efficacy of near-total laryngectomy for advanced lesions of the larynx and pyriform sinus that are unsuitable for radiotherapy, that are deemed too large or risky (because of aspiration) for partial laryngectomy, and that in the past would have merited total laryngectomy.
Sudden Death after Neck Dissection for Cancer
Authors: Gueret Gildas , Cosset Marie-France , Luboinski Bernard , McGee Kathleen , Bourgain Jean-Louis
Published: October 2014

The goal of this study was to analyze the mortality data following neck dissection and determine the risk factors of early death. The hospital mortality records were analyzed from 3,015 consecutive patients who underwent neck dissection. A case control study analyzed risk factors of death during the first 3 postoperative days. The mortality incidences were 0.50% and 1.33%, respectively, during the first 3 and the first 30 postoperative days. Eleven of the 12 unexplained deaths occurred during the first 3 postoperative days, and most of these patients died suddenly. They were more likely to be alcoholic and to have undergone nerve section. In most of the patients who died after the third postoperative day, death was related to a postoperative complication. Although the mechanisms of sudden death remain unclear, careful follow-up of these patients during the early postoperative days should be performed to reduce the mortality risk by shortening the delay of care.
Detection of Cytokeratins in Normaland Malignant Laryngeal Epithelia by Means of Reverse Transcriptase-Polymerase Chain Reaction
Authors: Lahat Nitza , Resnick Murray B. , Cohen-Kerem Raanan , Elmalah Irit , Doweck Ilana , Greenberg Elhanan , Rahat Michal A.
Published: October 2014

Cytokeratins (CKs) are a subgroup of intermediate filament proteins that take part in forming the cytoskeleton. The epithelial cells in different organs express distinct CKs, and this expression may be modified during malignant transformation. Here we describe the use of reverse transcriptase–polymerase chain reaction followed by Southern blotting to determine the profile of expression of CKs in both normal and malignant laryngeal samples. Thirty-six samples were subjected to histologic examination and classified as 17 squamous cell carcinomas, 3 dysplastic lesions, and 16 normal samples. CK8 and CK 19 were expressed in almost all samples, both cancerous and normal, and were therefore used to verify the integrity of RNA. Expression of CK2, CK9, and CK20 was not detected in any of the samples, normal or cancerous. CK 15 and CK 18 showed low sensitivity for detection of cancer (36.4% and 45.5%, respectively). CK 10 showed relatively high sensitivity (91%), but only moderate specificity (69.2%). Only CK 17 showed both high sensitivity and specificity (91% and 92.3%, respectively; positive predictive value, 91%). We propose that CK17 may be considered a promising candidate to use as a molecular marker for malignant transformation in laryngeal squamous cell carcinoma.
Metachronous Second Primary Cancers after Successful Partial Laryngectomy for Invasive Squamous Cell Carcinoma of the True Vocal Cord
Authors: Laccourreye Ollivier , Veivers David , Hans Stéphane , Brasnu Daniel , Garcia Dominique , Laccourreye Laurent
Published: October 2014

The current retrospective studies documented the incidence, sites of occurrence, risk factors, and outcome of metachronous second primary cancers (MSPCs) among an inception cohort of 410 patients with invasive squamous cell carcinoma of the true vocal cord successfully treated with partial laryngectomy at a single institution. The Kaplan-Meier actuarial life-table method was used to document the relationship between the incidence of MSPCs and survival data. Univariate analysis was performed for potential statistical relationships among the incidence of MSPCs, the site of occurrence, and different variables. The overall incidence of MSPCs was 23.9% (98/410). The 10-year actuarial survival estimate for MSPCs was 20.4%. The incidence curve of MSPCs was linear, resulting in a 2%/y rate of development for MSPCs. In univariate analysis, the only variable that demonstrated a statistical correlation with the incidence of MSPCs was smoking, with MSPCs being statistically more likely to occur in smokers than in nonsmokers (p = .04). The main sites of origin for MSPCs were the lung (25.5% of cases), other non-upper aerodigestive tract sites (32.7%), and the upper aerodigestive tract (41.8%). The 10-year actuarial estimates for MSPCs were 9.1% in the upper aerodigestive tract, 7.1% in sites other than the lung or upper aerodigestive tract, and 6.6% in the lung. The incidence curve for MSPCs was linear, whatever the site of origin, resulting in 1%/y, 0.7%/y, and 0.6%/y rates of development for MSPCs in the upper aerodigestive tract, sites other than the lung or upper aerodigestive tract, and the lung, respectively. Survival was statistically reduced when an MSPC developed; the 10-year actuarial survival estimates were 76.8% in patients who did not develop an MSPC and 43.7% in patients who developed an MSPC (p < .0001). Overall, 68.4% of patients who developed an MSPC (67/98) died of this disease. The 10-year actuarial survival estimates were 24% for lung MSPCs, 43.7% for non-lung, non-upper aerodigestive tract MSPCs, and 63.4% for upper aerodigestive tract MSPCs.
Auditory Consequences of Recurrent Acute Purulent Otitis Media
Authors: Ryding Marie , Kalm Olof , Konradsson Konrad , Prellner Karin
Published: October 2014

To investigate whether recurrent purulent otitis media results in permanent hearing loss, we studied 2 subgroups of children from a cohort, earlier prospectively followed from birth to the age of 3 years. One subgroup had recurrent acute otitis media (n = 12), and the other had no acute otitis media at all (“healthy” children; n = 21). At follow-up of these subgroups at the age of 10, no child had acute otitis media or secretory otitis media. There was no difference between the groups in hearing level thresholds at the frequencies 125 Hz to 8 kHz. However, in the children with recurrent acute otitis media, as compared with the controls, the hearing levels at high frequencies (8 to 16 kHz) and the acoustic middle ear reflex thresholds were elevated, the middle ear compliance was higher, and click-evoked otoacoustic emission response levels and middle ear pressures were lower. The results suggest that the middle ear mechanics of children with recurrent acute otitis media are affected, and also that their cochlear function might be disturbed.
Early Histopathologic Changes after Lateral Semicircular Canal Transection and Occlusion in Guinea Pigs
Authors: Nam Boo Hyun , Park Chan Il , Jung Timothy T. K.
Published: October 2014

Occlusion of the semicircular canals has been used in otoneurologic and skull base surgeries with preservation of hearing. In order to understand the role of occlusion in hearing preservation, we observed early histopathologic changes of the lateral semicircular canal following transection and occlusion in guinea pigs. After surgery, the membranous endolymphatic canal was collapsed, and its torn ends were sealed by intramural bone dust in the bony semicircular canal. On the first postoperative day, the endolymphatic canal was expanded to its normal shape, and the sealing at the torn ends was maintained by the bone dust. These findings suggest that occlusion after semicircular canal injuries, by making blind ducts in the membranous endolymphatic canal, is important for the preservation of postoperative hearing.
Acoustic Signature of the Normal Swallow: Characterization by Age, Gender, and Bolus Volume
Authors: Cichero Julie A. Y. , Murdoch Bruce E.
Published: October 2014

Despite growing clinical use, cervical auscultation suffers from a lack of research-based data. One of the strongest criticisms of cervical auscultation is that there has been little research to demonstrate how dysphagic swallowing sounds are different from normal swallowing sounds. In order to answer this question, however, one first needs to document the acoustic characteristics of “normal,” nondysphagic swallowing sounds. This article provides the first normative database of normal swallowing sounds for the adult population. The current investigation documents the acoustic characteristics of normal swallowing sounds for individuals from 18 to more than 60 years of age over a range of thin liquid volumes. Previous research has shown the normal swallow to be a dynamic event. The normal swallow is sensitive to aging of the oropharyngeal system, and also to the volume of bolus swallowed. The current investigation found that the acoustic signals generated during swallowing were sensitive to an individual's age and to the volume of the bolus swallowed. There were also some gender-specific differences in the acoustic profile of the swallowing sound. It is anticipated that the results will provide a catalyst for further research into cervical auscultation.
Further Delineation of the DFNA5 Phenotype: Results of Speech Recognition Tests
Authors: Van Zuijlen Diederick A. , Huygen Patrick L. M. , De Leenheer Els M. R. , Van Laer Lut , Huizing Egbert H. , Van Camp Guy , Cremers W. R. J.
Published: October 2014

Speech recognition scores were analyzed in 34 carriers of a DFNA5 mutation. Cross-sectional linear regression analysis (last visit, maximum recognition score in %Correct on age or PTA1,2,4 kHz) established onset age (score 90%) at 16 years and onset PTA1,2,4 kHz level (score 90%) at 41 dB hearing level. The deterioration rate was 0.7%/y in the plot of maximum score against age, whereas the deterioration gradient was 0.4%/dB in the plot of maximum score against PTA1,2,4 kHz. Given the previously demonstrated rapid progression of hearing impairment, speech recognition was relatively good: at age 70, the score was still >50%.
Dysphagia and Aspiration with Unilateral Vocal Cord Immobility: Incidence, Characterization, and Response to Surgical Treatment
Authors: Bhattacharyya Neil , Kotz Tamar , Shapiro JO
Published: October 2014

To objectively determine the incidence of dysphagia associated with unilateral vocal cord immobility (UVCI) and to evaluate the potential for response to vocal cord medialization, we made videofluoroscopic swallowing (VFS) recordings of patients with newly diagnosed UVCI and prospectively analyzed them in a blinded fashion using the Penetration-Aspiration Scale (PAS) and pharyngeal transport function measures. A subset of patients underwent vocal cord medialization and were evaluated with a postoperative VFS study. Comparison was made between preoperative and postoperative VFS results to study the effects of vocal cord medialization in this setting. Eighty-seven VFS recordings were studied in 64 adult patients with UVCI; 23 patients underwent VFS testing before and after vocal cord medialization. The UVCI was most commonly left-sided (53 cases) and most commonly resulted from thoracic or cardiac surgery (53.1%), followed by malignancy (15.6%). Overall, the median PAS score was 2.0 (25th-75th percentiles, 1.0–5.0), with 20 patients (31.3%) and 15 patients (23.4%) exhibiting penetration or aspiration, respectively. No significant differences in swallowing function were noted between surgical and nonsurgical causes of paralysis (PAS scores of 2.0 and 2.0, respectively; p = .901). The median PAS score improved from 4.0 to 3.0 (p = .395, Wilcoxon paired samples test) in patients studied after undergoing a vocal cord medialization procedure (6 laryngoplasties and 17 vocal cord injections). Laryngoplasty was not more successful than vocal cord injection in resolving aspiration (p = .27). Radiographically significant penetration or aspiration occurs in approximately one third of patients with UVCI, independent of the cause of paralysis. Vocal cord medialization may not be as effective as thought for eliminating aspiration in these patients.
Interference of Nontypeable Haemophilus Influenzae and Moraxella Catarrhalis by Streptococcus Oralis in Adenoid Organ Culture: A Possible Strategy for the Treatment of the Otitis-Prone Child
Authors: Bernstein Joel M. , Belmont Michael , Faden Howard S. , Dryja Diane , Scannapieco Frank , Wolf Judy
Published: October 2014

The role of viridans group streptococci (Streptococcus oralis) in the prevention of colonization with nontypeable Haemophilus influenzae and Moraxella catarrhalis was investigated in an adenoid organ culture system. The adenoids from 100 patients who were undergoing adenoidectomy for either hypertrophy or recurrent otitis media were used. Streptococcus oralis Parker uniformly inhibited colonization with nontypeable H influenzae or M catarrhalis over a 24-hour period of incubation in adenoid organ culture. Streptococcus oralis Booth, a noninhibitory strain, did not significantly reduce colonization with nontypeable H influenzae and M catarrhalis. The results indicate that some strains of S oralis may inhibit colonization with potential pathogens in the nasopharynx. It is therefore possible that colonization with inhibitory strains of viridans streptococci may be used in the nasopharynx as a relatively safe and inexpensive approach to prevention of recurrent otitis media in some children.
Complication-Free Laryngeal Surgery after Irradiation Failure with Prostaglandin E1 Administration
Authors: Shiga Kiyoto , Tateda Masaru , Saijo Shigeru
Published: October 2014

To examine the usefulness and efficacy of administration of prostaglandin E1 (PGE1) after laryngeal surgery in patients who were previously treated with radiotherapy, we retrospectively examined the clinical data of 12 patients who had undergone partial laryngectomy and 21 patients who had undergone total laryngectomy. Complications were observed in 5 of the 7 cases treated with partial laryngectomy without PGE1 administration, while no complications were observed in the 5 cases treated with PGE1 after operation. Also, complications, including major leakage, were observed in 6 of the 15 patients who underwent total laryngectomy without PGE1, and no complications were observed in the 6 patients who received PGE1. The hospital stay was shorter for the patients treated with PGE1 than for those not receiving such treatment. Although this study was a small, nonrandomized pilot trial, the results indicated that PGE1 administration may be useful and effective for patients who undergo laryngeal surgery after irradiation failure, in decreasing the risk of postoperative complications and increasing the quality of life of the patients.
Hearing Loss in Finnish Adults with Osteogenesis Imperfecta: A Nationwide Survey
Authors: Kuurila Kaija , Johansson Reijo , Kaitila Ilkka , Grénman Reidar
Published: October 2014

Hearing loss, bone fragility, and blue sclerae are the principal clinical features in osteogenesis imperfecta (OI), a genetic disorder of connective tissue. In a nationwide search, an audiometric evaluation of 133 adult patients was performed. According to the criteria introduced by Sillence, type I was the most common form of OI. Of the patients with normal hearing on audiometry, 17.1% reported subjective hearing loss, and 19.1% of the patients with impaired hearing did not recognize it. On audiometry, 57.9% of the patients had hearing loss, which was progressive, often of mixed type, and mostly bilateral, and began in the second to fourth decades of life. The frequency or severity of the hearing loss was not correlated with any other clinical features of OI. Hearing loss is common, affecting patients with all types of OI. Subjective misjudgment of hearing ability supports the need for repeated audiometry in all OI patients. A baseline study at the age of 10 years followed by audiograms every third year thereafter is recommended.
Survivin Expression in Juvenile-Onset Recurrent Respiratory Papillomatosis
Authors: Poetker David M. , Sandler Anthony D. , Smith Richard J. H. , Scott David L. , Bauman Nancy M.
Published: October 2014

Recurrent respiratory papillomatosis (RRP), caused by the human papillomavirus, is characterized by unregulated growth of wartlike neoplasms on laryngeal mucosa. Apoptosis is important in normal cellular homeostasis, and dysregulation of this process is thought to govern the behavior of certain neoplasms. This study evaluates the expression of several pro-apoptotic and anti-apoptotic factors in papillomas of patients with RRP, with a specific interest in survivin, a cell cycle-regulated anti–apoptotic factor. Three anti-apoptotic and 6 pro-apoptotic messenger RNA (mRNA) species were quantified by ribonuclease protection assay in 11 RRP papilloma specimens and 5 normal laryngeal specimens. Anti-apoptotic and pro-apoptotic mRNA ratios were quantified by normalizing to the ribosomal protein L32 and compared between specimens. Protein expression of survivin in tissue samples was also evaluated. The mean (±SD) expression of survivin was almost fivefold greater in the RRP papillomas than in normal tissue (14.2% ± 2.5% versus 3.0% ± 0.8% of L32, p = .003). The RRP specimens also had greater expression of XIAP, Fas, and p53 than did the normal tissue. Survivin protein was differentially expressed in the papilloma specimens, and was greatest in a papilloma that underwent malignant transformation. Survivin was absent in all normal laryngeal tissue tested. Apoptotic factors in general appear to be ***upregulated in papillomatous tissue as compared to normal laryngeal tissue and may suggest a higher proliferation rate and cell turnover. Survivin is abundant in papillomas and absent in normal laryngeal tissue. Dysregulation of apoptosis as determined by abnormal expression of anti-apoptotic factors like survivin and XIAP probably favors papilloma growth and survival. Such factors may represent potential targets in the treatment of this disease.