bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngeal Brain Stem Evoked Response in the Porcine Model
Authors: Cohen Scott , Esclamado Ramon M. , Aloe Louise , Telian Steven , Kileny Paul
Published: October 2014

Exaggeration of normally protective laryngeal reflexes is thought to play a role in several disorders, including the sudden infant death syndrome. An analysis of brain stem neural activity following laryngeal stimulation may provide insight into the pathophysiology of pathologic laryngeal reflexes and help to identify individuals at risk for these disorders. The purpose of this study was to define the far-field brain stem activity following laryngeal stimulation in the porcine model. This activity has been termed the laryngeal brain stem evoked response and may represent a potentially useful and objective measure of the neuronal activity in the laryngeal reflex pathway. Electrical stimulation of the superior laryngeal nerve was performed in 14 mixed-breed piglets under a variety of physiologic conditions. A total of six positive and six negative discrete waves were detected, with mean latencies ranging from 1.24 to 7.16 milliseconds. Stimulations performed during hypoxic, hypercapneic, or hypocapneic conditions resulted in no significant differences in waveform latencies. There appears to be a reproducible, but somewhat variable, brain stem response elicited by superior laryngeal nerve stimulation that can be recorded via a far-field technique in the porcine model.
Comparison of Quantitative DNA Measurements and Cytomorphology in Squamous Cell Carcinomas of the Upper Aerodigestive Tract with and without Lymph Node Metastases
Authors: Welkoborsky Hans-Juergen , Gluckman Jack L. , Mann Wolf J. , Freije James E.
Published: October 2014

Cytologic smears of squamous cell carcinomas (UICC T2 through T4) from the mucosa of the upper aerodigestive tract without cervical lymph node metastases (n = 10) and with metastases (n = 20) were examined. Subsequently, the cytologic smears of the metastases (n = 20) obtained by fine-needle aspiration or following neck dissection were evaluated morphologically. Each specimen was then stained with Papanicolaou and Feulgen techniques, and quantitative DNA measurements were performed with an image analysis system. Morphologically, the primary tumors with metastases revealed an increased mean nuclear perimeter and mean nuclear area compared with tumors unassociated with metastases. On quantitative DNA measurements, the tumors with metastases had an increased DNA content, a higher 2c deviation index, and a higher DNA malignancy grade and increased number of aneuploid cells. The specimens obtained from the metastatic nodes yielded the highest values for mean DNA content, 2c deviation index, aneuploidy, and malignancy grade. The stem lines of metastasis were always nondiploid. These data indicate a positive correlation between aneuploid tumor cell clones in primary cancer and the manifestation of lymph node metastases.
Correlation between the Laryngeal Brain Stem Evoked Response and the Laryngeal Chemoreflex in the Porcine Model
Authors: Cohen Scott , Kileny Paul , Esclamado Ramon M. , Telian Steven
Published: October 2014

The laryngeal brain stem evoked response (LBR) represents the neural activity involved in laryngeal reflex pathways. The laryngeal chemoreflex (LCR) is a centrally mediated response consisting of apnea and hemodynamic changes that result from laryngeal stimulation. The purpose of this study is to determine the characteristics of the LBR that are predictive of LCR severity in the porcine model. The duration of apnea resulting from stimulation of the supraglottic larynx defined LCR severity. The LBR tracings were recorded from electrodes flanking the brain stem following direct electrical stimulation of the superior laryngeal nerve. The LBR peak latencies from piglets demonstrating prolonged LCR apnea were compared to those without an exaggerated LCR response. Two LBR peak latencies demonstrated a statistically significant difference between the two piglet groups. These peak latencies appear to be indicators of susceptibility to exaggerated laryngeal reflex sensitivity. Thus, the LBR may prove useful in identifying and evaluating subjects predisposed to conditions associated with dysfunctional laryngeal reflex activity.
Intracranial Longitudinal Splitting of Facial Nerve: A New Approach for Hemifacial Spasm
Authors: Fan Zhong
Published: October 2014

A new surgical technique for the treatment of hemifacial spasm consisting of longitudinal splitting of the facial nerve in the cerebellopontine angle is described. Thirty-three cases have been treated with good results. Follow-up of 20 cases for 1 year or more showed no recurrence or facial paresis. One case required a second operation. The novelty of this approach lies in its effectiveness in relieving the symptoms without running the risk of overmanipulating the aberrant artery.
Histopathology of Olfactory Mucosa in Kallmann's Syndrome
Authors: Schwob James E. , Leopold Donald A. , Szumowski Karen E. Mieleszko , Emko Precha
Published: October 2014

Olfactory mucosa was harvested by intranasal biopsy from a man with Kallmann's syndrome in whom the absence of the olfactory bulbs was documented by magnetic resonance imaging. On electron microscopic examination, several pathologic changes were evident in the olfactory mucosa. First, most olfactory neurons lacked cilia (ie, were morphologically immature). Second, the fila olfactoria had fewer than the normal number of axons, and a large proportion of them were apparently undergoing electron lucent degeneration. Finally, neuromatous collections of axons were seen superficial to the basement membrane in the epithelium. Similar changes have been observed in the mucosa of experimentally bulbectomized rodents. Accordingly, a constellation of pathologic changes — axonal degeneration, neuronal immaturity, and the formation of intraepithelial neuromas — seems to be characteristic of olfactory mucosa that cannot innervate the olfactory bulb in both humans and animals. On the basis of our observations, it is worth investigating the status of the olfactory bulb in other forms of human anosmia in which similar morphological changes are observed in the mucosa, such as persistent posttraumatic anosmia and isolated congenital anosmia.
Adenomatoid and Calcifying Epithelial Odontogenic Tumors
Authors: Hicks M. John , Flaitz Catherine M. , Batsakis John G.
Published: October 2014

The histologic diversity of the odontogenic epithelium's neoplasms is nicely illustrated by the adenomatoid and the calcifying epithelial odontogenic tumors. The former has a predilection for the maxilla, the latter for the mandible. Neither has a malignant variant, and each is controlled by conservative local removal. The recurrence rate of the adenomatoid odontogenic tumor is 0.2%, while the calcifying epithelial odontogenic tumor's rate is 14%.
Management of Airway Obstruction in Patients with Congenital Heart Defects
Authors: Davis Deborah A. , Tucker John A. , Russo Pierantonio
Published: October 2014

Airway obstruction may complicate the course of infants undergoing repair of congenital heart disease. Airway obstruction was encountered in seven patients following surgery for complex congenital heart defects (two with interrupted aortic arch, one with pulmonary atresia and a ventricular septal defect, one with tetralogy of Fallot and an abnormal left anterior descending coronary artery, one with truncus arteriosus, and two with complex univentricular heart). In four patients, a conduit was implanted at the time of surgery. In all cases, bronchoscopy accurately demonstrated the cause of the airway obstruction. Two infants had hypoplasia of the left bronchus, and five had tracheobronchomalacia associated with extrinsic compression of the airway by a great vessel or conduit. All were treated conservatively with therapeutic bronchoscopy, tracheotomy, and/or stenting with prolonged mechanical ventilation. Follow-up ranged from 2 to 40 months. Four infants have been weaned from mechanical ventilation and decannulated; two are awaiting decannulation; and one was decannulated and died awaiting surgical repair. To reduce morbidity in infants undergoing surgery for congenital heart disease, the presence of preoperative airway anomalies should be sought and surgery planned to avoid airway compression. Conservative management using diagnostic and therapeutic bronchoscopy, tracheotomy, and stenting together with prolonged ventilator care is rewarding.
Laryngotracheal Reconstruction for Subglottic Stenosis
Authors: April Max M. , Marsh Bernard R.
Published: October 2014

Laryngotracheal reconstruction (LTR) has been employed for the treatment of severe laryngotracheal stenosis for the past 6 years at Johns Hopkins Hospital. Thirty-one children underwent LTR with costal cartilage grafting, 24 of whom had Aboulker stents placed. Short stents were used in 22 patients. Six patients received definitive treatment in a single-stage LTR; 1 child had no stent placed. Twenty-six (84%) of the 31 patients were decannulated. It was concluded that decannulation can be obtained in selected patients with the short Aboulker stent or single-stage LTR. A new classification system for laryngotracheal stenosis, based on objective measurements and the separate analysis of posterior glottic fibrosis, was developed. The proposed classification system allows recommendations for treatment. Moreover, it can be easily reproduced and may facilitate comparison of results.
Cutaneous Squamous Cell Carcinoma Occurring in a Pectoralis Major Myocutaneous Flap: Case Report and Literature Review
Authors: Montgomery William W. , Samson Michael J. , Varvares Mark A. , Goodman Max L.
Published: October 2014

The pectoralis major myocutaneous flap is a reliable regional flap commonly used for the reconstruction of head and neck defects. We report a case of a squamous cell carcinoma that occurred on the cutaneous paddle of a pectoralis flap in a patient with previous chest wall lesions. The need for a careful history of previous chest wall cutaneous lesions is stressed in patients who are to undergo this type of reconstruction.
Auricular Cartilage Grafts in Laryngotracheal Reconstruction
Authors: Lusk Rodney P. , Kang D. Richard , Muntz Harlan R.
Published: October 2014

Introduction of the anterior cricoid split (decompression) and laryngotracheal reconstruction with costal cartilage graft has resulted in the successful management of many cases of subglottic stenosis. However, the procedure does not allow uniform extubation, and laryngotracheal reconstruction with costal cartilage may be too aggressive for neonates. We have explored the use of autogenous auricular cartilage graft in laryngotracheal reconstruction. Its high rate of success and low morbidity have enabled us to expand the indications. We report our experience in 23 patients with auricular cartilage grafts.
Stroboscopic Videolaryngoscopy: A Comparison of Fiberscopic and Telescopic Documentation
Authors: Yanagisawa Eiji , Yanagisawa Ken
Published: October 2014

The clinical value of stroboscopic videolaryngoscopy (SVL) for the evaluation of laryngeal disorders has been emphasized. Some investigators advocate the use of a flexible fiberscope, while others recommend the use of a rigid telescope for SVL. In order to determine which procedure is more useful for clinical diagnosis, the senior author (E.Y.) performed both fiberscopic and telescopic SVL on 120 consecutive patients who complained of hoarseness. Equipment used included the Olympus ENF-P3 fiberscope, the Nagashima SFT-1 rigid telescope, the Nagashima LS-3A laryngostroboscope, and color video cameras. Our study indicated that stroboscopic images produced by telescopic SVL were superior to those from fiberscopic SVL in the majority of cases. The purpose of this paper is to compare fiberscopic and telescopic SVL, to evaluate the advantages and disadvantages of fiberscopic and telescopic SVL, and to present the authors' recommendations.
Rigid Bronchoscopy Balloon Catheter Dilation for Bronchial Stenosis in Infants
Authors: Skedros Demetrios G. , Siewers Ralph D. , Chan Kenny H. , Atlas Arthur B.
Published: October 2014

Stenosis of the tracheobronchial tree can be a life-threatening problem. Management options for symptomatic stenosis include serial dilation, cryotherapy, laser resection, and open surgical correction. Recently, balloon angioplasty catheters have been used to dilate stenotic airway segments. The experience in infants is limited and has for the most part utilized guide wires and fluoroscopy for balloon placement. We present two infants with symptomatic bronchial stenosis who underwent endoscopic angioplasty balloon catheter dilation. Operative technique involved catheter placement under direct vision with a rigid bronchoscope. Catheters (6F) with 8-mm-diameter balloons were used. Balloon expansion was controlled with a hand-held manometer. Both infants demonstrated significant lumen size improvement intraoperatively and marked clinical improvement postoperatively, substantiated by endoscopy and radiographs. One infant has required one repeat dilation and has subsequently been asymptomatic. The other infant has had no further respiratory problems. Our technique, using a rigid bronchoscope with direct visualization of catheter placement, obviates the need for guide wires and C-arm fluoroscopy as previously described. Endoscopic placement enables direct visualization of balloon position, and fine adjustments are possible if further dilation is necessary. Rigid bronchoscopic balloon catheter dilation can be a successful technique for bronchial stenosis and should be considered prior to attempting more invasive surgical correction.
Eighteenth Daniel C. Baker, Jr, Memorial Lecture Art and Science of Laryngeal Photography
Authors: Benjamin Bruce
Published: October 2014

Photography of the pharynx, larynx, and trachea has exercised the ingenuity of laryngologists and photographers for 100 years. There have been many successful methods. The most reliable and versatile modern system uses a 35-mm single frame, single lens reflex camera with Hopkins telescopes and a synchronized, automatic exposure, computer-controlled, remote electronic flash generator. The technique described, which has been used by the author for many years, not only allows excellent visualization and reliable documentation, but yields consistently reproducible photographs under all conditions.
Pendred's Syndrome
Authors: Kabakkaya Yilmaz , Bakan Ebubekir , Gökçe Gültekin , Yiǧitoǧlu M. Ramazan , Doǧan Mehmet
Published: October 2014

Although 5% of all cases of congenital deafness are caused by Pendred's syndrome, there are few reports in the literature. Seven patients with Pendred's syndrome in three families living in the same village were detected. For that reason, the syndrome is reviewed in light of the literature. The sex distribution of the patients with Pendred's syndrome and their families was recorded. We tested for thyroxine, triiodothyronine, thyroid-stimulating hormone, triiodothyronine resin uptake, and perchlorate, and performed caloric testing. In one patient, subtotal thyroidectomy was performed. In the histopathologic study, a thyroid nodule filled with colloid was found. Chromosome studies showed no anomalies in any patient. Five of the patients were deaf-mutes. We observed that the parents were cousins in all three families. These families also had healthy children, and the existence of the syndrome in both sexes points to an autosomal recessive trait.
Aerodynamic Assessment of the Speech of Adults Undergoing Multichannel Cochlear Implantation
Authors: Leeper Herbert A. , Parnes Lorne S. , Gagné Jean-Perre , Vidas Silvia
Published: October 2014

This investigation was designed to evaluate the aerodynamic characteristics of the speech of adult multichannel cochlear implant (Nucleus, 21-channel) recipients. Five adults with an acquired profound sensorineural hearing loss were tested before implantation, immediately following implantation, and 3, 6, 9, and 12 months after implantation. A commercially available computerized pressure-flow instrumentation system was employed to assess the respiratory, laryngeal, velopharyngeal, and oral articulatory subsystems of speech of the implantees. The results of the investigation indicated 1) a slight increase in airflow rate values for sustained vowel /a/ phonation after implantation, 2) a slight increase in duration of sustained vowel phonation from the preimplant period to the last postimplant period, 3) an increase in laryngeal airway resistance after implantation that resulted from a larger increase in estimated transglottal pressure than in transglottal airflow, 4) maintenance of normal velopharyngeal closure in oral-nasal contrastive contexts, and 5) slight increases in oral orifice area for fricative syllable utterances following implantation. Individual strategies for coordinated control of the speech mechanism appear to be potent variables to consider when assessing speech production.
Effects of Stellate Ganglion Stimulation on Bilateral Cochlear Blood Flow
Authors: Ren Tianying , Laurikainen Esa , Quirk Wayne S. , Miller Josef M. , Nuttall Alfred L.
Published: October 2014

The effect of intraneural electrical stimulation of the stellate ganglion (SG) on bilateral cochlear blood flow (CBF) was investigated with laser-Doppler flowmetry. The SG of 15 anesthetized guinea pigs was exposed by a novel surgical approach and stimulated with a specially designed intraneural bipolar platinum-iridium electrode. Bilateral CBF was continuously monitored. Stimulation of 0.25 mA caused a detectable increase of the systemic blood pressure (BP) and a bilateral decrease of the cochlear vascular conductance (R, defined as the ratio CBF/BP). A stimulus of 0.5 mA elicited a statistically significant ipsilateral CBF (CBFi) decrease of 3.6% ± 5.1% from the baseline and a contralateral CBF (CBFc) decrease of 3.1% ± 5.5%. That no statistical difference was found between CBFi and CBFc indicates that a unilateral sympathetic stimulation of the SG can cause equal bilateral responses. These responses were accompanied by a significantly increased BP (8.7% ± 5.2% of baseline) and consequently a greatly decreased R (12.2% ± 6.5%) of the ipsilateral cochlea. Bilateral sections of the cervical sympathetic trunk below the level of the superior cervical ganglion did not alter the evoked changes in CBF, BP, and R. It is concluded that SG stimulation can decrease the conductivity of the cochlear vessels or the supplying vessels of the cochlea. Additionally, the SG nerve fibers that cause these effects do not pass through the superior cervical ganglion.
Atelectasis of the Maxillary Sinus with Enophthalmos and Midface Depression
Authors: Blackwell Keith E. , Goldberg Robert A. , Calcaterra Thomas C.
Published: October 2014

Enophthalmos previously has been reported to be a rare complication of maxillary sinus mucoceles. We report three patients treated by the senior author (T.C.C.) over a 2-month period for enophthalmos or obvious deformity of the midface associated with complete opacification of the maxillary antrum. Most previous authors have stressed the role of chronic pressure necrosis or osteitis leading to bone destruction, with primary involvement of the orbital floor. No patients in this series had symptoms typical of maxillary sinus mucoceles. Two of our three patients presented with minimal symptoms of chronic infection. There was inward collapse of the anterior, superior, lateral, and medial walls of the maxillary sinus, with no radiographic or intraoperative confirmation of bone destruction. We speculate that this process may be the result of chronic maxillary hypoventilation with subsequent atelectasis of the antrum secondary to chronic negative pressure. All patients had obstruction at the osteomeatal complex and were treated by endoscopic enlargement of the natural maxillary ostium.
Far-Advanced Otosclerosis
Authors: Frattali Mark A. , Sataloff Robert T.
Published: October 2014

Profound deafness has received increasing attention in recent years, largely because of the availability of cochlear implants. Consequently, it is especially important for otolaryngologists to remember that a “blank” audiogram does not necessarily mean total or even profound deafness. Patients with far-advanced otosclerosis may have no measurable hearing with routine audiometric testing even in the presence of serviceable sensorineural hearing. Review of nine patients (10 ears) who underwent stapedectomy from 1980 to 1987 reveals that seven of the nine (78%), who had been unable to use a hearing aid preoperatively, obtained serviceable hearing with hearing aids following surgery. Otolaryngologists should depend on a good history and tuning fork examination to avoid being misled by the audiogram, and should not hesitate to offer stapes surgery to patients with far-advanced otosclerosis.
Animal Model for Persistent Tympanic Membrane Perforations
Authors: Spandow Odd , Hellström Sten
Published: October 2014

Topically applied hydrocortisone was used to develop an animal model for persistent tympanic membrane (TM) perforations. Hydrocortisone suspension was applied on the margins of TM perforations of standardized size in rats once daily for 10 days. The healing patterns of the TMs were mapped weekly and, when the perforations were about to close, daily. After 50 days, all hydrocortisone-treated perforations were open, whereas the controls closed within 9 to 12 days. At 3 months, when one third of the perforations still were open, the TMs were studied by otomicroscopy and light microscopy. All TMs were thickened and covered by keratin and wax. The thickened epidermal layer at the border of the TM perforations that remained open also draped the surface of the perforation facing the middle ear cavity. The thickened connective tissue layer contained abundant fibroblasts with their axes of length oriented at random. Both application of 1.4% hyaluronan and wounding of the perforation border enhanced the healing rate of the hydrocortisone-induced chronic TM perforation.
Therapeutic Effects of an Anticholinergic-Sympathomimetic Combination in Induced Rhinovirus Colds
Authors: Riker Donald K. , Hendley J. Owen , Doyle William J. , McBride Timothy P. , Swarts J. Douglas , Hayden Frederick G. , Gwaltney Jack M.
Published: October 2014

This study's objective was to determine if the combination of pseudoephedrine hydrochloride and atropine sulfate attenuates the symptomatic and pathophysiologic response of individuals to experimental rhinovirus infection when given after illness begins. Forty-three susceptible adult volunteers were challenged with rhinovirus type 39 and randomly assigned to 1 of 2 treatment groups. Twenty-one subjects were treated with the active medication (0.3 mg atropine sulfate and 60 mg pseudoephedrine) and 22 subjects were treated with inert capsules identical in appearance. Treatments were administered 4 times daily beginning approximately 24 hours after rhinovirus challenge and extending for 5 days. Before challenge and on each of 5 treatment days, all volunteers were asked to rate symptom severity and were evaluated for secretion production (weighed tissues), nasal patency (active posterior rhinomanometry), nasal clearance (dyed saccharin technique), eustachian tube function (9-step test), and middle ear status (tympanometry). Twenty subjects in each group were infected with rhinovirus type 39 and were included in the efficacy analysis. Between-group comparisons showed no significant differences in total symptom scores, combined nasal symptom score, secretion production, or the frequencies of persons with eustachian tube obstruction or abnormal middle ear pressures. However, an objective measure of nasal congestion was significantly lower in the active treatment group. The nasal mucociliary clearance rate was significantly more impaired in that group. Side effects consistent with anticholinergic activity were reported more frequently in the active treatment group.
Middle Ear Susceptibility to Pseudomonas Infection during Acute Otitis Media
Authors: Antonelli Patrick J. , Goycoolea Marcos V. , Juhn Steven K. , Giebink G. Scott
Published: October 2014

Pneumococcal otitis media was induced bilaterally, and Pseudomonas was inoculated unilaterally into the middle ears of 36 chinchillas to study the pathogenesis of chronic suppurative otitis media. Half of the animals were treated with penicillin prior to Pseudomonas inoculation (day 7, late Pseudomonas), and half were inoculated with Pseudomonas before penicillin treatment (day 3, early Pseudomonas). A third group of 18 chinchillas received unilateral Pseudomonas inoculation without pneumococcus or penicillin (control). Animals with early Pseudomonas were significantly less susceptible to Pseudomonas infection in the Pseudomonas-inoculated ear than animals with late Pseudomonas and controls. Susceptibility to Pseudomonas infection in the contralateral ears, which were not inoculated with Pseudomonas, was significantly lower in early Pseudomonas and control animals than in late Pseudomonas animals. Increased susceptibility in the late Pseudomonas group might have been due to altered nasopharyngeal microflora or persisting eustachian tube dysfunction — factors that may be important in the pathogenesis of chronic suppurative otitis media in humans.
Bacterial Flora in the External Ear Canal and in Induced Cholesteatoma in the Mongolian Gerbil
Authors: Fortuny Joan C. , Palomar Victor M. , Nogués Antonio
Published: October 2014

We report on the bacterial flora of the external ear canal and of induced aural cholesteatoma in 14 Mongolian gerbils ( Meriones unguiculatus). In the control, nonmanipulated external ear canal, gram-positive and gram-negative organisms were isolated. In the contents of the cholesteatoma sac, only monomicrobial, gram-negative isolates were found; in each animal they were different from the isolates from the nonmanipulated external ear canal. Obligate anaerobes were absent in all cases. Ligation of the external ear canal in the left ear provoked cholesteatoma in all cases.
Carcinoma in Situ of the Glottis: Radiotherapy or Excision Biopsy?
Authors: Murty George E. , Diver Joseph P. , Bradley Patrick J.
Published: October 2014

Excision biopsy, radiotherapy, and laryngofissure cordectomy have all been used, but the best treatment regimen for glottic carcinoma in situ remains controversial. A 20-year experience of 37 cases is reported. For the first 10 years biopsy with radiotherapy was the first-line treatment (n = 20), but for the last 10 years surgical or laser excision biopsy alone has been performed (n = 17). The T stage of the carcinoma in situ does not determine its premalignant potential. Malignancy appears to be a recurrence, rather than a new expression of carcinogenesis. Excision biopsy alone provides local control results (75%) comparable to those of primary radiotherapy (85%). Excision biopsy alone, however, retains the option of subsequent radiotherapy with preservation of laryngeal function, but very close follow-up, especially in the first year, is required.
Experimental Endolymphatic Hydrops and Glycerol Electrophysiologic Study
Authors: Magliulo Giuseppe , Petti Roberto , Vingolo Gianluca Maria , Cristofari Piera
Published: October 2014

The object of the present study was to evaluate electrophysiologically the therapeutic effect of glycerol on the cochlear function of guinea pigs in which experimental hydrops had been surgically induced. Fifteen albino guinea pigs were used. Each animal was chronically implanted to follow the evolution of hearing. The experimental protocol considered 3 groups of guinea pigs (5 animals each). Group 1 received no drug treatment, while groups 2 and 3 were given glycerol orally at 0.75 and 0.50 g/kg of body weight once a day for 4 months. The audiograms of the animals treated with glycerol showed a statistically significant hearing improvement compared with the control group. Clinically, our results seem to support the view of those who favor the use of glycerol for the medical treatment of Meniere's disease at an early stage.
Whole Organ Evaluation of Collagen in the Developing Human Larynx and Adjoining Anatomic Structures (Hyoid and Trachea)
Authors: Cohen Seymour R. , Perelman Natasha , Mahnovski Vladimir , Nimni Marcel E. , Cheung David T.
Published: October 2014

The collagen composition (types I, II, and III) of the normal developing human larynx and trachea was examined by biochemical methods. Autopsy specimens of larynges with attached upper tracheal rings were obtained from 28 humans ranging in age from birth to 44 years. The specimens were randomly collected, but excluded if laryngeal disease existed. The age, sex, and cause of death were documented. Collagen is important in the growth, development, repair, regeneration, and structural and functional integrity of the laryngeal framework. A preliminary report of selected cartilaginous components of the larynx was previously published by the authors, which studied the changes in the phenotypic expression of the collagen genes in children from the newborn period to 5 years 10 months of age. The current study included all of the functioning components of the skeletal larynx and trachea. The results of biochemical examination of these tissues are reported, and the potential clinical significance of the results of the study is discussed.
Plastination: A New Approach to Morphological Research and Instruction with Excised Larynges
Authors: Eckel Hans Edmund , Sittel Christian , Walger Martin , Sprinzl Georg , Koebke Jürgen
Published: October 2014

Impregnation of biologic materials with curable polymer (plastination) allows wider use of human tissue for both basic and clinical research and instruction. The aim of this study was to determine for the first time the potential of this method in the field of laryngology. A feasibility study on 54 pig larynges established a detailed methodology for larynx plastination and determined the extent of shrinkage by using computer-assisted morphometry. The process involves dehydration, saturation with an appropriate intermediate solvent, and infiltration with cured polymer in vacuo. In the main study 20 fresh, intact human larynges and 12 laryngectomy specimens were submitted to plastination. The resulting resin blocks were cut with a diamond band saw into 0.8-mm sections in the transaxial plane. The resulting specimens are dry, odorless, and durable, and do not deteriorate with time. The subtle features of soft tissue pathology are well preserved. Shrinkage of plastinated larynges is less than 10%. The complete process is accomplished within 5 weeks. Staining of sections with toluidine blue provides an enhanced contrast between different types of tissue, allowing a clear identification of tumor invasion. Plastination is considerably faster than celloidin embedding and causes minor anatomic changes. It provides durable specimens of high quality for teaching purposes. In research, it allows the investigation of all tissue components in their undisturbed context in the borderline area between gross anatomy and histology.
The World Health Organization's Revised Classification of Tumours of the Larynx, Hypopharynx, and Tracheax
Authors: Ferlito Alfio
Published: October 2014

A second edition of the Histological Typing of Upper Respiratory Tract Tumours in the WHO series International Histological Classification of Tumours was published in 1991. The new edition has been entitled Histological Typing of Tumours of the Upper Respiratory Tract and Ear. The task of revising the first edition, which was published in 1978, was undertaken at the WHO Center for Upper Respiratory Tract Tumours by K. Shanmugaratnam in collaboration with L. H. Sobin and pathologists in 8 countries. Several tumour types have been added to the classification, and some have been redefined in light of current knowledge. This presentation outlines the changes in the revised WHO classification as regards tumours of the larynx, hypopharynx, and trachea and discusses the grounds for said revisions.
Resection of Tracheal Stenosis with End-to-End Anastomosis
Authors: Har-El Gady , Shaha Ashok , Chaudry Rashid , Lucente Frank E.
Published: October 2014

We present our experience with circumferential tracheal resection with end-to-end anastomosis. Between 1985 and 1992 we performed this procedure on 19 patients with tracheal stenosis. The cause of the stenosis was related to intubation and/or tracheotomy in 78.9% of the patients. Two to 8 tracheal rings were resected and a tension-free anastomosis was achieved with mobilization techniques that were limited to suprahyoid release, peritracheal dissection, and chin-to-chest suture. Infrahyoid release and intrathoracic perihilar mobilization techniques were not used. The anastomosis success rate was 94.7%.
Bipolar Hooked-Wire Electromyographic Technique in the Evaluation of Pediatric Vocal Cord Paralysis
Authors: Gartlan Michael G. , Peterson K. Linnea , Luschei Erich S. , Hoffman Henry T. , Smith Richard J. H.
Published: October 2014

Laryngeal electromyography is a valuable test to assess vocal cord paralysis in adults. This technique can be applied and adapted to the pediatric patient. In the operating room under general anesthesia and endoscopic guidance, bipolar hooked-wire electrodes are passed percutaneously through the anterior neck skin into both thyroarytenoid muscles. Electromyographic signals are evaluated during light anesthesia and on awakening. A critical appraisal of this technique is presented, including an analysis of sources of electrical interference in the operating room.
Giant Suprastomal Granuloma as a Laryngeal Mass
Authors: Hartig Gregory K. , Wiatrak Brian J. , Myer Charles M. , Bower Charles M.
Published: October 2014

The presence of suprastomal granulomas after tracheotomy is a common occurrence. Under most circumstances, this never becomes clinically relevant. However, in the pediatric population, granulomas can on occasion cause partial or complete airway obstruction after decannulation. This report describes 2 cases of giant suprastomal granulomas that presented as laryngeal masses. These cases stress the indications for routine endoscopic evaluation in patients with long-term tracheotomies. Also, the treatment of extensive suprastomal granulomas requires open excision, which differs from the endoscopic approach recommended for smaller granulomas.
Perioperative Stroke in Patients Undergoing Head and Neck Surgery
Authors: Nosan David K. , Gomez Camilo R. , Maves Michael D.
Published: October 2014

The risk of perioperative strokes has been demonstrated to be very low in general surgical procedures, and somewhat higher in cardiac and carotid artery procedures. We describe 5 patients who underwent major head and neck procedures not requiring carotid ligation and who postoperatively suffered strokes. These occurred between the first and ninth postoperative days. Four of the patients were thought to have had emboli, 3 to the cerebral hemispheres (2 ipsilateral and 1 contralateral to the neck dissections), and another to the lower brain stem. Hypoperfusion was thought to have caused the stroke in the fifth patient. All patients had risk factors for stroke. The cases in our series were difficult to diagnose because of the delayed onset and subtle nature of symptoms, as well as masking of speech and communication due to the operative procedures involved. Thrombogenesis within the internal carotid and vertebral artery systems due to patient positioning and intraoperative cervical manipulation may be an important etiologic factor in this form of stroke.
Tussometry: An Objective Assessment of Vocal Cord Function
Authors: Murty George E. , Kelly Peter J. , Bradley Patrick J.
Published: October 2014

A number of techniques have recently been developed for altering laryngeal function, including structural framework surgery, reinnervation procedures, augmentation of the vocal cords, electrical stimulation, and pharmacologic intervention. The application of such procedures to appropriate disorders would be facilitated by better objective measures of the outcome. This study describes the new technique of tussometry, which investigates the airflow pattern produced during coughing. The value of 1 parameter, peak value time, is shown by a study of 35 vocal cord palsies versus a control, and of 17 vocal cord palsies before and after augmentation, to be an accurate assessment of vocal cord position. The technique is independent of lung function parameters and intraoral pressures. It is truly objective, having an interobserver variation of 0%, and is eminently reproducible, with an intrasubject coefficient of variation of 3.1% to 5.7%. Tussometry is a rapid, noninvasive technique providing inexpensive objective assessment of vocal cord function in the office setting.
Hair Relaxer Ingestion: A New Trend
Authors: Forsen James W. , Muntz Harlan R.
Published: October 2014

Although the health care system has done much to reduce the incidence of ingestion of such alkalis as drain and oven cleaners, in recent years we have seen an overwhelming increase in the incidence of hair relaxer ingestion. In a 5-year review (1987 to 1992) of 48 cases of caustic ingestion, 15 cases involved alkaline hair-relaxing agents. This retrospective study was undertaken to evaluate the agents ingested, the presenting signs and symptoms, the diagnostic procedures, and the outcomes in those 15 cases. Oral cavity and lip burns were common in these children, but none of the 15 had significant esophageal burns. Education of the medical and lay community about the risk of hair relaxer ingestion should be undertaken to reverse this worrisome trend.
Dedifferentiated Chondrosarcoma of the Larynx with Regional and Distant Metastases
Authors: Nakayama Meijin , Brandenburg James H. , Hafez G. Reza
Published: October 2014

Chondrosarcoma of the larynx is an unusual tumor, with only approximately 200 cases having been reported. This tumor is relatively nonaggressive and tends to remain localized in the larynx. Two cases with aggressive clinical behavior manifested by regional or distant metastasis are presented. In the first case, cervical node metastasis appeared 6 months after total laryngectomy. A dedifferentiated chrondrosarcoma was identified by pathologic examination. In the other case, clavicular metastasis developed 7 years after initial local excision. Despite additional treatments, the patient later developed cervical node, lung, and vertebral metastasis. Transformation from low-grade to dedifferentiated chondrosarcoma was verified by pathologic examination. We believe this case to be the first reported laryngeal chondrosarcoma with bone metastasis. A review of the literature regarding regional and/or distant metastasis of laryngeal chondrosarcoma, including the present observations, reveals a total of 20 cases. In all cases, tumor grade has been directly correlated with the development of metastasis.
Positron Emission Tomography of Auditory Sensation in Deaf Patients and Patients with Cochlear Implants
Authors: Ito Juichi , Iwasaki Yasushi , Sakakibara Junji , Yonekura Yoshiharu
Published: October 2014

The present study investigated the function of the auditory cortices in severely hearing-impaired or deaf patients and cochlear implant patients before and after auditory stimulation. Positron emission computed tomography (PET), which can detect brain activity by providing quantitative measurements of the metabolic rates of oxygen and glucose, was used. In patients with residual hearing, the activity of the auditory cortex measured by PET was almost normal. Among the totally deaf patients, the longer the duration of deafness, the lower the brain activity in the auditory cortex measured by PET. Patients who had been deaf for a long period showed remarkably reduced metabolic rates in the auditory cortices. However, following implantation of the cochlear device, the metabolic activity returned to nearnormal levels. These findings suggest that activation of the speech comprehension mechanism of the higher brain system can be initiated by sound signals from the implant devices.
Early-Stage Development of Auditory Center: An Experimental Study of Auditory Evoked Electrophysiologic Recordings from Fetal and Newborn Guinea Pigs
Authors: Wang Zhi , Li Dong J. , Liou LI , Liou Weng Z.
Published: October 2014

Five guinea pig fetuses at 8 weeks' gestation (term is 9 weeks) were tested for auditory brain stem response (ABR) generated by earphones placed outside the maternal abdomen. The results obtained from these fetuses were compared with the ABRs in 10 term newborn guinea pigs on the 1 st and 20th days after delivery. The ABRs indicated a decreasing peak latency over wave III with increasing age. The interpeak latency to wave III-V decreased markedly, with very little change in wave I-III. The results suggested rapid maturation of the upper brain stem and midbrain during late gestation and in newborns. They also exhibited an increasing peak latency of ABRs from both fetuses and newborns with decreasing stimulus intensity.
Growth Rate of Acoustic Neuroma Expressed by Ki-67 Nuclear Antigen versus Symptom Duration
Authors: Charabi Samih , Engel Peter , Tos Mirko , Jacobsen Grete Krag , Thomsen Jens
Published: October 2014

The growth rate of acoustic tumors varies widely. An immunohistochemical study with Ki-67 monoclonal antibody was performed on a random sample of 21 acoustic neuromas. The tumors belonged to 2 well-defined groups: 1 with a short duration of preoperative symptoms (<1 year) and 1 with a long duration of preoperative symptoms (>5 years). The tumors were of small to medium size (7 to 27 mm), and no large, cystic, or Recklinghausen tumors were included. The tumor proliferative fraction expressed by monoclonal antibody Ki-67 was determined. The results revealed a significant relation between the tumor proliferative fraction and symptom duration. Tumors with a high proliferative status had a short preoperative symptom duration, while tumors with a low proliferative status had a long symptom duration. The clinical implications of these results are discussed.
Recurrent Laryngeal Nerve Paralysis during Transvenous Insertion of a Permanent Endocardial Pacemaker
Authors: Zohar Yuval , Buller Nora , Shvilly Ytzhak
Published: October 2014

We present 2 patients with sudden onset of dysphonia due to acute unilateral vocal cord paralysis that occurred during transvenous insertion of a permanent endocardial pacemaker. Acute paralysis of the vocal cord due to this kind of medical intervention is a very unusual complication that has been rarely reported. We believe that traumatic insertion of a pacemaker through the subclavian vein triggered a dynamic process that led to vocal cord paralysis. Three hypothetic explanations are presented: 1) a direct vagus nerve lesion, 2) a direct inferior laryngeal nerve lesion, and 3) a central nervous system lesion caused by a cerebral microembolus. Physicians should be aware of the possibility that associated acute paralysis of the vocal cord may occur after transvenous insertion of an endocardial pacemaker.
Dexamethasone Inhibition of the Development of Dysplastic Bony Lesions in Lp/J Mice
Authors: Brodie Hilary A. , Chang Po-Shen , Chole Richard A.
Published: October 2014

Inbred LP/J mice have been observed to spontaneously develop abnormal bony lesions of the ossicles and otic capsule that progress throughout the life of the animals. This genetically inherited murine disorder produces bony lesions that share some gross and histologic features with bony lesions seen in human tympanosclerosis. Previous studies on LP/J mice have demonstrated evidence of immunologically mediated injury in the progression of the newly forming bony lesions. This study was designed to examine the effects of dexamethasone on the development of the bony lesions in LP/J mice. The purpose was to attempt to elucidate the relationship of the immunologic injury observed in earlier studies and the progression of the dysplastic bony lesions. The results show that LP/J mice treated with dexamethasone developed significantly fewer dysplastic bony lesions compared to the age-matched, saline-treated controls. There was also a statistically significant difference in the quantity and cellularity of the middle ear effusions between the experimental and control animals.
Repair of a Laryngotracheoesophageal Cleft in an Infant by Means of Extracorporeal Membrane Oxygenation
Authors: Geiduschek Jeremy M. , Kozak Frederick K. , Inglis Andrew F. , Mayock Dennis E. , O'Rourke P. Pearl , Sawin Robert S.
Published: October 2014

Few survivors have been reported following attempted repair of laryngotracheoesophageal clefts (LTECs). The major challenge is maintaining oxygenation, both during the surgical repair and during the postoperative period of healing. We report a neonate with an LTEC extending to the carina whose successful repair was facilitated by extracorporeal membrane oxygenation (ECMO) begun intraoperatively and continued postoperatively for 11 days. The intraoperative surgical exposure of the defect was excellent. Postoperative trauma to the fresh tracheal repair from ventilatory pressures and endotracheal tube motion was eliminated through the use of ECMO. The patient was discharged without a tracheotomy and with a normal voice, cry, and swallow. According to this result, the use of ECMO may represent a significant advance in facilitating the correction of major laryngotracheoesophageal anomalies. The rationale, advantages, disadvantages, and potential pitfalls of this approach are presented, as well as preoperative and postoperative documentation of our results.
Hydroxylapatite Laryngeal Implants for Medialization
Authors: Cummings Charles W. , Purcell Laura L. , Flint Paul W.
Published: October 2014

Laryngeal implantation for medialization has improved our ability to manage the patient with vocal fold motion impairment. We present preliminary data evaluating the use of preformed hydroxylapatite laryngeal implants and instrumentation for rapid determination of implant size and position. A window in the thyroid ala is created by means of a standard fenestra template. One of 5 prosthesis templates is inserted through the window for determination of correct size and position. The corresponding implant is then inserted and secured with a hydroxylapatite shim. Thirty-five patients have been implanted for vocal fold paralysis, and 4 patients were implanted for soft tissue deficits or bowing. Thirty-one of 35 patients have reported subjective improvement (89%). Improvement was demonstrated in 13 of 15 (87%) patients with complete preoperative and postoperative objective voice function measurements. Complications include 1 implant extrusion and 1 case of airway obstruction secondary to edema. Preliminary results indicate that prefabricated hydroxylapatite implants are effective for medialization thyroplasty. Advantages include a readily available implant selection, rapid determination of correct size and position, and improved implant stabilization with a hydroxylapatite shim.
Esophageal Stricture: An Uncommon Complication of Foreign Bodies
Authors: Doolin Edward J.
Published: October 2014

Ingestion of foreign bodies is common in infants. As a rule, the infant is being observed and the event is witnessed. When it is unwitnessed, acute symptoms bring the problem to the attention of a physician. When the ingestion is not witnessed or symptomatic, its presence can only be surmised. The object can create injuries and chronic symptoms that are not typical for this accident. Here is reported an ingestion of a coin that went undiagnosed and untreated for more than a year. The result was a transmural esophageal injury with stricture formation. The diagnostic methods and transcervical repair are described.