bluuebunny/crossref_metadata_2025 huggingface dataset:
Hereditary Congenital Unilateral Deafness: A New Disorder?
Authors: Dikkers Frederik G. , Verheij Joke B. G. M. , van Mechelen Monique
Published: October 2014

Congenital unilateral deafness is a rare disorder. The prevalence rates are unknown. The prevalence of children with severe to profound hearing losses that are congenital (or acquired before the development of speech and language) is 0.5 to 3 per 1,000 live births. Evidently, congenital unilateral deafness must have a lower prevalence. The purpose of this research was to present a new disorder, hereditary congenital unilateral deafness. A pedigree is presented in which both male and female members display symptoms of congenital unilateral deafness. Two affected persons and a normal-hearing member of the family have vestibular abnormalities without dysequilibrium. The inheritance pattern of this new syndrome is not clear. We hypothesize that the disorder might be new. A family like this has never before been presented in the medical literature.
Fiberoptic Endoscopic–Assisted Diverticulotomy: A Novel Technique for the Management of Zenker's Diverticulum
Authors: Altman Jason I. , Genden Eric M. , Moche Jason
Published: October 2014

Endoscopic diverticulotomy is rapidly becoming the procedure of choice for treatment of Zenker's diverticulum. The endoscopic approach has resulted in significant decreases in patient morbidity, time to resumption of oral intake, and overall cost as compared with open treatment. However, a small but significant patient population is unable to accommodate the rigid laryngoscope and therefore requires open treatment. We present a novel technique, flexible fiberoptic endoscopic–assisted diverticulotomy, for the management of patients who are unable to undergo rigid endoscopy.
Effect of Deficits in Laryngeal Sensation on Laryngeal Muscle Biochemistry
Authors: Nagai Hiromi , Ota Fumikazu , Connor Nadine P.
Published: October 2014

Swallowing deficits in elderly people are significant clinical problems and may be associated with impaired pharyngolaryngeal sensation. However, the extent to which sensory innervation affects the motor system is unclear. Our purpose was to examine differences in biochemical properties of laryngeal muscles following sensory nerve ablation. We used sodium dodecyl sulfate–polyacrylamide gel electrophoresis to evaluate laryngeal muscles of young and old Fischer 344/Brown Norway rats, and rats that underwent sensory ablation via bilateral section of the superior laryngeal nerve, internal branch (SLNi), or mixed sensory-motor nerve ablation via left-sided recurrent laryngeal nerve (RLN) section. In lateral thyroarytenoid muscle, a reduction was found in the proportion of the most rapidly contracting myosin heavy chain isoform (type 2B) with SLNi section, RLN section, and aging. Section of the SLNi did not alter the proportion of any myosin heavy chain isoform within the lateral cricoarytenoid or posterior cricoarytenoid muscles, but RLN section resulted in a reduction in the proportion of type 2B. Accordingly, alteration in biochemical properties of the lateral thyroarytenoid muscle alone was demonstrated following sensory ablation. We conclude that sensory changes may affect properties of laryngeal muscles, and may thus have an impact on motor control during critical functions, such as airway protection during swallowing.
Effect of Cochlear Implantation on Residual Spiral Ganglion Cell Count as Determined by Comparison with the Contralateral Nonimplanted Inner Ear in Humans
Authors: Khan Aayesha M. , Handzel Ophir , Eddington Donald K. , Damian Doris , Nadol Joseph B.
Published: October 2014

It is generally assumed that at least a minimal number of spiral ganglion cells is essential for successful speech perception with a cochlear implant. Although the insertion of a multichannel cochlear implant frequently results in loss of residual hearing in the implanted ear, this outcome does not imply that significant damage to residual populations of spiral ganglion cells has occurred. The purpose of the current study was to compare spiral ganglion cell counts in implanted and nonimplanted cochleas in 11 patients for whom both temporal bones were available and in whom a multichannel cochlear implant had been placed unilaterally. The temporal bones were processed for light microscopy by standard techniques. The cochleas were reconstructed by 2-dimensional methods. Spiral ganglion cell counts of the implanted and nonimplanted sides were compared by a paired t-test (2-tailed). The mean spiral ganglion cell counts for implanted and nonimplanted ears were not statistically different in the most basal three segments of the cochlea. However, the mean spiral ganglion cell count in segment 4 (apical segment) and the mean total spiral ganglion cell count were lower in the implanted cochleas than in the nonimplanted cochleas (p < .01). The results of this study suggest a modest decrease in the total spiral ganglion cell count in the implanted ears as compared to the nonimplanted ears, principally in the apical segment. Possible interpretations of this finding are discussed.
Tissue-Specific Immunoglobulin E in Human Nasal Polyps
Authors: Wei Chih-Yen , Fang Sheen-Yie
Published: October 2014

Allergy is generally believed to be an underlying cause of nasal polyps. The objective of this study was to define allergic nasal polyps. We investigated specific immunoglobulin E (sIgE) in polyp tissue. Thirty pieces of polyp tissue were taken from patients with positive allergic symptoms, and 30 from patients without allergic symptoms. Nasal polyp tissue homogenate and serum from these patients were prepared for detecting sIgE by a CAP method. For patients with allergic symptoms and/or positive serum CAP test results, the rates of positive tissue CAP tests were low: 36.7% and 35.7%, respectively. However, nearly all of the tissue CAP-positive subjects had allergic symptoms and positive serum CAP tests. We conclude that the local tissue sIgE profile reflects more specifically the allergic status of patients with nasal polyps than does the systemic serum test or the presentation of allergic symptoms. Thus, polyp tissue CAP tests might be performed in patients with positive allergic symptoms and positive serum CAP tests to define an allergy-induced polyp precisely. Then, specific antiallergic treatment could be administered to prevent polyp recurrence.
Radiographic Evaluation of Aspirated Metallic Foil Foreign Bodies
Authors: Orgill Richard D. , Pasic Thomas R. , Peppler Walter W. , Hoffman Mark D.
Published: October 2014

Objectives:

Aspirated objects generally represent items accessible to children. When metallic candy wrapper aspiration is questioned, radiographic studies may aid diagnosis. An infant with repeated chest radiographs negative for a metallic foreign body was found to have a multi-layer metallic candy wrapper in the left main bronchus. The purpose of this study was to determine whether conventional and dual-energy radiographic techniques exclude the presence of aspirated metallic foil wrappers.

Methods:

Single-layer and multi-layer metallic candy wrappers were radiographically studied with conventional and dual-energy radiographic techniques in 3 tissue models.

Results:

No single-layer metallic samples were detectable with conventional or dual-energy radiography. The multi-layer samples were not detectable at less than 8 layers (pulmonary tissue model) or 16 layers (mediastinal model) by either conventional or dual-energy radiography.

Conclusions:

Conventional and dual-energy chest radiographic techniques do not reliably exclude the presence of aspirated metallic foil wrappers.
Laryngeal Electromyography for Adult Unilateral Vocal Fold Immobility: A Survey of the American Broncho-Esophagological Association
Authors: Halum Stacey L. , Patel Nalin , Smith Timothy L. , Jaradeh Safwan , Toohill Robert J. , Merati Albert L.
Published: October 2014

Objectives:

Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among otolaryngologists. The aim of this study was to determine the current attitudes and practices regarding laryngeal electromyography (LEMG) for the management of adult UVFI within a cohort of subspecialty laryngologists.

Methods:

A 19-item instrument focused on diagnosis and management of adult UVFI was mailed to active members (n = 249) of the American Broncho-Esophagological Association (ABEA). The subset of questions related to LEMG is reviewed in this report. Statistical analysis using a χ2 test was performed.

Results:

The survey response rate was 34% (n = 84), with 8 surveys returned incomplete because of pediatric-limited practices. Of the respondents, 75% (n = 57) rely on LEMG for evaluation of UVFI, whereas 25% (n = 19) do not use LEMG. Of those who use LEMG, 54% place their own electrodes and 44% interpret the LEMG results themselves. Monopolar electrodes are used by 57% (n = 25), bipolar electrodes by 27% (n = 12), and hooked-wire electrodes by 17% (n = 7). Muscles evaluated by LEMG include the thyroarytenoid (100%), cricothyroid (94%), posterior cricoarytenoid (70%), lateral cricoarytenoid (43%), cricopharyngeus (27%), and interarytenoid (17%). The LEMG is performed in an unblinded fashion by most respondents (85%), and many (66%) feel a more accurate result is obtained when clinical information is known. There was no statistically significant difference in use of LEMG, placement of electrodes, and interpretation of LEMG according to percentage of laryngology practice.

Conclusions:

The survey results demonstrate congruence among ABEA members in the utility of LEMG in the management of adult UVFI. Some variability was noted in the methods by which LEMG is performed and interpreted.
Regenerative Medicine of the Trachea: The First Human Case
Authors: Omori Koichi , Nakamura Tatsuo , Kanemaru Shinichi , Asato Ryo , Yamashita Masaru , Tanaka Shinzo , Magrufov Akhmar , Ito Juichi , Shimizu Yasuhiko
Published: October 2014

Objectives:

The objective of the present study was to demonstrate regenerative medicine of the tracheal tissue by using an in situ tissue engineering technique for airway reconstruction.

Methods:

Based on the previous successful experimental animal studies, the current regenerative technique was applied to repair of the trachea of a 78-year-old woman with thyroid cancer. A Marlex mesh tube covered by collagen sponge was used as a tissue scaffold. The operative intervention included right hemithyroidectomy, resection of the trachea, and tracheoplasty using the scaffold. The right half of three rings of the trachea was resected, and the scaffold material was sutured to the defect of the trachea.

Results:

After 2 weeks, the mesh collagen structure of the artificial material could be seen with endoscopy in most of the implanted area. The artificial material was covered with epithelial growth after 2 months. Epithelialization continued to cover the artificial material completely for 2 years without any complications.

Conclusions:

The current regenerative technique avoided tracheotomy, a second operation, and deformity. Good epithelialization has been observed on the tracheal luminal surface without any complications for 2 years. Although long-term observation is required, regenerative medicine of the tracheal tissue appears feasible for airway reconstruction.
Accuracy of Measurements on Digital Videostroboscopic Images of the Vocal Folds
Authors: Speyer Renée , Wieneke George H. , Kersing Willem , Dejonckere Philippe H.
Published: October 2014

Objectives:

The reliability of objective measurements on digital laryngeal images was investigated.

Methods:

The magnitude of the error of measurement of surface areas by visually tracing the outline was determined for three different areas: the area of the lesion and, during vibration, the glottal area on maximal opening of the vocal folds and the glottal area on maximal closing of the vocal folds.

Results:

The errors in these areas were 10% to 30%. The results suggest that the error is mainly due to the uncertainty of the real outline of areas with a vague boundary. Correction for differences in magnification between two images (posttherapy and pretherapy) is of importance in about 25% to 65% of cases, depending on the area measured.

Conclusions:

Only when the magnification ratio is small (less than about ±10% from 1.0) may a correction not be necessary.
Use of Interferon-Alpha in Recurrent Respiratory Papillomatosis: 20-Year Follow-up
Authors: Gerein Valentin , Rastorguev Eugen , Gerein Johann , Jecker Peter , Pfister Herbert
Published: October 2014

Objectives:

The aim of this study was analysis of the results of use of interferon-α (IFN-α) in patients with recurrent respiratory papillomatosis (RRP) and correlation of the results with human papillomavirus (HPV) type.

Methods:

A multicenter prospective series (42 patients from 22 hospitals) yielded 20 years of follow-up of patients with RRP and HPV typing who were treated with IFN-α in doses of 3 MU/m2 3 times per week.

Results:

During long-term follow-up (mean ± SD, 172 ± 36.8 months), the rate of event-free survival evaluated by Kaplan-Meier analysis was 42.8%, and the overall survival rate was 82.6%. The HPV typing revealed an association of HPV 11 with a more aggressive disease course (64% of HPV 11 patients versus 24% of HPV 6 patients), a lower incidence of long-term response to IFN-α therapy (14% of HPV 11 patients versus 64% of HPV 6 patients), and a higher incidence of malignant transformation and mortality during follow-up (36% and 24%, respectively, of HPV 11 patients versus 0% of HPV 6 patients).

Conclusions:

The obtained results revealed maximal effectiveness of IFN-α therapy in RRP patients with HPV 6 as compared with HPV 11. The association of HPV 11 with a worse long-term response to IFN-α therapy and a higher incidence of malignant transformation and mortality is clinically important and indicates the necessity of HPV typing in RRP patients after the first biopsy.
Prevention of Posterior Glottic Stenosis by Mitomycin C
Authors: Roh Jong-Lyel
Published: October 2014

Objectives:

Posterior glottic stenosis (PGS) is a disabling disease commonly induced by endolaryngeal injury from intubation or surgery. Few experiments on PGS prevention, however, have been performed. The purpose of this study was to investigate the preventive effect of mitomycin C (MMC) on PGS in a randomized, controlled animal study.

Methods:

Twenty-six rabbits underwent laser injury of 6 W, continuous-focus mode on the posterior glottis. There were 6 uninjured controls. Thirteen animals were treated by a single topical use of 0.4 mg/mL MMC solution on the injured posterior glottis for 5 minutes, and 13 were sham-treated controls. The posterior glottis of all groups was blindly evaluated by telescopic examination under direct laryngoscopy 2 months after injury and was harvested for histologic analyses.

Results:

Scar, granulation tissue, and synechia formation of the posterior glottis were clearly induced by laser injury. Microscopic examination showed increased collagen content and fibroblast proliferation in the region. The use of MMC significantly decreased the incidence of such gross and microscopic changes of the posterior glottis (p < .05).

Conclusions:

This study suggests that topical MMC can be helpful in preventing the progression of PGS from mucosal injury of the posterior glottis.
Oxymetazoline Solutions Inhibit Middle Ear Pathogens and are Not Ototoxic
Authors: Isaacson Glenn , Buttaro Bettina A. , Mazeffa Valorie , Li Geming , Frenz Dorothy A.
Published: October 2014

Objectives:

This study was performed to explore the antimicrobial activity of two commercially available oxymetazoline hydrochloride preparations against the common pathogens of otitis media and to demonstrate the lack of ototoxicity of these agents and of United States Pharmacopeia (USP) oxymetazoline in a standard animal model.

Methods:

Disc diffusion assays and minimum inhibitory concentration studies against American Type Culture Collection reference strains of common middle ear pathogens were used to evaluate the antimicrobial activity of oxymetazoline solutions and fluoroquinolone drops, and outer hair cell counts were performed on scanning electron micrographs of guinea pig basal cochlear segments after chronic exposure to oxymetazoline solutions and positive and negative controls.

Results:

Oxymetazoline nasal spray and eyedrops had activity against all species tested except Haemophilus influenzae and Pseudomonas aeruginosa. The USP oxymetazoline had limited antimicrobial activity. Oxymetazoline nasal spray, oxymetazoline eyedrops, and USP oxymetazoline had ototoxicity profiles indistinguishable from that of the saline solution control.

Conclusions:

Commercially available oxymetazoline solutions are active against several of the common pathogens of otitis media. This antimicrobial activity is not due to oxymetazoline, and is more likely due to preservatives present in the solutions. The solutions tested are not ototoxic to guinea pig outer hair cells. Oxymetazoline solutions are potential substitutes for broad-spectrum antibiotic drops after tympanostomy tube placement.
In Vivo Engineering of the Vocal Fold Extracellular Matrix with Injectable Hyaluronic Acid Hydrogels: Early Effects on Tissue Repair and Biomechanics in a Rabbit Model
Authors: Hansen Jennifer K. , Thibeault Susan L. , Walsh Jennifer F. , Shu Xiao Zheng , Prestwich Glenn D.
Published: October 2014

Objectives:

A prospective, controlled animal study was performed to determine whether the use of injectable, chemically modified hyaluronic acid (HA) derivatives at the time of intentional vocal fold resection might facilitate wound repair and preserve the unique viscoelastic properties of the vocal fold extracellular matrix.

Methods:

We performed bilateral vocal fold biopsies on 33 rabbits. Two groups of rabbits were unilaterally treated with 2 different HA derivatives — Carbylan-SX and HA-DTPH-PEGDA — at the time of resection. Saline was injected as a control into the contralateral fold. The animals were painlessly sacrificed 3 weeks after biopsy and injection. The outcomes measured included histologic fibrosis level, tissue HA level, and tissue viscosity and elasticity.

Results:

The Carbylan-SX—treated vocal folds were found to have significantly less fibrosis than the saline-treated controls. The levels of HA in the treated vocal folds were not significantly different from those in the controls at 3 weeks as measured by enzyme-linked immunosorbent assay. The Carbylan-SX—treated vocal folds had significantly improved biomechanical properties of elasticity and viscosity. The HA-DTPH-PEGDA injections yielded significantly improved viscosity, but not elasticity.

Conclusions:

Prophylactic in vivo manipulation of the extracellular matrix with an injectable Carbylan-SX hydrogel appears to induce vocal fold tissue regeneration to yield optimal tissue composition and biomechanical properties favorable for phonation.
Seasonal Variations in Rhino-Cerebral Mucor Infection
Authors: Shpitzer Thomas , Keller Nathan , Wolf Michael , Goldschmied-Reouven Anna , Bahar Gideon , Bahar Irit , Kronenberg Jona , Feinmesser Raphael , Talmi Yoav P.
Published: October 2014

Objectives:

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, potentially lethal infection that occurs mostly in immunocompromised hosts. The seasonal occurrence of ROCM was studied in two of Israel's largest medical centers.

Methods:

A total of 36 patients were seen during a 25-year period in this retrospective bi-institutional cohort study. Meteorologic data were obtained and analyzed for a possible linkage of infection with precipitation and temperature.

Results:

Twenty-one of the 36 patients (58%) presented between the months of August and October, and 27 patients (75%) presented between the months of August and December. A peak incidence of ROCM was noted in the month of September (13/36 patients; 36%). No association was noted between meteorologic conditions and the incidence of ROCM infection.

Conclusions:

A consistent seasonal peak was observed in ROCM. Heightened awareness is important for early recognition and treatment of this disease.
Otosclerosis: Incidence of Positive Findings on High-Resolution Computed Tomography and Their Correlation to Audiological Test Data
Authors: Naumann Ilka C. , Porcellini Beat , Fisch Ugo
Published: October 2014

Objectives:

Computed tomographic (CT) scanning with slices of 1 mm or more has not been sufficient to demonstrate otosclerotic foci in most cases to date.

Methods:

We investigated the validity of CT scans with a 0.5-mm cubical scan technique, with and without planar reconstruction, and correlated these findings with audiological data. Forty-four temporal bone CT scans from 30 patients with conductive or mixed hearing loss were evaluated.

Results:

Otosclerotic foci were visualized in 74% of the cases. With reconstruction at the workstation, the sensitivity increased to 85%. Whereas in fenestral otosclerosis a correlation was found between the size of the focus and the air-bone gap, no correlation was seen between the size of the focus and bone conduction thresholds with cochlear involvement. Otosclerotic foci in patients treated with sodium fluoride were smaller than those in patients without treatment. This finding may indicate a beneficial effect of sodium fluoride on otosclerotic growth.

Conclusions:

High-resolution CT scans are a valid tool that can be used to confirm, localize, and determine the size of clinically suspected otosclerotic foci.
Changes in Vestibular Evoked Myogenic Potentials after Meniere Attacks
Authors: Kuo Shih-Wei , Yang Ting-Hua , Young Yi-Ho
Published: October 2014

Objectives:

The aim of this study was to apply videonystagmography (VNG) and vestibular evoked myogenic potential (VEMP) tests to patients with Meniere attacks, to explore the mechanics of where saccular disorders may affect the semicircular canals.

Methods:

From January 2001 to December 2003, 12 consecutive patients with unilateral definite Meniere's disease with vertiginous attacks underwent VNG for recording spontaneous nystagmus, as well as VEMP tests.

Results:

At the very beginning of the Meniere attack, the spontaneous nystagmus beat toward the lesion side in 5 patients (42%) and toward the healthy side in 7 patients (58%). Twenty-four hours later, only 6 patients (50%) showed spontaneous nystagmus beating toward the healthy side. Nevertheless, spontaneous nystagmus subsided in all patients within 48 hours. The VEMP test was performed within 24 hours of a Meniere attack; the VEMPs were normal in 4 patients and abnormal in 8 patients (67%). After 48 hours, 4 patients with initially abnormal VEMPs had resolution and return to normal VEMPs, and the other 4 patients still had absent VEMPs.

Conclusions:

Most patients (67%) with Meniere attacks revealed abnormal VEMPs, indicating that the saccule participates in a Meniere attack. This is an important idea that stimulates consideration of the mechanism of Meniere attacks.
Prefabricated Composite Free Flaps for Tracheal Reconstruction: A New Technique
Authors: Teng Marita S. , Malkin Benjamin D. , Urken Mark L.
Published: October 2014

Objectives:

Successful laryngotracheal reconstruction requires both structurally supported tissue that withstands airway pressure changes and well-vascularized epithelial lining to prevent granulation and stricture formation. For circumferential defects, end-to-end anastomosis achieves favorable results, but for long-segment or large noncircumferential defects, no proven methods have emerged. Several animal studies describe prefabricated soft tissue flaps wrapped around synthetic materials or cartilage. However, prefabricated flaps have had very little use in human airway reconstruction. We present a patient with laryngeal stenosis and tracheostomy dependence following chemoradiotherapy for hypopharyngeal carcinoma.

Methods:

In an attempt to widen the patient's laryngeal airway, a thyrotracheal autograft procedure, previously described by our institution, was performed. We transferred a segment of hemitrachea cephalad using the thyroid gland as a “vascular carrier,” thus creating an 8-cm-long trough inferiorly that involved a 40% defect of the anterior tracheal circumference. Severe radiation damage to the cervical skin precluded use of traditional tracheoplasty methods. We used a technique whereby costal cartilage strips were implanted into a radial forearm free flap, designed to replicate the anterior tracheal wall.

Results:

Four weeks later, we harvested the prefabricated composite flap and placed it into the defect, using forearm skin as tracheal lining. The cervical skin defect was closed with an island deltopectoral flap. A soft stent was kept in the neotrachea for 3 weeks, and a tracheostomy tube was left beneath it. The tracheostomy was subsequently closed with local advancement flaps, and the patient currently maintains an excellent airway.

Conclusions:

Prefabricated composite free flaps are an attractive option for certain challenging cases of airway reconstruction.
Case of Progressive Dysplasia Concomitant with Intralesional Cidofovir Administration for Recurrent Respiratory Papillomatosis
Authors: Wemer Richard D. , Lee John H. , Hoffman Henry T. , Robinson Robert A. , Smith Richard J. H.
Published: October 2014

Recurrent respiratory papillomatosis (RRP) is characterized by benign wartlike growths in the larynx with occasional spread to the lungs. A broad range of therapeutic measures have been used to treat RRP; the primary treatment is laser vaporization of the lesions. Recurrences of the disease are common, and alternate methods of treatment are being used to prevent recurrence, including cidofovir. Cidofovir is a cytosine nucleotide analog with antiviral properties that is approved by the US Food and Drug Administration for treatment of cytomegalovirus retinitis and is currently being used off-label for RRP. Cidofovir has gained initial success in slowing the rate of disease recurrence when used at the time of surgery. However, the use of cidofovir lends concern to several adverse side effects, including the potential for carcinogenesis. We report here a 28-year-old woman who was treated with intralesional cidofovir at the time of surgery over the span of 27 months. The initial pathology results demonstrated benign disease with progression to severe dysplasia during the treatment time. Cidofovir's potential for carcinogenicity remains largely undefined, and thus, we are currently undertaking a project involving the evaluation of sequential paraffin-embedded samples of resections from a large cohort of patients with RRP treated at the University of Iowa Hospitals and Clinics.
Nonsyndromic Isolated Unilateral Cochlear Nerve Aplasia without Narrow Internal Auditory Meatus: A Previously Overlooked Cause of Unilateral Profound Deafness in Childhood
Authors: Ito Ken , Endo Asayo , Monobe Hiroko , Ochiai Atsushi , Iwasaki Shinichi
Published: October 2014

Objectives:

Juvenile or adolescent unilateral profound sensorineural deafness (worldwide prevalence, 0.1% to 0.2%) has been attributed to postnatal viral infection, sudden deafness, prenatal and perinatal problems including maternal rubella and viral infections, congenital inner ear anomalies, and other factors. Herein, 2 cases are reported and another potentially important cause of unilateral profound hearing loss is proposed.

Methods:

Two nonsyndromic cases of a presently “very rare” cause of pediatric unilateral deafness are presented as a retrospective case study.

Results:

The 2 patients showed isolated aplasia of the cochlear nerve; other branches of the eighth cranial nerve, the seventh nerve, and the inner ear were spared, and there was no anomaly of the internal auditory meatus. Both functional and imaging studies confirmed the isolated lesion (absence) of the cochlear nerve.

Conclusions:

Because of the absence of bony abnormalities, such cases may have been overlooked. The authors would like to advocate this isolated anomaly of the cochlear nerve as an important cause of juvenile or adolescent unilateral profound deafness.
Interactive Effects of High-Pass Filtering and Masking Noise on Word Recognition
Authors: Elangovan Saravanan , Stuart Andrew
Published: October 2014

Objectives:

This study sought to examine the word recognition performance in noise of individuals with a simulated low-frequency hearing loss. The goal was to understand how low-frequency hearing impairment affects performance on tasks that challenge temporal processing skills.

Methods:

Twenty-two normal-hearing young adults participated. Monosyllabic words were presented in continuous and interrupted noise at 3 signal-to-noise ratios of −10, 0, and +10 dB. High-pass filtering of the stimuli at 3 different cutoff frequencies (ie, 1,000, 1,250, and 1,500 Hz) simulated the low-frequency hearing impairment.

Results:

In general, performance decreased with increasing cutoff frequency, was higher for more favorable signal-to-noise ratios, and was superior in the interrupted condition relative to the continuous noise condition. One important revelation was that the magnitude of the performance superiority observed in the interrupted noise condition did not diminish with high-pass filtering; ie, the release from masking in interrupted noise was preserved.

Conclusions:

The results of the present study complement previous findings in which this paradigm was used with low-pass filtering to simulate a high-frequency hearing loss. That is to say, low-frequency hearing channels are inherently poorer than high-frequency channels in temporal resolution.
Anatomic Study of Laser-Assisted Endoscopic Cricopharyngeus Myotomy
Authors: Chang C. W. David , Liou Steve S. , Netterville James L.
Published: October 2014

Objectives:

Laser-assisted endoscopic cricopharyngeus muscle (CPM) myotomy has been used to correct dysphagia caused by CPM dysfunction. The aim of this study was to anatomically characterize this procedure in hopes of demonstrating its safety and efficacy.

Methods:

A Dohlman endoscope was used to isolate the CPM in 5 lightly preserved, thawed cadavers. A carbon dioxide laser at 10 W continuous power was used to section through the CPM in conjunction with a micromanipulator connected to an operating microscope. The specimens were then carefully dissected and photographed to demonstrate the anatomy of the pharyngoesophageal segment, including the location of the incision and the condition of the tissue planes. The CPM was harvested for histologic studies, sectioned, and prepared with modified Gomori trichrome stain.

Results:

Gross examination of the retropharyngeal region revealed the presence of intact buccopharyngeal fascia between the lasered region and the retropharyngeal space. Histologic analysis demonstrated sectioning of the CPM with preservation of this fascia layer. Placement of the endoscope was difficult in 1 cadaver, in which we were unable to properly identify the CPM.

Conclusions:

The carbon dioxide laser-assisted endoscopic CPM myotomy is a potentially anatomically safe and viable procedure when properly performed. However, the potential for violation of the retropharyngeal space is real.
Medial Arytenoidectomy versus Transverse Cordotomy as a Treatment for Bilateral Vocal Fold Paralysis
Authors: Bosley Brooke , Rosen Clark A. , Simpson C. Blake , McMullin Brian T. , Gartner-Schmidt Jackie L.
Published: October 2014

Objectives:

Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared.

Methods:

The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained.

Results:

Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively.

Conclusions:

Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.
Three-Dimensional Reconstruction of the Human Semicircular Canals and Measurement of Each Membranous Canal Plane Defined by Reid's Stereotactic Coordinates
Authors: Hashimoto Shinichiro , Naganuma Hideaki , Tokumasu Koji , Itoh Akihiko , Okamoto Makito
Published: October 2014

Objectives:

Equations for estimating the planar relationships of the human semicircular canals were devised by Blanks et al from a dissected bony labyrinth in a human skull. However, a similar study on the membranous semicircular canal planes has never been published.

Methods:

In this study, the angle between each membranous canal plane and Reid's stereotactic horizontal plane was measured on serial histologic sections of 7 temporal bones from Japanese adults. We reconstructed the 3 semicircular canals by computer-aided 3-dimensional analysis. The angles between each pair of both bony and membranous canal planes were measured.

Results:

In the bony labyrinth, the angles between the 2 canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.51° ± 2.98° (mean ± SD), 91.70° ± 1.85°, and 94.52° ± 3.32°, respectively. The angles between the 2 membranous canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.05° ± 4.74°, 91.03° ± 2.93°, and 91.92° ± 5.22°, respectively.

Conclusions:

The data from our study of the membranous labyrinth showed that the angles between each canal plane and the others were much closer to 90° than was found by Blanks et al for the bony labyrinth.
Efficacy of Montelukast in the Treatment of Nasal Polyposis
Authors: Kieff David A. , Busaba Nicolas Y.
Published: October 2014

Objectives:

Twenty-four consecutive patients with symptomatic nasal polyposis and nonallergic or perennial rhinitis who were undergoing chronic nasal steroid therapy were prospectively evaluated for response to adjunctive oral montelukast sodium therapy.

Methods:

The patients were undergoing daily intranasal steroid sprays for a minimum of 6 months before being started on montelukast sodium 10 mg by mouth per day for 3 months while intranasal steroids were continued. The patients were given a validated symptom score survey at the start and end of therapy, with a lower score indicating fewer symptoms. The nasal polyps were submitted to biopsy before and after treatment to determine their degree of eosinophilia. Eosinophilia was graded in a blinded fashion by an independent pathologist on a scale of 0 to 3, with 3 being severe. Patients with seasonal allergies were excluded, and the studied patients were treated during the winter season to avoid confounding by potential seasonal allergic responses.

Results:

The patients tended to improve on montelukast therapy in terms of their symptom scores and polyp eosinophil counts. The symptoms improved in 17 patients (71%) and remained the same or worsened in 7 patients (29%). The symptom score for the group improved from a pretreatment value of 33.4 (SD, 7.73) to a posttreatment value of 23.3 (SD, 13.73; p < .001). In addition, the eosinophilia score improved from 2.3 (SD, 0.68) to 1.5 (SD, 0.82; p < .01). The improvement was most noticeable in the patients with perennial allergies.

Conclusions:

These results suggest that montelukast appears to be beneficial for some patients with nasal polyposis. Patients with perennial allergies and nasal polyposis seem more likely to respond to the treatment than those with nonallergic nasal polyposis.
Endoscopic Treatment of Severe Tracheal Stenosis
Authors: Schweinfurth John M.
Published: October 2014

Objectives:

Endoscopic treatment of subglottic and tracheal stenosis has traditionally been reserved for short-segment and web-like stenoses with normal cartilage. This retrospective case series review was undertaken to examine my experience with definitive endoscopic treatment for circumferential and complete tracheal stenosis with loss of cartilaginous support.

Methods:

Patients who presented with tracheostomy dependence or dyspnea as a result of clinically significant tracheal stenosis over a 2-year period were treated endoscopically. Mitomycin C was applied after dilation in 19 patients. Three patients with complete stenosis and cartilage collapse underwent endoscopic placement of a silicone elastic stent, which was in place for less than 23 days.

Results:

Twenty patients were treated for tracheal stenosis over a 2-year period. No surgical complications were observed after operation in the endoscopic treatment group. Three of 6 patients with complete stenoses and 8 of 10 patients with circumferential stenoses with cartilage involvement gained airways that remained patent. Nine patients' stenoses resolved after the initial treatment. Three patients (15%) eventually required tracheal resection. The follow-up periods ranged from 5 to 25 months.

Conclusions:

Although some limitations apply, severe and complete tracheal stenoses may be successfully treated endoscopically with the techniques described. Definitive endoscopic treatment may be considered before tracheal resection in select cases. Endoscopic treatment is associated with few complications, low morbidity, a short operative time, and a short length of hospitalization.
Effect of Pepsin on Laryngeal Stress Protein (Sep70, Sep53, and Hsp70) Response: Role in Laryngopharyngeal Reflux Disease
Authors: Johnston Nikki , Dettmar Peter W. , Lively Mark O. , Postma Gregory N. , Belafsky Peter C. , Birchall Martin , Koufman Jamie A.
Published: October 2014

Objectives:

The objectives of this study were to define the conditions that give rise to a stress protein response in laryngeal epithelium and to investigate whether and how stress protein dysfunction contributes to reflux-related laryngeal disease.

Methods:

Western analysis was used to measure stress protein (squamous epithelial proteins Sep70 and Sep53 and heat shock protein Hsp70) and pepsin levels in esophageal and laryngeal tissue specimens taken from both normal control subjects and patients with pH-documented laryngopharyngeal reflux (LPR) who had documented lesions, some of whom had laryngeal cancer. A porcine organ culture model was used to examine the effects of low pH and pepsin (0.1% porcine pepsin A) on stress protein levels. A laryngeal squamous carcinoma (FaDu) cell line was used to examine uptake of human pepsin 3b-tetramethyl-5 and -6 isothiocyanate.

Results:

Sep70, Sep53, and Hsp70 were found to be expressed at high levels, and pepsin was not detected, in esophageal and laryngeal specimens taken from normal control subjects and in esophageal specimens taken from LPR patients. The patients with LPR were found to have significantly less laryngeal Sep70 (p = .027) and marginally less laryngeal Sep53 (p = .056) than the normal control subjects. Laryngeal Hsp70 was expressed at high levels in the LPR patients. The patients with laryngeal cancer had significantly lower levels of Sep70, Sep53 (p < .01), and Hsp70 (p < .05) than the normal control subjects. A significant association was found between the presence of pepsin in laryngeal epithelium from LPR patients and depletion of laryngeal Sep70 (p < .001). Using the organ culture model, we demonstrated that laryngeal Sep70 and Sep53 proteins are induced after exposure to low pH. However, in the presence of pepsin, Sep70 and Sep53 levels are depleted. Confocal microscopy analysis of cultured cells exposed to labeled pepsin revealed that uptake is by receptor-mediated endocytosis.

Conclusions:

These findings suggest that receptor-mediated uptake of pepsin by laryngeal epithelial cells, as may occur in LPR, causes a change in the normal acid-mediated stress protein response. This altered stress protein response may lead to cellular injury and thus play a role in the development of disease.
Immunohistochemical Distinction of Intestinal-Type Sinonasal Adenocarcinoma from Metastatic Adenocarcinoma of Intestinal Origin
Authors: Resto Vicente A. , Krane Jeffrey F. , Faquin William C. , Lin Derrick T.
Published: October 2014

Objectives:

Distinction of intestinal-type sinonasal adenocarcinoma (ITAC) from adenocarcinoma of intestinal origin metastatic to the sinonasal cavity may be extremely difficult on histologic grounds alone. We studied the role of cytokeratin (CK) and mucin (MUC) expression in differentiating ITAC, metastatic adenocarcinoma of intestinal origin, and non-intestinal-type sinonasal adenocarcinoma (non-ITAC).

Methods:

We stained specimens from 5 cases of ITAC and 4 cases of non-ITAC, along with 4 colonic and 3 duodenal adenocarcinoma controls, with CK7 and CK20, MUC2 and MUC5, neuron-specific enolase (NSE), chromogranin (CHR), and carcinoembryonic antigen (CEA) in order to examine the possible combinations of markers that best aid in the diagnosis of these lesions. We also performed a retrospective review of our clinical experience with these rare lesions.

Results:

CK7 staining was positive in all ITAC and non-ITAC cases, whereas all cases displaying gastrointestinal-type differentiation (ITAC and metastatic intestinal cases) stained positive for both CK20 and MUC2. Staining for MUC5, NSE, CHR, and CEA was variable.

Conclusions:

Tumors with the CK7+, CK20+, MUC2+ immunophenotype are likely primary sinonasal lesions, whereas tumors with the CK7−, CK20+, MUC2+ profile warrant further clinical evaluation to exclude metastatic disease from the gastrointestinal tract. Complete surgical resection of ITAC remains the mainstay of therapy.
Treatment of Adductor-Type Spasmodic Dysphonia by Surgical Myectomy: A Preliminary Report
Authors: Koufman Jamie A. , Rees Catherine J. , Halum Stacey L. , Blalock David
Published: October 2014

Objectives:

Despite the belief that it represents a central neurologic dysfunctional process, adductor-type spasmodic dysphonia without tremor is usually effectively treated by injection of botulinum toxin A; however, in most cases such injections must be repeated every few months. A promising new surgical procedure is herein reported.

Methods:

Under local anesthesia with intravenous sedation, a large laryngoplasty window is created, and under direct vision with intraoperative voice monitoring, fibers from the thyroarytenoid and lateral cricoarytenoid muscles are removed until breathiness occurs. The two sides are staged; that is, one side is done at a time, with surgery on the second side being performed 3 to 6 months after that on the first side, if needed.

Results:

This was a retrospective, unblinded study of 5 patients who underwent myectomy of the thyroarytenoid and lateral cricoarytenoid muscles. The preliminary results show improved voice fluency in all patients at 5 to 19 months of follow-up. There was no period of prolonged breathiness or dysphagia in any of the patients, and there were no surgical complications.

Conclusions:

Myectomy of the thyroarytenoid and lateral cricoarytenoid muscles is a promising new surgical treatment for adductor-type spasmodic dysphonia that may effectively mimic “permanent” botulinum toxin injections.
Quantitative and Comparative Studies of the Vocal Fold Extracellular Matrix I: Elastic Fibers and Hyaluronic Acid
Authors: Hahn Mariah S. , Kobler James B. , Starcher Barry C. , Zeitels Steven M. , Langer Robert
Published: October 2014

Objectives:

This study examines the elastic fiber and hyaluronic acid (HA) content of the midmembranous vocal fold laminae propriae (LPs) of humans, dogs, pigs, and ferrets.

Methods:

Lamina propria elastin was quantified by measuring the amino acid desmosine, and HA was measured by an enzyme-linked immunosorbent assay-based technique. Quantitative histology was used to evaluate elastin and HA levels in specific LP regions. The distributions of fibrillin-1, a primary microfibrillar component of elastic fibers, and of tropoelastin, an indicator of elastin synthesis, were immunohistochemically analyzed.

Results:

Elastin and HA constituted 8.5% ± 2.1% and 0.82% ± 0.11% of human LP, respectively, relative to tissue total protein. Although the mean LP desmosine levels were similar across species, the mean HA levels in canine (p < 3.1 × 10−5), porcine (p < 1.5 × 10−5), and ferret (p < 6.6 × 10−4) LPs were 3 to 4 times higher than that in humans. Marked interspecies differences in elastin, fibrillin-1, tropoelastin, and HA distributions were observed histologically.

Conclusions:

The elastin content of the human LP is roughly twice that of the dermis, whereas the HA content of the human LP is similar to that of the dermis. Although all species had similar levels of desmosine, histologic evaluation indicates that the porcine elastin distribution is most similar to that of the human LP. Fibrillin-1 staining suggests that stress in the human LP may be particularly high in the superior superficial layer, and tropoelastin staining indicates that the rate of LP elastin turnover may vary spatially.
Virtual versus Conventional Laryngeal Endoscopy
Authors: Businco Lino Di Rienzo , Turchio Piergiorgio , Guazzaroni Marco , Tirelli Guido Coen
Published: October 2014

We have evaluated the capacity of virtual laryngoscopy and conventional laryngoscopy conducted with a rigid or flexible instrument to visualize laryngeal structures in 64 patients with normal endoluminal anatomy. Virtual laryngoscopy allowed total visualization of laryngeal structures, including those that could not be reached by a flexible instrument. There was good correlation between virtual laryngoscopy and “real” images, indicating satisfactory diagnostic accuracy (p > .05). Although virtual laryngoscopy does not provide histologic data, it is a fast and noninvasive technique that can be added to and integrated with conventional laryngoscopy, and it can be an alternative in cases in which conventional laryngoscopy is difficult, contraindicated, or impossible. It is particularly useful for the study of laryngeal narrow spaces and in the visualization of subglottic regions and of other more restricted areas (inferior tonsil region, posterior surface of the epiglottis, glossoepiglottic vallecula, Morgagni's ventricle, anterior commissure).