bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Microvascular Compression of the Vestibulocochlear Nerve a Cause of Unilateral Hearing Loss?
Authors: van der Steenstraten Femke , de Ru J. Alexander , Witkamp Theo D.
Published: October 2014

Objectives:

We sought to confirm earlier findings in the literature that microvascular compression of the vestibulocochlear nerve might cause unilateral sensorineural hearing loss. We measured the length and width of the internal auditory canal (IAC) to investigate a possible association between a narrow porus, the presence of an anterior inferior cerebellar artery (AICA) loop, and the development of a microvascular compression syndrome.

Methods:

We performed a prospective blinded analysis of 167 magnetic resonance imaging scans of the cerebellopontine angle. The presence of an AICA loop was scored. We analyzed these 167 patients for unilateral sensorineural hearing loss, which was defined as an interaural difference of 20 dB at 1 frequency or 10 dB at 2 or more frequencies. Furthermore, the width and length of the IAC on magnetic resonance imaging were measured.

Results:

An AICA loop was identified in 94% of the 167 patients. There were 196 type I loops, 106 type II loops, and 14 type III loops. Sixty-six patients had unexplained unilateral hearing loss. There was no association between type II and III vascular loops, the width of the IAC, and unilateral hearing loss (p > .05).

Conclusions:

In this study we found no association between the depth of extension of the AICA loop into the IAC and the presence of unilateral hearing loss.
Bilabial Contact Pressure and Oral Air Pressure during Tracheoesophageal Speech
Authors: Searl Jeff
Published: October 2014

Objectives:

This study compared bilabial contact pressure (CPsp) and oral air pressure (Po) for /p/, /b/, and /m/ produced by tracheoesophageal (TE) versus laryngeal speakers. Nonspeech maximum bilabial contact pressures (CPmax) were measured to calculate the percentage of the range utilized for bilabial phonemes.

Methods:

Ten TE speakers and 10 laryngeal speakers produced syllables and sentences loaded with bilabial phonemes. The CPsp was measured with a miniature pressure transducer on the lower lip while the Po was simultaneously measured with a catheter in the corner of the mouth coupled to a differential pressure transducer. The speakers completed a non-speech lip-press task with the contact pressure transducer in place.

Results:

The TE speakers produced bilabial phonemes with significantly higher CPsp and Po than did laryngeal speakers. There was no difference in CPmax between the groups. The percentage of the contact pressure range utilized for bilabial phonemes was significantly higher for TE speakers.

Conclusions:

The increased CPsp and Po exhibited by TE speakers may reflect an attempt to overexaggerate articulation, although an alternate explanation related to neoglottal and oral aerodynamics must also be considered in future work. Subsequent studies evaluating the relationships between magnitude of articulatory contact pressure, phoneme intelligibility, and speaker's sense of effort should contribute to a better understanding of TE speech demands and may guide novel interventions to facilitate TE speech intelligibility.
Management of Aerodigestive Tract Foreign Bodies: Innovative Teaching Concepts
Authors: Deutsch Ellen S. , Dixit Divya , Curry Joseph , Malloy Kelly , Christenson Tom , Robinson Barbara , Cognetti David
Published: October 2014

Objectives:

We discuss a method to provide medical education in bronchoesophagology by using high-fidelity patient simulation manikins.

Methods:

A sophisticated, life-sized infant manikin with realistic anatomic, physiologic, and hemodynamic responses to interventions was programmed to simulate endobronchial foreign body lodgment by blocking ventilation of one lung and manifesting audible stridor, asymmetric chest wall motion, and decreased oxygen saturation.

Results:

Otolaryngology residents participated in simulation exercises incorporating the cognitive and technical skills necessary for successful airway endoscopy, including technical proficiency and teamwork, to learn to coordinate endoscopy and ventilation and manage laryngospasm. Rather than relying on instructor description, the participants responded directly to the manikin. This sense of realism stimulated participants to rehearse to improve provider performance and patient safety. Simulation provided an agenda determined by the needs of the learners, exploration without direct risk to patients, immediate feedback, and objective documentation.

Conclusions:

Rapidly evolving medical simulation technologies support activated, effective adult learning; they will play an increasing role in medical education.
True Vocal Fold Immobility in the Setting of Well-Differentiated Thyroid Carcinoma: Unusual Illustrative Cases and Recommendations for Operative Strategy
Authors: Amini Kamyar , Frank Douglas K.
Published: October 2014

Objectives:

We present cases of transient true vocal fold (TVF) immobility caused by well-differentiated thyroid carcinoma (WDTC), and review the literature concerning management of WDTC invading the recurrent laryngeal nerve (RLN).

Methods:

A description of the clinical course of 2 patients with WDTC and transient TVF immobility is presented in the context of a review of the literature concerning locally advanced WDTC with extrathyroidal extension and RLN involvement.

Results:

Both patients had papillary thyroid carcinoma with ipsilateral TVF paralysis that resolved completely before operation. During the operation, the RLN was found to be grossly involved with disease and inseparable from the tumor, necessitating resection. Review of the literature revealed the following points that should be considered when confronting an RLN invaded by WDTC. 1) Benign disease can mimic invasive WDTC and must be ruled out. 2) RLN invasion does not carry the same prognostic implications as other categories of extrathyroidal extension of WDTC. 3) RLN sacrifice does not increase the overall survival rate. 4) There is no evidence that a paralyzed RLN will regain function when preserved. 5) The majority of RLNs that function before operation can be expected to function after the operation if preserved.

Conclusions:

Resolution of TVF paralysis should not reduce suspicion of RLN involvement by WDTC. When RLN involvement is discovered during operation, every attempt should be made to preserve a functioning RLN.
Optical Recording of the Intrinsic Signal from the Human Olfactory Cleft
Authors: Ishimaru Tadashi
Published: October 2014

Objectives:

Endoscopy of the human olfactory cleft is important for both research in human olfaction and clinical examination with regard to olfactory disorders. However, endoscopy only provides information on the morphology and functional status of the epithelium, and it does not allow discrimination between respiratory and olfactory mucosa. To obtain information on the functional status of the olfactory mucosa, I used endoscopy to investigate the optical intrinsic signal recording from the human olfactory cleft.

Methods:

A light-emitting diode (617 nm) light source and a cooled charge-coupled device camera were prepared for endoscopy of the olfactory cleft. Subjects were exposed to various odors presented in front of their nostrils. In addition, blanks were used for control.

Results:

When normosmic subjects sniffed the odors, the intensity of the signal from the olfactory mucosa changed, which was not the case when blank stimuli were presented. Different odors activated different response patterns. A decrease of the oxyhemoglobin level in the activated olfactory epithelium is suspected to be responsible for this observation.

Conclusions:

The optical intrinsic signals were recorded from the human olfactory cleft with an endoscope. This technique may be applicable to basic research in olfaction and to a clinical test for the assessment of olfactory disorders.
Localization and Expression of MUC5B and MUC7 Mucins in Pediatric Sinus Mucosa
Authors: Peña Maria T. , Aujla Pawandeep K. , Zudaire Enrique , Watson Alan M. , Przygodzki Ronald , Zalzal George H. , Rose Mary C.
Published: October 2014

Objectives:

The purpose of this study was to analyze the secretory cell population and distribution of MUC5B and MUC7 mucins in the sinus mucosa of pediatric patients with and without chronic rhinosinusitis (CRS).

Methods:

Sinus mucosal specimens were collected at surgery in a pediatric tertiary care facility. Histologic, immunohistochemical, and morphometric analyses were performed on sinus mucosa of 20 children with CRS and 7 children without CRS.

Results:

A significant increase in the area of submucosal glands was evident in the sinus mucosa of children with CRS as compared to controls. MUC5B and MUC7 mucins were expressed in the submucosal glands, as well as in goblet cells, in the sinus mucosa of both populations. No differences in MUC5B or MUC7 expression were observed when mucin expression was normalized to glandular area.

Conclusions:

Children with CRS have an increased number of submucosal glands, indicating that glandular mucins contribute to mucus overproduction in CRS. MUC5B and MUC7 mucins, which have previously been considered only glandular mucins, are also expressed in goblet cells in the sinus mucosa.
Reflux Symptom Index versus Reflux Finding Score
Authors: Mesallam Tamer A. , Stemple Joseph C. , Sobeih Tarek M. , Elluru Ravindhra G.
Published: October 2014

Objectives:

We examined the correlation between the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS) to determine the laryngeal signs and symptoms that were most significantly correlated.

Methods:

Forty randomly selected patients were included in the study. A retrospective chart review was performed for patients who fit the inclusion criteria. Videostroboscopic samples for the study group were reviewed and RFS-rated by 6 experienced raters on 2 different occasions to evaluate the interrater and intrarater reliability. The RSI and the RFS were statistically compared regarding both the total scores and the individual parameters.

Results:

The RFS ranged from 0 to 20, and the RSI varied from 14 to 38. There was a high agreement between the raters' scores, demonstrating high interrater and intrarater reliability for RFS. Additionally, the RSI and RFS were highly correlated (p < .0001). Hoarseness was highly correlated with vocal fold edema and thick laryngeal mucus (p < .01), and excessive throat clearing correlated significantly with thick endolaryngeal mucus (p < .01).

Conclusions:

The study demonstrates a highly significant correlation between the RFS and the RSI.
Dysfunction of the Recurrent Laryngeal Nerve and the Potential of Gene Therapy
Authors: Heavner S. Brett , Rubin Adam D. , Fung Kevin , Old Matthew , Hogikyan Norman D. , Feldman Eva L.
Published: October 2014

Injury to the recurrent laryngeal nerve causes vocal fold paresis or paralysis resulting in poor voice quality, and possibly swallowing dysfunction and/or airway compromise. Injury can occur as part of a neurodegenerative disease process or can be due to direct nerve trauma or tumor invasion. Management depends upon symptoms, the cause and severity of injury, and the prognosis for recovery of nerve function. Surgical treatment techniques can improve symptoms, but do not restore physiologic motion. Gene therapy may be a useful adjunct to enhance nerve regeneration in the setting of neurodegenerative disease or trauma. Remote injection of viral vectors into the recurrent laryngeal nerve is the least invasive way to deliver neurotrophic factors to the nerve's cell bodies within the nucleus ambiguus, and in turn to promote nerve regeneration and enhance both nuclear and nerve survival. The purpose of this review is to discuss the potential role for gene therapy in treatment of the unsolved problem of vocal fold paralysis.
Quantitative Analysis of OX62-Positive Dendritic Cell Distribution in the Rat Laryngeal Complex
Authors: Friedman Aaron D. , Dan Olivia , Drazba Judith A. , Lorenz Robert R. , Strome Marshall
Published: October 2014

Objectives:

Dendritic cells (DCs) are key instigators of rejection after transplantation. Their distribution has not been systematically characterized in all locations of the larynx and its surrounding tissues.

Methods:

Rat larynges were stained with monoclonal antibodies identifying DCs. These cells were then enumerated by a new combination of techniques including immunofluorescence, confocal microscopy, and imaging software.

Results:

The vast majority of DCs were located in the epithelium and subepithelium of the airway; the mean DC density ranged from 9 cells per square millimeter (0.2% of cells) to 645 cells per square millimeter (10.3% of cells). Their density in the epithelium was 3 to 11 times higher than that in the subepithelium. Non-airway sites (thyroid, parathyroid, muscle, fat) had mean DC densities varying from 3 cells per square millimeter (0.2%) to 57 cells per square millimeter (0.8%). No DCs were detected in cartilage.

Conclusions:

Dendritic cells are concentrated in the laryngotracheal epithelium and subepithelium and represent a much smaller proportion in the other sites studied. A baseline for laryngeal DC population studies has been established, and a computerized model for consistent quantitation using confocal microscopy has been developed. This unique method will serve as a foundation for investigating DC trafficking after rat laryngeal transplantation.
Chevalier Jackson Lecture 2006 Concepts and Culture of Innovation
Authors: Zeitels Steven M.
Published: October 2014

“So great and radical are the changes which occur in medicine that we may paraphrase Davy Crockett, Be sure you are right & then look around to see what's wrong.” “Discussion and difference of opinion mean progress. And we must progress. To stand still means retrogression.” (Chevalier Jackson1)
Multilevel Esophageal Biopsy in Children with Airway Manifestations of Extraesophageal Reflux Disease
Authors: Mitzner Ron , Brodsky Linda
Published: October 2014

Objectives:

Extraesophageal reflux disease (EERD) is a recognized cause of upper airway symptoms in children. Direct microlaryngoscopy and bronchoscopy (MLB) is performed for diagnostic information as to the extent and severity of the inflammation caused by gastric refluxate. Esophagoscopy with multilevel biopsy performed at the time of MLB may provide the clinician with additional information to assist in the management of EERD. We undertook to determine the role of multilevel esophageal biopsy in children who have airway manifestations secondary to EERD.

Methods:

We performed a retrospective chart review of 139 esophagoscopies with multilevel biopsy done at the time of MLB by a single provider for evaluation of symptoms highly associated with EERD at a tertiary care children's hospital. The histopathologic presence of esophagitis was analyzed by site and compared to the presence and location of tracheolaryngeal abnormalities.

Results:

Tracheolaryngeal abnormalities associated with EERD were found in 97% of patients when evaluated by MLB. Concomitant esophagitis was found in 59% of these patients. Of patients who had 0, 1, 2, 3, 4, or 5 positive findings on MLB, 75% (3 of 4), 58% (7 of 12), 57% (20 of 35), 62% (32 of 51), 56% (18 of 32), and 80% (4 of 5), respectively, had at least 1 positive biopsy.

Conclusions:

We found that EERD that affects the pediatric upper airway was associated with esophagitis in more than half of the patients. The usefulness of 4-level biopsies during esophagoscopy and concomitant airway endoscopy will be discussed.
Intraobserver and Interobserver Reliability in Laryngopharyngeal Sensory Discrimination Thresholds: A Pilot Study
Authors: Cunningham Jeffrey J. , Halum Stacey L. , Butler Susan G. , Postma Gregory N.
Published: October 2014

Objectives:

Laryngopharyngeal sensory discrimination threshold (LPSDT) testing is a method used to detect sensory deficits in patients in whom swallowing disorders are suspected. LPSDTs have been used to stratify patient risk status with regard to aspiration and to guide dietary management. The aim of this pilot study was to evaluate the intraobserver and interobserver reliability of LPSDT testing among a group of examiners with differing levels of testing experience.

Methods:

Twenty-seven healthy volunteers were enrolled in the study to elicit LPSDTs for intraobserver and interobserver reliability measurements. The examiners represented 3 levels of testing experience: An attending laryngologist, a laryngology fellow, and an otolaryngology resident. With the examiners blinded to test results, each subject was examined twice by one examiner and once by a different examiner in an alternating fashion.

Results:

Six subjects were unable to tolerate the examinations because of coughing and gagging. Spearman rank correlations revealed strong intraobserver reliability for the experienced endoscopists (ie, attending and fellow) but poor reliability for the novice endoscopist (ie, resident). Poor interobserver reliability regardless of endoscopy experience was found. Eighteen percent of the participants demonstrated LPSDTs of more than 4.0 mm Hg (above normal).

Conclusions:

1) Intraobserver reliability was good for experienced endoscopists. 2) Interobserver LPSDT agreement between endoscopists was poor. 3) Eighteen percent of the subjects demonstrated elevated LPSDT thresholds of more than 4 mm Hg.
Tonsillectomy in the Anticoagulated Patient
Authors: Cole Stephanie M. , Patterson Matthew B. , Cupp Craig L.
Published: October 2014

Objectives:

The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks.

Methods:

A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low–molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage.

Results:

Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up.

Conclusions:

Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.
Expression of Neutrophil Gelatinase—Associated Lipocalin in Human Salivary Glands
Authors: Woo Jeong-Soo , Kim Kyoung-Min , Kang Jae Seong , Zodpe Prakash , Chae Sung-Won , Hwang Soon-Jae , Lee Heung-Man
Published: October 2014

Objectives:

We performed an observational study of RNA and protein expression in human tissue to examine the distribution of neutrophil gelatinase–associated lipocalin (NGAL) in normal and chronic inflammatory salivary tissues, and to investigate the expression level of NGAL in inflammatory conditions of salivary glands.

Methods:

Normal salivary gland tissues and tissue samples of salivary glands with chronic sialadenitis were obtained. Expression of NGAL was investigated by reverse transcriptase–polymerase chain reaction, and semiquantitative analysis of these results was also performed. The differential localization and amount of immunoreactivity to NGAL protein was evaluated by immunohistochemistry and Western blot analysis in normal salivary gland tissues and salivary glands with chronic sialadenitis.

Results:

NGAL messenger RNA transcripts were detected in the tissues from the salivary glands with chronic sialadenitis, but only a small amount was detected in the tissues from the normal salivary glands. A weak expression of NGAL protein was occasionally seen in a few ductal epithelial cells of normal salivary gland tissue. However, in tissue samples from glands with chronic sialadenitis, the NGAL protein was expressed strongly in ductal epithelial cells and infiltrating inflammatory cells.

Conclusions:

These results imply that NGAL is associated with the regulation of inflammation in salivary glands.
Nimodipine Improves Reinnervation and Neuromuscular Function after Injury to the Recurrent Laryngeal Nerve in the Rat
Authors: Hydman Jonas , Remahl Sten , Björck Gunnar , Svensson Mikael , Mattsson Per
Published: October 2014

Objectives:

Injury of the recurrent laryngeal nerve (RLN) is associated with a high degree of neuronal survival, but leads to various levels of vocal fold motion impairment or laryngeal synkinesis, which has been attributed to misdirected reinnervation of the target muscles in the larynx or aberrant, competing reinnervation from adjacent nerve fibers. The aim of the present study was to evaluate the impact of the regeneration-promoting agent nimodipine on reinnervation and neuromuscular function following RLN crush injury.

Methods:

Sixty adult rats were randomized into nimodipine-treated or untreated groups and then underwent RLN crush injury. Reinnervation of the posterior cricoarytenoid muscle (PCA) was assessed by electrophysiological examination, retrograde tracing of lower motor neurons before and after injury, and quantification of neuromuscular junctions in the PCA muscle.

Results:

At 6 weeks after injury, the nimodipine-treated animals showed significantly enhanced neuromuscular function and also demonstrated a higher number of motor neurons in the brain stem that had reinnervated the PCA, compared to the untreated animals. The somatotopic organization of ambiguus motor neurons innervating the larynx was similar before injury and after reinnervation.

Conclusions:

Nimodipine improves regeneration and neuromuscular function following RLN injury in the adult rat, and could be of use in future strategies following RLN injury.
Correlation of Bone SPECT Scintigraphy with Histopathology of the Ethmoid Bulla: Preliminary Investigation
Authors: Catalano Peter J. , Dolan Robert , Romanow John , Payne Spencer C. , Silverman Mark
Published: October 2014

Objectives:

Reports in the rhinology literature suggest that osteitis of the ethmoid bone may be responsible for refractory and/or recurrent sinusitis. If so, bone scanning technologies capable of detecting osteitis may be useful in diagnosing this condition and its response to treatment. The objective of this prospective cohort study was to determine the correlation of single photon emission computed tomography (SPECT) bone scintigraphy with the histopathology of the ethmoid bulla.

Methods:

Thirty-six patients with a diagnosis of chronic sinusitis who were scheduled to undergo sinus surgery underwent a presurgical SPECT bone scan using technetium 99m-methylene diphosphonate. All bone scans were done within 5 days of surgery. During the procedure, bone samples from the face of the ethmoid bulla were obtained and examined by a pathologist blinded to the bone scan result. In this study, histopathology consistent with osteitis was defined as a change from lamellar to woven bone. A positive bone scan was defined by the presence of increased radiotracer uptake in the ethmoid sinuses.

Results:

Thirty-two of the 36 patients had a positive bone scan on SPECT imaging, and 31 specimens demonstrated histopathologic bone changes consistent with osteitis, for a sensitivity of 93.9%. An additional 4 patients had a negative bone scan on SPECT imaging, and osteitis was identified in 2 of the 4. The specificity was 66.7%, and the positive predictive value was 96.9%.

Conclusions:

We found that SPECT bone scanning with technetium 99m-methylene diphosphonate is a highly sensitive test for identifying osteitis in patients with chronic rhinosinusitis. It may be a useful tool in the armamentarium of the otolaryngologist to better define this disease process.
Giant Basal Cell Carcinoma of the Forehead with Extensive Intracranial Involvement
Authors: Naumann Ilka Charlotte , Cordes Susan R.
Published: October 2014

Basal cell carcinoma (BCC) is the most common malignant skin lesion and is frequently curatively treated with local excision. Improper removal or neglect of BCC is a particular problem for head and neck surgeons. We describe a case of a recurrent BCC that aggressively grew from the forehead skin through the skull and into the frontal lobe. We also present a review of the literature. Despite its fairly benign growth pattern, BCC should never be underestimated, and care should be taken not only in the complete primary excision but also in cancer surveillance.
Critical Look at the Surgical Approaches of Nasopharyngeal Angiofibroma Excision and “Total Maxillary Swing” as a Possible Alternative
Authors: Dubey Siba P. , Molumi Charles P.
Published: October 2014

Objectives:

We critically analyzed different surgical approaches used for the excision of nasopharyngeal angiofibroma (NPA) at our hospital in a 10-year period and proposed “total maxillary swing” as a possible alternative approach.

Methods:

Retrospective review of the clinical and operative records was done regarding 39 cases of NPA that were surgically managed from 1995 to 2005. The duration of the surgical procedures, amount of blood loss and transfusion, time to recurrence, frequency of recurrence, functional and cosmetic deformity, and complications of all surgical procedures were thoroughly analyzed. These parameters were compared with total maxillary swing, a new approach recently being used by us, for the one-time excision of NPA.

Results:

A total of 61 operations including revision surgeries for recurrences were done in the 39 cases of NPA. Conventional surgical approaches were performed in 37 cases, and the total maxillary swing approach was used in 2 cases. This new approach provided a wider surgical exposure for complete tumor resection and better hemostasis without any recurrence or major functional deformity, which were seen with some of the conventional approaches.

Conclusions:

We found total maxillary swing to be a relatively safe alternate approach for the resection of NPA. We removed the entire tumors in a wider surgical field under the microscope with reduced blood loss and minimal complications or chance of recurrences.
Comparison of Fundamental Frequency Nasalance between Trained Singers and Nonsingers for Sung Vowels
Authors: Fowler Linda P. , Morris Richard J.
Published: October 2014

Objectives:

The purpose of this study was to determine the effect of vocal training on fundamental frequency nasalance measures under selected vowel and frequency conditions.

Methods:

Fundamental frequency nasalance measures were reported for 2 groups of women: 36 trained singers and 36 nonsingers. Each group sang and sustained the vowels (/i/, /æ/, /u/, /a/) for 6 seconds' duration at 3 frequency levels. A 3-second segment from the middle of each vowel was measured to generate fundamental frequency nasalance scores.

Results:

No significant differences were found in the mean fundamental frequency nasalance scores between the trained singers and the nonsingers. The fundamental frequency nasalance scores were significantly higher for front vowels for both groups. Additionally, both groups displayed a pattern of producing significantly higher fundamental frequency nasalance scores at lower fundamental frequencies than at higher fundamental frequencies.

Conclusions:

These findings support the practice of training singers to elevate the velum when singing at high frequencies but not when singing at low ones.
Sleep-Related Deglutition in Children
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

Clearance of the pharynx by deglutition is important in protecting the airway. The pattern of deglutition during sleep was investigated in children.

Methods:

Ten normal human children (8.6 ± 2.9 years) were examined via time-matched recordings of polysomnography and of surface electromyography (EMG) of the thyrohyoid and suprahyoid muscles.

Results:

During sleep, deglutition was episodic, and it was absent for long periods. The mean number of swallows per hour (±SD) during the total sleep time was 2.8 ± 1.7 per hour. The mean period of the longest absence of deglutition was 59.7 ± 20.3 minutes. Most deglutition occurred in association with spontaneous electroencephalographic arousal in rapid eye movement (REM) and non-REM sleep. Deglutition was related to sleep stage. The mean number of swallows per hour was 27.4 ± 27.4 during stage 1 sleep, 3.1 ± 3.5 during stage 2 sleep, 2.8 ± 3.3 during stage 3 sleep, and 0.9 ± 0.8 during stage 4 sleep. The deeper the sleep stage became, the lower the mean deglutition frequency became. The mean number of swallows per hour was 2.2 ± 2.1 during REM sleep. The EMG amplitude dropped to the lowest level of recording during REM sleep.

Conclusions:

Deglutition, a vital function, is infrequent during sleep in children.
Intra-Arterial Chemotherapy Less Intensive Than RADPLAT with Concurrent Radiotherapy for Resectable Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Study
Authors: Yoshizaki Tomokazu , Wakisaka Naohiro , Murono Shigeyuki , Kondo Satoru , Shimizu Yoshinori , Takanaka Tsuyoshi , Sanada Jun-Ichiro , Terayama Noboru , Matsui Osamu , Furukawa Mitsuru
Published: October 2014

Objectives:

This study was designed to evaluate the efficacy and feasibility of our intra-arterial chemotherapy protocol with a lower amount and frequency of cisplatin delivery than in RADPLAT for the treatment of resectable advanced head and neck cancer.

Methods:

Fifty-one patients with advanced squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx were included in this prospective study. The patients were treated with 3 courses of cisplatin (100 mg at 1 treatment, intra-arterial) and sodium thiosulfate (28 g at 1 treatment, intravenous) once every 2 weeks during concurrent radiotherapy (66 to 70 Gy, 2 Gy per fraction, daily for 5 days over 7 weeks). Nodal metastases larger than 3 cm in diameter were treated with an additional 50 mg of cisplatin. The patients with less than 50% tumor reduction after 40 Gy and 2 courses of chemotherapy were treated with surgery.

Results:

The protocol was completed for 49 patients. All living patients had a minimum follow-up period of 2 years. Including the 3 patients with salvage surgery, local disease-free control was achieved in 39 patients (80%). For 36 patients (73.5%), disease-free primary organs were preserved at 2 years after treatment. Locoregional disease-free control for 2 years was obtained for 38 patients (77.6%), in 30 of them without salvage surgery. The patients treated with surgery had an overall survival rate similar to that of the patients with a complete response (80% and 84.6%, respectively). The patients with a partial response had a worse prognosis (40%; p = 0069).

Conclusions:

This treatment regimen is feasible and effective for advanced resectable head and neck cancer.
Development of Endoscopic Arytenoid Adduction Using Cricoid Implant
Authors: Kwon Tack-Kyun , Jeong Woo-Jin , Sung Myung-Whun , Kim Kwang Hyun
Published: October 2014

Objectives:

We sought to develop a less-invasive alternative to conventional arytenoid adduction using a cricoid implant.

Methods:

We performed a preliminary study with excised human and canine larynges. A nail-shaped stainless steel rod and an insertion device were designed for an in vivo animal trial. After unilateral recurrent laryngeal denervation surgery in 5 adult mongrel dogs, the implants were inserted endoscopically through a small mucosal incision over the cricoarytenoid joint. Acoustic and aerodynamic data were obtained from each animal before serial euthanasia followed by examination of the excised larynges.

Results:

The canine cricoid cartilage demonstrated adequate marrow space for implantation. We found that the arytenoid cartilage was successfully medialized and tightly fixed over a sufficient period of time just by inserting an implant in the cricoid cartilage. The animal study showed that the implantation procedure was relatively easy and relatively safe. Acoustic and aerodynamic studies confirmed the functional improvement of the voice. Histopathologic study revealed a favorable tissue response to the implant.

Conclusions:

Endoscopic arytenoid adduction using a cricoid implant is feasible and could be a noninvasive surgical option for the treatment of unilateral vocal fold paralysis.
Drilling Simulated Temporal Bones with Left-Handed Tools: A Left-Hander's Right?
Authors: Torgerson Cory S. , Brydges Ryan , Chen Joseph M. , Dubrowski Adam
Published: October 2014

Objectives:

Left-handed trainees can be at a disadvantage in the surgical environment because of a right-handed bias. The effectiveness of teaching left-handed trainees to use an otologic drill designed for their dominant hand versus the conventional right-handed drill was examined.

Methods:

Novice medical students were recruited from the university community. Twenty-four subjects were left-handed, and 12 were right-handed. Eight left-handed surgeons also participated. A randomized controlled trial was conducted to compare the performance of left-handed trainees using novel left-handed drills to that of left-handed trainees using right-handed tools and to that of right-handed trainees using right-handed tools. The evaluation consisted of 3 phases: Pretest, skill acquisition, and 2 post-tests. The measurement tools included expert assessment of performance, and subjective and objective final product analyses.

Results:

An initial construct validity phase was conducted in which validity of the assessment tools was ensured. Both the left-handers using left-handed tools and the right-handers using right-handed tools significantly outperformed the left-handers using right-handed tools at pretest, immediate posttest, and delayed posttest. All participants improved their performance as a function of practice.

Conclusions:

The left-handed trainees learned bone drilling better with tools designed for the left hand. These tools may be incorporated into residency training programs for the development of surgical technical skills. Future studies should assess skill transfer between the left-handed and right-handed drills.
Prevalence of Upper Airway Tumors and Cysts among Patients Who Snore
Authors: Suzuki Masaaki , Saigusa Hanako , Chiba Shintaro , Hoshino Tadahiko , Okamoto Makito
Published: October 2014

Objectives:

Sleep specialists usually do not pay much attention to the upper airway in patients who snore, because they can make the diagnosis of sleep-disordered breathing without performing nasopharyngeal endoscopy if they have the Epworth Sleepiness Scale scores and the results of polysomnography. The purpose of this study was to determine the prevalence of benign and malignant tumors and cysts in the upper airway in patients who snore.

Methods:

A retrospective multicenter trial was performed in 4 sleep laboratories. Adult male and female patients whose chief complaint on their first visit was witnessed snoring were enrolled in this study. All of the patients were evaluated by otolaryngologists using nasopharyngeal endoscopy to detect organic diseases in the upper airway.

Results:

Among 2,923 patients, 2 patients had malignant tumors, 5 had benign tumors, and 2 had cysts in the upper airway. The prevalence of upper airway benign and malignant tumors and cysts among adult male and female patients was 0.24%.

Conclusions:

Routine detailed nasopharyngeal endoscopy should be carried out in each institution so as not to overlook organic diseases in the upper airway among patients who snore.
Benign Paroxysmal Positional Vertigo in Mountain Bikers
Authors: Vibert Dominique , Redfield Robin C. , Häusler Rudolf
Published: October 2014

We evaluated 4 men who had benign paroxysmal positional vertigo (BPPV) that occured several hours after intensive mountain biking but without head trauma. The positional maneuvers in the planes of the posterior and horizontal canals elicited BPPV, as well as transitory nystagmus. This was attributed to both the posterior and horizontal semicircular canals (SCCs) on the left side in 1 patient, in these 2 SCCs on the right side in another patient, and to the right posterior SCC in the other 2 patients. The symptoms disappeared after physiotherapeutic maneuvers in 2 patients and spontaneously in the other 2 patients. Cross-country or downhill mountain biking generates frequent vibratory impacts, which are only partially filtered through the suspension fork and the upper parts of the body. Biomechanically, during a moderate jump, before landing, the head is subjected to an acceleration close to negative 1 g, and during impact it is subjected to an upward acceleration of more than 2 g. Repeated acceleration-deceleration events during intensive off-road biking might generate displacement and/or dislocation of otoconia from the otolithic organs, inducing the typical symptoms of BPPV. This new cause of posttraumatic BPPV should be considered as an injury of minor severity attributed to the practice of mountain biking.
Chondromyxoid Fibroma of the Temporal Bone: Case Report and Review of the Literature
Authors: Otto Bradley A. , Jacob Abraham , Klein Michael J. , Welling D. Bradley
Published: October 2014

Objectives:

We describe the clinical presentation, imaging, and pathology results of a patient with chondromyxoid fibroma (CMF) involving the mastoid portion of the temporal bone. The literature covering CMF of the head and neck is reviewed.

Methods:

The patient chart, including imaging and pathology results, was analyzed. An English-language literature review of skull base CMF was performed.

Results:

Eighty-seven cases of CMF involving the head and neck have been reported in the scientific literature. Sixty-two cases involved the skull base, temporal bone, nasal cavity, or paranasal sinuses. Including this patient, only 8 cases of CMF isolated to the temporal bone have been reported. Most patients experience insidious onset of symptoms such as hearing loss or headache. A computed tomographic scan best shows the relationship of the tumor to surrounding bone and may show intratumoral calcification. Surgical removal was the treatment most commonly used. Although irradiation has been used in selected cases, it is usually avoided because of the potential risk for malignant transformation.

Conclusions:

Chondromyxoid fibroma, a slow-growing bone tumor, is exceedingly rare within the mastoid. Its differential diagnosis includes chordoma, chondroid chordoma, and low-grade myxoid chondrosarcoma. Surgical excision is the treatment of choice.
Endoscopic Management of Sphenoid Sinus Cerebrospinal Fluid Leaks
Authors: Sautter Nathan B. , Batra Pete S. , Citardi Martin J.
Published: October 2014

Objectives:

Cerebrospinal fluid (CSF) leaks that originate within the sphenoid sinus pose a unique surgical challenge due to difficulties with access and visualization. The objective of this report is to illustrate concepts for the successful management of sphenoid sinus CSF leaks.

Methods:

Retrospective data analysis was performed on 9 patients who presented to a tertiary care medical center for endoscopic repair of a sphenoid sinus CSF leak from January 2002 to January 2006.

Results:

The patient cohort included 7 women and 2 men with a mean age of 51.7 years. In 5 cases the CSF leak was caused by a previous neurosurgical procedure; the other 4 cases were idiopathic. An endoscopic pterygomaxillary fossa approach was required in 4 cases. A layered reconstruction of the sphenoid sinus wall with collagen allografts (cadaveric acellular dermal allograft, 8 patients; bovine collagen membrane, 1 patient) and mucosa under endoscopic visualization with intraoperative surgical navigation was performed in all cases. The reconstruction was buttressed with autologous bone in 2 cases and with cartilage in 2 cases. Fibrin sealant was used in 7 cases. Two patients developed transient diabetes insipidus after the repair. Two patients developed a recurrent CSF leak necessitating revision repair 2 and 15 months, respectively, after the initial repair procedure. The average hospital stay was 6.5 days. The mean length of follow-up was 21.1 months.

Conclusions:

This series demonstrates that minimally invasive endoscopic repair of sphenoid sinus CSF leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Extended endoscopic approaches, including the pterygomaxillary fossa approach, may be useful in selected instances.
Institutional and Comprehensive Review of Laryngeal Leukoplakia
Authors: Isenberg Jason S. , Crozier Daniel L. , Dailey Seth H.
Published: October 2014

Objectives:

The nature and interpretation of vocal fold leukoplakia has been limited by small study sizes. The present study reviewed institutional data and the published literature to better characterize vocal fold leukoplakia.

Methods:

At our institution, the histopathology, age, and malignant conversion rates of 136 patients (208 biopsies) with vocal fold leukoplakia from 1990 to 2005 were reviewed.

Results:

No dysplasia (ND), mild and/or moderate dysplasia (MM), and severe dysplasia and/or squamous cell carcinoma in situ (SS) was identified in, respectively, 110 of 208 (53%), 38 of 208 (18%), and 31 of 208 (15%) biopsies. After 30 months (range, 1 to 134 months), malignant transformation was observed in 8 patients on subsequent biopsies. Additionally, a literature search was performed from 1960 to 2005 for the medical subject headings (MeSH) premalignant laryngeal lesions, laryngeal dysplasia, laryngeal leukoplakia, vocal cord dysplasia, and hyperkeratosis of the larynx. Fifteen reports were included for review. When these were combined with our institutional data, 1,173 of 2,188 biopsies (53.6%) revealed ND. Mild and/or moderate dysplasia and SS were present in 717 of 2,140 (33.5%) and 375 of 2,471 (15.2%) biopsies, respectively. Squamous cell carcinoma developed in 52 of 1,388 (3.7%), 83 of 824 (10.1%), and 56 of 310 (18.1%) patients whose initial biopsies demonstrated ND, MM, or SS.

Conclusions:

More than half of the reported leukoplakia lesions with biopsies showed ND. However, even lesions characterized as ND were associated with an increased risk of development of squamous cell carcinoma. Importantly, the risk of developing malignancy appears to correlate with the severity of dysplasia present on initial biopsy. Because clinical examination does not accurately predict the risk of malignancy, future studies, including genomic evaluation of this lesion, may be necessary to further characterize its biologic behavior.
Office Pulsed Dye Laser Treatment for Benign Laryngeal Vascular Polyps: A Preliminary Study
Authors: Ivey Chandra M. , Woo Peak , Altman Kenneth W. , Shapshay Stanley M.
Published: October 2014

Objectives:

The 585-nm pulsed dye laser (PDL) was recently deemed relatively safe and effective for treatment of laryngeal papilloma, dysplasia, and granuloma. We report on in-office PDL treatment of laryngeal vascular polyps.

Methods:

Retrospective case results from 29 consecutive cases of laryngeal polyps were evaluated to determine the percent change in polyps after PDL treatment. Preoperative and postoperative measurements of polyp size, total power delivered to the site, and whether patients opted for postprocedure phonomicrosurgery were analyzed.

Results:

After PDL treatment, the results varied from complete to partial resolution of the polyp. Four patients requested conventional phonomicrosurgery, and the rest had enough improvement to defer surgery. Almost 40% of patients with larger polyps desired operative intervention after laser treatment, whereas only 13% of those with small polyps opted for phonomicrosurgery. Thirty-eight percent (11 of 29) of the lesions had greater than 70% improvement after 1 or 2 laser treatments (average of 1.1 procedures). Smaller lesions responded better. Thirty-nine percent of small polyps resolved by greater than 70%, whereas only 20% of larger lesions improved by the same amount. There were no adverse events from the office procedure.

Conclusions:

In-office use of the PDL for treatment of vascular polyps may be a safe alternative to phonomicrosurgery. Small polyps seem to show a better response.
Qualification of a Quantitative Laryngeal Imaging System Using Videostroboscopy and Videokymography
Authors: Popolo Peter S. , Titze Ingo R.
Published: October 2014

Objectives:

We sought to determine whether full-cycle glottal width measurements could be obtained with a quantitative laryngeal imaging system using videostroboscopy, and whether glottal width and vocal fold length measurements were repeatable and reliable.

Methods:

Synthetic vocal folds were phonated on a laboratory bench, and dynamic images were obtained in repeated trials by use of videostroboscopy and videokymography (VKG) with an imaging system equipped with a 2-point laser projection device for measuring absolute dimensions. Video images were also obtained with an industrial videoscope system with a built-in laser measurement capability. Maximum glottal width and vocal fold length were compared among these 3 methods.

Results:

The average variation in maximum glottal width measurements between stroboscopic data and VKG data was 3.10%. The average variations in width measurements between the clinical system and the industrial system were 1.93% (stroboscopy) and 3.49% (VKG). The variations in vocal fold length were similarly small. The standard deviations across trials were 0.29 mm for width and 0.48 mm for length (stroboscopy), 0.18 mm for width (VKG), and 0.25 mm for width and 0.84 mm for length (industrial).

Conclusions:

For stable, periodic vibration, the full extent of the glottal width can be reliably measured with the quantitative videostroboscopy system.
Obstruction of the Eustachian Tube Orifice and Pressure Changes in the Middle Ear: Are They Correlated?
Authors: Kindermann Christine Aparecida , Roithmann Renato , Neto José Faibes Lubianca
Published: October 2014

Objectives:

We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear.

Method:

Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear.

Results:

In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001).

Conclusions:

Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.