bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunocytochemical Study of Proteoglycans in Vocal Folds
Authors: Pawlak Agnieszka S. , Hammond Elizabeth , Hammond Thomas , Gray Steven D.
Published: October 2014

We evaluated the proteoglycan composition of normal vocal folds using immunocytochemical techniques. Frozen sections of 14 normal cadaveric vocal folds were obtained within 12 hours of death and sectioned immediately. Vocal fold sections were stained with antibodies against keratan sulfate, chondroitin sulfate, heparan sulfate proteoglycan (HSPG), decorin, and hyaluronate receptor. We found that the lamina propria has diffuse staining of fibrillar components with keratan sulfate and decorin. Intense staining was observed in the vocal ligament area with keratan sulfate. The HSPG was localized to the basement membrane zone. Chondroitin sulfate, HSPG, and hyaluronate receptor were detected in the cytoplasm of interstitial cells with immunocytochemical characteristics of macrophages. The keratan sulfate distribution suggests that fibromodulin may be significant in normal vocal folds. Production of HSPG and probably versican occurs in macrophages and fibroblasts in the lamina propria.
Visualizing the Pediatric Airway: Three-Dimensional Modeling of Endoscopic Images
Authors: Dunham Michael E. , Wolf Rosalee N.
Published: October 2014

Three-dimensional reconstruction of medical images has emerged as an important visualization tool for studying complex anatomy. These tools have found important applications in neurology and plastic surgery using computed tomography (CT) and magnetic resonance imaging (MRI) data. However, CT and MRI do not sufficiently delineate lesions of the pediatric airway. Inspection through the rod lens telescope remains the standard diagnostic method. A video recording of an endoscopic procedure is essentially a sequence of two-dimensional images captured as the telescope traverses the airway lumen. Using digitized endoscopic video recordings and computer graphics reconstruction techniques, we have developed a preliminary three-dimensional modeling system for the pediatric airway. A series of normal and abnormal telescopic airway examinations were video recorded. Serial sections were obtained by digitizing the video images at uniform intervals as the scope traversed the airway lumen between the vocal folds and the carina. The digitized images were calibrated and used to reconstruct the airway lumen in three dimensions. Classifying airway abnormalities according to the minimal cross-sectional area or with descriptive terms can be subjective and dependent on the endoscopist's observational skills. We hope that this preliminary work will lead to more precise and understandable methods for representing complex airway lesions.
Comparative Perilymph Permeability of Cephalosporins and its Significance in the Treatment and Prevention of Suppurative Labyrinthitis
Authors: Sun Ai-Hua , Parnes Lorne S. , Freeman David J.
Published: October 2014

Cephalosporins are nonototoxic antibiotics that provide excellent coverage for almost all bacteria that can cause suppurative labyrinthitis. In this study we performed comparative perilymph permeability determinations of the three cephalosporins that we deemed to have the most clinical potential in these varied situations. Perilymph pharmacokinetic profiles were established for ceftazidime, cefuroxime, and cefotaxime and its metabolite desacetylcefotaxime in 36 guinea pigs by using the technique of high-performance liquid chromatography. At 1,2, 3,4, and 6 hours after intravenous administration of the three cephalosporins at a dose of 100 mg/kg of body weight, ceftazidime consistently exhibited the highest perilymph concentration. Desacetylcefotaxime showed the next highest capacity for penetration into perilymph. Keeping in mind that the choice of drug for the treatment of suppurative labyrinthitis should be based foremost on culture and sensitivity studies, we consider ceftazidime to be the first-line agent for treatment and prevention of both meningogenic labyrinthitis and labyrinthitis complicating acute or chronic otitis media.
Clinical Evaluation of Extracorporeal Shock Wave Lithotripsy for Salivary Stones
Authors: Yoshizaki Tomokazu , Maruyama Yumjxo , Wakasa Rinichiro , Motoi Isamu , Furukawa Mitsuru
Published: October 2014

The treatment of sialolithiasis is discussed in this report. Generally, stones within the distal salivary duct are easily removed by transoral ductotomy, although proximal stones are usually treated by excision of the salivary gland and its duct. Since 1980, extracorporeal shock wave lithotripsy (ESWL) has been in clinical use for the treatment of renal and gallbladder stones. We used this technique as a treatment for sialolithiasis. We undertook ESWL on 14 submandibular gland stone patients, 1 parotid gland stone patient, and 3 submandibular duct stone patients. In 10 of 14 submandibular gland stone patients and 1 parotid gland stone patient, clinical symptoms such as pain and swelling disappeared without excision of the affected salivary gland. Stones larger than 10 mm seem to have a tendency to form Steinstrassen. Although computed tomography findings correlate with success in breaking up gallstones, they did not predict success for salivary stones. We conclude that sialolithiasis is treated successfully without adverse effects by ESWL in selected patients.
Pathophysiology of Reactive Airway Disease and Sinusitis
Authors: Marney Samuel R.
Published: October 2014

The association between asthma and sinusitis was recognized more than a century ago. Since 1980, several studies have documented that severe asthma improved after coexisting sinusitis was effectively treated either medically or surgically. Because the mechanism relating sinusitis to asthma is not known, several theories have been proposed: 1) aspiration of infected sinus secretions into the lungs during sleep, 2) enhanced vagal stimulation in the infected sinus producing direct bronchospasm, 3) bronchospasm from excessive airway drying from mouth breathing, 4) production of bacterial toxins that induce partial beta blockade, and 5) production in the infected sinus of cytokines and bronchoconstrictive mediators. There are data to support each of these hypotheses, and any or all of them may be operative. In view of recent demonstrations of activated lymphocytes and eosinophils in asthmatic airways, it is intriguing that biopsies of chronic hypertrophic sinusitis have revealed increased numbers of eosinophils and increased levels of granulocyte-macrophage colony stimulating factor, interleukin-3, and interleukin-5 compared to control tissue. These findings suggest that sinusitis might induce asthma by stimulating eosinophil production and activation and thereby supplying peptidoleukotrienes (LTC4 and LTD4) and other asthmagenic eosinophil products.
Ontogenetic Expression of Spot 35 Protein (Calbindin-D28K) in Human Olfactory Receptor Neurons and its Decrease in Alzheimer's Disease Patients
Authors: Yamagishi Masuo , Takami Shigeru , Getchell Thomas V.
Published: October 2014

Expression of a calcium-binding protein, spot 35 protein (S-3S, calbindin-D28k), was investigated immunohistochemically in the human olfactory mucosa of patients who ranged in age from 16 weeks of fetal development to 98 years old, including some with Alzheimer's disease (AD). S-35 immunoreactivity was observed clearly in olfactory receptor neurons (ORNs) and olfactory nerve bundles that were identified previously with antibodies to olfactory marker protein (OMP) and neuron-specific enolase (NSE). Throughout all ages, the mean number of ORNs immunoreactive for OMP did not change significantly, whereas the mean number of NSE- and S-35-immunoreactive ORNs declined markedly in the postnatal infant, young, and old patients when compared with that of the prenatal fetuses. S-35-immunoreactive ORNs decreased significantly in AD patients when compared with AD control patients. These results indicate that ORNs in humans express S-35 and that there is an age-related trend in the expression of S-35. Furthermore, the marked decrease of S-35 expression in ORNs of AD patients suggests that cell excitability associated with calcium ions and cell protective function against overload of intracellular calcium ions decline in these patients.
Effects of Platelet Activating Factor on Mucociliary Clearance of the Eustachian Tube
Authors: Ganbo Tetsuya , Nakajima Mayumi , Hisamatsu Ken-Ichi , Inoue Hajime , Kjxushima Kazuhito , Murakami Yoshihiko
Published: October 2014

The effects of platelet activating factor (PAF) on mucociliary clearance of the eustachian tube were investigated both in vitro and in vivo. Normal ciliated epithelium was obtained from the eustachian tube of guinea pigs and incubated with PAF at concentrations ranging from 10−10 to 10−6 mol/L. Ciliary activity was observed under an inverted microscope and quantified photoelectrically. The PAF dose-dependently inhibited ciliary activity. One milliliter each of 10−5 mol/L PAF, 10−5 mol/L prostaglandin E2 (PGE2), 10−5 mol/L PAF and PGE2, or the control solution (0.1 v/v% methanol-phosphate-buffered saline) was directly injected into the tympanic bullae of anesthetized chinchillas. The middle ear was examined by otomicroscopy, tympanometry, and auditory brain stem response in relation to time. The PAF delayed middle ear clearance, and the PGE2 augmented its delay. These findings suggest that PAF inhibits mucociliary clearance of the eustachian tube from the middle ear, and that PGE2 plays an important role in the augmentation of inflammatory disorders.
Bifid Epiglottis
Authors: Goldenberg John D. , Bressler Fred J. , Holinger Lauren D. , Hutchinson Lewis R.
Published: October 2014

The true bifid epiglottis is a rare congenital anomaly typically discovered during the evaluation of stridor in an infant or newborn. While it is not classified as a specific syndrome, there are frequent associations of other congenital anomalies with the bifid epiglottis. These include midline defects (such as microphallus, hypospadius, imperforate anus, and midline laryngeal cleft), endocrine disorders (including congenital hypopituitarism), and central nervous system neoplasms, including hypothalamic hamartoblastoma. The embryogenesis and options for surgical management of this anomaly are reviewed, and one case is presented in detail.
Treatment of Head and Neck Hemangiomas with Recombinant Interferon Alpha 2B
Authors: Soumekh Benhoor , Adams George L. , Shapiro Ralph S.
Published: October 2014

Fifteen patients with head and neck hemangiomas were treated with systemic recombinant interferon alpha 2b (rIFNα2b, Schering). There were 14 infants and 1 adult in the group, ranging in age from 5 weeks to 24 years old. Of the 15 patients in the group, 5 had involvement of the airway. Three of the patients had previously failed alternative systemic therapy. Twelve patients have had a beneficial response. Ten patients have completed the therapy and have been off interferon from 6 to 53 months without reappearance or progression of the disease. Two patients are currently on the therapy with resolving lesions. Three patients had minimal response and underwent successful surgical resection. No major toxicity was encountered during the therapy. Our experience demonstrates that rIFNα2b is a well-tolerated and effective therapy for hemangiomas of the head and neck that require intervention.
Analysis of T Cell Receptor β Chain Repertoire in Middle Ear Effusions
Authors: Takeuchi Kazuhiko , Fujita Yuichi , Tomemori Takashi , Yuta Atsushi , Iriyoshi Noriko , Sakakura Yasuo
Published: October 2014

In order to elucidate the immune response in otitis media with effusion (OME), the polymerase chain reaction was employed to examine T cells in middle ear effusions in patients with OME for utilization of T cell receptor (TCR) variable region genes. Specimens of RNA were extracted from 13 ears of 12 patients (9 children and 3 adults). Oligonucleotide primers specific for individual TCR Vβ gene families were used to amplify TCR gene products in each sample. Although the number of Vβ families utilized by each sample varied from 1 family to 21, a few significant trends emerged. Eleven ears out of 13 expressed Vβ7, which was the most frequently utilized (84.6%) Vβ family among the 24 Vβ families. In 5 of the 13 samples, the number of Vβ families utilized was restricted to 1, which was Vβ7 in all 5 samples. This result indicates the possibility that Vβ7-bearing T cells in the middle ear are responding to a certain common antigen in some cases of OME.
Effect of Oxymetazoline Nose Drops on Acute Sinusitis in the Rabbit
Authors: Bende Mats , Fukami Masaya , Arfors Karl E. , Mark Joakim , Sterna Pontus , Intaglietta Marcos
Published: October 2014

This investigation was designed to evaluate the effect of the common topical nasal decongestant oxymetazoline hydrochloride on the early local tissue defense in an experimental bacterial infection. For that purpose, a bilateral infection of the maxillary sinus was induced in 14 rabbits. Nose drops (oxymetazoline) were instilled in one nasal cavity, and placebo in the other. After 48 hours, the degree of infection was judged by using a semiquantitative inflammatory score to evaluate histologic preparations of the maxillary sinuses. On the oxymetazoline-treated side, we found a significantly higher degree of inflammation. We conclude that oxymetazoline nose drops, commonly used in acute rhinitis and sinusitis, interfere with the normal defense mechanisms during bacterially induced sinusitis, possibly by a decrease in mucosal blood flow.
Experimental Otitis Media with Moraxella (Branhamella) Catarrhalis
Authors: Fulghum Robert S. , Marrow Henry G.
Published: October 2014

Two hundred fifty gerbils and 7 chinchillas were utilized in 11 experiments to determine the effect of inoculating viable and heat-killed suspensions of Moraxella (Branhamella) catarrhalis into the middle ear cavity. Development of otitis media was observed by otoscopy and histopathology. Gerbils were found to be susceptible to 2 × 104 viable M catarrhalis cells. Depending on the number of cells inoculated, the resulting untreated inflammation was a very mild to moderately severe, self-limiting disease with no permanent sequelae except in animals inoculated with high (106 to 107) numbers of bacteria. Viable bacteria could not be isolated from the middle ears 24 hours after inflammation was induced. Heat-killed cells produced less severe acute inflammation with no permanent sequelae. We conclude 1) gerbils and chinchillas are susceptible to a self-limited inflammation caused by M catarrhalis, 2) no infection occurs, since viable bacteria cannot be recovered from middle ear aspirates, and 3) viable cells produce more severe inflammation than heat-killed cells.
“Early” Cancer of the Larynx: The Concept as Defined by Clinicians, Pathologists, and Biologists
Authors: Ferlito Alfio , Carbone Antonino , Rinaldo Alessandra , Desanto Lawrence W. , D'Angelo Luigi , Barnes Leon , Devaney Kenneth O.
Published: October 2014

Since a great deal of confusion surrounds the different uses made by clinicians, pathologists, and biologists of the term, this paper clarifies the concept of “early” cancer of the larynx. Clinically, this is usually a glottic neoplasm in which full cordal mobility is still present; early supraglottic cancer is infrequent, and usually a chance finding. Whatever the site, early laryngeal cancer is a minimally invasive neoplastic lesion that does not invade the muscle or cartilage, but is still capable of metastasis. Being confined to the lamina propria, it is more than a carcinoma in situ but less than a deeply infiltrating carcinoma. Superficial extending carcinoma is therefore an early cancer. Biologically, early cancer belongs to stage II.
Total Tracheobronchial Thrombosis Due to Extracorporeal Membrane Oxygenation
Authors: Duff Brian , Gruber Benjamin
Published: October 2014

Extracorporeal membrane oxygenation (ECMO) is widely used for neonatal respiratory failure that is potentially reversible but unresponsive to conventional management. Because of the anticoagulation necessary for maintaining the extracorporeal circuit, hemorrhagic complications occur in up to one third of patients. We present an unusual and previously unreported complication of ECMO, total tracheobronchial thrombosis. The thrombus filled the entire lower respiratory tract and resulted in airway obstruction and inability to ventilate. The airway was successfully managed with repeated bronchoscopic pulmonary toilet. Our experience and review of the literature provide a summary of ECMO-related complications likely to present to the otolaryngologist, and management strategies are discussed.
Bilateral Evoked Otoacoustic Emissions in a Child with Bilateral Profound Hearing Loss
Authors: Laccourreye Laurence , Huy Esther Tran BA , François Martine , Narcy Philippe
Published: October 2014

Recording of bilateral evoked otoacoustic emissions in a 3-year-old girl with bilateral profound hearing loss is presented. No component of auditory-evoked brain stem potentials was recorded. Findings on computed tomography of the inner ear were within normal limits. At retest 3 months later, these results were unchanged. Explanations for this particular condition are presented together with a review of the literature.
Laryngotracheal Manifestations of Rhinoscleroma
Authors: Amoils C. Philip , Shindo Maisie L.
Published: October 2014

Rhinoscleroma is a rare, chronic granulomatous disease of infective causation. It usually begins in the nose and may progress to involve the larynx and trachea and cause dysphonia, stridor, and airway obstruction. Early rhinoscleroma is usually successfully treated with oral tetracycline, yet laryngotracheal disease may require operative intervention. The disease is rare in the United States, but with an increase in immigration from endemic areas, otolaryngologists should be familiar with the management of this rare disease. Current literature contains only a few reports describing the manifestations of this disease, mostly in the form of case studies. This study is a retrospective review of our institutional experience with the management of 22 patients with rhinoscleroma, 13 of whom had laryngotracheal involvement. The focus of this report is on the clinical manifestations of laryngotracheal scleroma. All of the patients were treated with long-term antibiotics. Nine patients underwent endoscopy with or without dilation and laser excision. Three patients required emergency tracheostomy, all of whom were ultimately decannulated without any sequelae. A rational approach to management of this unusual disease is provided.
Fragmented, Distorted Cricoid Cartilage: An Acquired Abnormality
Authors: Tan Henry K. K. , Chen Jiann-Chyuan , Holinger Lauren D. , Gonzalez-Crussi Frank
Published: October 2014

This paper reports the identification of the fragmented, distorted cricoid cartilage. The laryngeal findings in four patients with this acquired abnormality are presented. The postmortem whole organ serial section of their larynges is described and illustrated with horizontal sections from the Laryngeal Development Laboratory in Chicago. The histopathologic sequence, pathogenesis, and clinical relevance are elucidated.
Adherence of Nontypeable Haemophilus Influenzae to Respiratory Epithelium of Otitis-Prone and Normal Children
Authors: Faden Howard , Foels Thomas , Duffy Linda , Hong Jung J.
Published: October 2014

Three hundred six children were enrolled at birth in a prospective study of otitis media and followed up for 2 years. Adherence of nontypeable Haemophilus influenzae to buccal epithelial cells was compared between otitis-prone children and age- and sex-matched normal controls at birth, 1 year, and 2 years. The mean ± SD/median percent adherence was similar for the two groups at birth (1.6 ± 2.3/1.0 versus 1.2 ± 1.4/1.0; NS) and at 2 years (1.6 ± 1.7/1.5 versus 2.1 ±2.1/1.5; NS). At 1 year of age the adherence rate for the otitis-prone group (2.4 ± 2.6/1.0) was statistically greater than that for the control group (1.0 ± 1.3/0.0; p < .02). Because this difference is probably clinically insignificant, other explanations must be sought for the increased colonization rates of nontypeable H influenzae observed in otitis-prone children.
Bell's Palsy Treatment with Acyclovir and Prednisone Compared with Prednisone Alone: A Double-Blind, Randomized, Controlled Trial
Authors: Adour Kedar K. , Ruboyianes John M. , Trent Christopher S. , Von Doersten Peter G. , Quesenberry Charles P. , Byl Frederick M. , Hitchcock Thomas
Published: October 2014

In a double-blind study, we compared the final outcome of 99 Bell's palsy patients treated with either acyclovir-prednisone (53 patients) or placebo-prednisone (46 patients). For patients receiving acyclovir, the dosage was 2,000 mg (400 mg 5 times daily) for 10 days. Electrical tests included electroneurography and the maximal stimulation test. Univariate comparisons of outcome and electrical tests between the two groups were made with χ2 analysis, Fisher's exact test, and t-tests. The outcome in acyclovir-prednisone-treated patients was superior to that in placebo-prednisone-treated patients. Treatment with acyclovir-prednisone was statistically more effective in returning volitional muscle motion (recovery profile of 10; p = .02) and in preventing partial nerve degeneration (p = .05) than placebo-prednisone treatment. The t-tests indicated that the recovery profile and index means were significantly better for the acyclovir-treated group (recovery profile t = 1.99, p = .051; recovery index t = 2.10, p = .040). We conclude that acyclovir-prednisone is superior to prednisone alone in treating Bell's palsy patients and suggest that herpes simplex is the probable cause of Bell's palsy.
Measuring Patient Benefit from Otorhinolaryngological Surgery and Therapy
Authors: Robinson Ken , Gatehouse Stuart , Browning George G.
Published: October 2014

The Glasgow Benefit Inventory (GBI) is a measure of patient benefit developed especially for otorhinolaryngological (ORL) interventions. Patient benefit is the change in health status resulting from health care intervention. The GBI was developed to be patient-oriented, to be maximally sensitive to ORL interventions, and to provide a common metric to compare benefit across different interventions. The GBI is an 18-item, postintervention questionnaire intended to be given to patients to fill in at home or in the outpatient clinic. In the first part of the paper, five different ORL interventions were retrospectively studied: middle ear surgery to improve hearing, provision of a cochlear implant, middle ear surgery to eradicate ear activity, rhinoplasty, and tonsillectomy. A criterion that was specific to the intervention was selected for each study, so that the patient outcome could be classified as above and below criterion. In all five interventions, the GBI was found to discriminate between above- and below-criterion outcomes. The second part of the paper reports on the results and implications of a factor analysis of patient responses. The factor structure was robust across the study, and so led to the construction of subscales. These subscales yield a profile score that provides information on the different types of patient benefit resulting from ORL interventions. The GBI is sensitive to the different ORL interventions, yet is sufficiently general to enable comparison between each pair of interventions. It provides a profile score, which enables further breakdown of results. As it provides a patient-oriented common metric, it is anticipated that the GBI will assist audit, research, and health policy planning.
Subtotal Carbon Dioxide Laser Arytenoidectomy by Endoscopic Approach for Treatment of Bilateral Cord Immobility in Adduction
Authors: Remacle Marc , Mayné Alain , Lawson Georges , Jamart Jacques
Published: October 2014

Subtotal carbon dioxide (CO2) laser ary tenoidectomy for endoscopic treatment of bilateral immobility of the vocal folds in adduction is a variant of total arytenoidectomy. The principal modification involves preservation of a thin posterior shell providing good postoperative fixation of the arytenoid region. The risk of aspiration is thus averted and collapse of arytenoid mucosa into the larynx during inspiration is prevented. The risk of synechia with the posterior commissure is avoided. The CO2 laser is operated at a working distance of 400 mm with a continuous 7-W beam in superpulse mode. Operation time is thus reduced to approximately half an hour and the risk of postoperative edema is reduced. Tracheotomy is not necessary. Forty-one patients, including 16 men and 25 women, were treated by this technique between 1985 and 1994. Their mean age was 55 ± 17 years, ranging from 11 to 83 years. Follow-up ranged from 1 month to 111 months (9 years 3 months), with a mean of 56 ± 29 months (4 years 8 months). The mean peak forced expiratory flow-peak inspiratory flow ratio (normal = 1), which permits a measurement of respiratory quality, is improved from 3.7 ± 1.4 preoperatively to 1.6 ± 0.5 postoperatively (p < .001). Postoperative voice measurements show a mean vocal intensity of 61 ± 3 dB hearing level, a mean maximum phonation time of 8 ± 4 seconds, and a mean phonation quotient of 397 ± 150 mlVs. As for vocal quality, 38% of the patients now have a near-normal voice according to our high-resolution frequency analysis, and all of the patients retained satisfactory voice quality.
Value of Electromyography in Differential Diagnosis of Laryngeal Joint Injuries after Intubation
Authors: Yin Shengguang S. , Qiu William W. , Stucker Fred J.
Published: October 2014

Laryngeal joint injury or arytenoid dislocation is not an uncommon complication resulting from intubation trauma, and is best evaluated by laryngeal electromyography (EMG) combined with laryngoscopic examinations. Two cases of cricoarytenoid joint injuries after intubation are reported along with laryngeal EMG findings. Early diagnosis of arytenoid dislocation is important for appropriate surgical management and better prognosis. However, the reported cases, because of delayed referrals, showed prolonged cricoarytenoid joint injuries associated with thyroarytenoid muscle denervation or myopathy, and resultant vocal fold immobility. The results of laryngeal EMG in cricoarytenoid joint injuries can be classified into three different patterns: 1) normal recruitment, 2) myopathy, and 3) denervation or reinnervation of the thyroarytenoid muscles. It is particularly valuable to sample different portions of the thyroarytenoid muscles with EMG in order to evaluate different patterns or pathologic changes of the muscles and nerve paralysis.
Histopathologic Changes of the Tympanic Membrane in Acute and Secretory Otitis Media
Authors: Berger Gilead , Sachs Zvi , Sadé Jacob
Published: October 2014

The histopathologic changes observed in 40 normal and inflamed temporal bones of infants and children are reported. The tympanic membranes of patients with acute and secretory otitis media underwent considerable swelling compared to those of normal controls. Tympanic membranes with acute otitis media were thicker than those with secretory otitis media, but the difference was not statistically significant. The epithelial layer showed an increase in the number of cell layers. The lamina propria demonstrated the most significant changes of all layers with a marked swelling due to edema, engorged blood vessels, and inflammatory cell infiltration. Increased numbers of distended capillaries were present, predominantly in the subepithelial connective tissue layer, while infiltration of inflammatory cells was mainly in the submucosal connective tissue layer. By contrast, the involvement of the mucosal layer was modest and was composed of cuboidal cells, except for small islands of metaplastic mucosa with mucus production occasionally encountered in specimens with secretory otitis media.
Facial Canal Dehiscence: A Report of 1,465 Stapes Operations
Authors: Li Daqing , Cao Yulin
Published: October 2014

We retrospectively reviewed 1,465 stapes operations for facial canal dehiscences. The incidence of facial canal dehiscence was found to be 11.4%. A facial canal dehiscence with protrusion of the facial nerve is more common than a dehiscence without protrusion. In addition, 3 cases (0.2%) had a herniation of the facial nerve. Our data suggests that heredity could be one of the factors associated with a facial canal dehiscence. If an operated ear shows a dehiscent facial canal, there is a 29% possibility that the contralateral ear also has a dehiscence. Bilaterality of facial canal dehiscence is, therefore, exceptional.
Evaluation and Management of Hemoptysis in Infants and Children a Report of Nine Cases
Authors: Thompson Jerome W. , Nguyen Chi D. , Schoumacher Robert A. , Lazar Rande H. , Hamdan Firas , Stocks Rose Mary , Van Nguyen K.
Published: October 2014

Hemoptysis is an occasional complication of adult pulmonary disease and is rare in children. The most common causes in adults are infection, bronchiectasis, pulmonary neoplasm, cystic fibrosis, pulmonary infarct, and trauma; in children the most common causes are infection and congenital abnormalities of the cardiopulmonary vasculature. Nine cases of hemoptysis in seven infants and two children will be presented. Two cases were fatal, thus illustrating the importance of rapid and definitive therapy early in the course. One of the fatal cases is the first case report in the otolaryngological literature of fatal hemoptysis in the newborn as a result of vascular anomalies associated with an absent left pulmonary artery. Eight cases of various causes, including small vessel vascular abnormality, trauma, recurrent pulmonary infection, and laryngotracheal papilloma, are discussed. The literature is reviewed, embryology is discussed, and a mechanism of death is theorized for the patient with the congenital vessel anomaly. Management considerations for hemoptysis in infants and children are discussed.
Immunohistochemical Characterization of Benign Laryngeal Lesions
Authors: Courey Mark S. , Scott Margie A. , Shohet Jack A. , Ossoff Robert H.
Published: October 2014

It has been proposed that laryngeal nodules and polyps represent injury to the basement membrane zone of the vocal fold. Repeated trauma from shearing forces produced by excessive or abusive phonation leads to basement membrane zone disruption and thickening. This thickening, along with poorly understood vascular changes, creates the characteristic clinical appearance of the vocal nodule or polyp. As such, to better understand vocal fold nodules it is imperative to characterize the extracellular matrix in this area of injury. Secondary to the small size and relatively acellular nature of these lesions, hematoxylin and eosin (H & E) preparations of histologic material are unsatisfying. A previous study examined this area with immunohistochemical techniques to better characterize its contents. The report, however, contained little information with regard to the clinical appearance of the lesions prior to excision. Therefore, we were prompted to review histologic material from 31 patients who underwent microsurgical excision of 41 benign lesions, vocal nodules (4), polyps (19), polypoid corditis (4), and cysts (14) with immunohistochemical techniques to characterize the patterns of fibronectin and collagen type IV within these lesions. Normal human vocal folds were stained for control. All material was correlated with the H & E preparations and the clinical diagnosis. Collagen type IV and fibronectin appeared present in relatively abnormal patterns in the areas adjacent to the lesion. This study validates earlier results. In addition, correlation with clinical data allows association of immunohistochemical staining patterns with clinical diagnosis.
Omohyoid Muscle Transposition for the Treatment of Bowed Vocal Fold
Authors: Kojima Hisayoshi , Hirano Shigeru , Omori Koichi , Shoji Kazuhiko , Honjo Iwao
Published: October 2014

Imperfect glottal closure is usually the most important factor causing dysphonia in patients with bowing of the vocal folds. We have performed laryngeal framework surgery, which allows the medialization of the vocal folds from the outside without creating any scar tissue on them. Over the past 6 years, however, we encountered three cases with marked bowing of the vocal folds that could not be cured by laryngeal framework surgery alone. We used an open laryngeal procedure in these cases, even though such procedures had been considered contraindicated in the treatment of hoarseness. After performing a laryngofissure, we made a small pocket beneath the vocal fold mucosa at the anterior commissure. The superiorly based omohyoid muscle flap was then transposed into the mucosal pocket and sutured to the vocal process. This procedure should be considered an option in treating highly bowed vocal folds.
Nitrergic Innervation of the Rat Larynx Measured by Nitric Oxide Synthase Immunohistochemistry and Nadph-Diaphorase Histochemistry
Authors: Tadaki Nobuhisa , Tanaka Masaki , Hisa Yasuo , Uno Toshiyuki , Okamura Hitoshi , Koike Shinobu , Ibata Yasuhiko
Published: October 2014

We evaluated the involvement of nitric oxide (NO) in the laryngeal innervation of rats using NADPH-diaphorase (NADPH-d) histochemistry and neuronal nitric oxide synthase (nNOS) immunohistochemistry. The findings obtained by NADPH-d histochemistry were identical with those obtained by nNOS immunohistochemistry, indicating that NADPH-d is nNOS in the laryngeal innervation system. We found NADPH-d-positive nerve fibers in every region of the larynx. In the epithelia of the mucosa, a small number of NADPH-d-positive nerve fibers were detected. The plexus of NADPH-d-positive nerve fibers was commonly found in the lamina propria, and some of these fibers were clearly associated with blood vessels. We also noted NADPH-d-positive nerve fibers in the region of laryngeal glands. Some of these fibers appeared to terminate in the glandular cells. We found NADPH-d-positive nerve fibers with varicosities in the intrinsic laryngeal muscle and free-ending nerve fibers on the muscle fiber. Motor end plate-like structures were positive for NADPH-d histochemistry. The NADPH-d-positive nerve fibers appeared to terminate at motor end plate-like structures in two of nine rats examined. A cluster of NADPH-d-positive neurons were occasionally present in the lamina propria of the laryngeal mucosa, in the connective tissue between the thyroid cartilage and intrinsic laryngeal muscle, and in the connective tissue near the cricoarytenoid joint. The present findings suggest that NO participates in the autonomic, sensory, and motor innervation of the larynx.
Laryngeal Lymphoma Derived from Mucosa-Associated Lymphoid Tissue
Authors: Horny Hans-Peter , Ferlito Alfio , Carbone Antonino
Published: October 2014

Extranodal lymphomas account for as many as 40% of non-Hodgkin's lymphomas, and most arise in the gastrointestinal tract, but other mucosal organs may be involved, especially the upper aerodigestive tract. Low-grade B-cell lymphomas arising in the gastrointestinal tract and other mucosae have been found to recapitulate the structure and cytologic features of mucosa-associated lymphoid tissue (MALT). Histologically low-grade MALT lymphomas are characterized by centrocyte-like B-cells with a phenotype similar to that of so-called marginal zone B-cells. Tumors evolving from MALT are generally rare among lymphomas of the upper aerodigestive tract, but a few cases of laryngeal lymphomas derived from MALT have been reported. Primary MALT lymphoma of the larynx should always be considered in tumors with histopathologic features of low-grade B-cell lymphoma, or so-called pseudolymphoma
Long-Term Follow-up of Recurrent Laryngeal Nerve Avulsion for the Treatment of Spastic Dysphonia
Authors: Jewett Brian S. , Stone R. E. , Weed Donald T. , Rainey Cheryl , Ossoff Robert H. , Zealear David L. , Netterville James L.
Published: October 2014

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.
Residue of Middle Ear Cholesteatoma after Intact Canal Wall Tympanoplasty: Surgical Findings at One Year
Authors: Gyo Kiyofumi , Hinohira Yasuyuki , Sasaki Yasushi , Yanagihara Naoaki
Published: October 2014

The rate of residual disease after surgery for acquired middle ear cholesteatoma was investigated in 167 ears of 164 patients who had undergone planned second-look tympanoplasty by the intact canal wall technique. Overall, operative findings at the second stage revealed 65 cases of residual disease in 48 ears (29%). These consisted of 50 squamous pearls, 11 cases of the flat, open type, and 4 cases of the extensive type. The configuration of residual disease is closely related to the technical difficulty of eradication, since en bloc removal is much easier in the squamous pearl than in the open or extensive type, mainly because of the unclear margin with the surrounding tissues. The proportion of cases of the open type was greater in children than in adults, in pars tensa cholesteatoma than in pars flaccida cholesteatoma, and in severe primary middle ear disease than in moderate or mild disease, although these differences were not statistically significant. The extensive type occurred in 4 ears with severe primary disease, 3 of which were in children. These results support the value and importance of the staged procedure for middle ear cholesteatoma, particularly when operated on by the intact canal wall technique.
Circulating Intercellular Adhesion Molecule-1 and its Cellular Expression in Head and Neck Non-Hodgkin's Lymphomas, Including Lethal Midline Granuloma
Authors: Harabuchi Yasuaki , Kataura Akikatsu , Imai Kohzoh
Published: October 2014

Extranodal non-Hodgkin's lymphoma in the head and neck, especially T-cell lymphoma of the lethal midline granuloma (LMG) type, has unique clinical and histologic features differentiating it from other lymphomas. The authors measured soluble intercellular adhesion molecule-1 (ICAM-1) in sera from 12 patients with T-cell lymphoma of the LMG type and from 52 patients with other head and neck non-Hodgkin's lymphomas, by double-determinant immunoassay. The expression of ICAM-1 in lymphoma tissue was examined in 26 patients by the avidin-biotin immunoperoxidase method. The serum ICAM-1 levels were significantly higher in T-cell lymphoma of the LMG type than in other head and neck lymphomas or in healthy adult controls. Elevated levels of serum ICAM-1 were associated with increased levels of serum lactate dehydrogenase, poor prognosis, and impaired T-cell-dependent immune functions, both in T-cell lymphoma of the LMG type and in other head and neck lymphomas. When we monitored serum ICAM-1 levels in individual patients, the levels decreased in the complete remission interval compared to before treatment and went up again when the lymphoma relapsed. Although the staining intensities of ICAM-1 in lymphoma cells were not related to serum ICAM-1 levels, a markedly intense expression of ICAM-1 was found on the angiocentric or angiodestructive lymphoreticular infiltrate region in the tissues from T-cell lymphoma of the LMG type. A higher serum ICAM-1 levelanditstissue expression in T-cell lymphoma of the LMG type may be one of the clues to understanding this particular lymphoma. The serum ICAM-1 level could be an efficient parameter for monitoring the clinical course of head and neck non-Hodgkin's lymphomas.
Electrical Pacing of the Paralyzed Human Larynx
Authors: Rainey Cheryl L. , Herzon Garrett D. , Zealear David L. , Netterville James L. , Ossoff Robert H.
Published: October 2014

This study represents the first attempt to electrically pace the paralyzed human larynx. The goal was to determine if electrical stimulation of the posterior cricoarytenoid muscle could produce functional abduction of the vocal fold in pace with inspiration. An external apparatus was used to sense inspiration and reanimate the unilaterally paralyzed larynx of a thyroplasty patient. Stimuli were delivered through a needle electrode to locate and pace the abductor muscle. The magnitude of electrically induced abduction was comparable to spontaneous movement on the normal side. The abduction was appropriately timed with inspiration; this finding demonstrated that this simple pacing system could effectively modulate stimulation with patient respiration.
Role of the Agger Nasi Cell in Chronic Frontal Sinusitis
Authors: Jacobs Joseph B. , Shpizner Barry A. , Brunner Eugenie , Lebowitz Richard A. , Holliday Roy A.
Published: October 2014

Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.
Semon's Law Revisited: An Electromyographic Analysis of Laryngeal Synkinesis
Authors: Blitzer Andrew , Jahn Anthony F. , Keidar Anat
Published: October 2014

Felix Semon's fascination with vocal fold paralysis led to his theory attributing medialization to isolated abductor paralysis. Later, the Wagner-Grossman hypothesis explained the vocal fold position on the basis of cricothyroid muscle activity. Other authors since that time have dispelled the notion of a role for the cricothyroid muscle in vocal fold position with paralysis. Utilizing laryngeal electromyography, several authors have found electrical activity suggestive of variable reinnervation and synkinesis. This current study included patients with persistent vocal fold immobility. Fourteen patients were studied: half with good voice and half with poor voice. The patients with good voice had a relatively normal arytenoid position and evidence of synkinesis. The group with poor voice had an arytenoid that tipped into the laryngeal inlet and had denervation or poor reinnervation. This suggests that the medialization and upright position of the arytenoid is due to synkinesis.
Benign Paroxysmal Positional Vertigo of Posterior Semicircular Canal: Results in 160 Cases Treated with Semont's Maneuver
Authors: Serafini Giovanni , Palmieri Anna Maria Rosaria , Simoncelli Constantino
Published: October 2014

One hundred sixty patients affected by benign paroxysmal positional vertigo of the posterior semicircular canal were treated with Semont's maneuver. Complete recovery after only one session was achieved in more than 50% of cases. After a maximum of five sessions, almost all patients had recovered; only 8 needed another kind of rehabilitation. No drug therapy was required for any patient.
Dimensions of the Sinus Tympani and its Surgical Access VIA a Retrofacial Approach
Authors: Ozturan Orhan , Miller Charles C. , Bauer Carol A. , Jenkins Herman A.
Published: October 2014

The sinus tympani (ST) is a critical anatomic region of the temporal bone. It lies medial to the facial nerve, between the ponticulus and the subiculum, and therefore is not easily visualized by routine surgical approaches to the middle ear and mastoid. This limited access makes the ST a site that is notorious for residual cholesteatoma. An extensive evaluation of the anatomic dimensions of the ST was made from human temporal bones. Three hundred twenty-seven bones were examined at four standardized levels to describe the dimensions and anatomic relationships of the ST with other structures of the temporal bone. The region of the stapedial tendon was found to be the most limited anatomic substructure in the vicinity of the ST. This study demonstrates the feasibility of a retrofacial approach to the ST as an aid in eradication of otherwise hidden disease.
Pneumatization of the Tympanic Bulla after Blockage of the Ventilation Route through the Eustachian Tube in the Pig
Authors: Ikarashi Fumio , Nakano Yuichi , Okura Takahiro
Published: October 2014

To examine whether gas exchange occurs in the middle ear air cell system independent of the eustachian tube (ET), we occluded the middle ear clefts of piglets, whose tympanic bullae closely resemble the human mastoid air cell system, and investigated subsequent changes in the air cell system. We anticipated that pneumatization and development of the air cell system would continue if gas were exchanged through the mucosa lining the air cell system. If, on the other hand, mastoid air cells depend on the ET, mastoid development would be impaired or arrested. In noninflamed ears, pneumatization was maintained, and development of the air cell system continued after the middle ear cleft had been occluded with an acrylate adhesive and the bullar air cell system was thus excluded from any communication with the ET. These results indicate that the normal middle ear air cell system has the capacity to perform gas exchange independently of the ET, with gas exchange appearing to occur through the submucosal capillary network.