bluuebunny/crossref_metadata_2025 huggingface dataset:
Production of Diagnostic Rules from a Neurotologic Database with Decision Trees
Authors: Kentala Erna , Pyykkö Ilmari , Viikki Kati , Juhola Martti
Published: October 2014

A decision tree is an artificial intelligence program that is adaptive and is closely related to a neural network, but can handle missing or nondecisive data in decision-making. Data on patients with Meniere's disease, vestibular schwannoma, traumatic vertigo, sudden deafness, benign paroxysmal positional vertigo, and vestibular neuritis were retrieved from the database of the otoneurologic expert system ONE for the development and testing of the accuracy of decision trees in the diagnostic workup. Decision trees were constructed separately for each disease. The accuracies of the best decision trees were 94%, 95%, 99%, 99%, 100%, and 100% for the respective diseases. The most important questions concerned the presence of vertigo, hearing loss, and tinnitus; duration of vertigo; frequency of vertigo attacks; severity of rotational vertigo; onset and type of hearing loss; and occurrence of head injury in relation to the timing of onset of vertigo. Meniere's disease was the most difficult to classify correctly. The validity and structure of the decision trees are easily comprehended and can be used outside the expert system.
Mucociliary Transport Pathway on Laryngotracheal Tract and Stented Glottis in Guinea Pigs
Authors: Lee Shiann-Yann , Tan Ching-Ting , Yeh Te-Huei , Su Mao-Chang , Lou Pei-Jen , Montgomery William W.
Published: October 2014

We investigated the laryngotracheal mucociliary transport pathway of guinea pigs in vivo and immediately postmortem. Only intraperitoneal anesthesia was used during the procedure to avoid the disturbance of mucociliary function. Resin particles were used as the marking substance. A microcolpohysteroscope was placed at different levels in the laryngotracheal region for observing the marking particles and recording the transport pattern. The tracheal mucociliary transport flow primarily moved along the posterior wall and both lateral walls in a zigzag trace. Upon reaching the subglottis, the resin particles stayed underneath the vocal cords, and a whirlpool phenomenon developed. The majority of the particles were shifted and directed onto the posterior glottic area. With a short delay, some resin particles crossed over the free edge of the vocal cords and turned posteriorly along the medial upper cordal margin. No mucociliary transport could be observed on the entire upper surface of the true vocal cords, which is covered by squamous epithelium. Occasionally, a few resin particles in the vicinity of the epiglottic root traveled along the aryepiglottic folds toward the posterior commissure. All streams of mucociliary transport finally joined together in the interarytenoid area. After leaving the glottis, the resin particles traveled to the hypopharynx and entered the esophagus through the motion of deglutition. The pattern of mucociliary clearance in the laryngotracheal region was not delayed by stenting.
Histopathologic Study of Alternative Substances for Vocal Fold Medialization
Authors: Stein Jeannine , Eliachar Isaac , Myles Jonathan , Munoz-Ramirez Hector , Strome Marshall
Published: October 2014

This research investigated the histopathologic and migratory properties of injectable alternatives for vocal fold medialization. Thirteen dogs underwent sectioning of the recurrent laryngeal nerve followed by vocal fold injection with 1 of 4 substances: Teflon, autologous fat, silicone suspension, or hydroxyapatite cement. Six months later, the animals were painlessly sacrificed and histopathologic analysis of the larynx and regional lymph nodes was performed. Although regional lymph node migration was noted, Teflon injection resulted in minimal vocal fold inflammatory reaction. Vocal folds injected with autologous fat exhibited persistence of fat at the injection site without significant inflammation or migration. Silicone suspension caused a localized giant cell reaction without regional lymph node migration, and 1 study subject died secondary to acute inflammation with critical respiratory compromise. Hydroxyapatite cement was well tolerated without inflammation or migration. This pilot study indicates that a wide range of possible substances for vocal fold medialization exist. Many of these may produce results superior to those obtained with Teflon and are thus far untested.
Sinusitis and Carotid Artery Stroke
Authors: Barreto María Perez , Sahai Soma , Ameriso Sebastián , Ahmadi Jamshid , Rice Dale , Fisher Mark
Published: October 2014

The relationship between sinusitis and ischemic stroke is unexplored. The anatomic proximity between the paranasal sinuses and the internal carotid artery suggests that inflammation of the sinuses could easily extend to the intracranial vasculature. We report 4 patients with acute ischemic stroke and extensive disease of the paranasal sinuses. All patients had large vessel stroke involving the internal carotid artery territory. All patients had extensive disease of the sphenoid and other sinuses. The sinus disease was demonstrated by magnetic resonance imaging. These case report observations suggest a relationship between inflammation of the paranasal sinuses, particularly sphenoid sinusitis, and ischemic stroke.
Osteomyelitis of the Skull Base with Atypical Onset and Evolution
Authors: Magliulo Giuseppe , Varacalli Serena , Ciofalo Andrea
Published: October 2014

Skull base osteomyelitis arises as a complication of malignant external otitis, but it can be also due to middle ear and/or mastoid infection. Other causes can be infections of the paranasal sinuses or of the mandible or maxilla due to odontic caries. Generally, osteomyelitis involves elderly patients affected by diabetic immunodeficiency or microvascular disease. In this paper, we present 3 new cases of skull base osteomyelitis with atypical onset and evolution. The difficulties of diagnosis and details of the management are discussed.
Effect on Families and Caregivers of Caring for a Child with Laryngomalacia
Authors: Milczuk Henry A. , Johnson Stephen M.
Published: October 2014

We used a retrospective chart review and telephone interviews using a standard format to 1) measure the outcome and psychosocial costs of caring for a child with upper airway obstruction due to laryngomalacia and 2) develop an epidemiologic instrument that measures the impact on the lives of families who have a child with laryngomalacia. Forty-four patients had laryngomalacia documented by endoscopy between 1993 and 1997. Complete follow-up information through 1998 was available on 26 patients. Of the 44 patients, 37 were managed expectantly and 7 (16%) required surgical intervention. Polysomnograms were obtained on 11 before neonatal discharge. Twelve patients wore an apnea monitor for at least 1 month. The quality of life analysis found that the majority of caregivers were not substantially affected by caring for the stridorous child. Loss of sleep and heightened anxiety were commonly reported by these caregivers. Younger parents or parents with fewer than 3 other children were more affected by caring for a child with laryngomalacia. There was no substantial loss of workdays, increase in doctor visits, or difficulty in obtaining day care. Caring for a child with laryngomalacia results in minor disruption of a family's lifestyle.
Surgical Planning of the Treatment of Cholesteatoma and Postoperative Follow-Up
Authors: Sadé Jacob
Published: October 2014

There is no single surgical treatment of choice for aural cholesteatoma. The extent of the cholesteatoma, the amount of preoperative destruction, and the size of the mastoid pneumatization should guide the surgeon in choosing the type of operation for a particular ear — which may range from a simple extraction of the cholesteatoma (delivery) all the way to a radical mastoidectomy. It is the clinical acumen that will determine the type of surgery for a given cholesteatomatous ear, algorithms being of little use in the complex situation of a pathological condition with infinite variables. However, even when the most suitable surgical modality is chosen by the best of surgeons, the operated ear will still be left with the innate cause of the cholesteatoma, namely, its Physiopathologic background and its tendency to develop a negative gas balance in the middle ear. Because of this tendency to redevelop negative middle ear pressure, insertion and reinsertion of ventilation tubes are often necessary to prevent recurrent retractions and maintain aeration of the middle ear in posterior tympanotomies and modified radical mastoidectomies. Further, when the mastoid bowl is marsupialized, as in radical and modified radical mastoidectomies, the mastoid bowl is often not self-cleansing, thus periodically requiring the help of the otologist to keep it clean and dry. My study consisted of a long-term follow-up of 368 cholesteatomatous ears, which were operated on according to 6 different surgical modalities, ie, 112 radical mastoidectomies, 88 modified radicals, 72 posterior tympanotomies, 52 atticotomies, 36 deliveries, and 8 obliterations. Of the 368 ears, 11% did not require any postoperative toilet, whereas 89% required revisiting the surgeon periodically on an average of every 5 months, for cleansing of the mastoid cavity or securing the aeration of the middle ear by reinserting a ventilation tube.
Slow-Release 5-Fluorouracil and Triamcinolone Reduces Subglottic Stenosis in a Rabbit Model
Authors: Ingrams Duncan R. , Ashton Paul , Shah Rahul , Dhingra Jagdish , Shapshay Stanley M.
Published: October 2014

A previous pilot study suggested that a sustained-release conjugate that provided a slow release of 5-fluorouracil and triamcinolone acetonide injected into the tracheal and paratracheal tissues of rabbits at the time of subglottic surgery reduced the formation of subglottic stenosis. Our study was undertaken to confirm the effect. Ten milligrams of the compound suspended in hyaluronic acid was injected at the time of injury via a laryngofissure approach. The results showed that the control group had a mean stenosis of 52%, whereas the treated group had a mean stenosis of 32%. There was a significant difference between the treated and untreated groups (p = 003). It is hoped that this co-drug ultimately can be used in humans to reduce stenosis formation after laryngotracheal surgery and in other forms of otorhinolaryngological surgery.
Experimental Autoimmune Inner Ear Disease: An Electrocochleographic and Histophysiologic Study
Authors: Bouman Henk , de Groot John C. M. J. , Klis Sjaak F. L. , Smoorenburg Guido F. , Meeuwsen Frits , Veldman Jan E.
Published: October 2014

Systemic immunization with swine inner ear antigens in complete Freund's adjuvant induces functional disturbances in the cochlea. Morphometric data indicate that an endolymphatic hydrops develops within 2 weeks. It diminishes 6 weeks after immunization. A progressive decrease in the compound action potential amplitude is observed from 2 to 6 weeks after immunization. Enhancement of the amplitude of the summating potential is present without a clear overall correlation to the presence of endolymphatic hydrops. The amplitude of the cochlear microphonics shows no significant changes after immunization. Western blot analysis of the sera performed 2 and 6 weeks after immunization shows enhanced reactivity at 68,50,45, and 27 kd molecular weights, as compared to controls. The same spectrum of cross-reacting antibodies is believed to be instrumental in immune-mediated sensorineural hearing loss in patients. Apparently, cross-reacting antibodies and released mediators disturb cochlear homeostasis, resulting in the observed changes in the electrophysiological responses. However, these changes are not clearly related to structural changes at the light and electron microscopic levels.
Quantification of the Three-Dimensional Displacement of Normal Facial Movement
Authors: Coulson Susan E. , Croxson Glen R. , Gilleard Wendy L.
Published: October 2014

This study was undertaken to quantify 3-dimensional (3-D) facial movement in normal subjects, and to identify the individual axes in which this movement occurred. Displacement data on 42 subjects were collected and analyzed with the Expert Vision Motion Analysis System. The 3-D displacement was calculated by vectorially subtracting maximum marker movement from previously identified reference marker points. The 3-D range of normal facial movement was quantified, with the greatest displacement occurring during maximum smile. When the individual axes were examined, we found that most movement occurred in the vertical axes for the majority of expressions, followed by the anterior-posterior axis. These results may create an objective baseline from which disorders of the facial nerve, and hence, medical, surgical, and physiotherapy treatment interventions, can be analyzed in the future.
Prevention of Pharyngoesophageal Spasm after Laryngectomy with a Half-Muscle Closure Technique
Authors: Deschler Daniel G. , Doherty E. Thomas , Hayden Richard E. , Reed Charles G. , Singer Mark I.
Published: October 2014

Because pharyngoesophageal spasm can limit successful voice restoration after total laryngectomy, 24 patients underwent a modified pharyngeal closure in an effort to avoid this problem. All patients underwent total laryngectomy with appropriate neck dissections and pharyngeal closure with a half-muscle closure technique in which only one side of the remnant constrictor muscles was used to reinforce the primary closure. Twenty-three patients underwent voice restoration. Twenty-two (96%) had a functional voice, and 1 patient (4%) had pharyngoesophageal spasm that required a secondary myotomy. One fistula (4%) occurred and resolved with conservative measures. Quantitative voice analysis demonstrated no significant differences between half-closure patients and control patients for fundamental frequency (96 Hz versus 101 Hz) or intensity (57 dB versus 64 dB). Extensive qualitative analysis by trained and naive listeners revealed no differences. This preliminary report indicates the half-muscle closure modification of the pharyngeal closure at primary laryngectomy may provide a simple and effective means of avoiding pharyngoesophageal spasm and maintaining an effective voice without increased complications.
Length of the Eustachian Tube and its Postnatal Development: Computer-Aided Three-Dimensional Reconstruction and Measurement Study
Authors: Ishijima Ken , Sando Isamu , Suzuki Chiaki , Balaban Carey , Takasaki Kenji
Published: October 2014

Eleven normal human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals whose ages were 3 months to 88 years were studied to investigate the path length along the ET lumen and its postnatal development by means of a computer-aided 3-dimensional reconstruction and measurement method. The path length of the ET lumen of the 3-month-old infant was 21.2 mm, and its growth was in correlation with age to attain its adult length (average, 37.00 ± 4.16 mm). The ratio of the length of the cartilaginous portion together with the junctional portion to the length of the bony portion was 8:1 in an infant at the age of 3 months and 4:1 in adults. That the bony portion of the ET develops relatively more than the cartilaginous and junctional portions may cause this finding. In addition, there is a developmental shift in the orientation of the cartilaginous portion with respect to the bony portion of the ET. In children, the cartilaginous and bony portions are both aligned with the line that connects the pharyngeal orifice and the tympanic orifice. In adults, however, the cartilaginous portion is angled inferiorly and laterally from the bony portion. This change may reflect the relative growth of the face.
Effects of Dehydration on Phonation in Excised Canine Larynges
Authors: Jiang Jack , Verdolini Katherine , Jennie NG , Aquino Ben , Hanson David
Published: October 2014

The effects of exposure to dry air on phonation were measured in an ex vivo model of vocal fold vibration. Excised canine larynges were mounted on an apparatus and made to phonate at a constant subglottal pressure by means of unhumidified airflow. The phonation threshold pressure (FTP), glottal airflow, sound intensity of the acoustic output, and effects on vocal efficiency were also assessed. Student's r-test was performed on the results. In 17 larynges, the average PTP increased from 10.0 cm H2O to 15.0 cm H2O after exposure to dry airflow (p < .001). In addition, the average flow increased from 585 mL/s to 801 mL/s at a constant suprathreshold subglottal pressure (p < .001), and from 323 mL/s to 610 mL/s at the PTP (p < .001). The average acoustic output levels, measured during stable phonation segments, markedly decreased with exposure to the dry airflow, from 91.5 dB to 88.5 dB (p < .001). The average vocal efficiency decreased from 3.63 × 10−4 to 7.00 × 10−5 (p < .001). No such changes were seen in control larynges phonated with 100% humidified air used for driving the airflow. The results support previously reported modeling and experimental findings that dehydration of the vocal fold generally degrades laryngeal performance.
Site of Airway Collapse in Obstructive Sleep Apnea after Uvulopalatopharyngoplasty
Authors: Farmer Wayne C. , Giudici Stanley C.
Published: October 2014

The objective of this prospective study was to determine the site and pattern of upper airway collapse by a multiple-catheter technique in subjects demonstrated to have obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Standard diagnostic nocturnal polysomnography (PSG) was done on all subjects. The PSG recordings included electroencephalogram, electro-oculogram, electrocardiogram, chin and leg electromyograms, nasal and oral airflow, and abdominal effort. Polysomnography with a multiport flexible airway Gaeltec catheter was performed in 22 subjects. The Gaeltec flexible airway catheter has 4 high-fidelity pressure sensors to aid in determining the primary site of airway collapse. The primary site of airway collapse was determined by differential pressure gradients between pressure ports and by visual inspection of the pressure tracings. Forty-two subjects with prior UPPP from a total of 60 (39 men and 3 women, ages 33 to 61) agreed to be to studied by the standard PSG technique. Thirty-five subjects complained of excessive daytime sleepiness. Ten had mild OSA, 10 had moderate OSA, 12 had severe OSA, and 10 were “normal.” Of the 22 subjects who had airway catheter monitoring, 3 of the normals were reclassified as having upper airway resistance (mean peak negative esophageal pressure of —28 cm H2O); 2 patients demonstrated airway obstruction in the nasopharynx, 2 at the oropharynx, and 11 at the level of the hypopharynx. Postoperative nocturnal PSG data were compared to data gathered prior to UPPP. The mean respiratory disturbance index (RDI) for the catheter group was 54 events per hour prior to UPPP, and the mean RDI after surgery was 44. There was no correlation between the severity of OSA and the stage of sleep. We conclude that the majority of patients who complain of excessive daytime sleepiness following UPPP have OSA with the primary site of obstruction at the level of the hypopharynx. The severity of airway collapse is variable during each stage of sleep. Esophageal pressure monitoring during sleep should be considered when evaluating symptoms of persistent OSA in patients who have had UPPP.
Comparison of Functional Endonasal Sinus Surgery with and without Partial Middle Turbinate Resection
Authors: Havas Thomas E. , Lowinger David S. G.
Published: October 2014

The aim of endonasal sinus surgery is to ameliorate sinonasal symptoms and to achieve a functional nose. Although the importance of opening the ostiomeatal complex is accepted, the role of middle turbinate surgery remains controversial. Although some surgeons emphasize the importance of maintaining the middle turbinate as a physiological humidifier and anatomic landmark, others resect it without adverse sequelae. To date, there have only been limited reviews published to support either approach. This paper examines 1,106 matched patients who underwent similar functional endonasal sinus surgery with (509 patients) or without (597 patients) middle turbinate surgery. We demonstrate a paucity of complications and the potential outcome benefits of judicious partial middle turbinate resection in some patients with more severe rhinosinusitis.
Lack of Predictive Value of the Epworth Sleepiness Scale in Patients after Uvulopalatopharyngoplasty
Authors: Giudici Stanley , Andrada Timothy , Farmer Wayne , Torrington Kenneth , Dollinger Anthony , Rajagopal Krishnan
Published: October 2014

The Epworth Sleepiness Scale (ESS) has been recognized as a valid measure of sleep propensity. Statistically significant correlations between ESS scores, the respiratory disturbance index (RDI), and the lowest arterial oxygen saturation (LSAT) have been described in patients with surgically untreated obstructive sleep apnea (OSA). We investigated whether the same relationships hold true after uvulopalatopharyngoplasty (UPPP). Forty-two adults with documented OSA treated by UPPP were reevaluated with the ESS questionnaire and 8-hour diagnostic nocturnal polysomnography (nPSG). We found no significant correlation between the ESS scores and the RDI or LSAT in patients after UPPP. Because postoperative ESS scores do not correlate with the RDI or LSAT, we conclude that the ESS is not a reliable surrogate for nPSG testing.
Ultrastructure of the Vocal Process of the Arytenoid Cartilage
Authors: Sato Kiminori , Hirano Minoru , Nakashima Tadashi
Published: October 2014

An investigation of the ultrastructure of the vocal process of the arytenoid cartilage was performed on excised human adult larynges. The results are summarized as follows. 1) The size of the chondrocytes is small and their density is high at the tip of the vocal process. 2) The size of the chondrocytes increases and their density decreases toward the posterior portion of the vocal process. 3) At the tip of the vocal process, the collagenous fibers are thin and run in various directions. 4) The thickness of the collagenous fibers increases and they form thick bundles toward the posterior portion of the vocal process. 5) The elastic fibers are dense at the tip of the vocal process, and their number decreases toward the posterior portion of the vocal process. 6) The elastic fibers, which are slender, branched, and anastomosed to form a loose network, run among the collagenous fibers at the tip of the vocal process. 7) Elaunin fibers are the predominant elastic fibers at the tip of the vocal process. 8) Even in the hyaline cartilage portion of the vocal process, elastic fibers are found. 9) The vocal processes are firm in forming the framework of the glottis and are more pliable toward the tip. 10) The 3-dimensional structure of the gradual changes in stiffness between the vocal fold and the vocal process makes a functional contribution to the roles of the vocal folds and the vocal processes.
Cat-Scratch Disease of the Parotid Gland: An Often-Misdiagnosed Entity
Authors: Malatskey Shelton , Ben-David Jacob , Fradis Milo , Podoshin Ludwig
Published: October 2014

A case of cat-scratch disease involving the parotid area in a young adult is presented. Thanks to meticulous history-taking, the correct diagnosis was suggested and later established, thus preventing unnecessary surgery. The pertinent literature is discussed.
Use of Methotrexate for Autoimmune Hearing Loss
Authors: Matteson Eric L. , Tirzaman Oltita , Kasperbauer Jan , Facer George W. , Beatty Charles W. , Fabry David A. , McDonald Thomas J.
Published: October 2014

To assess the efficacy of low-dose methotrexate (MTX) given long-term for the treatment of autoimmune hearing loss, we performed a prospective open-label study of 11 patients with treatment-refractory autoimmune hearing loss. All patients had ongoing episodic worsening of hearing in 1 or both ears before enrollment despite traditional medical therapy. The MTX dose was 7.5 to 17.5 mg/wk. Hearing loss and vertigo were evaluated at baseline and at completion of the study. Hearing improvement was defined as an improvement in the pure tone threshold (PT) average of >10 dB or an increase in speech discrimination (SD) of >15%, whereas worsening was defined as a worsening of >10 dB in PT or a decrease of >15% in SD in at least 1 ear. The MTX was well tolerated. Among the 6 patients with Meniere's disease, 4 had improvement or resolution of vertigo, while 2 had no improvement. Disequilibrium improved in all 3 patients with Cogan's syndrome. According to the parameters defined above, hearing improved in 9 patients (82%), was unchanged in 1 patient (9%), and worsened in 1 patient (9%). Long-term low-dose MTX therapy may be a useful therapy for some patients who have hearing loss with a presumptively autoimmune-mediated component that is refractory to traditional therapies.
Timing of Swallowing Events after Single-Modality Treatment of Head and Neck Carcinomas with Radiotherapy
Authors: Kendall Katherine A. , Leonard Rebecca J. , McKenzie Susan W. , Jones Christopher U.
Published: October 2014

This paper reports the results of a preliminary study designed to evaluate swallowing function in 20 patients 1 year after successful treatment of head and neck carcinomas with radiotherapy. The timing of swallowing events was evaluated by videofluoroscopy. The mean values for each measure were compared to the normative data from 60 control subjects. The radiotherapy patients demonstrated prolonged pharyngeal bolus transit and a delay of laryngeal closure. Hyoid bone elevation began late relative to the onset of bolus movement. A strong trend toward a delay in hyoid elevation relative to bolus movement was demonstrated. The time required for the hyoid bone to reach maximal elevation did not differ from that in normals, but the hyoid was held in an elevated position for a longer period of time. As a result of changes in hyoid movement, the upper esophageal sphincter tended to open early relative to the arrival of the bolus. In conclusion, changes in deglutition occur after radiotherapy, presumably as an adaptation to changes in tissue compliance.
Epiglottic Hypoplasia Associated with Lacrimo-Auriculo-Dental-Digital Syndrome
Authors: Azar Taraneh , Arnold James E. , Scott Jennifer A. , Robin Nathaniel H.
Published: October 2014

We present a case of a young boy with clinical manifestations of lacrimo-auriculo-dental-digital syndrome (LADD) with the additional finding of a hypoplastic epiglottis that caused airway obstruction at birth. We also reviewed the 30 cases of LADD that have been reported since 1967. It is a rare syndrome that includes lacrimal system, aural, digital, and dental anomalies. Our patient has lacrimal duct obstruction, deficient tissue in the inferior portion of the ear pinnae, and a hypoplastic epiglottis with collapse of the supraglottic tissue. Many findings of LADD are recognizable at birth. The clinical spectrum has widened with more case reports. Our patient adds a life-threatening airway abnormality, a hypoplastic epiglottis, to the clinical spectrum of LADD.
Tracheobronchial Extension of Recurrent Respiratory Papillomatosis
Authors: Blackledge F. Adair , Anand Vinod K.
Published: October 2014

Endobronchial and pulmonary dissemination reportedly occurs in 5% of patients with laryngeal papillomatosis. It is more frequently observed in the juvenile form, and carries significant implications for treatment. In this study, we review our experiences with pulmonary and endobronchial extension of laryngeal papillomatosis. The records of the 52 patients with laryngeal papillomas treated at our institution since 1980 were reviewed. Twenty-nine percent of the patients (N = 15) developed tracheobronchial extension; 7% (N = 4) demonstrated pulmonary involvement. The birth history, race, sex, age at onset of symptoms, presenting symptoms, site and type of papillomas, surgical procedures, other methods of treatment, complications, and mortality data were analyzed. Eighty percent of the patients with tracheobronchial involvement were born to mothers with a positive history of vaginal condylomas. Pulmonary changes in 4 patients were observed on either chest radiographs or computed tomography and were manifested as multiple parenchymal nodules in 3 of the 4 patients. Pneumatoceles, cavitary empyema, and multiple recurrent pneumonias were the predominant complications of pulmonary involvement. Of the 15 patients with tracheobronchial extension, 80% (N = 12) required tracheotomy before their presentation to us. The number of multiple surgical procedures performed to remove papillomas ranged from 7 procedures in 1 patient with a solitary tracheobronchial lesion to more than 100 procedures in 2 patients with diffuse bronchopulmonary papillomatosis. As our study shows, tracheobronchial involvement continues to complicate surgical treatment in this challenging disease process.
Postoperative Radiotherapy in Patients with Positive Nodes after Functional Neck Dissection
Authors: Gavilán Javier , Prim María Pilar , Hardisson David , De Diego Juan Ignacio , Pozuelo Alfonso
Published: October 2014

A study was designed to assess the usefulness of postoperative radiotherapy (RT) in patients with surgically treated laryngeal and hypopharyngeal cancer with histologically proven positive neck nodes. Patients underwent operation between 1984 and 1995, with functional neck dissection (FND) being part of the treatment in all cases. The selection criteria included squamous cell carcinoma, negative margins for the primary tumor, and no previous treatment. For evaluation purposes, patients were divided into 2 groups: surgery alone versus surgery with postoperative RT. Eighty-three patients fulfilled the inclusion criteria and entered the study. All but 1 of the patients were men. The mean age was 58 years (range, 35 to 77 years). A multivariate analysis was used to analyze the prognostic parameters selected by univariate analysis, eg, age, alcohol, tumor location, T and N stages, and presence or absence of extracapsular spread and a desmoplastic pattern. Postoperative RT was not selected by univariate analysis as a prognostic factor, but was included in the multivariate analysis in order to assess its impact on survival and recurrence rates. Using the statistical method of multivariate analysis, we could not find evidence of a benefit to survival or local recurrence rates with postoperative RT in this series. Patients younger than 55 years and those with extracapsular spread had a decreased survival rate and a higher neck recurrence rate, irrespective of the treatment method.
Postoperative Headache after Surgery for Vestibular Schwannoma
Authors: Levo Hilla , Pyykkö Ilmari , Blomstedt Göran
Published: October 2014

Postoperative headache was studied among 251 patients who underwent operation for vestibular schwannoma. A questionnaire based on the McGill Pain Questionnaire and the Finnish Pain Questionnaire was sent to the patients. Twenty-one expressions describing postoperative headache were extracted with a factor analysis. The pain intensity was expressed on a visual analog scale, and the risk factors for postoperative headache were evaluated. Immediately after the operation, 154 subjects reported headache. Eighty-nine of the patients had had headache before operation, whereas 65 patients experienced headache only after operation. An average of 8.9 years after surgery, 93 patients still reported headache. Headache was a major problem for 27 subjects; 18 of the 27 had suffered from headache before operation. A retrosigmoidal approach, postoperative gait problems, preoperative headache, and small tumor size predicted postoperative problems with headache. When headache is present before operation, it tends to continue after operation, and if headache continues for 1 year, it usually persists without being reduced.
Evaluating Laryngotracheal Stenosis in a Canine Model with Virtual Bronchoscopy
Authors: Davros William , Eliachar Isaac , Eliashar Ron , Gramlich Terry , Esclamado Ramon , Moffett Kaven , Strome Marshall
Published: October 2014

We performed a prospective masked animal study to determine whether virtual bronchoscopy, a noninvasive computed tomography technique, can accurately measure upper airway stenosis. Virtual bronchoscopy creates a 3-dimensional endoscopic image from spiral computed tomography data. Laryngotracheal stenosis was endoscopically induced in 18 dogs. The excised larynges were examined by endoscopy, virtual bronchoscopy, and macrodissection. Measurements were made of the anteroposterior (A-P) diameter, the left-right (L-R) diameter, the full length of stenosis in the sagittal plane, and the length of the tightest stenotic segment. Each measurement method was performed independently. All investigators were unaware of measurements made by others. The measurements obtained through virtual bronchoscopy and actual endoscopy were compared to those made at dissection by interclass correlation coefficients (ICCs). Endoscopy was better than virtual bronchoscopy in measuring the A-P diameter (ICC = .79, p< .0001; ICC = .42, p = .01). Both were equally effective in measuring the L-R diameter (ICC = .53, p = .0062; ICC = .52, p = .0064). The endoscopes could not assess the full length of the stenosis, whereas virtual bronchoscopy measured it fairly accurately (ICC = .72, p = .0001). Virtual bronchoscopy relatively accurately measured the length of the tightest stenotic segment (ICC = .68, p = .0002), whereas endoscopy produced measurements in only 11 of 18 larynges, and the measurements were less accurate (ICC = .45, p = .0068). Virtual bronchoscopy can provide good measurements of stenotic lesions in the airway. It is more accurate than actual endoscopy in determining the length of stenosis. It may therefore be useful as an adjunct imaging method in preoperative planning for reconstructive surgery.
Tracheal Reconstruction with Porous High-Density Polyethylene Tracheal Prosthesis
Authors: Haliloĝlu Tamer , Onar Vedat , Yildirim Güven , Sapçi Tarik , Savci Nejat , Kahvecioĝlu Oya , Karavus Ahmet
Published: October 2014

The variety of methods used for the treatment of severe tracheal stenosis and the occasional failure to obtain lasting and consistent relief are measures of the difficulty of the problem. Presently, several surgical approaches are used for reconstructing large defects of the cervical trachea, reminding us that no single technique has gained wide clinical acceptance. We resected a U-shaped cartilage from 6 to 8 rings of the trachea of 10 New Zealand rabbits. We used a porous high-density polyethylene (PHDP) prosthesis to reconstruct the cervical trachea, and did not perform a tracheotomy during this operation. We followed up the rabbits for 4 to 10 months. One of the rabbits died in the second month because of respiratory distress; another was lost in the fourth month of the study while delivering young. The others continued to thrive; in fact, one of them gave birth 3 times after our study and was well able to take care of her young. At the end of the study, the rabbits were painlessly sacrificed in order to remove the larynx and trachea and examine them histopathologically. In the histopathologic examinations, the prostheses were incorporated into the native trachea and adhered to the surrounding organs, especially to the esophagus. No mucosal irregularities were seen on the surface of the prosthesis, and all the surfaces appeared to be covered with ciliated pseudostratified epithelium. This tracheal prosthesis provides good results in rabbit tracheal reconstruction, and appears very promising for the clinical repair of tracheal defects.
Retrograde Mastoidectomy with Canal Wall Reconstruction: A Single-Stage Technique for Cholesteatoma Removal
Authors: Dornhoffer John L.
Published: October 2014

The goal of this retrospective study was to report the preliminary results of the retrograde mastoidectomy technique with canal wall reconstruction used as a primary treatment method for cholesteatoma. This synthesis of canal wall up (CWU) and canal wall down (CWD) techniques was performed in 70 patients (75 ears; 35 pediatric, 40 adult) with an average 45-month follow-up. Surgical intervention involved removal of a portion of the canal wall for exposure and extirpation of the cholesteatoma, followed by reestablishment of the canal wall during reconstruction in a single stage. This leaves the mucosa relatively undisturbed and limits the extent of canal wall removal, facilitating mastoid aeration and preservation of anatomy. Recurrent disease occurred in 5% of cases. The hearing improvement was statistically significant (p < .05), with an average preoperative 4-frequency pure tone average air-bone gap of 27.2 dB improving to 11.5 dB. No patient had a worsening of hearing. The surgery takes less time than traditional techniques, is reproducible and easily taught, and can be universally applied to all cholesteatoma patients as primary treatment.
Inferior Turbinectomy versus Submucosal Diathermy for Inferior Turbinate Hypertrophy
Authors: Fradis Milo , Danino Joshua , Gaitini Luis , Gershinski Michael , Malatskey Shelton , Golz Avishai , Goldsher Moshe , Armush Walid
Published: October 2014

In order to compare and evaluate bilateral inferior turbinectomy (BIT) and submucosal diathermy (SMD), we retrospectively examined these two well-known techniques for treatment of nasal obstruction due to bilateral congestion of the inferior turbinates. One hundred patients with bilateral nasal obstruction were divided into 4 groups according to their nasal airflow patency. Forty-nine patients underwent BIT, and 51 patients underwent SMD. All 100 patients were followed for 2 months after surgery. Patients with difficult postoperative courses were followed up to 1 year after surgery, in order to decide on the necessity of operative revision. Postoperative improvement in nasal breathing after BIT was reported for 96% of patients 2 weeks after surgery, and for 88% 2 months after surgery. Only 1 BIT patient had to undergo revision operation. Diathermy showed good results in 78% of cases 2 weeks after surgery. The efficacy of the procedure was reduced to 76% 2 months after surgery. Twenty percent of SMD patients were advised to undergo operative revision. Postoperative bleeding occurred in 20% of BIT patients and in only 4% of SMD patients. We found that the extent of postoperative improvement does not depend on preoperative conditions; therefore, it is impossible to predict the extent of postoperative improvement on the basis of the results of preoperative assessment. Both procedures can be performed under local anesthesia, are relatively safe and effective, and do not need expensive instrumentation that may not be available in many medical centers.
Thyroid Cartilage and Vocal Fold Reduction: A New Phonosurgical Method for Male-to-Female Transsexuals
Authors: Kunachak Somyos , Prakunhungsit Supawadee , Sujjalak Kanjalak
Published: October 2014

To date, there is a paucity of literature on surgery to alter vocal pitch in male-to-female transsexuals. The currently available pitch-raising surgical techniques yield neither a good long-term result nor a high enough pitch to simulate a female voice. We investigated a new procedure to alter vocal pitch in 6 male-to-female transsexuals. The principle is to shorten and increase tension on both vocal folds by composite resection of a vertical strip of the anterior thyroid cartilage along with a segment of vocal fold. This resulted in a satisfactory pitch alteration from an average of 147 Hz before operation to 315 Hz afterward. In addition to a marked pitch elevation, all patients were particularly pleased with the softness of the voice and the simultaneous loss of the prominentia laryngea (Adam's apple). The longest follow-up was 6 years. In conclusion, thyroid cartilage and vocal fold reduction is an effective method for long-term alteration of voice in male-to-female transsexuals.
System for Nasopharyngeal Carcinoma: Comparison of Fourth and Fifth Editions of UICC TNM Classification
Authors: Tatsumi-Tamori Akiko , Miwa Takaki , Yoshizaki Tomokazu , Furukawa Mitsuru
Published: October 2014

Staging nasopharyngeal carcinoma (NPC) by the UICC 4th-edition TNM classification system (the old system) did not give an accurate prognosis because of the uneven distribution of patients in each stage. This system was revised in 1997 (the new system). To evaluate the performance of the new system, 35 patients with NPC who had been staged by the old system were restaged according to the new system. Restaging of the patients resulted in an overall “downstaging.” Differences in the overall survival rates of the early group (stages I, II, III), stage IVA, stage IVB, and stage IVC patients were statistically significant (75%, 48%, 74%, and 0%, respectively; p = .01). T4 was a significant factor of poor outcome (hazard rate, 2.932; 95% CI, 1.667 to 8.545), whereas N3 was not (hazard rate, 0.858; 95% CI, 0.281 to 2.618). The new staging system is more useful than the old system.
Comparison of 18-Fluoro-2-Deoxyglucose Positron Emission Tomography and Computed Tomography in Detection of Cervical Lymph Node Metastases of Nasopharyngeal Carcinoma
Authors: Hsieh Jih-Fang , Yen Ruoh-Fang , Rao Chia-Hung , Tsai Shih-Chuan , ChangLai Sheng-Ping , Ho Yung-Jen , Chieng Poon-Ung
Published: October 2014

Neck lymph nodes (LNs) from 18 patients with nasopharyngeal carcinoma (NPC) were evaluated with 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Eighteen NPC patients underwent head and neck FDG-PET and computed tomography (CT) for detection of suspected neck LN metastases. For final diagnosis, biopsies were taken from neck LNs with discordant findings between FDG-PET and CT. Meanwhile, standard uptake values (SUVs) of the FDG-PET images were calculated to differentiate metastatic LNs from benign LNs. A total of 90 neck LNs found on either FDG-PET or CT were evaluated. In addition to 27 concordant positive results and 42 concordant negative LN results, biopsy findings revealed 11 metastatic LNs that were detected by FDG-PET but not by CT. However, the SUVs of the 11 metastatic LNs and 7 benign LNs were not significantly different. The CT scanning showed positive findings for 1 metastatic LN with negative FDG-PET findings. In addition, the tumor stage was upgraded in 5 patients on the basis of FDG-PET findings. In comparison with CT, FDG-PET has a higher potential for detecting neck LN metastases of NPC and assessing NPC tumor stage.
In Vitro Ear Cartilage Shaping with Carbon Dioxide Laser an Experimental Study
Authors: Velegrakis George A. , Papadakis Chariton E. , Nikolidakis Antonios A. , Prokopakis Emmanuel P. , Volitakis Miltiadis E. , Naoumidi Irene , Helidonis Emmanuel S.
Published: October 2014

Deformed cartilage remodeling appears to be a challenge, as cartilage tends to keep its initial shape because of internal stresses. Cartilage can be remodeled with heat, and this report describes the use of a CO2 laser beam for in vitro cartilaginous tissue remodeling. Straight cartilage samples were removed from the ears of 21 rabbits deprived of perichondrium and remodeled with the CO2 laser at an output power of 3 W, a spot diameter of 2 mm, and an exposure time of 0.5 second. The remodeled cartilages and control samples were implanted into the rabbits' backs and retrieved 6 to 12 months later. Histologic and morphological analysis showed that the irradiated cartilages retained both their shape and their viability. This may be a useful clinical technique for in situ remodeling of a deformed cartilage in operations such as septoplasty.
Performance Characteristics of Fluorescence Endoscope in Detection of Head and Neck Cancers
Authors: Kulapaditharom Boonchu , Boonkitticharoen Vipa
Published: October 2014

Laser-induced fluorescence endoscopy (LIFE) is a noninvasive method for detecting early cancers in hollow organs. A laser-induced fluorescence endoscope that was designed for lung imaging was investigated for its effectiveness in comparison to white light endoscopy (WLE) in localizing head and neck cancers. A total of 196 images from 98 sites in 56 patients were graded into 5 levels from normal to definitely abnormal. A cutoff level to differentiate normal from abnormal images was chosen from a receiver operating characteristic curve. On this basis, LIFE (sensitivity, 92.86%; specificity, 78.57%) was observed to be more effective and reliable than WLE (sensitivity, 67.86%; specificity, 70%) in locating neoplastic foci and precancerous lesions. Nevertheless, WLE was helpful in presenting anatomic details. The reliability of LIFE varied from site to site. It excelled in examination of the oropharynx (sensitivity, 100%; specificity, 96.20%), but was less effective for lesions of the nasopharynx (sensitivity, 66.70%; specificity, 75.00%). In standardizing the test, interobserver variation was assessed, and good agreement in image interpretation was confirmed by statistical analysis. In conclusion, LIFE was found to be an effective and reliable tool for detecting head and neck cancers.
Congenital Nasal Pyriform Aperture Stenosis: Diagnosis and Management of 20 Cases
Authors: Van Den Abbeele Thierry , Triglia Jean-Michel , François Martine , Narcy Philippe
Published: October 2014

The objective of this study was to review the characteristics of congenital nasal pyriform aperture stenosis (CNPAS) in a series of 20 children seen between 1993 and 1996. The diagnosis was made by physical examination and computed tomography scan. A single central maxillary incisor was detected in 12 cases (60%). Three children had morphological abnormalities of the pituitary gland shown on magnetic resonance imaging. One child had an antidiuretic hormone deficiency, and another child had a growth hormone deficiency. Two children had craniosynostoses, 1 of which was Apert's syndrome. All patients underwent operation by a sublabial approach, and 1 was referred for a columellar necrosis after nasal stenting. After surgery, all patients showed improvement, and the nasal stenting was usually removed 1 week after surgery. Follow-up revealed normal breathing. In conclusion, CNPAS was previously considered to be an unusual cause of nasal obstruction in neonates and infants. The number of cases treated recently in our department suggests that this newly recognized entity is more common than expected.
Immortalization of Rat Middle Ear Epithelial Cells by Adeno 12-SV40 Hybrid Virus
Authors: Ueyama Shigehiro , Jin Sunji , Ueyama Tomoyo , Rhim Johng S. , Lim David J.
Published: October 2014

Rat middle ear epithelial cells were infected with the adeno 12–SV40 hybrid virus. The cell line thus obtained displays features of primary cultured epithelial cells in both light microscopic and ultrastructural examinations. The immortalized cells have been in continuous proliferation for 40 passages and more than 17 months. Immunohistochemical analysis of the immortalized cells was positive for the SV40 T antigen and the tumor suppressor protein p53. The cells also stained positive for cytokeratin, an epithelial cell marker, and negative for vimentin, a fibroblast marker. These results, together with karyotype analysis, indicate that this cell line originated from rat middle ear epithelial cells and retains the characteristics of epithelial cells. This cell line will be useful for studying the normal cellular biology of middle ear epithelial cells, as well as the cellular and molecular mechanisms involved in the bacteria-middle ear epithelial cell interaction.