bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-Related Changes in Vitamin A-Storing Stellate Cells of Human Vocal Folds
Authors: Sato Kiminori , Hirano Minoru , Nakashima Tadashi
Published: October 2014

Light and electron microscopic investigation of age-related changes in vocal fold stellate cells (VFSCs) of the human vocal fold mucosa was carried out on 10 excised human adult larynges from autopsy and surgical cases. The results are summarized as follows. Aged VFSCs were stellate in shape and possessed slender cytoplasmic processes. Aged VFSCs also possessed lipid droplets in the cytoplasm and stored vitamin A. Basically, the morphological characteristics of the aged VFSCs were the same as those of younger adults. The number of VFSCs had decreased. There were fewer intercellular organelles than in younger adults. Some components of the cytoplasm had degenerated. The nuclei of the VFSCs were dense and cleaved. There were few vesicles at the periphery of the cytoplasm of aged VFSCs, and few newly released amorphous materials. Some aged VFSCs had degenerated, and an accumulation of glycogen particles was seen in the cytoplasm. The number of fibers synthesized by these inactivated cells had decreased. These findings were recognized to various degrees. The aged VFSCs in the maculae flavae appear to have decreased activity, have abnormal metabolism, and undergo degeneration. Age-related changes in the VFSCs of the maculae flavae are postulated to influence the metabolism of extracellular matrices in the vocal fold mucosa, as well as the viscoelasticity of the aged vocal fold mucosa, and are one of the causes of aging of the voice.
Endoscopic Supraglottic Laryngectomy with Postoperative Irradiation
Authors: Davis R. Kim , Kriskovich Mark D. , Buntin Chante S. , Galloway Edgar B. , Jepsen Matthew C.
Published: October 2014

Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of N0 patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.
Monostotic Fibrous Dysplasia Originating from Ethmoid Bone: Treatment with Endoscopic Approach
Authors: Kutluhan Ahmet , Kiroğlu A. Faruk , Arslan Halil , Yurttas Veysel , Özen Süleyman
Published: October 2014

We present a case of monostotic fibrous dysplasia of the ethmoidal sinus in an 11-year-old boy. This condition is of interest to the otorhinolaryngologist because of the difficulty of differential diagnosis and treatment. This tumorlike growth was not restricted to the right ethmoidal sinus, but also compressed the orbit and the globe. Endoscopic and transnasal removal of the mass with a drill was performed under general anesthesia. No residual tumor was observed 6 months later.
Sinus Tissue Concentration of Moxifloxacin after a Single Oral Dose
Authors: Dinis Paulo Borges , Monteiro Maria Conceição , Silva Nuno , Martins Maria Luz , Morais José Guimarães
Published: October 2014

Moxifloxacin is a new fluoroquinolone antimicrobial approved for the treatment of acute bacterial rhinosinusitis. In order to assess its distribution pattern into the paranasal sinuses, and specifically to evaluate how the histopathologic changes associated with chronic inflammation affect its tissue penetration, we conducted the present investigation, a randomized, open-label, single dose, sinus-tissue pharmacokinetic study with oral moxifloxacin. Twenty adult subjects, selected for surgery because of recalcitrant chronic rhinosinusitis, were preoperatively randomly allocated to receive a tablet of 400 mg moxifloxacin 3 or 4 hours before the procedure. During the operation, tissue samples were collected at specific sinonasal sites, and the concentration levels of the antimicrobial in the different parts of the paranasal sinuses were assayed. Simultaneously, the degree of inflammation at each site was evaluated. We found that moxifloxacin was distributed extensively throughout the sinuses, in both inflamed and noninflamed mucosae, but tended to be concentrated in maxillary sinus cysts. The tissue-to-blood ratios exceeded 4:1 at most sites, with mucosal concentration levels well above the MIC90 values of the drug against a wide range of microorganisms. We concluded that the oral moxifloxacin tissue kinetics provides an extremely potent antimicrobial activity in all parts of the sinuses, regardless of the inflammatory status of the mucosa.
Lymphatic Malformations of the Head and Neck in Adults: A Case Report and Review of the Literature
Authors: Naidu Srikanth I. , McCalla Mary R.
Published: October 2014

Lymphatic malformations (LMs), primarily diagnosed in children, are uncommon in adults. Nevertheless, one should consider LM in one's differential diagnosis in cases of adult neck masses. We report the oldest known patient with an LM, a 91-year-old woman. We also provide a review of the literature encompassing all reported adult cases. Since 1828, 91 adult cases of LMs have been reported in the English-language literature. We describe the clinical findings, diagnostic methods, and therapeutic management of LMs of the head and neck. We believe that surgery remains a therapeutic option even in patients of advanced age.
Isolated Necrotizing Epiglottitis: Report of a Case in a Neutropenic Patient and Review of the Literature
Authors: Sengör Atilla , Willke Ayse , Gündes Sibel , Aydin Ömer , Almaç Ahmet
Published: October 2014

Isolated necrotizing epiglottitis (INE) is an unusual condition that may develop in immunocompromised patients. Only 3 cases of INE have been reported in the English-language literature; this is the fourth case, one in a 27-year-old woman who had neutropenia due to cytomegalovirus infection. Stenotrophomonas maltophilia and Candida albicans were isolated from the culture of necrotic material. The features of INE are discussed here by reviewing the literature and by examining the characteristics of this case.
Particulate Silicone for Vocal Fold Augmentation: Morphometric Evaluation in a Rabbit Model
Authors: Bernal-Sprekelsen Manuel , Caballero Miguel , Calvo Carlos , Farrè Xavier , Alòs Llucia
Published: October 2014

To study the augmentation of the paralyzed vocal fold in response to the injection of particulate plastics in a rabbit model, we performed a prospective, experimental, and controlled study in 45 New Zealand rabbits with surgical vocal fold paralysis. We compared a control group (acute unilateral recurrent nerve section) with a group that underwent polytetrafluoroethylene (PTFE) injection and with another group that underwent polydimethylsiloxane (PDMS) injection. Equal volumes of implant material were injected. The animals were killed either 6 weeks or 6 months after intervention and compared by histomorphology using a digital measuring system. The injection sites showed a substantial foreign body giant cell reaction against the PDMS and PTFE, surrounded by a light, fibrous stroma. No differences in the frequency of displacement or disaggregation of implants were observed. No extrusion to the laryngeal lumen, signs of migration outside the larynx, or malignant changes were seen. No differences were found in the length of the vocal fold between the PDMS group and the PTFE group. The vocal fold was thicker in the PDMS group than in the PTFE group, but a statistically significant difference was found only for the anterior and middle thirds at 6 weeks. In the PDMS sample, the thicknesses were similar in the 6-week and 6-month subgroups. The group with injection of PDMS yielded histologic images compatible with greater and more stable medialization than did the group with injection of PTFE.
Successful Adjuvant Tamoxifen Therapy for Estrogen Receptor-Positive Metastasizing Sweat Gland Adenocarcinoma: Need for a Clinical Trial?
Authors: Schröder Ursula , Dries Volker , Wittekindt Claus , Klussmann Jens Peter , Eckel Hans Edmund
Published: October 2014

We report on successful adjuvant tamoxifen therapy for a metastasizing sweat gland adenocarcinoma of the scalp in a 64-year-old woman. Before the antihormonal therapy, the patient had undergone repeated surgery for ipsilateral intraparotid, soft tissue, and lymph node metastases and had had disease-free intervals of less than 5 months. As the immunohistochemical analysis of the tumor tissue revealed a 100% nuclear reactivity to estrogen and progesterone receptors, we started empirical tamoxifen citrate therapy, which dramatically changed the course of the disease. The patient has been in complete remission for 3 years. This is the third report in the literature of substantial therapeutic benefit of antiestrogen therapy in metastasizing eccrine gland adenocarcinoma with positive hormone receptor immunohistochemistry. We suggest examining the hormone receptor expression in these neoplasms regularly. A prospective study should be commenced to assess the benefit of adjuvant antihormonal therapy in eccrine gland adenocarcinomas.
Vocal Efficiency Measurements in Subjects with Vocal Polyps and Nodules: A Preliminary Report
Authors: Jiang Jack , Chen Hui-Jun , Stern Jennifer , Solomon Nancy Pearl
Published: October 2014

Vocal efficiency is a quantitative measure of the ability of the larynx to convert subglottal power to acoustic power. On the basis of the scant previous literature and clinical intuition, we tested the hypothesis that vocal efficiency, as an indicator of the functional status of the larynx, is abnormally reduced in persons with vocal nodules and polyps. Because the most difficult aspect of obtaining measures of vocal efficiency has been the determination of subglottal pressure, we applied a noninvasive airflow interruption technique for this purpose. Subjects with normal voices (n = 22), vocal polyps (n = 14), and vocal nodules (n = 16) phonated at different intensities into a mask connected by way of piping to a flow meter, a pressure transducer, and an acoustic microphone. Inflation of a balloon-type valve located within the piping provided interruption of phonation. The intraoral pressure plateau occurring during flow interruption was used to estimate subglottal pressure. Subglottal power and acoustic power were determined, and their quotient provided a measure of vocal efficiency. The vocal efficiency in the normal subjects averaged 1.15 × 10−5 at 70 dB, 3.17 × 10−5 at 75 dB, 7.52 × 10−5 at 80 dB, and 1.41 × 10−4 at 85 dB. The vocal efficiency in the patients with vocal polyps averaged 3.62 × 10−6 at 70 dB, 8.34 × 10−6 at 75 dB, 2.10 × 10−5 at 80 dB, and 4.26 × 10−5 at 85 dB. The vocal efficiency in the patients with vocal nodules averaged 4.32 × 10−6 at 70 dB, 1.57 × 10−5 at 75 dB, 4.26 × 10−5 at 80 dB, and 8.34 × 10−5 at 85 dB. As compared to the normal subjects, the patients with laryngeal polyps or vocal nodules had significantly reduced vocal efficiency. These results provide quantitative verification of the clinical impression of inefficient phonation in patients with mass lesions of the vocal folds.
Pediatric Airway Reconstruction: Principles, Decision-Making, and Outcomes at the University of Iowa Hospitals and Clinics
Authors: Cable Benjamin B. , Bauman Nancy M. , Manaligod Jose M. , Smith Richard J. H.
Published: October 2014

Pediatric airway stenosis challenges the treating surgeon, from the initial evaluation and decision-making process to the final postoperative care and follow-up setting. As our approach to these cases evolves, we must critically evaluate our outcomes in reference to our stated goals. We describe our process in treating this population and critically examine our outcome data from 1990 to the present. Emphasis is placed on selection of procedure and postoperative management.
Sphenoid Sinus Mucocele with Unilateral Blindness
Authors: Nerurkar Nupur Kapoor , Muranjan Sujata , Bradoo Renuka , Khare Milind
Published: October 2014

Mucoceles of the sphenoid sinus are rare and may frequently remain undiagnosed until symptoms due to compression of surrounding structures set in. In such cases, the optic nerve, because of its close proximity to the sphenoid sinus, is at risk, and pressure exerted by the mucocele may result in visual impairment. A case of a sphenoid sinus mucocele with sudden-onset unilateral blindness as the only presenting symptom has been described. Early diagnosis and prompt surgical intervention enabled the vision to be restored completely.
Association between Polymorphisms of the Angiotensinconverting Enzyme and Angiotensinogen Genes and Allergic Rhinitis in a Korean Population
Authors: Kim Jeong Joong , Kim Hyun-Ju , Chung Hun Taeg , Lee Il-Kwon , Lee Jae Hoon
Published: October 2014

Angiotensin-Converting enzyme (ACE) inactivates bradykinin, substance P, and neurokinin A, which are thought to play important roles in the pathogenesis of inflammatory diseases. Expression of angiotensinogen, a precursor of angiotensin, is enhanced by augmented secretion of proinflammatory cytokines (eg, interleukin-1) in the site of inflammation. Insertion or deletion (I/D) ACE and M235T angiotensinogen gene polymorphisms were reported to be associated with atopy in a Czech population. Using polymerase chain reaction restriction fragment length polymorphism and SNaPshot typing analysis, we investigated the frequencies of the genotypes and alleles of the ACE gene in 137 patients with allergic rhinitis, of the M235T angiotensinogen gene in 186 patients with allergic rhinitis, and of both in 219 healthy control subjects. There was no difference in the frequency of the DD genotype of the ACE gene in the controls and patients (odds ratio, 1.32 [0.66–2.60]; p > .05). The D allele was more frequent in patients, but the difference was not statistically significant (odds ratio, 1.21 [0.89–1.64]; p > .05). There was no difference in the frequency of the TT genotype of the angiotensinogen gene in the controls and patients (odds ratio, 1.01 [0.38–2.69]; p > .05). The T allele was more frequent in patients, but the difference was not statistically significant (odds ratio, 1.10 [0.78–1.55]; p > .05). Our results indicate that polymorphisms in the genes for ACE and angiotensinogen may not be related to the development of allergic rhinitis in the Korean population.
Clinical Ototoxicity of Teicoplanin
Authors: Bonnet Raymond M. , Mattie Herman , Schoemaker Hendrik C. , de Laat Jan A. P. M. , Frijns Johan H. M.
Published: October 2014

No strong evidence of ototoxicity of teicoplanin can be found in the literature, possibly because of conservative definitions of ototoxicity. We performed audiometry over time to compare the ototoxicity of teicoplanin with that of cloxacillin as a non-ototoxic standard. The data were analyzed with a linear mixed-effects model. The hearing thresholds of 12 patients who were treated with teicoplanin for severe staphylococcal infections showed a slight but significant increase over time, whereas the thresholds of 5 patients treated with cloxacillin decreased significantly during treatment. This improvement in hearing with cloxacillin may be attributed to improvement of the clinical condition. This outcome implies that previous reports that suggest a lack of ototoxicity of teicoplanin potentially underestimate the risk and should be interpreted accordingly.
Enlarged Translabyrinthine Approach for the Management of Large and Giant Acoustic Neuromas: A Report of 175 Consecutive Cases
Authors: Sanna Mario , Russo Alessandra , Falcioni Maurizio , Taibah Abdelkader , Agarwal Manoj
Published: October 2014

The translabyrinthine approach was once considered inadequate for the removal of acoustic neuromas (ANs), but that theory has few proponents today. Over the years, the translabyrinthine approach has been modified into the enlarged translabyrinthine approach, with experience and technical refinements leading to a wider access. Between April 1987 and December 2001, the Gruppo Otologico of Piacenza-Rome was able to remove 175 ANs 3 cm or larger in size from the cerebellopontine angle by adopting this modified surgical technique. These tumors represented 24.7% of all 707 ANs for which surgery was performed during the same period of time. Among the 175 cases, there was only I death. The incidence of complications was very low and was comparable to results previously published in the literature. Consequently, the hospital stay was short, with a mean of 7.3 days (5.1 days in the last 45 cases). The preoperative ipsilateral hearing was already compromised in 119 of the 175 cases (68%; class C/D according to the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery, 1995). From our results, we can conclude that the use of the enlarged translabyrinthine approach in AN surgery is not dependent on tumor size. On the contrary, the advantages of a low rate of morbidity and a short hospital stay are ample proof that this is the best approach for the removal of large ANs.
Database for the Collection and Analysis of Clinical Data and Images of Neoplasms of the Sinonasal Tract
Authors: Trimarchi Matteo , Pini Massimiliano , Lund Valerie J. , Senna Massimo , Nicolai Piero , Howard David J.
Published: October 2014

The Neoplasms of the Sinonasal Tract software package (NSNT v 1.0) implements a complete visual database for patients with sinonasal neoplasia, facilitating standardization of data and statistical analysis. The software, which is compatible with the Macintosh and Windows platforms, provides multiuser application with a dedicated server (on Windows NT or 2000 or Macintosh OS 9 or X and a network of clients) together with web access, if required. The system hardware consists of an Apple Power Macintosh G4500 MHz computer with PCI bus, 256 Mb of RAM plus 60 Gb hard disk, or any IBM-compatible computer with a Pentium 2 processor. Image acquisition may be performed with different frame-grabber cards for analog or digital video input of different standards (PAL, SECAM, or NTSC) and levels of quality (VHS, S-VHS, Betacam, Mini DV, DV). The visual database is based on 4th Dimension by 4D Inc, and video compression is made in real-time MPEG format. Six sections have been developed: demographics, symptoms, extent of disease, radiology, treatment, and follow-up. Acquisition of data includes computed tomography and magnetic resonance imaging, histology, and endoscopy images, allowing sequential comparison. Statistical analysis integral to the program provides Kaplan-Meier survival curves. The development of a dedicated, user-friendly database for sinonasal neoplasia facilitates a multicenter network and has obvious clinical and research benefits.
Treatment of the Interarytenoid Muscle with Botulinum Toxin for Laryngeal Dystonia
Authors: Hillel Allen D. , Maronian Nicole C. , Robinson Lawrence , Waugh Patricia F. , Klotz Darrell A.
Published: October 2014

The treatment of laryngeal dystonia with botulinum toxin has provided various degrees of relief to the majority of patients with adductor dysphonia; however, a significant number of patients have limited or no improvement with this type of therapy. It remains unclear why some patients respond to the routine administration of toxin to the thyroarytenoid muscles whereas others do not. Injections into the lateral cricoarytenoid muscles have provided an improved voice in some patients who were unresponsive to injections into the thyroarytenoid muscles. Fine-wire electromyography can demonstrate the particular dystonic activity of these muscles to help determine which muscle is predominantly involved. It can also demonstrate dramatic dystonic activity in the interarytenoid (IA) muscle in many patients. We present the results of 23 patients treated with injections to the IA muscle after demonstration of dystonic IA activity. Ten have benefited from IA therapy. Five of these 10 patients did not have a good result from botulinum toxin until IA injections were added to the treatment plan. In 8 patients, IA therapy provided no improvement, and 5 patients were lost to adequate follow-up. According to fine-wire electromyography and clinical response, the IA muscle is an active dystonic muscle in some patients with laryngeal dystonia and should be treated with botulinum toxin in selected patients.
Large Intraosseous Hemangioma of the Temporal Bone in a Child
Authors: Fierek Oliver , Laskawi Rainer , Kunze Ekkehard
Published: October 2014

Hemangiomas of the temporal bone are extremely uncommon tumors, predominantly arising in the area of the geniculate ganglion and the internal auditory canal and affecting mainly middle-aged adults. We present a 6-year-old boy who had suffered from recurrent infections of the left ear associated with a slight conductive hearing loss, but without facial nerve dysfunction. Using high-resolution computed tomography and gadolinium-enhanced magnetic resonance imaging, we detected an unusually large 32 × 32 × 24-mm mass of the left temporal bone occupying the entire mastoid. Histopathologically, a capillary hemangioma was diagnosed. The tumor was removed surgically by a transmastoid approach. We present a thorough review of the literature, focusing on the clinical and radiologic features, as well as the pathogenesis of intratemporal vascular lesions.
Controversies and Criticisms on Designs for Experimental Autoimmune Labyrinthitis
Authors: García-Berrocal José Ramón , Trinidad Almudena , de la Fuente Raquel , Ramírez-Camacho Rafael , Zurita Mercedes , Lobo David
Published: October 2014

Although immune-mediated inner ear disease was reported around 25 years ago, numerous attempts to identify the inner ear antigens have been performed. Experimental animal models have been used to study the immune mechanisms involved in hearing loss and to develop new therapies. Because animal models of autoimmune labyrinthitis have been developed by means of different antigens, we cannot yet show a valid immunopathologic explanation. A critical analysis of the more relevant experimental models employed has been performed in order to validate the methodology. Comparison between these models and animals with spontaneous systemic autoimmune disease has raised more questions concerning the pathophysiology of autoimmune hearing loss. A new pathogenetic theory is suggested, involving the supporting cells of the organ of Corti.
State and Federal Regulations for Hearing
Authors: Welsh Louis W. , Welsh John J.
Published: October 2014

Mandated federal and state requirements for hearing function prescribed for military and pilot performance, schoolchildren, and commercial and school bus drivers are summarized in the following review. The material is directed toward involved otolaryngologists, industrial physicians, and appropriate review boards for reference in licensure examinations or student hearing assessments.
Hearing Loss in Young Adults Who Had Ventilation Tube Insertion in Childhood
Authors: de Beer Brechtje A. , Snik Ad F. , Schilder Anne G. M. , Zielhuis Gerhard A. , Ingels Koen , Graamans Kees
Published: October 2014

It is known that insertion of ventilation tubes can cause damage to the tympanic membrane and hearing deterioration in the long term. To investigate long-term effects of recurrent otitis media and of ventilation tube insertion, we used a study group (n = 358 subjects), with or without a history of otitis media and/or ventilation tube insertion, derived from a birth cohort that had been followed for 16 years. At 18 years of age, a standardized audiometric and otoscopic examination was performed. We found that ventilation tube insertion in childhood was associated with a mean persistent hearing loss in young adults of about 5 to 10 dB at the group level with a sensorineural component of 3 to 4 dB. This hearing loss could not be explained by the disease load of otitis media in childhood. Repeated insertions of ventilation tubes caused a greater deterioration of hearing than did a single insertion. Structural changes of the tympanic membrane were a mediating factor in the causal relationship between ventilation tube insertion and hearing loss. We conclude that ventilation tube insertion in childhood may induce hearing deterioration in the long term.
Isolated Chronic Maxillary Sinusitis of Non-Dental Origin Does Not Correlate per Se with Ipsilateral Intranasal Structural Abnormalities
Authors: Kieff David A. , Busaba Nicolas Y.
Published: October 2014

A case series of 35 patients with isolated chronic maxillary sinusitis of inflammatory non-dental origin was retrospectively reviewed to determine the correlation of ipsilateral intranasal structural abnormalities. The records were examined for computed tomographic, nasal endoscopic, and intraoperative findings. The incidence of ipsilateral and contralateral intranasal structural abnormalities at the ostiomeatal complex region, including conchae bullosae, Haller cells, paradoxical middle turbinates, and septal deviations, was determined. Nineteen of 35 patients (54%) had ipsilateral abnormalities and 16 (46%) did not. Of the 19 patients with ipsilateral abnormalities, 4 had Haller cells, 4 had conchae bullosae, 2 had paradoxical middle turbinates, and 12 had septal deviations. (Two patients had multiple ipsilateral factors.) Of the 16 patients with contralateral abnormalities, 4 had Haller cells, 3 had conchae bullosae, 2 had paradoxical middle turbinates, and 9 had septal deviations. Ten patients had only contralateral abnormalities, and 6 had no identifiable anatomic abnormality. The difference between the incidences of ipsilateral and contralateral abnormalities in this series of 35 patients with isolated chronic maxillary sinusitis was not statistically significant when the factors were analyzed as a group or by individual factor (range in odds ratios for the various factors, 1 to 1.54; range in p values for the various factors, .25 to 1). Thus, the data show that ipsilateral structural abnormalities at the ostiomeatal complex region, including conchae bullosae, Haller cells, paradoxical middle turbinates, and septal deviations, did not correlate per se with isolated chronic maxillary sinusitis that was not attributable to dental disease.
Immunohistochemical Localization of Histamine Receptor Subtypes in Human Inferior Turbinates
Authors: Nakaya Muneo , Takeuchi Naonobu , Kondo Kenji
Published: October 2014

Histamine is an important chemical mediator in allergic rhinitis and plays an important role in eliciting the nasal symptoms of the disorder. However, the immunohistochemical localization of histamine receptor subtypes (H1R, H2R, H3R, and H4R) in human nasal mucosa is unknown. There are also no prior studies of H3R and H4R in human nasal mucosa. The objective of this study was to examine the distribution of histamine receptor subtypes in the human inferior turbinates by an immunohistochemical method. H1R was localized primarily in the epithelium, vessels, and nerves. H2R was localized primarily in the epithelium and the glands. H3R and H4R were clearly distributed on the nerves. In addition, H1R, H3R, and H4R were clearly localized on the same nerves. This result indicates that H1R, H3R, and H4R adjoin and regulate each other in the same nerves. All histamine receptor subtypes may play some role in patients with allergic rhinitis.
Differential Changes in Peripheraland Central Components of the Brain Stem Auditory Evoked Potentials during the Neonatal Period Interm Infants after Perinatal Hypoxia-Ischemia
Authors: Jiang Ze D. , Xu Xiu , Shao Xiao M. , Yin Rong , Wilkinson Andrew R.
Published: October 2014

To identify any differences in dynamic changes between peripheral and central hearing after perinatal hypoxia-ischemia, we studied 80 term infants during the neonatal period by serially recording brain stem auditory evoked potentials (BAEPs) at 60 dB normal hearing level. All BAEP wave latencies and the I-V interval increased significantly on day 1 (analysis of variance, all p < .001). Thereafter, the wave I latency decreased gradually with some variation. The wave V latency and the I-V interval increased further on day 3 and then decreased progressively. On day 30, neither the latencies nor the I-V interval differed significantly from those of normal controls, but the wave v latency and the I-V interval still tended to increase slightly. These results suggest that hearing is impaired shortly after hypoxia-ischemia. Peripheral hearing gradually recovers after day 1, whereas central impairment progresses during the first 3 days and then starts to recover. We conclude that peripheral impairment recovers sooner than central impairment after perinatal hypoxia-ischemia.
Quality-of-Life Outcomes following Laryngeal Endoscopic Surgery for Nonneoplastic Vocal Fold Lesions
Authors: Johns Michael M. , Garrett C. Gaelyn , Hwang Joanna , Ossoff Robert H. , Courey Mark S.
Published: October 2014

Preservation of the vocal fold cover during laryngeal surgery should optimize vocal outcomes for patients with benign glottal lesions. The aim of this study was to evaluate changes in the quality of life, perceptual voice evaluation, and acoustic and aerodynamic measures of patients before and after endoscopic laryngeal microsurgery for true vocal fold cysts, polyps, and scarring. Preoperative and postoperative Voice Handicap Index (VHI) scores, Short Form 36 scores, and perceptual, acoustic, and aerodynamic voice measures were obtained prospectively from 42 patients who underwent phonomicrosurgery from February 2000 through May 2003. The mean (±SD) preoperative VHI was 49.6 ± 21. The mean postoperative VHI score at a minimum of 3 months after surgery decreased to 26.8 ± 21 (p < .001). When divided by lesion type, VHI scores improved significantly after surgery for vocal fold polyps and cysts. Although patients with vocal fold scarring demonstrated improvement in VHI scores after surgery, statistical significance was not achieved. For the entire group, the Short Form 36 scores were not significantly different from US norms either before or after operation. The acoustic data showed statistically significant decreases in jitter (2.05% to 1.26%), shimmer (7.06% to 4.03%), and noise-to-harmonics ratio (0.18 to 0.13) after surgery (p <.05) in female patients. The upper pitch limit increased after surgery in women (495.3 Hz to 654.9 Hz, p < .001). These results indicate that the voice-related quality of life and some acoustic parameters improve significantly for patients who have undergone laryngeal microsurgery for vocal fold cysts and polyps. Vocal fold scarring remains a difficult clinical problem with less favorable outcomes following surgical treatment in this patient set.
Findings of Multiple Muscle Involvement in a Study of 214 Patients with Laryngeal Dystonia Using Fine-Wire Electromyography
Authors: Klotz Darrell A. , Shahinfar Ariana , Maronian Nicole C. , Robinson Lawrence , Waugh Patricia F. , Hillel Allen D.
Published: October 2014

Although perceptual and stroboscopic data help in diagnosing and classifying laryngeal dystonia, these measures do not aid the voice clinician in targeting which specific muscles to treat with botulinum toxin. Most patients achieve smoother, less effortful voicing with standard injection regimens. However, there is a notable failure rate. We performed fine-wire electromyography on 214 consecutive patients with laryngeal dystonia. We correlated voice ratings, stroboscopy data, and fine-wire electromyography data. Videostroboscopy was successful in visually demonstrating most of the audible findings in isolated vocal tremor, but it was much less successful in identifying breaks alone or a combination of breaks and tremor. Fine-wire electromyography revealed that the thyroarytenoid muscle was significantly more likely than the lateral cricoarytenoid muscle to be the predominant muscle associated with adductor spasmodic dysphonia, and that the thyroarytenoid and lateral cricoarytenoid muscles were equally likely to be predominantly involved in tremor spasmodic dysphonia. In addition, several patients in both the adductor spasmodic dysphonia and the tremor spasmodic dysphonia groups presented with interarytenoid muscle predominance. All of the intrinsic laryngeal muscles are capable of being the predominant muscle in laryngeal dystonia, and there are patterns of muscle abnormalities that differ between adductor spasmodic dysphonia and tremor spasmodic dysphonia. Some of the failures in treating adductor spasmodic dysphonia with botulinum toxin, and the greater difficulty with success in treating patients with tremor spasmodic dysphonia, are due to failure to deliver toxin to the appropriate muscles.
Tracheal Resection with End-to-End Anastomosis for Benign Tracheal Stenosis
Authors: Wynn Rhoda , Har-El Gady , Lim Jessica W.
Published: October 2014

To review our experience with tracheal resection with end-to-end anastomosis for tracheal stenosis, we performed a retrospective review at a tertiary-care academic medical center. Twenty-eight patients underwent circumferential tracheal resection with end-to-end anastomosis by 2 attending otolaryngologists from 1989 to 2002. Patients were excluded if they were under 12 years of age or if the surgical indication was tracheal or thyroid neoplasm. The indications for tracheal resection were postintubation stenosis (n = 9; 32%), posttracheotomy stenosis (n = 7; 25%), both postintubation and posttracheotomy stenosis (n = 9; 32%), external tracheal trauma (n = 2; 7%), and presence of a foreign body (n = 1; 4%). Two to 8 rings were resected. The follow-up periods ranged from 18 months to 13.5 years. The anastomotic success rate was 89% (n = 25). No patients died as a result of the procedure. We conclude that tracheal resection with end-to-end anastomosis is a relatively safe and reliable procedure for the treatment of tracheal stenosis in appropriately selected patients.
Fdg-Pet Scan in Local Follow-up of Irradiated Head and Neck Squamous Cell Carcinomas
Authors: Conessa Claude , Foehrenbach Herve , Hervé Stephane , Poncet Jean-Luc
Published: October 2014

We performed a prospective study to assess the value of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) in the prediction of local control in irradiated head and neck squamous cell carcinomas (HNSCCs). Forty-two patients with irradiated HNSCCs underwent 49 FDG-PET scans between 3 and 6 months after the end of radiotherapy. The mean follow-up time after the first FDG-PET scan was 17 months. The result of the FDG-PET scan was true-positive in 6 patients, false-positive in 7 patients, and true-negative in 29 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET scanning were 100%, 81%, 46%, and 100%, respectively. We conclude that FDG-PET scanning is useful for prediction of therapy outcome in irradiated HNSCCs. No biopsy is needed for at least 1 year if an FDG-PET scan is negative. If the scan is positive and the biopsy is negative, decreased FDG uptake measured in a follow-up scan indicates that a local recurrence is unlikely.
Transapical Extension in Difficult Cerebellopontine Angle Tumors
Authors: Sanna Mario , Mancini Fernando , Agarwal Manoj , Taibah Abdelkader
Published: October 2014

The transapical extension of the enlarged translabyrinthine approach is aimed at making the removal of certain tumors of the cerebellopontine angle simpler and with less morbidity. The extension is classified into 2 types — type I and type II — based on the extent of bone drilling around the internal auditory canal. Type I extension involves drilling for 300° to 320° around the canal and is indicated for large or giant vestibular schwannomas and vestibular schwannomas with significant extension anterior to the internal auditory canal. Type II extension entails complete removal of the bone around the canal for 360° and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal. The extension allows better control over the anterior pole of the tumor, the displaced facial nerve, the prepontine cistern, and the venous vascularity of the cerebellopontine angle. The aim of this report is to present our experience with this extension.
Audiovestibular Evolution in a Patient with Multiple Sclerosis
Authors: Tu Chuan-En , Young Yi-Ho
Published: October 2014

Multiple sclerosis is characterized by the presence of multiple plaques within the central nervous system, manifesting as remission and exacerbation of neurologic dysfunction over variable time courses. We present the case of a 20-year-old woman. Before treatment, her auditory brain stem response (ABR) test revealed bilateral prolongation. A caloric test showed canal paresis of the right ear and a normal response on the left. A vestibular evoked myogenic potential (VEMP) test displayed an absent response in the right ear and a delayed response in the left. A magnetic resonance imaging (MRI) scan demonstrated multiple diffuse high signal lesions in the hemispheres, brain stem, and cerebellum. Six months after treatment, the demyelinating plaques were shown to have resolved spontaneously on MRI. Recovery of caloric responses was anticipated. Bilateral prolongation of ABRs remained, but the VEMP test disclosed a normal response in the right ear and a delayed response in the left. Accordingly, in addition to MRI, caloric tests and ABR and VEMP tests are useful in monitoring the evolution of audiovestibular function in patients with multiple sclerosis.
Effect of Corticosteroid on Salicylate-Induced Morphological Changes of Isolated Cochlear Outer Hair Cells
Authors: Nam Boo-Hyun , Worrell Lewit A. , Jung Timothy T. K. , Kim Pyong S. , Park Seong Kook , Duncan John , Park Yong-Soo , John Earnest O. , Fletcher William H.
Published: October 2014

Our previous studies showed that pretreatment with corticosteroids, which inhibits release of arachidonic acid (precursor of prostaglandins and leukotrienes), partially prevented salicylate-induced hearing loss in vivo. The purpose of this study was to determine the effect of pretreatment with corticosteroid (dexamethasone sodium phosphate) on isolated cochlear outer hair cells (OHCs) exposed to salicylate in vitro. Isolated OHCs from the chinchilla cochlea were exposed to salicylate with or without pretreatment with dexamethasone. Images were stored and analyzed on the Image program. The OHCs exposed to salicylate demonstrated a significant shortening in cell length. The OHCs exposed to salicylate after pretreatment with dexamethasone exhibited no significant change in cell length. We conclude that corticosteroid treatment of isolated OHCs is effective in blocking the morphological changes induced by salicylate. This study gives additional evidence that salicylate ototoxicity is mediated by alteration in the levels of arachidonic acid metabolites.
Laryngeal Amyloidosis: Localized versus Systemic Disease and Update on Diagnosis and Therapy
Authors: Bartels Hilke , Dikkers Frederik G. , Lokhorst Henk M. , Van Der Wal Jacqueline E. , Hazenberg Bouke P. C.
Published: October 2014

The clinical and pathological characteristics, possibility of systemic disease, and effect of local therapy were studied in laryngeal amyloidosis. Records of all patients with localized laryngeal amyloidosis in a single tertiary referral center were examined retrospectively at diagnosis and after local therapy. Of 188 new patients with amyloidosis between 1990 and 2003, 5 patients had localized laryngeal amyloidosis. A sixth patient with localized laryngeal amyloidosis turned out to have systemic AL (immunocyte-derived) amyloidosis 8 years later. Free light chains were found in this patient, as well as in 1 of the other 5 patients. Amyloid interfering with laryngeal or airway function was removed during microlaryngoscopy with a carbon dioxide laser or cold endoscopic excision. The best results were seen when glottic deposits were removed by cold endoscopic excision, and supraglottic deposits by a carbon dioxide laser. Four patients had recurrent disease. A systematic workup, including measurement of free light chains, helps to rule out systemic disease.
Locally Advanced Thyroid Carcinoma
Authors: Kasperbauer Jan L.
Published: October 2014

Patients with locally advanced thyroid carcinoma were studied to document survival, posttreatment vocal cord function, and dysphagia. A retrospective medical record review collected patient data recorded, including age, gender, and tumor-specific data. The outcome data collected included vocal cord function, presence of a tracheotomy or feeding tube, and the presence or absence of dysphagia. I studied 95 patients with surgically managed thyroid cancer. Forty-three patients had locally invasive disease and/or recurrent disease. During a median follow-up of 5 years, 18% of the patients with invasive cancer died of disease. The patients with completely resected invasive cancers had a significantly better survival rate than did the patients with microscopic residual disease. I conclude that complete resection of invasive disease provides a survival advantage and should be accomplished if speech and swallowing can be preserved. Most patients can obtain local control with minimal morbidity, and they rarely die of local disease.
Functional Outcomes of Reduced Hyaluronan in Acute Vocal Fold Scar
Authors: Rousseau Bernard , Sohn Jinho , Tateya Ichiro , Montequin Douglas W. , Bless Diane M.
Published: October 2014

To examine the functional effects of hyaluronan and collagen alterations in acute vocal fold scar, we injured 15 pig larynges by vocal fold mucosa stripping. At 3, 10, and 15 days after operation, we performed excised larynx experiments to measure phonation threshold pressure (PTP) and vocal economy (an acoustic output-cost ratio; OCR), and then performed hyaluronan and collagen assays. Five uninjured larynges were used as excised controls. Hyaluronan was reduced in the scarred vocal folds through 15 days of wound healing. Collagen was increased at day 15. The PTP was increased and OCR was decreased in scarred larynges, indicating decreased vocal efficiency and ease of phonation. Thus, PTP and OCR were sensitive to the biomolecular changes in acute vocal fold scar. Hyaluronan was more susceptible than collagen to acute tissue ultrastructural alterations. These findings may provide a rationale for increasing hyaluronan in acute vocal fold scar to improve postoperative vocal outcomes.
Aberrant Recurrent Laryngeal Nerve Reinnervation as a Cause of Stridor and Laryngospasm
Authors: Woo Peak , Mangaro Manuel
Published: October 2014

Unilateral vocal fold paralysis rarely presents with symptoms of stridor, laryngospasm, and dyspnea. Abnormal reinnervation of abductor nerve branches into adductor fibers may be one cause. Four patients have been positively identified by laryngeal electromyography. Two patients presented after thyroid surgery for thyroid neoplasm. One presented after cervical disk surgery. One patient presented after herpes simplex infection with multiple cranial nerve involvement. All patients had new onset of dyspnea with exertion many months after the recurrent nerve injury. Fiberoptic laryngoscopy showed the affected vocal fold to be immobile. However, with hyperventilation and deep inspiration, there was paradoxical adductor motion of the paretic vocal fold. Laryngeal electromyography showed evidence of reduced but intact voluntary motor units in the thyroarytenoid muscle. These motor units fired on inspiration and not on phonation. This pattern was not seen on the normal side. These findings are consistent with paradoxical innervation and/or synkinesis. Each patient was managed by Botox injection into the adductor muscle. Periodic reinjections may be necessary to manage the condition.
Laryngeal Electromyographic, Cardiovascular, and Respiratory Effects of Neuropeptide Injections into the Nucleus Tractus Solitarius of Rats
Authors: Bauman Nancy M. , Wang DeQiang
Published: October 2014

Identifying central neurotransmitters that mediate laryngeal adductor activity may aid in managing pathological laryngeal adduction as occurs in laryngospasm or apparent life-threatening events in infants. We studied the effect on cricothyroid (CT) and thyroarytenoid (TA) electromyography (EMG) and on cardiovascular parameters of neurotransmitter injections into the rat nucleus tractus solitarius (NTS), the primary sensory relay center of the larynx. Twenty nanoliters of vasoactive intestinal peptide (VIP; 2.5 pmol), neurokinin B (NKB, 16 pmol), calcitonin gene-related peptide (3.0 pmol), neurokinin A (NKA; 35 pmol), or artificial cerebrospinal fluid (control solution) was stereotactically injected into the region of the NTS and the control nucleus gracilis in 119 studies performed in 24 mature, anesthetized Sprague-Dawley rats. Changes in diaphragm, CT, and TA EMG activity and blood pressure (BP) were compared. Injection sites were verified histologically. Injections of both VIP and NKB into the region of the NTS, but not the nucleus gracilis, induced life-threatening changes, including apnea, a marked decline in BP (p < .05), and increases in EMG activity of the CT and TA adductor muscles ranging from sustained contraction to mild phasic increases during inspiration. Calcitonin gene-related peptide injection also decreased BP (p < .05), but caused only mild increases in CT and TA EMG activity. NKA and control injections into the NTS did not alter respiration, BP, or CT or TA EMG activity. VIP and NKB may play important roles in modulating EMG activity of the CT and TA muscles. This information may prove useful in evaluating pharmacological targets of central reflex activity to manage life-threatening laryngeal adduction.
Cytokeratin-17 as a Potential Marker for Squamous Cell Carcinoma of the Larynx
Authors: Cohen-Kerem Raanan , Rahat Michal A. , Madah Wahid , Greenberg Elhanan , Sabo Edmond , Elmalah Irit
Published: October 2014

To assess cytokeratin-17 (CK17) as an immunohistochemical marker for squamous cell carcinoma of the larynx, we stained 63 tissue samples from 63 consecutive patients who were believed or suspected to have squamous cell carcinoma of the larynx for CK17 and analyzed them by computerized histomorphometry. The mean staining intensity for CK17 was significantly stronger (p < .01) in cancerous cells, dysplasia, and normal epithelium proximal to the tumor than in distal normal epithelium and polyps. The percentage of stained area, within samples taken from a single patient, was significantly higher in malignancy and dysplasia as compared to distal normal epithelium and in malignancy as compared to dysplasia and proximal normal epithelium (p < .001). The integrated optical density was significantly higher in the malignant epithelium, dysplasia, polyps, and proximal normal epithelium than in distal normal epithelium (p < .0001). We conclude that CK17 is a highly sensitive and specific immunohistochemical marker for premalignant and malignant transformation in the larynx. Further investigation is warranted in order to assess the role of CK17 in determining safe resection borders.