bluuebunny/crossref_metadata_2025 huggingface dataset:
Volume of Mastoid Pneumatization: Three-Dimensional Reconstruction with Ultrahigh-Resolution Computed Tomography
Authors: Luntz Michal , Malatskey Shelton , Bar-Meir Elisha , Tan Mark , Ruimi David
Published: October 2014

The volume of the mastoid air cell system was measured in 69 patients with normal middle ears. All patients underwent axial ultrahigh-resolution computed tomography. Mastoid pneumatization was marked on each axial slice, and 3-dimensional reconstruction was performed. The volumes were measured with a volumetric algorithm. A polyethylene tubing phantom with a density similar to that of bone on computed tomography was devised. The polyethylene tubing was tied in a particular fashion so as to create interconnecting air spaces with a known volume. The phantom was scanned with the imaging parameters used for scanning the temporal bone. The air in the tubing was marked, and 3-dimensional reconstruction for the marked phantom air was performed. The volume of the interconnecting air spaces was measured and found to be identical to its known volume, thereby verifying the accuracy of the method used. The mean mastoid volume was 6.61 cm3. The smallest volume measured was 1.3 cm3, and the largest was 12.7 cm3. The importance of this technique lies in its high accuracy, ease of use, and ability to directly correlate mastoid size and clinical findings.
Open Zenker's Diverticulectomy Using Stapling Techniques
Authors: Busaba Nicolas Y. , Ishoo Edwin , Kieff David
Published: October 2014

This is a prospective review of patients who underwent Zenker's diverticulectomy, closure of the pharyngotomy with nonabsorbable staples, and cricopharyngeal myotomy through an open neck approach over a period of 2 years. The study group consisted of 9 men with a mean age of 67 years. The diagnosis of Zenker's diverticulum was based on a barium swallow esophagram. The mean operative time was 1.5 hours, with a mean estimated blood loss of 25 mL. Barium swallow esophagrams performed on the first postoperative day showed no pharyngeal fistulas. Oral feeding was started after the esophagram. One patient was discharged on postoperative day I, I was discharged on postoperative day 3, and the remaining 7 were discharged on postoperative day 2. All patients were able to take oral feeding by postoperative day I. There were no operative complications in this series. We conclude that stapling with nonabsorbable staples is a relatively safe and effective method for closing pharyngeal defects after Zenker's diverticulectomy. The technique leads to shortening of the operative time and hospital stay, and allows early resumption of oral feeding.
Hemicricoidectomy for Voice Rehabilitation following Hemilaryngectomy with Ipsilateral Arytenoid Removal
Authors: Amin Milan R. , Koufman James A.
Published: October 2014

The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent. This technique may be used at the time of the primary cancer extirpation or as a secondary rehabilitative procedure. Generally, patients who have undergone this procedure have had minimal postoperative breathiness with good phonatory and airway function. We recommend this reconstructive technique for patients with large posterior defects following hemilaryngectomy.
Intraoperative Pediatric Laryngeal Electromyography: Experience and Caveats with Monopolar Electrodes
Authors: Wohl Daniel L. , Kilpatrick Jefferson K. , Leshner Robert T. , Shaia Wayne T.
Published: October 2014

We report our experience with intraoperative laryngeal electromyography (L-EMG) using direct laryngoscopy and placement of monopolar electrodes under general anesthesia in the evaluation and management of laryngeal dysfunction in pediatric patients. In this series of case studies, we present clinical data on 30 pediatric patients with known or suspected anatomic or neurologic laryngotracheal disorders evaluated with placement of shielded monopolar electrodes into the thyroarytenoid muscles during direct laryngoscopy under general anesthesia. Diagnoses included congenital vocal fold paralysis (VFP), laryngotracheal stenosis, cerebral palsy, laryngeal tumors, traumatic vocal fold dysfunction, and postsurgical VFP. The impact of L-EMG on patient management was assessed. We found that L-EMG objectively supported clinical findings, but provided new objective data relevant toward management recommendations in only a few selected pediatric patients with new-onset vocal fold paralysis or paresis or infiltrative laryngeal tumors, and in selected postsurgical cases involving decannulation decisions. The prognostic utility of L-EMG in newborns with congenital VFP has not been established. A normal L-EMG recording indicates an intact neuromuscular axis, but does not guarantee vocal fold mobility or guarantee muscle function in a partially denervated or deconditioned muscle. The potential for false-negative recordings is the major limitation of this technique.
Laryngeal Reinnervation with the Hypoglossal Nerve
Authors: Paniello Randal C. , West Steven E. , Lee Patty
Published: October 2014

This study was performed to determine whether the hypoglossal nerve (cranial nerve XII [XII]) would serve as a useful donor for laryngeal reinnervation by anastomosis to the recurrent laryngeal nerve (RLN). Twenty hemilarynges in 10 dogs were studied pro-spectively after XII-RLN anastomosis (group A; n = 5), split XII—RLN anastomosis (group B; n = 3), XII-RLN anastomosis with a 2-cm interposition graft (group C; n = 2), no treatment (group D; n = 5), RLN section (group E; n = 2), or ansa cervicalis—RLN anastomosis (group F; n = 3). Spontaneous activity was observed monthly by infraglottic examination through permanent tracheostomies and was recorded by electromyography. Laryngeal adductory pressure and induced phonation were obtained by stimulating the RLN while passing a pressure transducer balloon or humidified air through the glottis. At sacrifice, the laryngeal muscles were stained for adenosine triphosphatase to determine the ratio of type I to type II fibers. Retrograde labeling of the brain stem was performed with horseradish peroxidase. Infraglottic examination at 6 months showed a full range of adductory motion in groups A and B during the swallow reflex, comparable with that in group D. Groups C and F showed good bulk and tone, but little spontaneous motion. Group E remained paralyzed. Stimulation of the transferred nerves caused more activity in groups A and B than in the other groups; groups C and F partially adducted at high levels. The laryngeal adductory pressure responses of groups A and B were similar to those of group D. The XII-reinnervated larynges were capable of producing normal induced phonation. Retrograde labeling of the RLN showed that the reinnervating axons originated only in the hypoglossal nucleus. Electromyography of the reinnervated adductor muscles confirmed spontaneous activity in the dogs (awake). Histochemical analysis confirmed slow-to-fast transformation of both the posterior and lateral cricoarytenoid muscles, indicating that significant reinnervation occurred. We conclude that the hypoglossal nerve functions well as a donor for adductory reinnervation of the larynx.
Combined Buccal Mucosa Island and Sternohyoid Flaps: A New Technique of Hemilaryngeal Reconstruction Studied in a Canine Model
Authors: Andrews Robert J. , Wang Marilene B. , Blackwell Keith E. , Calcaterra Thomas C. , Berke Gerald S. , Sercarz Joel A.
Published: October 2014

No single method of reconstruction has proven ideal for all patients with defects following vertical hemilaryngectomy. In this report, we detail a new technique for hemilaryngeal reconstruction involving the use of a pedicled buccal mucosa island flap supplied by the facial artery and vein. The buccal flap was used to resurface a transversely oriented sternohyoid myofascial flap. The reconstructive outcome was analyzed in 4 animals, 3 of which survived the early postoperative period. Videoendoscopy and stroboscopy were performed to analyze the laryngeal configuration and vibration. Each subject was decannulated and had a competent airway free of aspiration. After sacrifice of the animals, whole organ axial sections were made at multiple levels. Endoscopic and histologic findings documented that this technique produced an appropriate neocord position. Laryngeal stroboscopy in each animal showed bilateral mucosal traveling waves, with entrainment of the reconstructed neocord mucosa and native vocal cord mucosa. We conclude that the layered reconstructive technique described, compared to traditional methods of reconstruction, more closely replicates the structure of the excised tissue in hemilaryngeal reconstruction, potentially resulting in an improved voice outcome.
Diagnosis of Recurrent Intermittent Airway Obstruction (“Recurrent Croup”) in Children
Authors: Farmer Tonia L. , Wohl Daniel L.
Published: October 2014

Children with a history of recurrent intermittent airway obstruction can present with a constellation of signs and symptoms labeled by their primary care physician as “recurrent croup.” Recurrent croup, however, is not a diagnosis and should alert the clinician to the potential for intrinsic or extrinsic laryngotracheal pathology. This study was undertaken to evaluate referral patterns, diagnostic algorithms, and diagnoses for children with a history of recurrent intermittent airway obstruction initially characterized as “recurrent croup.” We performed a retrospective analysis of office and operative records of children with a history of recurrent intermittent airway obstruction characterized as “recurrent croup.” The setting was a university-based pediatric otolaryngology practice with both urban and suburban referral patterns. The medical records of 53 children (median age, 2 years) with a history of mild to severe recurrent intermittent airway obstruction characterized as “recurrent croup” were evaluated with respect to referral source, duration of signs and symptoms, diagnostic algorithm, and findings. We conclude that recurrent intermittent airway obstruction in children is an underappreciated clinical scenario. Upper aerodigestive tract endoscopy is a key component in a diagnostic evaluation to ascertain the cause. The decision for an endoscopic evaluation is best determined after analysis of the patient's age, past medical history, clinical severity, and suspected diagnosis. By virtue of his or her knowledge of aerodigestive tract anatomy and endoscopy skills, the otolaryngologist can take a proactive role in arriving at an accurate diagnosis in these children.
Pediatric Laryngoscopes: Design and Application
Authors: Benjamin Bruce
Published: October 2014

Examination of the upper aerodigestive tract for diagnosis and treatment has become more important in pediatric otolaryngology. Techniques of endoscopy have improved, anesthesia is safer, and there are many specialized laryngoscopes designed specifically for the small, sensitive airways of infants and children. Knowledge of the design advantages, specifications, and applications, including the use of telescopes and the operating microscope, will assist in selection of the appropriate laryngoscope for optimum exposure.
Chromosomal Abnormalities in Idiopathic Congenital Bilateral Vocal Cord Paralysis
Authors: Berkowitz Robert G. , Moxham J. Paul , Bankier Agnes , Gardner R. J. McKinlay
Published: October 2014

Idiopathic congenital bilateral vocal cord paralysis (BVCP) can occur as an isolated abnormality or as part of a multisystem disorder. The chromosomal abnormalities found in 4 children who presented with idiopathic congenital BVCP in association with other congenital abnormalities between January 1991 and April 1999 are described. Three children had abductor paralysis, and tracheostomy was required in 1. The fourth child had adductor paralysis and required a feeding gastrostomy for management of aspiration. There was no clinically significant improvement in vocal cord function observed in any child. Idiopathic congenital BVCP, when associated with other congenital disorders, may occur as a consequence of an underlying chromosomal abnormality, and chromosome studies should be performed in this group of children. Similarly, the possibility of vocal cord dysfunction should be considered in children who are found to have chromosomal abnormalities. A chromosomal abnormality appears to preclude the possibility of early spontaneous improvement in vocal cord function.
Oral Administration of Collagen Conjugated with Cholera Toxin Induces Tolerance to Type II Collagen and Suppresses Chondritis in an Animal Model of Autoimmune Ear Disease
Authors: Kim Nacksung , Mora Renzo , Cheng Kuang Chuan , Barbieri Marco , Kwon Soon Seog , Yoo T. J.
Published: October 2014

B10.RIII (H-2r) mice were orally administered cyanogen bromide peptide 11 (CB 11) or cholera toxin B (CTB)–conjugated CB 11 to induce tolerance in collagen-induced autoimmune ear disease. Oral administration of a high dosage of CB 11 provided partial protection from chondritis. However, administration of a tiny amount of CTB-CB 11 conjugate effectively suppressed chondritis. Oral administration of CTB-CB 11 conjugate did not alter the stimulation of T cells in vitro or the fine specificities of B cells. The oral administration of CTB-CB 11 caused a higher level of type II collagen-specific IgG and its subclass. Interestingly, increases of Th1 cytokine (interferon-γ) in Peyer's patches and of Th1/Th2 cytokines (interleukin-2 and interleukin-4) in lymph nodes were detected in mice that had been fed CTB-CB 11. An increase of CD8+ T cells in the Peyer's patches with a decrease of CD8+ T cells in lymph nodes was seen in mice that had been fed CTB-CB 11. These results suggest that protection from chondritis by oral administration of minute amounts of CTB-CB 11 conjugate can be achieved by a mechanism distinct from that of conventional oral tolerance induction.
Myelination of the Human Auditory Nerve: Different Time Courses for Schwann Celland Glial Myelin
Authors: Moore Jean K. , Linthicum Fred H.
Published: October 2014

The goal of this study was to trace the development of myelin in the human auditory nerve. To do this, we used the Woelcke ironhematoxylin technique to stain myelin sheaths in sections from fetal temporal bones and brain stems. In the cochlea, aggregations of Schwann cells are seen in the modiolus and along the spiral lamina by the 15th fetal week. By the 22nd fetal week, dense arrays of stained Schwann cells are present on auditory nerve axons within the temporal bone. By the 24th fetal week, light myelin sheaths extend up to, but not beyond, the glial junction. Myelin sheaths are not present in the auditory nerve central to the glial junction until the 26th fetal week or later. These results demonstrate a gap of several weeks between the onset of Schwann cell myeltnation distally and glial myelination proximally. The period between these two events may represent the time of final maturation of the organ of Corti.
Effects of Catecholamines on Calvarial Bone Resorption in Vitro
Authors: Sherman Bret E. , Chole Richard A.
Published: October 2014

Many important diseases in otolaryngology manifest through abnormal bone remodeling or destruction. The mechanisms for such pathological remodeling remain poorly understood. Bone is known to be innervated by norepinephrine-containing sympathetic nerves, and sympathectomy is known to induce bone resorption. The role, however, of norepinephrine as a potential bone-modulatory substance is unknown. Using the calvarial calcium release assay, we conducted the following experiment to evaluate the bone-modulatory activity of norepinephrine, the alpha-agonist octopamine, and the beta-agonist isoproterenol. Each agent was tested at 2 concentrations with and without parathyroid hormone. Norepinephrine was found to have no effect on calcium release. In contrast, octopamine at 10–8 mol/l exerted a significant stimulatory effect on calcium release, and isoproterenol at 10–6 mol/l exerted a significant inhibitory effect on parathyroid hormone-induced calcium release. The investigation suggests that a bimodal, concentration-dependent, receptor-specific model for catecholamine-mediated modulation of bone resorption may operate in calvarial bone.
Lack of Evoked Laryngeal Electromyography Response in Patients with a Clinical Diagnosis of Vocal Cord Paralysis
Authors: Damrose Edward J. , Blackwell Keith E. , Huang Robert Y. , Sercarz Joel A. , Blumin Joel H. , Berke Gerald S.
Published: October 2014

There has been recent debate about whether patients with vocal cord immobility have a neurologic paralysis or whether synkinesis, the misdirection of axons to competing laryngeal muscles, is responsible for the lack of voluntary vocal cord motion. This issue was studied in 15 patients with vocal cord paralysis who underwent laryngeal reinnervation. Evoked electromyography was performed with a surface electrode endotracheal tube. The recurrent laryngeal nerve (RLN) was identified and stimulated with constant current. Of the 15 patients, only 1 produced a compound muscle action potential upon nerve stimulation. The remaining 14 patients had no evoked response during RLN stimulation. a control group of 8 patients with normal vocal cord mobility was studied, and each had a normal evoked electromyography response after RLN stimulation. These results support the assertion that patients who require treatment for vocal cord paralysis do not have synkinesis produced by RLN reinnervation.
Oncological Results of Endoscopic Resections of Tis and T1 Glottic Carcinomas by Carbon Dioxide Laser
Authors: Peretti Giorgio , de Zinis Luca O. Redaelli , Nicolai Piero , Valentini Sergio , Piazza Cesare , Antonelli Antonino R.
Published: October 2014

A cohort of 88 patients with glottic cancer (13 Tis, 75 T1) who underwent endoscopic CO2 laser excision between January 1995 and June 1997 was prospectively studied. The mean follow-up was 43 months (range, 30 to 60 months). The depth and extent of the excision (graded according to the European Laryngological Society Classification, which includes 5 types of resection) were based on the results of a preoperative and intraoperative diagnostic test battery. Five patients died of other diseases, and none of glottic cancer. Of the 12 patients who developed a local recurrence, 5 underwent a second endoscopic procedure, 5 a total laryngectomy, and 1 a supracricoid laryngectomy, and 1 was treated with radiotherapy. The 5-year local control rate with endoscopic surgery alone, according to the Kaplan-Meier method, was 91%. None of the variables (8 related to the tumor and 2 to the treatment) tested in a univariate analysis by the log-rank test was found to have a significant impact on disease-free survival rates. The present study confirmed that endoscopic partial cordectomy for Tis and T1 glottic cancers can be regarded as a valid alternative to radiotherapy in terms of oncological results.
The DFNA10 Phenotype
Authors: De Leenheer Els M. R. , Huygen Patrick L. M. , Smith Richard J. H. , Wayne Sigrid , Cremers W. R. J.
Published: October 2014

We present a detailed analysis of the DFNA10 phenotype based on data from 25 hearing-impaired persons coming from a large American pedigree segregating for deafness at the DFNA10 locus (chromosome 6q22.3–23.2). Cross-sectional analysis of air conduction threshold—on—age data from all available last-visit audiograms (linear regression analysis, age over 15 years) showed progression of hearing loss at a rate of 0.6 dB/y over all frequencies, with a flat to gently sloping age-corrected threshold of about 50 dB. The results were significant at 0.25, 4, and 8 kHz, but only if corrections for presbycusis were not included. Longitudinal threshold analysis performed in 1 case, covering ages 6 to 32 years, showed progression of hearing loss at a rate of 2 to 3 dB/y over 0.25 to 8 kHz. Nonlinear regression analysis was performed on phoneme discrimination scores with use of sigmoidal dose-response curves with variable slope. On the basis of these data, the hearing loss phenotype in this American DFNA10 family can be described as postlingual, initially progressive, and resulting, without the influence of presbycusis, in largely stable, flat sensorineural deafness.
Measurements of Drill-Induced Temperature Change in the Facial Nerve during Mastoid Surgery: A Cadaveric Model Using Diamond Burs
Authors: Abbas Gregory M. , Jones Raleigh O.
Published: October 2014

The purpose of this study was to investigate the changes in temperature in the facial nerve that occur during mastoid drilling by the facial recess approach and to confirm the beneficial effects of constant irrigation while drilling. Mastoid drilling was performed on human cadaveric temporal bones by means of 4-mm diamond burs with and without irrigation. There were 6 subjects in each group. Changes in facial nerve temperature were recorded on a continuous-output monitor. Significant changes were found in temperature for both the irrigation and non-irrigation groups (p < .0001). Constant irrigation minimized the rise in temperature. Facial recess drilling poses a potential threat to cranial nerve VII via thermal injury. The temperature elevation in the non-irrigation group was significantly greater than that in the irrigation group and was greater than the tolerable limits of peripheral nervous tissue. This finding supports the need for constant irrigation during the approach to the facial recess in mastoid surgery.
Multicentricity of Intraparotid Facial Nerve Schwannomas
Authors: Chiang Ching-Wen , Chang Yih-Leong , Lou Pei-Jen
Published: October 2014

Facial nerve schwannomas are uncommon neoplasms. Multiple schwannomas of the facial nerve in the parotid region are rare. Research regarding the pathogenesis of multiple facial nerve schwannomas is incomplete. Both the neoplastic bridging of tumor cells and tumor multicentricity have been hypothesized. We present a case of multiple intraparotid facial nerve schwannomas. In this case, the histologic features of the tumors support the multicentric hypothesis.
Mechanism of Hearing Loss in Irradiated Ears: A Long-Term Longitudinal Study
Authors: Young Yi-Ho , Lu Ying-Chih
Published: October 2014

A 10-year longitudinal follow-up study of hearing was conducted in patients with nasopharyngeal carcinoma (NPC) in order to elucidate the mechanism of hearing loss in irradiated ears. Ten NPC patients were subjected to a battery of audiological tests before irradiation and 6 months, 5 years, and 10 years after irradiation. The tests included pure tone audiometry, tympanometry, eustachian tube function testing, and myringotomy to confirm middle ear effusion. The prevalences of otitis media with effusion (OME) were 25%, 25%, 40%, and 25% at the 4 testing periods described above, respectively. The prevalences of chronic otitis media were 0%, 0%, 15%, and 25%, respectively. In myringotomized ears (n = 17), the mean hearing levels for both air conduction and bone conduction were preserved from the preirradiation period to 10 years after irradiation. In contrast, in grommeted ears (n = 3), the mean hearing levels for both air conduction and bone conduction deteriorated progressively from the preirradiation period to 10 years after irradiation. We conclude that hearing can be preserved in NPC patients 10 years after irradiation if middle ear inflammation is well controlled. We do not recommend grommet insertion in irradiated NPC patients with OME, as it may result in persistent otorrhea and hearing deterioration.
Histopathologic Study of Temporal Bone and Eustachian Tube in Oculoauriculovertebral Spectrum
Authors: Miura Makoto , Sando Isamu , Haginomori Shin-Ichi , Takasaki Kenji , Hirsch Barry E.
Published: October 2014

Bilateral temporal bone specimens from a 21-month-old girl and a left temporal bone-eustachian tube (ET) specimen from a full-term female newborn, both with oculoauriculovertebral spectrum, were studied histopathologically. The external and middle ears demonstrated severe anomalies, similar to those of previous reports describing the histopathologic findings of this syndrome. In addition, despite having a normal auricle, the 21-month-old child had bilateral hypoplastic cochleas as seen in Mondini dysplasia. The newborn had several anomalies of the ET, including a widely opened cartilaginous portion of the ET lumen and absence of the lateral lamina of the ET cartilage. We discuss the implications of the observed anomalies with regard to developmental and clinical issues.
Transient Inflammation and Dysfunction of the Eustachian Tube Secondary to Multiple Exposures of Simulated Gastroesophageal Refluxant
Authors: Heavner S. Brett , Hardy Stuart M. , Prazma Jiri , White David R. , Pillsbury Harold C.
Published: October 2014

Gastroesophageal reflux is a common problem in the newborn and preschool periods. Recent research suggests that it may be related to eustachian tube dysfunction and otitis media with effusion. The purpose of this experiment was to investigate the relationship between simulated gastroesophageal reflux and eustachian tube dysfunction. Rat middle ears were repeatedly exposed (transtympanically) to pepsin in hydrochloric acid or to phosphate-buffered saline solution. Their eustachian tube function was evaluated by assessing passive opening and passive closing pressures, and active clearance of positive and negative pressure. The passive pressure function tests showed variable results. The rats exposed to pepsin in hydrochloric acid had an impaired ability to clear positive and negative pressure from the middle ear as compared to the rats exposed only to phosphate-buffered saline solution. The results demonstrate that multiple middle ear exposures to pepsin in hydrochloric acid leads to eustachian tube dysfunction in rats.
Screening of Olfactory Function with a Four-Minute Odor Identification Test: Reliability, Normative Data, and Investigations in Patients with Olfactory Loss
Authors: Hummel Thomas , Rosenheim Kati , Konnerth Claus-Günther , Kobal Gerd
Published: October 2014

The study aimed to create a screening test on the basis of the odor identification test as used in the “Sniffin‘ Sticks” olfactory test kit. It should appeal to the practitioner in terms of 1) time required for testing, 2) reliability, 3) separation of “normal” from “abnormal,” and 4) the fact that it allows lateralized screening. Experiments should provide a normative database (number of subjects > 1,000), establish test-retest reliability (n > 100), and compare results from patients with olfactory loss (n > 200). The correlation between results on 2 repetitive tests was .78. The test differentiated anosmics, hyposmics, and normosmics (p < .001). None of the 112 anosmics reached a score higher than 8; the 90th percentile was at a score of 6. When only 6 odors were used for calculating scores, for anosmics the 95th percentile was at a score of 4. These data provide a basis for the screening of patients by means of “Sniffin' Sticks.”
Involvement of Level I Neck Lymph Nodes in Advanced Squamous Carcinoma of the Larynx
Authors: dos Santos Carlos Roberto , Paulo São , Magrin José , Ferlito Alfio , Filho João Gonαalves , Johnson Luiz Fernando P. , Kowalski Luiz Paulo
Published: October 2014

This study was performed to evaluate the incidence of metastasis at level I in patients with squamous laryngeal cancer. One hundred consecutive patients with squamous carcinoma of the larynx were submitted to surgical treatment including radical neck dissection. The tumor stage was T3 or T4, and the neck stage was N1-N2c. Lymph node metastases were pathologically confirmed in 80 patients. Metastases were concentrated within level II in 59% of cases, level III in 17% of cases, level IV in 11% of cases, and level V in 6% of cases. Only 2 patients (2%) had detectable tumors in the lymph nodes of the submandibular triangle (level IB). This study shows that patients with laryngeal cancer rarely present metastases at the submandibular triangle, even in advanced local disease with cervical metastasis staged as N1 to N2c. Therefore, dissection of the submandibular triangle is indicated only in the presence of clinical, radiographic, or cytologic evidence of metastatic disease at level I.
Prevention of Anterior Glottic Restenosis in a Canine Model with Topical Mitomycin-C
Authors: Spector Jared E. , Huang Shan , Werkhaven Jay A. , Sanders David , Spector Nicole C. , Reinisch Lou
Published: October 2014

To develop a model for recurrent anterior glottic stenosis and to test the efficacy of topical mitomycin-C in preventing restenosis, we induced anterior glottic stenosis with a CO2 laser in 5 dogs. In 3 dogs, recurrence was established after surgical lysis. Subsequently, the 3 dogs received a single topical 3-minute treatment with a 1% solution of mitomycin-C after a second surgical lysis. In a parallel experiment, the other 2 dogs received a single topical 3-minute treatment with a 1% solution of mitomycin-C after the initial surgical lysis. An anterior glottic web was induced in all 5 dogs with the CO2 laser. The 3 dogs experienced restenosis at the anterior glottis after surgical lysis alone. Mitomycin-C prevented anterior glottic restenosis in 2 of the 3 dogs treated twice and in both of the dogs treated once (p = .02). We conclude that a recurrent stenosis of the anterior glottis may be induced reproducibly in the canine model with the CO2 laser. Application of topical mitomycin-C after lysis of an anterior glottic stenosis produces a statistically significant reduction in the rate of restenosis as compared to surgical lysis alone.
Ciliary Beat Frequency in Cultured Human Nasal Epithelial Cells
Authors: Min Yang-Gi , Lee Chang-Ho , Rhee Chae-Seo , Lee Chul Hee , Yi Won Jin , Kwon Tae-Young , Park Kwang-Seok
Published: October 2014

This study aimed to determine the characteristics of ciliogenesis and the ciliary beat frequency (CBF) of cultured human nasal epithelial cells by means of an in vitro air-liquid interface (ALI) culture system. On the 14th, 21st, and 27th days of ALI culture, CBFs of cultured cells were measured with a video computerized analysis system, and the epithelial cell-collagen matrix complex was examined by scanning and transmission electron microscopy. Using a CBF distribution map, we calculated the proportion of ciliary beating area (CBA) on the cultured cells. On the 14th day, ciliated cells could be easily distinguished from other cells on scanning electron microscopy by their elongated cilia. Between the 14th and 27th days, the number of mature cilia increased, and after 27 days of air exposure, the cilia of each cell pointed to one direction. From the beginning of air-exposure culture until the 7th day, the number of secretory cells increased; however, from the 7th day to the 27th day, it decreased, and the number of ciliated cells increased. Total CBAs increased from the 7th day to the 21st day. The proportions of actively beating cells and the mean CBFs of beating cells among cultured epithelial cells increased with culture time. On the 21st day, the mean CBF of the cultured cells was similar to that of nasal ciliated cells in biopsy specimens (10.9 ± 0.5 Hz versus 11.4 ± 1.3 Hz), but until the 27th day, the CBF of cultured cells increased significantly (13.9 ± 0.8 Hz). It is suggested that there may be some difference in CBF between nasal epithelial cells submitted to biopsy and nasal epithelial cells cultured by the ALI culture system.
Jacobson's Nerve Schwannoma: A Rare Middle Ear Mass
Authors: Kesser Bradley W. , Ma Yanling , Brackmann Derald E. , Weiss Marc
Published: October 2014

The case of a 55-year-old woman with a middle ear mass is presented. The preoperative diagnostic workup, including an audiogram and imaging studies, and the histopathologic findings of the tumor are reviewed. The tumor, a schwannoma, arose from Jacobson's nerve in the middle ear. The surgical anatomy of Jacobson's nerve and the surgical approach to this tumor and to other tumors of the middle ear space are discussed. Tumors of the tympanic cavity are rare, with the exception of cholesteatoma; otherwise, the most common among them are paraganglioma and facial nerve neuroma. This report represents the first documented case of a schannoma arising from Jacobson's nerve in the tympanic cavity.
Serum Level of Macrophage Migration Inhibitory Factor as a Useful Parameter of Clinical Course in Patients with Wegener's Granulomatosis and Relapsing Polychondritis
Authors: Ohwatari Ryuichiro , Inuyama Yukio , Fukuda Satoshi , Onoé Kazunori , Iwabuchi Kazuya , Nishihira Jun
Published: October 2014

Novel biological activities of macrophage migration inhibitory factor (MIF) have been rediscovered. In addition, elevation of the serum MIF level has been reported in different types of disorders, including various inflammatory and autoimmune diseases. In the present study, serum MIF levels were analyzed in patients with Wegener's granulomatosis (WG) and relapsing polychondritis. It was shown that the serum MIF levels in these patients were significantly higher than those of normal healthy controls. In a WG patient, the MIF level showed a good correlation with clinical symptoms and C-ANCA titers. Thus, serum MIF levels will be a useful laboratory parameter for following the clinical course of WG patients and determining medical treatment. The immunopathologic roles of MIF in these diseases are discussed.
Venous Collateral Blood Flow Assessed by Doppler Ultrasound after Unilateral Radical Neck Dissection
Authors: Doepp Florian , Lammert Ingeborg , Hoffmann Olaf , Einhäupl Karl Max , Schreiber Stephan , Valdueza José Manuel
Published: October 2014

Removal of the internal jugular vein (IJV) in unilateral radical neck dissection (rND) necessitates redirection of cerebrovenous blood to collateral pathways. If adaptation is insufficient, neurologic sequelae develop that are due to impaired venous drainage and increased intracranial pressure. The authors studied venous hemodynamic effects of unilateral rND using Doppler and duplex ultrasound in 17 patients. Blood flow velocities (BFVs) were recorded from the distal IJV (dIJV) and the vertebral vein (VV) before and 9 to 88 days after surgery. A preoperative compression test of the dIJV was performed to identify the side of dominant drainage. The BFV increased in the contralateral dIJV after right-sided rND (n = 10) by 111% (range, 50% to 320%), and after left-sided rND (n = 7) by 34% (range, 5% to 105%). In the contralateral VV, a rise of BFV by 75% was found. Our results confirm the role of the contralateral dIJV as the predominant collateral pathway. The VVs serve as an important additional major outflow. Doppler ultrasound may help to identify patients at risk of insufficient cerebrovenous drainage after rND.
Accommodation to Changes in Bolus Viscosity in Normal Deglutition: A Videofluoroscopic Study
Authors: Kendall Katherine A. , Leonard Rebecca J. , McKenzie Susan W.
Published: October 2014

Videofluoroscopic swallow studies were performed on 60 normal adult volunteers. Swallowing variables were measured during swallows of a 3-cm3 paste bolus and a 3-mL liquid bolus and were compared to identify changes in swallow gesture displacement and timing, as well as changes in bolus movement timing. The study revealed that some differences measured by videofluoroscopy appear to be the result of the inherent bolus characteristics, while others likely represent changes in swallow gestures needed to accommodate variations in bolus viscosity. The overall timing of pharyngeal transit did not vary between bolus types. Oropharyngeal transit trended toward being faster for a liquid bolus with a concurrent early elevation of the aryepiglottic folds. The hyoid bone elevated at the same time, at the same rate, and to the same extent irrespective of bolus viscosity. During a liquid bolus swallow, the hyoid bone trended toward a more prolonged elevation, corresponding to prolonged pharyngoesophageal sphincter opening. The pharyngoesophageal sphincter, however, opened to a greater extent with a paste bolus.
Complete Branchial Fistula
Authors: Ang Annette Hui-Chi , Pang Kenny Peter , Tan Luke Kim-Siang
Published: October 2014

Branchial anomalies, a result of aberrant embryonic development, are rarely seen in clinical practice. Lesions of the second branchial pouch commonly present as a neck lump or discharging sinus that may be complicated by infection. Clinical examination often reveals the lesion to be related to the junction of the upper two thirds and the lower one third of the sternocleidomastoid muscle. Branchial fistulas often present as a discharging sinus in the neck with the fistula tract extending upward within the deep neck tissue for a variable distance. A complete branchial fistula is one that has a defined internal opening in the tonsillar area and an external opening at the skin overlying the sternocleidomastoid muscle at the junction of the upper two thirds and the lower one third of the muscle. The incidence of such lesions is extremely rare. Surgical excision is the treatment of choice for branchial anomalies. We present the case of a patient who presented with a complete branchial fistula and discuss the clinical presentation and surgical management of such lesions, with a review of the relevant literature.
Cell Biology of Laryngeal Epithelial Defenses in Health and Disease: Preliminary Studies
Authors: Axford Sophie E. , Sharp Nikki , Dettmar Peter W. , Ross Peter E. , Panetti Marguerite , Pearson Jeffrey P. , Koufman James A.
Published: October 2014

Esophageal epithelium has intrinsic antireflux defenses, including carbonic anhydrases (CAs I to IV) that appear to be protective against gastric reflux. This study aimed to investigate the expression and distribution of CA isoenzymes in laryngeal epithelium. Laryngeal biopsy specimens collected from the vocal fold and interarytenoid regions were analyzed by Western blotting and immunofluorescence. Carbonic anhydrases I and II were expressed by the majority of samples analyzed. In contrast, CA III was differentially expressed in the interarytenoid samples and was not detected in any vocal fold samples. The expression of CA III was increased in esophagitis as compared to normal esophageal tissue. Carbonic anhydrase I and III isoenzymes were distributed cytoplasmically in the basal and lower prickle cell layers. The laryngeal epithelium expresses some CA isoenzymes and has the potential to protect itself against laryngopharyngeal reflux. Laryngeal tissue may be more sensitive to injury due to reflux damage than the esophageal mucosa because of different responses of CA isoenzymes.
Esophageal Motor Function in Laryngopharyngeal Reflux is Superior to That in Classic Gastroesophageal Reflux Disease
Authors: Postma Gregory N. , Belafsky Peter C. , Tomek Michael S. , Koufman James A.
Published: October 2014

Laryngopharyngeal reflux (LPR) in otolaryngology patients appears to be different from classic gastroesophageal reflux disease (GERD). In particular, esophagitis and its principal symptom, heartburn, considered the diagnostic sine qua non of GERD, are often absent in LPR. It has therefore been postulated that LPR patients have superior esophageal function. Esophageal acid clearance (EAC) is a measure of the ability of the esophagus to restore neutral pH after reflux events have occurred. It is considered an excellent overall measure of esophageal function. The mean EAC can be calculated from 24-hour pH monitoring data. A comparison of EAC in patients with GERD and LPR has not been previously reported. To compare the EAC of 1) patients with LPR alone, 2) patients with GERD alone, 3) patients with both LPR and GERD, and 4) patients without either LPR or GERD, we studied 200 otolaryngological patients who had undergone 24-hour double-probe (simultaneous pharyngeal and distal esophageal) pH monitoring, 50 in each group. The subgrouping of each patient was determined by previously established pH monitoring criteria. We defined GERD as abnormal esophageal reflux and LPR as abnormal pharyngeal reflux. The patients with GERD had a mean (±SD) EAC of 1.44 ± 1.2 minutes, and those with LPR had a mean EAC of 1.00 ± 1.00 minutes (p <.05). The patients with both GERD and LPR had a mean EAC of 1.53 ± 1.01 minutes. The patients without reflux had a mean EAC of 0.53 ± 0.38 minutes. We conclude that patients with LPR have significantly better EAC than those with GERD. These data suggest that patients with LPR have superior esophageal function. This finding may clarify our understanding of the differences in mechanisms, symptoms, and incidence of esophagitis in patients with LPR and GERD.
Comparison of the Phonation-Related Structures among Pig, Dog, White-Tailed Deer, and Human Larynges
Authors: Jiang Jack J. , Raviv Joseph R. , Hanson David G.
Published: October 2014

There is an important need for good animal models of the larynx for the study of the physiology of phonation. The dog's larynx has been used as an animal model for more than 2 centuries of phonatory research. However, there is some evidence that the pig larynx has advantages over the dog larynx as a model of phonation. Another larynx that is readily available is the deer larynx. In this comparative study, the laryngeal anatomy and function were examined in 4 species — human, pig, dog, and white-tailed deer. Particular attention was directed to those structures that one would predict could affect phonation, from the anatomic and biomechanical point of view. Although the vocal fold length was similar for all 4 species, the larynges described differed in some phonation-related characteristics. The data suggest that from a structural perspective, the pig larynx is a superior model for phonatory research.
Geometric Characterization of the Laryngeal Cartilage Framework for the Purpose of Biomechanical Modeling
Authors: Tayama Niro , Kaga Kimitaka , Chan Roger W. , Titze Ingo R.
Published: October 2014

Some new anatomic data on the laryngeal cartilage framework have been obtained for the biomechanical modeling of the larynx. This study attempted to define and measure some biomechanically important morphometric features of the laryngeal framework, including both the human and the canine laryngeal frameworks, because the canine larynx has been frequently used as an animal model in gross morphology and in physiological experiments. The larynges of 9 men, 7 women, and 9 dogs were harvested and dissected after death. Linear and angular geometric measurements on the thyroid cartilage, the cricoid cartilage, and the arytenoid cartilage were made with a digital caliper and a protractor, respectively. The results are useful for constructing quantitative biomechanical models of vocal fold vibration and posturing (abduction and adduction), eg, continuum mechanical models and finite-element models of the vocal folds.
Larynx Preservation with Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy
Authors: Weinstein Gregory S. , Dooley Patricia , Laccourreye Ollivier , Chalian Ara , Ruiz Cesar , Mirza Natasha
Published: October 2014

Classically, the formation of a mucosal wave is dependent on the pliable mucosa present in the vocal fold. The supracricoid partial laryngectomy with cricohyoidoepiglottopexy is an organ preservation surgical technique in which both true vocal folds, both false vocal folds, both paraglottic spaces, and the entire thyroid cartilage are resected. The functional goal is speech and swallowing without a permanent tracheostomy. In an effort to further study voice production in these patients, we performed laryngeal stroboscopy in 5 patients. Analysis was performed with a modified Bless grading system. In addition, speech and voice parameters were also measured and correlated with stroboscopic findings. The key finding in this study was the presence of a periodic mucosal wave on the anterior aspect of the arytenoid cartilage, where it abuts the epiglottic cartilage. Patients with lower periodicity and symmetry scores tended to have lower jitter and shimmer percentages.
Submandibular Diagnostic and Interventional Sialendoscopy: New Procedure for Ductal Disorders
Authors: Marchal Francis , Barki Gerard , Dulguerov Pavel , Disant François , Becker Minerva , Lehmann Willy
Published: October 2014

We present our initial experience with submandibular sialendoscopy, a new therapeutic approach for disorders of Wharton's duct. We review the sialendoscopes used and discuss their respective merits. We evaluated and treated 129 consecutive patients with suspected ductal disorders. Diagnostic sialendoscopy was used for classifying ductal lesions as sialolithiasis, stenosis, sialodochitis, or polyps. Interventional sialendoscopy was used to treat these disorders. The type of endoscope used, the type of sialolith fragmentation and/or extraction device used, the total number of procedures, the type of anesthesia, and the number and size of the sialoliths removed were the dependent variables. The outcome variable was the endoscopic clearing of the ductal tree and resolution of symptoms. Diagnostic sialendoscopy was possible in 131 of 135 glands (97%), with an average (±SD) duration of 28 ± 15 minutes. Interventional sialendoscopy was attempted in 110 cases, with an average duration of 71 ± 41 minutes, with a success rate of 82%. Multiple sialendoscopies were necessary in 25% of cases. General anesthesia was used in 12% of cases. Submandibular gland resection was performed in 4%. The average size of the stones was 4.9 ± 2.9 mm. Multiple sialoliths were found in 31 cases (29%). Sialolith fragmentation was required in 26%. Larger and multiple stones often required longer and multiple procedures and general anesthesia, and more often resulted in failures. Semirigid endoscopes had a higher success rate (85%) than flexible sialendoscopes (54%). Complications were mostly minor, but were encountered in 10% of cases. Diagnostic sialendoscopy is a new technique for evaluating salivary duct disorders that is associated with low morbidity. Interventional sialendoscopy allows the extraction of sialoliths in most patients, thus preventing open gland excision.
Evaluation of Nasal Mucociliary Clearance Function in Allergic Rhinitis Patients with Technetium 99M-Labeled Macroaggregated Albumin Rhinoscintigraphy
Authors: Sun Shung-Shung , Hsieh Jih-Fang , Ho Yung-Jen , Tsai Shih-Chuan , Kao Chia-Hung
Published: October 2014

Nasal mucociliary clearance is the first line of defense of the ciliated epithelium of the respiratory tract against inhaled particles. Several rhinopathic conditions involve alterations in nasal mucociliary clearance. The purpose of this study was to assess the clinical role of rhinoscintigraphy in evaluation of nasal mucociliary clearance function in allergic rhinitis patients and in sinusitis patients and healthy controls for comparison. A technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) drop was deposited on the floor of the nasal meatus about 1 cm behind the mucocutaneous junction, and its course was followed with a gamma camera. The nasal mucociliary clearance function was measured as the velocity of the nasal mucociliary transport of the Tc-99m MAA droplet. The mean velocity of nasal mucociliary transport in the allergic rhinitis patients was 2.71 ± 0.76 mm/min (2.65 ± 0.76 mm/min in the right nostril; 2.77 ± 0.76 mm/min in the left nostril). The mean velocity of nasal mucociliary transport in the sinusitis patients was 1.80 ± 0.64 mm/min (1.79 ± 0.65 mm/min in the right nostril; 1.82 ± 0.63 mm/min in the left nostril). The mean velocity of nasal mucociliary transport in the 25 healthy controls was 4.28 ± 1.38 mm/min (4.30 ± 1.35 mm/min in the right nostril; 4.27 ± 1.42 mm/min in the left nostril). A significant difference in nasal mucociliary clearance was observed among the 3 groups. We suggest that Tc-99m MAA rhinoscintigraphy may be a useful noninvasive tool to evaluate the nasal mucociliary clearance function in allergic rhinitis patients.