bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiogenic Non-Hodgkin T/Natural Killer (NK)-cell Lymphoma: Report of Three Cases
Authors: Martins-Filho Rubens A. , Demarco Ricardo C. , Valera Fabiana C.P. , Shaletich Catarina , Félix Paulo R. , Badiale Giovana B. , Anselmo-Lima Wilma T.
Published: May 2019

Angiogenic T/natural killer (NK)-cell lymphoma is anon-Hodgkin lymphoma characterized by necrosis and vascular destruction that is strongly associated with Epstein-Barr virus and AIDS. Early diagnosis is essential to improve the chances of patient survival, but severe local inflammatory infiltrate impairs histologic diagnosis by obscuring neoplastic cells. The most common markers are CD2, CD56, cytoplasmic CD3, and CD43 EBV. We describe 3 cases of angiogenic T/NK-cell lymphoma that show the diverse presentation of the same disease. Patient 1 was HIV positive and had nasal obstruction, facial edema, and ulceration of the nasal mucosa. Patient 2 had fever, a sore throat, and weight loss. Patient 3 had facial edema, fever, proptosis, and rapid development of neurologic alterations. Several biopsies were needed for histologic confirmation in these patients, despite positivity for the CD3 and CD56 markers.
Aspergillus Otomycosis in an Immunocompromised Patient
Authors: Rutt Amy L. , Sataloff Robert T.
Published: May 2019

Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic unilateral otomycosis in a 55-year old, immunocompromised man who had been unresponsive to a variety of treatment regimens. The patient presented with intermittent otalgia and otorrhea and with a perforation of his left tympanic membrane. A niger was identified in a culture specimen obtained from the patient's left ear canal. In immunocompromised patients, it is important that the treatment of otomycosis be prompt and vigorous, to minimize the likelihood of hearing loss and invasive temporal bone infection.
Aggressive Fibromatosis of the Oropharynx: A Multidisciplinary Approach to a Benign Disease
Authors: Kiverniti Eleftheria , Cilasun Ulkem , Singh Arvind , Kazi Rehan , Clarke Peter M. , Archer Daniel J.
Published: May 2019

We present the case of a 23-year-old woman with aggressive fibromatosis of the oropharynx that was initially treated elsewhere as a peritonsillar abscess. We discuss the characteristics of this rare tumor and review the literature, stressing the importance of postoperative follow-up for peritonsillar abscesses to avoid missing other important diagnoses, such as the one described here.
Management of the Difficult Pediatric Airway: Efficacy of Airway Exchange Catheters with Rigid Bronchoscopy
Authors: Mohyuddin Nadia , Sulman Cecillie , Wheeler Melissa
Published: May 2019

The airway exchange catheter can be used both to ventilate the lungs and to act as a guide for reintubation in patients of all ages who have a tenuous airway. We report the case of a 2-year-old boy with an anatomically challenging airway in whom both an airway exchange catheter and a rigid bronchoscope were used to visualize and maintain a secure airway. We also review the literature as it pertains to the management of the difficult pediatric airway.
The Nasal Septum: An Osteometric Study of 16 Cadaver Specimens
Authors: Prabhu Latha Venkatraya , Ranade Anu Vinod , Rai Rajalakshmi , Pai Mangala M. , Kumar Arunachalam , Sinha Prakash , Nayak Soubhagya Ranjan
Published: May 2019

Studies of the shape, dimensions, and other morphologic characteristics of the nasal septum are scant in the literature. We conducted a study of 16 male cadavers to measure six osseous components of the nasal septum and to calculate the proportional contribution that each made to the total septal bone surface area. We found a wide range of inter-specimen variations in both categories. It is our hope that a better understanding of nasoseptal anatomy will improve surgical technique.
Intraoperative Bupivacaine for Reduction of Post-Tonsillectomy Pain: A Randomized, Placebo-Controlled, Double-Blind Study of 26 Patients
Authors: Watts Tammara L. , Kountakis Stilianos E.
Published: May 2019

We conducted a randomized, controlled, double-blind, prospective study to evaluate the effect of intraoperative bupivacaine injection on postoperative pain control following Bovie cautery-assisted tonsillectomy in 26 adults. Sixteen patients were injected with 10 ml of 0.5% bupivacaine with 1:200,000 epinephrine, and 10 were injected with 10 ml of normal saline solution. For 10 days after surgery, patients completed a questionnaire to rate their overall pain and to record their narcotic consumption and oral intake. At study's end, there was no statistically significant difference in pain scores, narcotic use, and oral intake between the bupivacaine group and the controls (p = 0.13, 0.37, and 0.35, respectively). We conclude that the effects of perioperative bupivacaine on postoperative pain control in tonsillectomy patients are similar to those of placebo.
External Auditory Canal Cholesteatoma: A Rare Complication of Tympanoplasty
Authors: Viswanatha Borlingegowda
Published: May 2019

The author describes a rare case of external auditory canal cholesteatoma. This particular case occurred in a 20-year-old woman who had undergone a tympanoplasty 1 year earlier. Previous tympanoplasty is one of several known predisposing factors for external auditory canal cholesteatoma. The mass was excised, and it was diagnosed on histopathology. The patient recovered uneventfully.
Granulocytic Sarcoma of the Nasal Cavity: A Case Report
Authors: Gorman Mary , Ahmed Khwaja Asif , Pallera Arnel , Samant Sandeep
Published: May 2019

Granulocytic sarcoma of the nasal cavity is exceedingly rare. We describe the case of a 55-year-old man who presented with an intranasal mass that was later diagnosed as a granulocytic sarcoma. The mass was treated with rapid initiation of chemotherapy, which produced a substantial decrease in tumor bulk. Granulocytic sarcoma is often mistaken for lymphoma or other poorly differentiated malignancies, and the correct diagnosis requires a high index of clinical suspicion.
Pediatric Airway Consultation Survey in a Tertiary Care Children's Hospital: An Interobserver Analysis
Authors: Naseri Iman , Durden Frederick L. , Sobol Steven E.
Published: May 2019

We conducted a prospective analysis to independently observe the initial opinion of: (1) consulting pediatric residents (postgraduate year 2 [PGY-2]), (2) corresponding considting attending physicians (general pediatric or pediatric emergency medicine) physician, and (3) consulting otolaryngology PGY-2 residents when assessing patients for “noisy breathing.” Each was asked to define the type of noisy breathing present and to formulate a diagnosis based on a limited set of choices. The final diagnosis was determined by a single attending pediatric otolaryngologist (S.E.S.) at the completion of the diagnostic workup. The accuracy for characterization of breath sounds for the pediatric residents, attending pediatricians, and otolaryngology residents were 26.1%, 23.5%, and 98.6%, respectively. The positive predictive values for the determination of diagnosis were 71.6%, 69.4%, and 76.6%, respectively. These findings indicate that pediatric residents and attending pediatricians may be deficient in their ability to characterize the breath sounds commonly seen inpatients with noisy breathing. Further education of pediatricians may lead to a more accurate diagnostic evaluation of a child with noisy breathing.
Bulimia: The Otolaryngology Head and Neck Perspective
Authors: Rothstein Steven G. , Rothstein Janet M.
Published: May 2019

Bulimia nervosa is an eating disorder found predominantly in young females and characterized by binge-purge cycles as well as medical and psychological problems. The patient with bulimia may present to the otolaryngologist with an upper aerodigestive complaint. It is of paramount importance that the otolaryngologist be cognizant of the disease in order to refer the patient for further therapy.
Revision Functional Endonasal Sinus Surgery
Authors: Lazar Rande H. , Younis Ramzi T. , Long Thomas E. , Gross Charles W.
Published: May 2019

Revision functional endonasal sinus surgery (FESS) is recommended for patients whose symptoms of chronic or recurrent sinusitis persist despite primary FESS, long-term maximal medical therapy, and no sign of other abnormalities as demonstrated by computed tomography. After analyzing the charts of 673 patients who underwent primary FESS, we reviewed the 63 cases of revision surgery performed between 1986 and 1989. This retrospective analysis presents the management and outcome of 16 children (<16 years) and 47 adults who had revision FESS. The overall success rate of revision FESS was 78%, with no major complications, reflecting the improved management of sinus disease offered by this procedure.
Neurosurgical Approaches to Cerebrospinal Fluid Rhinorrhea
Authors: Aarabi Bizhan , Leibrock Lyal G.
Published: May 2019

The evolutionary concepts of pinpointing and treating cerebrospinal fluid (CSF) fistulas over the past few decades are reviewed taking into consideration the dynamic character of CSF circulation. The localization of the site of leakage is greatly facilitated by the judicious use of a variety of radioisotope and radiological techniques. The most recent are Metrizamide CT Cisternography and Magnetic Resonance Imaging. It is asserted that still the most challenging cases are those with intermittent liquorrheas, and those patients in which the site of the fistula is not easily defined. The authors will describe their personal experience with intracranial surgical repair of fistulas located in the anterior fossa.
Cerebrospinal Fluid Rhinorrhea
Authors: Syms Charles A.
Published: May 2019

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the United States Air Force or the Department of Defense.
Lateral Cervical Radiographs and Adenoid Size: Do They Correlate?
Authors: Cohen Lance M. , Koltai Peter J. , Scott John R.
Published: May 2019

Clinicians have questioned the value of lateral soft tissue neck x-ray (LSTN) in assessing adenoid size. Elaborate cephalometric assays have been devised to measure degree of nasopharyngeal obstruction secondary to adenoid hypertrophy. This study prospectively studied 73 children, aged 11 months to 13 years, with clinical evidence of adenoid hypertrophy to assess how well a LSTN correlates with direct intraoperative observation of adenoid size and nasopharyngeal obstruction. We found a relatively weak correlation (Pearson coefficient r = 0.34) between x-ray and operative observations. We conclude that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy. However, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.
Indirect Microsurgery of the Vocal Folds - Videostroboscopy vs. Microstroboscopy
Authors: Milutinović Zoran
Published: May 2019

In spite of the great significance of direct microlaryngeal surgery (DML), the inadequacies of this technique are evident. In order to avoid surgical trauma and introduce functional control during surgery, indirect microstroboscopic (IMS) and indirect videostroboscopic surgery (IVS) of the vocal folds are advocated. Both of these meet most criteria for surgical work in this field. The aim of this work was to make a comparative study of these techniques. The study is based on 603 operations conducted for benign lesions of the vocal folds. We are of the opinion that indirect vocal fold surgery for small benign lesions has significant advantages when compared with the conventional microlaryngoscopy, including laser surgery, which was proven elsewhere. When comparing these two indirect surgical approaches, the principal advantages of IVS surgery over the IMS method are easier surgical manipulation and better view. With respect to other areas of comparison, these techniques are quite similar. As complementary methods to conventional microlaryngoscopy, we believe that both IVS and IMS surgery should be used in practice.
Aggressive Fibromatosis (Fibrosarcoma) of the Facial Nerve
Authors: Pulec Jack L.
Published: May 2019

Aggressive fibromatosis of the facial nerve is a very rare tumor. Three cases have been previously reported. The tumor is locally recurrent and often has a fatal outcome. This report is of a ten-year-old boy whose tumor originally developed in the parotid area with subsequent spread to the base of the skull, the neck and the cerebellopontine angle. Treatment was by wide surgical excision, radiation therapy and chemotherapy. Despite treatment, the patient died. The clinical features of this case will be described. Only wide surgical excision early in the course of the disease may offer a chance for cure.
A New Method for Intraoperative Recurrent Laryngeal Nerve Monitoring
Authors: Maloney Richard W. , Murcek Benjamin W. , Steehler Kirk W. , Sibly Dennis , Maloney Richard E.
Published: May 2019

The recurrent laryngeal nerve is at risk of iatrogenic. injury during surgical procedures in which its anatomical location is exposed. Borrowing from biotechnology currently available for facial nerve monitoring, we have deve loped a method of electrophysio logically assessing the function of the recurrent laryngeal nerve during technically difficult neck surgeries. Electromyographic as well as nerve action potential recordings are monitored using the Xomed-Treace Nerve Integrity Monitor-2 (NIM-2). This method differs from those previously published in that it is much less cumbersome and time-consuming. The technique as well as an illustrative case are reported.
Acoustic Neuroma Surgery in Patients over 65 Years of Age
Authors: Pulec Jack L. , Giannotta Steven L.
Published: May 2019

Patients over 65 years old develop acoustic neuromas with the same signs and symptoms as younger patients. Age limits beyond which surgery for acoustic neuroma is not offered have been suggested. Untreated vertigo in the older patient frequently results in a fall which causes a fracture of the femur followed by significant morbidity and mortality. A review of 62 cases done over a period of five years reveals that surgical removal of acoustic neuroma in eight patients over 65 years of age gave results equally good to those in younger patients. This study suggests that the patient's general medical condition, life expectancy and factors other than chronologic age should be considered in the indications for surgery of acoustic neuroma. Acoustic neuroma surgery for the older patient can provide gratifying results.
Early Oral Feeding after Total Laryngectomy
Authors: Umut Akyol Mehmet , Özdem Cafer , Çelikkanat Serdar
Published: May 2019

Following total laryngectomy, 110 patients were orally fed on the first/second postoperative day without using a nasogastric (NG) tube. Pharyngo-cutaneous fistula was observed in 23 patients (21%) only nine of which (8%) needed surgical intervention to close the fistula. Early postoperative oral feeding of laryngectomized patients does not increase the fistula rate but decreases postoperative hospitalization time and eliminates the disadvantages of the NG tube.
Uvulectomy in the Office Setting
Authors: Ariyasu Laurence , Young Gary , Spinelli Frank
Published: May 2019

Snoring is a common problem which affects 50% of male and 30% of female patients.1 In a small number of patients, partial uvulopalatoplasty in the office setting has been found to ameliorate loud snoring.2

In our study, 28 patients had uvulectomy for snoring, 17 of whom responded to our survey. The procedure was somewhat beneficial (rated 3.2 on a scale of 10, with 10 representing no snoring) and had little impact on quality of life (rated 2.7 on a scale of 10, with 10 representing great improvement). After the procedure patients had considerable pain (rated 7.4 on a scale of 10, with 10 representing excruciating pain) which lasted >10 days in 35% and led to a mean of 2.9 missed work days. There were no complications. Fourteen of 17 patients wanted additional treatment to reduce snoring.
Branchial Cleft Cyst Posterior to the Carotid Vessels
Authors: Halvorson David J. , Porubsky Edward S.
Published: May 2019

Branchial cleft anomalies may appear as a sinus fistula or cyst. An understanding of the developmental embryology and anatomy can predict branchial cleft anomalies by the relationship of the corresponding branchial arches that form at the time of development. The second branchial cleft anomalies are the most common and may be found along a tract from the anterior border of the sternocleidomastoid muscle anterior to the carotid vessels and IX and XII. A cyst may form anywhere along this tract but most commonly is just lateral to the internal jugular vein anterior to the carotid vessels.

We describe a patient with a second branchial cleft cyst that was posterior to the carotid vessels documented by computed tomography. The cyst was found intraoperatively to be clearly posterior to the common carotid artery. This case demonstrates the need for an understanding of developmental embryology, anatomical landmarks and variations.
To Abandon or Not Abandon: Antesigmoid Craniotomy with Retrolabyrinthine Vestibular Nerve Section
Authors: Luetje Charles M. , Whittaker C. Keith , Gentner Patricia
Published: May 2019

Increasing popularity of the retrosigmoid approach would have one believe this is the preferred posterior fossa approach for a vestibular nerve section. The authors take issue with this. The antesigmoid posterior lateral retrolabyrinthine approach is a gentle craniotomy, easily performed and with low morbidity. A review of 70 consecutive cases revealed no procedural alteration because of surgical exposure, an absence of meningitis, no VIIth nerve weakness, minimal headache, average hospital stay of five days, and only one patient with a significant CSF leak. Hyperventilation anesthesia, patience during delicate VIIIth nerve exposure, incorporation of abdominal fat into dural closure sutures and prophylactic antibiotics have made this operation easy for the patient…and the surgeon. Don't abandon it!
Tympanoplasty in Adults: A Five-Year Survey
Authors: Podoshin Ludwig , Fradis Milo , Malatskey Shelton , Ben-David Jacob
Published: May 2019

In order to identify factors that could influence the success of tympanoplasties in adults, a retrospective study of 291 tympanoplasties performed on patients aged 15 years and older during the years 1984–1989 was carried out. Surgical success was defined as an intact membrane after two years follow-up and hearing improvement of at least 15 decibels. The success rate of the tympanoplasties was 90%. A functioning eustachian tube was found to be important for graft take. No difference was found in the rate of graft take regardless of whether fascia of the temporal muscle or tragal perichondrium was used or if fibrin glue was used. An audiological improvement was seen in 77% of the patients, and no significant difference regarding hearing gain was found between the different prostheses. It is concluded that tympanoplasty in adults is a simple operation with a high probability of success which can improve the quality of life of those operated upon.
Powered Instrumentation in Dissection of the Frontal Recess
Authors: Christmas Dewey A. , Krouse John H.
Published: May 2019

The use of powered instrumentation in functional endoscopic sinus surgery has become very popular due to its safety and thoroughness. An area which has been more problematic in the use of this technique has been the frontal recess, due to its anatomic location and associated risk of serious complications. We have done a number of powered dissections of the frontal recess as a surgical treatment of refractory frontal sinusitis, and find that it is extremely safe and effective. The ability of the powered devices to preserve normal mucosa allows an adequate surgical approach while significantly decreasing the postoperative risk of frontal recess stenosis and reocclusion. We feel that powered dissection of the frontal recess offers a significant advantage over standard techniques in this anatomic location.
The 3849+10 kB C—>T Mutation in a 21-Year-Old Patient with Cystic Fibrosis
Authors: Kaplan D.M. , Niv A. , Aviram M. , Parvari R. , Leiberman A. , Fliss D.M.
Published: May 2019

Cystic fibrosis (CF) is the most common lethal inherited disease in the white population. It is characterized by exocrine gland epithelia dysfunction, which leads to pulmonary and pancreatic insufficiency. Since the cloning of the CF gene in 1989 and the identification of the most common CF mutation (ΔF508), more than 400 different mutations have been described. These mutations appear to contribute to the heterogeneity of the CF phenotype and several reports have speculated on the relationship between the most common CF mutations and the patient's clinical status.

We report the case of a 21-year-old woman with longstanding chronic pansinusitis, nasal polyposis, chronic cough and severe nasal crusting. During a period of five years she had been followed by her otolaryngologist and pediatric pulmonologist. Sweat tests performed at the age of 17 and 18 were within normal limits and she underwent repeated conventional sinonasal procedures, with no improvement in her clinical status. On her present admission, sweat tests showed a 70 meq/l chloride concentration. The diagnosis of CF was then confirmed by DNA analysis and the patient was found to carry the 3849+10 kB C—>T mutation. The early detection of this newly recognized form of CF in adults as well as in children presenting with sinonasal symptoms is critical for life expectancy and quality.
Ablation of Posterior Semicircular Canal for Benign Paroxysmal Positional Vertigo
Authors: Pulec Jack L.
Published: May 2019

Obstruction of the posterior semicircular canal to prevent fluid movement without injury to the neurosensory end organ has been shown to be effective treatment for benign paroxysmal positional vertigo. Risk of Injury to the inner ear with loss of hearing has been reported with a variety of techniques. This paper will describe a modification of the procedure to ablate the posterior semicircular canal and to minimize the risk of inner ear injury. The procedure has been performed on 17 patients with prompt and lasting relief of vertigo and no hearing loss. The procedure seems to be a valuable and effective treatment for the disturbing condition of benign paroxysmal positional vertigo.
Scanning Laser Doppler Vibrometry of the Middle Ear Ossicles
Authors: Ball Geoffrey R. , Huber Alex , Goode Richard L.
Published: May 2019

This paper describes measurements of the vibratory modes of the middle ear ossicles made with a scanning laser Doppler vibrometer. Previous studies of the middle ear ossicles with single-point laser Doppler measurements have raised questions regarding the vibrational modes of the ossicular chain. Single-point analysis methods do not have the ability to measure multiple points on the ossicles and, consequently, have limited ability to simultaneously record relative phase information at these points. Using a Polytec Model PSV-100, detailed measurements of the ossicular chain have been completed in the human temporal bone model. This model, when driven with a middle ear transducer, provides detailed three-dimensional data of the vibrational patterns of the middle ear ossicles. Implications for middle ear implantable devices are discussed.
The Bone-Anchored Hearing Aid (BAHA) in Children with Auricular Malformations
Authors: Granström Gösta , Tjellström Anders
Published: May 2019

A retrospective study was undertaken to evaluate the outcome of the use of the bone-anchored hearing aid (BAHA) in children. All patients included in the study had bilateral auricular malformations. Previous alternatives had been conventional hearing aids or surgical middle ear reconstruction. Thirty-seven patients under 16 years of age were studied. The most common syndrome in the group was Treacher Collins. Sixteen of the patients had earlier middle ear reconstruction, the results of which did not produce social hearing. Of 40 inserted fixtures to anchor the BAHA, three were lost during the follow-up period because of failed osseointegration. Skin reactions were graded according to a clinical scoring system and were determined to be comparable in number and severity to those of an adult population. All patients in the study considered the BAHA to be superior to earlier bone-conduction devices.

It is concluded that the BAHA is an excellent alternative to bone-conduction devices in children with auricular malformations. Middle ear surgery can be postponed until adulthood or abandoned, especially in syndromic patients in whom it is known to be difficult and unpredictable.
Giant Cell Reparative Granuloma of the Maxilla
Authors: Spraggs Paul D. R. , Roth Jeffrey , Young-Ramsaran Joy , Goodwin W. Jarrard
Published: May 2019

Giant cell reparative granuloma (GCRG) is a rare nonneoplastic proliferative lesion of unknown etiology. It most commonly occurs in the mandible, but also occurs in other bones of the facial skeleton and cranial vault. Two cases of GCRG arising from the maxilla are presented. Histological and radiological features, and the pertinent literature on the subject are reviewed.
The Role of Acoustic Rhinometry in Nasal Provocation Testing
Authors: Roithmann Renato , Shpirer Isaac , Cole Philip , Chapnik Jerry , Szalai John Paul , Zamel Noe
Published: May 2019

Geometric changes of the nasal airway in response to allergen challenge were measured by acoustic rhinometry (AR) and the sensitivity of the method was compared with that of rhinomanometry. Ten asymptomatic patients who suffered from ragweed allergic rhinitis were challenged out of season. The use of a custom-made noninvasive nasal adapter was an important feature of the measurement technique. A dose-dependent decrease in nasal cross-sectional area was found at and posterior to the entrance to the nasal valve. Both rhinometric and rhinomanometric methods were equivalent in sensing the changes in nasal patency due to allergen exposure (p=0.73). Acoustic rhinometry, however, was simpler, more quickly performed and more comfortable for the subjects than was rhinomanometry by body plethysmography. AR is an alternative objective method for measurement of nasal mucosal responses, as in allergen challenge.
Oat Cell Carcinoma of the Tongue from an Unknown Primary
Authors: Mitchell Ron B. , Stedeford Judith , Buchanan George
Published: May 2019

Oat cell carcinoma is rarely diagnosed in the head and neck and can be primary or secondary. Primary tumors arise from amine precursor uptake and decarboxylation cells which are found throughout the head and neck. Secondary deposits metastasize most commonly from the lungs.

We report a 64-year-old woman with a known pancreatic oat cell carcinoma who came to the ENT Department with dysphagia. On examination, a lesion was seen at the base of the tongue and was histologically an oat cell carcinoma. No treatment was administered and the patient died one month after discharge.

This report highlights the difficulty in determining the primary site when a rare tumor metastasizes to the head and neck and no autopsy findings are obtained. To our knowledge, oat cell carcinoma of the tongue has not been previously reported.
Nasopharyngeal Carcinoma: Evidence for Improved Survival with Combined Chemoradiation
Authors: Smith Timothy L. , DiRugguero Douglas C. , Weissler Mark C.
Published: May 2019

Radiation therapy has been the traditional treatment for nasopharyngeal carcinoma. Patients with advanced disease have a higher rate of locoregional as well as distant metastases, which has warranted the addition of chemotherapy in an attempt to improve survival. This retrospective study was designed to determine the absolute survival of patients with nasopharyngeal cancer treated with radiation alone, compared to that of patients receiving concurrent chemoradiation. Between December 1975 and December 1993 eight patients were treated with radiotherapy alone and 14 patients were treated with concurrent chemoradiation using 5-fluorouracil and cisplatin. Analysis of Kaplan-Meier cumulative absolute survival plots revealed that patients receiving chemoradiation survived longer than those receiving radiation alone (p=0.0321). Patients with lymphoepithelioma, as opposed to squamous cell carcinoma, and patients younger than 30 years were also found to have longer survival, although these differences were not statistically significant (p=0.0913 and p=0.04044, respectively).
Cochlear Neuronal Loss as Determined by Use of a Neurofilament Protein Antibody in Cases of Bilateral Profound Deafness
Authors: Iino Yukiko , Komiya Taku , Fujii Tomoko , Nakamoto Yoshinori , Koyama Satoru , Suzuki Jun-Ichi , Toriyama Minoru
Published: May 2019

The temporal bones of two patients with profound bilateral deafness from infancy were studied immunohistochemically, using a neurofilament protein antibody to detect the cochlear neuronal elements. One patient exhibited Mondini dysplasia of the inner ear, with the organ of Corti almost completely deteriorated. The other patient is the first reported case involving complete aplasia of the organ of Corti in all turns. In both cases, the immunohistochemical staining clearly revealed a severe reduction in the number of afferent neurons, such as dendrites, spiral ganglion cells and cochlear axons. The number of efferent spiral bundles in the osseous spiral lamina and intraganglionic portion also decreased in parallel with the reduction in the number of cochlear afferent neurons. Our results are inconsistent with previously reported cases of presbycusis and acquired deafness induced by the measles virus, in which efferent neurons were preserved while afferent neurons degenerated. The loss of both the efferent and afferent neurons might be characteristics of congenital deafness.
Endoscopic Transpterygoid Approach to the Lateral Sphenoid Recess
Authors: Bolger William E. , Osenbach Richard
Published: May 2019

The endoscopic transpterygoid approach appears to be a viable treatment option for selected patients with an encephalocele or cerebrospinal fluid fistulae from the middle cranial fossa into a lateral sphenoid recess. This case report describes a patient with cerebrospinal fluid leak and seizures in whom a large temporal lobe encephalocele was found. The encephalocele entered the sphenoid sinus through a bony defect in the roof of the lateral recess of a widely pneumatized sphenoid. The endoscopic transpterygoid approach was successfully used to repair the skull base defect. The only disappointing result was that the patient had a reduced sense of smell postoperatively.
Neurofibromatosis Type 2: Genetic and Clinical Features
Authors: Evans D. Gareth
Published: May 2019

For decades, neurofibromatosis type 2 (NF2) was misclassified with the more common neurofibromatosis type 1 (NF1), until 1987 when it was found via genetic linkage analysis that the gene for NF1 was localized to chromosome 17 and the gene for NF2 was localized to chromosome 22.

Large, population-based studies have shown that vestibular schwannomas (VS), the hallmark of NF2, do not occur at increased frequency inpatients with NF1. Typical clinical features of NF2 are bilateral VS or a family history of NF2, plus either unilateral VS or any two of the following: meningioma, glioma, neurofibroma, schwannoma or posterior subcapsular lenticular opacities. Presymptomatic genetic tests are now possible in the majority of families, and it is hoped that somatic gene therapy will be developed for the treatment of this disease.
A Role for Tonsillectomy in the Treatment of Psoriasis?
Authors: McMillin B. Denise , Maddern Bruce R. , Graham Walter R.
Published: May 2019

Our objective was to determine whether tonsillectomy is beneficial in the treatment of recurrent childhood guttate psoriasis that is associated with recurrent streptococcal pharyngitis and tonsillitis. We retrospectively reviewed the cases of two children who were referred to our facility for treatment of repeated exacerbations of psoriasis and recurrent streptococcal pharyngotonsillitis. Both patients experienced a significant improvement in their psoriasis after undergoing adenotonsillectomy, and both were completely free of psoriatic outbreaks after 16 months of follow-up. We conclude that tonsillectomy appears to be of benefit in the treatment of children with recurrent guttate psoriasis and recurrent streptococcal pharyngotonsillitis, and we hope that further investigation will be undertaken.
Vocal Fold Granuloma Induced by Rigid Bronchoscopy
Authors: Heller Andrew J. , Wohl Daniel L.
Published: May 2019

Vocal fold granulomas secondary to endotracheal intubation, vocal abuse, and laryngopharyngeal reflux are a well-described cause of hoarseness, generally in the adult population. The mean age of onset is usually in the fourth or fifth decade, and the position is most commonly on the vocal process or one of the arytenoids.1 We present an atypical case involving a pediatric patient with a large, anterior, true vocal fold granuloma following rigid endoscopy of the upper conductive airway.
Teflon-Wire Piston or Stainless-Steel Bucket Stapes Prosthesis: Does it Make a Difference?
Authors: Farrior Jay B. , Temple Anne E.
Published: May 2019

The goal of this study was to determine whether postoperative (implantation of a stapes prosthesis) hearing gain and the amount of air-bone gap overclosure are more improved with the Teflon-wire piston or with the stainless-steel bucket prosthesis. We retrospectively reviewed the outcomes of 82 surgeries that had been performed by the primary author; 41 of these patients had received a Fisch Teflon-wire piston, and 41 had received a Bailey-modified Robinson stainless-steel bucket prosthesis.

The mean hearing gain for the patients who received the Teflon-wire piston was 23.3 dB after primary stapes surgery and 20.5 dB after revision surgery. Patients who received the stainless-steel bucket prosthesis experienced a mean hearing gain of 20.7 and 20.3 dB, respectively. Following primary stapes surgery, the air-bone gap overclosure was 4.4 dB with the Teflon-wire piston and 5.2 dB with the stainless-steel bucket prosthesis. There was no statistically significant difference in either hearing gain or air-bone gap overclosure between the two prostheses.
A Proposal for a Staging System for Hyperplastic Rhinosinusitis Based on the Presence or Absence of Intranasal Polyposis
Authors: Eichel Berkley S.
Published: May 2019

This study of 30 patients with hyperplastic rhinosinusitis reveals that the major determinant of the success or failure of conservative therapy is the presence or absence of intranasal polyposis. When polyposis is confirmed both clinically and radiographically, surgical intervention appears to be the rational way to handle most cases. When intranasal polyps are not present, an aggressive medical regimen is called for, one that includes a short-term, low-dose oral corticosteroid and an antibiotic, along with periodic radiographic assessment. Regardless of how much disease is seen on computed tomography, if it does not also detect intranasal polyps or masses, the potential for clearing with conservative therapy is extremely high.
Ethical Issues for Otolaryngology and Surgery in the Elderly
Authors: Seidman Michael D. , Shapiro Donald P. , Shirwany Najeeb A.
Published: May 2019

Clinical ethics is an intrinsic aspect of medical practice. Concerns for ethical conduct arise in the management of medical benefits, patient preferences, quality of life, and the relationship between patient care and its attendant familial, social, economic, and legal circumstances.

Ethical concerns in surgical practice are central to the essence of the Hippocratic doctrine, “First do no harm.” In caring for our patients, particularly in light of the modern practice of medicine, we often use the risk-benefit calculus. The range of ethical concerns for the otolaryngologist who deals with the elderly and infirm covers many diverse situations. Superimposed over this spectrum is the idea of patient autonomy, which is considered to be a cardinal issue in any ethical discussion. Furthermore, increasing medical care costs have created a debate regarding the rationing of healthcare. Ethicists continue the discussion as to whether age should be a decisive factor in the rationing of this care.

Definitions of “heroic” and “extraordinary” assume greater significance, and controversies of language become pivotal when the comprehension and cognitive orientation of the patient are compromised by disease and senescence.
Xerostomia: A Prevalent Condition in the Elderly
Authors: Astor Frank C. , Hanft Kendall L. , Ciocon Jerry O.
Published: May 2019

Although xerostomia is associated with aging, studies have determined that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably not a condition of aging, but most likely one of systemic or extrinsic origin. Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva can become thick and viscous and present problems for the elderly.

One of the most prevalent causes of xerostomia is medication. Anticholinergics, such as psychotropic agents and antihistamines, and diuretics can dry the oral mucosa. Chronic mouth breathing, radiation therapy, dehydration, and autoimmune diseases, such as Sjögren's, can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis, and thyroid dysfunction. Xerostomia can lead to dysgeusia, glossodynia, sialadenitis, cracking and fissuring of the oral mucosa, and halitosis. Oral dryness can affect denture retention, mastication, and swallowing. Dry mouth symptom can be treated with hydration and sialagogues or with artificial saliva substitutes. Because patients are at risk for dental caries, they should be referred to a dentist for preventive care. In patients with Sjögren's syndrome and in those who have undergone radiation therapy, pilocarpine has been used recently with good results.
Tympanoplasty in Geriatric Patients: Surgical Considerations
Authors: Radpour Shokri
Published: May 2019

The outcomes of tympanoplasty in the elderly are generally no different from those in the young. Although some reports suggest that hearing results were not as good in patients older than 60, the instance of graft failure in these patients did not differ greatly by age.

Patients older than 65 do have the highest incidence of perioperative death or complications, with elderly men being at a greater risk than elderly women. The risk is also higher inpatients who have concomitant diseases, such as coronary artery disease, congestive heart failure, myocardial infarction, diabetes mellitus, hypertension, renal disease, chronic obstructive pulmonary disease, cerebral vascular disease, dementia, and peripheral vascular disease. The presence of coexisting disease is more important than age itself although physiologic age is more important than chronological age.
Cochlear Implants in the Geriatric Population: Benefits Outweigh Risks
Authors: Buchman Craig A. , Fucci Michael J. , Luxford William M.
Published: May 2019

Cochlear implantation has become widely accepted as an effective means of hearing rehabilitation in severely and profoundly deaf individuals. In the elderly, cochlear implantation involves a number of unique issues that can affect patient outcomes. These factors include age-related changes in the auditory system, prolonged durations of deafness, diminished communication abilities, and coexisting medical and psychosocial problems.

In general, the results of cochlear implantation in the elderly have been comparable with those of younger adults. Perioperative attention to medical and surgical details allows for safe insertion and a minimum of postoperative complications. Patients older than 65 have obtained excellent results by both audiologic and quality-of-life measures.
Time-variant characteristic under the piston wind on subway tunnel billboard
Authors: Han Guixin , Luo Zhong , Sun Yonghang , Li Chaoshuai
Published: May 2019

The study of the time-variant characteristic on billboards caused by the piston wind deals with the issue of the billboards falling out in the subway tunnel. A method of a full-scale physical model and the corresponding numerical model are established, and the dynamic meshing deformation to simulate the metro runs in the tunnel was used, where good agreement between the simulation result and the experimental result was achieved proving the model to be correct. On this basis, the flow field in the actual subway tunnel is simulated, and the wind pressure time-variant characteristic on the billboards is analyzed. The results demonstrate that the static pressure on the billboard surface goes through a series of changes: “uniform distribution – left and right gradient – up and down gradient – uniform distribution”. The billboard’s upper right corner of the driving direction is subjected to the largest pressure and hence most vulnerable to damage. This method can provide guidance to the installation and maintenance of billboards in practical engineering applications.
Mosaic APP Gene Recombination in Alzheimer’s Disease—What’s Next?
Authors: Lee Ming-Hsiang , Chun Jerold
Published: May 2019

A first example of somatic gene recombination (SGR) within the human brain was recently reported, involving the well-known Alzheimer’s disease (AD)-related gene amyloid precursor protein ( APP). SGR was characterized by the creation of APP genomic complementary DNA (gencDNA) sequences that were identified in prefrontal cortical neurons from both normal and sporadic Alzheimer’s disease (SAD) brains. Notably, SGR in SAD appeared to become dysregulated, producing many more numbers and forms of APP gencDNAs, including 11 single-nucleotide variations (SNVs) that are considered pathogenic APP mutations when they occur in families, yet are present mosaically among SAD neurons. APP gene transcription, reverse transcriptase (RT) activity, and DNA strand-breaks were shown to be three key factors required for APP gencDNA production. Many mechanistic details remain to be determined, particularly how APP gencDNAs are involved in AD initiation and progression. The possibility of reducing disease-related SGR through the use of RT inhibitors that are already FDA-approved for HIV and Hepatitis B treatment represents both a testable hypothesis for AD clinical trials and a genuine therapeutic option, where none currently exists, for AD patients.
Decreasing impact of late relapses on disability worsening in secondary progressive multiple sclerosis
Authors: Ahrweiller Kevin , Rousseau Chloé , Le Page Emmanuelle , Bajeux Emma , Leray Emmanuelle , Michel Laure , Edan Gilles , Kerbrat Anne
Published: May 2019

Background:

Changes in relapse activity during secondary progressive multiple sclerosis (SPMS) need to be accurately characterized in order to identify patients who might benefit from continuing disease-modifying therapies.

Objective:

To describe relapse occurrence in patients with SPMS during long-term follow-up and assess its impact on disability worsening.

Methods:

This retrospective cohort study included 506 patients. We assessed the influence of relapses on time from SPMS onset to an Expanded Disability Status Scale score of 6 (EDSS 6), and on irreversible worsening of EDSS scores across different periods.

Results:

The annualized relapse rate (ARR) decreased with patient’s age (mean reduction of 43% per decade) and SPMS duration (mean reduction of 46% every 5 years). Post-progression relapses were associated with shorter time from secondary progressive (SP) phase onset to EDSS 6 (hazard ratio (HR) = 1.29, 95% confidence interval (CI) = (1.01, 1.64)). Relapse occurrence during the first 3 years and 3–5 years after SP onset was associated with an increased risk of irreversible EDSS worsening (OR = 3.12 (1.54, 6.31) and 2.04 (1.16, 3.58)). This association was no longer significant after 5 years.

Conclusion:

The occurrence of relapses was a marker of short-term disability progression during early SPMS, but did not have decisive impact in later SPMS.
Trading time and space: Grassroots negotiations in a Brazilian mining district
Authors: de Souza Santos Andreza A.
Published: May 2019

Participatory governance has been used to direct public budget and policy priorities. Grassroots politics also offers democratic pathways for negotiations over permits for businesses such as mining. In this paper, I focus on notions of time in policy-meetings between a mining company, the affected community in the district of Miguel Burnier, Brazil, and mediators between them – members of a municipal council for cultural heritage. I used ethnographic data to investigate whether participatory councils could abridge temporalities and offer a compromise. While the company offered improvements in quality of life in an uncertain future and the council needed to preserve local cultural heritage, residents suffered from pressing problems in the present: depopulation, pollution, and unemployment. My findings show that participation could not solve residents’ socio-economic problems efficiently, for these same problems affected their ability to voice concerns and wait for compensations. Relaxing immediate economic pressures improves the process of participation.
Young African American women’s participation in an m-Health study in cardiovascular risk reduction: Feasibility, benefits, and barriers
Authors: Kathuria-Prakash N , Moser DK , Alshurafa N , Watson K , Eastwood JA
Published: May 2019

Background:

Young black women have an increased risk of cardiovascular disease, and thus identifying innovative prevention strategies is essential. A potential preventive strategy is mobile health; however, few studies have tested this strategy in young black women.

Aim:

The purpose of this study was to assess the feasibility of a mobile health intervention through a digital application to reduce cardiovascular disease risk factors in young black women, and identify benefits and barriers to participation.

Methods:

Forty black women aged 25–45 years completed four sessions of cardiovascular disease risk reduction education and a six-month smartphone cardiovascular disease risk reduction monitoring and coaching intervention, targeting heart-healthy behavior modifications. At follow-up, women responded to a semi-qualitative online survey assessing the user-friendliness and perceived helpfulness of the intervention.

Results:

Of 40 women, 38 completed the follow-up survey. Sixty per cent of participants reported that the applications were easy or very easy to maintain, 90% reported that the application was easy or very easy to use. Over 60% observed that their family’s nutrition improved “a lot” or “a medium amount,” and many participants noted positive changes in their children’s diets. Only 8% of participants cited time or cost required to prepare healthy foods as barriers to implementing dietary changes.

Conclusions:

The m-Health intervention was feasible as a means of cardiovascular disease risk reduction for young black women. In addition, we found that targeting women provided indirect benefits for other family members, especially children. Most of the participants did not encounter systemic barriers to participation, suggesting that mobile health interventions can be effective tools to improve health behaviors in vulnerable populations.