bluuebunny/crossref_metadata_2025 huggingface dataset:
Sites of Predilection in Recurrent Respiratory Papillomatosis
Authors: Kashima Haskins , Leventhal Brigid , Mounts Phoebe , Hruban Ralph H.
Published: October 2014

Florid and widespread respiratory papillomatosis is a devastating disorder occurring in a subset of patients with recurrent respiratory papillomatosis, and it poses a major dilemma for the patient and the surgeon. Contrary to common belief, the distribution of papilloma lesions is not random, but follows a predictable pattern, with lesions occurring at anatomic sites in which ciliated and squamous epithelia are juxtaposed. The predominant sites of disease in recurrent respiratory papillomatosis are the limen vestibuli, the nasopharyngeal surface of the soft palate, the midzone of the laryngeal surface of the epiglottis, the upper and lower margins of the ventricle, the undersurface of the vocal folds, the carina, and bronchial spurs. These sites have the common histologic feature of a squamociliary junction. Papillomata also occur at the tracheostomy tract and at the midthoracic trachea in patients with tracheostomies. At the latter sites, abrasion injury to ciliated epithelium heals with metaplastic squamous epithelium and creates an iatrogenic squamociliary junction. The apparent preferential localization of papilloma at squamociliary junctions has at least 2 implications: first, that detection of occult asymptomatic papillomata is enhanced by careful examination of squamociliary junctions, and, second, that iatrogenic papilloma “implantation” is preventable by avoiding injury to nondiseased squamous and ciliated epithelia.
Papillary Neoplasms (Heffner's Tumors) of the Endolymphatic SAC
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

The sources of adenomatous neoplasms in the temporal bones are usually metastases or direct extensions from extratemporal lesions, or primary from the middle ear cleft. In 1989, Heffner added the endolymphatic sac's epithelium as another possible generative origin. In contrast to the adenomatous tumors of the middle ear or mastoid, the papillary cystic neoplasms of the endolymphatic sac are large and locally aggressive and often involve the middle and posterior cranial fossae and bone. These biologically low-grade adenocarcinomas have not been shown to be able to metastasize.
Posterior Glottic Fixation in Children
Authors: Zalzal George H.
Published: October 2014

Vocal cord fixation from posterior glottic stenosis may produce progressive airway obstruction. Treatment involves scar excision with adjunctive procedures on healthy tissue, including arytenoidopexy, arytenoidectomy, cordectomy, and cordotomy. Twenty-five children with posterior glottic stenosis were studied; 6 had vocal cord fixation in the midline and 6 had limited vocal cord abduction. All were tracheotomy-dependent because of posterior glottic stenosis and secondary impairment of vocal cord mobility. All children were decannulated after scar incision and widening of the laryngeal framework with posterior cricoid split and stenting. Cartilage grafting was used in 11 patients to maintain an adequate glottic lumen. Ten regained full vocal cord mobility. One had limited adduction, while another's cords were refixed in the midline. A second procedure in the latter patient resulted in limited abduction. Aspiration did not occur in any of the patients, and the voice results were good. Scar incision with cricoid split, cartilage grafting, and stenting is an excellent method for treating posterior glottic fixation without destroying healthy tissue.
Atelectatic Tympanic Membrane: Histologic Study
Authors: Sadé Jacob
Published: October 2014

This study aims to elucidate the morphological difference between the noncollapsible physiologic tympanic membrane (TM) and the collapsible atelectatic TM. Histologic examination of atelectatic TMs obtained at surgery from 16 ears revealed inflammatory changes and destruction of the pars tensa collagenous “backbone.” The disappearance of the organized collagenous layer seen in atelectatic TMs explains their conversion from the stiff physiologic membrane to a flexible one. This in turn will convert the middle ear from a noncollapsible gas pocket to a partially collapsible gas pocket, in which minimal pressure of only a few millimeters of water can cause retraction or ballooning of the atrophic TM. These pressure differences are too small to equilibrate automatically the difference created with the atmospheric pressure. Integrity of the pars tensa collagenous layer thus appears to be essential for the proper mechanical functioning of the physiologic TM.
Treatment of Dysfunction of the Cricopharyngeal Muscle with Botulinum a Toxin: Introduction of a New, Noninvasive Method
Authors: Schneider Imma , Pototschnig Claus , Thumfart Walter F. , Eckel Hans E.
Published: October 2014

Botulinum toxin is known as a relatively safe and efficacious agent for the treatment of various neurologic and ophthalmologic disorders. Since dysphagia and deglutition problems combined with aspiration are often caused by spasticity, hypertonus, or delayed relaxation of the upper esophageal sphincter (UES), conventional treatment including lateral cricopharyngotomy was replaced by localized injections of botulinum toxin into the cricopharyngeal muscle (CM) in a series of 7 patients. The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems. Preoperative diagnostic evaluation included careful history-taking, physical examination, cineradiography, and esophageal manometry to exclude other causes of dysphagia. For precise localization, injections were performed under general anesthesia after location of the CM by direct esophagoscopy and electromyographic guidance. Injections were administered into the dorsomedial part and on both sides into the ventrolateral parts of the muscle. Depending on the severity of symptoms and the intraluminal pressure of the UES, the dose varied between 80 and 120 units (botulinum toxin A from Dysport). The treatment outcome was evaluated by a disability rating score: patients' complaints were scored by subjective and objective parameters before and after injection. All but 2 patients experienced complete relief or marked improvement of their complaints. There were no severe side effects or postoperative complications. Local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.
Klippel-Feil Syndrome Associated with Malformed Larynx
Authors: Clarke Raymond A. , Davis Pamela J. , Tonkin John
Published: October 2014

We report a case of a 45-year-old man with Klippel-Feil syndrome with fusion of the C2–3 and C4–5 cervical vertebrae and severe voice impairment associated with malformation of the laryngeal cartilages. The condition was also complicated by bilateral inflexibility of the arms and legs and external malformation of the ears. This case broadens the spectrum of anomalies, of branchial arch derivation, now identified in association with Klippel-Feil syndrome. We discuss the possibility that perturbation of segmentation, distinct from somitogenesis, may be linked to Klippel-Feil syndrome—associated craniofacial abnormalities.
Results from Four Cochlear Implant Patients with Usher's Syndrome
Authors: Hinderink Johannes B. , Brokx Jan P. L. , Mens Lucas H. M. , van den Broek Paul
Published: October 2014

Individual results are presented of 4 patients with Usher's syndrome type 1 who received a cochlear implant. Both single-channel and multichannel implants were used. Because of implant failure, one of the single-channel systems was replaced by a Nucleus multichannel system. Results are compared to the results of 5 other prelingually deaf cochlear implant users. The performance of the patients with Usher's syndrome on suprasegmental and segmental speech perception tests and on a connected discourse tracking task did not differ significantly from the performance of the other prelingually deaf patients. A significant improvement over time was found at the suprasegmental level for the combined group of Usher's and other patients. No obvious differences were found between the scores from the patients with a single-channel and the patients with a multichannel device. The rehabilitation of the Usher's patients required very little extra effort in comparison with that of the other prelingually deaf patients; all patients reported considerable advantages in hearing abilities and social life.
Audiological Results of the Bone-Anchored Hearing Aid HC200: Multicenter Results
Authors: Mylanus Emmanuel A. M. , Snik Ad F. M. , Jorritsma Frank F. , Cremers Cor W. R. J. , Verschuure Hans
Published: October 2014

Sixty-two patients with conductive or mixed hearing loss (average bone conduction threshold at 0.5, 1, and 2 kHz ranged from 1 to 44 dB hearing level) were fitted with a bone-anchored hearing aid (BAHA type HC200). Previously, 52 of them had used a conventional bone conduction hearing aid (CBHA) and 10 of them an air conduction hearing aid (ACHA). Audiological tests were conducted to compare the patients' performance with the BAHA to that with their previous conventional hearing aid. In the speech recognition in quiet test, only 5 patients in the CBHA group improved significantly: the majority had 100% scores with both hearing aids. In the speech recognition in noise test, 28 patients improved significantly. The mean improvement in the signal to noise ratio (S/N) in the CBHA group was −2.3 ± 2.4 dB. That none of the patients in the CBHA group performed worse with the BAHA led us to the conclusion that the BAHA is superior to the CBHA. None of the patients in the ACHA group achieved a better speech recognition in quiet score using the BAHA. On average, there was no significant improvement in the S/N ratio in the ACHA group, although in 6 patients the S/N ratio improved significantly, and in 1 patient it worsened significantly. From the whole group, the performance of only 2 patients, both in the ACHA group, was significantly worse with the BAHA on one of the speech recognition tests.
Three-Dimensional Development of the Facial Nerve Path through the Ear Region in Human Embryos
Authors: Gasser Raymond F. , Shigihara Shuntaro , Shimada Kazuyuki
Published: October 2014

The goal was to determine how the facial nerve path forms normally through the ear region. Five three-dimensional computer reconstructions and eight wax plate—graphic, two-dimensional reconstructions were made from a group of 47 serially sectioned human embryos that were in the blastemal period of ear development, when most of the definitive arrangement is established. The size, shape, and positional changes of the facial nerve relative to the external ear and notochord were studied in both lateral and frontal views. The vertical (dorsoventral) position of the external ear region remains constant but shifts caudally. After formation, the geniculate ganglion assumes a position that gradually becomes rostrodorsal to the external ear. Facial nerve branches form and grow into regions expanding peripherally. The superficial petrosal branch appears to hold the ganglion in position as the horizontal segment of the facial nerve forms when the external ear shifts caudally. Possible growth movements explaining abnormal nerve paths are discussed.
Changes in Immunostaining of Cochleas with Experimentally Induced Endolymphatic Hydrops
Authors: Adams Joe C. , Ichimiya Issei , Kimura Robert S.
Published: October 2014

Cochleas with experimentally induced endolymphatic hydrops were immunostained for Na+,K+-ATPase, intracellular Ca++-ATPase, carbonic anhydrase, aldehyde dehydrogenase, calcium-binding proteins, vimentin, and the gap junction protein, connexin 26. No changes in immunostaining of hydropic ears were observed 1 week after blockage of the endolymphatic duct. Two weeks to 1 month after the operation, immunostaining of type I fibrocytes in the spiral ligament, which are positive for all but Na+,K+-ATPase, was slightly decreased on the operated side. These changes became more pronounced 3 months after the operation. However, staining for Na+,K+-ATPase of the stria vascularis and of type II fibrocytes of the spiral ligament was not reduced until 6 months postoperative. The reduction of enzymes and other cell constituents that may be involved in ion balance of cochlear fluids indicates that cells in the spiral ligament play an important role in cochlear homeostasis and that they merit further study in animal and human otopathology.
Osteoma of the Internal Auditory Canal Case Report and Literature Review
Authors: Clerico Dean Michael , Jahn Anthony F. , Fontanella Stephen
Published: October 2014

Osteomas of the internal auditory canal are rare lesions, with only 12 reported cases in the world literature. Symptoms are those of eighth nerve compression, and include unilateral hearing loss and vestibular weakness, thus mimicking symptoms of acoustic neuroma. We report a patient with an osteoma of the internal auditory canal, along with a review of the literature. We note age and sex characteristics from the literature, give evidence of localized trauma as a possible etiologic factor for this lesion, and discuss the pitfalls of relying exclusively on magnetic resonance imaging in the workup of suspected retrocochlear lesions.
Increase or Decrease in Nasal Airway Resistance Induced by Acetylcholine in Anesthetized Dogs: Vascular Mechanisms
Authors: Lung Mary A. , Wang James C. C.
Published: October 2014

In sodium pentobarbital-anesthetized dogs with spontaneous nasal blood flow or constant-flow vascular perfusion of the nasal mucosa, we measured nasal airway resistance, vascular resistance, and arterial inflow and outflow of the anterior and posterior venous systems. Acetylcholine in low doses (<5 μg/kg per minute, intraarterially) increased nasal airway resistance, and the response was greater in dogs with spontaneous blood flow. Nasal vascular resistance was decreased. However, the posterior venous outflow was increased and the anterior venous outflow was decreased in dogs with constant-flow vascular perfusion. Acetylcholine in higher doses (<5 μg/kg per minute, intraarterially) decreased nasal airway resistance, and vascular resistance fell further, but both venous outflows were increased in dogs with spontaneous blood flow or constant-flow vascular perfusion. The results indicate that acetylcholine may increase or decrease nasal airway resistance, depending on the dose administered, probably via a dose-dependent differential action on different components of the nasal vascular bed.
Noninvasive Measurement of Traveling Wave Velocity in the Canine Larynx
Authors: Nasri Sina , Sercarz Joel A. , Berke Gerald S.
Published: October 2014

Laryngologists have long recognized that assessment of the mucosal wave is an important part of laryngeal evaluation. This is the first report of a noninvasive measurement of vocal fold displacement velocity in an in vivo canine model. a newly developed calibrating endoscopic instrument capable of measuring distances on the vocal fold surface is described. Displacement velocity was determined in three dogs and compared to physiologic measures in the in vivo phonation model. The results indicate that the calculated displacement velocity is linearly proportional to traveling wave velocity and fundamental frequency. Because traveling wave velocity has been shown to reflect vocal fold stiffness, this method may advance the usefulness of stroboscopy for the study of mucosal wave abnormalities.
Effects of Denervation on Posterior Cricoarytenoid Muscle Physiology and Histochemistry
Authors: Zealear David L. , Hamdan Abdul-Latif , Ratney Cheryl L.
Published: October 2014

The effects of chronic posterior cricoarytenoid muscle denervation were assessed at 3 and 7 months in 26 animals following resection of 10 cm of recurrent laryngeal nerve with stump ligation. The physiology of denervation was characterized by a decrease in contraction strength and an increase in contraction time. The reduction in contraction strength reflected the loss in muscle weight and atrophic changes in fiber density and diameter. a change in muscle composition occurred because of the increased susceptibility of fast-twitch (type 2) fibers to degeneration. However, the compositional change alone could not account for the slowing of muscle contraction. Muscle fibrosis was negligible at 3 months, but encompassed one third of the fiber population by 7 months. In view of the irreversible nature of fibrosis, this study suggested that clinical intervention to rescue denervated posterior cricoarytenoid muscle fibers should be delayed no longer than 7 months to improve the chances for full recovery.
Ciliogenesis and Mucus Synthesis in Cultured Human Respiratory Epithelial Cells
Authors: Hanamure Yutaka , Deguchi Kouji , Ohyama Masaru
Published: October 2014

The mechanisms for the regulation of ciliogenesis and for the synthesis of mucus are not well understood. We sought to develop a culture system for differentiating ciliated and secretory types of human respiratory epithelial (HRE) cells. Dissociated HRE cells obtained from nasal polyps and maxillary sinus mucosa were cultured on type I collagen gel. Cells grown to confluence on collagen gel lost their cilia and exhibited a flat, squamouslike appearance. After reaching confluence, the cultured cells with a collagen gel substrate were removed from plastic dishes and floated in the culture medium. After 7 days in the floating culture, some cells exhibited several centrioles or basal bodies, while others showed secretory granules. The secretory phenotype predominated after 7 days. After 14 days in the floating culture, nearly all cells were ciliated. The results demonstrate that the differentiation of HRE cells can be induced by floating cultured cells with a collagen gel substrate in a defined culture medium.
Chondrogenesis by Free and Vascularized Rabbit Auricular Perichondrium
Authors: Hartig Gregory K. , Esclamado Ramon M. , Telian Steven A.
Published: October 2014

Many qualitative studies examining the chondrogenic potential of perichondrium have suggested that it may be useful for airway reconstruction. This study was performed to quantitatively evaluate cartilage formation by free and vascularized rabbit perichondrium placed in sterile and contaminated (airway) environments for 8 weeks. The mean cartilage thickness for free sterile perichondrium was 0.09 mm, for free contaminated perichondrium was 0.13 mm, for vascularized sterile perichondrium was 0.16 mm, and for vascularized contaminated perichondrium was 0.44 mm. Contaminated vascularized grafts produced significantly more cartilage when compared to both sterile vascularized grafts (p = .001) and contaminated free grafts (p < .001). No differences in cartilage formation were seen between sterile and contaminated free grafts (p =. 198), or between free and vascularized grafts that were sterile (p =. 170). These findings support further investigation of airway reconstruction with vascularized perichondrial grafts.
Tracheoesophageal Voice following Tubed Free Radial Forearm Flap Reconstruction of the Neopharynx
Authors: Deschler Daniel G. , Doherty E. Thomas , Anthony James P. , Reed Charles G. , Singer Mark I.
Published: October 2014

Tracheoesophageal voice restoration after laryngectomy is possible with a variety of neopharyngeal reconstructions. We have used the tubed radial forearm free flap for neopharyngeal reconstruction since 1991. Six patients have undergone voice restoration with the Blom-Singer prosthesis and were available for quantitative and qualitative speech analysis. These patients were compared to five laryngectomy patients with standard pharyngeal closures and similar voice restorations. The free flap patients produced similar loudness levels compared to the standards with soft speech (52.06 dB and 47.19 dB, respectively) and loud speech (62.66 dB and 60.91 dB, respectively). The free flap patients demonstrated adequate intelligibility, with fundamental frequencies comparable to standards (124.82 Hz and 135.66 Hz, respectively), although with increased jitter (5.00% versus 1.96%). No differences were statistically significant, but evaluation by trained and naive listeners demonstrated significant differences in voice quality. This quantitative and qualitative analysis of tracheoesophageal speech after radial forearm free flap reconstruction of the neopharynx demonstrates that acceptable voice can be achieved, but with limitations.
Function of the Interarytenoid Muscle in a Canine Laryngeal Model
Authors: Nasri Sina , Kreiman Jody , Beizai Pouneh , Graves Michael C. , Sercarz Joel A. , Berke Gerald S.
Published: October 2014

The interarytcnoid (IA) muscle has rarely been studied in the living larynx. In this work, the role of the IA muscle in phonation was studied in three dogs by means of an in vivo phonation model. The isolated action of the IA muscle was studied by sectioning and stimulating its nerve branch. As IA activity increased, subglottic pressure increased significantly until a plateau was reached. In the absence of superior laryngeal nerve stimulation, the fundamental frequency rose with increasing IA activity. In the presence of superior laryngeal nerve stimulation, however, no significant change in fundamental frequency was observed with increasing IA activity. Measurement of adductory force demonstrated that the IA muscle adducts primarily the posterior vocal fold. In this canine model, phonation was not possible without IA stimulation, owing to a large posterior glottic chink.
Autologous Fat Injection for Vocal Fold Paralysis: Long-Term Histologic Evaluation
Authors: Zaretsky Lauren S. , deTar Michael , Shindo Maisie L. , Rice Dale H.
Published: October 2014

Many techniques have been developed for medialization of the paralyzed vocal fold. The purpose of this study is to evaluate autologous fat as an alternative to alloplastic substances for use in vocal fold medialization. Eight dogs underwent left recurrent laryngeal nerve sectioning. Autologous fat was harvested, and the paralyzed vocal fold was medialized by injecting the fat into the thyroarytenoid muscle. The animals were divided into three groups for evaluation at 1, 3, and 6 months. Videolaryngoscopy was performed prior to sacrificing the animals. The larynges were sectioned coronally, and histologic studies were performed. The studies confirmed the preservation of viable fat at the injected site in all animals. Only a minimal inflammatory response was observed in the 1-month group. It would appear that fat injection is a viable alternative to Teflon injection and thyroplasty; it eliminates the need for alloplastic materials, does not appear to migrate, and does not require an open procedure.
Management of Posterior Cranial Fossa Meningiomas
Authors: Hart Michael J. , Lillehei Kevin O.
Published: October 2014

Posterior cranial fossa meningiomas are relatively common extra-axial tumors with important relationships to the cochleovestibular system, facial nerve, and/or cranial base. Nevertheless, objective reporting of auditory and vestibular function is rare for this patient population, and a full discussion of the nonsurgical management is all but totally discounted in the otolaryngology literature. Nine cases (8 operative cases) are presented, with the purpose of correlating neurotologic function with precise anatomic tumor location, available by magnetic resonance imaging and computed tomography. The usefulness of this information for diagnosis and meaningful scrutiny of the operative results is discussed. a comprehensive review of posterior fossa meningiomas in terms of epidemiology, etiology, and pathology, as well as nonsurgical treatment alternatives, is provided.
Cartilaginous Tumors of the Larynx
Authors: Devaney Kenneth O. , Ferlito Alfio , Silver Carl E.
Published: October 2014

Cartilaginous tumors of the larynx, while rare, will on occasion be encountered by the otolaryngologist in routine daily practice. True laryngeal chondromas are exceedingly rare, and as a consequence, a putative diagnosis of chondroma should be viewed with suspicion. On pathologic examination, laryngeal chondromas usually prove to be small lesions (less than 2 cm in maximum dimension) and may arise in children or adults. Laryngeal chondrosarcomas, by contrast, usually prove to be larger lesions (exceeding 3 cm in greatest dimension) and are typically found in adults. While high-grade chondrosarcomas are readily identifiable on light microscopic study, the distinction between a chondroma and a low-grade chondrosarcoma is often not so clear-cut. Some low-grade chondrosarcomas may show a slight increase in both cellularity and cytologic atypia when compared with chondromas, but the two patterns often overlap. When faced with a limited biopsy specimen of a laryngeal cartilaginous lesion in which neither increased cellularity nor recognizable cytologic atypia is found, a diagnosis of “cartilaginous tumor without obvious evidence of malignancy — further classification dependent on examination of the lesion in its entirety,” or words to this effect, is recommended.
Intracranial Complications of Sinusitis in Childhood
Authors: Lerner Don N. , Zalzal George H. , Choi Sukgi S. , Johnson Dennis L.
Published: October 2014

Complications of sinusitis in children, such as intracranial abscess formation, are uncommon and are often clinically unremarkable in comparison to similar disease processes in adults. Between 1983 and 1991, 443 children were admitted to Children's National Medical Center in Washington, DC, for treatment of sinusitis. Fourteen of these children presented with intracranial extension of the infection and abscess formation. A retrospective review of these patients revealed that the risk of developing an intracranial abscess secondary to sinusitis was 3%. The management of these patients included surgical drainage of the infected sinuses and intracranial surgical exploration. Cranialization and exenteration of the frontal sinus proved to be effective single-stage procedures. While not indicated in all patients, these procedures eliminated the sinus as a source of continued or potential infection and obviated the need for a second obliterative procedure. Combined antimicrobial therapy and surgical drainage should be the management protocol.
Cyclic Adenosine Monophosphate Stimulation of Mucociliary Activity in the Upper Airways in Vivo
Authors: Cervin Anders , Lindberg Sven , Dolata Jan , Mercke Ulf
Published: October 2014

Xanthine derivatives are known to accelerate mucociliary transport in the lower airways, probably by preventing degradation of cyclic adenosine monophosphate (cAMP) and thereby increasing its intracellular concentration. The purpose of this study was to investigate the effects of cAMP on mucociliary activity in the upper airways. The effect on the mucociliary activity in the rabbit maxillary sinus of the xanthine derivatives theophylline and enprophylline was compared to that of the cAMP analog dibutyryl cAMP. The compounds were administered into the maxillary artery, and the response was recorded with a photoelectric technique. Infusions of theophylline (1.0 and 10 mg/kg) increased mucociliary activity (22.8% ± 5.9%, n = 6, and 21.6% ± 4.9%, n = 7, p < .05, respectively). Infusions of enprophylline (1.0 and 10.0 mg/kg) accelerated mucociliary activity (at the highest dosage tested, 24.3% ± 4.1%). Infusions of dibutyryl cAMP (0.1 and 1.0 mg/kg) stimulated mucociliary activity, with the maximum increase (20.1% ± 3.0%, n = 13, p < .05) being observed at a dosage of 0.1 mg/kg. The infused substances increased mucociliary activity within 1 minute after the start of the infusion, the duration of the response being approximately 20 minutes for theophylline, 22 minutes for enprophylline, and 12 minutes for dibutyryl cAMP. The present results support the view that cAMP is involved in regulating mucociliary activity in the upper airways. It remains to be elucidated whether xanthines such as theophylline and enprophylline are beneficial in upper airway disease in which mucociliary function is impaired (eg, chronic sinusitis).
Effects of L-Baclofen and D-Baclofen on the Auditory System: A Study of Click-Evoked Potentials from the Inferior Colliculus in the Rat
Authors: Szczepaniak William S. , Møller Aage R.
Published: October 2014

The drug baclofen is a potential treatment for severe tinnitus, but its action in relieving tinnitus is not known. Baclofen is available as an approved drug only in racemic form with about equal content of the two enantiomers. In the present paper we show that l-baclofen causes a considerable (40.7%) suppression of the amplitude of the second peak in the click-evoked response from the cochlear nucleus. Bipolar recordings from the external nucleus of the inferior colliculus showed that l-baclofen caused a reduction in the amplitude of three or four distinct peaks in this response. d-Baclofen had no detectable effect on the response from the cochlear nucleus, and had only a slight effect on one component of the response from the external nucleus of the inferior colliculus. The demonstrated effect of l-baclofen on excitation in the ascending auditory pathway indicates that this drug may be a potential treatment for hyperactive auditory disorders such as tinnitus and hyperacusis.
Laser Aryepiglottoplasty for the Treatment of Neurasthenic Laryngomalacia in Cerebral Palsy
Authors: Hui Yau , Gaffney Robert , Crysdale William S.
Published: October 2014

Patients with cerebral palsy usually suffer from lack of coordination in the neuromuscular mechanism in their upper airway and digestive tract. Difficulty in swallowing and aspiration are common problems in these patients, and stridorous breathing sometimes develops as a secondary symptom. Laryngoscopic examination revealed that redundant tissue in the aryepiglottic fold area was the cause of stridor and upper airway obstruction in four patients with cerebral palsy. We report on these four patients in whom laser reduction of the redundant mucosa led to dramatic improvements in stridor. Secondary benefits to family members and others were equally impressive.
Postnatal Development of the Internal Auditory Canal Studied by Computer-Aided Three-Dimensional Reconstruction and Measurement
Authors: Sakashita Tetsushi , Sando Isamu
Published: October 2014

Postnatal development of the internal auditory canal (IAC) was investigated in 20 normal human temporal bones obtained from individuals 1 month to 72 years old. Computer-aided three-dimensional reconstruction and measurement of bones showed that the superior, inferior, anterior, and posterior walls of the IAC lengthen significantly from birth until about 10 years of age, with development mainly attributable to lengthening of the part of the IAC medial to the foramen singulare. The lengths of the part of the IAC lateral to the foramen singulare and of the transverse crest and Bill's bar did not appear to develop postnatally. The IAC diameter increased slightly at the porus for about the first year after birth, but not at the fundus or the middle portion of the canal. This finding was confirmed by studying the shape of the IAC. Postnatal increases in the volume of the IAC followed patterns similar to that of increases in length of the IAC walls. These results show that postnatally the IAC increases significantly in length until about 10 years of age and slightly in diameter until about 1 year of age, especially medial to the foramen singulare. This concentration of growth of the IAC medially implies that its postnatal development is mainly due to growth of the bone around the otic capsule, which has implications for IAC surgery.
Teratomas of the Head and Neck with Emphasis on Malignancy
Authors: Batsakis John G. , El-Naggar Adel K. , Luna Mario A.
Published: October 2014

The great majority of teratomas of the head and neck present in the neonate or infant and are biologically benign and yet with a high mortality because of their space-occupying and obstructive character. Teratomas in the adult neck and sinonasal tract are histologically and biologically malignant, with an often unpredictable response to therapy.
Teflon Granuloma of the Larynx: Etiology, Pathophysiology, and Management
Authors: Varvares Mark A. , Montgomery William W. , Hillman Robert E.
Published: October 2014

Intralaryngeal Teflon injection for correction of unilateral vocal cord paralysis is known to produce a foreign body giant cell reaction. In our practice, we have seen increasing numbers of patients who had developed dysphonia related to Teflon injection. This patient series was reviewed, as were the surgical technique to correct this condition, voice results, and acoustic analysis of a subset of the patient series. We conclude that dysphonia, secondary to Teflon injection, can be either from overinjection of Teflon or inappropriate injection, or from the proliferative granulomatous response of the larynx to the Teflon. Our technique of laser incision into the superior aspect of the Teflon implant, followed by vaporization and preservation of a margin of mucosa of the cord medially, resulted in improved voice in 8 of 11 patients treated in this manner. Acoustic and aerodynamic analyses reveal significant deficits in vocal function that may persist after procedures used to correct this condition.
Internal Jugular Vein Patency after Functional Neck Dissection: Venous Duplex Imaging
Authors: Zohar Yuval , Sadov Rima , Strauss Michael , Sabo Ghideon , Sabo Reni , Lehman Johnathan
Published: October 2014

We present a retrospective study performed to determine jugular patency after functional neck dissection (FND). Twenty-six patients, 16 females and 10 males, ranging in age from 16 to 78 were examined. These patients underwent either unilateral FND or bilateral FND for cervical lymph node metastases. Cervical duplex and pulsed Doppler imaging were chosen to determine internal jugular vein (IJV) patency. The examination was performed after a minimum postoperative period of 2 months and a maximum one of 22 years. Thirty-one IJVs were examined. All but 4 IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in FND was found to be high (27 of 31 or 87%). These results favor the use of FND for IJV preservation, particularly in bilateral neck dissection.
Malignant Laryngeal Tumors: Phenotypic Evaluation and Clinical Implications
Authors: Ferlito Alfio , Rinaldo Alessandra , Devaney Kenneth O.
Published: October 2014

Malignant laryngeal tumors include a variety of oncotypes with differing biologic connotations, each calling for a different therapeutic approach and giving rise to a different prognosis. But the oncotype can only be accurately identified histologically by means of a technically adequate, representative biopsy specimen. Intrinsic malignancy varies with the structure of the neoplasm, so the choice of surgery, radiotherapy, chemotherapy, or laser therapy depends largely on tumor type. Most malignant laryngeal neoplasms are squamous cell carcinomas, but the rare cases of nonsquamous tumor include a wide array of oncotypes of which the true incidence is difficult to assess. Diagnosis is based on light microscopy, but may be supported by histochemical, immunocytochemical, and ultrastructural investigations that improve the accuracy of categorization of the specific tumor type. A precise histologic diagnosis, based on representative biopsy material, will lead to a better understanding of the tumor's likely behavior, and consequently to more effective treatment.
Respiratory Epithelial Adenomatoid Hamartomas of the Sinonasal Tract and Nasopharynx: A Clinicopathologic Study of 31 Cases
Authors: Wenig Bruce M. , Heffner CAPT Dennis K.
Published: October 2014

We report the clinicopathologic features of 31 cases of respiratory epithelial adenomatoid hamartomas occurring in the nasal cavity, paranasal sinuses, and nasopharynx. The patients included 27 men and 4 women ranging in age from 27 to 81 years (median, 58 years). Symptoms included nasal obstruction, nasal stuffiness, deviated septum, epistaxis, and chronic (recurrent) rhinosinusitis. The symptoms occurred over various time periods from as short as a few months to up to 8 years in duration. Physical examination identified the presence of a polypoid mass lesion(s), most often identified in one or both nasal cavities (n = 22). Within the nasal cavity the most common site of occurrence was the nasal septum, particularly along its posterior aspect. Other areas within the nasal cavity were also involved, as were the ethmoid sinus, frontal sinus, and nasopharynx. The gross appearance of the mass lesions suggested a diagnosis of an inflammatory polyp, but because of subtle differences, including frequent occurrence along the nasal septum and a more indurated quality, these polyps were considered unusual for the typical inflammatory polyps. Histologically, these lesions were characterized by a prominent glandular proliferation lined by ciliated respiratory epithelium originating from the surface epithelium. The differential diagnosis of these adenomatoid hamartomas includes schneiderian papillomas of the inverted type and adenocarcinomas. Diagnostic misinterpretations may result in untoward surgical intervention. Limited but complete surgical resection was the treatment of choice, following which there were no instances of recurrent disease.
Cryptococcosis Presenting as a Neck Mass
Authors: Schmidt David M. , Kevorkian Kevin F. , Sercarz Joel A. , Canalis Rinaldo F.
Published: October 2014

A rare case of cryptococcal infection presenting as a neck mass in an otherwise healthy individual is reported. The mass resulted in lytic destruction of portions of the cervical vertebrae and produced a focal neurologic deficit in one of the upper extremities. Although other lesions in the skull, femur, and humerus were identified, no involvement of the lungs or central nervous system could be detected. The patient was initially treated with amphotericin B and flucytosine, but eventually also required fluconazole and surgical debridement for complete resolution of the infection. The diagnosis, treatment, and manifestations of cryptococcosis in the head and neck are discussed.
Stress Velopharyngeal Incompetence in an Adolescent Trumpet Player
Authors: Conley Stephen F. , Beecher Robert B. , Marks Susan
Published: October 2014

The youngest reported patient with stress velopharyngeal incompetence is presented. The patient's symptoms responded to rest with a possible contribution from palatal exercise. Surgical correction would appear to best be reserved for the professional musician with this unusual condition.
Are Clinical Classifications for Laryngeal Cancer Satisfactory?
Authors: Ferlito Alfio , Bailey Byron J. , Harrison Donald F. N. , DeSanto Lawrence W.
Published: October 2014

All clinical classifications for laryngeal cancer are compromises based on clinical and imaging evaluations, with no concern for important elements such as phenotype, host-tumor relationship, and any concomitant nonneoplastic disease. The various staging systems are critically examined along with a report on the outcome of an international survey on the applicability of the TNM system in relation to laryngeal neoplasms, promoted by The Laryngeal Cancer Association.
Method for Embedding Temporal Bones of Rats in Methyl-Methacrylate
Authors: Nageris Benny , Gazit Dan
Published: October 2014

The commonly used method of preparing the temporal bone for light microscopy is a refinement of a basic formula that has been employed for a century. This process includes fixation, decalcification, neutralization, dehydration, embedding in celloidin, and hardening. The main disadvantage of this process is that decalcification is performed. This article describes a new method for preparing the temporal bone of rats for light microscopy. The main advantage of this new method is that no decalcification is involved, so that all bony elements are retained in their normal shape and location, and even retain some enzymatic activity. Other advantages are that the fixation is reversible and the process is short (approximately 2 weeks) and therefore relatively inexpensive. Our vast and positive experience with this technique has led us to report this method not in a specific experiment, but rather as a specific laboratory technique.
Substance P and Ciliary Beat of Human Upper Respiratory Cilia in Vitro
Authors: Schuil Paul J. , Berge Maartje Ten , Graamans Kees , Van Gelder José M. E. , Huizing Egbert H.
Published: October 2014

On stimulation of trigeminal nerve endings, neuropeptides are released into the nasal mucosa. Among these neuropeptides is substance P (SP). In this study, we determined the effect in vitro of SP, as well as SP together with thiorphan, a blocker of the SP-degrading enzyme neutral endopeptidase, on the ciliary beat frequency (CBF) of the human upper respiratory tract. Ciliated epithelium of human adenoid tissue was used in the experiments. The CBF was measured by means of a computer-assisted photoelectric method. Substance P (10−8 to 10−5 mol/L, n = 7) showed a small but statistically significant dose-dependent decrease in CBF. On perfusion with SP (10−8 to 10−5 mol/L, n = 8) in combination with thiorphan, no statistically significant effect was found. We conclude that SP does not have a direct effect on ciliary activity to such an extent that it will affect mucociliary transport in vivo.
Age- and Gender-Related Trends in the Expression of Glutathione S-Transferases in Human Nasal Mucosa
Authors: Krishna N. S. Rama , Getchell Thomas V. , Awasthi Yogesh C. , Dhooper Nimrat , Getchell Marilyn L.
Published: October 2014

The cellular expression of α, μ, and π classes of glutathione S-transferases (GSTs) was investigated in human nasal mucosa by means of immunocytochemical techniques. In the olfactory mucosa, immunoreactivity for GST-α was most intense in the acinar cells of the Bowman's glands, with weak immunoreactivity in the supranuclear region of sustentacular cells. Whereas GST-π was localized only in the sustentacular cells, no GST-μ was detected. In the respiratory mucosa, GST-α and GST-π were detected at the brush borders of ciliated columnar epithelial cells. There were age- and gender-related trends in the expression of GST-α, but not GST-π, in the olfactory mucosa. The intensity of immunoreactivity in the olfactory mucosa was decreased in older subjects. The expression of GST-α in the olfactory mucosa of females consistently exhibited greater intensity than that of males at all the ages studied. These differences were not observed in the respiratory mucosa. These results indicate that acinar cells of the Bowman's glands and sustentacular cells are the major sites of phase II biotransformation in the human nasal mucosa.
Age-Related Changes of the Macula Flava of the Human Vocal Fold
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

This investigation was carried out to determine the histologic structure and age-related changes of the macula flava of human aged vocal folds. Excised human adult senescent larynges served as the material for this study. Light microscopic and transmission electron microscopic observations were made. The results are summarized as follows. 1) The anterior and posterior maculae flavae were elliptical in shape and about 1.5 × 1.5 × 1 mm in size. 2) The macula flava was composed of fibroblasts, elastic fibers, collagenous fibers, and ground substance. 3) The number of fibroblasts decreased. 4) Components in the cytoplasm, such as Golgi apparatus and rough endoplasmic reticulum, were fewer than in younger adults. 5) Some fibroblasts and some components in the cytoplasm degenerated. 6) The accumulation of glycogen granules and lipid droplets were seen in the cytoplasm. 7) The number of collagenous and elastic fibers synthesized by the fibroblasts decreased. 8) These findings were evident to various degrees and suggested the reduction of fibroblast activation, abnormal metabolism, and degeneration. A decrease in the number and activation of fibroblasts in maculae flavae indicates decreased synthesis of fibrous components in the vocal fold mucosa. This in turn influences the viscoelasticity and stiffness of vibrating tissue and contributes partially to aging of the voice.
Gore-Tex for Nasal Augmentation: A Recent Series and a Review of the Literature
Authors: Queen Timothy A. , Palmer Francis R.
Published: October 2014

Gore-Tex soft tissue patches were used in 12 cases for augmentation during rhinoplasty. This synthetic material proved to be completely inert and tissue-compatible. There were no cases of untoward effects such as overlying skin changes, infection, or implant extrusion. A literature review reveals a total of 52 reported cases of nasal augmentation with Gore-Tex. Similar results were reported in these studies. By all reports, Gore-Tex is an acceptable synthetic implant for nasal dorsal augmentation, when autogenous cartilage is not available or would require a second procedure for harvesting.
Horseradish Peroxidase Permeability across Rat Nasal Mucosa in Selective Stimulation of Substance P Innervation with Capsaicin
Authors: Kim Namju , Hong Soonkwan , Jeon Seayuong , Hwang Euigee , Min Yang-Gi
Published: October 2014

To investigate the physiological role of substance P innervation (SPI) in the nasal mucosa from inhaled irritant macromolecules, SPI in the rat nasal mucosa was selectively stimulated with capsaicin and the degree of horseradish peroxidase (HRP) permeability across the nasal epithelium was evaluated by enzyme immunoassay or by histochemical electron microscopy. The serum level of HRP was reduced significantly in capsaicin-administered rats compared to control rats along the time course with quantitative analysis of the enzyme immunoassay. Control rats showed heavy permeation of HRP across the epithelium, but capsaicin-administered rats showed weak permeation of HRP across the epithelium with histochemical electron microscopy. The epithelial lining and its tight junctions were left intact as judged by electron microscopy. In conclusion, selective stimulation of SPI of the rat nasal mucosa with capsaicin decreased the epithelial absorption permeability to HRP without compromising the epithelial integrity. These findings imply that the physiological role of capsaicin-sensitive SPI in the rat mucosa is to protect the airway from inhaled irritant macromolecules.
Ability of Histamine to Increase Nasal Mucosal Permeability to Macromolecules in Guinea Pigs
Authors: Kaise Toshihiko , Sakakura Yasuo , Ukai Kotaro
Published: October 2014

The effect of histamine on nasal mucosal permeability against an antigen was investigated by using modified passive cutaneous anaphylaxis (PCA) reactions in normal and actively sensitized guinea pigs. The administration of a dinitrophenyl-coupled Ascaris (DNP- Ascaris) solution as an antigen into the nasal cavity caused PCA reactions in the dorsal skin of normal guinea pigs. The administration of histamine into the nasal cavity before the antigen treatment significantly enhanced the anaphylactic responses. The PCA reactions did not occur when ovalbumin (OA) was administered intranasally in normal guinea pigs. In guinea pigs sensitized against DNP-Ascaris, however, PCA reactions to anti-OA antiserum were elicited by the intranasal administration of OA. The intranasal administration of histamine before the antigen treatment also enhanced anaphylactic responses in sensitized guinea pigs. These results indicate that histamine increases nasal mucosal permeability and that this may be one of the causes of nasal hypersensitivity in nasal allergy.