bluuebunny/crossref_metadata_2025 huggingface dataset:
Healing of Tympanic Membrane after Myringotomy during Streptococcus Pneumoniae Otitis Media an Otomicroscopic and Histologic Study in the Rat
Authors: Magnuson Karin , Hermansson Ann , Hellström Sten
Published: October 2014

The purpose of our study was to elucidate the course of healing of the tympanic membrane (TM) when myringotomy was performed during acute otitis media. The early and long-lasting structural changes of the TM were studied in an animal model. Rats were inoculated with Streptococcus pneumoniae (PnC) type 3 in the bulla. When the infection was manifest, myringotomy was performed. On days 4 and 12, and 3 and 6 months after myringotomy, the TM status was checked by otomicroscopy and TMs were prepared for light and electron microscopy. Comparison was made with PnC-infected TMs that were not perforated, as well as myringotomized noninfected TMs. The infection resolved more slowly in myringotomized ears compared to PnC-infected ears that were left untouched. After 6 months, the pars tensa of the myringotomized infected ears was thickened and showed a disorganized collagen structure, compared with myringotomized noninfected ears, in which TMs were normalized. The PnC-infected TMs without myringotomy were completely normalized after 2 months. We conclude that a combination of bacterial infection and myringotomy causes long-lasting changes in TM structure. This impaired structure of the connective tissue could be of importance in chronic middle ear disease as a presumptive site for retraction and perforation of the TM.
Dentact for Evaluating Mandibular and Maxillary Invasion in Cancer of the Oral Cavity
Authors: Bar-Ziv Jacob , Eyal Ana , Talmi Yoav P. , Yahalom Ran , Shehtman Itshak , Teicher Shlomo , Kronenberg Jona
Published: October 2014

We used a retrospective analysis of charts, imaging studies, and histologic findings when available in 17 patients with cancer of the oral cavity to define the value of DentaCT or multiplanar reformation software in assessing bony involvement by malignant tumors of the oral cavity. From two academic tertiary-referral medical centers, the 17 patients had a mean age of 63 years and suspected maxillary (2) or mandibular (15) invasion. All patients had conventional computed tomography scanning and multiplanar reformation scans with several additional imaging studies obtained. Two patients demonstrated no bony involvement by imaging and histologic studies. Twelve of the remaining 15 patients had surgically documented bony involvement also correctly detected by DentaCT. DentaCT was found to be a valuable tool in defining extent of bony invasion by tumor. Although not compared to other imaging modalities, our experience supports the use of DentaCT where available for this purpose.
Morphologic and Motility Changes of Nasal Cilia in Primary Culture Caused by Haemophilus Influenzae
Authors: Yamanaka Noboru , Ogra Pearay L. , Fujihara Keiji , Bernstein Joel M. , Hard Robert
Published: October 2014

We focused on the pathogenicity of otitis media with effusion (OME) with respect to the susceptibility of the upper respiratory tract mucosa to Haemophilus influenzae. Human nasal polyps in outgrowth culture were used to study H influenzae disturbance of the ciliary beat frequency (CBF) and the morphology of cilia. The CBF of control primary culture was 11.7 ± 2.7 Hz. The CBF slowed down significantly, to 8.5 ± 5.7 Hz, after incubation with the filtrate of 108 CFU/mL of H influenzae, and to 4.1 ± 4.1 Hz with a suspension of 108 CFU/mL of H influenzae (p < .05). In the morphologic study, we classified the shapes of the cilia into five types: normal cilia, immotile cilia, swollen cilia, clumped cilia, and exfoliated ciliated cells. The abnormal shapes of cilia increased after incubation with the suspension or the filtrate of H influenzae. By scanning electron microscopy, we saw that aggregated bacteria tended to associate with cilia. Thus, the findings suggest that H influenzae disturbs the ciliary clearance of nasal cells and makes them more susceptible to infections.
Reversibility of Compound Action Potential during the Acute Phase after Transitory Local Ischemia
Authors: Asai Yoshihiro , Umemura Kazuo , Nakashima Mitsuyoshi
Published: October 2014

We investigated the reversibility of compound action potential (CAP) changes induced after transitory local ischemia induced by rose bengal photochemically induced thrombosis of the rat anterior inferior cerebellar artery (AICA). Cochlear blood flow (CBF) was measured with a laser-Doppler flowmeter positioned on the lateral bony wall of the basal turn of the cochlea, and the CAP to an 8-kHz half-wave of sinusoid sound at 100 dB sound pressure level was monitored. The irradiation was started 5 minutes before the rose bengal administration and continued through the thrombosis formation. Tissue-type plasminogen activator (t-PA, 1 mg/kg) dissolved in saline was injected intravenously 2 minutes after complete photothrombotic blockade of the AICA in the rats presenting complete abolition of CAPs just after the vascular occlusions. Nineteen of the 51 rats presented complete abolition of the CAP just after the AICA occlusion, and the thrombosed AICA was successfully reperfused by t-PA administration in 11 of the 19 rats. The result showed that duration of ischemia was the more important determinant for the reversibility of CAPs during the acute phase (p = .00001), and the residual level of cochlear blood flow during ischemia was also an important factor (p = .066). It appeared that the critical time of ischemia for the complete recovery of CAPs was around 5 minutes, and that the critical limit for the irreversibility of CAPs within the acute phase was between 20 and 25 minutes.
Effect of SC-41930, a Potent Selective Leukotriene B4 Receptor Antagonist, in the Guinea Pig Model of Middle Ear Inflammation
Authors: Sutbeyaz Yavuz , Karasen Murat , Yakan Birkan , Doner Fehmi , Ozdemir Hasan , Kufrevioglu Irfan
Published: October 2014

Arachidonic acid metabolites such as prostaglandins and leukotrienes have been shown to play an important role in the pathogenesis of otitis media (OM). Among these mediators, leukotriene B4 (LTB4) is one of the most potent inducers of inflammatory processes. SC-41930 has been shown to be a specific LTB4 receptor antagonist both in vitro and in vivo. In this study, anti-inflammatory effects of SC-41930 were investigated in a guinea pig model of OM induced by middle ear (ME) inoculation of killed Staphylococcus aureus. Outcome of treatment was determined by measurement of myeloperoxidase activity in the samples of ME mucosa, evaluation of temporal bone histopathology, and presence of ME fluids. Myeloperoxidase activity in the SC-41930-treated group was found to be significantly lower than that in the control group. Histopathology of temporal bones indicated decreased inflammation in the treated group as compared to the controls. In addition, ME fluids were absent in four out of six treated animals. These results demonstrate that SC-41930 can produce significant anti-inflammatory effects in this model of OM.
Morphologic Patterns and Molecular Pathways of Aids-Related Head and Neck and other Systemic Lymphomas
Authors: Carbone Antonino , Tirelli Umberto , Gaidano Gianluca , Rinaldo Alessandra , Gloghini Annunziata , Ferlito Alfio
Published: October 2014

Head and neck manifestations of human immunodeficiency virus (HIV) infection include lymph nodal and extranodal localization of non-Hodgkin's lymphoma (NHL). A histopathologic characteristic common to head and neck NHLs and to all the other systemic lymphomas in HIV patients is the frequent occurrence of cases displaying pleomorphic features and some overlap between established histologic subtypes. This article highlights the difficulties in defining HIV-related NHLs correctly, and proposes a specific pathologic categorization of these disorders accounting for their pathogenetic aspects as gathered from molecular data
Long-Term Follow-up of Tracheoesophageal Puncture Results
Authors: Geraghty James A. , Smith Bonnie E. , Wenig Barry L. , Portugal Louis G.
Published: October 2014

Since its introduction by Blom and Singer in 1980, tracheoesophageal puncture with a voice prosthesis has become the most frequently recommended choice for speech rehabilitation of total laryngectomees. Many studies have reviewed the initial speech acquisition success rates following tracheoesophageal puncture; however, long-term follow-up in these initial successes has been lacking. In addition, factors predictive of long-term success with tracheoesophageal speech have not been defined. Over a 10-yearperiod, we retrospectively reviewed all total laryngectomy patients, including those who have undergone primary or secondary tracheoesophageal puncture, at the University of Illinois Hospital and Clinics and the Westside Veterans Administration Hospitals. Survival in the total laryngectomy cohort of 202 patients ranged from 35% to 50%. Forty of these patients underwent tracheoesophageal puncture, in whom survival was 75%. Short-term success with tracheoesophageal speech was approximately 70% for our patients, while long-term success was achieved in 66%. Despite low socioeconomic status and relatively high alcoholism rates, successful maintenance of tracheoesophageal speech was achieved in the majority of cases. Tracheoesophageal speech should therefore be considered as a primary method of vocal rehabilitation in all patients undergoing total laryngectomy.
Acute Airway Obstruction in the Hospitalized Infant: Four Hard Lessons in the Distal Trachea
Authors: Isaacson Glenn
Published: October 2014

Acute obstructing lesions of the distal (lower) trachea present a unique challenge to the pediatric otolaryngologist. The small caliber of the airway and tenuous medical status of such patients test the ingenuity of the surgeon and the limits of instrumentation. This report presents the operative findings and management of four hospitalized infants with worsening respiratory distress. Difficulties encountered in maintaining airway control while diagnosing and correcting these lesions are described.
Management of Subglottic Foreign Bodies
Authors: Halvorson David J. , Mann Christopher , Merritt Robert M. , Porubsky Edward S.
Published: October 2014

Foreign body aspiration is not an infrequent encounter in the practice of otolaryngology and requires immediate attention. The vast majority of foreign body aspirations occur in children less than 3 years of age, and the actual event of aspiration is frequently not witnessed. Although inhaled foreign bodies most often lodge in the bronchi, laryngotracheal foreign bodies also occur and are potentially more dangerous. Specifically, subglottic foreign bodies present unique clinical challenges. The diagnosis of subglottic foreign bodies is often difficult and they are commonly confused with other causes of upper airway obstruction. We present our experience with the diagnosis and management of seven patients with subglottic foreign bodies, who presented with an abnormal airway and whose problems were initially misdiagnosed. The radiographic and clinical features are discussed with a review of our surgical management.
Adenovirus-Mediated Gene Therapy for Head and Neck Squamous Cell Carcinomas
Authors: Davidson Beverly L. , Graham Scott M. , Goebel Eric A. , Zabner Joseph , Kern Jeffrey A.
Published: October 2014

Advanced head and neck squamous cell carcinomas (HNSCCs) have a poor prognosis despite aggressive multimodal therapy. The goal of our study was to test the feasibility of gene transduction as a novel therapy for head and neck cancer. Three human HNSCC cell lines were transduced in vitro with a replication-deficient recombinant adenovirus containing the lacZ marker gene (Ad2/CMVßgal). Gene transduction efficiency was dependent on multiplicity of infection, duration of exposure to the virus, and viral concentration. Next, the HEp-2 cell line was transduced with an adenoviral vector (Ad.RSV tk) containing the herpes simplex virus thymidine kinase (HSV tk) gene, which, when expressed, sensitizes transduced cells to ganciclovir (GCV). Subsequent administration of GCV resulted in complete rumor cell killing. These results suggest that adenovirus-mediated transfer of KSV tk and administration of GCV has potential as a new therapy for HNSCC.
Effect of Stenting on Graft Vascularization after Laryngotracheoplasty
Authors: Logan Thomas C. , Henrich Douglas E. , Shockley William W.
Published: October 2014

The management of pediatric airway stenosis has been an important topic of debate over the last few decades as prolonged intubation has become more common in the neonate. Although many surgical options are available, most would agree that use of expansion techniques (laryngotracheoplasty) with cartilaginous grafting is the procedure of choice for the severely stenotic airway. Controversy persists, however, regarding the role of stents. Advocates feel that stents serve to counteract scar contracture and support the newly constructed airway. In contrast, recent studies suggest that stenting results in impaired wound healing and an increased complication rate. The present study addresses the effect of stenting on the vascularization of cartilaginous grafts in an animal model. Thirty-six New Zealand white rabbits were evaluated after laryngotracheoplasty with autogenous cartilage grafting. Half of the animals were stented with a 2-cm section of an endotracheal tube that was secured just below the glottis. Three rabbits from each group were then painlessly sacrificed on days 4, 6, 8, 10, 14, and 21. Gross and histologic comparisons of the stented and nonstented specimens revealed similar wound healing. Measurements of graft vascularization were obtained with a computerized image measurement program, and a comparison was made regarding the rate of vascularization. There was a statistically significant increase in the rate of vascularization in the stented group (mean 73% versus 53% at day 10; p < .05). This analysis suggests that stenting does not inhibit early wound healing and specifically graft vascularization after laryngotracheoplasty.
Ultrastructural Study of Peripheral Nerve Injury Induced by Monopolar and Bipolar Diathermy
Authors: Zohar Yuval , Strauss Michael , Sadov Rima , Djialdetti Meir
Published: October 2014

The effect of unipolar and bipolar electrocoagulation on human and albino rat peripheral nerves was examined by transmission electron microscopy. The greater auricular nerve obtained from operated patients and the femoral nerve of an albino rat were chosen for this study. The nerves were divided into three groups: controls, segments of nerves spot-coagulated with unipolar instruments, and segments of nerves spot-coagulated with bipolar instruments. Significant cell injury, expressed by marked damage of the Schwann cells, was induced by unipolar coagulation in both myelinated and unmyelinated nerves, in humans as well as in the albino rat. However, in bipolar-treated nerves, the Schwann cell architecture remained well preserved in both types of nerves. The results are in favor of bipolar electrocoagulation when applied in areas rich in neurovascular supplies.
Sleep Fluoroscopy for Localization of Upper Airway Obstruction in Children
Authors: Gibson Sharon E. , Strife Janet L. , Myer Charles M. , O'Connor David M.
Published: October 2014

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides adynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.
Kinematic and Dynamic Characteristics of Solid Pellet Movement during the Pharyngeal Phase of Swallowing
Authors: Ren Junlong , Hofmann Candy L. , Kern Mark K. , Arndorfer Ronald C. , Shaker Reza
Published: October 2014

Information on solid particle movement through the pharynx, in addition to its physiologic importance, has relevance to the swallowing of medications in pill form. The purpose of this study was to determine the kinematics of a solid particle during the oral-pharyngeal phase of swallowing. We used a concurrent manometric-videofluoroscopic technique and identified two distinct zones of increasing bolus velocity, one at the tongue base and the other at the pharyngo-upper esophageal sphincter (UES) region. Velocity decreased significantly (p < .05), to 9.0 ± 1.0 cm/s, while the bolus traversed the area located between the tip of the horizontal epiglottis and the pharyngeal wall. The velocity of the liquid barium bolus head was similar to that of the solid barium pellet. The average bolus tail velocity was relatively constant. The acceleration of the barium pellet was temporally associated with development of an incrementally decreasing pressure distal to the location of the pellet in the hypopharynx and across the UES. In conclusion, the kinematics of a solid particle are similar to those of the head of a liquid bolus, but both are different from bolus tail kinematics. During the pharyngeal phase of swallowing, the area located ahead of the bolus exhibits an incrementally decreasing pressure, caudally. This may facilitate bolus transport and contribute to airway protection.
Speech Results and Complications of Near-Total Laryngectomy
Authors: Gavilán Javier , Prim Pilar , Herranz Jesús , Rabanal Ītaki
Published: October 2014

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.
Radiotherapy in Early Glottic Carcinoma
Authors: Kanonier Georg , Fritsch Esther , Rainer Thomas , Thumfart Walter Franz
Published: October 2014

Radiotherapy is widely accepted as primary treatment in the T1 stage of glottic cancer, but controversy surrounds the proper approach to T2 lesions of the glottis. A retrospective review of 90 patients addresses treatment results for T1 and T2 lesions of glottic carcinoma managed by primary radiotherapy with 60 to 64 Gy from 1977 to 1989. Seventy-nine patients met the criteria for local control analysis with a minimum follow-up of 5 years. Radiotherapy alone controlled disease in 93% (43 of 46) of patients with T1 lesions and 18% (6 of 33) of those with T2 tumors (including 10 patients in whom radiotherapy was terminated at 40 Gy because of persistent tumor). Ultimate control of disease for T1 and T2 lesions, including surgical salvage, was 100% and 82%, respectively. Larynx preservation was achieved in 100% of Tl and in 45% of T2 lesions. Extension of tumor and impaired vocal cord mobility showed statistical significance for adverse prognosis (p < .001). This paper discusses how these results affect treatment of glottic carcinoma, particularly in the T2 stage.
Fibrosarcoma of the Thyroid in a Man Exposed to Fallout from the Chernobyl Accident
Authors: Wygoda Marc , Osin Pinchas , Sichel Jean-Yves , Dano Isaac , Eudan Josef
Published: October 2014

Since the Chernobyl accident in April 1986, a dramatic increase in the incidence of thyroid carcinoma has been described, especially in children. A case of sarcoma of the thyroid in a man exposed to the Chernobyl fallout is presented. Sarcoma of the thyroid is a rare finding. The present patient lived in a region that is known to be one of the most exposed to Chernobyl fallout. The case suggests a high probability of a relationship between the sarcoma of the thyroid and the exposure to radiation.
Allograft Tympanoplasty Type 1 in the Childhood Population
Authors: Hamans Evert P. P. M. , Somers Thomas , Govaerts Paul J. , Offeciers F. Erwin
Published: October 2014

Seventy allograft type 1 tympanoplasties in children under 16 years of age were studied retrospectively. Only patients with a tympanic membrane perforation without cholesteatoma and a normal ossicular chain were included. Short-term and long-term anatomic and functional results were analyzed after a mean follow-up of 40 months. The overall short-term take rate was 97% and the long-term take rate was 88%. A number of variables with alleged prognostic value for surgical outcome were analyzed, but none showed statistical correlation with either anatomic or functional results. A median hearing gain of 10 dB was achieved, which was stable over time. We conclude that allograft tympanoplasty type 1 in this group of children is anatomically and functionally successful regardless of age.
Early Sound Deprivation and Long-Term Hearing
Authors: Healy Michael P. , Welsh John J. , Welsh Louis W.
Published: October 2014

The long-term effects of hearing loss in early life were analyzed by tests of central auditory function. A majority of individuals failed the Compressed Speech identification with statistically significant results. There was an impact on a minority of individuals evaluated by Dichotic Sentences; little impairment was noted through Speech Reception in Noise. Delayed maturation of the central auditory complex may improve these findings, although during the period of investigation a negative impact was measured. Other issues of diagnosis, remediation, and the consequences of short- and long-term deafness are discussed.
Prevalence of Severe to Profound Sensorineural Hearing Loss in Children Having Family Members with Hearing Impairment
Authors: Zakzouk Siraj M. , Bafaqeeh Sameer Ali
Published: October 2014

The purpose of this paper is to study the prevalence rate of hearing impairment among children with siblings and family members having hearing and speech disorders. A random survey of 6,421 Saudi infants and children between 2 months and 12 years of age was conducted in the Riyadh area. Children with no or few siblings and those who were firstborn were at relatively higher risk, and there was a strong association between children in the hearing-impaired group among those having living siblings with deafness. Those children who had family members with hearing and speech problems were at twice the risk of their counterpart groups regarding hearing impairment.
Eustachian Tube Function and Middle Ear Barotrauma Associated with Extremes in Atmospheric Pressure
Authors: Miyazawa Takashi , Ueda Hiromi , Yanagita Noriyuki
Published: October 2014

Eustachian tube (ET) function was studied by means of sonotubometry and tubotympano-aerodynamography (TTAG) prior to and following exposure to hypobaric or hyperbaric conditions. Forty normal adults were subjected to hypobaric pressure. Fifty adults who underwent hyperbaric oxygen (HBO) therapy also were studied. Following hypobaric exposure, 14 of 80 ears (17.5%) exhibited middle ear barotrauma. Following hyperbaric exposure, 34 of 100 ears (34%) exhibited middle ear barotrauma. Dysfunction of the ET, characterized by altered active and passive opening capacity, was more prevalent following exposure to extremes in atmospheric pressure compared to baseline. The ET function, which was impaired after the first HBO treatment, improved gradually over the next 2 hours. Overall, however, ET function was worse after the seventh treatment The patients who developed barotrauma exhibited worse ET function prior to hypobaric or hyperbaric exposure. Thus, abnormal ET function can be used to predict middle ear barotrauma prior to exposure to hypobaric or hyperbaric atmospheric pressure.
Growth Factors in Subglottic Stenosis
Authors: Scioscia Kenneth A. , Miller Frederick , April Max M. , Gruber Barry L.
Published: October 2014

We sought to define the role of fibrogenic peptides in subglottic stenosis (SGS). Biopsy specimens were obtained from patients with stenosis following endotracheal intubation (group 1, n = 5, mean age 5), patients without a history of any precedent trauma, ie, idiopathic stenosis (group 2, n = 3, mean age 40), and those without stenosis (group 3, n = 3, mean age 70). Formalin-fixed biopsy specimens were analyzed following immunohistochemical staining to determine if epidermal growth factor (EGF), platelet-derived growth factor-AA and -BB (PDGF-AA/BB), transforming growth factor-β1 and -β2 (TGF-β,β2), or basic fibroblast growth factor ( bFGF) was deposited in these tissues. Blinded analysis revealed TGF-β2 and PDGF-AA to be present in seven of eight biopsy specimens from SGS and absent in controls. Staining for PDGF-BB was observed in the mucosa and submucosa and occasionally within vessel walls. Staining of individual growth factors appeared to correlate closely with the presence of granulation tissue. Essentially no bFGF or TGF-β1 was observed. Differences were found between patients in groups 1 and 2; tissue from group 1 revealed deposition of EGF and PDGF-BB in submucosa, epithelium, and vasculature. In summary, our experimental findings implicate PDGF and TGF-β2, perhaps acting in concert, in mediating the pathologic fibrotic process observed in subglottic stenosis. Epidermal growth factor, in conjunction with TGF-β and PDGF, may also have a role, but further investigation is needed to more precisely define it.
Cranial Nerve and Hearing Function after Combined-Approach Surgery for Glomus Jugulare Tumors
Authors: Gjuric Mislav , Wolf Stephan Rüdiger , Wigand Malte Erik , Weidenbecher Manfred
Published: October 2014

In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce mutilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.
Stable and Progressive Hearing Loss in Type 2A Usher's Syndrome
Authors: van Aarem Annelies , Pinckers Alfred J. L. G. , Kimberling William J. , Huygen Patrick L. M. , Bleeker-Wagemakers Elisabeth M. , Cremers W. R. J.
Published: October 2014

Audiograms were traced or additionally performed on 23 Usher's syndrome patients in 10 Dutch multi-affected families, all linked to chromosome 1q (USH2A locus). Serial audiograms, available in 13 patients, were used for a regression analysis of binaural pure tone average on age (follow-up, 9 to 32 years) to test for “significant progression,” ie, a significant regression coefficient, here called the “annual threshold increase” (ATI, expressed in decibels per year). A significant ATI (>1 dB/y) was observed in 3 patients. Analysis of variance of ATI demonstrated significant heterogeneity; hearing loss was either stable or progressive. This implies a significant clinical heterogeneity. A similar analysis performed on our progressive USH2A cases and “type III” cases previously reported by others (ATI of 1 to 5 dB/y), some of which were recently linked to chromosome 3q (USH3 locus), failed to show any significant heterogeneity in the progression of hearing loss.
Role of Leukotriene B4 and Interleukin-8 in Acute Bacterial and Viral Otitis Media
Authors: Patel Janak A. , Sim Tommy , Chonmaitree Tasnee , Garofalo Roberto , Owen Mary J. , Uchida Tatsuo , Howie Virgil M.
Published: October 2014

In order to evaluate the role of polymorphonuclear leukocytes (PMNs) in acute otitis media (AOM), levels of leukotriene B4 (LTB4), a potent inflammatory product of PMNs, and interleukin-8 (IL-8), a PMN chemotactic cytokine, were measured in 271 middle ear fluid (MEF) samples from 106 children with AOM. Forty-two percent of the patients had evidence of respiratory viral infection. At the time of diagnosis, levels of both LTB4 and IL-8 were higher in the MEFs from patients with AOM associated with bacterial or bacterial and viral infection than those MEFs containing no pathogen (p < .05). Antibiotic treatment was not associated with a significant change in levels of LTB4 or IL-8 in the MEFs obtained 2 to 5 days into treatment, compared to those obtained at diagnosis. Bacteriologic failure after 2 to 5 days of treatment was associated with high LTB4 levels in the initial MEFs (p = .05). Recurrence of AOM within 1 month was associated with high IL-8 levels in the initial MEF (p = .04). Our findings suggest that LTB4 and IL-8 are produced during acute infection of the middle ear, and these PMN-related inflammatory substances may play an important role in delaying recovery or in recurrence of AOM. Effective treatment of AOM may require eradication of bacteria by antibiotics, as well as pharmacologic agents that modulate PMN functions.
Three-Dimensional Analysis of Spontaneous Nystagmus in Peripheral Vestibular Lesions
Authors: Böhmer Andreas , Straumann Dominik , Fetter Michael
Published: October 2014

The direction of spontaneous nystagmus was recorded in three dimensions with scleral dual search coils in three patients after vestibular neurectomy and in seven patients with vestibular neuritis. The rotation vectors of the spontaneous nystagmus clustered along the sensitivity vector of the lateral semicircular canal (SCC). The direction of the spontaneous nystagmus after resection of the whole eighth nerve was not different from that after resection of only the superior branch of the vestibular nerve. Deviations from this direction were observed only after resection of the inferior vestibular nerve and in one patient with vestibular neuritis. The absence of nystagmus components in direction of the vertical SCC reflects an anisotropy of oculomotor efferents of the vestibulo—ocular reflex arc rather than alesion limited to the lateral SCC afferents. Therefore, the three-dimensional analysis of spontaneous nystagmus does not permit accurate localization of a peripheral vestibular lesion.
Immunohistochemical Localization of Manganese Superoxide Dismutase in Rat Vestibular Dark Cell Regions
Authors: Lai Ming-Tang , Ohmichi Takuya , Egusa Kentaro , Yoreane Satoshi , Masuda Yu
Published: October 2014

A modified immunoglobulin peroxidase bridge sequence method was used to detect the localization of manganese superoxide dismutase (MnSOD), a superoxide radical (O2−) scavenging enzyme locating in mitochondrial matrix, in the vestibular labyrinth of pigmented rats. Strong positive MnSOD immunostaining was demonstrated in the dark cell regions of the ampullae, utricle, and common crus. The result provides for the first time direct evidence demonstrating the existence of mitochondrial O2− scavengers in the vestibular labyrinth and illustrates that the specific sites for vestibular MnSOD immunolocalization are the dark cell regions. This site specificity of MnSOD immunolocalization suggests that dark cell regions may possess high metabolic activity and may encounter constant threat from O2−. We assume MnSOD is needed in protecting some physiologic functions of the dark cell regions. Cell types showing negative MnSOD immunostaining may conceivably be relatively vulnerable to acute O2− damage.
Cartilaginous Tumors of the Larynx: Clinicopathologic Review of 47 Cases
Authors: Lewis Jean E. , Olsen Kerry D. , Inwards Carrie Y.
Published: October 2014

We reviewed the clinical and pathologic features of 47 laryngeal cartilaginous tumors treated at the Mayo Clinic. This represents the largest reported series of these tumors. The patient group consisted of 36 men (77%) and 11 women (mean age, 63 years; range, 44 to 91 years). The tumors included 44 chondrosarcomas, all low-grade, and 3 chondromas. The overall 5-year survival was 90.1%, which did not differ significantly from the expected survival. Laryngectomy was performed as primary treatment for chondrosarcoma in 6 patients. Of the patients with chondrosarcoma, 40% had tumor recurrence or symptomatic tumor progression at an average of 4.5 years after diagnosis. Only 15 of the patients with chondrosarcoma (34%) required total laryngectomy. There were no metastases, and 4 patients died of local disease (all received treatment before 1960). At latest follow-up, 34 patients with chondrosarcoma (77%) were alive without disease or had died of other causes. We conclude that laryngeal chondrosarcoma can be treated with conservative surgery in most cases, both initially and for recurrent disease.
Surgical Morbidity of Neck Dissection after Chemoradiotherapy in Advanced Head and Neck Cancer
Authors: Newman James P. , Fee Willard E. , Terris David J. , Goode Richard L. , Pinto Harlan A. , Goffinet Donald R.
Published: October 2014

The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.
Rhinolith: An Unusual Case and an Update
Authors: Ézsiás András , Sugar Adrian W.
Published: October 2014

An unusual case is reported in which a cleft palate patient with an oronasal fistula developed a true rhinolith. An update and discussion on rhinoliths are given.
Morbidity of Combined Therapy for the Treatment of Supraglottic Carcinoma: Supraglottic Laryngectomy and Radiotherapy
Authors: Steiniger Joseph R. , Parnes Steven M. , Gardner Glendon M.
Published: October 2014

Many surgeons find that patients have increased morbidity after supraglottic laryngectomy if postoperative irradiation is given, but this remains poorly documented. Twenty-nine patients undergoing supraglottic laryngectomy were retrospectively reviewed. Seventeen received postoperative radiotherapy, and 12 did not. The mean follow-up was 64 months. When compared to patients treated with supraglottic laryngectomy alone, irradiated patients had a significantly higher incidence of lifelong gastrostomy dependency (35% versus 0%; p = .03) and acute upper airway obstruction (29% versus 0%; p = .05). There was a trend toward greater tracheotomy dependency (24% versus 0%), aspiration pneumonia (35% versus 9%), and delayed independent swallowing (34.8 weeks versus 7.8 weeks) in the patients treated with combined therapy, but this difference was not significant. A morbidity index score was developed to evaluate the overall lifelong morbidity of these patients, and this was found to be significantly higher in patients treated with surgery and radiotherapy (2.29 versus 0.83; p = .04). Overall survival was equal in both groups. We have shown that radiotherapy increases the morbidity of supraglottic laryngectomy. This should be considered when planning treatment for patients with supraglottic carcinoma.
Pathology Consultation Intracellular Crystalline Deposits in Lymphoplasmacellular Disorders
Authors: Suarez Patricia , El-Naggar Adel K. , Batsakis John G.
Published: October 2014

Crystalline immunoglobulin intracellular inclusions may be found in a range of B-cell neoplasias, including MALT (mucosa-associated lymphoid tissue) lymphoma. The crystals are regarded as an outcome of impaired cell secretory activity leading to their accumulation. At times the deposits may be so profound as to obscure the diagnosis and may even lead to misdiagnosis. Examples of the crystals are presented along with a brief literature review.
Perceived Hearing Handicap of Patients with Unilateral or Mild Hearing Loss
Authors: Newman Craig W. , Hug Gerald A. , Jacobson Gary P. , Sandridge Sharon A.
Published: October 2014

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average ≤40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.
Effect of Intraoperative Ischemia on Chondrogenesis by Vascularized Auricular Perichondrium Grafted in the Airway
Authors: Naficy Saman , Esclamado Ramon M.
Published: October 2014

Vascularized perichondrium and periosteum are potentially ideal grafts for airway reconstruction. We quantitatively evaluated the effect of a 2-hour interruption of blood supply on subsequent growth of cartilage from vascularized auricular perichondrium grafted in the rabbit airway. Two pedicled auricular perichondrocutaneous flaps were elevated and used to repair two small anterior airway defects in each animal (n = 17). One of the two flaps was randomly clamped for a 2-hour period during the operation, with the other flap serving as a paired control. We found no significant difference in chondrogenesis between the two groups. Our findings support the use of perichondrium and periosteum as free revascularized grafts for airway reconstruction.
Posttransplant Lymphoproliferative Disease Presenting as Sudden Respiratory Arrest in a Three-Year-Old Child
Authors: Hague Karin , Catalano Peter , Strauchen James , Rothschild Michael , Fyfe Billie
Published: October 2014

Posttransplant lymphoproliferative disease (PTLD) is an occasional complication of pediatric organ transplantation that, heretofore, has not been associated with airway obstruction. We report the first documented case of PTLD associated with complete airway obstruction resulting in sudden respiratory arrest and death in a 3-year-old child. This is contrasted to a subsequent case of PTLD wherein heightened clinical suspicion and prompt tonsillectomy resulted in a definitive diagnosis and improved outcome. The early clinical hallmarks of PTLD are a mononucleosis-like syndrome, tonsillar enlargement, and positive Epstein-Barr virus seroconversion. The potential for a fatal outcome of PTLD involving Waldeyer's ring components warrants early recognition and aggressive treatment.
Yolk SAC Tumors (Endodermal Sinus Tumors) of the Extracranial Head and Neck Regions
Authors: Devaney Kenneth O. , Ferlito Alfio
Published: October 2014

Yolk sac tumors (or endodermal sinus tumors) are rare neoplasms of germ cell origin that have been reported in gonadal sites (testis and ovary). Extragonadal yolk sac tumors are uncommonly seen, and in particular, they are rare in the extracranial head and neck regions; we found 27 well-documented cases in the English-language literature. We discuss their clinical and pathologic features.
Functional Outcome and Prognosis Factors after Supracricoid Partial Laryngectomy with Cricohyoidopexy
Authors: Naudo Philippe , Hans Stéphane , Laccourreye Ollivier , Laccourreye Henri , Weinstein Gregory , Brasnu Daniel
Published: October 2014

A retrospective analysis of the medical records and operative files of 124 patients who consecutively underwent supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) was undertaken. The objective of this study was to analyze the postoperative course and functional results of SCPL-CHP. The mean duration of follow-up was 7 years (range 1 to 20 years). The postoperative mortality was 1.6%. The average times until tracheostomy and nasogastric feeding tube removal were 8 and 22 days, respectively. All patients but 1 were decannulated. The rate of pneumonia from aspiration was 11.5%. Completion total laryngectomy and permanent gastrostomy were required in 2.5% and 2.5% of patients, respectively. Overall normal swallowing without permanent gastrostomy and respiration without tracheostomy were achieved by the first postoperative year in 91% and 99.1% of patients, respectively. Univariate analysis of the potential correlation between various variables and the duration of the tracheostomy and nasogastric feeding tube, the incidence and causes of mortality, the incidence and type of the various complications, the recovery of swallowing, and the length of hospitalization is presented. The report also discusses the management and follow-up care.
Lower Cranial Nerve Schwannomas Involving the Jugular Foramen
Authors: Mazzoni Antonio , Saleh Essam , Sanna Mario , Achilli Vittorio
Published: October 2014

Schwannomas involving the jugular foramen are rare lesions, and no consensus exists on their management. This paper reports on 20 such cases treated in our centers. Nineteen cases were operated on for removal of the tumors, and the remaining case is being managed by watchful expectancy. Fifteen cases were operated on by the petro-occipital trans-sigmoid approach with or without labyrinthectomy, 2 by the infratemporal fossa approach, 1 by the modified transcochlear approach, and 1 by the jugulo-petrosectomy approach. The petro-occipital trans-sigmoid approach allowed single-stage, total tumor removal with preservation of the facial nerve and of middle and inner ear functions. Lower cranial nerve paralysis was the major complication and seemed to be inherent to the disease rather than to the approach used. No cerebrospinal fluid leak or meningitis occurred in the present series. So far, no recurrence has been detected.
Marrow-Mesenchyme Connections in the Fetal and Newborn Tympanum
Authors: Linthicum Fred H. , Tian Qing , Slattery William
Published: October 2014

Examinations of 41 human fetal, 8 infant, and 8 juvenile temporal bones prepared for light microscopic evaluation revealed direct connections between the hematopoietic bone marrow and the unresolved mesenchyme in the middle ear. The connections first appeared at 15 weeks of gestation and became bridged by fibrous tissue, in most cases, by the postpartum age of 10 months. Between 16 and 18 months after birth, the marrow-mesenchyme connections gradually disappeared. The areas in which the connections were most numerous were the anterior epitympanum, the sinus tympani medial to the stapedius muscle, and transitory bone that occupies the area that will become the aditus of the antrum. Immunohistochemical staining demonstrated the existence of mature leukocytes in these connections. These connections may help protect the middle ear against bacterial invasion during the postnatal period.
Giant Cholesteatoma of the External Auditory Canal
Authors: Sapçi Tarik , Uğur Gökhan , Ağrali Nalan , Karavus Ahmet , Akbulut Uğur Günter
Published: October 2014

Cholesteatomas are found almost exclusively in the middle ear and mastoid. Occasionally this disease is seen in the external auditory canal. Cholesteatoma of the external auditory canal is a rare condition. Severe pain and profuse discharge associated with a normal eardrum and normal hearing are essential clinical features. In addition, we found facial paresis and conductive hearing loss in our case. Smaller cholesteatomas can be managed by frequent debridement in the office; larger lesions require surgical intervention. Surgery is successful in resolving otorrhea and relieving pain. In addition, our own experience has shown that surgery is successful in relieving facial paresis.
Decrease in Immunoreactive Neutral Endopeptidase in Uvula Epithelium of Patients with Obstructive Sleep Apnea
Authors: Zakkar Mohamed , Sekosan Marin , Olopade Christopher O. , Wenig Barry , Rubinstein Israel
Published: October 2014

The purpose of this study was to determine whether neutral endopeptidase (NEP; EC 3.4.24.11) is decreased in the uvula epithelium of patients with obstructive sleep apnea (OSA). Tissues were obtained by uvulopharyngopalatoplasty in seven patients with moderate OSA and by autopsy in five individuals not known to have OSA. Using antisera to human NEP and immunoperoxidase staining, we found that NEP was localized in uvula epithelial cells of both patients with OSA and controls. However, there was a significant decrease in the number of epithelial cells staining for NEP in patients with OSA relative to controls (67 ± 10 cells versus 261 ± 33 cells, in 5 randomly selected high-power microscopic fields, respectively; mean ± SEM; p <.05). The intensity of staining for NEP was similar in both groups. We conclude that immunoreactive NEP is significantly decreased in the uvula epithelium of patients with OSA.