bluuebunny/crossref_metadata_2025 huggingface dataset:
Ropivacaine Peritonsillar Infiltration for Analgesia after Adenotonsillectomy in Children: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: Gemma Marco , Piccioni Lucia Oriella , Gioia Luigi , Beretta Luigi , Bussi Mario
Published: October 2014

Objectives:

Our randomized, double-blind, placebo-controlled study evaluates the possible benefit of peritonsillar infiltration with 0.75% ropivacaine hydrochloride on the pain level after adenotonsillectomy in 3- to 7-year-old children.

Methods:

We randomly administered intraoperative peritonsillar infiltration with 0.2 mL/kg ropivacaine 0.75% (group R) or 0.2 mL/kg saline 0.9% (group F) to sixty 3- to 7-year-old children (ASA 1 or 2) who were undergoing adenotonsillectomy. Postoperative pain was assessed 6 and 24 hours after surgery by a 6-face Faces Pain Scale that allowed quantification of pain on a 100-mm horizontal line (0 = no pain). The number of rectal doses of acetaminophen-codeine required during the first postoperative day was recorded.

Results:

The pain scores did not differ between the groups, either 6 or 24 hours after surgery (group F, 43 ± 26, versus group R, 29 ± 23, and group F, 24 ± 23, versus group R, 30 ± 28, respectively). Acetaminophen-codeine doses were similarly required in the two groups.

Conclusions:

Peritonsillar infiltration with 0.75% ropivacaine does not provide any major postoperative analgesic effect in 3- to 7-year-old children after adenotonsillectomy. A possible clinically minor analgesia 6 hours after surgery is suggested.
Role of Otolaryngologists in Health Care for the Homeless
Authors: Gurgel Richard K. , Lund Glen , Gundlapalli Adi V.
Published: October 2014

Objectives:

This study describes the prevalence of head and neck disease in patients seen at an urban, federally qualified clinic for those experiencing homelessness and determines the need for otolaryngologists in providing health care for the homeless.

Methods:

All adult patient visits from 2000 to 2004 were reviewed for ICD-9 diagnostic codes representing otolaryngological diseases. Chart review was performed for patients referred to a volunteer otolaryngologist to confirm diagnoses and referrals.

Results:

During the study period, the clinic served 11,690 unique patients in 59,060 patient visits. Otolaryngological diagnoses accounted for 8,959 of these total visits (15.2%), 94% of which were managed by primary care providers. The most common diagnoses were “upper respiratory infections,” “symptoms, signs, and ill-defined conditions of the head and neck, cough, dysphagia,” “other diseases of upper respiratory tract,” and “disorders of the ear/mastoid process.” An on-site volunteer otolaryngologist provided consultation on 6% of all patients with otolaryngological diagnoses, averaging 108 consultations per year; 39 patients were subsequently referred to community specialists for surgery and audiology services.

Conclusions:

There is a small but significant need for otolaryngologists in providing health care for homeless individuals in an urban setting. The authors encourage otolaryngologists and homeless health-care clinics to establish a relationship for volunteer services.
Unilateral Vocal Fold Paralysis in Premature Infants after Ligation of Patent Ductus Arteriosus: Vascular Clip versus Suture Ligature
Authors: Spanos William C. , Brookes James T. , Smith Mark C. , Burkhart Harold M. , Bell Edward F. , Smith Richard J. H.
Published: October 2014

Objectives:

We investigated risk factors associated with unilateral iatrogenic vocal fold paralysis (IVFP) in the context of ligation of patent ductus arteriosus (PDA) and compared the rates of paralysis between vascular clip and suture ligation procedures.

Methods:

We performed a prospective examination of infants with isolated PDA treated surgically during 1995 to 2005. Statistical significance was determined with a 2-tailed t-test.

Results:

Of 68 PDA ligations, 13 cases of left-sided IVFP were diagnosed, for an overall incidence of 19%. All cases of IVFP occurred in 55 infants who weighed less than 1 kg at birth. Suture ligature was used in 60% of all PDA ligation patients, and vascular clips in 40%. The incidence of IVFP in patients with vascular clips (19%) was similar to the incidence in those with suture ligature (20%). Hoarseness or stridor was present in 69% of patients with IVFP, compared to 17% of normal controls (p < 0.001). The rate of aspiration was not increased in the IVFP group; however, 15% of the patients with IVFP had episodes of decreased oxygen saturation, versus 7% of infants with normal vocal fold mobility.

Conclusions:

A hoarse infant with a birth weight of less than 1 kg who has undergone PDA ligation should be examined for unilateral IVFP. Vascular clips and suture ligature are associated with similar rates of IVFP.
Long-Term Acoustic Comparison of Thyroplasty versus Autologous Fat Injection
Authors: Hartl Dana M. , Hans Stephane , Crevier-Buchman Lise , Vaissière Jacqueline , Brasnu Daniel F.
Published: October 2014

Objectives:

Medialization by thyroplasty or intracordal autologous fat injection provides voice improvement in patients with unilateral vocal fold paralysis. Thyroplasty is considered a “permanent” medialization, whereas fat injection is considered “temporary” because of reabsorption. The objective of this study was to compare the evolution of acoustic parameters for these procedures over 1 year and to evaluate the results of fat injection at 2 years.

Methods:

From 1994 to 1998, 46 consecutive patients (17 women and 29 men) were treated exclusively by intracordal injection of autologous fat, and then from 1999 to 2002, 48 consecutive patients (19 women and 29 men) were treated with the Montgomery Thyroplasty Implant System or Gore-Tex thyroplasty. Each patient's voice was prospectively recorded before operation and at 1, 3, 12, and 24 months after operation. Six patients (13%) in the injection group underwent a second injection, and 1 patient (2%) in the thyroplasty group underwent revision surgery. Jitter, shimmer, and noise-to-harmonics ratio (NHR) were calculated for a 1,000-ms midvowel segment of the vowel / a/.

Results:

One month after operation, jitter, shimmer, and NHR were significantly improved in both groups (Wilcoxon's test, p < 0.05 in all cases). Jitter and shimmer did not change significantly between 1 and 3 months or between 1 and 12 months (p > 0.05). The NHR had improved at 12 months in both groups (injection, p = 0.0004; thyroplasty, p = 0.0178) and at 24 months in the injection group (p = 0.0076). No significant difference was noted between the two techniques before operation or at 1, 3, or 12 months after operation (Mann-Whitney test, p > 0.05). Jitter and shimmer had not changed significantly after 24 months in either group. At 24 months, there was no difference in acoustic parameters between the two treatment groups.

Conclusions:

The two techniques provided comparable objective acoustic voice improvement. At 2 years, autologous fat injection provides long-term acoustic voice improvement comparable to that of thyroplasty, but it has a higher rate of revision surgery.
Anatomy of the Optic Canal: A Computed Tomography Study of Endoscopic Nerve Decompression
Authors: Hart Catherine K. , Theodosopoulos Phillip V. , Zimmer Lee A.
Published: October 2014

Objectives:

Endoscopic optic nerve decompression has variable success rates. Our goal was to further delineate the radiographic anatomy of the optic canal to determine whether the variable success can be explained on anatomic principles.

Methods:

The optic canal dimensions and the degree of optic canal exposure to the sphenoid sinus were measured on sinus computed tomography images of 96 patients.

Results:

A total of 191 optic canals were analyzed (111 female subjects and 80 male subjects). The average medial canal wall length was 1.48 cm (range, 0.7 to 2.3 cm). The length in male subjects was 1.61 cm (range, 1.1 to 2.3 cm), as compared to 1.39 cm (range, 0.7 to 2.0 cm) in female subjects (p < 0.001). Onodi cells and pneumatized anterior clinoid processes were present on 14 and 16 images, respectively. The average degree of exposure of the optic canal to the sphenoid sinus in optic canals without Onodi cells or clinoid pneumatization was 99.3°, and in optic canals with both Onodi cells and clinoid pneumatization it was 117.7°. The potential area of canal exposed was 0.66 cm2, or 28% of the total surface area.

Conclusions:

A wide variation in medial canal wall length and exposure of the optic canal to the sphenoid sinus exists on computed tomography images. Variation in medial canal wall length and optic canal exposure may limit the surface area of nerve available for endoscopic optic nerve decompression.
Relationship between Squamous Cell Carcinoma Antigen and the Clinical Severity of Allergic Rhinitis Caused by Dermatophagoides Farinae and Japanese Cedar Pollen
Authors: Suzuki Kumiko , Inokuchi Akira , Miyazaki Junji , Kuratomi Yuichiro , Izuhara Kenji
Published: October 2014

Objectives:

Allergic rhinitis is known to be related to the Th2-type immune response, but no sensitive biomarker of severity yet exists. Serum squamous cell carcinoma antigen (SCCA) is clinically used as a popular tumor biomarker. We have demonstrated that SCCA is related to allergic diseases such as asthma. The purpose of the present study was to clarify the relationship between allergic rhinitis and SCCA, which had not yet been investigated.

Methods:

We compared the serum SCCA levels in patients with allergic rhinitis due to Japanese cedar pollen and Dermatophagoides farinae with those in normal subjects. Thereafter, the correlations between the clinical severity of allergic rhinitis and the serum levels of SCCA were investigated. Furthermore, the influence of 8 variables (serum levels of SCCA, immunoglobulin E, eosinophil cationic protein, and eosinophils; age; gender; oral administration of antiallergic or antihistaminic agents; and use of nasal drops) in regard to the severity of allergic rhinitis was studied by a multiple regression analysis.

Results:

The SCCA levels of the D farinae group were statistically higher than those of the control group, and they correlated with the severity of rhinitis. Among the 8 variables, only the SCCA level was found to be a predictive factor of severity on a multiple regression analysis. No relationship between SCCA level and Japanese cedar pollen allergy was demonstrated.

Conclusions:

These results suggest that the serum SCCA level may be a useful biomarker to evaluate the severity of allergic rhinitis caused by D farinae.
Effects of Gold Laser on the Avian Chorioallantoic Membrane
Authors: Rees Catherine J. , Allen Jacqueline , Postma Gregory N. , Belafsky Peter C.
Published: October 2014

Objectives:

Office-based lasers have revolutionized the treatment of laryngeal disease. The 980-nm Gold laser is a device that may offer some practical advantages over other office lasers. The chick chorioallantoic membrane has been proposed as a model for predicting the effects of photoangiolytic lasers on vocal fold microvasculature. We sought to evaluate the effects of the Gold laser in this model.

Methods:

Vascular reactions in first-order vessels were determined for the Gold laser with both 0° straight and 30° angled laser fibers. Vessels were treated at 15 W and a 500-ms pulse interval, with a 1-mm working distance. Pulse widths of 300 ms and 500 ms were evaluated. All vessels were treated until selective coagulation or vessel rupture.

Results:

We performed 60 trials on 30 embryos. The mean energy delivered was 33.7 J for the straight fiber and 51.2 J for the angled fiber. The laser achieved selective vessel coagulation without rupture in 100% (30 of 30) of straight fiber trials and in 100% (30 of 30) of angled fiber trials. In 6.7% (2 of 30) of straight fiber and 10% (3 of 30) of angled fiber trials, it caused minor injury to the surrounding albumin as indicated by white coagulum outside the vessel.

Conclusions:

The Gold laser effectively coagulates small vessels without rupture at a working distance of 1 mm and settings of 15 W, 500-ms pulse interval, and 300- to 500-ms pulse width.
Spontaneous and Evoked Laryngeal Electromyography of the Thyroarytenoid Muscles: A Canine Model for Intraoperative Recurrent Laryngeal Nerve Monitoring
Authors: Scott Andrew R. , Chong Peter Siao Tick , Hartnick Christopher J. , Randolph Gregory W.
Published: October 2014

Objectives:

We sought to determine the feasibility of performing spontaneous and evoked intraoperative laryngeal electromyography (L-EMG) using nerve monitoring equipment and to compare recording electrode configurations and methods of recurrent laryngeal nerve (RLN) stimulation in dogs.

Methods:

Four beagles underwent crush injury of the left RLN, and 2 beagles underwent left RLN transection. Serial spontaneous and evoked L-EMG was recorded with the NIM-Response nerve monitoring system under sedation. Transesophageal, percutaneous, and direct open RLN stimulation was performed. Recordings of spontaneous and evoked responses were made with endotracheal tube surface electrodes and bipolar vocal fold needle electrodes. The L-EMG procedures were repeated every 1 to 2 weeks after injury, and intersubject and intertrial differences were evaluated.

Results:

Low-amplitude motor unit action potentials, polyphasic potentials, fasciculations, and fibrillations were detected in injured animals with bipolar needle recording electrodes with this system of spontaneous L-EMG. The surface recording electrodes did not detect pathologic waveforms. Percutaneous needle stimulation of the RLN is possible at currents slightly higher than those used for direct stimulation. Consistent, discrete, transesophageal stimulation of the RLN could not be reliably performed. Recording evoked responses with needle electrodes generated sharper waveforms, facilitating calculation of latency and wave duration. Evoked L-EMG utilizing surface recording electrodes limited the intertrial and intersubject variability of evoked amplitude.

Conclusions:

Typical patterns of nerve injury can be detected with this system of intraoperative L-EMG in a canine model. Quantitative measures of amplitude, latency, and wave duration in healthy and injured canine RLNs may be determined with this system.
Serum Fatty Acids and Cardiovascular Risk Factors in Sudden Sensorineural Hearing Loss: A Case-Control Study
Authors: Cadoni Gabriella , Scorpecci Alessandro , Cianfrone Francesca , Giannantonio Sara , Paludetti Gaetano , Lippa Silvio
Published: October 2014

Objectives:

We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels of fatty acids, total cholesterol, low-density lipoproteins (LDLs), and the antioxidant coenzyme Q10.

Methods:

Forty-three patients with SSNHL and 43 healthy subjects were enrolled in the study. The main outcome measures were serum levels of fatty acids, coenzyme Q10, total cholesterol, and LDLs.

Results:

On univariate logistic regression analysis, high levels of total cholesterol (p < 0.001), LDLs (p = 0.024), behenic acid (p < 0.001), docosahexaenoic acid (p < 0.001), linolenic acid (p = 0.017), and oleic acid (p < 0.001) and low levels of coenzyme Q10 (p < 0.001) and nervonic acid (p < 0.001) were associated with an elevated risk of SSNHL. On multivariate analysis, only hypercholesterolemia (p = 0.15) and low levels of coenzyme Q10 (p = 0.02) and nervonic acid (p = 0.005) were significantly associated with SSNHL.

Conclusions:

This is the first report of low serum levels of nervonic acid as an independent risk factor for SSNHL. Considering that hypercholesterolemia, high serum levels of LDL, and low serum levels of the antioxidant coenzyme Q10 were associated with SSNHL as well, we hypothesize that saturated fatty acids may play a role in determining the dysmetabolic state in a subset of SSNHL patients. Together, these findings suggest that not only total cholesterol and LDL levels, but also fatty acid determination, may help identify SSNHL patients with cardiovascular risk factors.
Mutations of GNAS and TSHR Genes in Subclinical Toxic Multinodular Goiter
Authors: Liu Chunbo , Wu Changjun , Wang Fengjun , Zhou Min
Published: October 2014

Objectives:

This study aimed to detect the mutations of the GNAS and TSHR genes in subclinical toxic multinodular goiter (sTMG) and to evaluate the relationship between these mutations and sTMG.

Methods:

Forty-four patients with sTMG and 20 matched controls (multinodular goiter) were recruited into this study. All of the patients underwent subtotal thyroidectomy. Gene mutations were analyzed by direct DNA sequencing of the polymerase chain reaction—amplified part of exons.

Results:

In the sTMG group, 3 mutations of the GNAS gene were identified in 7 patients (15.9%), and 6 mutations of the TSHR gene were identified in 14 patients (31.8%). The mutation rate of the TSHR gene in patients with sTMG was significantly higher than that in the control group. Furthermore, in the sTMG group, statistical analysis indicated that mutations were significantly correlated with the serum level of thyroid-stimulating hormone for the TSHR gene, but no significant difference was found for the GNAS gene. Also, no significant difference was found in mutation positivity of the 2 genes between patients with nodules who were born before universal salt iodization and patients with nodules who were born afterward (p > 0.05).

Conclusions:

The results indicate that a mutation of the TSHR gene may be related to sTMG. The serum thyroid-stimulating hormone level plays an important role in the mutagenesis.
Histologic Study of Acute Vocal Fold Wound Healing after Corticosteroid Injection in a Rabbit Model
Authors: Campagnolo Andréa M. , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara , Imamura Rui , Saldiva Paulo H. N.
Published: October 2014

Objectives:

Injectable corticosteroids have been used in phonosurgery to prevent scarring of the vocal fold because of their effects on wound healing, and to ensure better voice quality. We histologically evaluated the effects of dexamethasone sodium phosphate infiltration on acute vocal fold wound healing in rabbits 3 and 7 days after surgically induced injury by quantification of the inflammatory reaction and collagen deposition.

Methods:

A standardized surgical incision was made in the vocal folds of 12 rabbits, and 0.1 mL dexamethasone sodium phosphate (4 mg/mL) was injected into the left vocal fold. The right vocal fold was not injected and served as the control. The larynges were collected 3 and 7 days after surgery. For histologic analysis, the vocal folds were stained with hematoxylin-eosin for quantification of the inflammatory response and with picrosirius red for quantification of collagen deposition.

Results:

There was no quantitative difference in the inflammatory response between vocal folds injected with the corticosteroid and control vocal folds. However, the rate of collagen deposition was significantly lower in the corticosteroid-treated group at 3 and 7 days after injury (p = 0.002).

Conclusions:

The present results suggest that dexamethasone reduces collagen deposition during acute vocal fold wound healing.
Imaging Evaluation in Otosclerosis: Single Photon Emission Computed Tomography and Computed Tomography
Authors: Berrettini Stefano , Ravecca Francesca , Volterrani Duccio , Neri Emanuele , Forli Francesca
Published: October 2014

Objectives:

The aim of our study was to demonstrate the utility of diphosphonate bone single photon emission computed tomography (SPECT) in diagnosing otosclerosis and to correlate the findings from SPECT with age, gender, and sensorineural hearing loss. We also evaluated the ability of high-resolution computed tomography (HR-CT) in detecting otospongiotic and otosclerotic foci and correlated the HR-CT findings with the SPECT results.

Methods:

Seventy-three subjects with surgically confirmed otosclerosis underwent SPECT, and 45 of the 73 patients also underwent HR-CT of the petrous bones.

Results:

In the patient sample examined in this study, SPECT demonstrated a sensitivity of 95.2% and a specificity of about 96.7%. By correlating the SPECT findings, we found an inverse relationship between bone radioactivity and age (ie, greater disease activity in younger patients) and a direct relationship between bone radioactivity and the severity of sensorineural impairment in younger patients. In the 45 patients who also underwent HR-CT, the sensitivity of HR-CT (58%) was lower than that of SPECT, and the comparison between SPECT activity and the HR-CT findings (fenestral or retrofenestral type) demonstrated a statistically significant correlation between the morphological finding of bone demineralization (pericochlear foci) and a high uptake index.

Conclusions:

The use of SPECT seems to be highly effective in differentiating normal from pathological petrous bone. It also provides a quantitative evaluation of disease activity and shows a significant correlation with bone demineralization revealed by HR-CT.
Relationship between Postoperative Recurrence Rate and Eosinophil Density of Nasal Polyps
Authors: Tosun Fuat , Arslan Hasan Huseyin , Karslioglu Yildirim , Deveci M. Salih , Durmaz Abdullah
Published: October 2014

Objectives

Nasal polyps develop as a result of chronic inflammation, mostly accompanied by pronounced eosinophil leukocyte infiltration. In this study we aimed to investigate the relationship between eosinophil density in nasal polyps and the postoperative recurrence rate of this disease.

Methods

Forty-two patients who underwent endoscopic sinus surgery for massive nasal polyposis by one surgeon were included in the study. The eosinophil leukocyte densities in nasal polyps were determined retrospectively on histologic slides by use of computer-assisted image analysis software. The patients were assigned to group 1, in whom nasal polyps contained up to 3 eosinophils per 1,000 urn2, and group 2, in whom nasal polyps contained 4 or more eosinophils per 1,000 um2. The postoperative recurrence rates of nasal polyps were compared in the two groups.

Results

There were 20 patients in group 1 and 22 patients in group 2. Postoperative polyp recurrence was detected in 5 of 20 patients (25.0%) in group 1 and in 18 of 22 patients (81.8%) in group 2 during the 30-month postoperative follow-up period (p < 0.05).

Conclusions

The eosinophil density of nasal polyps can be used to get an estimate of the postoperative recurrence risk. Eosinophil-rich nasal polyps have a higher postoperative recurrence rate.
Respiration-Related Laryngeal Electromyography in Children with Bilateral Vocal Fold Paralysis
Authors: Berkowitz Robert G. , Ryan Monique M. , Pilowsky Paul M.
Published: October 2014

We present 2 case reports to demonstrate the relationship between laryngeal muscle activity and respiration in children with bilateral vocal fold paralysis (BVFP) by simultaneous laryngeal electromyography (EMG) with recording of chest wall movement and intercostal muscle EMG. Laryngeal EMG was performed together with recording of chest wall movement in a 55-day-old girl who was undergoing tracheostomy for idiopathic congenital BVFP. Normal phasic activity was observed, ie, the thyroarytenoid (TA) muscle was active during expiration and the posterior cricoarytenoid (PCA) muscle during inspiration, suggesting a good prognosis for recovery. The child was decannulated at 11 months. Laryngeal EMG together with recording of chest wall movement and intercostal EMG in a 5-year-old girl who was tracheostomy-dependent following tracheoesophageal fistula repair due to BVFP showed phasic activity during expiration for both the TA and PCA muscles, indicating aberrant regeneration of the PCA motor nerve. The timing of laryngeal muscle activity with respiration in the assessment of pediatric congenital BVFP is essential to demonstrate the presence of normal or abnormal medullary respiratory neuronal input to laryngeal motoneurons. In cases in which BVFP is due to recurrent laryngeal nerve injury, respiration-related laryngeal EMG will identify aberrant regeneration. Laryngeal EMG should be combined with intercostal muscle EMG in the evaluation of children with significant vocal fold dysfunction of either central or peripheral origin.
Good Manufacturing Practices—Grade Preformed Ossicular Prostheses from Banked Bone via Computer Numerically Controlled Micromilling
Authors: Berrettini Stefano , Bruschini Luca , Stefanini Cesare , D'Alessandro Delfo , D'Acunto Mario , Danti Serena
Published: October 2014

Objectives:

The aim of this study was the fabrication of ossicular replacement prostheses (ORPs) from decellularized banked cortical bone via computer numerically controlled (CNC) ultraprecision micromilling, in order to obtain preformed clinical-grade tissue products, reproducing shape, size, and details perfectly comparable to those of synthetic devices.

Methods:

Banked femoral compact bone was used to fabricate partial and total ORPs via CNC micromilling according to Good Manufacturing Practices procedures. Drawings of ORPs with different shapes and sizes were uploaded to the computer interface, and different surface-finish parameters were tested. The obtained products underwent dimensional, weight, and surface characterizations. A histologic analysis was pursued to compare the bone matrix compactness of the produced ORPs to that of the ear ossicles.

Results:

Banked-bone ORPs were produced with high dimensional accuracy. Partial ORP weights averaged (±SD) 31.2 ± 0.6 mg, and total ORP weights averaged 69.3 ± 0.7 mg. The best-finish mode allowed microscale or nanoscale roughness free from machinery textures to be obtained. Finally, the histologic analysis confirmed that the extracellular matrix compactness of the produced ORPs was suitable for ossicular chain replacement.

Conclusions:

This study assesses the fabrication feasibility of novel banked-bone ORPs of extremely high dimensional accuracy. Such devices are aimed at combining the most favorable aspects of both synthetic (reproducibility, convenience, and biosafety) and biological replacements (total biocompatibility).
Head and Neck Cancer Surgery in the Elderly: Outcome Evaluation with the McPeek Score
Authors: Sesterhenn Andreas M. , Schotte Tobias L. , Bauhofer Artur , Timmesfeld Nina , Wiegand Susanne , Werner Jochen A. , Ovassapian Andranik , Torossian Alexander
Published: October 2014

Objectives:

There is international consensus that elderly patients with head and neck cancer should be treated curatively, like younger patients. Because of common comorbidities in elderly patients, perioperative complications are likely. The McPeek postoperative outcome score was used to evaluate the success of surgical interventions in patients with head and neck cancer.

Methods:

We included 168 patients in the study (56 in the study group, 75 years of age or more; and 112 in the control group, less than 60 years of age). All patients underwent major surgery for head and neck cancer.

Results:

The median McPeek scores were 8 in the study group and 9 in the control group (p = 0.04). Regression analysis revealed that neither age (p = 0.085) nor the American Society of Anesthesiologists physical status score (p = 0.342) were independent predictors of the McPeek score. Synchronous surgical interventions (p = 0.00051) and duration of surgery (p = 0.0015) had a significant impact on McPeek score performance.

Conclusions:

The McPeek score seems to be an appropriate tool for comparing major surgeries for head and neck cancer in different age groups. It is possible to assess the influence of anesthetic and surgical interventions and complications that affect the length of hospitalization. The results confirm that the overall complication rate after surgery in elderly patients does not differ significantly from that in their younger counterparts. Therefore, extended surgical treatment should be offered to both age groups when no serious comorbidities are present. The postoperative outcome seems to depend on the duration and extent of the surgical intervention.
Adipose-Derived Mesenchymal Stem Cells in Collagen—Hyaluronic Acid Gel Composite Scaffolds for Vocal Fold Regeneration
Authors: Xu Wen , Hu Rong , Fan Erzhong , Han Demin
Published: October 2014

Objectives:

We sought to characterize the changes in the extracellular matrix (ECM) of the lamina propria following the implantation of autologous adipose-derived mesenchymal stem cells (ADSCs) in composite scaffolds in a rabbit vocal fold wound model.

Methods:

The ADSCs were co-cultured with collagen or hyaluronic acid gel. Each vocal fold was injured by localized resection and injected with ADSC complexes, ADSCs, or scaffolds or left untreated. From 15 days to 12 months, the vocal fold shape and the characteristics of the ECM components were analyzed.

Results:

With implantation of the ADSC complexes, the collagen content was significantly increased and had a disorderly distribution at 3 months. Subsequently, it began to decrease and reached close to normal by 12 months. The hyaluronic acid content was increased at 40 days, but it was reduced to normal levels and was limited to the superficial and middle layers of the lamina propria over the following 12 months. Fibronectin continued to be scattered in the lamina propria, at peak levels at 40 days, and then decreased over the following 12 months to reach near-normal levels. At 12 months, the vocal folds had a normal surface.

Conclusions:

ADSC complexes can play a facilitatory role in vocal fold regeneration, regulating the generation and orderly distribution of ECM.
Phenotypes of Two Dutch DFNA3 Families with Mutations in GJB2
Authors: Weegerink Nicole J. D. , Pennings Ronald J. E. , Huygen Patrick L. M. , Hoefsloot Lies H. , Cremers W. R. J. , Kunst Henricus P. M.
Published: October 2014

Objectives:

We describe the phenotype of 2 Dutch DFNA3 families with mutations in the GJB2 gene.

Methods:

Two patients from family 1 and one isolated patient from family 2 were studied. The audiometric examination consisted of pure tone and speech audiometry. Two patients underwent vestibular testing and high-resolution computed tomographic scanning of the temporal bone. Mutation analysis of GJB2 and GJB6 was performed.

Results:

All 3 patients had severe to profound sensorineural hearing impairment. Cochlear implantation was performed in 2 patients, and their phoneme recognition scores were good. Mutation analyses revealed a p. Arg184Gln mutation in GJB2 in family 1 and a p. Arg75Trp mutation in GJB2 in family 2. No mutations in GJB6 were identified. Vestibular function tests and computed tomographic scans yielded normal findings in the examined subjects.

Conclusions:

Severe to profound sensorineural hearing impairment was found in these DFNA3 patients, and was well rehabilitated with cochlear implantation. A thorough genotype-phenotype correlation is difficult because of the small number of affected patients and the limited clinical data of these patients. More clinical data on DFNA3 families need to be published in order to create a reliable and precise phenotype characterization.
Morphology of Human Fungiform Papillae after Severing Chorda Tympani Nerve
Authors: Saito Takehisa , Narita Norihiko , Yamada Takechiyo , Manabe Yasuhiro , Ito Tetsufumi
Published: October 2014

Objectives:

We aimed to clarify the postoperative morphology of the fungiform papillae (FP) of the tongue in patients who recovered gustatory function after the chorda tympani nerve was severed during middle ear surgery.

Methods:

Fifty-four patients with normal preoperative gustatory function measured by electrogustometry (EGM) were included. The proximal and distal stumps of the severed nerves were re-adapted or re-approximated during surgery to promote regeneration of the nerve. The EGM thresholds over 2 years after surgery were compared with preoperative values. At the same time, the morphological characteristics of the FP in the midlateral region of the tongue were recorded with a digital microscope.

Results:

One month after surgery, EGM showed no response in any patients. At a time point of more than 2 years, the FP showed complete atrophy and no response to EGM on the surgical side in 21 of the 54 patients. In 16 patients who showed complete recovery of the EGM threshold (below 20 μA), the FP showed an almost normal appearance, and the mean number of FP was 77.5% (10 ± 4.1 papillae per square centimeter) of that on the contralateral side (12.9 ± 4.9 papillae per square centimeter; p > 0.05).

Conclusions:

The morphology of the FP was maintained in patients who recovered gustatory function after the chorda tympani nerve was severed. Because the results indicate regeneration of the taste buds, further observation is needed to detect regenerated taste buds in the FP.
Novel Model to Assess Laryngeal Function, Innervation, and Reinnervation
Authors: Old Matthew O. , Oh Sang Su , Feldman Eva , Hogikyan Norman D.
Published: October 2014

Objectives:

Laryngeal paralysis remains an unsolved problem, and the behavior of the laryngeal muscles following injury to the native innervation appears to be a function of denervation and reinnervation. The aim of the present study was to develop a reliable, accurate, and multifaceted animal model for study of laryngeal function, innervation, and reinnervation.

Methods:

A spontaneous-breathing anesthesia technique, suspension laryngoscopy, endoscopic evaluation of the rat larynx, and transoral injection of a retrograde neuronal tracer, hydroxystilbamidine (FluoroGold), were developed. We submitted 14 rats to the developed technique to map the brain stem projections of the superior laryngeal nerve and the recurrent laryngeal nerve and to determine the feasibility and accuracy of the endoscopic injection technique.

Results:

This endoscopic technique provided full evaluation of the rat larynx. We performed transoral endoscopic injection of FluoroGold and transcervical application of the tracer to transected superior laryngeal and recurrent laryngeal nerves in 14 different rats and successfully created a neural projection map for the superior laryngeal nerve, the recurrent laryngeal nerve, and the cervical ganglia.

Conclusions:

A reliable, accurate model for the characterization of laryngeal function, routes of innervation, and sources of spontaneous reinnervation following recurrent laryngeal nerve resection has been developed. This stable and reproducible model can serve as a dependable tool in future investigations of laryngeal nerve injury and recovery.
Pharyngocutaneous Fistula after Total Laryngectomy: Less Common with Mechanical Stapler Closure
Authors: Calli Caglar , Pinar Ercan , Oncel Semih
Published: October 2014

Objectives:

The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure.

Methods:

In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed.

Results:

The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014).

Conclusions:

Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.
Radiolocalization of Sentinel Lymph Nodes in Clinically N0 Laryngeal and Hypopharyngeal Cancers
Authors: Hu Guohua , Zhong Shixun , Xiao Qing , Li Zhongwan , Hong Suling
Published: October 2014

Objectives:

We sought to analyze the characteristics of radioactive lymph nodes with metastatic disease and to explore methods for the localization of sentinel lymph nodes (SLNs) with radionuclide in clinically N0 laryngeal and hypopharyngeal cancer.

Methods:

Forty-five patients with T1–T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient, a peritumoral submucosal injection of 99mTc-labeled sulfur colloid was administered, and lymph node mapping was performed by lymphoscintigraphy 2 hours after injection. The SLNs were localized during operation by a handheld gamma probe 10 to 12 hours after the injection, and we defined the radioactive counts from the parotideomasseteric region as background values. All lymph nodes that had accumulated radioactivity were harvested and initially termed as SLNs. Selective neck dissection was performed in all patients. The SLN specimens were sent for formal paraffin–embedded sectioning, serial sectioning, and immunohistochemical assay. The results were compared to those for the remaining lymphadenectomy specimen. Resection of the primary tumor depended on its location and the T classification.

Results:

Sentinel lymph nodes were identified in 41 of 45 patients (51 necks). Sentinel lymph nodes with occult metastases were found in 13 patients (15 necks). In a false-negative case, metastasis was found in a nonsentinel lymph node in 1 of the neck specimens. The SLN identification rate was 92.7%, the sensitivity was 93.7%, the false-negative rate was 6.3%, and the accuracy was 98.0%. In 11 of the 15 necks (73.3%) with pathologically positive SLNs, metastasis was found in the node with the highest radioactivity. Harvesting the first 3 nodes with the highest radioactive counts may identify patients with occult metastatic disease.

Conclusions:

Excision of the first 3 SLNs with the highest radioactive counts can be used to accurately identify the status of cervical lymph node metastases in patients with clinically N0 laryngeal or hypopharyngeal cancer.
Fallopian Canal Stapedotomy in Congenital Stapes Fixation with Aberrant Facial Nerve
Authors: Visvanathan Anjana , Rinaldi Vittorio , Visvanathan Pumalur G.
Published: October 2014

Congenital stapes ankylosis is reported to have an occurrence rate of 3% to 4%, and it represents 20% to 35% of ossicular malformations. Surgical treatment of congenital stapes ankylosis is described to be satisfactory in the large majority of the case series reported in the literature. In these cases, special attention should be paid to exclude any aberrations of the course of the facial nerve, which have been demonstrated to be frequently associated with congenital middle ear malformations. We describe a case of congenital stapes ankylosis associated with a previously unreported facial nerve abnormality, characterized by the presence of an empty fallopian canal in combination with a dehiscent facial nerve running over the footplate and almost totally covering it.
Spasmodic Dysphonia: Onset, Course, Socioemotional Effects, and Treatment Response
Authors: Tanner Kristine , Roy Nelson , Merrill Ray M. , Sauder Cara , Houtz Daniel R. , Smith Marshall E.
Published: October 2014

Objectives:

This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD).

Methods:

A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD.

Results:

Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor.

Conclusions:

The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.
New Surgical Procedure for Laryngotracheal Separation without a Cannula or Postoperative Treatment
Authors: Nakaya Muneo , Onuki Yuka , Kida Wataru , Watanabe Kenta , Abe Kazuya
Published: October 2014

Objectives:

Laryngotracheal separation is a surgical procedure used in the treatment of intractable aspiration. As with total laryngectomy and laryngotracheal diversion, this procedure requires postoperative pressure above the suture location to prevent leakage at the anastomosis. To date, there have been no reports regarding laryngeal separation without postoperative treatment. The purpose of this study was to evaluate a new surgical procedure for laryngotracheal separation that is performed without a cannula and requires no postoperative treatment.

Methods:

We performed the new surgical procedure in 7 patients. The mucosa of the cricoid cartilage was sutured to achieve tracheal closure. The closure was covered with a musculocutaneous flap of strap muscle; gauze was then tied over the skin and a 2–0 nylon suture was used to pierce the posterior part of the cricoid cartilage. In addition, a permanent tracheostoma was constructed without a tracheal cannula.

Results:

No patients required a tracheal cannula or treatment after the operation. Additionally, aspiration pneumonia was prevented without complications in all patients.

Conclusions:

This new surgical procedure eliminates the need for a cannula and postoperative treatment. The effects of this method in terms of aspiration prevention are comparable to those of other surgical techniques.
Management of Plastic Bronchitis in a Child with Mild Intermittent Asthma
Authors: Pawar Sachin S. , Chun Robert H. , Rao Aparna R. , Kerschner Joseph E.
Published: October 2014

Objectives:

We describe the clinical presentation of a 7 1/2-year-old boy with a history of mild intermittent asthma who presented with left lung collapse and was found to have plastic bronchitis.

Methods:

We reviewed the patient chart and imaging results and performed a literature review of plastic bronchitis and its management.

Results:

Bronchoscopy in our patient demonstrated a large white, friable, cast-like material that obstructed the entire left main stem bronchus and could not be easily suctioned. The cast was removed in a piecemeal fashion by means of serial rigid bronchoscopy over a 6-month period with use of both optical forceps and flexible suction catheters. Microscopic examination of the cast-like material showed a predominance of eosinophils along with neutrophils encased in proteinaceous material.

Conclusions:

Plastic bronchitis in children is a rare condition that can mimic foreign body aspiration and can be associated with underlying pulmonary inflammatory disorders or cardiovascular disease. Aggressive bronchoscopic management of the airway obstruction and medical management of the underlying disease process are important for the successful treatment of plastic bronchitis.
Chronic Pharyngitis is Associated with Severe Acidic Laryngopharyngeal Reflux in Patients with Reinke's Edema
Authors: Kamargiannis Nikolaos , Gouveris Haralampos , Katsinelos Panagiotis , Katotomichelakis Michael , Riga Maria , Beltsis Athanasios , Danielides Vasilios
Published: October 2014

Objectives:

We evaluated the association between pathological acidic laryngopharyngeal reflux (LPR) events and chronic pharyngitis in patients with Reinke's edema.

Methods:

We performed a prospective controlled study in 20 consecutive patients with Reinke's edema without pathological acidic LPR events (group A) and 40 consecutive patients with Reinke's edema with both clinical symptoms and 24-hour pH-metry suggesting acidic LPR (group B). The severity of acidic LPR was assessed by use of the Reflux Finding Score (RFS), the Reflux Symptom Index (RSI), and dual antimony probe 24-hour pH-metry. The patients were evaluated for the presence of chronic pharyngitis by clinical examination and biopsy specimens taken from the posterior pharyngeal wall. The χ2 test was used to compare the groups for the presence of pharyngitis. In group B, the RSI, the RFS, and the total duration and number of acidic LPR events on 24-hour pH-metry were compared between patients with and without concomitant pharyngitis by use of the Mann-Whitney test.

Results:

Five patients of group A and 20 patients of group B had chronic pharyngitis. Therefore, more patients with Reinke's edema and clinical signs of LPR tended to have chronic pharyngitis than did those with Reinke's edema and no clinical signs of LPR, but the difference was not statistically significant (p = 0.064; odds ratio, 3.0; 95% confidence interval, 0.9 to 9.8). Among group B patients, those with pharyngitis had significantly more acidic LPR events (p < 0.001) and a greater exposure time to gastric fluid (p = 0.008) than did those without pharyngitis. Their RFS and RSI did not differ significantly (p = 0.692 and p = 0.914, respectively).

Conclusions:

Only in the subgroup of patients with Reinke's edema and LPR was there a statistically significant correlation between the pH probe results and the incidence of clinical pharyngitis. Awareness should increase among physicians about addressing chronic pharyngitis in therapy for acidic LPR and/or Reinke's edema.
Parapharyngeal Ganglioneuroma with Neurofibromatosis: An Unusual Presentation
Authors: Sinha Parul , Sharma Suresh C. , Agarwal Shipra , Gupta Siddhartha Datta
Published: October 2014

Objectives:

Ganglioneuroma is a rare benign tumor of the sympathetic nervous system that is seldom localized to the head and neck. Rarer still are cases of functional ganglioneuroma with catecholamine production. We report an unusual case of a large parapharyngeal space ganglioneuroma in a patient with neurofibromatosis that caused an intraoperative hypertensive crisis in the absence of a neuroblastomatous component — Hitherto an undocumented complication.

Methods:

We present a case of functional parapharyngeal ganglioneuroma and review the clinicopathologic and biochemical features of these rare tumors.

Results:

Fewer than 40 anecdotal cases of parapharyngeal ganglioneuromas have been reported, and there is a lack of ade quate literature on the biology and appropriate treatment approach of these tumors.

Conclusions:

Our case illustrates the importance of vigilant preoperative precautions in the management of neurogenic tumors, particularly ganglioneuromas. These usually nonfunctional tumors can result in sudden intraoperative and postoperative hypertensive crises even in the absence of any preoperative autonomic symptoms.