bluuebunny/crossref_metadata_2025 huggingface dataset:
Otoneurological Expert System
Authors: Kentala Erna , Auramo Yrjö , Pyykkö Ilmari , Juhola Martti
Published: October 2014

An otoneurological expert system was developed to help collect data and diagnose both central and peripheral diseases causing vertigo. Patient history and otoneurological and other examination results are used in the reasoning process. The case history data can be either mandatory or supportive. Mandatory questions are used to confirm a diagnosis, and conflicting answers are used to reject an unlikely disease. Supportive questions support or suppress a diagnosis, but their presence is not obligatory. The reasoning procedure of the otoneurological expert system scores every question independently for different diagnoses, depending on how well they agree with the symptom entity of a disease. Diagnostic criteria are set for each disease. Graphic displays illustrate the linear and nonlinear correlation between the symptoms and diseases. Emphasis is placed on diminishing the possibility of a wrong decision rather than maximizing the likelihood of reaching only one right decision, so that even rare diseases can be taken into consideration.
Meningitis after Adenoidectomy: An Anatomic Explanation
Authors: Isaacson Glenn , Parke Wesley W.
Published: October 2014

Meningitis is a rare complication of adenoidectomy. During a 5-month period, two children at St Christopher's Hospital for Children developed meningitis within days following this surgical procedure. The potential causes of this complication that we investigated include coincidence, systemic hematogenous spread of bacteria to the central nervous system, and direct or indirect contamination of the cerebrospinal fluid by bacteria introduced by retropharyngeal injection of lidocaine hydrochloride and epinephrine. Based on statistical analysis of the available literature and anatomic studies of the pediatric nasopharyngeal region, we conclude that a retrograde flow of bacteria via a newly described anastomotic network of veins was the most likely cause of this sequela.
Cause of Eustachian Tube Constriction during Swallowing in Patients with Otitis Media with Effusion
Authors: Takahashi Haruo , Honjo Iwao , Miura Makoto , Fujita Akihiko
Published: October 2014

In order to clarify the cause of the constriction of the eustachian tube during swallowing that is often seen in patients with otitis media with effusion, video endoscopy of the pharyngeal orifice of the eustachian tube was performed and superimposed with videograms of the tubal airflow and resistance, which were simultaneously examined by the forced response test. In children with otitis media with effusion (17 ears), when the eustachian tube constricted on the videogram on swallowing, the tubal orifice was found to be squeezed between an elevated soft palate and a hypertrophied adenoid (7/17), squeezed between an elevated soft palate and edema of the posterior lip (7/17), or blocked by nasal discharge (5/17). In adults with otitis media with effusion (7 ears), edema of the posterior lip (5/7) was the main cause of the constriction of the tubal orifice during swallowing. Inflammation in the nasopharynx and the pharyngeal portion of the eustachian tube was considered to be closely related to the tubal constriction, which represents a considerable part of the cause of tubal ventilatory dysfunction in otitis media with effusion.
Recordings of Mucociliary Activity in Vivo: Benefit of Fast Fourier Transformation of the Photoelectric Signal
Authors: Lindberg Sven , Runer Thomas , Cervin Anders , Thomasson Lars
Published: October 2014

Investigations of mucociliary activity in vivo are based on photoelectric recordings of light reflections from the mucosa. The alterations in light intensity produced by the beating cilia are picked up by a photodetector and converted to photoelectric signals. The optimal processing of these signals is not known, but in vitro recordings have been reported to benefit from fast Fourier transformation (FFT) of the signal. The aim of the investigation was to study the effect of FFT for frequency analysis of photoelectric signals originating from an artificial light source simulating mucociliary activity or from sinus or nasal mucosa in vivo, as compared to a conventional method of calculating mucociliary wave frequency, in which each peak in the signal is interpreted as a beat (old method). In the experiments with the artificial light source, the FFT system was superior to the conventional method by a factor of 50 in detecting weak signals. By using FFT signal processing, frequency could be correctly calculated in experiments with a compound signal. In experiments in the rabbit maxillary sinus, the spontaneous variations were greater when signals were processed by FFT. The correlation between the two methods was excellent: r = .92. The increase in mucociliary activity in response to the ciliary stimulant methacholine at a dosage of 0.5 μg/kg was greater measured with the FFT than with the old method (55.3% ± 8.3% versus 43.0% ± 8.2%, p < .05, N = 8), and only with the FFT system could a significant effect of a threshold dose (0.05 μg/kg) of methacholine be detected. In the human nose, recordings from aluminum foil placed on the nasal dorsum and from the nasal septa mucosa displayed some similarities in the lower frequency spectrum (<5 Hz) attributable to artifacts. The predominant cause of these artifacts was the pulse beat, whereas in the frequency spectrum above 5 Hz, results differed for the two sources of reflected light, the mean frequency in seven healthy volunteers being 7.8 ± 1.6 Hz for the human nasal mucosa. It is concluded that the FFT system has greater sensitivity in detecting photoelectric signals derived from the mucociliary system, and that it is also a useful tool for analyzing the contributions of artifacts to the signal.
Basement Membrane in Middle Ear Cholesteatoma Immunohistochemical and Ultrastructural Observations
Authors: Bujía Jesus , Holly Anja , Sudhoff Holger , Borkowski Gerd , Hildmann Henning , Koc Can , Fisseler-Eckhoff Annette
Published: October 2014

We investigated the distribution of basement membrane zone (BMZ) components collagen type IV, collagen type VII, and fibronectin in human middle ear cholesteatoma, auditory meatal skin, and middle ear mucosa using both immunohistochemical and ultrastructural methods. Collagen type IV inununoreactivity of skin and middle ear mucosa is continuous in the BMZ, whereas cholesteatoma frequently showed absent immunoreactivity or focal discontinuities. Collagen type VII inununoreactivity is detected similarly within the BMZ of cholesteatoma and skin. Fibronectin immunoreactivity is observed within the dermoepithelial junction of skin and middle ear mucosa. In cholesteatoma, however, fibronectin immunoreactivity is markedly increased within the extrinsic BMZ and the subepithelial connective tissue. The ultrastructural arrangement of the BMZ of cholesteatoma is like that of skin; however, it exhibits distinct alterations of the lamina fibroreticularis and lamina densa. Our results outline cholesteatoma as a disease with disturbed cell matrix interactions analogous to those of wound reepithelialization.
Ewing's Sarcoma and Peripheral Primitive Neuroectodermal Tumor: An Interim Report
Authors: Batsakis John G. , MacKay Bruce , El-Naggar Adel K.
Published: October 2014

The primitive neuroectoderm and its progeny seemingly give rise to an ever-increasing number of clinicopathologic entities. Ewing's sarcoma and peripheral primitive neuroectodermal tumor have recently been united by relatively unique antigens expressed by the MIC-2 gene, commonly coexpressed neural markers, and cytogenetic and molecular genetic abnormalities. Because of these factors, the current thinking is that Ewing's sarcoma and the peripheral primitive neuroectodermal tumor are parts of a phenotypic spectrum. We present an “interim report” on this group of neoplasms, emphasizing their presentation in the head and neck
Management of Cervical Metastases in Supraglottic Cancer
Authors: Gregor R. Theo , Hart Augustinus A. M. , Oei Swi S. , Balm Alfons J. M. , Hilgers Frans J. M. , Keus Ronald B.
Published: October 2014

A retrospective review of patients from 1979 to 1988 was performed to assess the efficacy of neck dissection, prognostic factors, and the philosophy of treatment of me neck in supraglottic cancer. Of the 89 patients available for analysis, 26 were managed by horizontal partial laryngectomy (HPL), 44 by primary radiotherapy (RT), and 19 by total laryngectomy (TL). A total of 41 patients from the group had 63 neck dissections (NDs); 22 had bilateral and 19 unilateral dissections. A correlation of the pN with N staging revealed that when presenting with N2a nodes (>3 cm), one third had contralateral metastases, and with N2b (multiple), 100% had contralateral metastases. In multivariate analysis of the disease-free interval, age and staging emerged as independent prognostic variables. Although we observed no increased morbidity by dissecting the opposite side, our results did not support routine bilateral neck dissection in N0 patients. However, when the nodes are larger than 3 cm, or ipsilateral and multiple, bilateral neck dissection is recommended.
Muscle Tension Dysphonia and Spasmodic Dysphonia: The Role of Manual Laryngeal Tension Reduction in Diagnosis and Management
Authors: Roy Nelson , Ford Charles N. , Bless Diane M.
Published: October 2014

Excessive activity of the extralaryngeal muscles affects laryngeal function and contributes to a spectrum of interrelated symptoms and syndromes including muscle tension dysphonia and spasmodic dysphonia. Recognition of the role of extralaryngeal tension is helpful in ensuring proper diagnosis and selection of appropriate treatment. This report demonstrates the application of manual laryngeal musculoskeletal tension reduction techniques in the diagnosis and management of laryngeal hyperfunction syndromes The manual technique consists of focal palpation to determine 1) extent of laryngeal elevation, 2) focal tenderness, 3) voice effect of applying downward pressure over the superior border of the thyroid lamina, and 4) extent of sustained voice improvement following circumlaryngeal massage. The clinical utility of this innovative approach is discussed.
Role of Bronchoalveolar Lavage in Hospitalized Pediatric Patients
Authors: Yagoda Michelle R. , Stavola Joseph , Steinberg Charlotte , Ward Robert , Jones Jacqueline
Published: October 2014

Bronchoalveolar lavage (BAL) has been shown to be a rapid, relatively safe, and relatively noninvasive diagnostic procedure. Theoretically, BAL can be performed on all children hospitalized for pneumonia resistant to oral antibiotics, though practically and economically, this is not feasible. A 1-year retrospective review was conducted to define a cost-effective role for BAL in the management of hospitalized children with resistant pneumonia. The data revealed identification of at least one pathogen in 87% of sputum samples and in 95% of BAL specimens. Sputum samples provided the same information as the more invasive BAL technique in 60% of patients who had both sputum and BAL obtained for culture. Recommendations are made for the use of BAL as a diagnostic tool in the hospitalized child with resistant pneumonia.
Clinicopathological Consultation Squamous Neoplastic Component in Unconventional Squamous Cell Carcinomas of the Larynx
Authors: Ferlito Alfio , Devaney Kenneth O. , Rinaldo Alessandra
Published: October 2014

Both otolaryngologists and surgical pathologists arc involved in the diagnosis and treatment of lesions of the larynx that are best diagnosed as invasive squamous cell carcinomas of some specified degree of differentiation, not further subclassified (that is, conventional squamous cell carcinomas). On occasion, however, a patient will present with an invasive tumor that on histologic examination diverges from the expected pattern of a squamous cell carcinoma of the usual type and so raises the question of proper classification (on the part of the pathologist) and, following classification, a consideration of the prognostic and therapeutic implications of such a classification (on the part of the clinician). While some of these unconventional squamous cell carcinomas are rather indolent lesions (as, for example, the hybrid verrucous squamous cell carcinoma), others behave in a fashion similar to conventional squamous cell carcinomas (such as the adenoid squamous cell carcinomas), and yet others seem to behave more aggressively than do conventional squamous cell carcinomas of a similar size and stage (examples include the basaloid squamous cell carcinomas and adenosquamous carcinomas). Finally, the possibility exists within the larynx, as elsewhere in the body, that a nonepithelial lesion such as malignant melanoma may mimic a tumor more commonly encountered in that vicinity — namely, a squamous cell carcinoma — and so receive inappropriate treatment if such mimicry is not recognized.
Vertical Partial Laryngectomy without Tracheotomy: The Use of the Cook Airway Exchange Catheter to Avoid Tracheotomy
Authors: Rice Dale H.
Published: October 2014

Occasionally, advances in another specialty provide the opportunity for an advance in otolaryngology-head and neck surgery. One example is the Cook airway exchange catheter. In very selected cases, the use of this exchange catheter will allow the performance of vertical partial laryngectomy without the need for tracheotomy.
Age-Related Changes of Elastic Fibers in the Superficial Layer of the Lamina Propria of Vocal Folds
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

An investigation was carried out to determine the morphologic characteristics of elastic fibers in the superficial layer of the lamina propria of aged vocal folds (EFAVFs). Excised human adult vocal folds served as the material for this study. Scanning and transmission electron microscopic observations were made. The results can be summarized as follows. First, the EFAVFs were composed of amorphous substances and microfibrils. The amorphous substances increased in amount and the microfibrils became less numerous. Second, the EFAVFs ran in various directions, were branched, and formed a complicated network. The surface of the fibers was rough, and the fibers appeared to vary in size. Some EFAVFs united to form a sheet with a rough surface. Third, the EFAVFs could not be easily digested by elastase compared with those of younger adults. We conclude that the morphologic and metabolic changes of elastic fibers in the most important vibrating portion (superficial layer of the lamina propria) of the aged vocal folds contribute partially to aging of the voice.
Mechanics of Type IV Tympanoplasty: Experimental Findings and Surgical Implications
Authors: Merchant Saumil N. , Ravicz Michael E. , Rosowski John J.
Published: October 2014

In a type IV tympanoplasty, the stapes footplate is directly exposed to incoming sound while the round window is “shielded,” usually with a fascia graft. Postoperative hearing results are quite variable, with air-bone gaps ranging from 10 to 60 dB. A cadaveric human temporal bone preparation was developed to investigate the middle ear mechanics of this operation to identify causes of variable results and to test predictions of a recently described theoretic model of type IV tympanoplasty. The ear canal, tympanic membrane, malleus, and incus were removed so as to expose the stapes and round window to the sound stimulus. A “cavum minor” chamber (air space adjacent to the round window) was constructed around the round window niche. The round window could be isolated from sound by placing an acoustic shield over this chamber. The mechanical properties of the shield, cavum minor, annular ligament, and round window membrane were varied experimentally. Stapes velocity as determined by an optical motion sensor was used as a measure of hearing level. The largest stapes velocity occurred with a mobile stapes and round window, a stiff shield, and a well-aerated cavum minor. Partial fixation of the stapes or round window caused a decrease in stapes velocity. Acoustic shields of conchal cartilage or Silastic silicone rubber sheeting (approximately 1 mm thick) provided near-optimal shielding. A temporalis fascia shield resulted in a stapes velocity 10 to 20 dB less than that seen with a cartilage or Silastic silicone rubber shield at low frequencies. A cavum minor air space as small as 16 μL was sufficient for unrestricted stapes motion, provided the air was in contact with the round window membrane. These results qualitatively matched predictions of our model, but there were some quantitative differences. The clinical implications of our results are that in order to optimize postoperative hearing, the surgeon should 1) preserve normal stapes mobility, preferably by covering the footplate with a very thin split-thickness skin graft, not a fascia graft; 2) reinforce a fascia shield with cartilage or Silastic silicone rubber; 3) create conditions that promote aeration of the round window niche; and 4) preserve the mobility of the round window membrane.
Ear Cholesteatoma versus Cholesterol Granuloma
Authors: Devaney Kenneth O. , Wenig Bruce M. , Ferlito Alfio , Rinaldo Alessandra , Iurato Salvatore , Milroy Christopher M. , McCabe Brian F.
Published: October 2014

Cholesteatoma and cholesterol granuloma of the ear are two different pathologic conditions that have often been confused in the past, and even in the present, in the literature. The features differentiating the two lesions are presented.
Silent Laryngopharyngeal Sensory Deficits after Stroke
Authors: Sacco Ralph L. , Diamond Beverly , Aviv Jonathan E. , Thomson Jeanne , Martin John H. , Tandon Raj , Close Lanny G.
Published: October 2014

Dysphagia and aspiration are two devastating sequelae of stroke. Recent work has shown that laryngopharyngeal (LP) sensory deficits are associated with aspiration in stroke patients with dysphagia. The phenomenon of silent LP sensory deficits, where the patient exhibits no subjective or objective evidence of dysphagia, yet has an LP sensory deficit, has not been previously described. The aim of this study was to evaluate the sensory capacity of the laryngopharynx in stroke patients who had no subjective or objective complaints of dysphagia. We determined the sensory threshold in the laryngopharynx using air pulse stimulation of the mucosa of the pyriform sinus and aryepiglottic fold. Eighteen stroke patients (mean age 65.6 ± 11.5 years) and 18 age-matched controls were prospectively evaluated. Normal thresholds were defined as <4.0 mm Hg air pulse pressure (APP). Deficits were defined as either a moderate impairment in sensory discrimination thresholds (4.0 to 6.0 mm Hg APP) or a severe sensory impairment (>6.0 mm Hg APP). Stroke patients were followed up for 1 year to determine the incidence of aspiration pneumonia (AP) as verified by chest radiography. In 11 of the stroke patients studied, either unilateral (n = 6) or bilateral (n = 5) severe sensory deficits were identified. The elevations in sensory discrimination thresholds were significantly greater than those in age-matched controls (7.1 ± 0.6 mm Hg APP versus 2.5 mm Hg APP; p < .01, Wilcoxon score). Among patients with unilateral deficits, sensory thresholds were severely elevated in all cases on the affected side compared with the unaffected side (p < .01, Wilcoxon score). Moreover, the sensory thresholds of the unaffected side were not significantly different from those of age-matched controls. Aspiration pneumonia did not occur in the patients with normal LP sensation or in the patients with unilateral severe LP sensory deficits. However, in the 5 patients with bilateral, severe LP sensory deficits, 2 developed AP, both within 3 months of their LP sensory test. The results of this study showed, for the first time, that stroke patients without subjective or objective clinical evidence of dysphagia could have silent LP sensory deficits. These impairments could contribute to the development of AP following stroke. The findings in this study suggest that LP sensory discrimination threshold testing should not be restricted only to patients with clinical dysphagia.
Vestibular Abnormalities in Charge Association
Authors: Murofushi Toshihisa , Graham Robert I. , Ouvrier Robert A. , Da Silva Merl , Parker Geoffrey D. , Halmagyi G. Michael
Published: October 2014

We report the vestibular abnormalities in 5 patients with the CHARGE association (Coloboma, Heart disease, Atresia of choanae, Retarded growth and development and/or central nervous system anomalies, Genital hypoplasia, and Ear anomalies). All patients had absent vestibular function as indicated by absent vestibulo-ocular reflexes and severe imbalance on simultaneous deprivation of proprioception and vision, as well as delayed motor development. All 6 semicircular canals were aplastic in each of the patients. While cochlear function was severely reduced in 6 of the 10 ears, it was absent only in 3 ears and was actually intact below 3 kHz in 1 ear. All 10 bony cochleas were present on computed tomography, and although 7 appeared abnormal, 3 appeared normal. This study confirms that absence of the bony semicircular canals in the presence of a bony cochlea is a characteristic finding in CHARGE association. It also demonstrates that these disproportionate structural abnormalities are reflected in the functional abnormalities: absent vestibular function with preservation of some cochlear function.
Use of a Composite Fascial Carrier for Laryngotracheal Reconstruction
Authors: Delaere Pierre R. , Blondeel Phillip N. , Guelinckx Paul J. , Hermans Robert , Feenstra Louw
Published: October 2014

A vascularized fascia flap may be used as a vascular carrier for free mucosal and cartilage grafts. This composite reconstruction technique has been performed in clinical situations with complex laryngeal or tracheal defects. This paper describes the technique and the rationale for applying this concept to some particular laryngotracheal defects. Morphologic and histologic aspects of this composite reconstruction technique using a transferable recipient bed are discussed.
Mucociliary Clearance of Stented Laryngotracheal Tract in Guinea Pigs in Vivo
Authors: Lee Shiann Yann , Yeh Te Huei , Chen Jiann Chyuan
Published: October 2014

The purpose of this study was to investigate laryngotracheal mucociliary transport by means of an in vivo guinea pig model with and without a stent. The experimental design involved marking with deep-colored resin powder and utilizing the serial photograph-analyzing method via endoscopic laryngeal videography. Fifteen animals were grouped into two airway conditions: 5 with laryngotracheal stent insertion and 10 without. The mucociliary transit time and mucociliary transport rate were measured in both groups. Significant differences between the two groups were found. In conclusion, stenting preserved and increased the clearance function of the laryngotracheal mucosa in the acute phase.
Expression of Matrix Metalloproteinases and Tissue Inhibitor of Metalloproteinases in Head and Neck Squamous Cell Carcinoma
Authors: Charous Steven J. , Stricklin George P. , Netterville James L. , Nanney Lillian B. , Burkey Brian B.
Published: October 2014

Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes implicated in the invasion and metastasis of many cancers. In situ hybridization techniques were used to reveal sites of expression of collagenase (MMP-1), gelatinase 72 kd (MMP-2), gelatinase 92 kd (MMP-9), and tissue inhibitor of metalloproteinase-1 (TTMP-1) in head and neck carcinomas (N=21). Both TTMP-1 and gelatinase 72 kd were expressed in nearly all tumors, whereas the expression of collagenase and gelatinase 92 kd showed variability. Tumor-associated expression of MMPs was strongest in stromal cells near advancing margins. No differences in expression levels were detected between primary and metastatic sites. This paper reviews the literature and discusses the significance and possible implications of MMPs in head and neck squamous cell carcinoma.
Phagophobia: A form of Psychogenic Dysphagia a New Entity
Authors: Franko Debra L. , Shapiro Jo , Gagne Adele
Published: October 2014

There is a group of patients presenting with either acute or chronic dysphagia secondary to fear of swallowing. We have termed this entity phagophobia. It is characterized by various significant swallowing complaints in the face of normal findings on head and neck examination, oropharyngeal swallowing videofluoroscopy, and standard barium swallow study. Ten patients who received diagnoses of phagophobia after a full evaluation at our swallowing disorders center are presented. Each patient was then evaluated by a psychologist, and an attempt at therapy was undertaken. We discuss the specific clinical features, assessment, and treatment of this frequently misdiagnosed disorder.
Complications Associated with 327 Foreign Bodies of the Pharynx, Larynx, and Esophagus
Authors: Singh Bhuvanesh , Har-El Gady , Kantu Manoj , Lucente Frank E.
Published: October 2014

We intended to identify the types and incidence of complications associated with foreign bodies (FBs) impacted in the upper aerodigestive tract (UADT) and to ascertain factors predisposing to the development of these complications. The design was a retrospective cohort study of 327 patients with UADT foreign bodies admitted to a tertiary care center. The overall incidence (7.6%) and types of complications varied by age. Complications developed in 4.8% of 208 patients 10 years of age and under, with pulmonary complications being most common. In contrast, complications occurred in 12.6% of 119 older patients, with retropharyngeal abscess being the most common (p < .0001). Delayed presentation (>24 hours after the onset of symptoms) was the only factor associated with an increase in the incidence of complications in the younger patients (p = .02). In contrast, pharyngeal location of the FB (p = .0004), the FB's being a fish bone (p = .006), and radiolucency (p = .02) were all associated with an increased incidence of complications in patients over 10 years of age. A significant risk for complications is present for patients admitted for the management of FBs in the UADT. Older patients with sharp FBs are at greatest risk. In this group of patients, close observation in the perioperative period is required, especially if there is evidence of mucosal injury.
Posterior Cephalometric Radiographic Analysis in Obstructive Sleep Apnea
Authors: Woodson B. Tucker , Feroah Thomas R. , Conley Stephen F. , Sewall Steven R. , Dohse Anthony , Fujita Shiro
Published: October 2014

Our objective was to evaluate the relationship between posterior facial cephalometric measures and obstructive sleep apnea syndrome (OSAS). We used a consecutive sample of 60 patients with OSAS who underwent upright lateral cephalograms, uvulopalatopharyngoplasty (UPPP), and preoperative and postoperative polysomnography. Successful responders to UPPP were arbitrarily defined as having a respiratory disturbance index reduced to fewer than 20 events per hour. Standard cephalometric measurements were used. Posterior facial height measures were constructed, based on a plane perpendicular to the Frankfort horizontal placed at hyoidale. The total and lower airway lengths were shorter and posterior mandibular height was longer in UPPP responders compared to nonresponders (p ≤ .05). There was no difference between the two groups by standard cephalometric measurements. Responders and nonresponders to UPPP have significant differences in posterior airway measures that are not reflected in standard cephalometric measures. Airway length likely is a critical factor in OSAS and surgical response.
Dependence of Middle Ear Gas Composition on Pulmonary Ventilation
Authors: Mover-Lev Haya , Harell Moshe , Levy Dalia , Ar Amos , Luntz Michal , Sadé Jacob
Published: October 2014

The middle ear (ME) steady state gas composition resembles that of mixed venous blood. We changed arterial and venous blood gases by artificially ventilating anesthetized guinea pigs and measured simultaneous ME gas changes during spontaneous breathing, hyperventilation, and hypoventilation. During hyperventilation, PaCO2 and PvCO2 (a = arterial, v = venous) decreased from 46.0 and 53.0 mm Hg to 17.9 and 37.5 mm Hg, respectively, while PaO2 and PvO2 (85.6 and 38.2 mm Hg) did not change. This was accompanied by an ME PCO2 decrease from 70.4 to 58.8 mm Hg and a PO2 decrease from 36.8 to 25.4 mm Hg. During hypoventilation, PaCO2 and PvCO2 increased to 56.8 and 66.4 mm Hg, while PvO2 decreased to 21.8 mm Hg. The ME PCO2 increased simultaneously to 88.8 mm Hg and the ME PO2 decreased to 25.4 mm Hg. The ME PO2 decrease during hyperventilation may be explained by a 33% decrease in ME mucosa perfusion, calculated from the ME ventilation-perfusion ratio. This study shows that ME gas composition follows fluctuations of blood gas levels and thus may affect total ME pressure.
Repair of Thyroid Cartilage Defect with Bone Morphogenetic Protein
Authors: Cui Peng-Cheng , Chen Wen-Xuan , Zhou Hui-Min
Published: October 2014

The object of this research was to investigate whether a thyroid cartilage defect can be repaired by newly formed bone induced by bovine bone morphogenetic protein (bBMP). Bilateral thyroid cartilage defects measuring 0.5 × 0.6 cm were created in 25 adult rabbits. Experimental defects were implanted with ceramic bone particles combined with bBMP, or in controls, without bBMP. The animals were painlessly killed at 2,4,8,12, and 16 weeks after implantation. The tissue responses were analyzed by routine histologic examination. An increase in the amount of new bone was observed in the interval from 4 to 12 weeks, and the defects were completely filled with new bone at 16 weeks, in contrast to a minimal new cartilage formation at the defect edges in controls. The results indicate that cartilage defects can be repaired by inducing new bone formation from mesenchymal cells in both perichondrium and muscular fascia.
Peculiar Snoring in Patients with Multiple System Atrophy: Its Sound Source, Acoustic Characteristics, and Diagnostic Significance
Authors: Sadaoka Tatsuya , Kanai Ryuichi , Kakitsuba Noriya , Fujiwara Yuki , Takahashi Hiroaki
Published: October 2014

It is known that abductor paralysis (AP) of the vocal folds sometimes occurs in patients with multiple system atrophy (MSA), and some of them have sleep apnea and loud snoring during sleep. However, the site of obstruction and the sound source of the snoring are still unknown. We performed fiberscopic examinations under diazepam sedation in 8 MSA patients with AP and analyzed the snoring sound. We found that the peculiar snoring occurred with inspiratory vibration of the vocal folds, and there was no obstruction in this portion. Acoustic analysis showed that the fundamental frequency of vocal fold snoring was 260 to 330 Hz, which is different from that of ordinary soft palate snoring. Recognition of vocal fold snoring is important in the early diagnosis of MSA and sleep-related breathing disorders.
Reversible Uremic Deafness: Is it Correlated with the Degree of Anemia?
Authors: Shaheen Faissal A. M. , Mansuri Noor A. , Sheikh Iftikhar A. , Al-Khader Abdullah A. , Al-Shaikh Abdul Munaim , Huraib Sameer O. , Zazgornik Jan
Published: October 2014

Hearing loss is a common finding in patients with end-stage renal failure. Uremic toxins, ototoxins, and axonal uremic neuropathy appear to be likely pathogenic factors. We analyzed whether an improvement in hearing capacity can be achieved with an improvement of anemia by erythropoietin (EPO) administration. Fifty patients on long-term hemodialysis in a single center were examined audiologically by otoscopy, tympanometry, pure tone audiometry, and the short increment sensitivity index. Twenty-five patients were treated with EPO in a dose of 120 U/kg per week over a period of 5 to 8 months, and the remaining 25 patients were not treated with EPO (controls). Both groups were reexamined audiologically after the study period, and the results were compared. In the group treated with EPO, the hemoglobin level increased from 7 ± 0.9 to 11 ± 0.8 g/dL, as against the control group, whose hemoglobin increased from 7.1 ± 0.9 to 8 ± 0.8 g/dL. The audiologic tests were repeated at the end of the study period, and a significant improvement of hearing was found in the patients treated with EPO as compared with the control group (p < .001). Our study suggests that improvement of anemia in patients on long-term hemodialysis by administration of EPO is associated with an improvement in hearing capacity in a significant number of patients. Thus, anemia seems to be an important factor responsible for hearing disorders in patients with end-stage renal failure. Studies with larger numbers of patients are required to confirm this observation.
Horseradish Peroxidase Permeation from the Capillaries of the Stria Vascularis after Inoculation of Endotoxin into the Middle Ear
Authors: Watanabe Kensuke , Tanaka Yasuo
Published: October 2014

Escherichia coli-derived endotoxin was inoculated in the middle ear of guinea pigs 24 hours after being injected intraperitoneally. Twenty-four hours after the middle ear inoculation, horseradish peroxidase (HRP) was injected via the femoral vein and the permeability of HRP through the capillaries of the stria vascularis and the destination of the leaked HRP were examined. A large amount of HRP leaked out of the capillary through the opened endothelial cell junctions and penetrated the enlarged intercellular spaces. Leaked HRP entered the pinocytotic vesicles of the intermediate cells. Even slightly degenerated intermediate cells retained this function. The HRP penetrated the spongelike structure of the marginal cells leading to the intercellular space. This structure was not observed without endotoxin. The HRP could not pass to the cochlear duct through the tight junctions between marginal cells. Blood sludging was observed in the strial capillaries. It appeared more frequently in the upper three turns than in the basal turn. The HRP leakage out of the capillaries was observed not only in the upper three turns but also in the basal turn.
Comparison of Soft Tissue Response in Rabbits following Laryngeal Implantation with Hydroxylapatite, Silicone Rubber, and Teflon
Authors: Flint Paul W. , Corio Russell L. , Cummings Charles W.
Published: October 2014

This study evaluates the soft tissue response in rabbits following laryngeal implantation for medialization using hydroxylapatite prostheses, carved silicone rubber prostheses, and injectable Teflon. Sixteen rabbits underwent left recurrent laryngeal nerve section for denervation and laryngeal implantation with hydroxylapatite. At 1, 3, 6, and 12 months, 4 animals were painlessly sacrificed and processed for histology. Similarly, animals were implanted with carved silicone rubber prostheses or with Teflon injected through a flap in the thyroid lamina for comparison at 1,3, and 6 months. In animals implanted with hydroxylapatite, histologic findings include limited acute inflammatory response, thin fibrous encapsulation, and osteogenesis in the region of the fenestra, with lamellar bone bridging the space between the implant and thyroid lamina. With silicone rubber prostheses, there is a limited inflammatory response and fibrous encapsulation of the implant without evidence of osteogenesis. Animals implanted with Teflon demonstrated a classic foreign body reaction with multinucleated giant cells, granuloma formation, and migration of Teflon into surrounding muscle. With respect to soft tissue response, both hydroxylapatite and silicone rubber are less reactive than Teflon. The osteogenesis observed in the presence of hydroxylapatite increases implant stability and minimizes the risk of migration. Conversely, the presence of bone growth may limit the reversibility of medialization procedures performed with hydroxylapatite.
Auditory Epithelial Migration III: An Immunohistologic Study Using Anti-Brdu Antibody on Tympanic Membrane in Mouse
Authors: Kakoi Hiroyuki , Anniko Math
Published: October 2014

A localization pattern of epidermal cells on the tympanic membrane (TM) and their migratory patterns were studied in mice, by means of immunohistologic technique using an anti-bromodeoxyuridine (BrdU) antibody. The BrdU was instilled intraperitoneally and the animals were painlessly sacrificed between 1 hour and 10 days after the injection. An immunostaining technique using anti-BrdU antibodies was applied on whole mount TM tissues. One hour after injection, BrdU-labeled cells were found in the handle of the malleus (HM) region and in the annular region of the pars tensa of the TM. Some labeled cells were observed in the intermediate region of the upper half of the superior quadrant, but no labeled cells were found in the remaining part of the intermediate region. Labeled cells were also evident in the pars flaccida without any particular pattern of distribution. As time elapsed after the injection, the labeled cells first appearing in the HM region had migrated laterally and inferiorly from the HM toward the annulus, while those in the annular region had considerably decreased in number. Results of the present study are the folio wing: 1) the proliferation center of epidermal cells in the pars tensa is located in two different areas, ie, the HM region and annular region, 2) newly generated cells in the HM region migrate from the HM region toward the annular region, whereas those in the annular region migrate from the annular region to the external auditory canal, and 3) no specific generation center is located in the pars flaccida. On the basis of these results, we discuss the relationship between the site of the proliferation center of epidermal cells and their migratory patterns.
Diagnosis and Management of Left Main Stem Bronchus Compression
Authors: Goldman Steven A. , Meza Manuel P. , Rimell Frank L. , Newman Beverly
Published: October 2014

There are four major variants of congenital vascular tracheal compression: innominate artery, aberrant subclavian, aorta or aortic arch anomaly, and pulmonary artery sling. These forms of vascular compression typically involve the trachea and/or the right main stem bronchus. We present eight cases of congenital vascular compression involving the left main stem bronchus. These cases represent a poorly understood variant of vascular tracheal compression. This variant represents approximately 10% of our pediatric tracheobronchial compression or stenosis patients. The finding, both noted endoscopically and now illustrated by magnetic resonance imaging, is caused by compression of the left main stem bronchus between the descending aorta and a portion of the pulmonary artery. Frequently, the descending aorta is in an abnormal anterior position with relation to the thoracic spine. Recognition of this entity is important in our experience and has influenced clinical management. In four of eight children, it required a surgical procedure directed toward the relief of the left main stem compression.
Middle Ear Pressure and Dysfunction of the Labyrinth: Is There a Relationship?
Authors: Maier Wolfgang , Fradis Milo , Ross Uwe , Richter Bernhard
Published: October 2014

Relationships between middle ear pressure and non-infection-related cochleovestibular dysfunction have been suggested by several authors. According to some data, vertiginous attacks can be prevented by the insertion of a ventilation tube in patients suffering from Meniere's syndrome. The aim of our study was to investigate if the incidence of eustachian tube malfunction and pathologic middle ear pressure is frequent, and if routine implantation of ventilation tubes is reasonable in ears with dysfunctions of the labyrinth, including clinical Meniere's syndrome. So, we determined in our pressure chamber all active and passive parameters of eustachian tube function in 40 patients suffering from Meniere's syndrome, sudden sensory hearing impairment (SSHI), or vestibular neuronitis. Our results disclosed no nonrandom incidence of impaired tubal function among our patients compared to healthy control subjects. Pressure equalization was sufficient in most patients suffering from clinical Meniere's syndrome, and only one patient with vestibular neuronitis presented with a patulous tube. Our results show that impairment of vestibular or cochlear function is not regularly accompanied by eustachian tube dysfunction. Furthermore, no patient reported symptoms while pressure variation was performed. We conclude that variation of middle ear pressure does not usually play a role in the genesis of Meniere's syndrome, vestibular neuronitis, or SSHI. Thus, from our data, we cannot recommend routine implantation of tympanic ventilation tubes in patients suffering from Meniere's syndrome, vestibular neuronitis, or sudden hearing loss.
Extracellular Fluid Pathway inside the Facial Nerve Fascicles
Authors: Nakao Yoshiaki , Sakihama Noriyuki , Tabuchi Tomizo , Nakajima Shigeto
Published: October 2014

The extracellular fluid pathway in the facial nerve and the diffusion of a tracer from the facial nerve to other cranial nerves was examined in the rabbit. Sodium fluorescein solution was injected into either the facial nerve fascicles or the epineurial connective tissue as a tracer at the stylomastoid foramen and then localized by fluorescence microscopy. In the facial nerve, fluorescence was observed in the endoneurium and external nerve sheath (epineurium and perineurium) through the geniculate ganglion following injection into the nerve fascicles. The vestibular, trigeminal, and glossopharyngeal ganglia also showed fluorescence on the injection side in ganglion cells and intercellular connective tissues. The results suggested that the endoneurial connective tissue constitutes a diffusion pathway inside the facial nerve fascicles and that the extracellular fluid pathway from the facial nerve to these cranial ganglia may be related to the neural spread of inflammation or neoplastic metastasis.
End-to-Side Neurorrhaphy Resulting in Limited Sensory Axonal Regeneration in a Rat Model
Authors: Tarasidis Gregory , Strasberg Suzanne R. , Watanabe Osamu , Haughey Bruce H. , Mackinnon Susan E. , Hunter Daniel A.
Published: October 2014

This study evaluated reinnervation of an end-to-side neurorrhaphy and the resultant functional recovery in a rat model. The cut distal posterior tibial nerve was repaired to the side of an intact peroneal nerve. In one group, the epineurium of the peroneal nerve was left intact; in another group, the epineurium was stripped; in the third experimental group, a perineurial slit was created. Evaluations included walking track analysis, nerve conduction studies, muscle mass measurements, retrograde nerve tracing, and histologic evaluation. Walking tracks indicated poor functional recovery. No significant difference in nerve conduction between the experimental and control groups was seen. Gastrocnemius muscle mass measurements revealed no functional recovery in the end-to-side groups. Retrograde nerve tracing revealed minimal staining of motor neurons. However, sensory neuronal staining of the dorsal root ganglia occurred in all groups. Histology revealed minimal myelinated axonal regeneration. These results suggest that predominantly sensory neural regeneration occurs in an end-to-side neurorrhaphy at an end point of 16 weeks.
Vocal Fold Atrophy: Quantitative Glottic Measurement and Vocal Function
Authors: Omori Koichi , Kojima Hisayoshi , Slavit David H. , Kacker Ashutosh , Matos Carlos , Blaugrund Stanley M.
Published: October 2014

Videostroboscopic glottic measurements and vocal function were evaluated in 41 vocal fold atrophy patients with bowed vocal folds. The amount of bowing in the resting position and the glottal gap area and vibratory amplitude during phonation were measured from digitized videostroboscopic images. Vibratory amplitude was not decreased on atrophic vocal folds. With the same amount of total bowing, the glottal gap area for bilateral atrophy was smaller than for unilateral atrophy. These results suggest that vocal fold atrophy is not disadvantageous to thyroplasty type I, and that bilateral procedures may produce a better outcome than a unilateral procedure in the treatment of bilateral atrophy. Acoustic, aerodynamic, and perceptual parameters of vocal function were measured. The acoustic high-frequency power ratio and the H-index correlated with the glottal gap area. The mean flow rate correlated with the amount of bowing. The degree of dysphonia was related to the size of the glottal gap and bowing.
Endoscopic Management of a Combined Laryngocele
Authors: Szwarc Brian J. , Kashima Haskins K.
Published: October 2014

A 70-year-old woman presented with hoarseness, foul sputum, and a soft neck mass. Clinical and radiographic examination disclosed findings consistent with a combined internal and external laryngopyocele. Antibiotics, throat irrigations, and warm packs applied to the neck resulted in full resolution of the neck mass and subtotal regression of the supraglottic swelling. Endoscopic vestibulectomy was performed with a carbon dioxide laser; neither residual neck mass nor a tract leading to the extralaryngeal neck swelling was detected. The immediate and long-term clinical course has been uneventful. This report is the first description of the definitive endoscopic management of a combined laryngocele. The pathogenesis of the laryngocele and the rationale and technique for endoscopic management are discussed.
Epiglottic Position after Cricothyroidotomy: A Comparison with Tracheotomy
Authors: Lim Jessica W. , Lerner Patricia Kerman , Rothstein Stephen G.
Published: October 2014

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.
Effects of Platelet Activating Factor on Vascular Permeability of the Middle Ear Mucosa
Authors: Rhee Chung-Ku , Park Yong-Soo , Jung Timothy T. K. , Long Steven A. , Davamony David
Published: October 2014

Platelet activating factor (PAF), a potent inflammatory mediator, seems to play a significant role in the pathogenesis of otitis media with effusion (OME), along with other inflammatory mediators such as leukotrienes and prostaglandins. The purpose of this study was to investigate the effect of PAF on the vascular permeability of middle ear mucosa, in an experimental OME model using chinchillas. We injected PAF in doses of 1, 4, 8, and 16 μg and normal saline as a control into the bullae of chinchillas. Vascular permeability was measured by the Evans blue vital dye technique. All the PAF-injected animals showed a significant increase in middle ear vascular permeability compared to the control group. This study demonstrated that PAF in the middle ear cavity contributes significantly to the development of OME by increasing the vascular permeability of the middle ear mucosa.