bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Results of the Sternohyoid Myocutaneous Rotary Door Flap for Laryngotracheal Reconstruction
Authors: Chen Wen-Xian , Cui Peng-Cheng , Ruan Yan-Yan , Sun Yong-Zhu
Published: October 2014

In the past 8 years, 45 patients with laryngotracheal stenosis have undergone reconstruction with the sternohyoid myocutaneous rotary door flap (RDF) technique at Tang Du Teaching Hospital in Xi'an, China. All patients were tracheostomy-dependent before reconstruction. Thirty-six patients had previously undergone 2 to 7 surgical procedures. Forty-one of the 45 patients (91%) were successfully decannulated. Decannulation failed in the other 4 because of RDF prolapse into the tracheal lumen or because of hypertrophic scar in the operative region. The follow-up period ranged from 1 to 8 years. Forty of the 41 patients had a stable airway and effective voice, and 1 patient had restenosis 3 years after decannulation. The results demonstrate that the RDF technique is a relatively simple and effective way to treat patients with laryngotracheal stenosis.
Lymphatic Metastasis to the Supraretrospinal Recess in Laryngeal Squamous Cell Carcinoma
Authors: Köybasioǧlu Ahmet , Inal Erdoǧan , Uslu Sabri , Ileri Fikret , Yilmaz Metin , Asal Korhan
Published: October 2014

In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squamous cell carcinoma (SCC), we separately dissected SRSR lymph nodes and submitted them to pathological examination. Fifty-three lateral neck dissections (LNDs), 2 radical neck dissections (RNDs), and 19 modified RNDs were performed in 49 previously untreated patients with laryngeal SCC. The nodal status of the patients was NO in 29 patients, N1 in 17, and N2 in 3. The neck was pathologically positive in both RNDs (100%), in 7 of 19 modified RNDs (37%), and in 7 of 53 LNDs (13%). No SRSR lymph nodes were positive in any of the dissection materials. No metastasis was found in the SRSR lymph nodes in the N0 necks treated with LND, and none was found even in N1 and N2 necks treated with RND or modified RND. We conclude that the SRSR may be left undissected during treatment of an N.0 neck with LND so that accessory nerve dysfunction can be minimized and operative time can be saved.
In vivo Measurements of an Improved Tracheostoma Valve Based on Inhalation
Authors: Geertsema Albert A. , Schutte Harm K. , Verkerke Gijsbertus J.
Published: October 2014

An improved, inhalation-based tracheostoma valve (TSV) was designed to facilitate finger-free tracheoesophageal speech. In contrast to existing models, the TSV closes by means of strong inhalation (instead of exhalation) to reach the “speaking position.” Air is inhaled through a small 1-way valve that allows unlimited phonation time. The device can be deliberately changed to the “breathing position” by a fast expiration. Experimental setups were used to measure in vitro and in vivo the performance of the inhalation TSV. In patients, the inhalation TSV was compared with existing TSVs on the following parameters: air volume used to close the TSVs, speaking time of the TSVs, and total air volume during exhalation through the TSVs. The inhalation TSV functions well in physiological ranges, is optimally adjustable, and is an improvement over existing devices. It makes continuous speech possible and saves as much as 22% of the total exhalation volume for speaking, in contrast to existing TSVs.
Gastroesophagopharyngeal Reflux in Patients with Contact Granuloma: A Prospective Controlled Study
Authors: Ylitalo Riitta , Ramel Stig
Published: October 2014

The aim of this study was to compare the incidences of gastroesophagopharyngeal reflux in patients with contact granuloma and healthy controls. A 24-hour ambulatory esophagopharyngeal pH monitoring technique was used to measure reflux parameters in the pharynx and distal esophagus. Pharyngeal acid reflux events occurred in 17 of 26 granuloma patients (1 to 20 episodes per patient) and 5 of 19 controls (1 to 8 episodes per patient). The reflux episodes were typically short and occurred predominantly in an upright position. A comparison between the groups showed a significant difference in the number of pharyngeal reflux episodes (p =.009) and in the total time of pH below 4 (p =.006). On the other hand, we found no significant differences in any esophageal reflux parameters, except for the percentage of distal esophageal reflux episodes that reached the pharynx (p =.006). In this study, pharyngeal acid exposure was significantly more prevalent in patients with contact granuloma than in healthy controls.
Comparison of the Microbial Composition of Voice Prosthesis Biofilms from Patients Requiring Frequent versus Infrequent Replacement
Authors: Elving G. Jolanda , van der Mei Henny C. , van Weissenbruch Ranny , Busscher Henk J. , Albers Frans W. J.
Published: October 2014

This study was performed to establish a possible difference in biofilm composition in patients who require frequent versus infrequent prosthesis replacement. Only Groningen button voice prostheses that were removed because of increased airflow resistance or leakage of food or liquids through the prosthesis were considered for this study. These prostheses were selected from a total of 692 failed voice prostheses over a 2-year evaluation period. The failed voice prostheses were subdivided into a short-lifetime group, corresponding to an implantation period of less than 4 months (20 voice prostheses), and an extended-lifetime group, corresponding to an implantation period of greater than 9 months (18 voice prostheses). The biofilm was removed from the valve sides of the prostheses. The bacterial strain Rothia dentocariosa and the yeast strains Candida albicans I and Candida tropicalis were the predominant strains isolated from the biofilms on the voice prostheses in the short-lifetime group, whereas in the extended-lifetime group, R dentocariosa was found with a fourfold lower isolation frequency and C albicans I was found with a twofold lower isolation frequency. Candida tropicalis was absent from the extended-lifetime group.
Swallowing and Sensation: Evaluation of Deglutition in the Anesthetized Larynx
Authors: Sulica Lucian , Hembree Amanda , Blitzer Andrew
Published: October 2014

To better characterize the role of laryngeal sensory systems in swallowing, we assessed 5 healthy adult volunteers via functional endoscopic evaluation of swallowing before and after bilateral superior laryngeal nerve block. The volunteers were tested multiple times with both liquid and puree consistencies. Laryngeal anesthesia resulted in a significantly higher (p < .05) incidence of premature spillage, pharyngeal residual, and laryngeal penetration with all consistencies, and a higher incidence of tracheal aspiration with liquid. Aspiration of puree was increased, but the difference did not achieve significance. These results contrast with those achieved by others with topical anesthesia, which caused little impairment. Other afferent modalities besides light touch, interrupted by superior laryngeal nerve block but not by topical anesthesia, may account for the difference. It is likely that this study underestimates the severity of clinical disability from afferent deficits, because of the short duration of the experimental deficit and the lack of associated comorbidities in the subjects. These findings have implications for clinical sensory testing and sensate flap reconstruction of pharyngeal defects.
Adenovirus-Mediated Ex Vivo Gene Transfer of Human Vascular Endothelial Growth Factor in a Rabbit Laryngotracheal Reconstruction Model
Authors: Samadi Daniel S. , Bouchard Sarah , Jacobs Ian N. , Herlyn Meenhard , Walsh Danielle , Crombleholme Timothy M.
Published: October 2014

Free autologous cartilage, which is used in laryngotracheal reconstruction (LTR), may undergo progressive necrosis as a result of delayed revascularization. Angiogenic growth factors, such as vascular endothelial growth factor (VEGF), promote angiogenesis in the ischemic environment. We studied the effect of ex vivo gene transfer of VEGF121 on cartilage angiogenesis and graft survival in a rabbit model of LTR. Sixty rabbits underwent LTR with auricular cartilage. The grafts were treated at 1 × 109 plaque-forming units with 1) VEGF121 (n = 20), 2) LacZ reporter gene (n = 20), or 3) saline solution (n = 20). Graft neovascularization and survival were histologically assayed at 1 and 10 weeks. Angiogenesis was enhanced at both 1 and 10 weeks after treatment with VEGF121 as compared to controls (p < .001). No statistical improvement in graft survival was evident after treatment with VEGF121. Ex vivo gene transfer to cartilage may be a promising gene therapy strategy to enhance revascularization — and, potentially, cartilage survival — under the proper conditions.
Transtracheal Oxygen Catheters in a Pediatric Population
Authors: Preciado Diego A. , Panitch Howard B. , Thatcher Gentry , Rimell Frank L.
Published: October 2014

This is the first report to evaluate transtracheal oxygen catheter (TTOC) use in a pediatric patient series. Seven pediatric patients (4 boys and 3 girls) received TTOCs in 2 tertiary care medical centers. The medical indications included bronchopulmonary dysplasia in 4 patients and tracheomalacia in the other 3. The average age at the time of placement was 22 months (range, 2 weeks to 37 months). Catheter placement for 4 patients was through an open tracheotomy stoma. In 3, placement was through a percutaneous technique. The follow-up ranged from 2 weeks to 5 years. There were no long-term complications. Transient needs for supplemental oxygen were all met by the TTOC system. In 4 patients, the catheter has been removed because of resolution of the supplemental oxygen requirements. Minor complications included skin site infection and mucus plugging. In 1 patient, accidental dislodging of the catheter led to its replacement in the operating room. In 1 percutaneous placement, a pneumothorax occurred and resolved without any persistent morbidity. We conclude that transtracheal oxygen delivery can be a reasonable alternative to a nasal cannula or formal tracheotomy in selected pediatric patients in whom long-term oxygen delivery, but not an alternate airway, is required. In order to avoid complications, meticulous technique must be adhered to in using the percutaneous approach for placement.
Isolated Sphenoid Sinus Disease: An Analysis of 122 Cases
Authors: Kanoh Naoyuki , Xu Renzong , Wang Zheng-Min , Dai Chun-Fu , Chi Fang-Lu , Kutler David I. , Tian XI
Published: October 2014

Isolated sphenoid sinus disease (ISSD) is a relatively uncommon disease. The present study is a retrospective review of 122 patients with ISSD who were treated at the Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital at Shanghai Medical University over a 25-year period. The diagnosis of ISSD was made on the basis of history and physical examination, signs and symptoms, nasal endoscopy, and computed tomography (CT) and magnetic resonance imaging (MRI). The final diagnosis of ISSD was confirmed by histopathologic and microbiological examinations of the surgical specimens. The pathological findings in this study included sphenoid cyst (47 cases), sphenoid sinusitis (31 cases), fungal disease (19 cases), inverted papilloma (4 cases), sphenochoanal polyp (1 case), foreign body (8 cases), malignant tumors (8 cases), and others (4 cases). The most common initial symptom was headache, followed in decreasing order by visual changes, cranial nerve palsies, and nasal symptoms. The more frequent use of routine CT and MRI scanning, as well as endoscopy, in the diagnosis of sinus disease has led to an increase in the early diagnosis of ISSD. The recent advances in endoscopic sphenoidotomy has allowed for relatively safe and immediate treatment of ISSD, preventing late extension into adjacent vital structures, which is commonly fatal. Endoscopic surgery also enables the surgeon to make a precise pathological diagnosis.
Primary Parotid Gland Hodgkin's Lymphoma
Authors: Yencha Myron W.
Published: October 2014

Hodgkin's lymphoma with its primary manifestation in the parotid gland is an exceedingly rare entity and is not usually suspected in the initial evaluation of a parotid mass. Because it is not suspected, the results of fine-needle aspiration cytology are often misleading, and parotidectomy is needed for a definitive diagnosis. The most common subtype encountered is lymphocyte-predominant. The prognosis is favorable; the 5-year survival rate exceeds 90%. Treatment consists of chemotherapy, radiotherapy, or both. A case of primary parotid gland Hodgkin's lymphoma is presented along with a review of the literature and a discussion of the evaluation and management of this rare entity.
Limitations to Mobilizing the Intrapetrous Carotid Artery
Authors: Witiak Debora G. , Pensak Myles L.
Published: October 2014

The irregular and complex osteology of the bony skull base houses the intrapetrous internal carotid artery (ICA), which represents a potential obstacle to the complete extirpation of benign skull base lesions. This 2-part study 1) investigated the cadaveric basis for the mobilization of the intrapetrous ICA and 2) correlated the cadaveric anatomic findings with the authors' clinical experience. We conclude that the ICA can be mobilized relatively safely. The degree of mobility achieved directly relates to the surgical approach and exposure. Limited mobility is achieved when an anterior petrosal approach is used with various neurosurgical procedures. Conversely, transcochlear and infratemporal approaches allow for optimal ICA translation. The safety of ICA mobilization is documented by the low complication rate in our series.
Incidence of Regeneration of the Chorda Tympani Nerve after Middle Ear Surgery
Authors: Shibamori Yoshiyuki , Igawa Hideki , Saito Takehisa , Manabe Yasuhiro , Ohtsubo Toshio , Yamagishi Takahiro , Saito Hitoshi
Published: October 2014

We retrospectively reviewed 52 patients who underwent middle ear surgery during which the chorda tympani nerves were severed and who then underwent secondary surgery 1 to 5 years later. In 22 patients (42.3%), regenerated chorda tympani nerves (entire length of the tympanic segment) were detected in the submucosal layer of the reconstructed eardrum during the secondary surgery. Before the secondary surgery, 16 patients (30.8%) showed threshold recovery on electrogustometry. When 5 regenerated nerves were observed by transmission electron microscopy, myelinated nerve fibers were detected in a small fascicle or connective tissue, but the number of myelinated axons was significantly decreased (7.4% to 84.6%; p = .01) compared with that in normal subjects (1,911 ± 324; n = 4). There was a significant difference in the incidence of regeneration between the group with end-to-end anastomosis (5/5 or 100%) and that with nerve gap defects (17/47 or 36.2%; p < .05); this finding suggests that repair of the sectioned nerve produces a better incidence of regeneration than leaving the nerve unrepaired.
Temporal Bone Histopathology in Charge Association
Authors: Haginomori Shin-Ichi , Miura Makoto , Sando Isamu , Casselbrant Margaretha L.
Published: October 2014

Three temporal bones obtained at autopsy from 2 patients with CHARGE association (Coloboma, congenital Heart disease, Atresia of choanae, mental Retardation and/or central nervous system anomalies, Genital hypoplasia, and Ear anomalies) were examined histopathologically. Both temporal bones from 1 patient showed multiple anomalies in the middle ear, inner ear, and facial nerve. However, the temporal bone obtained from the other patient showed almost normal structures in the inner ear, middle ear, and eustachian tube. These results are different from those of 2 previous reports of temporal bone histopathology regarding CHARGE association. This difference suggests that CHARGE association may arise not from one etiopathogenetic factor, but from complex factors. Special attention to dehiscent facial canal and perilymphatic gusher during otologic surgery in patients with CHARGE association is discussed.
Measurement of the Electrically Evoked Compound Action Potential via a Neural Response Telemetry System
Authors: Lai Wai Kong , Müller-Deile Joachim , Dillier Norbert , Almqvist Bengt , Stecker Matthias , Frohne Carolin , von Wallenberg Ernst
Published: October 2014

The main aim of this study was to validate a new technique, neural response telemetry (NRT), for measuring the electrically evoked compound action potential in adult cochlear implant users via their Nucleus CI24M implant. Thirty-eight adults were evaluated with a variety of measurement procedures with the NRT software. Electrically evoked compound action potentials were obtained in 31 of the 38 adults (81.6%) and in 132 of the 160 electrodes (82.5%) tested. In addition to validating this technique, we also established a set of default clinical test parameters.
Anaerobic Bacteria in Upper Respiratory Tract and other Head and Neck Infections
Authors: Brook Itzhak
Published: October 2014

Anaerobic bacteria are common in chronic upper respiratory tract and head and neck infections. Anaerobes are the most predominant components of the normal human oropharyngeal bacterial flora, and are therefore a common cause of bacterial infections of the upper respiratory tract that are of endogenous origin. Because of their fastidious nature, anaerobes are difficult to isolate from infectious sites and are often overlooked. Anaerobic bacteria can be recovered in chronic otitis media and sinusitis, and play a role in tonsillitis. They are also important in complications of these infections. Anaerobes predominate in deep oral and neck infections and abscesses. In addition to their direct pathogenicity in these infections, they possess an indirect role through their ability to produce the enzyme β-lactamase. In this fashion, they are capable of “shielding” non–β-lactamase—producing bacteria from penicillins. The lack of directing adequate therapy against these organisms may lead to clinical failures. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. Treatment of anaerobic infections is complicated by the slow growth of these organisms, by their polymicrobial nature, and by the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy required, whereas in other cases, it is an important adjunct to a surgical approach. Because anaerobic bacteria generally are recovered mixed with aerobic organisms, the choice of appropriate antimicrobial agents should provide for adequate coverage of both types of pathogens.
Lack of Association between Gene Polymorphism of Transporters Associated with Antigen Processing and Allergic Rhinitis in a Japanese Population
Authors: Takeuchi Kazuhiko , Yuta Atsushi , Abe Saori , Majima Yuichi , Masuda Sawako , Sakakura Yasuo
Published: October 2014

Gene products of TAP1 and TAP2 (transporters associated with antigen processing) are involved in antigen presentation. It has been reported that polymorphisms in the TAP1 gene are associated with atopy in Tunisians. We designed a case-control study to investigate the potential association of polymorphisms of the TAP1 gene with allergic rhinitis in a Japanese population. We used the amplification refractory mutation system polymerase chain reaction to characterize TAP1 gene polymorphisms in 60 unrelated Japanese patients with allergic rhinitis and 62 healthy control subjects. There was no significant difference in the distribution of TAP1 alleles between the patient group and the control group. These findings suggest that the TAP1 gene is not primarily involved in susceptibility to allergic rhinitis in the Japanese population.
Electrically Stimulated Glottal Opening Combined with Adductor Muscle Botox Blockade Restores Both Ventilation and Voice in a Patient with Bilateral Laryngeal Paralysis
Authors: Zealear David L. , Billante Cheryl R. , Sant'anna Geraldo D. , Courey Mark S. , Netterville James L.
Published: October 2014

The purpose of this study was to determine whether paced electrical stimulation of the posterior cricoarytenoid muscle with an implantable device could restore ventilation in a patient with bilateral vocal fold paralysis without disturbing voice. In the first US case of a multi-institutional study, this patient was implanted with an Itrel II stimulator (Medtronic, Inc). In monthly postoperative sessions over an 18-month period, an effective stimulus paradigm was derived, the magnitude of stimulated vocal fold abduction and ventilation was measured, and perceptual judgments of voice quality were made. After identification of optimum parameters, posterior cricoarytenoid muscle stimulation produced a moderately large vocal fold abduction of 4 mm, but only marginal improvement in mouth ventilation, with no change in voice quality. After adductor muscle blockade with botulinum toxin, the patient's voice improved with increased phonatory airflow, but ventilation through the passive airway was still inadequate. However, by combining these Two therapeutic strategies, dynamic abduction increased to 7 mm, ventilation through the mouth surpassed that through the tracheotomy (allowing decannulation), and voice quality was restored to normal.
Electrically Stimulated Olfactory Evoked Potential in Olfactory Disturbance
Authors: Ishimaru Tadashi , Miwa Takaki , Shimada Takefumi , Furukawa Mitsuru
Published: October 2014

Olfactory evoked potential is considered a useful method of electrophysiological olfactometry for the diagnosis of olfactory disturbance. However, electrophysiological olfactometry is not as widely used as electrophysiological audiometry, such as the auditory brain stem response, because odor stimulation is difficult to perform. In contrast, electrical pulse stimulation is easy to perform, and its evoked potential is also easily recorded by the averaging method. We recorded olfactory evoked potentials from the scalp produced by electrical stimulation on the olfactory mucosa and investigated the relationship between this electrical olfactory evoked potential (EOEP) and the results of Toyoda and Takagi's perfumist's strip method (T&T) olfactometry, which is a standard Japanese means of psychophysical olfactometry. In EOEP-detectable cases, the detection and cognitive thresholds of T&T olfactometry were 1.32 ± 1.99 (mean ± SD; n = 10) and 3.02 ± 1.64 (n = 10), respectively. But in the undetectable cases, the thresholds were 4.67 ± 2.03 (n = 8; 5.8 means off the scale) and 5.80 ± 0.00 (n = 8), respectively. The differences between the T&T thresholds of EOEP-detectable and -undetectable cases were significant. We concluded that EOEP is suitable for electrophysiological olfactometry.
Perilymphatic Pressure Measurement in Meniere's Disease
Authors: Ayache Denis , Bouzerar Kemal , Plouin-Gaudon Isabelle , Elbaz Pierre
Published: October 2014

The aim of this study was to evaluate the perilymphatic pressure, by means of the MMS-10 Tympanic Displacement Analyzer (TDA), in patients with Meniere's disease (MD). Measurements were performed in 37 patients with MD and in 14 normal-hearing subjects. Data were collected from 3 groups: healthy ears of normal-hearing subjects, unaffected ears of patients with MD, and affected ears of patients with MD. Analysis of the results obtained with the TDA showed no significant differences between the 3 groups. Several hypotheses could explain this lack of difference: 1) perhaps indirect measurement of perilymphatic pressure with the TDA is not relevant; 2) perhaps hyperpressure of the inner ear is not the physiological basis for the clinical triad of MD; or 3) perhaps endolymphatic hydrops does not produce changes in perilymphatic pressure. The results of this series indicate that the TDA is not useful in the evaluation of patients with MD.
Bilateral Vocal Fold Paralysis and Adhesion in Anterior Spinal Artery Syndrome
Authors: Omori Koichi , Tsuji Tomoko , Isshiki Nobuhiko , Yamashita Masaru
Published: October 2014

The purpose of this report is to present a rare case of anterior spinal artery syndrome (ASAS) in which there proved to be a combined lesion of paralysis and adhesion. A 26-year-old woman with a history of ASAS complained of difficulty of tracheal decannulation. In 1988, she was intubated and underwent tracheotomy because of respiratory muscle weakness, and she was decannulated in 1990. In 1998, she had cesarean delivery under general anesthesia, and postdelivery dyspnea necessitated tracheotomy again. On her first visit to us, endoscopic examination revealed bilateral vocal fold immobility at the midline without an apparent web. Direct laryngoscopy under general anesthesia revealed a posterior glottic adhesion and scarring, which were treated by excision of the scar and local steroid injection. The left vocal fold gradually regained mobility, permitting decannulation 3 months after treatment. This complicated vocal fold immobility was found to be due to adhesion and partial paralysis combined.
Idiopathic Subglottic Stenosis Revisited
Authors: Valdez Tulio A. , Shapshay Stanley M.
Published: October 2014

Idiopathic subglottic stenosis (ISS) is a rare inflammatory process of unknown cause, usually limited to the subglottic region and the first 2 tracheal rings. We performed a retrospective analysis of our experience with a series of patients with this condition. The study involved retrospective review of the records of patients with ISS. A series of criteria that included patient clinical history, laboratory tests, flexible nasolaryngoscopic examination, and biopsies were used to establish a diagnosis. Symptoms, treatment, and outcome were examined. A total of 16 patients were identified; 14 were female (87.5%), and 2 were male. The mean follow-up time was 75.5 months. Fourteen patients required surgical treatment for respiratory compromise. Nine of these cases have been controlled effectively with endoscopic laser techniques. Endoscopic management failed in 5 patients, and 2 patients underwent laryngotracheal resection and reconstruction. Mitomycin-C was used in 6 patients as an adjuvant to endoscopic laser surgery. Patients in whom endoscopic treatment failed were noted to have thicker (>1 cm) and more complex stenoses. The diagnosis of ISS is a diagnosis of exclusion. A complete workup of the patient must be performed to rule out other causes of stenosis. Endoscopic laser surgery is a valid initial approach for thinner, noncomplicated lesions. Patients with thicker, complex lesions in whom endoscopic treatment fails are best managed with laryngotracheal resection and reconstruction. However, adjuvant use of mitomycin-C may prove beneficial in the treatment of these patients. Estrogen may play a role in the pathogenesis of ISS by altering the wound healing response.
Surgery of the Nasal Columella in External Valve Collapse
Authors: Ghidini Angelo , Dallari Stefano , Marchioni Daniele
Published: October 2014

The authors describe and discuss their experience with the collapse of the external nasal valve, focusing on the role that surgery of the columella plays in solving this problem. Thirty-seven cases were treated. In all but 1 there had been a previous septorhinoplasty. Seven patients had concomitant internal valve collapse. A modified alarplasty associated with columelloplasty was adopted in the cases with severe collapse. When the reduction of the nostril opening was mild to moderate, the surgical strategy varied depending on the width of the columella base: alarplasty in cases with a narrow to normal columella, and columelloplasty in the presence of a wide columella base. The authors' philosophy tends to minimize intervention on the nasal valve areas. Their results demonstrate that when the collapse and its functional effect are not too severe, a good result can be achieved by working only on the columella, especially if its base is significantly wide.
Acoustic Analysis of Upper Airway Obstruction in the Excised Human Larynx
Authors: McGinn Johnathan D. , Plant Randall L.
Published: October 2014

Upper airway obstruction is an emergency that requires quick and decisive intervention. Stridor is the sound created by airflow through a partially obstructed airway, and has been described to vary with the site and degree of obstruction. This study sought to determine the sound characteristics of stridor in the excised human larynx. Five fresh cadaver human larynges were harvested and subjected to obstructions at supraglottic, glottic, and subglottic subsites. Subglottic pressure, airflow, and audio signal were recorded. Data were analyzed on the basis of laryngeal obstruction subsite and the degree of laryngeal resistance. Visual inspection demonstrated certain trends in peak spectral energy depending on the site and, more significantly, the amount of obstruction. Statistical analysis of spectral waveforms showed better correlation with the amount of obstruction than with the site of obstruction. In summary, the frequency distribution of stridor produced in an excised human larynx was influenced by the amount of laryngeal resistance, but not by the site of airway obstruction.
Fluorodeoxyglucose Imaging Using a Coincidence Gamma Camera to Detect Head and Neck Squamous Cell Carcinoma and Response to Chemotherapy
Authors: Montravers Françoise , Tassart Marc , Périé Sophie , Kerrou Khaldoun , Talbot Jean-NOËL , Angelard Bruno , St Guily Jean Lacau
Published: October 2014

This prospective study was performed to evaluate the ability of a dual-head gamma camera with fluorine-18 fluorodeoxyglucose coincidence detection emission tomography (FDG-CDET) to detect primary tumor and cervical lymph nodes in head and neck squamous cell carcinoma (HNSCC), and to show the response of the carcinoma to chemotherapy. The findings were compared with those of physical examination, computed tomography (CT), and histopathology, before treatment in 61 patients, and after induction chemotherapy in 34 of them. Before treatment, the primary was detected in 93%, 79%, and 95% of cases on panendoscopy, CT, and FDG-CDET, respectively. After chemotherapy, 34 patients were evaluable for response of the primary tumor. Surgical resection was performed in 23 of them: agreement with histopathologic results for response to treatment was 74%, 69%, and 78% for panendoscopy, CT, and FDG-CDET, respectively. No surgical resection was performed in 11 of the 34 patients, but biopsies were performed before radiotherapy, and their rates of agreement with histopathologic results for response to treatment were 75%, 75%, and 67% on panendoscopy, CT, and FDG-CDET, respectively. For cervical lymph nodes, 245 sites were resected in 41 patients, and FDG-CDET appeared competitive with CT in detecting metastatic neck disease, especially after neoadjuvant chemotherapy; the accuracy was 93%. These results demonstrated the ability of FDG-CDET to detect primary tumors and cervical lymph nodes in HNSCC and to show its response to chemotherapy, as compared to the ability of CT and panendoscopy. It may be a complementary tool to evaluate residual disease after induction chemotherapy, although higher sensitivity would be required for FDG-CDET to be considered as a staging modality.
Management of Carotid Artery Invasion in Advanced Malignancies of Head and Neck Comparison of Techniques
Authors: Hafiz Gunter , Kiyak Erkan , Aslan Ismet , Baserer Nermin , Tinaz Mehmet , Yazicioglu Engin , Biliciler Necdet
Published: October 2014

The objective of this study was to retrospectively investigate a single institution's experience with carotid artery resection performed as part of an oncological procedure and to determine acute and convalescent complication and survival rates. We performed a record review of 28 patients with head and neck malignancy invading the carotid artery. Immediate carotid artery resection and ligation on an emergent basis was performed on 12 patients (group 1), elective resection and ligation was performed on 8 patients (group 2), and elective resection and revascularization was performed on 8 patients (group 3). In group 1, although 1 patient survived for 1 year and 1 patient survived for 2 years, 1 patient died of severe neurologic deficit, 2 patients experienced neurologic deficit with good recovery, and 1 patient was moderately disabled. In group 2, 2 patients survived without disease for 5 years, and 2 patients experienced neurologic deficit, 1 with good recovery and the other with complete recovery. In group 3, only 1 patient survived for 5 years, and within this group, 1 patient died of severe neurologic deficit, 1 patient had neurologic deficit with moderate recovery, and 1 patient had neurologic deficit with complete recovery. No significant difference in mortality and morbidity rate was observed between the “resection and ligation” group and the “resection and revascularization” group (p = .52, χ2 = 0.79). We conclude that the surgical treatment of patients with an invaded carotid artery, including carotid resection, provides a small but real chance of 5-year survival. The methods of carotid resection and repair should be guided by clinical presentation and by preoperative and intraoperative investigations.
Gamma Probe Accuracy in Detecting the Sentinel Lymph Node in Clinically No Squamous Cell Carcinoma of the Head and Neck
Authors: Sulfaro Sandro , Marus Wally , Barzan Luigi , Alberti Fulvio , Pin Marco , Politi Doriano , Savignano Maria Gabriella
Published: October 2014

The sentinel node, which is not always located at the first-echelon nodal area close to the primary tumor, is the initial recipient of possible metastasis. In order to verify the usefulness of the sentinel lymph node technique in the staging of head and neck cancers, we studied 31 untreated patients with squamous cell carcinoma of the upper airways by injecting them around the primary tumor with technetium 99m albumin microcolloid (99mTc) and submitting them to selective neck dissection with en bloc tumor removal. The nodes were examined after γ-probe identification of the sentinel node(s). No patients were found to have microscopic tumor spread outside the level(s) containing the γ-probe-identified sentinel node(s). In only 1 case was the metastatic node not the γ-probe-posi-tive one, but an adjacent one. Lymphoscintigraphy with 99mTc seems reliable in identifying the sentinel node(s) and might contribute to the reduction of surgical morbidity by reserving therapeutic neck dissection for cases with histologically confirmed nodal metastasis.
Comparison of Various Methods of Electromyographic Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery
Authors: Tschopp Kurt P. , Gottardo Christine
Published: October 2014

In the present study, 3 types of electrodes for recurrent laryngeal nerve (RLN) monitoring are compared: 1) intralaryngeal surface electrodes attached to a conventional endotracheal tube, 2) monopolar needle electrodes placed on the vocal cords by direct laryngoscopy, and 3) bipolar needle electrodes inserted intraoperatively through the cricothyroid ligament. Data were collected from stimulation of 21 RLNs in 16 patients undergoing thyroid surgery. The reliability in terms of distinct electromyographic (EMG) potentials following stimulation of the RLN was 100% with monopolar and bipolar needle electrodes and 76% with intralaryngeal surface electrodes. The mean (±SD) amplitudes of the EMG potentials were 1.61 ± 1.6 mV, 2.37 ± 1.8 mV, and 0.35 ± 0.4 mV for the monopolar endolaryngeal, bipolar transligament, and intralaryngeal surface electrodes, respectively. The advantages and disadvantages of each type of electrode are discussed.
Delayed Presentation of Lymphatic Malformation of the Cervicofacial Region: Role of Trauma
Authors: Rahbar Reza , Rowley Helena , McGill Trevor J. , Perez-Atayde Antonio R. , Healy Gerald B.
Published: October 2014

Lymphatic malformations (LMs) are uncommon congenital lesions that may occur throughout the body, although the head and neck region is the most common site. Most LMs are seen at birth. However, they may present in adolescence or adulthood, mainly as a result of trauma or infection. We report the case of a 7-year-old boy who presented with an LM of the cervicofacial region causing airway compression. We discuss the causes of delayed presentation of these congenital lesions. An overview of the causation, natural history, diagnosis, and treatment options is presented.
Ultrasonography in a Nasal Cavity Filled with Water during Endoscopic Sinus Surgery
Authors: Noda Kazuhiro , Doi Katsumi , Tamura Manabu , Kubo Takeshi
Published: October 2014

We developed a new ultrasonographic imaging technique to be used in a water-filled nasal cavity during endoscopic sinus surgery, and estimated how well surgically dangerous sites were depicted. Our newly developed balloon can completely fill the choana, preventing water from leaking into the pharynx. The balloon enables endoscopic sinus surgery to be relatively safely performed in “flowing water.” Fifteen patients with chronic sinusitis underwent endoscopic sinus surgery under local anesthesia, and a MicroTip Radial probe was inserted into the water-filled nasal cavity. The orbital contents, skull base, and maxillary sinuses were visualized in all cases. Even in cases with a thin lamina papyracea, the boundary of the orbit could be judged from the motion of the orbital contents. Ultrasound information obtained in real time will be useful for improving the safety of endoscopic sinus surgery. Our ultrasonographic imaging technique can provide an early warning to the surgeon and thereby prevent severe complications.
Abrupt Onset of Sensorineural Hearing Loss and Tinnitus in a Patient with Capillary Telangiectasia of the Pons
Authors: Morinaka Setsuko , Hidaka Akinari , Nagata Hiromi
Published: October 2014

Capillary telangiectasia is often found incidentally on magnetic resonance imaging and may be associated with minor neurologic symptoms, but there has been little evidence about whether such lesions are responsible for these symptoms. Here we report a case of capillary telangiectasia of the right mid pons, which was associated with the abrupt onset of tinnitus and sensorineural hearing loss. Examination of the auditory brain stem responses showed abnormalities of waves III and IV on the left and bilateral prolongation of the interwave intervals. Optokinetic nystagmus showed slight left-right asymmetry.
Glottal Configuration, Acoustic, and Aerodynamic Changes Induced by Variation in Suture Direction in Arytenoid Adduction Procedures
Authors: Inagi Katsuhide , Ford Charles N. , Connor Nadine P. , Bless Diane M. , Suzuki Tatsutoshi , Nakajima Masami
Published: October 2014

Arytenoid adduction is a phonosurgical procedure in which the arytenoid cartilages are approximated to reduce posterior glottal gap size and improve voice. Voice outcomes following arytenoid adduction are not always optimal. The goal of this study was to systematically vary suture direction and force of pull on the arytenoid cartilages in a human excised laryngeal model to determine the optimal combination of factors for reducing glottal gap and improving voice. Several factors demonstrated significant effects. Changes in suture direction and force of pull affected glottal configuration in both the horizontal and vertical planes. Increased force of pull on the muscular process resulted in increased adduction of the vocal process for all suture directions. Changes in suture direction and force of pull also affected acoustic and aerodynamic measures of induced voice. Therefore, voice outcomes can be optimized with arytenoid adduction if the vocal fold plane is accurately adjusted.
Endoscopic Botulinum Toxin Injection for Cricopharyngeal Dysphagia
Authors: Parameswaran Mahesh S. , Soliman Ahmed M. S.
Published: October 2014

Twelve patients underwent 17 endoscopic injections of botulinum toxin type A in the cricopharyngeus muscle for the treatment of dysphagia and cricopharyngeal spasm over a 3-year period. The patient's charts were reviewed. Preoperative and postoperative symptoms, examination, and swallowing studies were reviewed. Eleven of the 12 patients had improvement in their symptoms, which lasted for a mean of 3.8 months. Two patients elected cricopharyngeal myotomy for permanent correction of their dysphagia. There was 1 case of postoperative neck cellulitis in an immunocompromised patient undergoing simultaneous excision of a thyroglossal duct cyst. We conclude that endoscopic injection of botulinum toxin is a relatively safe and viable technique for the treatment of dysphagia associated with cricopharyngeal spasm. It requires simple tools readily available to otolaryngologists. Larger, prospective controlled studies are necessary to establish its effectiveness and role in the management of this condition.
Effect of Substance P Injection into the Nucleus Tractus Solitarius of Rats on Cricothyroid and Thyroarytenoid Motor Activity and Cardiovascular and Respiratory Systems
Authors: Bauman Nancy M. , Luschei Erich S. , Wang Deqiang , Talman William T.
Published: October 2014

Identification of central neurotransmitters that mediate laryngeal adductor and/or tensor activity may prove useful in managing pathological laryngeal adduction as occurs in laryngospasm or apparent life-threatening events. The putative transmitter substance P (SP) is found in the nucleus tractus solitarius (NTS), in which laryngeal afferents terminate. Therefore, we studied the laryngeal, cardiovascular, and respiratory effects of SP injected into the NTS of rats. We completed bilateral stereotactic injections of 20 nL of SP (15 μmol) or control solution into the region of the NTS, the dorsal motor nucleus (DMN), or the nucleus gracilis (GR) in 30 anesthetized rats. Changes in diaphragm, cricothyroid (CT), and thyroarytenoid (TA) electromyography (EMG), as well as blood pressure (BP), were compared. The injection sites were verified histologically. Injection of SP into the NTS altered CT and/or TA EMG activity in all animals. The change ranged from complete inhibition, to a phasic increase, to a tonic increase. No change in laryngeal adductor EMG activity was seen in 8 of 9 animals after SP injections into the DMN (4/5) or GR (4/4), but 1 animal demonstrated brief inhibition of CT and TA EMG activity after SP injection into the DMN. Injection of SP into the NTS induced central apnea and a significant decrease in BP in all animals. The duration of apnea tended to be longer after NTS injections than after DMN or GR injections (p < .10 and p < .05, respectively). We conclude that stereotactic injections of putative neurotransmitters in rats may be accomplished to identify effects on laryngeal motor activity. Direct application of SP into the NTS consistently elicits a change in CT and/or TA EMG activity, ranging from inhibition to excitation. This model may prove useful in evaluating pharmacological targets of central reflex activity to manage life-threatening laryngeal reflex activity.
Impact of Vocal Cord Paralysis on Cricoarytenoid Joint
Authors: Müller Andreas , Paulsen Friedrich P.
Published: October 2014

To demonstrate structural changes in the cricoarytenoid joint after recurrent laryngeal nerve paralysis, we performed a laboratory investigation of fixed arytenoid cartilages from adult humans obtained during laser surgical arytenoidectomy in cases of bilateral vocal fold paralysis, analyzing the articular cartilage, the joint capsule, and the attached laryngeal musculature. Ten arytenoid cartilages from adult humans were studied by means of histology, as well as scanning and transmission electron microscopy. After long-standing denervation (>6 months), all arytenoid cartilages showed degenerative changes in their joint surface structure at various levels of intensity. The articular surface revealed fibrillation in some places, demasking of collagen fibrils next to the joint surface, and formation of chondrocyte clusters near the joint surface. All specimens also showed muscle atrophy. We conclude that long-standing recurrent laryngeal nerve paralysis does not result in ankylosis of the cricoarytenoid joint, as assumed, but the articular cartilage undergoes structural changes comparable to those in osteoarthritis. Structural changes in the articular cartilage and in the surrounding musculature hamper efforts at joint function recovery, as do procedures aiming solely at either medialization or lateralization of the vocal fold.
Effect of Acoustic Tumor Extension into the Internal Auditory Canal on Distortion-Product Otoacoustic Emissions
Authors: Odabasi A. Onur , Telischi Fred F. , Stagner Barden , Gomez-Marin Orlando , Martin Glen
Published: October 2014

We studied the effects on distortion-product otoacoustic emissions (DPOAEs) of internal auditory canal (IAC) extension of acoustic neuromas (ANs) with the hypothesis that cochlear patterns of DPOAEs would be more commonly observed when the IAC was completely filled with tumor because of direct tumor involvement of either the inner ear or its blood supply. In a retrospective analysis of 86 patients with surgically proven ANs, DPOAEs were classified as having cochlear or noncochlear patterns on the basis of comparisons with the behavioral pure tone thresholds. The results of behavioral audiometry and DPOAEs were compared with the extension of the tumor into the IAC, which was categorized as full or partial. Of the 86 patients, 58 had tumors with full IAC extension, and 28 had tumors with partial IAC involvement. Cochlear patterns of DPOAEs were found in 55.2% of the tumors in the full IAC group and in 71.4% of those in the partial IAC group (not statistically different). It was concluded that the extent of IAC involvement by ANs was not significantly related to the negative effects of the tumor on cochlear function as represented by DPOAEs.
Immortalization of Rat Eustachian Tube Epithelial Cells by Adenovirus 12-Simian Virus 40 Hybrid Virus
Authors: Jin Sunji , Ueyama Shigehiro , Moon Sung-Kyun , Rhim Johng S. , Gu Xin-Xing , Lim David J.
Published: October 2014

The eustachian tube epithelial cells play an important role in the initial pathogenesis of otitis media. In order to study the role of the eustachian tube epithelial cells in the pathogenesis of otitis media, we have established a rat eustachian tube epithelial cell line. The cell line was derived by infecting primary cultures of eustachian tube epithelial cells with the adenovirus 12-simian virus 40 (Ad12-SV40) hybrid virus. The immortalized cells have retained the morphological characteristics of the parental cells and show positive staining with anti-cytokeratin antibodies (a marker for epithelial cells), but not with anti-vimentin antibodies (a fibroblast marker). The cells have been in continuous culture for more than 10 months and have undergone 38 passages. Western blotting and cell staining have confirmed the expression of the SV40 T antigen and p53. Chromosomal analysis indicates that the cell line is aneuploid and derived from male rat epithelial cells. Together, our results suggest that the cell line originated from eustachian tube epithelial cells from a male rat and was successfully immortalized by the Ad12-SV40 virus.