bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-Related Alterations in Myosin Heavy Chain Isoforms in Rat Intrinsic Laryngeal Muscles
Authors: Suzuki Tatsutoshi , Bless Diane M. , Connor Nadine P. , Ford Charles N. , Lee Kyungah , Inagi Katsuhide
Published: October 2014

Deficits in voice and swallowing are found in the elderly, but the underlying neuromuscular mechanisms are unclear. A potential mechanism may be denervation-induced muscle fiber transformation to a slower-contracting type of muscle fiber. This study examined young, old, and denervated rat laryngeal muscles (lateral thyroarytenoid, lateral cricoarytenoid, and posterior cricoarytenoid) to examine differences in myosin heavy chain (MHC) composition. Results of sodium dodecyl sulfate–polyacrylamide gel electrophoresis analyses indicated that all muscles were composed predominately of type IIB MHC. With aging and denervation, type IIB was reduced and type IIX, a slower-contracting isoform, was increased in the lateral thyroarytenoid and lateral cricoarytenoid muscles. In the posterior cricoarytenoid muscle, the MHC composition was relatively unchanged. These findings suggest that aging may affect laryngeal adductory function by altering muscle fiber type composition to a slower-contracting isoform, in a manner similar to that observed with denervation.
Bacteriology of Acute and Chronic Sphenoid Sinusitis
Authors: Brook Itzhak
Published: October 2014

Aspirates of 16 acutely infected and 7 chronically infected sphenoid sinuses were processed for aerobic and anaerobic bacteria. A total of 29 isolates were recovered from the 16 cases of acute sphenoid sinusitis (1.8 per specimen): 22 aerobic and facultative (1.4 per specimen), and 7 anaerobic (0.4 per specimen). Aerobic and facultative organisms alone were recovered in 10 specimens (62%), anaerobes alone were isolated in 3 (19%), and mixed aerobic and anaerobic bacteria were recovered in 3 (19%). The predominant aerobic and facultative species were Staphylococcus aureus (9 isolates), Streptococcus spp (9), and Haemophilus influenzae (2). A total of 28 isolates were recovered from the 7 cases of chronic sphenoid sinusitis (4.0 per specimen): 11 aerobic and facultative (1.6 per specimen) and 17 anaerobic (2.4 per specimen). Aerobic and facultative organisms alone were recovered in 1 instance (14%), anaerobes alone in 3 instances (43%), and mixed aerobes and anaerobes in 3 instances (43%). The predominant aerobic bacteria were gram-negative bacilli ( Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa; 1 each). The predominant anaerobes included Peptostreptococcus spp (4 isolates), Prevotella spp (5), and *** Fusobacterium spp (4). These findings illustrate the unique microbiology of acute and chronic sphenoid sinusitis.
Paraganglioma of the Cervical Sympathetic Trunk
Authors: Birchler Manfred T. , Went Philip T. , Landau Klara , Stoeckli Sandro J.
Published: October 2014

We report the case of a 17-year-old man who presented with left-sided Horner's syndrome. Magnetic resonance imaging revealed a spindle-shaped cervical tumor in the left paravertebral space. During operation, a tumor originating from the left sympathetic trunk was found. The histopathologic analysis showed a sympathetic paraganglioma. The sympathetic trunk is an extremely rare location for a cervical paraganglioma; only a few cases have been reported in the literature.
Simple Technique for Tracheocutaneous Fistula Closure in the Pediatric Population
Authors: Eaton Debbie A. , Brown Orval E. , Parry David
Published: October 2014

To review our experience with cauterization of persistent tracheocutaneous fistulas in children, we performed a retrospective review of patients who underwent cauterization of tracheocutaneous fistulas by the senior author (O.E.B.) from 1986 to 2001 in an academic, tertiary care children's hospital. We studied 13 pediatric patients ranging in age from 2.5 to 17.5 years of age at the time of surgery. Twelve patients underwent cauterization under endoscopic visualization. One patient underwent superficial cauterization of the tract without endoscopy. All patients had at least a 1-year history of an indwelling tracheotomy. All patients were decannulated at least 1 year before fistula cauterization. Of the 12 patients who underwent intraoperative airway endoscopy, the internal orifice of the fistula tract was specifically visualized and seen to be patent in 10. One patient was noted to have internal mucosalization of the tract, and no discrete opening to the trachea was noted in the other patient. Eleven patients had complete closure of the fistula site at follow-up (range, 2 weeks to 2 years). One patient developed a leak during a coughing spell 2 days after the operation, and the fistula was noted to be closing with a small leak at follow-up. Another patient (with Treacher Collins syndrome) ultimately required a repeat tracheotomy for persistent obstructive sleep apnea. This patient was the only one admitted after the operation, for a pulmonary infiltrate. No other patients required airway support in the immediate postoperative period. Cauterization of tracheocutaneous fistulas in children is a relatively simple, effective, and safe technique.
Postoperative Dysphagia versus Neurogenic Dysphagia: Scintigraphic Assessment
Authors: Valenza Venanzio , Gajate AnaMaria Samanes , Galli Jacopo , D'Alatri Lucia , Girolamo Stefano Di , Reale Francesca , Paludetti Gaetano
Published: October 2014

In order to differentiate the features of dysphagia that occur after supraglottic horizontal laryngectomy from those that occur during neurologic diseases, we divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2 comprised 8 patients who had residual dysphagia at least 1 year after supraglottic laryngectomy; and group 3 included 15 patients with various neurologic and neuromuscular disorders. In group 1, the mean values (±2 SD) of selected semiquantitative parameters were consistent with those reported in the literature for normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not significantly altered, and moderate tracheobronchial postdeglutitive aspiration was present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index was significantly increased (p = .0003) as compared to normal subjects in all cases (maximum value, 40%; mean value, 23%) and was associated in all cases with slight but consistent postdeglutitive aspiration. In group 3, the oral and esophageal phases were significantly prolonged and the retention indices were significantly increased. Statistical analysis documented a significant increase in oral transit time (p = .003), esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal retention index (p = .0007), and esophageal retention index (p = .009) as compared to normal subjects. The swallowing pattern was also altered by 1) an early loss of the bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition, reduced lingual propulsion, or the return of a small part of the bolus into the oral cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was present in some cases, mainly in patients affected by post-stroke dysphagia. On the basis of the obtained results and considering the low doses of radiation delivered to the patient (0.043 Gy), the limited invasiveness, and the excellent patient tolerance, scintigraphy appears to be clinically valid in the functional study of swallowing and in identifying different deglutition disorders.
Endoscopic Treatment of Upper Airway and Digestive Tract Lesions Caused by Caustic Agents
Authors: Saetti Roberto , Barion Umberto , Silvestrini Marina , Mirri Loris , Cutrone Cesare , Narne Surendra
Published: October 2014

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.
Post-Tonsillectomy and -Adenoidectomy Hemorrhage in Nonselected Patients
Authors: Windfuhr Jochen P. , Chen Yue-Shih
Published: October 2014

This retrospective study was undertaken to evaluate the incidence of hemorrhage in nonselected patients requiring surgical treatment after adenoidectomy (group 1; 7,785 patients) or tonsillectomy with or without adenoidectomy (group 2; 6,794 patients). Postoperative bleeding from the tonsillar fossae occurred in 200 patients (2.94%). Primary hemorrhage (<24 hours) clearly prevailed in groups 1 (86%) and 2 (78%). There was 1 case with a lethal outcome following tonsillectomy (0.007%). Bleeding from the epipharynx occurred in 17 patients of group 1 (0.21%). A total of 5 patients received blood transfusions, all of them belonging to group 2 (0.07%). The latest bleeding occurred 6 days (adenoidectomy) and 18 days (tonsillectomy) after surgery. Hemorrhage following both procedures is a rare complication predominantly occurring several hours after surgery and in nonselected patients. Male gender, age over 70 years, infectious mononucleosis, and a history of recurrent tonsillitis were found to be risk factors for posttonsillectomy hemorrhage.
Management of Bilateral Arytenoid Cartilage Fixation versus Recurrent Laryngeal Nerve Paralysis
Authors: Eckel Hans Edmund , Wittekindt Claus , Schroeder Ursula , Klussmann Jens Peter , Sittel Christian
Published: October 2014

Bilateral arytenoid cartilage fixation (ACF) closely resembles vocal cord immobility due to recurrent laryngeal nerve paralysis (RLNP). This study sought to determine the etiologic differences between these Two entities and to derive conclusions about treatment. The charts of 218 consecutive adult patients with immobility of both vocal cords requiring surgery for airway restoration were reviewed. The results of laryngeal electromyography and laryngotracheoscopy were used to distinguish ACF from RLNP. In 186 patients (85.3%), RLNP was identified. Of these, 154 paralyses (82.8%) were caused by surgical interventions, 5 (2.7%) were caused by previous intubation, 16 (8.6%) were caused by various malignancies, and 7 (3.8%) were neurogenic. In 4 patients (2.2%), the cause remained unclear. We identified ACF in 32 patients. The etiologic factors included previous long-term intubation in 22 patients (68.8%), short-term intubation in 3 patients (9.4%), Wegener's granulomatosis in 3 patients (9.4%), rheumatoid arthritis in 2 patients (6.3%), previous laryngeal surgery in 1 patient (3.1%), and caustic ingestion in 1 patient (3.1%). Additional second-site airway stenosis was found in 10 of the RLNP patients (5.4%) and in 15 of the ACF patients (46.9%). All RLNP patients had endoscopic surgery without temporary tracheotomy. Eighteen ACF patients required open surgery, and 4 were managed endoscopically but required temporary tracheotomy. The etiologic factors were significantly different for the Two entities under study. Additional sites of stenosis were more frequent in ACF patients. Stenosis due to RLNP could be managed endoscopically without preliminary tracheotomy, while ACF frequently required open surgery and temporary tracheotomy.
Physiologic Effects of Open and Closed Tracheostomy Tubes on the Pharyngeal Swallow
Authors: Gross Roxann Diez , Mahlmann Jeanne , Grayhack Judith P.
Published: October 2014

Studies linking aspiration and dysphagia to an open tracheostomy tube exemplify the possibility that the larynx may have an influence on oropharyngeal swallow function. Experiments addressing the effects of tracheostomy tube occlusion during the swallow have looked at the presence and severity of aspiration, but few have included measurements that capture the changes in swallowing physiology. Also, hypotheses for the importance of near-normal subglottic air pressure during the swallow have not been offered to date. As such, the aim of this study was to compare the depth of laryngeal penetration, bolus speed, and duration of pharyngeal muscle contraction during the swallow in individuals with tracheostomy tubes while their tubes were open and closed. The results of this series of experiments indicate that within the same tracheostomized patient, pharyngeal swallowing physiology is measurably different in the absence of subglottic air pressure (open tube) as compared to the closed tube condition.
Vocal Outcome after Endoscopic Cordectomies for Tis and T1 Glottic Carcinomas
Authors: Peretti Giorgio , Piazza Cesare , Cantarella Giovanna , Balzanelli Cristiano , Nicolai Piero
Published: October 2014

A cohort of 101 patients with previously untreated glottic cancer (15 Tis, 66 T1a, and 20 T1b) who underwent endoscopic CO2 laser excision between January 1995 and December 1997 was prospectively analyzed. The depth and extension of the excision were graded according to the European Laryngological Society Classification including 5 types of cordectomy. All patients were subsequently examined every 2 months for a period ranging from 30 to 66 months (mean, 48 months). The rates of 5-year overall survival, disease-free survival, ultimate local control with laser alone, and laryngeal preservation were 85%, 87%, 93%, and 95%, respectively. Sixty-nine patients underwent, at least 1 year after surgery, videolaryngostroboscopy combined with perceptual and objective evaluation of the voice, and spirometry. Acoustic parameters were compared with those obtained in a matched control group by Kruskal-Wallis test. No statistically significant difference was found (p > .05) between patients submitted to subepithelial (type I) and subligamental (type II) cordectomies and controls.
Decreasing Incidence of Malignant Tumors of the Paranasal Sinuses in Sweden
Authors: Norlander Tomas , Silfverswärd Claes , Frödin Jan-Erik , Änggård Anders
Published: October 2014

We reviewed 141 cases of paranasal sinus tumors treated at Karolinska Hospital from 1960 to 1980. Of these tumors, 100 were located in the maxillary sinus, 32 in the ethmoidal sinuses, 8 in both the ethmoidal and maxillary regions, and 1 in the sphenoidal sinus. The male-to-female ratio was 2.1 to 1. Squamous cell carcinoma and adenocarcinoma were the most frequent types of tumors (55% and 13%, respectively). Treatment included surgery, irradiation, or both. The 5-year survival rate was 34% for squamous cell carcinomas and 64% for adenocarcinomas. When compared to a previous material of patients treated at the same hospital from 1940 to 1950, the proportion of poorly differentiated squamous cell carcinomas had increased significantly. The age-adjusted incidence rate decreased from 1.2 to 0.4 for male patients and from 0.7 to 0.3 for female patients between 1960 and 1980. We conclude that the incidence of malignant paranasal sinus tumors has decreased, and that squamous cell tumors now seem to be generally less differentiated than they were 50 years ago.
Long-Term Results of Radiofrequency Volumetric Tissue Reduction of the Palate for Snoring
Authors: Said Bassem , Strome Marshall
Published: October 2014

To assess the long-term efficacy and morbidity of radiofrequency volumetric tissue reduction (RFVTR) of the soft palate for snoring, we examined the medical records of 39 patients who received this treatment at an academic medical center. Telephone interviews were conducted with the patients to evaluate the long-term subjective efficacy and sequelae. The average follow-up was 14 months (range, 3 to 26 months). Twenty-eight patients (72%) responded to treatment, defined as a 4-point decrease on a 10-point scale. The self-reported snoring score decreased an average of 52% (8.8 ± 1.9 to 4.2 ± 2.9). Sixty-seven percent of the patients were satisfied. The response to treatment did not always correlate with patient satisfaction. The snoring relapse rate was 11% among responders. No significant differences were identified between responders and nonresponders. No significant complications or long-term sequelae were observed. We conclude that RFVTR of the palate is a relatively safe and effective long-term treatment for snoring. Defining realistic pretreatment expectations is important in maximizing patient satisfaction.
Microvascular Transplantation of Tracheal Allografts in the Canine Model
Authors: Genden Eric M. , Gannon Patrick J. , Deftereos Maria , Smith Shane , Urken Mark L.
Published: October 2014

The inability to reconstruct extensive and often life-threatening tracheal defects is a clinical dilemma. The objective of this study was to achieve microvascular revascularization and transplantation of long-segment circumferential tracheal allografts in a canine model. Fifteen mongrel dogs were randomly assigned to 5 treatment groups. Twelve dogs underwent an excision of an 8-cm tracheal segment followed by transplantation and microvascular revascularization of an 8-cm cervical trachea allograft. Group 1 (n = 4) was treated with 10 mg/kg per day of cyclosporin A (CsA) and 7.5 mg/kg per day of mycophenolate mofetil (MM). Group 2 (n = 4) was treated with 5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 3 (n = 4) was treated with 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 4 (n = 2) underwent an autograft tracheal transplant and received postoperative 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 5 (n = 1) did not undergo surgery, but received postoperative 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. The animals were maintained for a duration of 30 days, during which time the graft was assessed by routine endoscopic examination and tracheal biopsies. Ex vivo, tracheal autografts were examined grossly for graft healing and microscopically for histologic architecture. The mean survival times were 13.25 days (group 1), 16 days (group 2), and 20 days (group 3). There was 1 early allograft failure secondary to microvascular thrombosis, and there were 4 delayed failures secondary to postoperative wound infections. Five dogs were euthanized before the end of the 30-day observation period because of failure to thrive or hypocalcemic tetany. None of the dogs in the study demonstrated endoscopic or histologic evidence of rejection before euthanasia. Postmortem examination of the surviving dogs demonstrated normal histologic architecture without evidence of rejection. For the first time, we have achieved allotransplantation of long tracheal segments based on the cranial thyroid artery and internal jugular vein. Minimal systemic immunosuppression appears to be associated with a higher survival rate and a lower complication rate.
Neuroepithelial Cysts of the Middle Ear
Authors: Chen Arthur F. , Samy Ravi N. , Gantz Bruce J. , Kirby Patricia , Rubinstein Jay T.
Published: October 2014

Neuroepithelial cysts are lesions of the central nervous system that have previously been reported in cerebral parenchyma, in the spinal cord, and within the ventricles in association with the choroid plexus. We describe 2 cases of neuroepithelial cysts of the middle ear. One was diagnosed after surgery for a retraction pocket and chronic otitis media complicated by an intraoperative cerebrospinal fluid (CSF) leak. The other produced bilateral spontaneous CSF otorrhea and mimicked the presentation of arachnoid granulations. Both cases were verified with immunohistochemical stains. Neuroepithelial cysts, although rare, should be considered in the differential diagnosis of spontaneous CSF otorrhea or an epitympanic mass.
Update on Treatment of Marshall's Syndrome (Pfapa Syndrome): Report of Five Cases with Review of the Literature
Authors: Berlucchi Marco , Bonvini Maria G. , Meini Antonella , Lombardi Davide , Plebani Alessandro , Nicolai Piero
Published: October 2014

Marshall's syndrome or PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is a recently described pediatric periodic disease characterized by recurrent febrile episodes associated with head and neck symptoms. The origin of this syndrome is unknown, and it can last for several years. During healthy periods, patients grow normally. The differential diagnosis includes other diseases characterized by periodic fevers, such as familial Mediterranean fever, familial Hibernian fever, hyperglobulinemia D syndrome, Behçet's disease, cyclic neutropenia, juvenile rheumatoid arthritis, and several infectious diseases. Many treatments have been used, with various results, including antibiotics, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, colchicine, antiviral medicines, steroids, Cimetidine, and tonsillectomy. We describe 5 new patients affected by PFAPA syndrome who were observed at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy, from November 2000 to August 2001. All children underwent physical examination, bacterial, fungal, and viral cultures, chest radiography, and several laboratory studies. The patients were treated by successful tonsillectomy, and after a mean follow-up of 10 months, no recurrence was observed. An analysis of the literature is also presented with particular emphasis on the differential diagnosis of this rare illness and the results of the different therapeutic options.
Recurrent Laryngeal Nerve Regeneration by Tissue Engineering
Authors: Kanemaru Shin-Ichi , Omori Koichi , Hiratsuka Yasuyuki , Kojima Hisayoshi , Ito Juichi , Nakamura Tatsuo , Magrufov Akhmar , Shimizu Yasuhiko
Published: October 2014

The recurrent laryngeal nerve (RLN) does not regenerate well after it has been cut, and no current surgical methods achieve functional regeneration. Here, we evaluate the functional regeneration of the RLN after reconstruction using a biodegradable nerve conduit or an autologous nerve graft. The nerve conduit was made of a polyglycolic acid (PGA) tube coated with collagen. A 10-mm gap in the resected nerve was bridged by a PGA tube in 6 adult beagle dogs (group 1) and by an autologous nerve graft in 3 dogs (group 2). Fiberscopic observation revealed functional regeneration of the RLN in 4 of the 6 dogs in group 1. No regeneration of the RLN was observed in any dog in group 2. We also tested for axonal transport, and measured the compound muscle action potential. The RLN can be functionally regenerated with a PGA tube, which may act as a scaffold for the growth of regenerating axons.
Effects of Age, Sex, and Disorder on Voice Range Profile Characteristics of 230 Children
Authors: Wuyts Floris L. , Heylen Louis , Rooman Raoul , Mertens Fons , Van de Heyning Paul H. , Caju Marc Du , De Bodt Marc
Published: October 2014

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, Two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.
Noise-Induced Autoimmune Sensorineural Hearing Loss
Authors: Gupta Reena , Sataloff Robert T.
Published: October 2014

Typically, autoimmune sensorineural hearing loss has been described as a slowly progressive, asymmetric hearing loss that is responsive to medications traditionally used in the treatment of other autoimmune conditions. These medications include steroids and cytotoxic drugs. Inciting factors in autoimmune inner ear disease are rarely cited. We describe a case of episodic sudden hearing loss triggered consistently by environmental noise. The hearing loss was responsive to steroids at the time of each occurrence and was determined to be autoimmune. This case raises questions about the relationship between autoimmune inner ear disease and sensitivity to environmental noise that warrant further research.
Effect of Growth Factors on Hyaluronan Production by Canine Vocal Fold Fibroblasts
Authors: Hirano Shigeru , Heisey Dennis , Bless Diane M. , Ford Charles N.
Published: October 2014

Hyaluronan (HYA) is considered to be a crucial factor in scarless wound healing and in maintaining tissue viscosity of the vocal fold lamina propria. In this study focusing on the effects of growth factors, we examined how HYA is produced and controlled in canine cultured vocal fold fibroblasts. Fibroblasts were taken from the lamina propria of the vocal folds of 8 dogs and cultured with and without growth factors. The production of HYA in the supernatant culture was quantitatively examined by enzyme-linked immunosorbent assay. Hepatocyte growth factor, epidermal growth factor, basic fibroblast growth factor, and transforming growth factor β1 all stimulated HYA synthesis from vocal fold fibroblasts. These effects differed with the concentration of growth factors and the incubation period. We also examined how frequently the growth factors had to be administered in order to maintain appropriate levels of HYA. A single administration was sufficient to maintain appropriate HYA levels for at least 7 days. The present studies have demonstrated positive effects of growth factors in stimulating HYA production. Further in vivo study is needed to clarify the usefulness of these growth factors in the management of vocal fold scarring.
Prevalence of Nasal Polyps in Adults: The Skovde Population-Based Study
Authors: Johansson Leif , Åkerlund Anders , Melén Ingemar , Holmberg Kenneth , Bende Mats
Published: October 2014

Patients with nasal polyps present repeatedly in otorhinolaryngology practices, but the prevalence of nasal polyps in the general population is not known. Our objective was to investigate the prevalence of nasal polyps in an adult Swedish population in relation to age, gender, asthma, and aspirin intolerance. A random sample of 1,900 inhabitants over the age of 20 years, stratified for age and gender, was drawn from the municipal population register in Skövde, Sweden, in December 2000. The subjects were called to clinical visits that included questions about rhinitis, asthma, and aspirin intolerance and examination by nasal endoscopy. In total, 1,387 volunteers (73% of the sample) were investigated. The sample size was adequate, with a good fit to the whole population. The prevalence of nasal polyps was 2.7% (95% confidence interval, 1.9–3.5), and polyps were more frequent in men (2.2 to 1), the elderly (5% at ≥60 years of age), and asthmatics. Subjective symptoms of aspirin intolerance were not found to correlate with polyps. Nasal polyps were more common in adults than was stated by the a priori estimate. The Skövde population-based study is considered representative for the Swedish population.
Computed Tomographic versus Surgical Findings in Complicated Acute Otomastoiditis
Authors: Migirov Lela
Published: October 2014

Computed tomography (CT) plays an important role in planning surgery in cases of complicated middle ear infection. The purpose of this study was to determine, by comparison of radiologic and surgical findings, the diagnostic value of CT in complicated acute otomastoiditis. The study group consisted of 37 patients without a history of chronic ear disease. In this study, CT enabled correct diagnosis of 26 of 27 cases (96%) of subperiosteal abscess, 17 of 18 cases (94%) of mastoid cortex erosion in patients with subperiosteal abscess, and several intracranial complications, including epidural abscess, subdural empyema, and perisinus abscess. The CT scan produced overdiagnosis in some cases: sigmoid sinus thrombosis in 1 patient, mastoid cortex erosion in 2 children with subperiosteal abscess, and bone erosion toward the posterior cranial fossa in 1 patient with meningitis. My findings suggest that subperiosteal abscess is a disease of young children; however, when it develops in an older child, cholesteatoma should be suspected. Furthermore, acute mastoiditis complicated with facial nerve paralysis may be associated with cholesteatoma in 66% of cases. My experience showed that CT had a sensitivity of 97% and a positive predictive value of 94% in the diagnosis of complicated acute otomastoiditis.
Two-Stage Removal of an Impacted Foreign Body with an Epoxied Anchor
Authors: Isaacson Glenn
Published: October 2014

A stone impacted in a child's external auditory canal had defied all conventional means of removal. It was extracted successfully after attachment of a specially formed metal anchor with epoxy glue. The technique of and rationale for this approach are discussed.
Zoledronic Acid Inhibits Osteoclastogenesis in Vitro and in a Mouse Model of Inflammatory Osteolysis
Authors: Sudhoff Holger , Faddis Brian T. , Jung Jae Y. , Hildmann Henning , Ebmeyer Jörg , Chole Richard A.
Published: October 2014

This study assessed effects of the bisphosphonate zoledronic acid (ZLNA) on osteoclastogenesis. To assess the effect of ZLNA on osteoclast formation in vitro, we cultured mouse bone marrow cells under conditions that promote osteoclastogenesis. Administered at concentrations from 10−6 to 10−9 mol/L, ZLNA led to a dose-dependent inhibition of osteoclastogenesis. Combined TUNEL staining and histochemical staining for tartrate-resistant acid phosphatase showed that ZLNA induced apoptosis in osteoclasts and monocytic precursor cells. To study the effects of ZLNA in vivo, we placed keratin particles onto the surface of the parietal bone of mice to induce localized inflammatory bone resorption. Three experimental groups received daily subcutaneous injections of ZLNA (1, 3, or 10 μg/kg body weight) from 4 days before surgery until 5 days after keratin implantation. The ZLNA significantly reduced osteoclast recruitment in a dose-dependent manner, but did not affect the degree of inflammation or the mineral apposition rate.
Hypopharyngeal Pharyngoplasty in the Management of Pharyngeal Paralysis: A New Procedure
Authors: Mok Paul , Woo Peak , Schaefer-Mojica Jacqueline
Published: October 2014

Dysphagia after a high vagal nerve injury may be associated with a patulous hypopharynx that serves as a reservoir for pharyngeal secretions, contributing to primary or secondary aspiration. We describe a new hypopharyngeal pharyngoplasty procedure for the paralyzed pharynx to improve swallow. The paralyzed pyriform sinus is resected to remove insensate and redundant mucosa. The inferior constrictor muscle is then advanced anterior to the oblique line of the thyroid cartilage to improve pharyngeal tone and prevent pharyngeal dilatation. The surgery is performed in conjunction with medialization laryngoplasty and arytenoid adduction. The utility of this procedure is reviewed retrospectively in 8 patients. They were evaluated by clinical evaluation, fiberoptic endoscopic evaluation of swallow, and modified barium swallow study. All had significant preoperative dysphagia. Three patients were gastrostomy tube-dependent. After operation, all patients had subjective and objective improvements in swallow and progressed to peroral feeding. There were no operative complications. We conclude that hypopharyngeal pharyngoplasty diminishes pyriform sinus pooling and improves pharyngeal transit. Dysphagia patients with unilateral pharyngeal paralysis secondary to cranial nerve palsies may benefit from this new procedure.
Cymetra Injection for Unilateral Vocal Fold Paralysis
Authors: Karpenko Andrew N. , Meleca Robert J. , Dworkin James P. , Stachler Robert J.
Published: October 2014

Cymetra has shown excellent tissue biocompatibility, a low rate of resorption, and no tissue reactivity when injected for treatment of facial wrinkling. On the basis of these findings, we hypothesize that injection of Cymetra into the thyroarytenoid muscle for treatment of glottal incompetence may demonstrate similar findings and lead to long-term improvement in voice quality and glottal gap closure. Ten patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent transoral injection of Cymetra into the thyroarytenoid muscle. Each subject underwent preoperative and postoperative acoustic analysis, aerodynamic measures, taped voice sampling, and videostroboscopy. Significant improvements were identified in maximum phonation time, relative glottal area, and subjective judgment of glottal competency. These results were not maintained at the 3-month study interval. No significant change in quantitative or subjective voice quality was noted for the study group during the investigation. Resorption of Cymetra may play a significant role in contributing to these findings.
Treatment of Idiopathic Sudden Sensorineural Hearing Loss with Antiviral Therapy: A Prospective, Randomized, Double-Blind Clinical Trial
Authors: Westerlaken Boris Olivier , Stokroos Robert Jan , Wit Hero Piet , Dhooge Inge Johanna Maria , Albers Frans Willem Jan
Published: October 2014

A subclinical viral labyrinthitis has been postulated in the literature to elicit idiopathic sudden sensorineural hearing loss (ISSHL). An etiologic role for the herpes family is assumed. Corticosteroids possess a limited beneficial effect on hearing recovery in ISSHL. In this study, we evaluated the therapeutic value of the antiherpetic drug acyclovir (Zovirax) on hearing recovery in 91 patients with ISSHL who received prednisolone in a prospective, randomized, double-blind, placebo-controlled, multicenter trial. The audiometric parameters included pure tone and speech audiometry. Subjective parameters studied included hearing recovery, a pressure sensation in the affected ear, vertigo, and tinnitus. A 1-year follow-up was obtained. Hearing recovery for the whole group averaged about 35 dB and was independent of the severity of the initial hearing loss or vestibular involvement. Speech audiometry improved from 49% to 75%. After 12 months, pressure sensation and vertigo decreased to 15.6% (acyclovir) and 10.3% (placebo) and 12.5% (acyclovir) and 10.7% (placebo), respectively. Tinnitus decreased slightly, to 46.9% (acyclovir) and 55.2% (placebo), in the same period (p > .05 for all parameters). We conclude that no beneficial effect from combining acyclovir with prednisolone can be established in patients with ISSHL.
In Vivo Visualization of Endolymphatic Hydrops in Guinea Pigs: Magnetic Resonance Imaging Evaluation at 4.7 Tesla
Authors: Zou Jing , Pyykkö Ilmari , Klason Tomas , Bretlau Poul , Bjelke Börje
Published: October 2014

In order to find out whether it is possible to visualize experimental endolymphatic hydrops in the cochlea with magnetic resonance imaging (MRI) at 4.7 T, we used 11 guinea pigs. Five normal guinea pigs were used as controls. Early manifestation of endolymphatic hydrops was evaluated in endolymphatic sac (ES)–intact animals (n = 6), and advanced manifestation in ES-damaged animals (n = 5) by means of MRI with gadolinium-diethylenetriaminepentaacetate-bismethylamide (Gd-DTPA-BMA) contrast agent. Hearing was tested with electrocochleography. The surface area of 3 partitions of the cochlea was used to quantify endolymphatic hydrops. The fine structure of the 3 partitions of the cochlea was visualized with MRI in all animals, as Gd-DTPA-BMA appeared mainly in the scala tympani and scala vestibuli. As early as 5 days after endolymphatic sac surgery, endolymphatic hydrops started to appear as visualized by MRI and also verified with histology. Severe damage to the inner ear barrier with Gd-DTPA-BMA leakage into the scala media was detected with MRI in 1 ES-damaged animal that had a 60-dB hearing loss. To conclude, endolymphatic hydrops can be visualized with high-resolution MRI by means of Gd-DTPA-BMA, and it is possible to quantify the extent of endolymphatic hydrops. Damage to the inner ear barrier or possible rupture of membranes can be shown with the assistance of Gd-DTPA-BMA.
Hearing Preservation Surgery in Vestibular Schwannoma: The Hidden Truth
Authors: Sanna Mario , Khrais Tarek , Piccirillo Enrico , Russo Alessandra , Augurio Angela
Published: October 2014

To compare the results of hearing preservation surgeries using different approaches — the enlarged middle cranial fossa approach and the retrosigmoid approach — and different classification systems, stressing the importance of preserving “normal hearing,” we performed a retrospective case review in a tertiary care medical center. The charts of 107 patients with vestibular schwannoma who underwent tumor resection were reviewed. Hearing preservation was reported according to 2 different classification systems: the modified Sanna classification and the classification of the American Academy of Otolaryngology—Head and Neck Surgery. The facial nerve results were graded according to the House-Brackmann scale. The hearing preservation rates differed markedly depending on the classification used. We conclude that hearing preservation in acoustic neuroma is a more difficult proposition than most surgeons appreciate, especially in terms of serviceable hearing.
Office-Based Treatment of Glottal Dysplasia and Papillomatosis with the 585-NM Pulsed Dye Laser and Local Anesthesia
Authors: Zeitels Steven M. , Burns James A. , Franco Ramon A. , Hillman Robert E. , Dailey Seth H. , Anderson R. Rox
Published: October 2014

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation, denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.
Roof of the Parapharyngeal Space: Defining Its Boundaries and Clinical Implications
Authors: Maheshwar Arcot A. , Pensak Myles L. , Kim Eun-Young , Keller Jeffrey T.
Published: October 2014

The roof of the parapharyngeal space (PPS) is poorly defined. Although it is generally described as having prestyloid and poststyloid compartments, we believe that these terms are imprecise. Therefore, we define its boundaries, partition, and compartments. We completed macroanatomical and microanatomical dissections in 10 specimens from 5 human cadaver heads; bone measurements in 50 dry skulls; and axial and coronal cross-sectional studies in 2 cadaveric specimens. The PPS roof is bordered laterally by the medial pterygoid fascia and medially by the pharyngobasilar fascia. The tensor veli palatini fascia (TVPF) partitions this roof into an anterolateral compartment containing fat and part of the deep lobe of the parotid gland, and a posteromedial compartment containing the cartilaginous part of the eustachian tube, internal carotid artery, internal jugular vein, and cranial nerves IX through XII. The anteroposterior length measures 32 mm (range, 26.1 to 36.9 mm), and the mediolateral width measures 16.3 mm (range, 12.1 to 21.3 mm). The PPS roof has 3 important bony landmarks (ie, scaphoid fossa, styloid process, sphenoid spine); 3 important fasciae (ie, medial pterygoid fascia, TVPF, pharyngobasilar fascia); and 2 compartments, which are anterolateral and posteromedial to the TVPF. We believe that this is the first report to specifically focus on the roof of the PPS.
Capsaicin Receptor Expression in Rat Laryngeal Innervation
Authors: Uno Toshiyuki , Koike Shinobu , Hirota Ryuichi , Bamba Hitoshi , Hisa Yasuo
Published: October 2014

Capsaicin elicits a sensation of burning pain by selectively activating sensory neurons that convey information about noxious stimuli to the central nervous system. Vanilloid receptor subtype 1 (VR1) and the vanilloid receptor-like protein 1 (VRL-1) are activated, not only by capsaicin, but also by noxious heat and protons, and it has been suggested that they are polymodal nociceptors. We investigated the expression of VR1 and VRL-1 in the rat larynx and nodose ganglion using VR1 and VRL-1 immunohistochemical analysis with visualization by diaminobenzidine reaction. Fibers positive for VRL-1 were detected in the laryngeal epithelium and lamina propria. Cells positive for VRL-1 were distributed in the intralaryngeal ganglia. Half of the neurons in the nodose ganglion had VR-1 immunoreactivity, and almost 10% of the nodose ganglion neurons were positive for VRL-1. These findings suggest that these capsaicin receptors play an important role in the nociception of the laryngeal innervation.
Otorhinolaryngological Procedures in the Fifteenth Century in Anatolia
Authors: Koç Ahmet , Erginoğlu Uğur , Karaaslan Osman
Published: October 2014

The author of one of the earliest surgical books was Serefettin Sabuncuoğlu (ad 1385 to 1468?). He is the author of Cerrahiyyetül-Haniyye (Imperial Surgery), which was written in 1465. This book contains miniatures of surgical procedures, and there were many important and major new contributions to the surgical literature originally described by Sabuncuoğlu himself. He described surgical management of nasal polyposis, nasal fracture, facial palsy, mandibular fracture and dislocation, hoarseness and constriction of the breath, tumors of the tonsil and uvula, laryngeal tumors, and goiter. The aim of this report is to describe his contributions to otorhinolaryngology.
Ecthyma Gangrenosum: A Rare Cutaneous Manifestation of a Potentially Fatal Disease
Authors: Solowski Nancy L. , Agarwal Anurag , Yao Francisca Brunelle , Nagorsky Matthew
Published: October 2014

Ecthyma gangrenosum is a cutaneous lesion frequently associated with Pseudomonas aeruginosa bacteremia, although it may develop in the absence of bacteremia and may originate from other bacterial and fungal organisms. Ecthyma gangrenosum most often occurs in patients with neutropenia and other immunocompromised hosts. It typically occurs on the extremities and gluteal and perineal regions. We report a rare case of ecthyma gangrenosum presenting as an aggressive necrotic skin lesion on the nasal ala of a patient with myelofibrosis. Tissue and blood cultures were positive for P aeruginosa. This clinical entity should be considered when otolaryngologists are asked to evaluate necrotic cutaneous lesions of the head and neck.
Transforming Growth Factor-β1, Myofibroblasts, and Tissue Remodeling in the Pathogenesis of Tracheal Injury: Potential Role of Gastroesophageal Reflux
Authors: Jarmuz Theresa , Roser Susanne , Gal Anthony , Rivera Hilda , Roman Jesse
Published: October 2014

Subglottic stenosis (SGS) is characterized by the obliteration of the tracheal lumen due to excessive deposition of connective tissue. We hypothesize that tracheal injury triggers the early production of transforming growth factor-β1 (TGF-β1), a factor implicated in fibroproliferative disorders. In turn, TGF-β1 stimulates the transformation of tracheal fibroblasts into myofibroblasts with increased matrix production and scar contraction that might be influential in laying the foundation for the development of SGS. Consistent with this hypothesis, histologic analysis of tracheas from humans with SGS and from rats with experimental tracheal injury revealed increased α–smooth muscle actin—positive cells as compared to control tracheas, suggesting increased myofibroblast differentiation. Rat tracheal fibroblasts exposed to TGF-β1 or gastric juice in vitro showed increased expression of α–smooth muscle actin, alterations in the expression of matrix molecules, and increased contraction of collagen gels. These findings suggest that gastric juice or other agents of tracheal injury promote tissue remodeling through the stimulation of the differentiation of fibroblasts into myofibroblasts.
Diagnosis and Therapeutic Management of Iatrogenic Parotid Sialocele
Authors: Capaccio Pasquale , Paglia Massimo , Manzo Raffaele , Minorati Davide , Ottaviani Francesco
Published: October 2014

Salivary gland sialoceles are relatively common and may be a complication of trauma with a penetrating salivary gland injury or may be a complication of salivary gland surgery. The development of new diagnostic tools such as magnetic resonance sialography and endoscopic techniques has led to further improvements in the clinical and diagnostic assessment of this condition, and botulinum toxin therapy has recently been described in the management of parotid sialoceles. We here report the case of a 41-year-old patient with an unusually complicated parotid sialocele following an unsuccessful attempt to remove a stone located in the distal third of Stensen's duct. Magnetic resonance sialography and sialoendoscopy were used in order to obtain an adequate diagnostic assessment. The patient underwent extracorporeal lithotripsy that led to partial symptom regression. After the development of a parotid abscess, he received antibiotics and a botulinum toxin type A injection that induced spontaneous drainage and disappearance of the symptoms. Magnetic resonance sialography and sialoendoscopy are promising new diagnostic techniques for better noninvasive management of iatrogenic sialoceles.