bluuebunny/crossref_metadata_2025 huggingface dataset:
Parotid Gland Carcinoma: Analysis of Prognostic Factors
Authors: Calearo Carlo , Storchi Omero Fini , Pasture Antonio , Polli Gianni
Published: October 2014

The histologic variety of parotid gland carcinomas, their different natural history, and the peculiar anatomy of the parotid region can make prognosis and therapeutic strategy quite controversial. The present study was designed to evaluate those prognostic factors able to affect the long-term results in a group of 167 consecutively treated parotid epithelial malignancies. The continuous or discrete covariants considered as potential prognostic factors are age, sex, histotype, grading, TNM and pTNM classification, facial nerve involvement, type of surgery on the tumor site and on nodes, facial nerve resection, and postoperative radiotherapy. All the material has been statistically analyzed and the results have been compared with the principal data published. According to the analysis, the most relevant prognostic factors in parotid gland carcinomas appear to be pTN staging, tumor grading, facial nerve involvement, and local extension. These factors could reliably predict the patient's chance for survival, and thus influence the therapeutic strategy.
Dynamics of Subneoglottic Lumen in Tracheoesophageal Phonation
Authors: Mohri Mitsuhiro , Kinishi Minoru , Amatsu Mutsuo
Published: October 2014

The patient who employs tracheoesophageal (TE) phonation uses expiratory air passing through the TE fistula to vibrate the mucosa of the neoglottis located in the hypopharynx. To clarify the dynamics of the subneoglottic lumen during phonation, we performed fiberoptic endoscopy and fluoroscopy in 13 TE speakers. During phonation, fiberoptic endoscopy showed concentric closure of the esophagus with ballooning of the subneoglottic lumen, followed by opening of the esophagus during inspiration. Fluoroscopy revealed a dilated subneoglottic lumen and a closure of the esophagus at the bottom of the lumen during phonation. These findings provide evidence for a mechanism to protect against the influx of air deep into the esophagus during TE phonation. We conclude that during TE phonation, a closed airway is established from the lung to the neoglottis that enables the TE speaker to use expiratory air effectively for phonation.
Flash Pump Dye Laser Treatment of Laryngeal Papillomas
Authors: Bower Charles M. , Flock Stephen , Waner Milton , Schaeffer Robert
Published: October 2014

To evaluate the feasibility and safety of the flash pump dye (FPD) laser for the treatment of laryngeal papillomas, we performed a prospective nonrandomized trial comparing FPD and carbon dioxide (CO2) laser treatment of laryngeal papillomas in a tertiary care children's hospital. Nine patients from 2 to 20 years of age with severe recurrent laryngeal papillomas were enrolled in the study. All patients underwent CO2 laser debulking of papillomas on the left hemilarynx, with 8 W continuous or pulsed energy. The right hemilarynx was treated with the FPD laser with 12 to 77 pulses at 8 to 12 J, through a custom-designed 90° firing fiber. An end point of blanching and purpura of the papillomas was used. The main outcome measures were the safety and ease of operation with the FPD laser, and decreased papilloma size based on visual inspection at 2 weeks postoperative and at the next laser procedure. Seven patients were irradiated 1 time with an FPD laser, and 2 patients 2 times. No intraoperative complications were noted. One patient developed early postoperative stridor. No patients described more discomfort, and 5 patients described their voice as being the same as or better than it was after prior CO2 laser procedures. Five patients had a 90% or more decrease in size of papillomas on the FPD-irradiated side 2 weeks postoperatively. Three patients had approximately a 50% reduction. A treatment effect was noted in all patients, and was similar to the results noted on the CO2 laser-treated side. Early results with FPD laser treatment of laryngeal papillomas suggest the protocol is relatively safe and feasible. Long-term results are pending. Because the FPD laser coagulates rather than vaporizing tissue, potential advantages may include decreased scarring relative to CO2 laser treatment, and improved patient and operator safety.
Treatment of Benign Positional Vertigo Using Heels-Over-Head Rotation
Authors: Furman Joseph M. , Cass Stephen P. , Briggs Brian C.
Published: October 2014

Particle repositioning, using either bedside techniques or whole-body manipulation devices, has been used effectively to treat benign positional vertigo (BPV). We assessed the efficacy of particle repositioning using a device designed and built specifically to treat BPV that rotated patients 360° heels-over-head in their sagittal body plane while their heads were turned to align the posterior semicircular canal with the plane of rotation. Eye movements were monitored during the maneuver by an infrared video recording system that allowed subsequent review of the induced nystagmus. Our results indicate that 1) heels-over-head rotation is an extremely efficacious procedure for treating patients with BPV and 2) the pattern of nystagmus during repositioning is consistent with the theory that free-floating debris is highly likely to account for BPV.
Neurotological and Auditory Brain Stem Response Findings in Human Immunodeficiency Virus—Positive Patients without Neurologic Manifestations
Authors: Castello Eolo , Baroni Nicoletta , Pallestrini Eugenio
Published: October 2014

Neurologic manifestations of human immunodeficiency virus (HIV) infection, rather than being a late complication of the disease, are principally correlated with the early central nervous system (CNS) localization of HIV. The CNS may be infected in the early stages of acquired immunodeficiency syndrome (AIDS) without evidence of neurologic disorders. Evoked potentials (visual, auditory, and somatosensory) and electronystagmographic test batteries have proven to be very sensitive in showing subclinical CNS disorders due to HIV. In this study, auditory brain stem response (ABR) and electronystagmographic test battery findings (smooth pursuit, saccades, caloric test) were performed in 29 neurologically asymptomatic, HIV-positive subjects at different stages of the disease. Compared to results of a control group, the ABR latencies of waves V, I, and III and interpeaks I-V and III-V were significantly increased in HIV patients. The same parameters did not differ significantly among the stages of the disease. In HIV-positive subjects, the accuracy of saccades was significantly reduced, while latency was normal. The velocity and the gain of pursuit were significantly reduced in HIV-positive patients, and 15 of 29 patients showed corrective saccades. Caloric tests revealed qualitative nystagmus abnormalities in 82% of HIV patients, while quantitative parameters were normal. The present results confirm that CNS involvement by HIV occurs early in the course of the disease. In particular, HIV does not seem to affect the labyrinth or the eighth cranial nerve, as demonstrated by the normality of the I-III value of the ABR and of the quantitative parameters of the caloric responses, but it does appear to involve the brain stem acoustic pathways, pontocerebellar pathways, and supratentorial areas.
Kimura's Disease: Two Case Reports and a Literature Review
Authors: Messina-Doucet Maria T. , Armstrong William B. , Pena Francisco , Allison Glen , Kim Joyce K. Valera
Published: October 2014

Kimura's disease (KD) is an allergic, inflammatory disorder of unknown cause. The typical presentation is in a young Oriental male with nontender subcutaneous swellings in the head and neck region, lymphadenopathy, peripheral eosinophilia, and elevated serum IgE. Many patients with KD also develop renal involvement. Treatment options range from conservative observation for asymptomatic patients to surgical excision, steroid therapy, and radiotherapy for symptomatic patients. Two cases of KD are presented. These emphasize not only the variability of disease presentation, but also the pitfalls of therapy leading to frequent recurrences. The literature is reviewed, summarizing patient presentation, differential diagnosis, current theories on causation, and therapy. A treatment protocol is also proposed.
Retropharyngeal Abscess and Epstein-Barr Virus Infection in Children
Authors: Takoudes Thomas G. , Haddad Joseph
Published: October 2014

A 6-year retrospective chart review was conducted of all pediatric patients with the diagnosis of retropharyngeal abscess (RPA) at the Columbia-Presbyterian Medical Center. The charts were examined for signs, symptoms, and serologic findings consistent with recent acute Epstein-Barr virus (EBV) infection. Of the 7 patients we studied, 4 had elevated immunoglobulin G antibodies that were consistent with recent acute EBV infection, and 3 patients were not tested. The 4 patients with positive titers also presented with signs typical for acute EBV infection, including fever (3/4), lymphadenopathy (4/4), and pharyngitis (4/4). Of note, the 2 patients who were older than expected for RPA (ages 18 and 11) had the most severe infections. We submit that there may be a role for EBV infection in the pathogenesis of RPA formation in children. Increasing age may correlate with a more severe infection in this setting.
Ectasias and Varices of the Vocal Fold: Clearing the Striking Zone
Authors: Hochman Ilan , Hillman Robert E. , Sataloff Robert T. , Zeitels Steven M.
Published: October 2014

Vascular malformations such as ectasias and varices (Es and Vs) are frequently encountered in patients who present with recurrent vocal fold hemorrhage and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface of the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous region (the striking zone), where the greatest aerodynamically induced shearing stresses occur during phonation. Treatment was performed with carbon dioxide laser cauterization (13 patients), or a new technique utilizing cold instrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant change in all patients in whom the cold instrument technique was used, and increased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted further hemorrhages by removing the the fragile Es and Vs from this injury-prone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of vocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.
Manometric Study of Paranasal Sinus Mucoceles
Authors: Kass Erik S. , Fabian Richard L. , Montgomery William W.
Published: October 2014

A paranasal sinus mucocele is a chronic cystlike lesion characterized by slowly progressive remodeling and expansion of the surrounding osseous walls. If left untreated, it may cause significant facial deformity, ophthalmic disturbances, and, in the worst instance, intracranial complications. According to a review of the literature, there is a long-held view that positive pressure exists within paranasal sinus mucoceles; however, to our knowledge, pressure measurements have not been recorded in humans. In this study, pressure measurements were taken of 4 paranasal sinus mucoceles by means of an 18-gauge needle probe and an amplified pressure transducer. The average value was +15 cm H2O with a range of +4 to +39 cm H2O. This study confirms the long-standing assumption that positive pressure exists within paranasal sinus mucoceles. The magnitude of the pressure was comparable to that which was found to be associated with bone resorption in several previously published studies. Further studies are needed to determine whether positive pressure and osseous remodeling are causally related in this condition.
Changes in Head and Neck Tumor Hypoxic Fraction during Split-Course Radiochemotherapy
Authors: Jund Rainer , Feldmann Horst-Jürgen , Stadler Peter , Wollenberg Barbara , Molls Michael
Published: October 2014

This study explored patterns of oxygen distribution in human tumors during primary radiochemotherapy. Patients with positive nodes from head and neck squamous cell carcinoma (n = 15) were investigated before therapy, before and after a 2-week respite, and at the end of the treatment. Intratumoral tissue oxygen tension (pO2) was measured with sterile polarographic needle electrodes and a computerized histography system. The 2 lowest pO2 classes, ie, 0 and 5 mm Hg, were designated the hypoxic fraction, and the mean and median pO2 were evaluated for each tumor. In the beginning, a marked variability in tissue pO2 was found. The initial size of the hypoxic fraction ranged from 0% to 61% of measured values. At the end of treatment, 4 tumors showed an increase in mean pO2, and 7 tumors a lower mean pO2 in comparison to the initial values. However, an impressive finding was that the hypoxic fraction of 9 tumors became smaller during the pause, 1 tumor showed no change, and 1 showed an increase in hypoxic fraction. The results show that there is a widely distributed tissue oxygenation with marked hypoxic zones in human neck nodes. During radiochemotherapy, tissue oxygenation changed, with great intertumor variability. A tendency toward a decrease of the hypoxic fraction after the respite could be seen. This change in tumor oxygenation during therapy needs further evaluation.
Carotid Artery Occlusion Due to Bacterial Paranasal Sinusitis
Authors: Özüer Mehmet Ziya , Ardiç Fazil Necdet , Yalçin A. Nevzat , Coskun Erdal , Akkoyunlu Nuran Sabirr
Published: October 2014

Complications of paranasal sinusitis still continue to be a serious health problem. We present an orbita-related complication of sinusitis in a patient with diabetic ketoacidosis. It was not a rhinocerebral mucormycosis, but a bacterial sinusitis-induced development of left cavernous sinus thrombophlebitis and carotid artery occlusion. We discuss the diagnosis, surgical options, and clinical outcome.
Smoking Increases Facial Skin Flap Complications
Authors: Kinsella John B. , Rassekh Christopher H. , Hokanson James A. , Wassmuth Zachary D. , Calhoun Karen H.
Published: October 2014

This study was undertaken to determine whether smokers have a higher risk of complications after reconstruction of facial skin defects. Ninety-one patients with facial skin defects reconstructed with local flaps were reviewed retrospectively. Thirty-eight (42%) were active smokers, 12 (13%) had not smoked for at least 1 year prior to surgery, and the rest were nonsmokers. Complications occurred in 23 patients (25%; 37% in smokers, 17% in ex-smokers, and 17% in nonsmokers; p < .03). All full-thickness skin losses and all cellulitis occurred in active smokers. We conclude that active smokers are at a higher risk for complications in facial skin flap surgery. That ex-smokers had a complication rate similar to that of nonsmokers suggests that part of smoking's adverse effect on skin flaps may be an acute phenomenon, and that smoking cessation for shorter (<1 year) periods of time before surgery may have a beneficial effect.
Transnasal Endoscopic Removal of an Orbital Cavernoma
Authors: Lot Guillaume , Portier Frédéric , Herman Philippe , Silhouette Bénédicte , Wassef Michel , Marianowski Rémi , Huy Patrice Tran Ba
Published: October 2014

The approach to posterior and medial orbital tumors is still a challenge, since poor functional results are frequent. We report a case of cavernoma successfully removed by a modified transnasal endoscopic procedure. The patient, a 56-year-old woman, complained of a decrease in vision of the left eye. Magnetic resonance imaging evidenced a lesion in the posterior part of the orbital cavity, inferior to the optic nerve, extending to the sphenoidal cleft. The lesion was isodense on T1-weighted images and showed contrast enhancement. Because of the medial location of the tumor, the patient was referred to the otolaryngology department by the neurosurgeons, and a transnasal endoscopic approach was chosen. A large exposure of the operative field was obtained, and a cavernoma was removed. Rapid relief of the symptoms was obtained. In view of this good result, we advocate the transnasal endoscopic approach in cases of inferomedial and posterior intraconal lesions as an alternative and addition to the standard techniques of orbital surgery.
Patients with Charge Association: A Model to Study Saccular Function in the Human
Authors: Guyot Jean-Philippe , Vibert Dominique
Published: October 2014

The term CHARGE association refers to a combination of congenital malformations, the mnemonic CHARGE designating the most frequently occurring anomalies in the constellation. “C” indicates coloboma of the retina, “H” heart defects, “A” choanal atresia, “R” retarded growth and/or central nervous system anomalies, “G” genital hypoplasia, and “E” ear anomalies and/or deafness. The inner ear anomaly consists of a specific form of labyrinthine dysplasia that includes Mondini dysplasia of the pars inferior (cochlea and saccule) and complete absence of the pars superior (utricle and semicircular canals). We observed the development of a child with CHARGE association up to the age of 10 years. There was complete absence of nystagmic response to bithermal caloric and rotatory pendular stimuli. A nystagmic reaction was elicited by the off-vertical axis rotation test, indicating stimulation of the saccular macula, the sole remaining vestibular sense organ in this dysplasia. This reaffirms that the saccule is a vestibular organ, even though it is located in the pars inferior. In spite of the severe bilateral vestibular deficit and coloboma of the retina, the child was able to walk at the age of 2 years. The delay in the development of walking was not due to central nervous system anomalies, as suggested by the “R” of the acronym CHARGE, but rather, to the severe sensorineural visual and vestibular deficits.
Carbon Dioxide Laser Microsurgery of Benign Vocal Fold Lesions: Indications, Techniques, and Results in 251 Patients
Authors: Remacle Marc , Lawson Georges , Watelet Jean-Baptiste
Published: October 2014

Two hundred fifty-one carbon dioxide laser-assisted cases of microphonosurgery are reported. Our series includes 167 women (66.5%) and 84 men (33.5%), with a mean age of 41 (±11) years. Single lesions represent 67.8% (n = 170) of the cases, with 20% (n = 50) being nodules, 18% (n = 44) Reinke's edema, 9% (n = 23) polyps, 8% (n = 19) sulci and related lesions, 6% (n = 16) mucosal cysts, 4% (n = 10) scars, 2% (n = 4) granulomas, and 2% (n = 4) vascular corditis. The cases with 2 or 3 lesions represented 32% (n = 81). Carbon dioxide laser-assisted microphonosurgery is efficient, provided the working parameters are strictly adhered to: micromanipulator micropoint providing a 250-μm laser beam for a 400-mm working distance; 0.1-second single pulses; and maximum power of 3 W with the superpulse wave. Glutaraldehyde-cross-linked collagen remains our filling material of choice in cases of vocal fold atrophy. Fibrin glue is useful for covering the resection area and for setting the microflaps. Microphonosurgery cannot be dissociated from speech therapy, the planning and duration of which, in relation to the procedure, depend on the nature of the initial lesion. Twenty to 30 sessions are usually adequate, but 6 months may be necessary in the case of sulcus vergetures. Our operating technique is derived from the microphonosurgery procedures with cold instruments. In addition to the classic advantage with regard to hemostasis, the carbon dioxide laser micropoint seems to make the dissection of microflaps easier.
Telescopic Video Microlaryngeal Surgery
Authors: Yeh Albert ReMing , Huang Hung-Meng , Chen Yu-Lin
Published: October 2014

Although traditional microscopic laryngeal surgery has been well developed, we still may encounter some clinical problems, including exposure difficulty, blind areas during examination, and inadvertent cutting through lesions. These problems may lead to an increased risk of complications or protracted or even repeated operations. We have partially overcome these problems since October 1992 with a new telescopic endolaryngeal surgery technique. This technique was developed by combining and modifying the principles of bronchoscopic surgery and endoscopic sinus surgery. With this technique, it is not necessary to use a very slim laryngoscope or apply overpressure on the larynx when introducing and suspending the laryngoscope. Difficult-to-examine regions can be accessed more easily. We can also get a 3-dimensional impression of lesions and related structures, so it is easier to determine a proper cutting line to avoid cutting through lesions. We consider this telescopic method to be a useful alternative to conventional microscopic laryngeal surgery.
Astrocyte Reaction in the Rat Vestibular Nuclei after Unilateral Removal of Scarpa's Ganglion
Authors: Li Hongyan , Godfrey Donald A. , Rubin Allan M.
Published: October 2014

Unilateral vestibular ganglionectomy (UVG) results in a complete degeneration of vestibular nerve fibers and terminals in the ipsilateral vestibular nuclear complex (VNC). A subsequent glial reaction may affect the activities of VNC neurons and thereby influence compensation for lesion-induced vestibular disorders. Expression of glial fibrillary acidic protein (GFAP), a specific marker for reactive astrocytes, was demonstrated immunohistochemically in the rat VNC at 7, 14, and 35 days after UVG. An increased GFAP-positive astrocytic response was evident at 7 days after lesion in all the VNC regions on the lesioned side and in some regions on the unlesioned side and remained through 35 days. The glial response included hypertrophy, which was more prominent at 7 days than at 14 days or 35 days, and proliferation, more prominent at the later times, of GFAP-positive astrocytes. Astrocytic projections around VNC neuron somata and proximal dendrites increased in number and became thicker and more elongated, especially at 14 days, in the lateral vestibular nucleus. It is suggested that UVG results in a bilateral astrocytic reaction in the VNC that would affect the subsequent compensation.
Decrease of Serum Levels of Soluble CD23 during Immunotherapy in Patients with Perennial Allergic Rhinitis
Authors: Tanaka Ayaki , Ohashi Yoshihiro , Nakai Yoshiaki
Published: October 2014

There is increasing in vitro evidence that soluble CD23 (sCD23) is capable of potentiating the synthesis of human IgE and is likely involved in the expression of allergic diseases. Our study has aimed at investigating whether serum sCD23 is elevated in patients with perennial allergic rhinitis as compared to nonatopic controls, whether sCD23 in perennial allergic rhinitis fluctuates during the natural course in untreated patients, and whether sCD23 is decreased by immunotherapy. This study included 139 patients with perennial allergic rhinitis due to Dermatophagoides farinae who gave informed consent to participation. They were divided into 2 groups — an untreated group and an immunotherapy group — according to their treatment background. Thirty-one nonallergic, healthy volunteers were included to serve as controls. Symptom scores and serum concentrations of IgE specific to D farinae and sCD23 were examined twice in each patient: at enrollment (first evaluation) and on a variant time course after enrollment (second evaluation). Serum concentrations of sCD23 were measured by a sandwich enzyme-linked immunosorbent assay. The level of sCD23 in patients with perennial allergic rhinitis was significantly higher than that in nonatopic controls (p < .0001). The level of sCD23 in perennial allergic rhinitis was correlated with the level of specific IgE against D farinae. The sCD23 level did not fluctuate during the natural course for a span of 2.8 ± 2.7 years in untreated patients (p = .1337), but was significantly decreased in patients who received immunotherapy for 2.7 ± 2.2 years (p < .0001). The rate of decrease in sCD23 was significantly correlated with the rate of decrease in specific IgE (rs = .523, p < .0001) and symptom scores (rs = .450, p < .0001). In conclusion, the reduction in sCD23 during immunotherapy is probably related to the decrease in specific IgE and also plays a role in mediating its clinical effect.
Successful Treatment of an Invasive Aspergillosis of the Skull Base and Paranasal Sinuses with Liposomal Amphotericin B and Itraconazole
Authors: Streppel Michael , Bachmann Gregor , Damm Michael , Arnold Georg , Stennert Eberhard
Published: October 2014

Invasive aspergillosis and fulminant aspergillosis are rarities with a high mortality. In the literature there is no patient surviving an extended invasive aspergillosis of the paranasal sinuses and skull base after failure of operative intervention and of postoperative amphotericin B therapy. We report a complete remission of an invasive, partially fulminant aspergillosis. After an incomplete removal of the mycotic mass, we started postoperative drug therapy with amphotericin B. Under this treatment, the mycosis progressed. Additionally, the patient developed severe side effects, so that the treatment was interrupted. At this moment, we started a combined antimycotic drug therapy with liposomal amphotericin B and itraconazole. Within 10 weeks, clinically and radiologically, there was complete remission. The patient died 63 weeks after this treatment, due to a fulminant bacterial pneumonia. Postmortem histologic examination showed no aspergillosis in the skull base, paranasal sinuses, or lung.
Hypoglossal Nerve Transfer for Laryngeal Reinnervation: A Preliminary Study
Authors: Paniello Randal C. , Lee Patty , Dahm J. David
Published: October 2014

The hypoglossal nerve is a logical donor nerve for hemilaryngeal reinnervation because 1) its activity coincides with normal laryngeal adduction during speech and deglutition; 2) it is a large nerve with many axons; and 3) donor site morbidity is low. This method of laryngeal reinnervation has not been previously reported. Previous studies using the ansa cervicalis for reinnervation have failed to show spontaneous activity. Hypoglossal-to—recurrent laryngeal nerve anastomosis was performed on a series of 5 dogs. The vocal folds were viewed monthly, with the animals awake, by infraglottic examination through a permanent tracheostomy. One dog failed due to technical error. The remaining 4 dogs began to exhibit spontaneous vocal fold adduction within 2 to 4 months. Vocal fold motion was synchronous with spontaneous tongue motion. Complete glottic closure was seen during swallowing at 3 to 5 months. Intraglottic pressure measurements following reinnervation were normal. Hypoglossal nerve transfer appears to be capable of providing functional adduction to the paralyzed hemilarynx. The potential advantages and disadvantages of this new technique are discussed.
Multifocal Cholesteatoma of the External Auditory Canal following Blast Injury
Authors: Wolf Michael , Megirov Lela , Kronenberg Jona
Published: October 2014

Posttraumatic cholesteatoma of the external auditory canal is a rare condition that may present years after the original injury. A unique case of multifocal cholesteatoma of the external auditory canal following blast injury is presented and discussed.
Vestibular Responses of Normal and Hydropic Ears of the Guinea Pig to Middle Ear Pressure Application
Authors: Sakikawa Yasuhiko , Wall Conrad , Kimura Robert S.
Published: October 2014

The pressure in the middle ears of normal and hydropic guinea pig ears was increased, and nystagmographic recordings were compared. Two-month unilateral hydropic guinea pigs and normal control guinea pigs underwent pressure treatments in which pressure was introduced into the middle ear. Significantly lower pressure was needed to elicit nystagmus in hydropic ears (mean 1.00 psi or 70.3 cm H2O) compared with normal control ears (mean 1.27 psi or 89.3 cm H2O). All of the normal control guinea pigs showed fast phase nystagmus toward the pressure-applied side, while hydropic guinea pigs showed nystagmus toward the normal ear. The duration of nystagmus was slightly longer in hydropic animals than in normal control animals. The slow phase velocity was slightly higher in the hydropic guinea pigs. Histologic examination revealed that the vestibular sensory cells remained normal and that changes in the organ of Corti were similar between the hydropic ears with and without pressure treatment at equal survival times.
Rat Eustachian Tube and its Musculature
Authors: Mulder Jef J. S. , Kuijpers Wim
Published: October 2014

The objective of this study was to evaluate the anatomy of the eustachian tube (ET) of the rat and the paratubal musculature. Microdissection and serial sections were used. The ET consists of collapsible membranous and membranocartilaginous segments and a noncollapsible bony segment. Tubal muscles are attached to the collapsible part; the salpingopharyngeus muscle (SPM) is well developed and consists of 3 distinct groups of muscle fibers; the tensor veli palatini muscle (TVPM) consists of 2 functionally different groups of fibers, but only 1 group assists in opening the ET. Attachment of the fibers of the SPM and TVPM that are involved in tubal opening is confined to the dorsal portion of the ET. This finding, together with the earlier observation that this part is mainly lined by squamous epithelium, strongly suggests that the dorsal part has a ventilatory function. The ventral portion of the ET, which is lined by ciliated-secretory epithelium and lacks the attachment of muscle fibers that can dilate the lumen, is assumed to serve clearance. The anatomic position of the levator veli palatini muscle suggests that this muscle contributes to the protective function of the ET. These findings are discussed with regard to the ET in humans.
Localization of Zinc in the Rat Submandibular Gland and the Effect of its Deficiency on Salivary Secretion
Authors: Ishii Kosuke , Akita Masumi , Sato Masami , Tomita Hiroshi
Published: October 2014

To clarify the role of zinc in the mechanism of salivary secretion, the effects of zinc deficiency on the morphologic findings and secretory function of the salivary gland were investigated with a rat model of chronic zinc deficiency, prepared by feeding a zinc-deficient diet, and a rat model of acute zinc deficiency, prepared by administration of a zinc chelator, dithizone. In rats with chronic zinc deficiency, the granule production in the granular duct cells was decreased, but the glandular epithelial cells and myoepithelial cells showed no degenerative or other destructive morphologic changes. The degranulation of the granular duct cells and acinar cells in response to acetylcholine hydrochloride seen in control rats was strongly inhibited in rats with acute and chronic zinc deficiency. The contractile response of the actin microfilament bundles in the myoepithelial cells to acetylcholine seen in the control rats was also absent in the zinc-deficient rats. Further, electron microscopy of the submandibular gland stained by Timm's method disclosed prominent zinc localization at the membrane surface, granules, and vesicles of the glandular epithelial cells and in the pits of the myoepithelial cells. These findings suggest that zinc, together with many zinc-dependent enzymes, is closely involved in the production and degranulation of secretory granules in the glandular epithelial cells, and also in the contraction of the myoepithelial cells in the submandibular gland.
Papillary Squamous Cell Carcinoma versus Verrucous Squamous Cell Carcinoma of the Head and Neck
Authors: Ferlito Alfio , Rinaldo Alessandra , Devaney Kenneth O. , Putzi Mathew J.
Published: October 2014

Papillary squamous cell carcinoma and verrucous squamous cell carcinoma of the head and neck may be confused. The clinicopathological profile of the two neoplasms is presented and the differential diagnosis is discussed. A correct diagnosis is imperative in order to institute the most appropriate treatment.
Integrity of the Auditory Pathway in Young Children with Congenital and Postmeningitic Deafness
Authors: Nikolopoulos Thomas P. , Mason Steve M. , O'Donoghue Gerard M. , Gibbin Kevin P.
Published: October 2014

This study compares the functional integrity of the auditory pathways of congenitally deaf and postmeningitically deaf children. We used the electrical auditory brain stem response evoked by promontory stimulation to assess 49 profoundly deaf children before cochlear implantation. The age at implantation ranged from 21 months to 15 years (mean 4.5 years). The onset of deafness was either congenital or up to the age of 2 years (mean 5 months). The cause of deafness was meningitis in 19 children (39%) and congenital in 30 (61%). The number of children with identifiable waveform components (eV, eIII, and eII) was significantly greater in the congenitally deaf group. We also analyzed the amplitudes, the latencies, and 4 parameters of the amplitude input-output functions. All the statistically significant differences were in favor of better responses in the congenitally deaf children. These results suggest that the functional status of the peripheral neurons of the auditory pathways may be more intact in congenitally deaf children than in postmeningitic children.
Endoscopic Sinus Surgery Improves Pulmonary Function in Patients with Asthma Associated with Chronic Sinusitis
Authors: Ikeda Katsuhisa , Tamura Gen , Shimomura Akira , Suzuki Hideaki , Nakabayashi Seiichiro , Tanno Noriko , Oshima Takeshi , Takasaka Tomonori
Published: October 2014

We evaluated the clinical efficacy of endonasal endoscopic sinus surgery (ESS) in patients with asthma associated with chronic sinusitis. Twenty-one patients (13 men and 8 women) from 27 to 72 years old were enrolled in this study. All patients had had sinus-related symptoms for more than 3 months and had computed tomographic evidence of paranasal sinus opacification. Fifteen patients underwent bilateral endonasal ESS under local anesthesia, and 6 other patients without surgery were controls. The sinus-related symptoms of the preoperative and postoperative periods were assessed via a questionnaire. The period 6 months prior to surgery was compared with that 6 months postoperatively with regard to peak expiratory flow and total dosage of systemic glucocorticoids. Sinus-related symptoms in the ESS group were significantly improved 6 months postoperatively. The average peak expiratory flow 6 months following surgery was improved in the ESS patients, ranging from 40 to 190 L/min. Seven patients showed a reduction in the need for corticosteroids, whereas 2 patients were unchanged and 2 patients required larger dosages. The remaining 4 patients needed no corticosteroids before or after ESS. No significant changes in sinus-related symptoms or peak expiratory flow were obtained for the control group. Improvement of paranasal sinus disease by successful ESS can alleviate pulmonary dysfunction in asthma associated with chronic sinusitis. We believe that adequate and positive treatment for chronic sinusitis would reduce not only the nasal and sinus-related symptoms evoked by chronic sinusitis, but also some of the signs induced by asthma.
Nasal Nitric Oxide Does Not Control Basal Nasal Patency or Acute Congestion following Allergen Challenge in Allergic Rhinitis
Authors: Silkoff Philip E. , Cole Philip , Roth Yehuda , Chapnik Jerry , McClean Patricia , Zamel Noe
Published: October 2014

Nasal nitric oxide (NO), a powerful vasodilator, could control the filling of nasal capacitance vessels, thus determining nasal patency and mediating the acute congestion accompanying allergen challenge. We examined the effect of topical N-nitro-l-argininemethyl-ester (l-NAME; 100 to 200 mg), an NO synthase inhibitor, on nasal NO and on nasal patency assessed by acoustic rhinometry in 7 subjects with nasal allergy, and in 4 subjects we examined the effects of nasal allergen challenge on nasal NO before and after a short course of nasal steroid. After l-NAME, nasal NO fell to 42.1% ± 15.7% of baseline (p < .0001) with no significant change in minimal cross-sectional area. After allergen challenge, acute congestion was associated with a significant fall in nasal NO, which returned to baseline by 4 hours, when the congestion resolved. Repeat challenge after 2 weeks of nasal corticosteroid yielded similar findings. A role for NO in modulating vascular tone was not supported by the present study.
Percutaneous Tracheostomy: A Comprehensive Evaluation
Authors: Moe Kris S. , Schmid Stephan , Stoeckli Sandro J. , Weymuller Ernest A.
Published: October 2014

Percutaneous tracheostomy (PT) is an ancient procedure that has recently attracted increasing interest. While there are numerous publications in the literature, there remains confusion due to the large variety of techniques and instruments with which it has been performed and the wide disparity in clinical outcome. This study evaluates the international literature on over 1,500 cases, classifies the techniques that have been used, analyzes the safety of each method, and reports a prospective outcome and cost analysis of 130 cases undergoing what we determined to be the safest method. We found that PT performed with the correct instruments and technique under bronchoscopic surveillance has a lower incidence of complications than open tracheostomy (OT). Cost estimation demonstrated that PT may be significantly more expensive than bedside OT. While we recommend PT as a relatively safe and expedient method of tracheostomy for selected intubated patients in an intensive care unit, it does not offer an advantage for patients who must be taken to the operating room, and should not deprive house officers of necessary experience in OT in this setting.
Schneiderian Papillomas of the Pharynx
Authors: Sulica R. Lucian , Debo Richard F. , Wenig Bruce M. , Sessions Roy B.
Published: October 2014

Sixteen cases of schneiderian-type mucosal papillomas arising in the nasopharynx and oropharynx are reported. The patients include 11 men and 5 women ranging in age from 45 to 79 years (median 62 years). In 12 patients, the papilloma was discovered as an incidental finding, and 2 patients complained of nasal airway obstruction. In the remaining 2 cases, information regarding the cause that led to discovery was unavailable. None of the patients had a prior or concurrent history of sinonasal (schneiderian) papillomas. Histologically, all of the tumors were identical to sinonasal inverted papillomas. Transnasal or transoral surgical excision was the treatment of choice. In 4 of the patients, recurrent tumor occurred within 6 months of initial resection, necessitating additional surgery. Extended follow-up information was available in 9 cases. Eight of the 9 patients are alive and have been free of disease over periods ranging from 15 to 201 months (median 114 months) from diagnosis. One patient was found to have a separate nasopharyngeal squamous cell carcinoma 14 months after the diagnosis of the schneiderian-type papilloma. This patient died secondary to the squamous cell carcinoma 30 months after his initial evaluation.
Therapy of Idiopathic Sudden Sensorineural Hearing Loss: Antiviral Treatment of Experimental Herpes Simplex Virus Infection of the Inner Ear
Authors: Stokroos Robert J. , Albers Frans W. J. , Schirm Jurjen
Published: October 2014

Experimental herpes simplex virus type 1 (HSV-1) labyrinthitis provides a model of idiopathic sudden sensorineural hearing loss (ISSHL). Corticosteroids improve the prognosis for hearing recovery in ISSHL, but the effects of acyclovir are unknown. To establish the therapeutic efficacy of acyclovir (Zovirax) and prednisolone in experimental HSV-1 viral labyrinthitis, we induced HSV-1 labyrinthitis in 12 guinea pigs. Three animals received no treatment, 3 received prednisolone, 3 received acyclovir, and 3 received both. Four other animals served as controls, receiving culture medium only. Hearing, HSV-1 antibody titers, and cochlear damage were evaluated. The HSV-1 labyrinthitis caused hearing loss within 24 hours. Combination treatment consisting of prednisolone and acyclovir resulted in earlier hearing recovery and less extensive cochlear destruction compared to prednisolone or acyclovir as a monotherapy. The beneficial effect of this treatment modality remains to be demonstrated in ISSHL.
Comparative Role of Peptide Leukotrienes and Histamine in the Development of Nasal Mucosal Swelling in Nasal Allergy
Authors: Numata Tsutomu , Hanazawa Toyoyuki , Konno Akiyoshi , Terada Nobuhisa , Yamakoshi Takayuki , Nagata Hiroshi
Published: October 2014

To evaluate the importance of histamine and peptide leukotrienes (LTs) in the development of nasal mucosal swelling in nasal allergy, H1 receptor antagonist (mequitazine, 6 mg, in 2 divided doses, Rhône-Poulenc Rorer, France) and LT receptor antagonist (ONO-1078, pranlukast, 450 mg, in 2 divided doses, Ono Pharmaceutical Co, Ltd, Osaka) were administered orally for 7 days to 16 subjects with perennial nasal allergy to house dust mites, and the effects of receptor blockers of these chemical mediators on the effective cross-sectional area of the nasal cavity (ECA) at rest, at exercise load, at antigen challenge, and at exercise load following antigen challenge were studied. After the administration of H1 receptor antagonist, ECAs at all measurement points slightly increased, but no statistical significance was observed. On the other hand, LT receptor antagonist inhibited ECAs 10 minutes after exercise load, just after the end of antigen challenge, 10 minutes later, and at exercise load following antigen challenge with statistical significance. These results suggest that LTs are involved markedly, and histamine slightly, in the development of nasal mucosal swelling in nasal allergy.
Extramedullary Solitary Plasmacytoma of the Head and Neck
Authors: Hotz Michel-Andre , Bosq Jacques , Schwaab Guy , Munck Jean-Nicolas
Published: October 2014

Monoclonal extramedullary plasmacytoma (EMP) is a rare, low-grade lymphoma found predominantly in the head and neck region. Only since the introduction of immunophenotyping techniques 2 decades ago has it been possible to differentiate EMP from benign polyclonal plasma cell proliferation. The purpose of this study was to trace the evolutionary profile of the disease under consideration of monoclonality assessment. The records of 24 patients with morphologically diagnosed EMP treated in a single institution underwent clinical and pathological review. Only 14 patients had true monoclonal plasmacytoma. No EMP-related deaths occurred. Two patients had local recurrence, and 2 patients developed multiple myeloma. Review of the literature confirms the low-grade malignancy of EMP. Diagnostic procedures must exclude benign polyclonal plasmacytoma, multiple myeloma, and solitary bone plasmacytoma. The slow natural progression of the disease and the rarity of secondary multiple myeloma favor nonmutilating local surgery whenever possible to avoid the long-term sequelae of radiotherapy.
Thoracic Duct Cyst: A Case Report and Review of 29 Cases
Authors: Mattila Petri S. , Tarkkanen Jussi , Mattila Severi
Published: October 2014

Cysts of the thoracic duct are rare. We report a case of a cervical thoracic duct cyst and review 29 thoracic duct cysts reported previously (19 mediastinal, 9 cervical, and 1 abdominal). The mean age of the patients was 47.6 years (range 17 to 86 years). Fourteen (46.7%) of the patients were asymptomatic. When symptoms were present, they ranged from retrosternal pain, dysphagia, and dyspnea to respiratory insufficiency and superior vena cava compression. Diagnosis of the cyst can be made after computed tomography or ultrasonography. The cystic fluid contains T lymphocytes and triglycerides in excess. The symptoms in a patient with a thoracic duct cyst are related to compression of adjacent structures. The most profound symptoms are likely to be produced by mediastinal cysts above the aortic arch. Treatment consists of surgical removal of the cyst and ligation of all lymphatics connected to the cyst.
Auditory Screening in Neonates by Means of Transient Evoked Otoacoustic Emissions: A Report of 2,842 Recordings
Authors: Aidan Didier , Avan Paul , Bonfils Pierre
Published: October 2014

The principal goal of an early identification program is to identify hearing impairment present at birth, in order to effect appropriate intervention as early as possible. Although recent research provides some evidence for the value of transient evoked otoacoustic emissions (TEOAEs) in neonate hearing screening, data are needed from large-scale clinical evaluations about the value of using TEOAEs for screening not only high-risk but also healthy neonates. A cohort of 1,421 neonates (2,842 ears) from the well-baby nursery was screened with TEOAEs in a 2-stage process. Neonates were referred from the first test prior to being discharged from the hospital. Those who failed were rescreened before the end of the first month. Those who did not pass the second-stage TEOAE screening were referred for diagnostic audiological evaluation for confirmation of hearing loss. Neonates transferred to a neonatal intensive care unit were not included in this study. Two neonates with bilateral sensorineural hearing loss of >40 dB hearing level were identified from this cohort. This study demonstrates the feasibility and the limitations of using TEOAEs as a universal hearing screening tool for all neonates. It confirms that the prevalence of hearing impairment in neonates has to be taken into account, even in a group of children without high-risk criteria. In France, a prevalence of 1.4 per 1,000 would represent 1,000 deaf children born every year, with reference to about 700,000 births per year. This study suggests that such universal screening programs would substantially increase the rate of early-identified infants with significant hearing impairment.
Percutaneous Implants in the Temporal Bone for Securing a Bone Conductor: Surgical Methods and Results
Authors: van der Pouw Catharina T. M. , Mylanus Emmanuel A. M. , Cremers W. R. J.
Published: October 2014

Clinical results of an extended follow-up of percutaneous titanium implants for application of bone conductors are presented. A simplified 1-stage surgical procedure is introduced. This study entails a consecutive series of 163 implants in 155 patients 9 to 80 years old who received a bone conductor coupled to a percutaneous titanium implant since June 1988 at the University Hospital Nijmegen. The maximum follow-up is 7 years. The bone conductor can be connected to a percutaneous abutment fixed to a titanium fixture anchored in the temporal bone. Several clinical trials from different clinics have shown its efficacy in patients with a conductive or mixed hearing loss. In this study attention is paid to the following issues: the occurrence of skin reactions, the condition of the skin around the abutment, the stability of the fixture, and a simplified surgical technique.