bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Motor Unit Activity of Human Intrinsic Laryngeal Muscles during Respiration
Authors: Chanaud Cheryl M. , Ludlow Christy L.
Published: October 2014

Individual motor units in the thyroarytenoid (TA) and cricothyroid (CT) muscles were studied in 10 normal human volunteers during quiet respiration. Both tonic and phasic firing patterns were found in both TA and CT units. The rate of firing was higher during inhalation than during exhalation in phasic TA units and in tonic CT units. Tonically active units had a higher firing frequency than phasically active units in both TA and CT muscles. Phasically active units corresponded with the respiratory cycle, with firing associated with inhalation in both the TA and CT muscles. A variety of firing patterns were found between units in both the TA and CT muscles, and in one subject, units recorded from the same muscle had very different firing patterns. The results suggest that although laryngeal motoneurons are modulated by the respiratory cycle, they do not respond uniformly to respiration.
Detection of Regulatory Factors of Lymphokine-Activated Killer Cell Activity in Head and Neck Cancer Patients Treated with Interleukin-2 and Interferon Alpha
Authors: Clayman Gary L. , Savage Howard E. , Young Gregory , Lavedan Pierre , Taylor Dorothy L. , Schantz Stimson P.
Published: October 2014

Interleukin-2 (IL-2) and interferon-α (INF-α) are biologic modifiers that have met with limited clinical success in the treatment of human malignancies. We conducted a phase 2 trial of IL-2-IFN-α in patients with advanced or unresectable squamous cell carcinoma of the upper aerodigestive tract. Two patients were analyzed sequentially for serum induction phase–blocking factors of lymphokine-activated killer (LAK) cell activity in their therapy. Serum also modulated LAK activity independent of autologous or allogeneic effector cells. Significantly inhibitory serum samples were stable in multiple freezings and thawings. Heat-treating the inhibitory serum, at 56°C for 30 minutes, only partially removed the serum inhibitory capacity. Sequential analysis of p55 and p75, subunits of IL-2 receptors, showed that absence of effector cell lytic activity was associated with markedly decreased fluorescence of the IL-2Rp75 subunit only. No significant alteration of the IL-2Rp55 subunit occurred with therapy. These studies support the theory that lymphocyte and multiple serum factors, developing during IL-2-IFN-α therapy, regulate the induction of in vitro LAK activity. Further understanding of these factors may lead to improvements in biologic modifier therapy.
Laryngeal Adenocarcinoma, Not Otherwise Specified, Treated with Carbon Dioxide Laser Excision and Postoperative Radiotherapy
Authors: Haberman Phillip J. , Haberman Rex S.
Published: October 2014

Glandular carcinomas of the larynx are aggressive neoplasms that comprise less than 1% of all laryngeal malignancies. Adenocarcinoma, not otherwise specified, is the most common histologic type. The rarity of these lesions has prohibited clarification of definitive therapy. Traditionally, radical surgery is performed because of the usually high stage at presentation and the relative insensitivity to radiotherapy. A case of glottic T1 adenocarcinoma, not otherwise specified, is reported. The tumor presented clinically as a vocal fold granuloma. The treatment modalities included endoscopic excision with the carbon dioxide laser and postoperative radiotherapy. The patient has been followed up for 39 months without evidence of recurrence or metastases. The current literature is reviewed in regard to treatment of laryngeal glandular carcinomas.
Ambulatory pH Monitoring in the Management of Reflux
Authors: Frank Michael , Komisar Arnold
Published: October 2014

Ambulatory pH monitoring is a useful tool in the diagnosis and treatment of different esophageal and pharyngeal complaints. We have studied its use in an office setting in 15 patients with suspected gastroesophageal reflux disease (GERD). The patients were monitored for at least 18 hours while wearing a two-channel probe at home. Data obtained confirmed severe GERD in 6 patients and chest pain without GERD in 2 patients. Two patients continued to have symptoms in spite of appropriate therapy, while 2 untreated patients had symptoms of GERD with normal pH studies. We feel this technique is relatively safe and cost-effective and causes minimal disruption of the patient's life-style, while enabling the physician to monitor therapy and help achieve a good therapeutic outcome.
Neuro-Otologic Abnormalities in Myelopathy Associated with Human T-Cell Lymphotropic Virus Type 1
Authors: Uno Kengo , Noguchi Satoshi , Minoda Ryosei , Ishikawa Takeru
Published: October 2014

Auditory testing (pure tone audiometry, auditory brain stem response), and vestibular tests (eye tracking test, optokinetic pattern test, and caloric test) were performed to define neuro-otologic abnormalities in myelopathy associated with human T-cell lymphotropic virus type 1. Of the eight patients tested, seven showed sensorineural hearing loss and one showed mixed hearing loss on pure tone audiometry. The auditory brain stem responses of five patients showed increases of the I-III and I-V interpeak latencies. Two patients showed fast superimposed saccadic movements on the smooth pursuit test, and one other patient showed canal paresis on the caloric test. These findings suggest both the presence of neuro-otologic abnormality and involvement of the brain stem in myelopathy associated with human T-cell lymphotropic virus type 1.
Development of Secretory Elements in Murine Tubotympanum: Lysozyme and Lactoferrin Immunohistochemistry
Authors: Park Keehyun , Lim David J.
Published: October 2014

Secretory activity, particularly of antibacterial agents such as lysozyme and lactoferrin, is an important aspect of the mucosal defense mechanism, and the development of these agents may have a direct bearing on the susceptibility of the ear to infection. In this study, the secretory cells of the murine tubal epithelium were first observed at gestational day 17. Although tubal glands began to develop on gestational day 18, their secretory activity was first shown on postnatal day 3. The number of secretory cells of the tubal epithelium increased rapidly immediately after birth, while that of the tubal glands showed a gradual increase from postnatal day 3. The epithelial secretory cells in the tubotympanum matured at birth, but the tubal glands matured gradually after birth. Lysozyme was first recognized in the epithelial secretory cells on postnatal day 1, while lactoferrin was first detected in the tubal glands on postnatal day 3. Both lysozyme and lactoferrin were co-localized in the serous cells of the tubal glands. The secretion of lysozyme and lactoferrin seemed to reflect the maturation of the secretory cells in the murine tubotympanum.
Gustatory Otorrhea: Frey's Syndrome of the External Auditory Canal
Authors: Redleaf Miriam I. , McCabe Brian F.
Published: October 2014

A case of Frey's syndrome of the external auditory canal is reported. The patient presented with unilateral gustatory otorrhea and thickened external auditory canal skin. Histopathologic examination of the canal skin showed sudomotor gland hyperplasia. Symptoms were relieved with canal skin excision and skin graft.
Australian Experience with Functional Endoscopic Sinus Surgery and its Complications
Authors: Kane Kevin
Published: October 2014

There have been reports of severe complications from functional endoscopic sinus surgery; however, it is unclear as to how the rate compares with that of the more traditional forms of intranasal surgery. To ascertain this, I circulated a questionnaire to 100 otolaryngologists in Australia known to have an interest in endoscopic nasal surgery and analyzed the results. The results of this survey show that complications are very infrequent and that the rates for functional endoscopic sinus surgery compare favorably with those of the traditional techniques.
Differential Osteoclast Activation in Endochondral and Intramembranous Bone
Authors: Chole Richard A.
Published: October 2014

Osteoclast activation within the temporal bone leads to hearing loss in a variety of pathologic conditions, including otosclerosis, osteogenesis imperfecta, Paget's disease of bone, and chronic otitis media. Although endochondral (EC) bone is remodeled in these diseases, it is relatively more resistant to remodeling when compared to intramembranous (IM) bone. In this study, localized bone resorption and remodeling were induced on the inner surface of the middle ear by pressurization with air to 10 mm Hg above atmospheric. Osteoclast surface increased in IM bone, but not in EC bone. This study supports the concept that there may be fundamental differences between EC and IM bone and that EC is more resistant to pressure-induced localized resorption than IM bone.
Development of the Paranasal Sinuses in Children: Implications for Paranasal Sinus Surgery
Authors: Wolf Gerald , Anderhuber Wolfgang , Kuhn Frederick
Published: October 2014

The pediatric nasal cavity and paranasal sinuses, when compared to those in adults, differ not only in size but also in proportion. Knowledge of the unique anatomy and pneumatization of children's sinuses is an important prerequisite to understanding the pathogenesis of sinusitis and its complications. It is also important in evaluation of radiographs and in planning surgical interventions. In order to study the development of the paranasal sinuses in children and relate clinical anatomy to sinus surgery, the sinuses in 102 pediatric skulls and cadaver heads were measured. The results were classified by stage of development into 4 different age groups: newborn and 1 to 4, 4 to 8, and 8 to 12 years. The characteristics of each group and their clinical importance for paranasal sinus surgery are described.
Outcome of Open Surgical Therapy for Glottic Carcinoma
Authors: Johnson Jonas T. , Hao Sheng-Po , Myers Eugene N. , Wagner Robin L.
Published: October 2014

A retrospective review was undertaken of the medical records of 270 patients with carcinoma of the glottic larynx. Patients were staged pathologically, and clinical pathologic correlates were made with outcome. In 92 patients with early glottic cancer, the 2-year rate of no evidence of disease for T1 was 98%, and for T2, 84%. Vertical partial laryngectomy resulted in voice preservation in 89%. Patients treated for advanced (T3 or T4) glottic carcinoma underwent total laryngectomy with or without neck dissection. Cervical nodes were involved in 22% of T3 and 41% of T4 patients at the time of treatment. Survival with no evidence of disease was chiefly determined by the development of regional recurrence, distant metastasis, and new primary cancer. Distant metastasis was associated with extracapsular spread (p = .003). Patients treated for T4 glottic carcinoma with neck dissection had improved survival compared with patients treated with laryngectomy alone (p = .006). Improved survival must be aimed at regional control, prevention, and management of distant metastasis and new primary carcinoma.
Air Pulse Quantification of Supraglottic and Pharyngeal Sensation: A New Technique
Authors: Aviv Jonathan E. , Martin John H. , Debell Mark , Keen Monte S. , Blitzer Andrew
Published: October 2014

There are no published studies evaluating the sensory capacity of the region innervated by the superior laryngeal nerve. A normal sensory capacity is important in this area, since hypesthesia or anesthesia of the pharynx and supraglottic larynx may result in dysphagia and aspiration. This often occurs after stroke or after ablative surgery of the pharynx and larynx. Evaluating the efficacy of restorative procedures for supraglottic and pharyngeal sensation is dependent on defining and quantifying the sensory deficit. We have developed a new, noninvasive method to measure sensation in the pharynx and supraglottic larynx. A puff of air—of precisely controlled duration and pressure—was delivered via a flexible telescope to the anterior wall of the pyriform sinus. Surface sensibility was determined according to the psychophysical method of limits by varying air pressure while holding puff duration constant. We conducted 204 trials in 20 healthy adults. The average sensory discrimination threshold was 2.09 ± 0.15 mm Hg. An intraclass correlation revealed excellent consistency (R̂ = .80). There was no statistically significant difference between the right and left sides. Brief air pulse stimulation is an easy, relatively safe, and reliable method of determining supraglottic and pharyngeal sensory discrimination thresholds.
Phrenic Nerve Reinnervation of the Cat's Larynx: A New Technique with Proven Success
Authors: Doyle Patrick J. , Westerberg Brian D. , Chepeha Douglas B. , Schwarz Dietrich W. F.
Published: October 2014

Reinnervation of the posterior cricoarytenoid muscle (PCA) should provide vocal cord abduction on inspiration, and passive adduction to enable phonation. Previous investigators have shown that reinnervation is possible, but results have not been clinically encouraging. When reinnervation was successful, the question remained whether it was provided by the transplanted nerve or by the ingrowth of adjacent nerves. In this study the phrenic nerve was transplanted directly into the PCA in a series of 12 cats. Fibrin glue was used to overcome nerve trauma and to prevent retraction of the nerve from the PCA. Laryngoscopy, electromyography, and retrograde labeling of the phrenic motoneurons provided evidence of functional reinnervation in 9 cats. Partial or complete failure in the remaining 3 was due to retraction of the nerve from the muscle. These results appear to justify trials of the procedure in humans.
Laryngeal Behavior in Unilateral Superior Laryngeal Nerve Paralysis
Authors: Tanaka Shinzo , Hirano Minoru , Umeno Hirohito
Published: October 2014

Laryngeal behavior in unilateral superior laryngeal nerve (SLN) paralysis was investigated in animal models and clinical cases. The occurrence of an oblique glottis caused by rotation of the posterior glottis to the paralytic side was the main focus of this study. The animal model study employed live dogs. When the SLN on one side was sectioned, spontaneous phonation did not cause a significantly oblique glottis. When the unaffected SLN was electrically stimulated during spontaneous phonation, an oblique glottis occurred. When the SLN was unilaterally stimulated during spontaneous phonation with both SLNs sectioned, a markedly oblique glottis occurred. In the clinical study, larynges of 17 patients with SLN paralysis were examined during a test task in which a low-pitched phonation was followed by a high-pitched phonation. The purpose of this task was to activate the unaffected cricothyroid muscle during the test phonation. Five patients could not perform the test task. The glottis obviously rotated in 9 patients, whereas no significant rotation of the glottis occurred in 3. One of the latter 3 had an incomplete paralysis, and the other 2 had marked scarring around the laryngeal framework. We conclude that a unilateral SLN paralysis causes a rotation of the posterior glottis to the paralytic side when the unaffected cricothyroid muscle is markedly activated. The test consisting of low-pitched phonation followed by high-pitched phonation is a relatively simple and accurate diagnostic procedure for unilateral SLN paralysis.
Distribution of Cytokeratins in the Vestibular Epithelium of the Guinea Pig
Authors: Meiteles Lawrence Z. , Raphael Yehoash
Published: October 2014

Cytokeratin expression in the vestibular labyrinth of the guinea pig was investigated with immunofluorescence and immunoperoxidase staining on surface preparations of the vestibular epithelium. Phalloidin, an F-actin—specific probe, was used to distinguish between hair cells and supporting cells. Cytokeratin expression was not found in the cytoplasmic domain of hair cells of the crista ampullaris, utricle, or saccule. Cytokeratin expression was abundant in supporting cells of the vestibular sensory epithelium. Electron microscopy revealed the presence of desmosomes, which are associated with cytokeratins, within type 2 hair cells of the vestibular epithelium. It appears that cytokeratins are absent within the cytoplasmic domain of hair cells, but are present in association with intercellular junctions. The functional significance of this unique pattern of cytokeratin expression within the vestibular epithelium is discussed.
Transmucosal Cricopharyngeal Myotomy with the Potassium-Titanyl-Phosphate Laser in the Treatment of Cricopharyngeal Dysmotility
Authors: Halvorson David J. , Kuhn Frederick A.
Published: October 2014

Cricopharyngeal dysfunction is a relatively uncommon disorder that is widely misunderstood. Cricopharyngeal dysmotility is thought to represent abnormal function of the upper esophageal or cricopharyngeal sphincter. The cause of this dysfunction is related to uncoordinated pharyngeal swallowing, achalasia, or a combination of these factors. Unfortunately, standard diagnostic tests have not consistently demonstrated a failure of the cricopharyngeal sphincter to malfunction; therefore, cricopharyngeal myotomy has been suggested as a diagnostic and therapeutic tool in the treatment of dysmotility. Our report focuses on the current trends in the diagnosis and treatment of cricopharyngeal dysfunction. We also present a case report of a transmucosal cricopharyngeal myotomy performed with the potassium-titanyl-phosphate (KTP) laser. The KTP laser was found to be relatively safe and effective and did not demonstrate significant morbidity. Our conclusion was that a transmucosal cricopharyngeal myotomy with the KTP laser may represent a viable alternative for patients with cricopharyngeal dysmotility.
Distribution of Substance P Immunoreactive Nerve Fibers in the Tracheal Submucosal Gland of Cats
Authors: Rha Ki Sang , Yasui Yukihiko , Majima Yuichi , Nakano Katsuma , Sakakura Yasuo , Ishihara Akinori
Published: October 2014

Immunohistochemistry combined with electron microscopy was employed to investigate the distribution of substance P—immunoreactive (SP-IR) nerve fibers in the tracheal submucosal gland of cats. The SP-IR nerve fibers were found to form a network around the glands. Numerous varicosities were also detected within the basement membrane of the acini and secretory tubules. All the intraglandular varicosities showed close spatial contact with serous cells, mucous cells, and myoepithelial cells. Our findings suggest that substance P—induced mucus secretion from tracheal submucosal glands in cats may be caused not only by a glandular contractile response of myoepithelial cells, but also by direct stimulation to both serous and mucous cells.
Rhinocerebral Aspergillosis in Patients Undergoing Bone Marrow Transplantation
Authors: Saah Daniel , Braverman Itzhak , Drakos Pavlos E. , Or Reuven , Elidan Joseph , Nagler Arnon
Published: October 2014

Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.
Endoscopic Endonasal Dacryocystorhinostomy: Results in 56 Patients
Authors: Weidenbecher Manfred , Hosemann Werner , Buhr Wolfgang
Published: October 2014

Fifty-six patients with a complete stenosis of the nasolacrimal duct were treated by endoscopically controlled intranasal dacryocystorhinostomy according to West. Forty-four patients had idiopathic stenosis and 12 had posttraumatic scarring. Revision surgery was done in 11 of these 56 cases (8 patients with a previous external Toti procedure, and 3 patients with previous endonasal surgery). Altogether, 95% of the patients were symptom-free (86%) or felt improved (9%) postoperatively. Surgical revision was successful in 82%. Of patients with an “idiopathic” stenosis, 84% were healed and an additional 11% were improved. The success rate in the 12 patients with posttraumatic stenosis was 92%. Endoscopic duct surgery is a highly successful procedure with a low complication rate, the worst complication being persistence of symptoms.
Effect of S-Carboxymethylcysteine on the Clearance of Middle Ear Effusion
Authors: Hori Fumihiko , Kawauchi Hideyuki , Mogi Goro
Published: October 2014

The therapeutic effect of S-carboxymethylcysteine (S-CMC) on otitis media with effusion was investigated by use of immune-mediated otitis media with effusion (OME) induced in chinchillas. The S-CMC was administered daily to individuals in two different doses (100 mg/kg and 200 mg/kg) for 2 weeks after the induction of immune-mediated otitis media. The severity of OME was evaluated by observation of the tympanic membrane under a surgical microscope, by tympanogram, and by histologic findings of the middle ear mucosa. Results of the study showed that the oral administration of S-CMC at a dose of 200 mg/kg of body weight is more effective than at a dose of 100 mg/kg in the clearance of middle ear effusions in experimental OME. An autoradiographic study using 14C-S-CMC revealed that orally administered S-CMC is rapidly absorbed by the digestive tract and transported to the tubotympanum via the circulation. The uptake and excretion by secretory cells were apparently greater in activated secretory cells. However, S-CMC does not act on the infiltrating cells to prevent the release of chemical mediators such as histamine and prostaglandin E2. This finding suggests that prophylactic use of S-CMC may not be anticipated.
“Window” Laryngoplasty: A New Combined Laser Endoscopic and Open Technique for Conservation Surgery
Authors: Shapshay Stanley M. , Wang Zhi , Perrault Donald F. , Rebeiz Elie E. , Pankratov Michail M.
Published: October 2014

Endoscopic laser resection of early laryngeal carcinoma is an increasingly used treatment modality; however, the limited exposure achieved and the alteration of vocal function are still major problems. A new surgical procedure, “window” laryngoplasty, has been devised and tested in an in vivo study in 6 canines with 50 days' survival. The right vocal cord was incised endoscopically with the carbon dioxide laser, and the en bloc specimen with adjacent thyroid cartilage was removed through a window approach made in the thyroid cartilage. A sternohyoid muscle flap based superiorly was inserted into the cartilaginous window to reconstruct a pseudocord with coverage of either mucosa or fascia. A diode laser soldering technique was used to secure the mucosal graft in place. Epithelial transplantation can be accomplished externally with precise endoscopic guidance for reliable placement of the pseudocord. The results show that the new technique, a combination of endoscopic and open approaches, may be a better treatment choice than standard vertical partial laryngectomy in selected patients. Advantages of this technique include adequate en bloc resection, including adjacent cartilage for pathologic evaluation, preservation of the integrity of most of the laryngeal framework, avoidance of tracheotomy, and better functional results.
Postnatal Development of the Vestibular Aqueduct in Relation to the Internal Auditory Canal
Authors: Fujita Shuji , Sando Isamu
Published: October 2014

To investigate a possible developmental relationship between the internal auditory canal (IAC) and the vestibular aqueduct (VA), we made the following measurements in 10 normal temporal bones from individuals 4 months to 70 years of age at death, using a computer-aided three-dimensional reconstruction and measurement method: the volume of the VA, the length of the IAC, and the distance between the IAC and the external aperture of the VA. The degree of periaqueductal pneumatization was also assessed qualitatively by means of a light microscope. The three parameters increased postnatally in parallel with the development of the periaqueductal air cells, and all pairwise comparisons of these parameters showed a statistically significant correlation. Our results indicate that the IAC and VA develop synchronously and in parallel with the development of the periaqueductal air cells. We believe that an understanding of this relationship will be of help during surgery involving the IAC and VA, and may shed some light on the morphological features of Meniere's disease.
Hyalinizing Clear Cell Carcinoma of Salivary Origin
Authors: Batsakis John G. , El-Naggar Adel K. , Luna Mario A.
Published: October 2014

The recently described hyalinizing clear cell carcinoma of salivary tissues joins other clinicopathologic entities in its segregation from the formerly nondescript and heterogeneous classification “clear cell neoplasms.” The carcinoma is preponderantly an intraoral (palate and base of tongue) neoplasm that is always infiltrative and capable of regional lymph node metastasis. To date, it has responded to locoregional control treatments and has not been life-consuming.
Life-Threatening Presentations of Fibrovascular Esophageal and Hypopharyngeal Polyps
Authors: Donovan Donald T. , Franklin Daniel J. , Owens Judith J. , Alford Eugene L. , Stewart Michael G. , McKechnie John C. , Schwartz Mary R.
Published: October 2014

Giant fibrovascular polyps of the esophagus and hypopharynx are benign tumors of the upper digestive tract Although a rare cause of asphyxiation, laryngeal impaction by a regurgitated polyp of the esophagus may be the initial symptom that brings the patient to request medical attention. Two new cases of giant fibrovascular polyps with dramatic and potentially life-threatening presentations illustrate the unpredictable behavior of these unusual tumors. Both patients presented to the emergency center with a history of coughing and eructation followed by temporary airway obstruction that was relieved by clenching a regurgitated fleshy mass between the teeth. Diagnostic and therapeutic intervention requires aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Tracheotomy was required in one patient, and successful endotracheal intubation provided satisfactory airway control in the second. Esophagoscopy revealed the origin of both tumors to be near the cricopharyngeal muscle. Complete surgical excision was curative in both cases.
Preoperatively Diagnosed Utricular Neuroma Treated by Selective Partial Labyrinthectomy
Authors: Forton Glen E. J. , Somers Thomas , Baert Albert L. , Hermans Robert , Offeciers F. Erwin
Published: October 2014

Unlike the acoustic neuroma that occupies the internal acoustic meatus and extends into the cerebellopontine angle, the true intralabyrinthine neuroma is an extremely uncommon finding. The majority of the published cases were found at autopsy or during destructive labyrinthectomy for uncontrollable Meniere's syndrome. To the best of our knowledge, we present the smallest exclusively intrautricular neuroma that has ever been diagnosed preoperatively. Detailed magnetic resonance imaging studies allowed the detection of this tumor, measuring only 3.5 mm in diameter. The tumor was removed via atticomastoidectomy and partial labyrinthectomy. The diagnostic workup, radiographic characteristics, and surgical treatment are discussed, together with a review of the literature.
Revascularization of a Salvage Supraglottic Laryngectomy Preliminary Report
Authors: Delaere Pierre R. , Van Damme Boudewijn , Liu Ziying , Blondeel Filip , Hermans Robert , Van Den Bogaert Walter
Published: October 2014

After supraglottic laryngectomy, particularly if there has been a large preoperative dose of radiotherapy, significant ischemia at the suspension anastomosis site may ensue. Neovascularization may play a major role in the healing of this salvage horizontal laryngectomy anastomosis. We have analyzed the process of angiogenesis and neovascularization from a fascial flap in a case of salvage supraglottic laryngectomy.
Histologic Investigation of the Macula Flava of the Human Vocal Fold
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

An investigation was carried out to determine the histologic structure of the maculae flavae of human adult vocal folds. Excised human adult larynges served as the materials for this study. Light microscopic, scanning, and transmission electron microscopic observations were made. The results are summarized as follows. 1) The maculae flavae are located at the anterior and posterior ends of the bilateral vocal folds. Vocal fold ligaments run between the anterior and posterior maculae flavae. 2) The maculae flavae are elliptical in shape and about 1.5 × 1.5 × 1 mm in size. 3) The maculae flavae are composed of fibroblasts, elastic fibers, collagenous fibers, and ground substance. 4) Fibroblasts in the maculae flavae synthesize, and occasionally engulf, the elastic and collagenous fibers. 5) The maculae flavae seem to control the synthesis of fibrous components in the vocal ligament.
Disturbance of Regulation of Sodium by CIS-Diamminedichloroplatinum in Perilymph of the Guinea Pig Cochlea
Authors: Komune Shizuo , Nakagawa Takashi , Inokuchi Akira , Kimitsuki Takashi , Komiyama Sohtaro , Matsuda Kenji , Hisashi Kazutaka , Kobayashi Toshimitsu
Published: October 2014

We studied the acute effects of cis-diamminedichloroplatinum (CDDP) on the cochlear partition and inner ear fluid in the guinea pig. At 48 hours after the administration of a single intramuscular injection of CDDP, 12.5 mg/kg of body weight, the endocochlear resting potential (EP) was significantly decreased to 32.1 ± 1.8 mV in the treated animals, versus 80.6 ±.1.0 mV in the control animals. There was a significant rise in potassium (K+), sodium (Na+), and chlorine (Cl−) in the endolymph of the animals treated with CDDP as compared with the control animals. Only Na+ was found to increase significantly in the perilymph, reaching more than twice the level of the control animals; both K+ and Cl− remained within the normal range. Serum electrolytes also remained within the normal range. Evaluation of modified ionic permeabilities across the endolymph-perilymph barrier showed an apparent increase in Na+ permeability and a normal range of K+ and Cl− permeabilities. Histopathologic examination of the cochlea showed a moderate collapse of the endolymphatic space, with atrophy of the stria vascularis and destruction of the outer hair cells. The findings suggest that the acute changes produced in the cochlea by administration of CDDP were attributable to a breakdown in the regulation of Na+ metabolism in the perilymph.
Inhibition of Mucociliary Clearance of the Eustachian Tube by Leukotrienes C4 and D4
Authors: Ganbo Tetsuya , Nakajima Tsukasa , Hisamaisu Ken-Ichi , Inoue Hajime , Shimomura Shin-Ichi , Murakami Yoshihiko
Published: October 2014

The effect of leukotrienes C4 (LTC4) and D4 (LTD4) and prostaglandin E2 (PGE2) on mucociliary clearance of the eustachian tube was investigated in vitro and in vivo. Normal ciliated epithelium was obtained from the eustachian tube of guinea pigs and incubated separately with LTC4, LTD4, and PGE2 at concentrations of 10−8 mol/L and 10−6 mol/L. Ciliary activity was measured photoelectrically. Leukotriene D4 progressively inhibited ciliary activity, while PGE2 promoted it. Leukotriene C4 also induced ciliary inhibition. One milliliter each of 10−5 mol/L LTC4, LTD4, and PGE2 was directly injected into the tympanic bullae of chinchillas under anesthesia. The middle ears were examined by otomicroscopy, tympanometry, and auditory brain stem response over time. Clearance of middle ear effusion was delayed by LTC4 and LTD4, as compared with PGE2 and the control. These findings indicate that LTC4 and LTD4 inhibit mucociliary clearance of the eusiachian tube.
Endoscopic and Caldwell-Luc Approaches in Chronic Maxillary Sinusitis: A Comparative Histopathologic Study on Preoperative and Postoperative Mucosal Morphology
Authors: Forsgren Karin , Fukami Masaya , Kumlien Jan , Penttilä Matti , Sterna Pontus
Published: October 2014

The aim of the present investigation was to study the histopathologic mucosal changes occurring in chronic maxillary sinusitis both preoperative and postoperative to functional endoscopic sinus (FES) surgery and the Caldwell-Luc (C-L) operation. Correlations were also sought between the histopathologic parameters and endoscopic findings, as well as patient symptoms. Sixty sinuses with the FES surgery and 55 sinuses with the C-L procedure were studied. The histologic parameters were graded semiquantitatively and compared preoperatively and postoperatively. The C-L operation reduced almost all parameters, whereas after the FES operation only edema and inflammatory cells were significantly reduced. Fibrosis increased postoperatively with both methods. The number of inflammatory cells was closely correlated to a thickened antral mucosa and to purulent secretion. No valid correlations were found when comparing histology with patient symptoms. All in all, histologic considerations suggest that asthmatic patients with severe sinonasal polyposis might benefit from the C-L procedure.
Supraglottic Laryngectomy with or without Postoperative Radiotherapy in Supraglottic Carcinomas
Authors: Suárez Carlos , Rodrigo Juan Pablo , Llorente José Luis , Herranz Jesús , Martínez José Antonio
Published: October 2014

A retrospective review of 193 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. All the patients received a supraglottic laryngectomy, and patients received a total of 284 elective or therapeutic neck dissections. Ninety-four (48.7%) of the patients received postoperative radiotherapy. The incidence of local recurrence was 8.2%, but the recurrence rate was unrelated to the use of postoperative radiotherapy. Neck recurrence was observed in 12.9% of patients, with no influence of postoperative radiotherapy in the dissected neck. The incidence of locoregional recurrences by stage in irradiated and nonirradiated patients did not reach significant difference. The 3-year survival was 74.3%. The overall survival of the whole series and by stage was not statistically altered in combined therapy compared to surgery.
Three-Dimensional Imaging of the Hypopharynx and Larynx by Means of Helical (Spiral) Computed Tomography
Authors: Silverman Paul M. , Zeiberg Andrew S. , Troost Thomas R. , Sessions Roy B. , Zeman Robert K.
Published: October 2014

A new computed tomography (CT) technology, helical (spiral) CT, allows the entire neck to be imaged in only 30 seconds. Although multiplanar and three-dimensional (3-D) imaging could be performed with conventional CT, the volumetric acquisition provided by helical (spiral) CT allows significantly improved quality and easier reconstruction for more applications. These 3-D models show an airway appearance similar to that obtained with laryngography. Independent review of the 3-D images in 12 patients with lesions by two radiologists and one otolaryngologist was performed to assess 1) image quality, 2) ability to judge lesion extent, and 3) assistance in understanding the lesion compared to that provided by routine axial scans. Rating scores of 1 to 5 were assigned, with 5 representing the best quality or greatest value. The results showed that both groups scored image quality equally: 4.7. Lesion extent for the radiologists was 2.6, while the otolaryngologist's ranking was 3.7 (p < .01). In assisting understanding of lesions versus axial scans, radiologists ranked 3-D images 2.1, while the otolaryngologist ranked them 3.1 (p < .01). In summary, 3-D models provide a complementary imaging technique in understanding upper airway disease.
Eustachian Tube Function of Patients with Nasopharyngeal Carcinoma
Authors: Hsu Mow-Ming , Young Yi-Ho , Lin Kun-Lin
Published: October 2014

Prolonged observations of the eustachian tube (ET) function were made on 40 ears of 20 patients with nasopharyngeal carcinoma (NPC) who survived more than 5 years after radiotherapy in a state of remission. The ET function tests included passive opening, inflation-deflation, and clearance, and were performed before, at 6 months, and at 5 years after radiotherapy. The test results were found to be worst at 6 months after radiotherapy and improved at 5 years after radiotherapy. Tubal obstruction and inflammation are the main causes of the ET malfunction that results in otitis media with effusion (OME) in NPC patients after radiotherapy. Insertion of a ventilation tube into the ear with OME can relieve tubal obstruction but can aggravate inflammation. Thus, myringotomy and aspiration of effusion and local treatment may be preferable to insertion of a ventilation tube in NPC patients with OME. When hearing improvement in prolonged survival of NPC patients with OME is needed, the use of amplification is recommended.
Evoked Otoacoustic Emissions and Electrocochleography in a Patient with Multiple Sclerosis
Authors: Nishida Hiroaki , Okada Mayumi , Tanaka Yasuo , Inoue Yoshie
Published: October 2014

A 24-year-old woman with multiple sclerosis had right-sided hearing impairment with tinnitus. She underwent electrocochleography (ECochG) and examination of evoked otoacoustic emissions (EOAEs) to assess cochlear function. An acoustic probe to measure EOAEs was inserted into the external ear canal. The ECochG action potential and cochlear microphonics were recorded by a transtympanic needle electrode technique. Both fast and slow components of EOAEs appeared in either the period of deteriorated hearing acuity or when it was improved. They showed normal detection thresholds and input-output curves during both periods. Cochlear microphonics with almost normal detection thresholds and input-output functions were obtained during the period of deteriorated hearing acuity. Action potential (N1) input-output curves during relapse with hearing loss were notably lower in amplitude and longer in latency than those obtained at the time hearing impairment showed improvement. The EOAE and ECochG findings suggested that this patient had almost normal cochlear function, and we assumed from the magnetic resonance imaging and auditory brain stem response findings as well as the ECochG that the hearing impairment was caused by dysfunction of auditory pathways in the brain stem, including structures that contribute to generation of the N1 potential of the ECochG.
Onset of Otitis Media in the First Eight Weeks of Life in Aboriginal and Non-Aboriginal Australian Infants
Authors: Boswell Judith B. , Nienhuys Terry G.
Published: October 2014

Otitis media (OM) is highly prevalent among Aboriginal Australians, in whom eardrum perforations with discharge have been reported in the first 3 months of life. Only one published study, however, has described middle ear status at birth or prior to eardrum perforation in young Aboriginal infants. This prospective study used otoscopy, tympanometry, and hearing tests to compare middle ear status and hearing sensitivity in Aboriginal and non-Aboriginal neonates. Immobile eardrums were observed immediately after birth, but mobility generally appeared within the first week. At examinations at 6 to 8 weeks of age, OM with effusion or acute OM was observed in 95% of 22 Aboriginal infants, but OM with effusion was seen in only 30% of 10 non-Aboriginal infants. There was a clinic record of unilateral perforation in 1 Aboriginal infant only. Hearing impairment was demonstrated by auditory brain stem response in 5 ears, all with evidence of middle ear abnormalities. Improved knowledge and diagnosis of the signs and symptoms of OM will contribute to improvements in the provision of early medical intervention to populations at high risk for early OM.
Surface-Coil Magnetic Resonance Imaging of the Internal Auditory Canal and the Inner Ear Preliminary Report
Authors: Honjo Iwao , Naito Eri , Natto Yasushi , Takahashi Haruo , Nishimura Kazumasa , Shiomi Yosaku , Sakaguchi Yasuhiko
Published: October 2014

Parasagittal surface-coil magnetic resonance imaging of the internal auditory canal and the inner ear was performed. We used T2-weighted fast spin-echo sequences to visualize the inner ear and the individual nerves in the internal auditory canal with high contrast in a short acquisition time. Computer-assisted quantitative measurement of the nerves was performed to estimate the cross-sectional areas and the diameters of the nerves. The average diameters of the facial nerve, the cochlear nerve, and the vestibular nerve of normal-hearing individuals were, respectively, 1.1 ± 0.2 mm (mean ± SD), 1.2 ± 0.2 mm, and 1.5 ± 0.2 mm. In the cerebellopontine angle, the average diameter of the eighth nerve was 1.8 ± 0.2 mm. Two patients with unilateral and bilateral hearing loss were also presented. In the patient with unilateral deafness, the cochlear nerve of the diseased side was not identified and the eighth cranial nerve diameter was smaller than that of the normal side. In the patient with bilateral deafness, fibrosis of the inner ear and atrophy of the eighth nerve were demonstrated in the ear with posttraumatic deafness. The present method may represent a new approach to the assessment of pathologic processes involving the inner ear and the nerves in the internal auditory canal.
Second Primary Malignancies in the Head and Neck Cancer Patient
Authors: Sturgis Erich M. , Miller Robert H.
Published: October 2014

With improvements in locoregional control, the problem of second primary malignancies is rapidly being pushed to the forefront of head and neck oncology. While the constant long-term risk for the head and neck cancer patient has been well established, efforts at prevention, early detection, and treatment have been somewhat futile. Recent advances in genetic predisposition, biomarkers, photodiagnostic imaging, and differentiation therapy may soon offer improved outcomes. The literature is reviewed and current research is presented regarding the history, epidemiology, etiology, diagnosis, and treatment of second primary malignancies.
Long-Term Effects of Botulinum Toxin Injections in Spasmodic Dysphonia
Authors: Davidson Bruce J. , Ludlow Christy L.
Published: October 2014

The purpose was to examine whether physiological changes can be found in laryngeal muscles following repeated treatment with botulinum toxin injections in spasmodic dysphonia. Seven patients whose treatment consisted of multiple unilateral thyroarytenoid injections were examined more than 6 months following their most recent botulinum toxin injection by fiberoptic laryngoscopy and electromyography. Comparisons were made between injected and contralateral noninjected muscles' motor unit characteristics, muscle activation patterns, and vocal fold movement characteristics. The results demonstrated that motor unit characteristics differed between injected and noninjected muscles and that these differences were greater in patients less than 12 months since last injection. Motor unit duration differences were reduced and motor unit amplitude and numbers of turns were increased in muscles sampled over 1 year after injection. These results suggest that while the physiologic effects of botulinum toxin are reversible, the reinnervation process continues past 12 months following injection.
Role of Herpes Simplex Virus Infection in the Pathogenesis of Facial Paralysis in Mice
Authors: Murakami Shingo , Hato Naohito , Doi Takashi , Mizobuchi Mutsuhiko , Yanagihara Naoaki
Published: October 2014

To clarify the role and site of herpes simplex virus (HSV) infection in the pathogenesis of facial paralysis, we examined the viral genome by the polymerase chain reaction and the neutralization antibody titer using microplates in an animal model. Following inoculation with HSV type 1 of the KOS strain into mouse auricles, HSV DNA appeared in the ipsilateral facial nerve on the 3rd day, and in bilateral facial nerves and the brain stem on the 10th day only in animals with facial paralysis. In animals without facial paralysis, no HSV DNA was detected in these tissues. The neutralization antibody titer was elevated between 4 and 20 days in all animals, with or without facial paralysis. Facial paralysis developed only on the inoculated side, even though HSV DNA was also present in the contralateral facial nerve. We conclude that HSV infection in the facial nerve and brain stem is prerequisite for facial paralysis, and suggest that an immunologic reaction following viral infection plays a key role in the pathogenesis.
Laryngeal Electromyography Findings in Idiopathic Congenital Bilateral Vocal Cord Paralysis
Authors: Berkowitz Robert G.
Published: October 2014

Children with idiopathic congenital bilateral vocal cord paralysis (BVCP) were investigated by electromyography (EMG) of the posterior cricoarytenoid and thyroarytenoid muscles to determine whether laryngeal EMG findings had diagnostic or prognostic significance. Four children between 3 weeks and 33 months of age were studied. Three had abductor paralysis and were tracheostomy-dependent, while the fourth had adductor paralysis requiring a feeding gastrostomy. Two of these patients also had other anomalies. Motor unit potentials showing phasic bursts with respiration were found in all four cases, while three children developed a full interference pattern on lightening of the anesthetic. Follow-up for between 37 and 52 months showed no significant clinical improvement in any of the patients. While the diagnosis of idiopathic congenital BVCP can represent a heterogeneous group of conditions, the findings suggest that normal laryngeal EMG findings may be a feature of idiopathic congenital BVCP but do not imply a favorable prognosis for early recovery. They may, however, have implications to explain the likely site of lesion in idiopathic congenital BVCP.
Evaluation of HER-2/NEU (C-ERBB-2) Oncogene Expression in Whole Organ Sections of Supraglottic Squamous Cell Carcinoma
Authors: Weinstein Gregory S. , Tucker John , Nuamah Isaac F. , Montone Kathleen
Published: October 2014

Adequate pathologic material and careful clinical follow-up are prerequisites for the analysis of the expression of particular oncogenic proteins that are prognostically important in squamous cell carcinoma of the larynx. The Gabriel Tucker, Jr, Collection of 150 whole organ specimens allows for the potential immunohistochemical study of the entire tumor. Sections from 32 supraglottic carcinomas were studied immunohistochemically for the presence of HER-2/neu (c-erbB-2) oncogene expression. Long-term follow-up data were available in all cases to assist in determining the prognostic significance of the specified oncogene in supraglottic squamous cell carcinoma. Our study revealed that joint presentation of immune staining for c-erbB-2 and positive lymph node status was significantly associated with distant metastasis (p = .00760).