bluuebunny/crossref_metadata_2025 huggingface dataset:
Thirty-Five-Millimeter Photography Using the Kantor-Berci Video Laryngoscope
Authors: Benjamin Bruce
Published: October 2014

The Kantor-Berci model II laryngoscopes employ a centrally located rigid telescope. Although the primary application is for video laryngoscopy, the system can also be used for 35-mm photography during microlaryngeal operations. The fixed, unchangeable field of view and the great depth of focus make this system ideal for photographic documentation during endolaryngeal surgery without interruption of the procedure.
Electroporation Therapy of Head and Neck Cancer
Authors: Panje William R. , Harrell Erin , Hier Michael P. , Goldman Andrew , Garman Guy R. , Bloch Isac
Published: October 2014

The purpose of this paper is to introduce the concept of electroporation therapy and present our results from using this new technique combined with intralesional bleomycin in head and neck cancer patients. Electroporation therapy is a technique wherein high-voltage electric impulses delivered into a neoplasm transiently increase cell membrane permeability to large molecules, including cytotoxic agents. In this phase I/II study, extremely low-dose bleomycin sulfate was electroporated into head and neck malignant neoplasms in 10 patients. Tumor responses included 2 nonresponders, 3 partial responders, and 5 complete responders, with a mean follow-up of 40 weeks. We conclude that this technique offers promising possibilities in the local treatment of head and neck cancer.
Pharyngeal Fibrovascular Polyp in a Child
Authors: Seshul Merritt J. , Galliani Carlos A. , Wiatrak Brian J. , Odrezin Gregory T.
Published: October 2014

Fibrovascular polyp of the upper aerodigestive tract is an uncommon tumor that may present in pediatric patients with symptoms ranging from dysphagia to asphyxiation and death. We present a unique case of a pediatric patient with an asymptomatic fibrovascular polyp noted as an incidental finding on a cervical ultrasound evaluation. This lesion extended from the posterior tonsillar pillar and prolapsed freely into the nasopharynx and esophagus. The literature relevant to this case is reviewed, and the etiology, pathophysiology, and management principles are discussed.
Clinical and Pathologic Characterization of Mucosa-Associated Lymphoid Tissue Lymphoma of the Head and Neck
Authors: Bhattacharyya Neil , Frankenthaler Robert A. , Kadin Marshall E. , Gomolin Hilary I. , Lauretano Arthur M.
Published: October 2014

Mucosa-associated lymphoid tissue (MALT) has recently been recognized as a possible site of origin for low-grade lymphomas of the B-cell type. Though relatively rare, these MALT lymphomas may arise within several sites in the head and neck, and often present diagnostic and therapeutic challenges. We review 4 cases of primary MALT lymphoma of the head and neck, treated with surgical excision (3 cases), irradiation (2 cases), and chemotherapy (1 case), to further characterize this new subtype of head and neck malignancy. The mean time from onset of symptoms to histologic diagnosis was 15 months. Fine needle aspiration identified an atypical lymphoid infiltrate in only 1 of 3 patients. Immunohistochemical analysis was essential in establishing the diagnosis of MALT lymphoma in all 4 of the cases, and demonstrated characteristic negative staining for CD3, CD5, and CD43, positive staining for CD20, and monotypic staining for either κ or Λ; light chain immunoglobulin markers. All patients achieved complete remission after primary therapy, and all remain free of disease with follow-up ranging from 6 to 54 months (mean 33 months). The diagnosis of MALT lymphoma should be considered in cases of atypical lymphoid infiltrates in the head and neck, and increased awareness coupled with detailed immunohistochemical analysis is essential to securing an accurate diagnosis. Clinical remission of MALT lymphoma may be achieved with several modalities, but further study will be required to determine the long-term response to treatment.
Human Vocalis Contains Distinct Superior and Inferior Subcompartments: Possible Candidates for the Two Masses of Vocal Fold Vibration
Authors: Sanders Ira , Han Yingshi , Rai Surinder , Biller Hugh F.
Published: October 2014

It is not understood how different parts of the thyroarytenoid muscle contribute to vocal fold vibration. This study investigated the medial part of the thyroarytenoid muscle, the vocalis compartment, for anatomic differences that might suggest functionally distinct areas. Twenty human vocal folds were frontally sectioned and stained with hematoxylin and eosin. A single section from the middle of each vocal fold was magnified, and the muscle fascicles of the most superficial 25% of the vocalis compartment were then examined. In all 20 specimens the vocalis compartment could be separated into 2 plainly distinct subcompartments: the inferior vocalis compartment was composed of a single large muscle fascicle that contained densely packed muscle fibers of similar size; the superior vocalis compartment was composed of multiple small fascicles in which the muscle fibers were loosely arranged and varied greatly in size. On average, the inferior vocalis subcompartment composed 60% of the medial surface of the thyroarytenoid muscle. The superior subcompartment composed the remaining 40% of the medial surface, but also continued past the vocal ligament to make up the superior surface of the thyroarytenoid muscle. It is concluded that 2 distinct entities make up the vocalis compartment of the thyroarytenoid muscle. Their anatomy is so markedly different it suggests that they may function independently. One possibility is that they reflect the 2 masses observed in the superior and inferior aspects of the vocal fold during vibration.
Utility of Conventional Radiography in the Diagnosis and Management of Pediatric Airway Foreign Bodies
Authors: Silva Andrew B. , Muntz Harlan R. , Clary Randall
Published: October 2014

Pediatric airway foreign bodies are potentially life-threatening situations. The otolaryngologist is often consulted to aid in the diagnosis and management of these difficult cases. Although radiographic studies are often obtained, the decision for surgical intervention is usually based on a suspicious history and physical examination. Our hypothesis is that radiographic imaging should not alter the decision for surgical intervention. We retrospectively reviewed the cases of pediatric airway foreign bodies managed by the otolaryngology department at St Louis Children's Hospital between December 1990 and June 1996 with both radiographic imaging and operative intervention. Ninety-three cases of potential aspiration were identified, with a median patient age of 20 months. The most common presenting signs and symptoms were aspiration event (n = 82), wheezing (n = 76), decreased breath sounds (n = 47), cough (n = 39), respiratory distress (n = 17), fever (n = 16), pneumonia (n = 14), and stridor (n = 7). At the time of endoscopy, 73 patients were found to have an airway foreign body. The sensitivity and specificity of the imaging studies in identifying the presence of an airway foreign body in the 93 patients were 73% and 45%, respectively. Our decision for operative intervention was based on the history and physical examination, and was not changed in the presence of a negative radiographic study. The routine use of radiography should not alter the management of airway foreign bodies, providing that there is a well-equipped endoscopic team familiar with airway foreign bodies.
First Report of Hürthle Cell Carcinoma Revealed by Octreotide Scanning
Authors: Wilson Charles J. , Woodroof Janet M. , Girod Douglas A.
Published: October 2014

Octreotide is an 8-chain amino acid analog of somatostatin. Somatostatin and its receptors occur naturally in multiple sites within the body and serve a suppressive role in endocrine hormone release. When octreotide, which has a considerably longer half-life than somatostatin, is combined with a radioactive isotope, receptor-based imaging can be performed to visualize tumors with high concentrations of somatostatin receptors. Tumors of neural crest origin — Pituitary adenomas, islet cell tumors, medullary thyroid carcinomas, pheochromocytomas, carcinoids, and paragangliomas — all express high levels of somatostatin receptors. We present the first reported positive octreotide scan of a Hürthle cell carcinoma of the thyroid and, more important, discuss the role of octreotide scanning in otolaryngology, which has not yet been reviewed by our literature.
Observations of Laryngeal Lesions with a Rhinolarynx Electronic Videoendoscope System and Digital Image Processing
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: October 2014

Laryngeal lesions were observed with the Olympus ENF-200 rhinolarynx electronic videoendoscope attached to the Olympus EVIS-200 system, an electronic videoendoscope system of Olympus Optical Co, Ltd. The electronic videoendoscope differs from conventional flexible fiberscopes in having a small light-sensitive charge-coupled device (CCD) chip built into the tip of the endoscope portion. This model has a small CCD chip in its 5-mm-outer diameter tip, and can be introduced into the laryngeal cavity by inserting it through the nasal passages. Dynamic color images obtained by this system were very clear and provided excellent resolution. This electronic videoendoscope system could also be connected to the Olympus EVIP-230 digital image processor, which was compatible with this system. Structure enhancement and color enhancement were performed by processing images. In this paper, the ordinary images and the processed images are described and discussed from the standpoint of diagnostic usefulness.
Extracorporeal Shock Wave Lithotripsy of Parotid Stones
Authors: Iro Heinrich , Benzel Wolf , Zenk Johannes , Schneider Thomas , Waldfahrer Frank , Ell Christian
Published: October 2014

The extracorporeal shock wave treatment of parotid stones is a rather new therapy. Its usefulness was determined in a prospective study. Seventy-six patients (36 female, 40 male, 2 to 80 years of age) with symptomatic, sonographically detectable solitary sialoliths of the parotid gland were treated with an extracorporeal piezoelectric shock wave therapy after unsuccessful conservative therapy (sialagogues, gland massage, bougienage of the secretory duct). At most, 3 treatments per patient were performed. Altogether, 38 of the 76 patients (50%) were free of stones and no longer suffered from complaints after completion of shock wave treatment and a mean follow-up period of 48 months (range 6 to 71 months). During the follow-up period, in no case could renewed stone formation be observed. Residual stone fragments were detectable in 20 patients (26%), but did not cause further symptoms. Thirteen patients (17%) with residual stone fragments stated a significant improvement of their complaints after therapy. Five patients (7%) did not observe any changes of their pretherapeutic complaints and underwent parotidectomy. The therapeutic success was not influenced by stone size or by stone localization within the gland. During the follow-up period, no side effects of the therapy were identified. With stones of the parotid gland, extracorporeal shock wave lithotripsy is — After one has used conservative therapies (sialagogues, gland massage) — the treatment of choice, avoiding in the majority of cases a parotidectomy with its operative risks (paresis of the facial nerve, Frey's syndrome).
Midbrain Regions for Eliciting Vocalization by Electrical Stimulation in Anesthetized Dogs
Authors: Liu Kang , Solomon Nancy Pearl , Luschei Erich S.
Published: October 2014

Eliciting vocalization in anesthetized dogs by midbrain stimulation is a useful procedure for studies of laryngeal and respiratory physiology. The goal of this report has been to construct a canine stereotaxic “map” that would allow investigators to locate midbrain stimulus sites producing vocalization. Motor responses to electrical stimulation at currents of 1.5 mA or less were observed at 1,158 stimulus sites throughout the midbrains of 8 dogs. Vocalization was observed at 213 stimulus sites. The highest probability of observing vocalization was for sites located 6 to 10 mm anterior, 6 to 7 mm lateral, and 5 to 8 mm dorsal to earbar zero. The vocalization region most likely consists of axons arising in the midbrain periaqueductal gray and coursing through the adjacent tegmentum; low-threshold sites are close to the medial lemniscus. The relationship between stimulus sites at which vocalization was elicited and sites producing other motor responses is described.
Use of Montgomery® T-Tube in Laryngotracheal Reconstruction in Children: Is it Safe?
Authors: Stern Yoram , Willging J. Paul , Cotton Robin T.
Published: October 2014

Montgomery® T-tubes are often used in adult patients; however, they are less commonly used in the pediatric age group. The purpose of this report is to describe our experience with this stent in pediatric laryngotracheal reconstruction. A retrospective chart review was performed to identify early and late complications. Nutritional assessments were made on the basis of weight percentile comparisons at the time of surgery and at the end of the stenting period. From 1990 to 1997, the Montgomery® T-tube was utilized in 26 children undergoing 36 airway reconstruction procedures (21 laryngotracheoplasties and 15 cricotracheal resections). The upper limb of the tube extended above the level of the glottis in all patients. The patients ranged in age from 2.4 to 17.9 years. The duration of stenting ranged from 2 weeks to 23 months. Three patients (11.5%) had significant aspiration and did not improve following diet modifications and swallowing therapy, requiring tube feedings. One patient had postoperative subcutaneous emphysema that resolved spontaneously. Three patients required early removal of the stent due to an inability to tolerate plugging. Granulation tissue above the upper limb of the stent during the stenting period was noted after 6 laryngotracheal reconstruction procedures (16%). Only 1 patient fell off his growth curves during the period of stenting. There were no deaths in this series, and no emergent procedures were required. Postoperative and home care and management of complications are discussed. Our experience indicates that Montgomery® T-tubes can be utilized relatively safely in children, providing that postoperative and home care are meticulous.
Thirty-Eight-Year Evaluation of a Surgical Technique to Protect the External Branch of the Superior Laryngeal Nerve during Thyroidectomy
Authors: Loré John M. , Kokocharov Stoyan I. , Richmond Allen , Kaufman Sol , Sundquist Nan
Published: October 2014

The purpose of this study is to evaluate a surgical technique for the preservation of the function of the external branch of the superior laryngeal nerve (EBSLN) during total thyroid lobectomy and total thyroidectomy. Permanent injury to this nerve can be a disaster, especially in singers and professional speakers who depend on control of pitch, and a clear and forceful voice. Voice changes may be either obvious or subtle. For better voice analysis, a detailed questionnaire is necessary. Thus, the evaluation in this study is based on laryngoscopy of 934 nerves in 675 patients and detailed subjective voice evaluation of 66 patients during the last 2 years of the study. There are 2 surgical principles. First, the EBSLN is not routinely exposed; the distal 1.5 to 2.0 cm (critical area) of the superior thyroid vessels are carefully dissected, exposed, and ligated, preferably independently. Careful observation ensures that the EBSLN is not included in the ligature. Second, the ultimate evaluation of the surgical technique is the effect of voice changes on the patient's lifestyle. Laryngoscopy of 934 nerves found bowing, temporary in 4 patients and permanent in 1 patient (limited follow-up). Of the 66 patients with voice evaluations, 14 had changes: 9 had temporary changes, while 5 had permanent changes. In these 14 patients, voice changes had no effect on lifestyle in 13, and the effects were indeterminate in 1 (unavailable for follow-up). The estimated deleterious effect of voice changes on lifestyle is no greater than 1.5% of the 66 patient responders.
Calcitonin Gene-Related Peptide-Like Immunoreactive Motoneurons Innervating the Canine Intrinsic Laryngeal Muscles
Authors: Hisa Yasuo , Tadaki Nobuhisa , Bamba Hitoshi , Koike Shinobu , Uno Toshiyuki
Published: October 2014

The percentage of calcitonin gene—related peptide (CGRP)–immunoreactive motoneurons in the nucleus ambiguus innervating the intrinsic laryngeal muscles of colchicine-treated dogs was examined by using cholera toxin B subunit—gold (CTBG) as a retrograde tracer and by immunohistochemistry. Neurons that were labeled with CTBG from the cricothyroid muscle were located in the ventromedial division of the rostral part of the nucleus ambiguus, and the ratio of CGRP-positive neurons was 93.0%. Neurons labeled with CTBG from the thyroarytenoid muscle were located in the dorsal division of the medial part of the nucleus ambiguus, and the percentage of neurons with CGRP was 71.4%. Neurons labeled with CTBG from the posterior cricoarytenoid muscle were located in the ventral division of the medial part of the nucleus ambiguus, and the percentage of CGRP-positive neurons was 85.5%. These findings suggest that the innervation and/or the neurotrophic mechanism involving CGRP for each intrinsic laryngeal muscle is different.
Experimental Approaches to Vocal Fold Alteration: Introduction to the Minithyrotomy
Authors: Gray Steven D. , Bielamowicz Steven A. , Dove Heather , Titze Ingo R. , Ludlow Christy
Published: October 2014

Treatment of challenging laryngeal disorders, such as lamina propria loss or neuromuscular dysfunction, may require novel approaches and techniques. This paper discusses an evolution of experimental techniques for treatment of lamina propria loss and use of the minithyrotomy. These techniques have been used for surgical access for lamina propria substitution, as well as placement of stimulating electrodes. The minithyrotomy is tolerated well by patients, provides access for microscopic instruments with the surgeon's hand close to the tissue of interest, avoids intralaryngeal mucosal incisions, and lines up the direction of dissection in an anterior-to-posterior orientation. This orientation is favorable for particular situations herein discussed. We present anatomic and physiologic concepts relevant to the surgical treatment of lamina propria dysfunction, as well as presenting our clinical experience. This paper is not intended to state how these difficult problems should be handled, but rather, to present our experience in techniques that may prove useful through further development.
Application of Labeling Techniques to Archival Temporal Bone Sections
Authors: Tian Qing , Linthicum Fred H. , Keithley Elizabeth M.
Published: October 2014

Pathology of the human inner ear has traditionally been studied in celloidin-embedded, hematoxylin and eosin-stained sections of the temporal bone. Although the traditional histologic approach has yielded valuable information, it is now possible to extend these studies to include analysis of molecules using immunohistochemical and histochemical staining techniques. Fourteen antibodies and 6 lectins have been applied to 420 archival, celloidin-embedded human temporal bone sections. Tissues had been fixed in 10% formalin, embedded in celloidin, sectioned, and stored for as many as 40 years. The staining intensities varied among sections, so they were ranked from “no label” to “dense label.” To investigate the relationships between the extent of postmortem changes (PMCs), storage time, and staining intensity for each antibody, the sections were graded according to their PMCs, which ranged from good preservation of the temporal bone histologic structure to severe postmortem autolysis. Although statistical analysis indicated that both extent of PMCs and storage time in general decrease the staining intensity, both poorly fixed tissue and sections stored for a long time can yield good immunostaining results with some antibodies.
Optical Tracking of a Microscope for Image-Guided Intranasal Sinus Surgery
Authors: Hauser Rolf , Westermann Birgit
Published: October 2014

The objective of this study was to examine the effects of optical and tracking properties on the accuracy of an optically locatable operating microscope. The intraoperative arrangement was based on experimental results obtained from a skull model. Measurements were taken from 24 patients undergoing intranasal microscopic sinus surgery for various disorders. Two major groups of influencing factors were determined from measurements on the model: 1) optical properties of the microscope, such as the method of focal point adjustment, focal length, and magnification of the lens; and 2) tracking properties of the microscope, such as the distance of the digitizer to the tracked object, the number of reference infrared light-emitting diodes (IR-LEDs), and the area circumscribed by these IR-LEDs. Patient measurements showed an overall spatial error of 2.39 ± 1.15 mm with a laser-supported adjustment of the focal point of the microscope. Although the associated 95th percentile was at 4.36 mm, such a value is encouraging for further development of microscopically navigable systems. It must be noted that the noninvasive patient-to-image registration was performed on the basis of a computed tomographic image with a slice distance of 2 mm.
Clinicopathological Consultation Aids-Related Plasmablastic Lymphomas of the Oral Cavity and Jaws: A Diagnostic Dilemma
Authors: Carbone Antonino , Ferlito Alfio , Gaidano Gianluca , Rinaldo Alessandra , Gloghini Annunziata , Stein Harald
Published: October 2014

Acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin's lymphomas are highly pleomorphic in their clinical, pathological, and biological features. Recent investigations have led to the identification of a particular type of AIDS-related non-Hodgkin's lymphomas presenting in the oral cavity and jaws. This novel category of AIDS-related non-Hodgkin's lymphomas derives from B-cells and has been defined as plasmablastic lymphoma on the basis of its morphological and immunophenotypic features. Clinically, AIDS-related plasmablastic lymphoma is generally limited to the oral cavity at the time of diagnosis, although extension to distant sites frequently occurs at a later stage. Histologically, AIDS-related plasmablastic lymphoma is composed of a monomorphic and cohesive pattern of plasmablasts with basophilic cytoplasm. Phenotypically, AIDS-related plasmablastic lymphoma fails to express the most common B-cell-associated surface antigens, whereas it consistently expresses high levels of plasma cell—associated markers, including VS38c and CD138/syndecan-1. For the purpose of differential diagnosis, the morphological and immunophenotypic peculiarities of AIDS-related plasmablastic lymphoma clearly distinguish these lymphomas from other categories of AIDS-related non-Hodgkin's lymphomas, as well as from undifferentiated large cell carcinomas.
Histomorphometric and Laryngeal Videostroboscopic Analysis of the Effects of Corticosteroids on Microflap Healing in the Dog Larynx
Authors: Smith Shane , Ossoff Jacob P. , Coleman John R. , Reinisch Lou , Deriso Walter , Billante Cheryl R. , Garrett C. Gaelyn
Published: October 2014

The histologic and functional effects of unilateral, layered corticosteroids on lateral microflap healing in 15 dogs were analyzed. Histologic sections of steroid-treated vocal folds (VFs) were studied with computer morphometry to examine differences in the tissue healing response. Paired analysis revealed increases in the inflammatory infiltrate around the microflap in the steroid-treated VFs at 2,4, and 6 weeks (6.3%, 30.6%, and 34.9%, all with p < .02). The neovascular response in the steroid-treated VFs was less at 2 weeks (–20.9%, p < .005) but greater at 4 and 6 weeks (16.3% and 4.3%, p < .005). To better characterize the effect of steroids on the healing process, a normal, time-dependent distribution was applied to the histologic data and demonstrated a delay in the steroid-treated VF tissue response of 12 days for the inflammatory infiltrate and 21 days for the neovascular response. Qualitative and quantitative analysis of in vivo laryngeal videostroboscopy (LVS) samples taken preoperatively and at sacrifice could not identify significant differences in appearance, amplitude, mucosal wave, or suppleness between the 2 VFs. Therefore, although corticosteroids cause a delay in wound healing, LVS does not discern differences in microflap characteristics between healing steroid-treated and control VFs at 2, 4, or 6 weeks. If steroids are used, the surgeon should account for a probable delay in wound healing, but should not expect an overall difference in functional outcome.
Diagnostic and Therapeutic Approach to Migrating Foreign Bodies
Authors: Chee Lincoln W. J. , Sethi Dharambir S.
Published: October 2014

Ingested foreign bodies are the commonest otolaryngological emergency in Singapore and other parts of Southeast Asia. One of the uncommon complications of ingested foreign bodies is migration, which has the potential to cause morbidity and mortality. A retrospective study of 24 patients presenting from 1990 to 1996 at Singapore General Hospital was done to evaluate the presentation, investigation, and diagnosis of migrated foreign bodies. Of interest, most patients had ingested foreign bodies within 24 hours. All the migrated foreign bodies were linear, sharp fish bones. Migration is said to have occurred in the presence of positive neck radiography and negative rigid esophagoscopy. Computed tomography is the investigation of choice to confirm migration. All patients had neck exploration, and factors for successful outcome are discussed. This is the largest series in the literature to date.
Clinicopathological Consultation Laryngeal Pathology in the Acquired Immunodeficiency Syndrome: Diagnostic and Therapeutic Dilemmas
Authors: Tami Thomas A. , Ferlito Alfio , Lee Kelvin C. , Rinaldo Alessandra , Singh Bhuvanesh
Published: October 2014

The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (HIV), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when HIV-infected patients present with laryngeal complaints.
Virtual Laryngoscopy
Authors: Moharir Vik M. , Lorensen William E. , Fried Marvin P. , Shinmoto Hiroshi , Hsu Liangge , Alyassin Abdalmajeid M. , Kikinis Ron
Published: October 2014

Virtual endoscopy enables computer-generated 3-dimensional visualization of a cavity by reconstructing 2-dimensional computed tomographic or magnetic resonance data. The technique has been used experimentally to study the colon, bronchi, ears, and other structures. Here, virtual laryngoscopies were created from the cross-sectional image data of 3 patients. The cases represented a normal airway, a squamous cell carcinoma of the glottic fold, and a posterior glottic stenosis. These reconstructions included extraluminal anatomy that is not typical of current virtual endoscopic techniques. The 2-dimensional computed tomographic and magnetic resonance images of the patients underwent post-processing for 3-dimensional reconstruction. The resulting models were imported into an experimental virtual endoscopy program for 1) airway lumen generation and 2) interactive viewing. Though they could not be used for biopsy, the virtual laryngoscopies provided, in a noninvasive fashion, good simulation of endoscopy. Virtual endoscopy also gave the added benefits of the ability to assess the transmural extent of disease and view the airway distal to areas of luminal compromise. This technology may well provide clinical benefit in preoperative planning, staging, and intraprocedural guidance for head and neck disease and merits further study.
Murine Model of Autoimmune Hearing Loss Induced by Myelin Protein P0
Authors: Matsuoka Hiroshi , Cheng Kuang-Chuan , Yazawa Yoshiro , Krug Marc S. , Yoo Tai-June
Published: October 2014

Myelin protein P0 has been identified as an autoantigen in inner ear diseases. In order to study autoimmune hearing loss, we performed brain stem auditory-evoked potential (BAEP) studies on P0-sensitized mice. Two P0-sensitized mice showed hunched posture, poor coat, loss of body weight, and abnormal walking with a waddling gait. About 25% of the P0-sensitized mice developed hearing loss. In the BAEP study, peak latencies of waves I, III, and V and the interpeak latency I-III were prolonged in the P0-sensitized hearing loss group of mice. Hearing thresholds were elevated in this group of mice in comparison with the control mice. Inflammatory cell infiltration was observed in the cochlear nerve region, and a reduced number of spiral ganglion cells was also detected. These results suggest that P0-sensitized mice are a useful model for studying autoimmune inflammation of the peripheral portion of the auditory system.
Effect of Thyroplasty on Laryngeal Airflow
Authors: Janas Janice D. , Swenson Erik R. , Waugh Pat , Hillel Allen
Published: October 2014

Thyroplasty has virtually replaced Teflon injection as the procedure of choice for treatment of the unilateral paralyzed vocal cord. Previous studies have shown that Teflon injection, by stiffening the vocal cord, decreases the extrathoracic airway obstruction occasionally measured by pulmonary function testing in patients with unilateral vocal cord paralysis. We became interested in the effect of thyroplasty on extrathoracic airflow. In this prospective study, patients underwent prethyroplasty and postthyroplasty pulmonary function testing. Flow volume loops combined with traditional spirometry were used. Postoperative pulmonary function tests were performed at least 2 months after surgery to allow resolution of surgical edema. Our study results support the previous finding that vocal cord paralysis alone causes some degree of extrathoracic obstruction. However, in contrast to Teflon injection, thyroplasty decreased extrathoracic airflow in all but 1 patient, and by criteria based on the ratio of the midexpiratory flow to the midinspiratory flow, caused new postoperative extrathoracic obstruction in 27% of patients. Symptomatic evidence of this obstruction may be more evident in those active patients with more ventilatory demand.
The “Sign of the Rising Tide” during Swallowing Fiberoscopy: A Specific Manifestation of Zenker's Diverticulum
Authors: Périé Sophie , Dernis Henri-Pierre , Angelard Bruno , Monceaux Guy , Guily Jean Lacau St
Published: October 2014

Pooling of secretions in the hypopharynx is a common sign of an impaired upper esophageal sphincter. Until now, no specific manifestation, observed by flexible laryngoscopy, of Zenker's diverticulum has been reported. Direct visualization of the diverticulum can be missed during flexible laryngoscopic examination. In this series of 12 patients with hypopharyngeal diverticulum, we have described a manifestation of Zenker's diverticulum obtained on videofiberoscopy during cream swallowing. We have called it the “sign of the rising tide” because it describes the backup of cream visible in the hypopharynx as a wave after its complete disappearance. Barium swallow study is necessary to confirm the presumptive diagnosis. This relevant manifestation seems to be specific for Zenker's diverticulum, since it is not observed in other upper esophageal sphincter disorders, and it disappears when surgical treatment is successful.
Effect of Sleep State on the Laryngeal Chemoreflex in Neonatal Piglets
Authors: Cleland-Zamudio Suzanne S. , Mahowald Mark , Goding George S. , Pernell Kerri J.
Published: October 2014

The laryngeal chemoreflex (LCR) is a brain stem—mediated response that is a potential mechanism for sudden infant death syndrome. The vast majority of sudden infant death occurs during sleep, yet it remains to be established whether there is a particular sleep state that makes an infant animal more susceptible to apneic events via the LCR. The purpose of this study was to investigate the LCR during different sleep states in the neonatal piglet. In this study, continuous physiologic monitoring and electroencephalographic, electro-oculographic, and electromyographic techniques were utilized to study neonatal piglets during a hypnotic induced sleep model. Propofol drip anesthetic was utilized to provide an anesthetic state and was titrated for dose-dependent sedation. The LCR was initiated in 11 animals during quiet sleep, rapid eye movement sleep, and the anesthetic state. Baseline respiratory and cardiovascular responses were measured. Durations of apnea were recorded and compared. This study found that despite known physiologic differences in respiratory control during different sleep states as compared to the anesthetic state, there appears to be no increased risk of profound apnea in one state versus another in piglets 19 to 28 days old.
Study of Systemic Lupus Erythematosus in Temporal Bones
Authors: Sone Michihiko , Paparella Michael M. , Schachern Patricia A. , Morizono Noriko
Published: October 2014

Despite some reports of sensorineural hearing loss with systemic lupus erythematosus (SLE), its pathologic correlate has remained unidentified due to the scarcity of human temporal bone studies. We here present findings in 14 temporal bones from 7 patients with SLE, examined histologically and immunohistochemically for pathologic conditions in the cochlea that might relate to their otologic histories. Blue-staining concretions were seen in the stria vascularis of 6 ears. Most of the cases showed a loss of spiral ganglion cells, with various degrees of hair cell loss and atrophy of the stria vascularis. One ear demonstrated formation of fibrous tissue and bone throughout the cochlea, with complete loss of the membranous labyrinth. Cochlear hydrops was found in only 1 ear. These findings in temporal bones from patients with SLE are discussed in relation to autoimmune disease of the inner ear.
Guided Tissue Generation in the Temporal Bone
Authors: Granström Gösta , Tjellström Anders
Published: October 2014

Ten patients with malformations of the temporal bones were submitted to installation of implants for anchorage of bone-anchored auricular epistheses or bone-anchored hearing aids. Due to lack of bone in the temporal region, expanded polytetrafluoroethylene membranes were used to aid bone generation, each patient serving as his or her own control. It was found that bone formation around the flange fixtures covered with membranes increased significantly compared to the uncovered fixtures. It is concluded that the use of barrier membranes is one way to support bone generation in temporal bones lacking sufficient bone for implant-related surgery.
Sinonasal Malignant Lymphomas: A Distinct Clinicopathological Category
Authors: Vidal Rachel W. , Devaney Kenneth , Rinaldo Alessandra , Ferlito Alfio , Carbone Antonino
Published: October 2014

Sinonasal lymphomas represent a distinct subset of extranodal head and neck lymphomas. While sinonasal lymphomas are relatively rare in Western countries, in Asian populations they are the second most frequent group of extranodal lymphomas, after gastrointestinal lymphomas. With advances in immunohistochemistry, these lymphomas have been separated into B-cell, T-cell, and most recently into natural killer (NK) cell phenotypes. The B-cell phenotype is typically located in the paranasal sinuses and has a slight predominance in Western countries. The T/NK-cell phenotype is the most common in Asian and South American countries. These tumors are typically located in the nasal cavity and have an aggressive, angioinvasive growth pattern that often results in necrosis and bony erosion. Thus, sinonasal lymphomas have been included in the past with other destructive malignant and benign lesions under the descriptive and nonspecific name lethal midline granuloma. Patients are classically in the sixth to eighth decades, with a 2:1 male-to-female ratio. The prognosis is generally better than that of nodal-based lymphomas of similar histologic grade. Treatment is a combination of local irradiation and chemotherapy with an anthracycline-based regimen.
Outcome of Brain Stem Auditory Electrophysiology in Children Who Survive Purulent Meningitis
Authors: Jiang Ze D.
Published: October 2014

Brain stem auditory electrophysiology was assessed in children long after purulent meningitis by examining the central components of brain stem auditory evoked response (BAER) at different presentation rates of clicks. Children with peripheral hearing loss were excluded from this study to avoid any possible influence of the loss on the measurements of BAER central components. Of the 70 children who had recovered from meningitis 2 to 8 years earlier, 9 (12.9%) showed abnormalities in BAER central components — mainly a slight reduction of wave V amplitude, at the click presentation rate of 10/s. Of the remaining 61 children who did not show any obvious abnormalities in the BAER at 10/s, an abnormally prolonged I-V interval and a reduced amplitude of wave V were seen in 5 children (8.2%) at the click rate of 90/s. The total BAER abnormality rate was therefore 20.0% (14/70 cases). The results suggest that most children who survive purulent meningitis have a favorable outcome for the brain stem auditory pathway, with about 1 in 5 having mild dysfunction or a suboptimal outcome in the pathway.
Cervical Anatomy of Phrenic Nerve Roots in the Rabbit
Authors: Marie Jean-Paul , Lerosey Yannick , Tadié Marc , Dehesdin Danièle , Andrieu-Guitrancourt Jérome
Published: October 2014

The cervical anatomy of the different nerve contributions that constitute the phrenic nerve (phrenic nerve roots and accessory phrenic nerve) were studied in rabbits. In 55 dissections, 6 main root arrangement types were observed. The roots that issued from the fourth and fifth cervical nerves (C4 and C5 roots) were constant. The C4 root was either short or long. The C6 root was at times absent, or sometimes double. An accessory phrenic nerve was present in 43% of the right and 28% of the left dissections. The distribution of the phrenic nerve roots often displayed left-right asymmetry. We conclude that a better knowledge of the cervical anatomy of the phrenic nerve is useful both in physiological studies involving diaphragm denervation and in experimental laryngeal reinnervation.
Course of IL-1β, IL-6, IL-8, and TNF-α in the Middle Ear Fluid of the Guinea Pig Otitis Media Model Induced by Nonviable Haemophilus Influenzae
Authors: Sato Katsuro , Kawana Masahiro , Nonomura Naobumi , Nakano Yuichi
Published: October 2014

To characterize the local response in acute otitis media, courses of interleukin (IL)–1β, IL-6, IL-8, and tumor necrosis factor (TNF) α in middle ear fluid (MEF) of the guinea pig otitis media model induced by nonviable Haemophilus influenzae were investigated with enzyme-linked immunosorbent assay (ELISA) kits. The IL-1β concentration in H influenzae–inoculated ears peaked 24 hours after inoculation. The IL-8 concentration was significantly higher in H influenzae–inoculated ears than in controls 48 and 96 hours after inoculation. The TNF-α concentration in H influenzae–inoculated ears had an initial peak 6 hours after inoculation and had significant late increases 48 and 96 hours after inoculation. The results suggest that IL-1β and TNF-α were produced by middle ear mucosa in the early stage of the experiment by stimulation of bacterial inoculation, which caused subsequent inflammatory cell accumulation, and that IL-8 and TNF-α were produced in the late stage by accumulating inflammatory cells.
Congenital Nasal Hemangiopericytoma: Intrauterine, Intraoperative, and Histologic Findings
Authors: Götte Karl , Hörmann Karl , Schmoll Jürgen , Hiltmann Wolf-Dieter
Published: October 2014

Hemangiopericytoma is a rare tumor of mesenchymal origin. To date, 91 cases of nasal or paranasal hemangiopericytoma and 59 congenital hemangiopericytomas have been reported in the literature. A congenital hemangiopericytoma arising from the nasal cavity and skull base has not yet been described. We report a case of a male newborn with a highly vascular nasal tumor diagnosed by in utero sonography with three-dimensional surface reconstruction. The tumor extended to the right anterior skull base, the right nasal cavity, and the right side of the nasal pyramid. A complete resection by neodymium:yttrium-aluminum-garnet–potassium titanyl phosphate (“Nd:YAG-KTP”) laser was performed on the day of cesarean section at 33 weeks' gestation. The tumor was diagnosed as hemangiopericytoma by histologic and immunohistochemical findings. Postoperative nasal flow, feeding, and sight were unimpaired. At the 9-month follow-up, the infant remained free of disease.
Distribution of Rantes and Interleukin-5 in Allergic Nasal Mucosa and Nasal Polyps
Authors: Lee Chul Hee , Lee Kang Soo , Rhee Chae-Seo , Lee Sung Ok , Min Yang-Gi
Published: October 2014

Eosinophil-chemoattracting cytokines are thought to be important in the pathogenesis of allergic inflammation. However, little is known about the presence and significance of RANTES in nasal allergy and nasal polyps, Two well-known rhinologic disorders characterized by eosinophil infiltration in the tissue. In order to evaluate the role of RANTES in eosinophil infiltration in vivo, the tissue distributions of RANTES and interleukin-5 (IL-5) and their correlation with eosinophil infiltration were investigated. Nasal mucosa specimens were obtained from 9 allergic and 12 control subjects, and nasal polyps from 6 allergic and 9 nonallergic subjects. All the subjects were divided into 4 groups: normal mucosa, allergic mucosa, nonallergic polyps, and allergic polyps. To identify the cellular localizations of RANTES and IL-5, we used specific immunohistochemical staining. We also investigated the differences in cytokine expression among the 4 groups, and the correlation between cytokine expression and eosinophil infiltration in the tissue. RANTES was expressed in the epithelium, endothelium, and some submucosal cells, while IL-5 was confined to the cells in the submucosa. Expression of both RANTES and IL-5 significantly increased in allergic mucosa and nasal polyps compared to normal mucosa; however, there was no significant difference in their expression between allergic and nonallergic polyps. Both cytokines had a significant correlation between their expression and either total or activated eosinophil numbers. The results of this study suggest that RANTES, as well as IL-5, plays a role in eosinophil recruitment in allergic nasal mucosa and nasal polyps in vivo.
Ability of Nucleus Cochlear Implantees to Recognize Music
Authors: Fujita Shuji , Ito Juichi
Published: October 2014

Eight adults with cochlear implants participated in experiments to test their ability to recognize music. Some subjects showed good ability to recognize songs that were sung with instrumental accompaniment but poor ability to recognize songs played on an electronic keyboard without verbal cues, indicating that they were recognizing the songs by verbal cues rather than by musical qualities such as tones and melodic intervals. This conclusion was strengthened by the finding that subjects were barely able to distinguish between songs with the same rhythm and pitch range, and they showed poor ability to discriminate musical intervals. (The closest discrimination was 4 semitones.) Subjects had good ability to distinguish among the synthesized sounds of various musical instruments played on the electronic keyboard. We speculate that subjects could distinguish the various musical instruments in the same way they distinguish among human voices using spectrographic patterns such as formants or maxima.
Expression of Intercellular Adhesion Molecule-1 in Rat Inner Ear Due to Bacterial Otitis Media
Authors: Sone Michihiko , Canafax Daniel M. , Russlie Henry Q. , Paparella Michael M.
Published: October 2014

Expressions of anti– Streptococcus pneumoniae antibody and anti–intercellular adhesion molecule–1 (ICAM-1) antibody in the inner ear were studied immunohistochemically in rats following inoculation of S pneumoniae type 6A into the middle ear cavity. Positive staining with anti– S pneumoniae antibody was detected in the marginal cells of the stria vascularis of rats sacrificed 3 days after S pneumoniae inoculation, but almost no staining was detected in those sacrificed at 14 days. Strong ICAM-1 expression was detected in the basal cell layer of the stria vascularis of rats sacrificed 3 days after inoculation, but the intensity of the staining had decreased by 14 days. These results suggest that the stria vascularis may be a site of the inner ear damage that follows bacterial inoculation into the middle ear cavity. The up-regulated expression of ICAM-1 in the basal cell layer may represent a reaction of the inner ear to the bacterial otitis media.
Results of Partial Laryngectomy for Benign Neural Tumors of the Larynx in Children
Authors: Garabédian Eréa-Noël , Ayache Denis , Ducroz Vincent , Triglia Jean Michel
Published: October 2014

The objective of this study was to assess the long-term results of partial laryngectomy for benign neural tumors of the larynx. We reviewed 8 patients with laryngeal involvement — 7 with neurofibromatosis and 1 without — treated between 1980 and 1994. The mean age was 6.5 years. A partial laryngectomy was performed in 7 cases. All the tumors were located in the aryepiglottic folds. Clinical, radiologic, and endoscopic follow-ups were used for evaluating recurrence. A good laryngeal airway, swallowing without aspiration, and voice quality were sought in assessing the functional results. Five patients had good functional results with no recurrences. One patient died of malignant transformation and metastatic dissemination of his disease. To summarize, partial laryngectomy is a relatively safe and effective procedure, even in childhood, for treating this rare localization of neurofibromatosis. A malignant transformation of the tumor is possible and carries a poor prognosis.
Review of the Literature and Report of Two Cases
Authors: Paczona Róbert , Tiszlavicz László , Jóri József , Czigner Jenö
Published: October 2014

Leiomyosarcoma of the larynx is an extremely rare malignancy. Until now, only 35 cases have been reported, and only 19 were reported in English. We present 2 new cases observed in the last 3 years at our department. Correct histologic diagnosis can only be made on immunohistochemical and electron microscopic grounds. A 65-year-old man previously treated for a premalignant vocal cord lesion and a 31-year-old woman who previously underwent operation on a benign vocal cord lesion are presented. Only surgical treatment (total laryngectomy and endolaryngeal laser resection) was performed. Thirty-six and 22 months after the initial surgical intervention, both patients are alive and well, with no evidence of local recurrence or distant metastasis.