bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure Gradients Affecting the Labyrinth during Hypobaric Pressure
Authors: Konrádsson Konrád S. , Carlborg Björn I. R. , Farmer Joseph C.
Published: October 2014

Hypobaric effects on the perilymph pressure were investigated in 18 cats. The perilymph, tympanic cavity, cerebrospinal fluid, and systemic and ambient pressure changes were continuously recorded relative to the atmospheric pressure. The pressure equilibration of the eustachian tube and the cochlear aqueduct was studied, as well as the effects of blocking these channels. During ascent, the physiologic opening of the eustachian tube reduced the pressure gradients across the tympanic membrane. The patent cochlear aqueduct equilibrated perilymph pressure to cerebrospinal fluid compartment levels with a considerable pressure gradient across the oval and round windows. With the aqueduct blocked, the pressure decrease within the labyrinth and tympanic cavities was limited, resulting in large pressure gradients toward the chamber and the cerebrospinal fluid compartments, respectively. We conclude that closed cavities with limited pressure release capacities are the cause of the pressure gradients. The strain exerted by these pressure gradients is potentially harmful to the ear.
Application of Oxygen Free Radical Scavengers to Diminish the Occurrence of Myringosclerosis
Authors: Mattsson Cecilia , Marklund Stefan L. , Hellström Sten
Published: October 2014

The present study was designed to establish whether or not an increased production of oxygen-derived free radicals is involved in the causation of myringosclerosis. Sclerotic lesions in the tympanic membrane were experimentally elicited by keeping rats with perforated tympanic membranes in an atmosphere containing roughly 40% oxygen. The animals were treated daily with a solution containing either copper zinc-supcroxide dismutase plus catalase, deferoxamine, or copper sulfate plus iron chloride, applied to the traumatized area. After 1 week the extension of myringosclerotic plaques was determined otomicroscopically. The pars tensa and pars flaccida were then dissected free and prepared for light microscopic studies. The results showed that treatment with copper zinc-superoxide dismutase plus catalase and deferoxamine inhibited or reduced the development of myringosclerosis, whereas die ears treated with copper sulfate plus iron chloride appeared unaffected. Consequently, the findings support the hypothesis that the formation of oxygen free radicals contributes significantly to the development of myringosclerosis.
Reinke's Edema: Phonatory Mechanisms and Management Strategies
Authors: Zeitels Steven M. , Bunting Glenn W. , Hillman Robert E. , Vaughn Traci
Published: October 2014

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.
Narrowest (ISTHMUS) Portion of Eustachian Tube: A Computer-Aided Three-Dimensional Reconstruction and Measurement Study
Authors: Sudo Masaharu , Sando Isamu , Ikui Akihiro , Suzuki Chiaki
Published: October 2014

Nine normal human temporal bones from persons 16 to 88 years old were studied by computer aided three-dimensional reconstruction and measurement. The length of the eustachian tube (ET) lumen in three portions (from pharyngeal orifice to tympanic orifice: cartilaginous, junctional, and bony) averaged 23.6 ±4.3 mm, 3.0 ± 1.9 mm, and 6.4 ± 2.6 mm. The narrowest portion of the ET lumen was in the cartilaginous portion in all cases: 20.5 ± 4.2 mm from the pharyngeal orifice and 3.1 ± 1.6 mm from the pharyngeal margin of the junctional portion. The cross-sectional area of the narrowest portion was 0.65 ± 0.2 mm2. The tendon of the tensor veli palatini muscle (TVPM) inserted into the lateral lamina in the narrowest portion of the ET lumen in five of nine cases. These results suggest that contraction of the TVPM opens the narrowest portion of the ET lumen to ventilate the middle ear and that this portion also plays a role in protecting the middle ear.
Recurrent Pleomorphic Adenoma of the Parotid Gland Involving the Osseous External Auditory Canal with a Note on the Foramen of Huschke
Authors: Rabinov C. Rose , Alavi Sassan , Canalis Rinaldo F. , Lee Edwin J.
Published: October 2014

A recurrence of a parotid pleomorphic adenoma presenting as an external ear canal mass is reported. The route of extension was radiographically documented as an incompletely closed foramen of Huschke. The historical and developmental features of this foramen and the mechanisms of tumor extension as they relate to it are discussed.
Cross-Innervation of the Thyroarytenoid Muscle by a Branch from the External Division of the Superior Laryngeal Nerve
Authors: Nasri Sina , Sercarz Joel A. , Beizai Pouneh , Kim Young-Mo , Ye Ming , Berke Gerald S.
Published: October 2014

The neuroanatomy of the larynx was explored in seven dogs to assess whether there is motor innervation to the thyroarytenoid (TA) muscle from the external division of the superior laryngeal nerve (ExSLN). In 3 animals, such innervation was identified. Electrical stimulation of microelectrodes applied to the ExSLN resulted in contraction of the TA muscle, indicating that this nerve is motor in function. This was confirmed by electromyographic recordings from the TA muscle. Videolaryngostroboscopy revealed improvement in vocal fold vibration following stimulation of the ExSLN compared to without it. Previously, the TA muscle was thought to be innervated solely by the recurrent laryngeal nerve. This additional pathway from the ExSLN to the TA muscle may have important clinical implications in the treatment of neurologic laryngeal disorders such as adductor spasmodic dysphonia.
Audiologic Features of Hearing Loss Due to the 1,555 Mutation of Mitochondrial DNA
Authors: Tsuiki Takashi , Murai Kazuo , Kitamura Ken , Murai Seiko , Tamagawa Yuya
Published: October 2014

We proved a 1,555 mutation of mitochondrial DNA in one member of each of three families with familial streptomycin hearing loss, and report the pedigrees and audiologic features. DNA was extracted by the standard method. The 1,555 A to G mutation was identified in all three patients and confirmed by direct sequencing of the polymerase chain reaction products by a cycle sequencing method. On audiograms, the hearing loss was sensorineural, bilateral, and symmetric, showing a high-tone loss or a profound loss particularly in the high-tone range, and the “symmetry law” of Langenbeck was applicable. The superimposed audiograms of members of one family did not cross themselves, proving the applicability of the “never-cross principle of audiograms.”
Meningioma of the Internal Auditory Canal
Authors: Zeitouni Anthony G. , Zagzag David , Cohen Noel L.
Published: October 2014

Meningiomas are the second most common tumor to involve the cerebellopontine angle (CPA), but controversy exists as to whether they can arise within the internal auditory canal (IAC) or whether involvement of the IAC occurs secondarily by extension from the CPA. This paper reports on a patient with an enhancing IAC meningioma that then grew and on subsequent scans was found to involve the CPA. This case demonstrates that these tumors can arise within the IAC and can grow out to involve the CPA. These findings are discussed within the context of meningioma tumor genetics and the histologic evidence for precursor cells in the IAC. The radiologic findings useful in distinguishing an acoustic neuroma from a meningioma are reviewed in the light of this case. While an enhancing mass projecting into the IAC is most often an acoustic neuroma, this radiologic finding is not pathognomonic.
Localization of Transforming Growth Factor-β- Expressing Cells and Comparison with Major Extracellular Components in Aural Cholesteatoma
Authors: Lang Stephan , Schilling Volker , Mack Brigitte , Wollenberg Barbara , Nerlich Andreas
Published: October 2014

Transforming growth factor-β (TGF-β) plays an important role in the regulation of extracellular matrix (ECM) deposition by stimulating the synthesis of individual matrix proteins like tenascin and fibronectin. Cholesteatoma shows significant changes in the ECM, supporting the view of adisturbed cell-matrix interaction. The purpose of our present study was to evaluate the distribution of TGF-β in comparison to the deposition of tenascin, fibronectin, and collagen as major components of the ECM in cholesteatoma (n = 12) by means of histochemistry and immunohistochemistry. We found TGF-P in lymphocytes and fibrohistiocytes in the stroma of 7 cholesteatomas. In corresponding sections, a marked expression of tenascin and fibronectin was seen manifesting as a continuous band along the epidermal-stromal junction, extending to the deeper stroma. In addition, in those cases of TGF-β expression, beginning collagen fibril formation was seen in adjacent deeper stroma layers, indicating beginning stromal fibrosis. These results suggest that TGF-β may be involved in the stimulation of the synthesis of tenascin, fibronectin, and collagen. Furthermore, the enhanced expression of tenascin and fibronectin provides evidence for a deregulated cell-matrix interaction in cholesteatoma associated with the enhanced proliferative process of cholesteatoma formation.
Impact of a Laryngectomy on Quality of Life: Perspective of the Patient versus That of the Health Care Provider
Authors: Otto Randal A. , Lawrence Valerie , Dobie Robert A. , Sakai Connie
Published: October 2014

This study retrospectively assesses the impact of laryngectomy on the quality of life of 46 patients as compared to the perception of the impact of laryngectomy of 13 health care providers (HCPs). Employing the “time trade-off methodology, we assessed patient and HCP preferences and calculated estimated utilities. We found that 20% of patients would be willing to compromise anticipated life expectancy to preserve voice or preoperative quality of life. By comparison, 46% of the HCPs perceived that their patients would be willing to accept a reduced life span in order to preserve their larynx and quality of life. In conclusion, the percentage of HCPs who believed their patients would compromise survival was substantially higher than the percentage of actual patients who expressed this preference. This perception may influence physicians' attitudes toward recommending laryngeal preservation therapy for their patients. For most laryngectomy patients, treatments attempting laryngeal preservation, particularly if associated with compromised survival, may not be warranted.
Glottic-Supraglottic Barrier: Fact or Fantasy?
Authors: Kirchner John A.
Published: October 2014

An anatomic structure that might act as a barrier between the glottic and supraglottic areas has never been demonstrated in whole organ serial section studies. Nevertheless, most squamous cell carcinomas arising on the supraglottic mucosa remain confined above the ventricle, and this fact is reflected in the high rate of local control obtained by surgeons performing horizontal supraglottic laryngectomy: 80.6% to 98%. Whole organ sections of laryngectomy specimens suggest that a tumor situated above and below the glottic level may have arrived there not by crossing the ventricle, but by encircling it. In so doing, part of the tumor is visible posterior to the ventricle or on the arytenoid cartilage — a finding that contraindicates conventional supraglottic laryngectomy, with or without limited mobility of the true vocal cord.
Idiopathic Subglottic Stenosis: Diagnosis and Endoscopic Laser Treatment
Authors: Benjamin Bruce , Jacobson Ian , Eckstein Robert
Published: October 2014

The records of 15 patients with idiopathic subglottic stenosis treated at Royal North Shore Hospital, Sydney, between 1980 and 1994 were reviewed. All were female and had similar characteristic clinical and histopathologic features. Endoscopic laser vaporization was the primary treatment in 12 patients and was successful in maintaining the airway of 8 of these 12; this outcome indicates that the disease can be managed, at least initially, by endoscopic laser treatment in most cases.
Correlation of Neutrophil Activation and Skin Flap Survival in Pharmacologically Altered Pigs
Authors: Kosko James R. , Williams Patricia B. , Pratt Michael F.
Published: October 2014

In inflamed tissue, neutrophils produce tissue necrosis factors such as free oxygen radicals. We investigated the role of neutrophils in random flap survival using the tissue neutrophil marker myeloperoxidase (MPO), and in whole blood using flow cytometry with the neutrophil activation marker 2′7′ dichlorofluorescein diacetate. Hypopigmented pigs were treated with the experimental 21-aminosteroid lipid antioxidant U-74389G (oxygen free radical scavenger) before dorsal random skin flaps were elevated. Extent of flap survival was measured by surface planimetry 7 days after surgery. Mean flap survival was 64.1% ± 3.4% in the 3-mg/kg—treated group, and 68.0% ± 3.4% in the 1-mg/kg—treated group — both significantly greater than the survival in vehicle-treated controls (48.6% ± 2.3%). We measured MPO in tissue extracts using an enzyme-linked immunoassay, which showed less MPO in treated animals than in controls. Flow cytometry results were nonspecific. These data suggest that U-74389G improves random skin flap viability by inhibiting neutrophil infiltration into the flap.
Role of DNA Measurements of Head and Neck Tumors
Authors: Milroy Christopher M. , Devaney Kenneth O. , Ferlito Alfio , Rinaldo Alessandra
Published: October 2014

The measurement of DNA ploidy has been used as a tool to try to determine the prognosis of many neoplasms. DNA ploidy can be determined by flow cytometry or image analysis of a tumor. In squamous carcinomas of the head and neck, a poorer prognosis has been associated with nondiploid tumors. Similar results have been obtained from studies of salivary gland neoplasms. The role of DNA ploidy as a provider of independent information has yet to be determined. With rarer head and neck tumors, measurement of tumor ploidy has yet to be established as a valuable adjunct to routine light microscopic study.
Perilymphatic Fistula: A Washington, DC, Experience
Authors: Fitzgerald Dennis C. , Getson Pamela , Brasseux Cynthia O.
Published: October 2014

One hundred ninety-seven patients who underwent surgical repair for a presumed unilateral perilymphatic fistula were reviewed. Of those patients, 87% with vestibular symptoms reported complete or near-complete relief of their symptoms. Forty percent of the patients with sudden hearing loss had an improvement in their hearing levels. An analysis of several diagnostic tests revealed their sensitivity and specificity ratings. A review of the patients' operative records showed a marked disparity between the visual identification of an actual fluid leak during surgery and their postoperative outcome. This review supports the premise that at the present time, the patient's surgical outcome is the best way of documenting a successfully repaired perilymphatic fistula.
Effect of Immunotherapy on Serum Levels of Eosinophil Cationic Protein in Perennial Allergic Rhinitis
Authors: Nakai Yoshiaki , Sakamoto Hirokazu , Ohashi Yoshihiro , Kakinoki Yasushi , Kato Akifumi , Ohno Yoshiharu , Tanaka Ayaki
Published: October 2014

Eosinophil cationic protein (ECP) levels in the serum of clotted blood could reflect the rate of activation of circulating eosinophils. We investigated the serum ECP levels in patients with perennial allergic rhinitis, with special reference to the effect of immunotherapy on the serum ECP levels. Serum ECP levels in untreated patients with perennial allergic rhinitis are significantly higher than those of nonatopic volunteers. Therefore, this elevation in the untreated patients represents an ongoing inflammation occurring in allergic rhinitis. The mean serum ECP level of a 1-year immunotherapy group was significantly higher than that of the nonatopic group, and was not different from that of the untreated group. In contrast, the mean serum ECP level in patients who had more than 2 years of immunotherapy was significantly lower than that of the untreated group, and was not different from that of the nonatopic group. Additionally, serum ECP levels were significantly correlated with the duration of immunotherapy. These findings suggest that activation of circulating eosinophils decreases gradually during immunotherapy, but this inhibition becomes apparent only after 2 years of immunotherapy. The control of circulating eosinophil activation might be one of the important working mechanisms behind the clinical effect of immunotherapy.
In Vivo Measurement of Human Nasal Mucociliary Motility Using a Laser Light Scattering Instrument
Authors: Paltieli Yoav , Podoshin Ludwig , Fradis Milo , Shiti Hala , Ben-David Jacob , Kam Zvi
Published: October 2014

The mucociliary system is one of the most important airway defense mechanisms, and knowledge of the mucociliary wave frequency (MWF) is important in the understanding of this system. Employing a laser light scattering technique and a thin, flexible fiberoptic probe, we developed and tested a simple and practical device for real-time in vivo measurements of mucociliary activity in the human nose. The laser instrument is user-friendly and does not produce any discomfort to the patient. The mean ± SE of MWF of 36 measurements in 16 normal subjects was 7.7 ± 0.5 Hz. The mean MWF of 17 measurements in 7 patients with allergic rhinitis was 5.5 ± 0.2 Hz (p < .005), and the mean MWF of 56 measurements in 17 patients with septum deviation was 5.8 ± 0.2 Hz (p < .001). The instrument presented in this study might provide a new and convenient method of studying the mucociliary activity in the respiratory tract.
QT Interval Changes following Neck Dissection
Authors: Dellsperger Kevin C. , Johnson Jonas T. , Rassekh Christopher H. , Hokanson James A. , Bollen Bruce A. , Snyderman Carl H. , Hoffman Henry T.
Published: October 2014

Studies from Europe have suggested that neck dissection, especially right radical neck dissection, causes a dangerous prolongation of the QT interval. Sudden cardiac arrest due to QT prolongation has been reported following right radical neck dissection. We investigated the prevalence of QT interval prolongation following neck dissection. Electrocardiogram tracings from 45 patients who underwent different combinations of neck dissection were studied. Preoperative and postoperative tracings were interpreted by a cardiologist blinded to the patient identification of each tracing. There were 28 unilateral neck dissection patients and 17 bilateral neck dissection patients eligible for analysis. There were 7 patients in the classic right radical neck dissection group, and only 3 of these had no neck dissection on the left. Comparisons of preoperative versus postoperative corrected QT interval for all subjects did not indicate a significant change. Stratification by neck dissection type (radical, modified or selective, and carotid artery resection) or by side dissected (left, right, or both) also showed no significant differences. No malignant arrhythmias were encountered. Thus, in contrast to the European experience, our findings show no significant predictable change in the QT interval after any of the combinations of neck dissection. Head and neck surgeons should be aware of the possibility of postoperative QT interval prolongation following neck dissection, although in the absence of other risk factors it appears to be a rare occurrence.
State-Dependent Laryngomalacia
Authors: Amin Milan R. , Isaacson Glenn
Published: October 2014

We have observed 5 infants who demonstrate normal breathing when awake, but develop stridor while asleep. Flexible laryngoscopy in the awake state reveals either a normal larynx or redundancy of the aryepiglottic folds or arytenoid soft tissue without prolapse into the laryngeal inlet. When these children are sedated, however, the classic signs of laryngomalacia appear. Wet inspiratory stridor with concomitant supraglottic prolapse can be demonstrated by flexible videolaryngoscopy in this state. As these findings vary with level of consciousness, we have dubbed this condition “state-dependent” laryngomalacia. We believe the appearance and disappearance of classic laryngomalacia with changes in level of consciousness adds credence to the neurogenic theory of laryngomalacia.
Surgical Management of Early-Stage Hypopharyngeal Carcinoma
Authors: Czaja Judith M. , Gluckman Jack L.
Published: October 2014

There is little consensus regarding the extent of surgical ablation that is needed to attain cure in early-stage hypopharyngeal carcinoma (HPC). To determine effective surgical management of early-stage HPC, we retrospectively reviewed all cases of stage I or stage II HPC treated at our institution between 1970 and 1992. Of 305 patients identified with HPC, 50 (16%) had stage I (N = 13) or stage II (N = 37) cancer at diagnosis. Thirty-seven of the 50 (74%) underwent surgery alone or combined with preoperative or postoperative radiotherapy (RT). Patients were divided into three surgical groups. Group 1 underwent partial pharyngectomy (N = 9), group 2 underwent total laryngectomy and partial pharyngectomy (N = 17), and group 3 underwent total laryngopharyngectomy with cervical esophagectomy and reconstruction (N = 11). Overall and disease-specific survivals were determined from Kaplan-Meier survival analysis. Disease-free 5-year survival in stage I and II HPCs was 40.1%. Univariate analysis showed a statistically significant decrease in survival for patients undergoing partial pharyngectomy when compared with those undergoing more extensive procedures (p < .03). This was confirmed with multivariate loglogistic regression analysis (p < .03) correcting for confounding variables of site and RT. These data suggest that wide resection improves disease-free survival in patients with early-stage HPC.
Electrocochleographic Evaluation of the Guinea Pig Model of Endolymphatic Hydrops
Authors: Badr-El-Dine Mohamed , Gerken George M. , Robinson Karen S. , Wright Charles G. , Meyerhoff William L.
Published: October 2014

Electrocochleography (ECochG) was used to evaluate cochlear function in guinea pigs with experimentally induced endolymphatic hydrops (ELH) before and after osmotic dehydration with either glycerol or urea. We surgically induced ELH in the right ears of 9 guinea pigs, while the right ears of 6 guinea pigs received a sham operation. The left ears of the 15 animals constituted the normal group. Eight weeks after surgery, summating potential (SP) and action potential (AP) amplitudes were measured prior to and following the administration of glycerol or urea. The SPs and SP/AP ratios were reduced in all groups, with no significant differences among groups or between dehydrating agents. Some of the hydropic ears, however, did show an increased AP threshold and a recruitment effect. In measurements from 6 additional animals, serum osmolarity increased more with urea than with glycerol. The guinea pig model remains valuable for investigation of ELH, even though it differs in significant respects from ELH in humans.
Angiosarcomas of the Head and Neck: Clinical and Pathologic Characteristics
Authors: Aust Michelle R. , Olsen Kerry D. , Meland N. Bradly , Lewis Jean E. , Foote Robert L. , Nascimento Antonio G. , Suman Vera J.
Published: October 2014

Between 1974 and 1992, 32 patients with pathologically diagnosed angiosarcoma of the head and neck were evaluated at our institution. The primary treatment group consisted of 24 patients who had the initial diagnosis made or confirmed at our institution, and the other 8 patients formed the salvage group. There were 23 men and 9 women. The median age in the primary treatment group was 63 years (range 18 to 91 years). The overall median survival among the primary group patients was 4.8 years, and the 3-year survival was estimated to be 57% (95% confidence interval 39% to 84%). The median follow-up was 2.1 years (range 83 days to 9.7 years). Patients who had tumors less than 7.0 cm in diameter and tumors with invasion only to the subcutaneous tissues had better overall survival and longer time to first adverse event. Diploid DNA content was a significant favorable prognostic factor for time to first adverse event. Mitotic activity was of borderline significance with both end points. Patients who had tumors of less than 1.5 cm were treated successfully with surgery alone. Patients treated with combined surgery and radiotherapy also tended to do better. Because most patients in whom regional recurrences developed had tumors larger than 7.0 cm, we conclude that patients with tumors of this size may benefit from regional neck node dissection at the time of primary excision or from elective neck irradiation.
Excision of Rhinophyma with the Carbon Dioxide Laser: A Ten-Year Experience
Authors: Ali M. Karim , Streitmann Michael J.
Published: October 2014

Rhinophyma is a disfiguring disease of the nasal skin, primarily affecting white men in the fifth to seventh decades of life. Hypertrophy of the sebaceous apparatus leads to an enlarged, erythematous nasal tip with comedones. Modalities of treatment include dermabrasion, freehand scalpel shave, cryosurgery, electrocautery, excision and closure with local flaps, and laser resection. A retrospective review of 18 patients treated with carbon dioxide laser excision of rhinophyma from 1983 to 1993 is presented. Discussion includes technique, postoperative care, complications, recurrence, operative blood loss, length of follow-up, time to complete reepithelialization, and pathologic findings. The carbon dioxide laser is a relatively safe, cosmetically efficacious, and curative method of treating rhinophyma.
Transoral Electromyographic Recordings in Botulinum Toxin—Injected Rat Larynges
Authors: Inagi Katsuhide , Ford Charles N. , Rodriquez Arthur A. , Heisey Dennis M.
Published: October 2014

Objective assessment of muscle function following botulinum toxin injections in laryngeal muscles is difficult in human subjects. We developed a rat laryngeal model for the study of botulinum toxin injection. A new laryngoscopic technique has made it possible to observe the rat larynx endoscopically and to obtain electromyographic measurements during and after injection of toxin. The electromyographic interference pattern, fibrillation potentials, and vocal fold movement were used for analyzing dose and volume effects of injected toxin. We conclude that the lowest dosage able to produce the maximal duration of functional laryngeal impairment is 0.07 U in a volume of 0.4 μL. This model will enable us to obtain physiologic and histologic parameters that can be used to assess the selection of optimal treatment regimens with botulinum toxin for the treatment of patients with spasmodic dysphonia.
Endoscopic Laryngotracheoplasty and Graft Soldering with the Carbon Dioxide Laser
Authors: Wang Zhi , Volk Mark S. , Shapshay Stanley M.
Published: October 2014

Laryngotracheoplasty (LTP) has had considerable success for treatment of selected cases of subglottic stenosis in children. However, certain complications have been associated with an open approach. Our study explores the possibility of decreasing these complications by means of a minimally traumatic endoscopic laser cricoid split and graft transplantation technique. In an in vivo study of six dogs, LTP was performed with a carbon dioxide laser. The gap between the divided cricoid cartilage was either left with no coverage or filled by autogenous mucosa or cartilage grafts through a laser-assisted soldering technique. Compared to LTP without coverage, autogenous grafts, with either mucosa or cartilage, resulted in improved healing. The cartilage graft seems to offer the best result for expansion of the subglottic space. The results show that the new intraluminal approach, a combination of an endoscopic cartilage split and graft transplantation, may be an alternative to standard LTP. The advantage of this technique is that it is less traumatic than the open procedure, with the potential for less morbidity.
Efficacy of Repeated Botulinum Toxin Injections as a Function of Timing
Authors: Inagi Katsuhide , Schultz Edward , Ford Charles N. , Bless Diane M. , Rodriquez Arthur A. , Heisey Dennis M.
Published: October 2014

This pilot study was designed to determine if the interval between repeated botulinum toxin injections influenced physiologic and histologic effects on laryngeal muscles in a rat model. The physiologic measurements included digitized videomicroscopic recording of vocal fold movement and electromyography. The histologic measurements included muscle fiber size and digitized optical density of laryngeal muscles after glycogen depletion by electrical stimulation. The results demonstrated that the effect of timing of the second injection was strongly correlated to laryngeal changes. Most notable were results in the subjects that underwent injections 6 weeks apart. We hypothesize that these findings might be related to terminal axonal sprouting with reinnervation. The results from this study help confirm and expand the validity of using the rat laryngeal model to understand the effect of botulinum toxin. Moreover, we believe that the data might be extrapolated to prove useful in predicting human responses to botulinum toxin treatment for functional dystonias such as spasmodic dysphonia.
Basaloid Squamous Cell Carcinoma of the Larynx and Hypopharynx
Authors: Ferlito Alfio , Rinaldo Alessandra , Altavilla Giuseppe , Doglioni Claudio
Published: October 2014

Basaloid squamous cell carcinoma (BSCC) is a recently described bimorphic variant of squamous cell carcinoma with distinct morphological and biological features. We describe the clinicopathological findings, along with immunohistochemical and ultrastructural investigations, in 15 new cases of BSCC of the larynx or hypopharynx observed and treated at the otolaryngology department of the University of Padua between 1989 and 1995. The world literature is also reviewed in order to develop a more accurate clinicopathological profile of the tumor. Patient records and histologic slides were reviewed in all of our 15 cases. The patient group consisted of 13 men (86.67%) and 2 women with a mean age of 63.33 years (median 69 years; range 44 to 84 years). Nine patients presented with cervical lymph node metastases. Surgical treatment was the therapy of choice; radiotherapy and chemotherapy have been applied in different combinations. Follow-up was available on all 15 cases. Local recurrence was described in 3 cases. Five of the 9 patients with cervical lymph node metastases developed distant metastases. Distant spread of the tumor without lymph node involvement was observed during follow-up in 4 cases. Nine patients died of disease, 2 are alive with widespread metastases, 2 are alive with no evidence of disease, and 2 have died of other causes. The determined 5-year survival was estimated to be 17.5% by the Kaplan-Meier method. In conclusion, BSCC is a distinctive carcinoma that is important to recognize, because it has a more aggressive biological behavior than conventional squamous cell carcinoma.
Comparison of Carbon Dioxide and Neodymium: Yttrium-Aluminum-Garnet Lasers in Surgery of the Inferior Turbinate
Authors: Lippert Burkard M. , Werner Jochen A.
Published: October 2014

At the Department of Otorhinolaryngology—Head and Neck Surgery of the University of Kiel, 533 patients with hyperplastic inferior turbinates were treated between 1987 and 1994 with various carbon dioxide (CO2) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser techniques. We report on the therapeutic results of both types of laser turbinectomy and compare their long-term results with those of submucosal diathermy. Among the different techniques, we preferred the following approaches. The CO2 laser technique involved the application of a few laser spots (laser energy density 6,100 J/cm2 per lesion) to the head of the turbinate under the operating microscope. In the Nd: YAG laser procedure, diffuse, low-power irradiation (laser energy density < 53 kJ/cm2) of the entire concha was performed under endoscopic control. The CO2 laser procedure involved little bleeding and hardly any pain. It produced a positive effect after only a few days and required no follow-up treatment. The success of Nd: YAG laser treatment, by contrast, only became evident after weeks or months, due to the slow scarring process. Compared to submucosal diathermy, both laser methods produced better long-term results. Two years postoperatively, the overall success rate, as defined by patient satisfaction, was 79.6% for the CO2 laser, 68.3% for the Nd: YAG laser, and 36% for submucosal diathermy.
Statistical Evaluation of Hearing Screening by Distortion Product Otoacoustic Emissions
Authors: Bonfils Pierre , Avan Paul , Erminy Manuel , Landais Paul , Biacabe Bernard
Published: October 2014

The aim of this study was to provide a statistical evaluation of the screening properties of distortion product otoacoustic emissions (DPOEs) in individuals with clinically normal hearing and in patients with pure sensorineural deafness of various degrees. The main informational parameters used were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the analysis of receiver operating characteristic (ROC) curves. For each frequency tested, ears were classified as a function of their audiometric threshold. Two groups were defined relative to an arbitrary reference, the “audiometric criterion.” The PPV decreased and NPV increased with increases in the audiometric criterion. Each point of the ROC curve represents the relationship between the false alarm rate and the hit rate for each audiometric criterion ranging between 10 and 75 dB hearing level: the lower the audiometric criterion, the lower the hit rate value, and the lower the false alarm value. The audiometric criterion giving the highest hit rate and the lowest false alarm rate was 55 to 60 dB hearing level for primaries at 60 and 70 dB sound pressure level, or 25 to 30 dB hearing level for primaries at 30,40, and 50 dB sound pressure level. These two different behaviors of ROC curves are consistent with the hypothesis that DPOEs do not represent activity at a single location along the basilar membrane.
Transection and Occlusion of Lateral Semicircular Canal in Guinea Pigs
Authors: Nam Boo Hyun , Yoon Seong Ki , Park Chan Il
Published: October 2014

Audiologic and histopathologic examinations were made after occlusion of the lateral semicircular canal in eight guinea pigs. The lateral semicircular canal was drilled out, and then the canal lumens were plugged with muscle pieces. After a serial recording of auditory brain stem responses for 2 months, histologic specimens of the temporal bones were prepared in the lateral semicircular canal plane. One animal developed profound hearing loss due to suppurative labyrinthitis. The other seven animals showed no significant threshold elevation during this period. Histopathologic examination revealed that the bone defect on the lateral canal was replaced with newly formed bone; the perilymphatic and endolymphatic spaces maintained their compartmentalization; and the membranous endolymphatic canal healed to form complete blind ducts. These findings suggest that proper management of the injured semicircular canal is important for maintenance of postoperative hearing.
Analysis of Adult Otitis Media: Polymerase Chain Reaction versus Culture for Bacteria and Viruses
Authors: Post J. Christopher , White Gregory J. , Liederman Eric M. , Aul Jerome J. , Buchman Craig A. , Sirko D. Alexa , Ehrlich Garth D.
Published: October 2014

Recent studies using the polymerase chain reaction (PCR) have identified bacterial and viral genomic sequences in culture-negative pediatric middle ear effusions. To evaluate this technique in adults, 19 effusions were analyzed to compare bacterial and viral culture and PCR detection of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and adenovirus. Effusions from 4 subjects positive for human immunodeficiency virus (HIV) were analyzed by PCR for HIV virus. Three of 19 effusions were culture-positive for bacteria, and 0 of 19 for viruses. Fifteen of 19 effusions were PCR-positive for bacterial genomic sequences, and 0 of 19 for adenovirus. Thirteen of 15 PCR-positive specimens demonstrated 5 pneumoniae, 5 of 15 H influenzae, and 0 of 13 M catarrhalis. All 4 effusions from HIV-positive subjects were PCR-positive for HIV. No effusion was culture-positive and PCR-negative. These results confirm that culture-negative middle ear effusions contain genomic sequences from bacterial pathogens. Finding of HIV RNA and DNA in effusion from HIV-positives suggests replicating virus in this fluid.
Primary Lymphoma of the Internal Auditory Canal
Authors: Angeli Simon I. , Poletti Bernard J. , Brackmann Derald E. , Carberry Joseph N. , Xenellis John E. , Hitselberger William E.
Published: October 2014

We report a rare case of a primary intracranial B cell lymphoma originating in the internal auditory canal. The clinical manifestations were indistinguishable from those of other, more common tumors of the same region. We achieved total gross tumor removal with preservation of the facial nerve. A detailed histologic examination and a systemic workup confirmed the primary nature of this tumor. To our knowledge, this is the second case reported in the literature of a primary malignant lymphoma originating in the internal auditory canal. This is the first instance that includes immunohistochemical and cytometric studies of fresh tissue. We discuss the management of primary lymphomas of the central nervous system, with special emphasis on their association with acquired immunodeficiency syndrome and other immune system diseases. Awareness of primary central nervous system lymphomas is important, since a greater occurrence of these rare tumors in the cerebellopontine angle is probable in the future.
Electron Microscopic Investigation of Sulcus Vocalis
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

This investigation was carried out to determine the histopathologic findings of sulcus vocalis in two human adult larynges. Observations were made by light and transmission electron microscopy. The results are summarized as follows. Sulcus was confined to the squamous epithelium area. The basement membrane thickness increased at the sulcus. The sulcus was situated in the superficial layer of the lamina propria, which was thin around the bottom of the sulcus. Collagenous fibers were dense, and fibrous long-spacing collagen was seen around the bottom of the sulcus. Elastic fibers decreased in number and were composed predominantly of microfibrils and reticular amorphous substances. In the maculae flavae, the fibroblasts were decreased in number and degenerated. Collagenous and elastic fibers, synthesized by fibroblasts in the maculae flavae, were decreased. There were many abnormal elastic fibers in the maculae flavae. The quality and quantity of the fibrous components were changed in the mucosa of sulcus vocalis, owing in part to dysfunction of the fibroblasts and abnormal fibrogenesis in the maculae flavae.
Neonatal Upper Airway Assessment by Awake Flexible Laryngoscopy
Authors: Berkowitz Robert G.
Published: October 2014

Awake flexible laryngoscopy (AFL) provides simple and quick assessment of both the structure and function of the upper airway. To determine its value in neonates, a prospective study was carried out over 2 years of 110 neonates (80 term, 30 premature) under 6 weeks of age (corrected for prematurity) presenting with symptoms suggestive of upper airway disease who underwent AFL performed by the author. A diagnosis was made in 79 cases, while no cause was found for the symptoms in 31. The commonest diagnoses were vocal cord paralysis (29; bilateral 16, unilateral 13), nasal stenosis (9), laryngomalacia (9), glossoptosis (7), subglottic stenosis (6), and choanal atresia (5; bilateral 2, unilateral 3). The AFL was repeated in 31 neonates and the condition was found to be stable in 16, improved in 8, resolved in 2, and progressed in 1, and an additional diagnosis was made in 4. Endoscopy under general anesthesia with or without corrective surgery was performed in 15 neonates (7 also having repeat AFL). The diagnosis was confirmed in 14 and an additional tracheal abnormality was found in 1. The AFL was complicated by cyanosis in 2 neonates and epistaxis in 1, but all complications resolved with minimal intervention. These data suggest that the neonatal upper airway can be relatively safely and reliably assessed by AFL performed by an experienced clinician.
Quantitative Measurement of Mucosal Wave by High-Speed Photography in Excised Larynges
Authors: Jiang Jack J. , Kadota Yoshimi , Yumoto Eiji , Kurokawa Hironobu , Lin Samuel J. , Hanson David G.
Published: October 2014

The movement characteristics of mucosal waves of the vocal fold are important components in normal phonation. Quantitative studies of the mucosal wave have used stroboscopic techniques from a supraglottic view. The current study measured displacement of mucosal epithelium during experimental phonation by using high-speed photography from an infraglottic view. Effects of thyroarytenoid contraction, increased mean airflow rate, and variation of vocal fold length were examined in canine larynges. Top and bottom vocal fold “lip” amplitude, fundamental frequency, and phase difference were the dependent variables examined. Thyroarytenoid contraction increased the amplitude of the top and bottom lips, decreased the fundamental frequency, and increased the phase difference. Increase in airflow through the glottis decreased the top lip amplitude and phase difference and appeared to increase the fundamental frequency and to decrease the bottom lip amplitude. Vocal fold lengthening decreased the bottom lip amplitude and increased the fundamental frequency and appeared to decrease the top lip amplitude and phase difference.
Vocal Evaluation of Thyroplasty Type I in the Treatment of Nonparalytic Glottic Incompetence
Authors: Lu Fang-Ling , Lundy Donna S. , Casiano Roy R. , Xue Jun-Wu
Published: October 2014

This study investigated the prethyroplasty and postthyroplasty voices of patients with glottic incompetence of mobile vocal folds related to vocal fold bowing and scarring. Seventeen patients underwent vocal function evaluation preoperatively and 1 month postoperatively with videostrobolaryngoscopic examination, acoustic and aerodynamic analysis, and perceptual judgment of voice characteristics. The postoperative voice outcome in this group of patients was compared to that of a group of patients with unilateral vocal fold paralysis. Patients with vocal fold bowing showed significant improvement in glottic gap size and hoarseness after the surgery. There was minimal improvement on other test measures. Patients with vocal fold scarring exhibited worse preoperative and postoperative vocal functions, with little voice improvement after surgery. The outcome of thyroplasty type I in cases of vocal fold bowing or scarring is not as good as that in unilateral vocal fold paralysis.
Otitis Media Health Status Evaluation: A Pilot Study for the Investigation of Cost-Effective Outcomes of Recurrent Acute Otitis Media Treatment
Authors: Alsarraf Ramsey , Jung Chung J. , Crowley Catherine , Perkins Jonathan , Gates George A.
Published: October 2014

There are no reliable and valid instruments that measure otitis media clinical or functional health status in children ages 1 to 3 years. This study develops and tests three new instruments of clinical and functional otitis health status: the Otitis Media Clinical Severity Index (OM-CSI), the Otitis Media Functional Status Questionnaire (OM-FSQ), and the Otitis Media Diary (OMD). The OM-CSI was found to be a reliable measure of clinical acute otitis media (AOM) severity, with high internal consistency (Cronbach's α) scores, as well as an accurate indicator of AOM severity. The OM-FSQ and OMD were demonstrated to be reliable and valid measures of otitis-specific functional health status, with reproducible scores over time, high internal consistency α scores, and high correlation with measures of AOM clinical severity and other functional health status instruments. These three new instruments were also sensitive and specific indicators of AOM episodes.
Axonal Regeneration in Severed Peripheral Facial Nerve of the Rabbit: Relation of the Number of Axonal Regenerates to Behavioral and Evoked Muscle Activity
Authors: Spector J. Gershon , Lee Patty
Published: October 2014

The minimum number of regenerating facial nerve myelinated motor axons that are required to innervate and activate the mimetic musculature is not known. We compare rabbit facial nerve regeneration following complete transectional injuries of the buccal division to the evoked and behavioral muscle activities of the quadratus labii superioris muscle of the rabbit in three experimental models: end-to-end direct anastomosis (N = 4), 8-mm autologous nerve grafts (N = 8), and 10-mm silicone chamber implants (N = 40). Data are presented as total numbers of regenerating myelinated axons that traverse the surgical repair and innervate the fascicles of the transected distal nerve stump, as well as the percentage of regenerating neurites, as compared to the preoperative normal controls. Five weeks after neural repair, direct end-to-end anastomosis regained more myelinated axons across the reconstructed defect (2,632 × 1,232; 67%) than silicone tube implants (2,006 × 445; 51%) or autologous cable graft repairs (1,660 × 1,169; 42%). However, only a small percentage of myelinated fibers innervated the intrafascicular region of the distal transected neural stump in direct anastomosis (948 × 168; 24%), silicone tube implants (670 × 275; 17%), or autologous nerve grafts (445 × 120; 12%) in rabbits that regained evoked and behavioral mimetic muscle activity. All rabbits with direct anastomosis and neural cable grafts regained motor activity, despite the fact that 66% of regenerating motor neurites in cable graft repairs and 54% in direct anastomosis were collateral sprouts that did not contribute to effective muscle activity. In 17 rabbits with neural regenerates within the silicone tube implants that did not regain mimetic activity, the mean number of regenerating myelinated motor axons across the defect was 504 × 419 (13%), and the mean number of axons that innervated the distal transected nerve stump fascicles was 277 × 128 (7%). Therefore, the minimal number of motor axons that is required to activate the quadratus labii superioris muscle is 12% of the original motor axon population of the normal buccal nerve division.