bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaerobes and Fungi in Chronic Suppurative Otitis Media
Authors: Ibekwe A. Olu , Shareef Zain Al , Benayam Ashraf
Published: October 2014

Microbiology of 102 ears with chronic suppurative otitis media was studied for aerobes, anaerobes, and fungi. Forty-four percent were pure cultures, 33.3% were mixed, and 18.6% had no growth. Seventy-four percent were aerobes, 25% fungi, and only 0.9% anaerobes. Pseudomonas aeruginosa (22.5%) was the most common isolate, followed by Staphylococcus aureus and the Aspergillus species. The possible reasons for low yield of anaerobes and the pathogenic roles of anaerobes and fungi in chronic suppurative otitis media are discussed. It is advocated that in investigating pathogenic organisms in chronic suppurative otitis media, requests should include anaerobes and fungi.
Invisible Culprit: Intralabyrinthine Schwannomas That do not Appear on Enhanced Magnetic Resonance Imaging
Authors: Zbar Ross I. S. , Khan Ashraf , Megerian Cliff A. , Rubinstein Jay T.
Published: October 2014

Intralabyrinthine schwannoma (ILS) is an infrequent tumor that arises in isolation within the periphery of the temporal bone. Only 32 cases have been reported to date in the literature, of which 12 were discovered at autopsy. Prior to the advent of gadolinium-enhanced magnetic resonance imaging (Gd-MRI), only 1 ILS had been diagnosed preoperatively. However, after Gd-MRI became a common modality, 5 ILSs were imaged. Two additional cases are reported that were discovered during labyrinth-destructive surgery despite normal Gd-MRI findings. Possible explanations for and potential ramifications of nonenhancing ILS are discussed.
Results of Surgical Salvage of Locoregional Recurrence of Carcinoma of the Tongue after Radiotherapy Failure
Authors: Yuen Anthony Po Wing , Wei William Ignace , Ho Wai Kuen , Lam Lai Kun , Kwong Dora
Published: October 2014

The aim of this study was to evaluate the efficacy of surgical salvage of local and nodal recurrence of carcinoma of the oral tongue after radiotherapy failure. Of the 47 patients in this retrospective review (between 1980 and 1992), there were 25 with local recurrence alone, 11 with locoregional recurrence, and 11 with nodal recurrence alone. There was no operative mortality, and 17% of patients had one or more surgical complications, including wound infection, flap necrosis, anastomotic leakage, and chest infection. Twenty-nine (62%) patients developed recurrences in the head and neck region after the salvage operation, and 9 of them had second surgical salvage operations. At the last follow-up, 53% of patients had died of carcinoma of the tongue and the overall 5-year actuarial survival rate was 43%. The 5-year actuarial survival rates were 39% for local recurrence alone, 27% for locoregional recurrence, and 68% for nodal recurrence alone. Surgical salvage had satisfactory results for patients with oral tongue carcinoma after radiotherapy failure. Close follow-up and early surgical intervention are essential for patients primarily treated with radiotherapy.
Vestibular and Optokinetic Function in the Normal Guinea Pig
Authors: Andrews James C. , Koyama Sumiko , Li June , Hoffman Larry F.
Published: October 2014

Vestibular and optokinetic function was quantitatively studied in the normal guinea pig through investigation of the vestibulo-ocular reflex (VOR), optokinetic nystagmus (OKN), and the visual vestibulo-ocular reflex (VVOR) by means of sinusoidal stimulation with a computer-controlled rate table (VOR and VVOR) or an optokinetic drum. The VOR exhibited high-pass filter characteristics with steady state gain achieved at 0.125 Hz. The maximum gain was 0.55 at a velocity of 60°/s. The VOR was modeled by a transfer function with best fits obtained with an adaptation time constant of 12.5 seconds. The OKN showed low-pass filter characteristics with a decrease in gain for increase in stimulus amplitude. The maximum gain measured was 0.64. A fractional pole model provided a fit of these data. The VVOR exhibited a mean gain of between 0.6 and 0.7 across the stimulus bandwidth and peak velocities. A model based on a linear combination of the actual OKN and VOR gains provided an estimate of the VVOR gain.
Incidence of Primary Ciliary Dyskinesia in Children with Recurrent Respiratory Diseases
Authors: Coste André , Millepied Marie-Claude , Chapelin Catherine , Reinert Philippe , Poron Françoise , Boucherat Michel , Escudier Estelle
Published: October 2014

The goal of the study was to evaluate the incidence of primary ciliary dyskinesia (PCD) in children suffering from recurrent respiratory tract infections (RRIs) by means of a noninvasive method. Respiratory ciliated cells were collected by nasal brushing in 118 children (4.6 ± 2.5 years) with RRIs. The ciliary beat frequency (CBF) was measured with a stroboscopic method, and when the CBF was abnormal, the ciliary ultrastructure was analyzed by a quantitative method. The CBF could be measured in 106 patients (90%) and was abnormal in 15 patients. The ciliary ultrastructure was found to be abnormal in 11 of 15 patients: PCD was diagnosed in 6 cases, and acquired ciliary defects were observed in the remaining 5 patients. Our conclusion, that PCD is rare but not exceptional (5.6%) in children with RRIs, justifies the systematic investigation of ciliated cells in such patients. For this purpose, nasal brushing can be used to sample ciliated cells even in young children.
Effects of Anesthetic Technique on the Hemodynamic Response to Microlaryngeal Surgery
Authors: Ayuso Angeles , Luis Mercedes , Sala Xavier , Sánchez Jesús , Traserra José
Published: October 2014

Our aim was to study the attenuation of the hemodynamic response to microlaryngeal surgery by β-blocking agents used as support drugs to the anesthetic technique. The study was carried out in 30 patients randomly allocated to one of three groups. The control group received only anesthetic drugs. The second group received labetalol hydrochloride 0.3 mg/kg 3 minutes before induction and 0.15 mg/kg 2 minutes prior to the start of suspension of the larynx. The third group received esmolol hydrochloride 500 μg/kg 3 minutes prior to induction and a continuous infusion of 300 μg/kg during the surgical procedure. Hemodynamic data in the three groups were compared by analysis of variance. A statistically significant difference (p < .05) was found in hemodynamic data among the two groups treated with blocking agents and the control group. The addition of β-blocking agents to the anesthetic technique attenuates the hemodynamic response to suspension laryngoscopy.
Partial Cricotracheal Resection with Primary Anastomosis in the Pediatric Age Group
Authors: Stern Yoram , Walner David L. , Gerber Mark E. , Cotton Robin T.
Published: October 2014

The traditional approach to severe subglottic stenosis (SGS) in the pediatric age group is laryngotracheal reconstruction (LTR). This approach may be complex and multistaged, with variable and unpredictable success rates in the individual patient. Excellent results have been reported in adults who had severe SGS and underwent partial resection of the cricoid and primary thyrotracheal anastomosis. This procedure has not been widely reported in infants and children. We report our experience with this procedure in 16 pediatric patients with grade III or IV SGS. Eleven patients had multiple previous LTR operations. The preoperative evaluation, surgical techniques, postoperative care, complications, and final results are described and discussed. Fourteen patients were decannulated after the procedure, 1 patient needed a second open procedure prior to decannulation, and 1 patient with concomitant bronchopulmonary dysplasia remains cannulated, for an overall 94% decannulation rate. Fourteen patients have no limitation of respiration, and 1 patient has moderate exercise intolerance. The results of this series suggest that partial cricotracheal resection with primary anastomosis is a relatively safe and effective procedure for pediatric patients with severe SGS.
Effect of Antagonism at Central Nervous System M3 Muscarinic Receptors on Laryngeal Chemoresponse
Authors: Richardson Brent E. , Pernell Kerri J. , Goding George S.
Published: October 2014

The laryngeal chemoresponse (LCR), comprising laryngeal adductor spasm, central apnea, and subsequent cardiovascular instability, is thought to be a factor in sudden infant death syndrome. A muscarinic subtype receptor, M3, appears to be involved in central respiratory drive and control. Both the duration of the LCR apnea and levels of M3 receptor messenger RNA in the brain stem change according to postnatal age. This study examined the effect of central nervous system antagonism at M3 receptors on the LCR with respect to animal age and dose of antagonist. Ten piglets in each of three age groups (group 1, 5 to 8 days; group 2, 18 to 21 days; and group 3, 40 to 43 days) received a series of four increasing doses of an M3 antagonist ( p-fluoro-hexahydro-siladiphenidol) by intracerebral ventricle injection. The LCR was evoked at baseline and after each dose of antagonist. An effect on susceptible animals (groups 1 and 2) was evident by the second antagonist dose, and persisted for the remainder of the experiment (2 hours). At completion of the experiment, mean apnea duration had decreased in group 1 (61%, p < .05), and group 2 (57%, p < .05), but was unchanged in group 3 (<10%, p not significant). Length of mean baseline apneas correlated directly with degree of apnea shortening. The reduction is not attributable to changes in arterial Po2 or Pco2 or baseline respiratory rate. These results support an age-related influence on the LCR by M3 receptors in younger animals that decreases with maturation.
Cervical Necrotizing Fasciitis
Authors: Kantu Sanjay , Har-El Gady
Published: October 2014

Cervical necrotizing fasciitis (CNF) is an aggressive infection of the head and neck with high complication and mortality rates. Sixty-eight cases of CNF have been reported in the English-language literature. We present a series of 8 patients with CNF, including 5 men and 3 women ranging in age from 25 to 92 years. To the best of our knowledge, this is one of the largest case series reported. Six of the 8 patients had a predisposing odontogenic focus of infection. Four patients had mediastinal involvement. Two patients, both with significant comorbidity at the time of presentation, died of CNF.
Effect of Cisplatin on the Basement Membrane Anionic Sites in the Ampulla, Macula, and Stria Vascularis of Guinea Pigs
Authors: Suzuki Mitsuya , Kaga Kimitaka
Published: October 2014

Our objective was to compare changes in the basement membrane anionic sites (BMAs) in the ampulla, macula, and stria vascularis following the infusion of cisplatin (CDDP). After CDDP was administered to anesthetized Hartley guinea pigs, the bony labyrinth was immersed in a solution of polyethyleneimine (PEI). The size and distribution of PEI particles associated with BMAs in the stria vascularis and in the dark cell and sensory cell areas of the vestibular labyrinth were determined by electron microscopy. A significant reduction in the number and size of PEI particles was observed on CDDP-treated strial vessels. The number and size of PEI particles on the basement membranes of the vestibular labyrinth did not differ from those in the control. Our findings suggest that the BMAs of the vestibular labyrinth were not significantly affected by the administration of a single dose of CDDP.
Reduction of Inner Ear Inflammation by Treatment with Anti-ICAM-1 Antibody
Authors: Takasu Tsuyoshi , Harris Jeffrey P.
Published: October 2014

The in vivo effect of systemic administration of monoclonal antibody (mAb) against ICAM-1 (αICAM-1) in experimental immune-mediated labyrinthitis was evaluated. The αICAM-1–treated rats showed reduced inflammatory cell infiltration in the scala tympani and the perisaccular tissue of the endolymphatic sac. However, with this experimental paradigm, labyrinthitis could not be completely abolished. These findings suggest that ICAM-1–dependent pathways play an important role in the series of immunologic events occurring in the inner ear, and that the use of ICAM-1 antagonist may be a possible therapeutic approach to labyrinthitis.
Auditory Evoked Responses under Total Spinal Anesthesia in Rats
Authors: Yamada Katsushi , Kaga Kimitaka , Uno Akira , Sakata Hideaki , Tsuzuku Toshihero
Published: October 2014

In order to investigate the function of the auditory pathway from the cochlea to the brain stem under total spinal anesthesia, the auditory brain stem response (ABR), compound action potential of the cochlear nerve (CAP), and cochlear microphonics (CM) were simultaneously recorded in rats. Total spinal anesthesia was induced by infusion of 2% lidocaine hydrochloride at a constant rate of 0.10 mL/min into the cerebrospinal fluid through the rats' skulls. The ABR completely disappeared within 1.5 to 4 minutes. After cessation of the injection, the ABR reappeared, starting from wave I and progressing through waves II and III to wave IV. The latency change of the CAP throughout the recording period was quite similar to that of wave I of the ABR. A reduction in amplitude of the CM was observed, but the CM did not disappear during the recording period. Disappearance of the ABR was due, not to loss of cochlear function, but to anesthetic effects on the acoustic nerve and the brain stem. Monitoring of the ABR provided information on the level of neural activity in the brain stem under total spinal anesthesia.
Th1/Th2 Cytokine Profiles in the Nasopharyngeal Lymphoid Tissues of Children with Recurrent Otitis Media
Authors: Bernstein Joel M. , Xiang Shunan , Ballow Mark , O'Neil Kathleen
Published: October 2014

The cytokine profile in adenoidal lymphoid tissue was studied in 22 patients. Lymphocytes from adenoid tissues and peripheral blood were submitted for cytokine assays using an enzyme-linked immunosorbent assay kit for interferon-γ, interleukin (IL)–2, IL-4, IL-5, IL-6, and IL-10. Adenoidal lymphocytes appear to produce significantly less Th1 cytokines (IL-2, interferon gamma) compared to the patient's peripheral blood lymphocytes, whereas IL-4 and IL-5 (Th2 cytokines) appear to be synthesized to the same extent as, if not slightly more than, in the homologous peripheral blood lymphocytes. Because the relationship between Th1 and Th2 cytokines is extremely important in modulating the immune response, it is advisable to determine the role of the cytokine profiles of T-lymphocytes in the nasopharynx and its relationship to the development of inflammation of the eustachian tube and middle ear.
Effects of Thrombin and Protease Nexin–1 on Peripheral Nerve Regeneration
Authors: Lee Patty , Spector J. Gershon , Derby Albert , Roufa Dikla G.
Published: October 2014

Thrombin and serine protease inhibitors such as protease nexin–1 (PN-1) have been implicated in neurite outgrowth activity. We compared rat sciatic nerve regeneration in 10-mm silicone tubes, bridging an 8-mm nerve gap, that were prefilled with thrombin (1.5 IU) and PN-1 (50 μg/mL or 1 mg/mL) to those filled with saline solution (control). Neural regeneration and fibrinoid matrix progression (deposition of extracellular matrix) were analyzed at 1, 4, 17, and 21 days after silicone tube implantation. At 1 and 4 days after implantation, thrombin reduced fibrinoid matrix length propagation from both the proximal and distal transected nerve stumps, but PN-1 and saline did not interfere with matrix progression (p <.05). Seventeen days after implantation, the number of silicone tubes containing myelinated neuronal regenerates at the mid-tube region was 1 of 6 for thrombin, 6 of 9 for PN-1, and 6 of 10 for saline solution. Twenty-one days after implantation, 11 of 11 tubes with saline solution, 9 of 11 with PN-1 at 1 mg/mL, and 7 of 9 with PN-1 at 50 μg/mL had myelinated neural regenerates in the mid—silicone tube region, while only 2 of 9 thrombin-containing silicone tubes contained myelinated axons. There was no statistically significant difference in myelinated neurite regenerates at 17 and 21 days after implantation among silicone tubes prefilled with saline solution and PN-1 (50 μg/mL or 1 mg/mL). Thrombin interfered with matrix progression and significantly reduced the number of myelinated neurite regenerates (p =.01). The PN-1 and saline solutions did not inhibit matrix progression or affect the number of myelinated axonal regenerates (p =.92).
Fiber Grouping in the Feline Vestibular Nerve before and after Labyrinthectomy
Authors: Wright Darin L. , Gacek Richard R. , Schoonmaker Joanne E.
Published: October 2014

The vestibular nerve is composed of fibers with a wide spectrum of diameters. The fibers of largest diameter are known to innervate the type I hair cells of the cristae, while the small-diameter fibers innervate the type II hair cells. Midsized fibers (dimorphic fibers) represent neurons that innervate both type I and type II hair cells. Reports by others have commented on the tendency for clustering of fibers with like diameters. Rigorous statistical proof for or against clustering has not yet been presented. The explanation for this is, in part, the mathematic complexity of analyzing clustering in a system composed of three elements. We report a new method for analysis of fiber clustering and apply this method to large-, medium-, and small-diameter fibers in the feline vestibular nerve. The fiber grouping in the caudal and rostral ends of the vestibular nerves of six normal animals is compared to that in similar areas of the nerves of five animals 12 to 17 months after unilateral labyrinthectomy. No statistically significant clustering of fiber types was found in the rostral portion of either the control or the labyrinthectomized animals. In the caudal portion of the control nerves, clustering of the large fibers was demonstrated (p <.005, χ2 test). This clustering was not demonstrated after labyrinthectomy. An explanation of these findings is discussed. The method used in this study to analyze fiber clustering may be applicable to other nerve systems of greater complexity.
Systematic Analysis of Snoring in Women
Authors: Ah-See Kim W. , Stewart Murray , Banham Stephen W. , Robinson Kenneth , Carter Roger , Wilson Janet A.
Published: October 2014

Nineteen percent of women are habitual snorers, yet most snoring studies report only on male snorers. The aim of this study was to identify the factors responsible for habitual snoring in women. Twenty-four snorers and 16 controls were studied prospectively in a special snoring clinic. Snorers were shorter (p =.005) and heavier (p =.001), and with greater body mass index (BMI; p <.001), collar size (p =.002), and submental skinfold thickness (p =.001) than controls. The area of the posterior pharyngeal wall visible on oral examination was smaller in snorers (p =.005). Acoustic rhinometry areas and volumes were similar in the two groups. Nasal flow-volume loops showed reduced expiratory (p =.01) and inspiratory (p =.07) flow in snorers. Inspiratory flow correlated inversely with nasal symptoms (p <.05). The factors that best predict habitual snoring in women are a high BMI, a high nasal symptom score, and heavy weight. Of these, BMI is the most powerful.
Ablation of Teflon Granuloma with the Free-Electron Laser Emitting in the Eight- to Nine-Micron Range
Authors: Bryant Grady Lee , Lano Charles F. , Reinisch Lou , Ossoff Robert H. , Werkhaven Jay A.
Published: October 2014

In this study, we developed a rat model for Teflon granuloma and used this model to evaluate the removal of the granuloma at laser wavelengths at which Teflon has a maximal absorption. Twenty-four Teflon granulomas were created in 12 rats, and the gross and histologic effects from laser incision at four different wavelengths (8.25, 8.5, 8.75, and 10.6 Jim) were evaluated acutely and at 7 and 14 days postoperatively. Polytetrafluoroethylene, or Teflon, is a relatively inert substance that has been used over the past 4 decades for endoscopic injection into the thyroarytenoid muscle of the larynx for the purposes of laryngeal rehabilitation in cases of unilateral vocal fold paralysis or incomplete glottic closure. In certain cases in which formation of granulomatous reaction to the Teflon occurs, patients may have significant dysphonia or airway compromise. Once Teflon has infiltrated the surrounding tissue planes, it is exceedingly difficult to remove endoscopically. Endoscopic removal of this granuloma is usually attempted with the carbon dioxide (CO2) laser and has had limited success. Examination of the infrared absorption spectrum of polytetrafluoroethylene reveals strong absorption in the mid-infrared region in the 8- to 9-μm range, with minimal absorption at 10.6 μm. Therefore, this absorption spectrum predicts a more efficient vaporization of Teflon at wavelengths near 8.5 μm. Using the free-electron laser to generate 8.25-, 8.5-, and 8.75-μm laser light, we found Teflon granuloma ablation was far superior to CO2 laser ablation at 10.6 μm. The 8.25-, 8.5-, and 8.75-μm wavelengths selectively ablated Teflon granuloma with minimal to no collateral thermal injury to tissue. The differences in thermal effects observed while actually using the lasers were confirmed histologically.
Pharmacologic Inhibition of Collagen in an Experimental Model of Subglottic Stenosis
Authors: Doolin Edward J. , Tsuno Kazuo , Strande Louise F. , Santos Mary C.
Published: October 2014

Subglottic stenosis occurs as a complication of prolonged endotracheal intubation secondary to inflammation with development of scar tissue and subsequent fibrosis. Collagen I and III levels increase during the healing process. Steroids alter the inflammatory response, decreasing recruitment of macrophages and fibroblasts. β-Aminopropionitrile (βAPN) inhibits the development of collagen cross-linking. A mechanism that would minimize hypertrophic scarring was sought. Eighteen dogs were anesthetized, had tracheostomies performed, and later had cautery of the mucosa and inner layer of the cricoid cartilage. Of 18 survivors, 6 animals were used as controls, 6 animals received oral Decadron, 2 mg/d, and 6 animals received oral βAPN, 40 mg/d. There were 9 early deaths — 5 in the steroid group. Animals were painlessly sacrificed, and the specimens were sectioned at the cricoid cartilage level and were stained immunohistochemically for antibodies to collagen types I to VI. Analysis of the area of scar and the intensity of stain was performed with Mocha image analysis software. Collagen III increased in control animals to 14.38 ± 1.85 (intensity stain index), but this reaction was reduced by βAPN (5.77 ± 1.78, p <.01). Steroids had no significant effect on formation of any type of collagen. Lathyrogens (βAPN) may offer a pharmacologic tool to reduce scar tissue.
Pneumoparotitis: A New Diagnostic Technique and a Case Report
Authors: Gudlaugsson Ólafur , Geirsson Árni Jón , Benediktsdóttir Kolbrún
Published: October 2014

Pneumoparotitis is a rare cause of parotid gland swelling. We report a case of self-induced pneumoparotitis that resulted in subcutaneous emphysema and pneumomediastinum after an open biopsy of the parotid gland. We suggest a new method for diagnosing this condition. This is done by insufflation of the cheeks with contrast in the oral cavity. A reflux of air and contrast is subsequently demonstrated by a computed tomography scan of the area.
Assessment of Vocal Function Using Simultaneous Aerodynamic and Calibrated Videostroboscopic Measures
Authors: Kobler James B. , Zeitels Steven M. , Hillman Robert E. , Kuo Jeff
Published: October 2014

Despite many attempts to model how vocal fold movements relate to the aerodynamic forces acting on them during phonation, there have been few simultaneous measurements of glottal area and transglottal air pressures and flows. A novel system is described that combines endoscopic measurement of glottal area with aerodynamic flow and pressure measures made during phonation. Results from bench top model tests and from one human subject are presented. For both tests, an aerodynamic model of airflow through a constriction was used to predict the area of the constriction (glottis), and these predictions were compared with endoscopic measurements. The results showed good correlation between predicted and observed areas; however, for small constrictions (<0.025 cm2), whether artificial or glottal, the errors in estimating areas with either optical or aerodynamic methods increase significantly. These results suggest that this measurement system has the potential to enhance the assessment of vocal function.
Upregulation of Messenger RNA for Inflammatory Cytokines in Middle Ear Mucosa in a Rat Model of Acute Otitis Media
Authors: Hebda Patricia A. , Burckart Gilbert J. , Alper Cuneyt M. , Diven Warren F. , Doyle William J. , Zeevi Adriana
Published: October 2014

A rat model for acute otitis media has been established and was used to delineate the temporal expression of messenger RNA for key inflammatory cytokines. Inoculation with live Streptococcus pneumoniae induced a rapid expression of tumor necrosis factor α (within 6 hours) followed by upregulation of message for interleukin (IL)–6 (peak at 12 to 24 hours, remaining elevated through 120 hours) and IL-10 (peak at 24 hours). Inducible nitric oxide synthase message was also selectively increased following live bacterial inoculation (peak at 12 to 24 hours). Although there was a detectable inflammatory response to killed bacteria, it was minimal, was of short duration, and preceded the peak for live bacteria; only expression of IL-6 was significantly increased in this group (peak at 12 hours, remaining elevated through 72 hours). We interpret this to be due to an inflammatory response to bacterial products (such as lipopolysaccharide) in the heat-killed bacterial inoculum. The phosphate-buffered saline (PBS)–inoculated group exhibited a transient increase of IL-6 message, which indicates that this cytokine is a sensitive marker of the acute response to trauma. Otherwise, PBS invoked only a slight reaction in the mucosa with respect to the other inflammatory mediators being measured.
Branchial Cleft Cyst Carcinoma: Myth or Reality?
Authors: Singh Bhuvanesh , Balwally Atul N. , Har-El Gady , Sundaram Krishnamurthi , Krgin Bojana
Published: October 2014

Skepticism has surrounded the existence of branchial cleft carcinoma since the entity was first described in 1882. However, a landmark work of 1950 established four criteria for the diagnosis of branchial cleft carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Of the 43 cases found in an extensive review of the literature, only 7 cases have satisfied all four of the criteria. To this we add 2 patients who had recurrent infections of a cervical cyst as children and later developed carcinoma within these structures. Additionally, we propose a minor modification to the 1950 criteria and a paradigm for diagnosis and management of these lesions.
Reconstruction with Free Jejunal Autograft after Circumferential Pharyngolaryngectomy: Eighty-Three Cases
Authors: Germain Michel A. , Bourgain Jean-Louis , Julieron Morbize , Schwaab Guy , Wibault Pierre , Marandas Patrick , Luboinski Bernard
Published: October 2014

The free jejunal autograft (FJA) has become a common procedure for pharyngeal reconstruction after circumferential pharyngolaryngectomy. In order to evaluate the postoperative outcome and the functional and carcinologic results, we retrospectively reviewed 83 cases of reconstruction with FJA. Fifty-one patients had received no prior radiotherapy, and 25 had received prior radiotherapy for their hypopharyngeal tumor or for another previous primary. Seven patients underwent a secondary reconstruction. In the postoperative course, there were 2 postoperative deaths, 4 graft failures (5%), and 11 salivary fistulas. The median time to removal of the nasogastric tube was 16 days, and to discharge, 23 days. Forty-eight patients received postoperative radiotherapy, with good tolerance. At 1 year postoperatively, 98% of the patients were able to eat a solid or soft diet. The postoperative radiotherapy did not impair the quality of the functional results in a long-term assessment. The vocal results were disappointing. The 3-year survival rate was 40%. The main carcinologic failures (45 patients) were locoregional recurrences (20 patients) and metastasis, which was the cause of death in 34% of the cases. It seems clear that FJA allows one-stage reconstruction and good swallowing rehabilitation, tolerates postoperative radiotherapy, and increases the quality of life in these patients with a poor prognosis.
Immunologic Aspects of Facial Nerve Paralysis Induced by Herpes Simplex Virus Infection in Mice
Authors: Hato Naohito , Hitsumoto Yasuo , Murakami Shingo , Honda Nobumitsu , Yanagihara Naoaki
Published: October 2014

The immunologic aspects of facial nerve paralysis due to herpes simplex virus type 1 (HSV-1) infection were investigated in a mouse model system. Half of the 4- to 5-week-old mice developed facial nerve paralysis, whereas none of the 6-week-old mice died or developed facial nerve paralysis on inoculation with HSV-1. Six-week-old mice showed significantly higher titers of anti-HS V-1 neutralizing antibody than did 4-week-old animals. Passive transfer of either anti-HSV-1 antibody or HSV-1-immunized splenic T cells into 4-week-old mice 3 hours after HSV-1 inoculation prevented development of facial nerve paralysis and death, whereas such transfers 48 or 96 hours after HSV-1 inoculation did not prevent or exacerbate facial nerve paralysis. These results demonstrate that the age and the immunologic potency of mice are closely related to the pathogenesis of facial nerve paralysis. That facial nerve paralysis developed even in 6-week-old mice whose T-cell function was suppressed with anti-CD3 antibody suggests that virus-induced cellular demyelination is unlikely as a cause of facial nerve paralysis in this animal model.
Aspirin, Nonsteroidal Anti-Inflammatory Drugs, and Epistaxis
Authors: Tay Huey L. , McMahon Alexander D. , Evans Josie M. M. , MacDonald Thomas M.
Published: October 2014

To assess the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and spontaneous epistaxis in adults over 50 years old, a case control study was carried out by using a record linkage database for the population of Tayside, Scotland, which included 319,465 people. The study group consisted of 326 patients who were hospitalized with epistaxis between May 1989 and December 1992, but who had not previously been hospitalized with this diagnosis. Six community controls and 4 hospital controls, matched for age and sex to each case, were used. Previous exposure to prescribed aspirin and other NSAIDs was investigated. There was a significant association between aspirin exposure and epistaxis when either community or hospital controls were used (p <.001). Patients who had aspirin prescriptions had a relative risk of hospital admission for epistaxis of between 2.17 and 2.75, depending on the control group used. No association between non-aspirin NSAIDs and epistaxis was evident with either control group.
Image Analysis of Benign and Malignant Neck Masses
Authors: Plant Randall L.
Published: October 2014

Current techniques for differentiating benign and malignant neck masses in computed tomography scans rely on basic features such as size and image density. Advances in digital imaging have led to development of sophisticated computerized image processing tools. Four different image processing algorithms were used to compare 10 patients with neck masses positive for squamous cell carcinoma and 11 patients with benign neck nodes. Statistically significant differences were seen between the malignant and benign masses for edge analysis and Fourier analysis. Significant differences were also seen in several texture parameters, although these results were considered less reliable. There were no differences between the two groups when compared by histogram analysis. It is concluded that both edge analysis and Fourier analysis can provide additional information to distinguish benign and malignant neck masses.
Cervical Thorotrast Granuloma: A Review of the Literature and a New Treatment Modality
Authors: Ung Feodor , Lazor John B. , Montgomery William W.
Published: October 2014

Extravasation of thorium dioxide after transcervical carotid angiography has resulted in persistent open draining neck wounds. These difficult problems have remained a challenge for the treating head and neck surgeon. Neck dissection has been the mainstay of treatment in the past; however, this has been fraught with complications. The application of doxycycline sclerosis is described in the successful resolution of a large Thorotrast granulomatous neck wound. A review of the literature and the management options of Thorotrast granulomas are discussed.
Meyer Procedure for Severe Laryngotracheal Stenosis
Authors: Donald Paul J.
Published: October 2014

Many surgical procedures have been devised to manage laryngotracheal stenosis secondary to trauma. Laryngotracheal atresia is the most severe form and the most difficult to repair. The Meyer procedure is a three-stage operation that provides structural support that is covered with mucosa. A laryngotracheal trough is created and a carved trough-shaped cartilage graft is placed above and lateral to it in the first stage. The skin over the graft is replaced by buccal mucosa in the second stage. In the last stage, the cartilage graft with overlying mucosa is swung onto the trough as a composite flap replacing the anterior and lateral laryngeal and tracheal walls. Attempt at reconstruction was made in 8 patients. All but one lesion was secondary to endotracheal intubation. Two patients were unable to be taken to completion of the third stage. Of the remaining 6 patients, all have a functional voice and only 1 remains cannulated at night.
Expression of Basic Fibroblast Growth Factor in Nasal Polyps
Authors: Powers Michael R. , Liebler Janice M. , Qu Zhenhong , Wall Michael A. , Lagesse Philip C. , Rosenbaum James T.
Published: October 2014

Basic fibroblast growth factor (bFGF) is a polypeptide that is mitogenic for a wide variety of cell types. We used Northern blot analysis and immunohistochemistry to determine if bFGF is expressed in the nasal polyp tissue; bFGF messenger RNA was detectable in the polyps examined by Northern blot analysis. Strong immunostaining for bFGF was found in blood vessels and along the basement membrane of the epithelial cell layers. Basal epithelial cells and some infiltrating mononuclear cells also stained for bFGF. Proliferating cell nuclear antigen colocalized with bFGF to basal epithelial cells, endothelial cells, and areas of focal epithelial metaplasia. The polyp tissue was double-labeled with a mouse monoclonal antitryptase, a specific mast cell marker, and anti-bFGF. A significant number (65% ± 19%) of the bFGF-positive mononuclear cells in the polyp tissues were positive for tryptase. These findings suggest that bFGF may contribute to the endothelial and epithelial proliferation in nasal polyp tissues and that mast cells are one source of this growth factor.
Recovery of Anaerobic Bacteria from a Post-Traumatic Nasal Septal Abscess
Authors: Brook Itzhak
Published: October 2014

This report presents 2 children (boys, 11 and 9 years old) who had post-traumatic nasal septal abscesses. Cultures for aerobic and anaerobic bacteria revealed Peptostreptococcus magnus and a ß-lactamase—producing Prevotella intermedia in the first patient, and Peptostreptococcus anaerobius, Streptococcus intermedius, and Prevotella melaninogenica in the second patient. Anaerobic bacteria may play a role in nasal septal abscesses.
Evaluation of Gastroesophageal Reflux in Patients with Laryngotracheal Stenosis
Authors: Toohill Robert J. , Ulualp Seckin O. , Shaker Reza
Published: October 2014

To report the incidence of pharyngeal acid reflux events in patients with laryngotracheal stenosis (LTS), we studied 12 patients with LTS and 34 healthy volunteers. All patients and controls underwent ambulatory 24-hour 3-site pH monitoring. In ambulatory pH monitoring, pH was recorded at manometrically determined sites of the pharynx, proximal esophagus, and distal esophagus. For all 3 sites, a pH value below 4 that was not related to the time of oral intake or belching was considered an acid reflux event. Eight of the 12 LTS patients exhibited pharyngeal acid reflux events. In the control group, pharyngeal acid reflux events were documented in 7 subjects. In between-group comparison, the number of reflux episodes and the percent acid exposure time in the pharynx were greater in LTS patients than in controls. Reflux parameters of the proximal and distal esophagus in LTS patients were similar to those of controls. The incidence of pharyngeal acid reflux events in LTS patients was higher than that in controls. It is suggested that identification and treatment of gastroesophageal reflux in patients will significantly simplify and improve the results of treatment for LTS.
Synovial Sarcoma of the Larynx and Hypopharynx
Authors: Tos Angelo P. Dei , Sciot Raf , Giannini Caterina , Furlanetto Alberto , Rinaldo Alessandra , Cin Paola Dal , Da Mosto M. Cristina , Ferlito Alfio
Published: October 2014

Synovial sarcoma represents a mesenchymal malignancy of unknown histogenesis that most often occurs in the lower limbs of young adults. The head and neck region is a relatively rare location, in which the hypopharynx and larynx are, respectively, the most and least often affected anatomic sites. Histologically, synovial sarcomas are classified into monophasic and biphasic variants. Immunohistochemistry plays a major part in the differential diagnosis, enabling the demonstration of epithelial differentiation. Both monophasic and biphasic synovial sarcomas are characterized cytogenetically by the reciprocal translocation t(X;18)(p11.2;q11.2) between chromosomes X and 18. Two cases of synovial sarcoma arising in the larynx and in the hypopharynx and in which cytogenetic analysis detected a diagnostic t(X;18) chromosome aberration are reported here.
Endoscopic Middle Ear Surgery
Authors: Tarabichi Muaaz
Published: October 2014

One hundred sixty-five middle ear procedures were performed with an endoscope, a camera, and a video monitor instead of the microscope. The endoscope offers the following advantages: 1) it visualizes the whole tympanic membrane and the ear canal without having to manipulate the patient's head or the microscope, 2) it extends the operative field in transcanal procedures into structures usually hidden from the microscope (anterior tympanic perforation, posterior retraction pocket, facial recess, and hypotympanum), and 3) it visualizes structures from multiple angles as opposed to the microscope's single axis along the ear canal. Disadvantages of the endoscope include the one-handed surgical technique, a loss of depth perception, limited magnification, and the need for training. The endoscope holds the greatest promise in tympanoplasty and cholesteatoma surgery and should increase the utilization of transcanal over postauricular procedures.
Effect of Intravenous Substance P on Laryngeal Adductor Activity in Young Dogs
Authors: Bauman Nancy M. , Wang DeQiang , Sandler Anthony D. , Jaffe Debra M. , Luschei Erich S.
Published: October 2014

Reflex laryngeal adduction is a component of both the laryngeal chemoreflex and the esophagolaryngeal adductor reflex, two life-threatening reflexes that occur in immature animals. These two reflex responses are also thought to exist in infants and may play a role in causing life-threatening laryngospastic events and perhaps sudden infant death syndrome. Identifying neurotransmitters that mediate laryngeal adduction is important to understanding the mechanism of reflex laryngeal responses and to identifying potential means of pharmacologic prevention. Substance P (SP), a tachykinin, putatively functions as a sensory neurotransmitter and may play a role in mediating laryngeal reflexes. Substance P-immunoreactive-like fibers and receptors are present in the subepithelial tissues of the larynx, the vagus nerves, the nodose and jugular ganglia, and the vagal brain stem nuclei. In this investigation, the effect of SP infusion on laryngeal motor activity in an in vivo model is reported. Substance P was infused intravenously into 8 puppies (20 to 133 days of age, mean 81.2), on a mean of 3.0 occasions (range 1 to 6). Cardiovascular, respiratory, arterial blood gas, and cricothyroid (CT), thyroarytenoid (TA), and genioglossus electromyographic (EMG) responses to infusion of the tachykinin were recorded and subsequently analyzed. The SP infusion induced a marked increase in CT or TA EMG activity in 23 of 24 studies, and the increase was typically apparent within 60 seconds of the infusion. An increase in genioglossus EMG activity did not occur. An immediate, profound decrease in mean arterial pressure and an increase in respiratory rate and depth of chest wall excursion accompanied the laryngeal response. Arterial blood gas values remained unchanged (p > .05). The laryngeal adductor response to SP infusion was blocked when animals were pretreated with a systemic SP antagonist (Pfizer CP-96,345). This study demonstrates that peripheral infusion of the tachykinin SP induces a marked increase in laryngeal adductor activity. The response may be blocked by pretreatment of animals with a systemic SP antagonist. Because SP is thought to act primarily as a sensory neurotransmitter, these findings may be important in understanding the mechanism of reflex laryngeal adductor responses.
Radiotherapy Followed by Neck Dissection for Small Head and Neck Cancers with Advanced Cervical Metastases
Authors: Wang Steven J. , Wang Marilene B. , Calcaterra Thomas C.
Published: October 2014

Patients with small or occult primary carcinomas of the head and neck with advanced cervical metastases present a difficult problem for the otolaryngologist. A retrospective review was performed of patients who presented to UCLA Medical Center between January 1986 and June 1996 with small or occult primary tumors of the head and neck with advanced cervical metastases. The treatment algorithm consisted of initial radiotherapy to the primary site and the neck, followed in 6 to 8 weeks with endoscopy and biopsy of the primary tumor site. As long as the repeat biopsy of the primary tumor site was negative by frozen section, an immediate neck dissection was performed, even if no residual neck disease was present. Almost 40% of patients with no clinical evidence of neck disease following radiotherapy had evidence of metastatic cancer on histopathologic examination. While some would consider a watchful waiting policy when there is no clinically detectable neck disease following radiotherapy, we believe it is preferable to perform immediate surgery in such patients, in light of the high incidence of microscopic metastatic disease.
Clinical Applications of Transiently Evoked Otoacoustic Emissions in the Pediatric Population
Authors: Choi Sukgi S. , Pafitis Irene A. , Herer Gilbert R. , Zalzal George H. , Patel Kantilal M.
Published: October 2014

Our objectives were 1) to determine whether transiently evoked otoacoustic emissions (TEOAEs) are affected by the status of the tympanic membrane (TM) and middle ear (ME) as determined by clinical examinations and tympanograms; 2) to determine the efficacy of TEOAEs in detecting hearing loss; and 3) to determine the relative effects of the ME status and hearing loss on TEOAEs. In a prospective observational study in a tertiary care children's hospital, 89 patients (169 ears; 9 ears eliminated from analyses) were examined by 2 attending pediatric otolaryngologists for otologic conditions and underwent audiologic evaluations including TEOAEs from August 1994 through May 1995. The main outcome measures were presence or absence of TEOAE whole reproducibility (WR) and reproducibility (R) at 2 kHz. Statistical analyses showed that of the 8 ME and TM conditions evaluated (normal, TM perforation, pressure equalization [PE] tube, TM retraction, tympanosclerosis, TM atrophy, ME effusion, surgery other than PE tube insertion), only the presence of ME effusion and normal examination findings had a significant effect on the results of WR and R at 2 kHz. Of the 6 different types of tympanograms evaluated (A, B, C, AD, AS, B with large volume), type A, B, and C tympanograms had a significant effect on WR and types A and B had a significant effect on R at 2 kHz. Hearing losses ≥25 dB hearing level (HL) at any of the 5 frequencies (0.25, 0.5, 1, 2, and 4 kHz) were well predicted by the absence of WR and R at 2 kHz. When clinical examination and impedance data were evaluated simultaneously with hearing status, hearing status had a greater effect on WR and R at 2 kHz. We conclude that type B and C tympanograms and the presence of ME effusion (which reflect abnormal ME status) have an adverse effect on TEOAEs. However, the presence of hearing loss is the most significant predictor of TEOAE results. The TEOAE WR and R at 2 kHz are effective in identifying patients with normal hearing and with hearing losses ≥25 dB HL.
Vasomotor Rhinitis following Trauma to the Nose
Authors: Segal Samuel , Berenholz Leonard , Shlamkovitch Nathan , Sarfaty Shlomo , Eviatar Ephraim , Kessler Alexander
Published: October 2014

Complaints of nasal obstruction following nasal trauma without any deformation have been noticed by rhinologists for many years. However, neither an epidemiologic nor a pathophysiologic connection has ever been established. The complaints and physical examination findings of these patients resemble those of vasomotor rhinitis. Only very few articles suggesting nasal trauma as a possible cause for vasomotor rhinitis have ever been published. We present a retrospective study that found 87 of 802 patients to suffer from vasomotor rhinitis following nasal trauma. No other factors known to cause vasomotor rhinitis were present in these patients. None had any previous nasal problems. We therefore suggest that nasal trauma was the causative factor in their vasomotor rhinitis.
Morphology of the Human Larynx during the First Five Years of Life Studied on Whole Organ Serial Sections
Authors: Eckel Hans Edmund , Sprinzl Georg Mathias , Koebke Juergen , Pototschnig Claus , Sittel Christian , Stennert Eberhard
Published: October 2014

The morphologic development of the human larynx during the first years of life is poorly understood to date. This study used plastinated whole organ serial sections to determine the growth and structure of the infant larynx. The larynges of 43 children 1 to 60 months old were plastinated. Whole organ serial sections were obtained by cutting the resulting specimen with a diamond band saw. The slices were then submitted to computer-assisted morphometric investigation. We found that the subglottic airway rapidly increases in size during the first 2 years of life. Further growth follows a linear mode. The relative proportion of the mucosal lining decreases likewise. In contrast to that in adults, and comparable to that in most mammals, the cartilaginous glottis accounts for 60% to 75% of the vocal folds' length at <2 years. No sexual dimorphism of the larynx exists during childhood. This study supplies detailed morphometric data on the growth and structure of the human larynx during the first years of life. It is the first to use plastinated whole organ serial sections for morphology of the pediatric larynx. Therefore, this study provides quantitative anatomic data of clinical interest that have not been available to date.