bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Intervention Improve the Natural Course of Glomus Tumors?
Authors: Frijns Johan H. M. , van Dulken Hans , van der Mey Andel G. L. , Cornelisse Cees J. , Terpstra Hans L. , Brons Eppo N. , Schmidt Pieter H.
Published: October 2014

To acquire more insight into the results of treatment versus the “natural” course of glomus tumors, we studied the clinical data of 108 patients, in 58 of whom the disease was hereditary. During a period of 32 years (1956 to 1988), 175 tumors were diagnosed: 52 glomus jugulotympanic tumors, 32 vagal body tumors, and 91 carotid body tumors. The results of radical surgical treatment were disappointing for tumors located at the skull base, ie, nonradical in 59% (n = 23) of the cases, but very good for the carotid body tumors, for which 96% (n = 68) radical excision was achieved. Moreover, surgery at the level of the skull base dramatically increased morbidity, since it frequently induced cranial nerve palsy. During the follow-up period (maximal observation time 32 years, mean 13.5 years) none of the patients died of residual or recurrent tumor or developed distant metastases, irrespective of the mode and outcome of treatment. When these results are combined with the results of pedigree analysis, a realistic approximation of the “natural” course of the disease for both hereditary and nonfamilial tumors can be made. The results raise the question of whether this natural behavior is really improved by intervention. We conclude that removal of carotid body tumors and solitary vagal body tumors should be considered in order to prevent future morbidity. However, for skull base and bilateral glomus tumors a more conservative monitored “wait and see” policy can be sensible and should be considered in any proposal for treatment of head and neck paragangliomas. When there is serious progression of cranial nerve palsy or when intracranial growth becomes life-threatening, surgical intervention cannot be avoided. The main goal of glomus tumor treatment should be to reduce morbidity rather than trying to increase survival rates.
Off-Vertical Axis Rotation: A Test of the Otolith-Ocular Reflex
Authors: Furman Joseph M. R. , Schor Robert H. , Schumann Timothy L.
Published: October 2014

The vestibulo-ocular reflex was studied via off-vertical axis rotation (OVAR) in the dark. The axis of the turntable could be tilted from vertical by up to 30°. Eye movements were measured with electro-oculography. Results from healthy asymptomatic subjects indicated that 1) a reliable otolith-induced response could be obtained during constant velocity OVAR using a velocity of 60°/s with a tilt of 30°; 2) constant velocity OVAR rotation was nausea-producing and, especially if subjects were rotated in the dark about an earth-vertical axis prior to being tilted, disorienting; and 3) sinusoidal OVAR produced minimal nausea; the eye movement response appeared to be the result of a combination of semicircular canal and otolith components. We conclude that OVAR has the potential of becoming a useful method for clinically assessing both the otolith-ocular reflex and semicircular canal—otolith interaction.
Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review
Authors: Bailey C. Martin , Ochi James W. , Evans John N. G.
Published: October 2014

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Ninety (83%) of the patients were decannulated. Over three quarters of the decannulations took place within 20 months of primary reconstruction. More than half of the patients (47, or 52%) had persistent tracheocutaneous fistulae after decannulation, which required elective closure. The likelihood of a persisting tracheocutaneous fistula is directly related to duration of cannulation.
Comparison of Speech Recognition Ability with Different Speech Processing Strategies by Korean Cochlear Implantees
Authors: Shim Yoon Joo , Cho Gyu Jong , Kim Hee-Nam , Kim Young Myoung , Moon Sung Kyun
Published: October 2014

Many variables affect the audiologic performance of cochlear implantees. With current methods of evaluation, it is difficult to directly compare auditory function with different speech coding strategies. We compared the audiologic performance directly with F0F1F2 and multipeak speech coding strategies in the same implanted ear of eight Korean cochlear implantees. We tested word and phoneme recognition abilities using Korean word lists for speech audiometry and two-syllable nonsense words, respectively. With the multipeak coding strategy, a significant difference in discrimination ability was found in the initial fricative consonant phonemes (/s/, /ss/, /h/). Our results suggest that the improvement of speech recognition ability with the multipeak coding strategy comes primarily from the better understanding of the initial fricative consonants.
Solitary Plasmacytoma of the Skull Base
Authors: Brookes Gerald B. , Marais Joe , Lee Chin-Cheng
Published: October 2014

Plasmacytomas involving the skull base are rare lesions that may be well advanced by the time of diagnosis. Because of their anatomic site they may produce a variety of signs and symptoms, some of which may be vague, often resulting in delays in presentation and in appropriate investigations. We present such a patient, discuss the diagnosis and management, and give a review of the literature.
Quantitative Ultrastructural Study of Cat Abducens Interneurons
Authors: Lyon Michael J. , Maloney Brian P. , Gacek Richard R.
Published: October 2014

Abducens interneurons project to the medial rectus subdivision of the contralateral oculomotor nucleus and have a role in the mediation of horizontal conjugate gaze. Two types of interneurons have been reported based on shape (fusiform and circular) and differences in organelles. In this study, 41 abducens interneurons from three young adult cats were examined in the transmission electron microscope and were classified, on the basis of eccentricity (e), as circular (e < 0.82; N = 18) or fusiform (e ≥ 0.82; N = 23). The volume fraction of nucleus, nucleolus, mitochondria, rough endoplasmic reticulum, polyribosomes, and Golgi complex and the number of synaptic profiles per 100 μm of membrane were determined. Although there is a qualitative difference in these cell types, statistical analyses indicate no significant differences in organelle content, mean area, number of synaptic profiles per 100 μm of membrane, or diameter. While the differences in shape may possibly indicate different functional groups, this notion is not supported by the variables examined or by physiological studies.
Neuroendocrine Tumors of Larynx
Authors: El-Naggar Adel K. , Batsakis John G. , Luna Mario A.
Published: October 2014

Neuroendocrine neoplasms of the larynx have either an epithelial or a neural basis. The former are more numerous and are classified as typical or atypical carcinoids and small cell neuroendocrine carcinomas. Paraganglioma is the sole type of neural neuroendocrine neoplasm. There is a significant worsening of prognosis from typical carcinoid to small cell neuroendocrine carcinoma, with the latter having a dismal 5-year survival rate regardless of therapy. Paragangliomas are the most benign of laryngeal neuroendocrine neoplasms, but their clinical behavior may not be predictable on the basis of their histologic appearance.
Effect of Blood Transfusion on Recurrence of Head and Neck Carcinoma
Authors: Woolley Audie L. , Haughey Bruce H. , Hogikyan Norman D. , Schechtman Kenneth B. , Gates George A. , Goldenberg John L.
Published: October 2014

To study the effect of transfusion on recurrence of squamous cell carcinoma of the head and neck, we analyzed the records of 143 patients with stage II through IV squamous cell carcinoma of the supraglottic larynx or hypopharynx for whom follow-up to recurrence or 5 years after surgical therapy was available. Variables studied were age, gender, TNM staging, duration of operation, estimated blood loss, units of blood products transfused, surgical margins, number of pathologic nodes, radiotherapy, chemotherapy, hematocrit, and serum albumin. Multivariate logistic regression demonstrated that transfusion, number of pathologic nodes, and preoperative hematocrit were significantly related to recurrence. The univariate odds ratio for tumor recurrence in patients receiving any blood products was 3.2 (95% confidence interval 1.5 to 6.9; p = .004). Based on a meta-analysis of the data from this study and the five published studies, the combined odds ratio for recurrence after transfusion was 2.6 (95% confidence interval 1.9 to 3.7; p < .0001). These data identify a clinically important adverse effect of transfusion of blood products on tumor recurrence in patients with advanced head and neck cancer. We recommend a policy of blood conservation surgery to enhance cancer control, and we encourage further research to clarify the mechanism(s) of this effect.
Phonation and Swallowing Considerations in Pediatric Laryngotracheal Reconstruction
Authors: Smith Marshall E. , Cotton Robin T. , Mortelliti Anthony J. , Myer Charles M.
Published: October 2014

Experience with laryngotracheal reconstruction (LTR) has resulted in and continues to yield modifications and refinements in approach and technique with the goal to restore and maintain total laryngeal function. In addition to airway obstruction, the laryngeal functions of phonation and swallowing also may be affected by the underlying injury as well as by procedures designed to enlarge the airway. This paper discusses various problems encountered with phonation and swallowing in pediatric patients who underwent LTR and postoperative patients who were seen during the year July 1, 1990, through June 30, 1991. Phonation problems became apparent as long-term difficulties that persisted after tracheotomy decannulation. Swallowing was frequently a short-term perioperative problem while a stent was in place following LTR. The approaches and techniques that have been employed to treat, minimize, and prevent these problems are discussed.
Pediatric Airway Manifestations of Gastroesophageal Reflux
Authors: Burton Deborah Mitchell , Pransky Seth M. , Kearns Donald B. , Katz Richard M. , Seid Allan B.
Published: October 2014

Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of “silent” GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.
Chondroblastoma of the Temporal Bone
Authors: Varvares Mark A. , Cheney Mack L. , Ceisler Emily , Goodman Max L. , Montgomery William W.
Published: October 2014

Chondroblastoma is a rare tumor of bone that represents approximately 1% of all primary bone tumors. In the temporal bone, only 33 have been reported. We present a case of chondroblastoma of the temporal bone, followed by a literature review and analysis of reported cases. We conclude that the best chance for a prolonged disease-free interval is total excision using a combined otolaryngologic and neurosurgical approach.
Carotid Artery Resection for Head and Neck Cancer
Authors: Maves Michael D. , Bruns Matthew D. , Keenan Michael J.
Published: October 2014

Occasionally, the head and neck surgeon encounters a patient whose malignancy involves the carotid artery. In these patients, curative or palliative surgery may require excision of the common or the internal carotid artery. However, the high complication and death rates dissuade many surgeons from undertaking carotid artery resection. This study reviews the outcomes in 20 patients treated between 1979 and 1985 at the Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, with resection of the carotid artery for head and neck cancer. The carotid artery was electively resected in 16 patients, while 4 patients underwent emergent carotid artery ligation. In the group of patients studied the stroke rate was 25%, the death rate 20%, and the combined stroke and death rate 30%. Of the patients who survived the procedure, all but 1 died of complications caused by tumor recurrence. These results are discussed, and compared with results from other studies.
Experimental Tracheal Replacement Using a Revascularized Jejunal Autograft with an Implantable Dacron Mesh Tube
Authors: Nuss Daniel W. , Friedman Craig D. , Costantino Peter D. , Snyderman Carl H. , Narayanan Krishna , Johnson Jonas T. , Houston Col Glen
Published: October 2014

Defects comprising more than 50% of the trachea cannot be reliably reconstructed by any current technique or prosthesis. A composite tracheal replacement implant consisting of a Dacron-urethane mesh tube and revascularized jejunal autograft was applied to this problem. This composite implant was used to replace 7 to 10 cm of trachea in eight dogs. The implant was sewn to the outside (serosal surface) of the jejunum to provide permanent structural support to the autograft, and an intraluminal silicone tube was placed inside the jejunal segment and left for 4 weeks following reconstruction. Six of eight animals survived the predetermined time periods and were killed painlessly in groups of two animals at 1, 2, and 6 months after removal of the intraluminal silicone tube. Postoperative intubation, ventilation, or tracheostomy was not necessary. Excessive secretions were not seen in any of the animals, and a fair to good performance status was maintained until death in all but one animal. Histologic examination revealed slight thinning of the jejunal mucosa, with no change in the jejunal muscularis. These data suggest that with further refinement this composite implant may be a viable reconstructive option in humans.
Immunologic Response of Adenoidal Lymphocytes to Respiratory Syncytial Virus
Authors: Soh Nobuo , Nadal David , Bernstein Joel M. , Schläpfer Erika , Ogra Pearay L.
Published: October 2014

Adenoidal lymphocytes obtained from 43 subjects with serum antibodies to respiratory syncytial virus (RSV) were established in culture in vitro and analyzed for immunoglobulin (Ig) and RSV-specific antibody synthesis. Spontaneous synthesis of Ig was consistently observed in culture supernatants. The ratios of IgA to IgG and IgM to IgG in adenoidal lymphocyte culture supernatant were higher than in serum. In cell cultures stimulated with RSV or pokeweed mitogen, RSV antibody activity was detected in 25 of 43 (58.1%) for IgG, 5 of 43 (11.6%) for IgA, and 4 of 43 (9.3%) for IgM. Also, RSV-specific IgG was detected in some supernatants from unstimulated cultures. In seven cases the cultures of autologous tonsillar lymphocytes were also investigated. Autologous organs exhibited similar polyclonal Ig production and RSV-specific antibody synthesis. These observations demonstrate that both adenoids and palatine tonsils are continuously engaged in synthesis of local antibodies to viral pathogens available to the nasopharynx and respiratory mucosa.
Pathology Consultation Solitary Fibrous Tumor
Authors: Batsakis John G. , Hybels Roger D. , El-Naggar Adel K.
Published: October 2014

First described as a pleural neoplasm, the solitary fibrous tumor has been reported in a number of extrapleural sites, including the upper respiratory tract. The neoplasm is of mesenchymal origin, exists in benign and malignant forms, and is a histopathologic diagnosis made after exclusion of other soft tissue neoplasms. None of the eight reported sinonasal and nasopharyngeal solitary fibrous tumors have been histologically or biologically malignant. Surgical excision appears to control the tumor at these sites.
High Jugular Bulb: Implications for Posterior Fossa Neurotologic and Cranial Base Surgery
Authors: Rauch Steven D. , Xv Wen-Zhuang , Nadol Joseph B.
Published: October 2014

The suboccipital-retrosigmoid approach to the internal auditory canal and cerebellopontine angle is being used with increasing frequency for neurotologic surgery, including vestibular nerve section and resection of acoustic neuroma. It offers wide exposure of the cerebellopontine angle and the cranial nerve VII—VIII complex as it courses from the brain stem to the temporal bone. Exposure of the internal auditory canal can be achieved by removing its posterior bony wall. Safe utilization of this approach requires familiarity with the variable position of structures within the petrous bone, including the lateral venous sinus and jugular bulb. We report here a case in which bleeding resulted from injury to a high jugular bulb during surgical exposure of the internal auditory canal via the suboccipital route and discuss the regional anatomy of the jugular bulb based on study of 378 consecutive temporal bone specimens from the collection of the Massachusetts Eye and Ear Infirmary. High jugular bulb was defined as encroachment of the dome of the bulb within 2 mm of the floor of the internal auditory canal. Forty-six percent of scoreable specimens met this criterion. However, when donors less than 6 years of age were excluded, a high jugular bulb was identified in 63% of specimens. Relevance to neurotologic surgery of the posterior fossa is presented.
Immune Response to Prevotella Intermedia in Patients with Recurrent Nonstreptococcal Tonsillitis
Authors: Brook Itzhak , Foote Perry A. , Slots Jörgen , Jackson William
Published: October 2014

The role of three oral flora organisms ( Prevotella intermedia, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans) was investigated in 31 children with recurrent nonstreptococcal tonsillitis. Antibody titers to the three organisms were measured by enzyme-linked immunosorbent assay in the 31 patients, as well as in 32 control patients who had not suffered from recurrent tonsillitis. None of the individuals in either group suffered from periodontal or dental illness. Significantly higher antibody levels to P intermedia were found in the study group as compared to controls (median 91.0 versus 72.5; p = .02). In contrast, the antibody titers to the other two organisms were generally low (less than 0.30), and no difference was found among the two study groups. The elevated antibody levels to P intermedia, a known oral pathogen that is also isolated from most recurrently inflamed tonsils, suggest a pathogenic role for this organism in recurrent tonsillitis.
Off-Vertical Axis Rotational Responses in Patients with Unilateral Peripheral Vestibular Lesions
Authors: Furman Joseph M. R. , Schor Robert H. , Kamerer Donald B.
Published: October 2014

Off-vertical axis rotation (OVAR) stimulates the otolith organs in a manner that is suitable for assessment of the otolith-ocular reflex. To further assess the potential clinical usefulness of OVAR, the eye movement responses of seven patients with surgically confirmed unilateral peripheral vestibular lesions were compared with the eye movement responses of a group of age-matched, healthy, asymptomatic control subjects. Patients and controls were tested with constant velocity rotations that followed a brief period of angular acceleration (velocity trapezoid) using either earth-vertical axis (EVA) rotation or OVAR. Both EVA and OVAR sinusoidal velocity profiles were also performed. Results indicated that each patient had 1) an asymmetric OVAR response, ie, a bias component whose direction was opposite normal when rotating toward the lesioned ear, and 2) a normal modulation component. Population data suggested that patients had 1) a more rapid decay of response than normal subjects during OVAR velocity trapezoids, 2) an increased phase lead as compared to normal subjects during sinusoidal OVAR, and 3) like normal subjects, a less rapid decay of response during OVAR velocity trapezoids than during EVA rotational velocity trapezoids. Taken together, these findings suggest that patients with unilateral peripheral vestibular deficits have abnormal otolith-ocular and semicircular canal—ocular reflexes but that a single labyrinth appears to provide an otolithic signal sufficient for qualitatively normal semicircular canal—otolith interaction.
Experimental Transferable Vascular Bed for Laryngotracheal Reconstruction: Further Observations
Authors: Delaere Pierre R. , Mebis Jos , Boeckx Willy D. , Ostyn Frans , Van Damme Boudewijn , Feenstra Louw
Published: October 2014

Free fascia flaps have proven most reliable in providing a vascular bed for an epithelial free graft without adding bulk. They may be a useful tool for laryngotracheal reconstruction. A free flap consisting of a vascular network running in connective tissue can be developed on the rabbit external ear. The vascular characteristics of this flap were examined to test the reliability of the transferable vascular bed in laryngotracheal repair. The perichondrial free flap is useful for bringing an internal lining inside the lumen and for circumferential protection of supporting tissue. However, the natural tendency for surface contraction of perichondrium is a major disadvantage.
Angiogenesis Induced by Head and Neck Squamous Cell Carcinoma Xenografts in the Chick Embryo Chorioallantoic Membrane Model
Authors: Petruzzelli Guy J. , Johnson Jonas T. , Snyderman Carl H. , Myers Eugene N.
Published: October 2014

The angiogenic potential of head and neck tumors compared to nonneoplastic control tissues was investigated by using the chick embryo chorioallantoic membrane (CAM) as a bioassay for angiogenesis. Eighty tumor specimens from 10 patients with squamous cell carcinoma of the head and neck were grafted onto the CAM of 7-day chick embryos. The presence of tumor in the original explant was confirmed histologically. Forty-four embryos (55%) survived and were evaluated histologically at day 17. Tumors were growing on or invading the CAM mesoderm in 30 of 44 embryos (68%). Before harvesting of the membranes, the tumors and surrounding blood vessels were photographed, and the angiogenic responses were graded by a panel of blinded observers. Tumor explants elicited a significantly greater angiogenic response than nontumor controls (p = .01). We conclude that head and neck squamous cell carcinomas can induce an angiogenic response in vivo, presumably secondary to the production of an unidentified angiogenic factor, and that the chick embryo CAM is an effective model for quantifying angiogenesis induced by head and neck tumors.
Effects of Nasal Allergen Challenge on Dynamic Viscoelasticity of Nasal Mucus
Authors: Hattori Masahiko , Ukai Kotaro , Majima Yuichi , Sakakura Yasuo
Published: October 2014

The effects of nasal provocation on the rheologic properties of nasal mucus were investigated in patients with allergic rhinitis provoked by house dust. The elastic modulus (G') and the dynamic viscosity (η') of nasal mucus were determined by an oscillating sphere magnetic rheometer. Before and after the allergen challenge, G' increased, whereas η' decreased with increasing oscillatory frequency; these findings indicate that the nasal mucus under these conditions is a non-newtonian fluid and has the cross-linked gel-like nature typical of mucus. Both G' and η' values after nasal provocation were significantly lower than before. The values of G' and η' after allergen challenge were in the optimal viscoelasticity range for mucociliary transport.
Particle Repositioning Maneuver for Benign Paroxysmal Positional Vertigo
Authors: Parnes Lorne S. , Price-Jones R. Greg
Published: October 2014

Benign paroxysmal positional vertigo is a common, most often self-limited, vestibular end organ disorder that in some cases may be quite disabling. Recent evidence suggests that some, if not most, cases result from free-floating posterior semicircular canal endolymph particles. We postulate that the particle repositioning maneuver displaces these particles from the posterior canal through the common crus into the utricle, where they no longer induce pathologic responses. Our report focuses on 38 consecutive patients treated with this simple bedside technique during a 10-month period. On follow-up, 26 patients (68.4%) were free of disease, 4 (10.5%) were significantly improved, 4 (10.5%) remained unchanged, and 4 (10.5%) were lost to follow-up. Of the 4 patients who remained unchanged, 2 underwent successful posterior semicircular canal occlusions. The direction of the nystagmus during the second stage of the maneuver appears important in predicting the efficacy, with reversal of nystagmus denoting a poor response. These findings provide additional insight into the pathophysiology of this disorder.
Early Diagnosis of Otologic Wegener's Granulomatosis Using the Serologic Marker C-Anca
Authors: MacIas John D. , Wackym Phillip A. , McCabe Brian F.
Published: October 2014

Wegener's granulomatosis is a systemic vasculitis that may involve any organ system. Otologic manifestations are common, and can be the presenting complaint. In the past, diagnosis often necessitated the development of characteristic pulmonary or renal disease. The identification of a new serologic marker, cytoplasmic pattern antineutrophil cytoplasmic autoantibody (C-ANCA), allows for the early diagnosis of Wegener's granulomatosis and gives the patient the best chance for remission with cytotoxic therapy. We report two patients with Wegener's granulomatosis who presented with refractory otitis media, one of whom subsequently developed facial nerve paralysis, in which an early diagnosis was facilitated by the use of the C-ANCA test. Otologic manifestations of Wegener's granulomatosis and the basis of the C-ANCA test are discussed.
Validation of World Health Organization Guidelines for Pain Relief in Head and Neck Cancer
Authors: Grond Stefan , Diefenbach Christoph , Zech Detlev , Schug Stephan A. , Lynch John , Lehmann Klaus A.
Published: October 2014

In a prospective study of 167 patients with head and neck cancer, we assessed the causes and mechanisms of pain, as well as the efficacy and side effects of analgesic treatment, along World Health Organization (WHO) guidelines. The majority of patients had pain caused by cancer (83%) and/or treatment (28%), 4% had pain due to debility, and 7% had pain unrelated to cancer. Palliative antineoplastic treatment was performed in 32% of patients. Systemic analgesics were administered on 97% of a total of 8,106 treatment days, and coanalgesics or adjuvant drugs on 100%. The treatment proved to be very successful, as severe pain was experienced only during 5% of the observation period. In the absence of serious side effects, the most frequent symptoms observed were insomnia, dysphagia, anorexia, constipation, and nausea. The use of analgesic and adjuvant drugs along WHO guidelines to treat pain in head and neck cancer is highly effective and relatively safe.
Comparison of Half-Band and Full-Band Electrodes for Intracochlear Electrical Stimulation
Authors: Xu Shi-Ang , Xu Jin , McAnally Ken I. , Clark Graeme M.
Published: October 2014

It was hypothesized that intracochlear stimulating electrodes oriented toward the modiolus would require a lower stimulus current to elicit a threshold neural response than longitudinal band electrodes. Electrically evoked auditory brain stem responses (EABRs) and electrode impedances were recorded with full-band and oriented half-band scala tympani electrodes in anesthetized, deafened cats. To elicit a threshold EABR, the stimulus current required for stimulation through half-band electrodes oriented toward the modiolus was not significantly different from the current required for stimulation through full-band electrodes. The impedances of full-band electrodes were significantly lower than those of half-band electrodes. Considering the significantly higher impedance and current density of half-band electrodes in comparison to full-band electrodes, as well as the critical orientation of half-band electrodes during implantation, we believe that full-band electrodes have advantages over half-band electrodes for scala tympani implantation.
Immunohistochemical Localization of a Cytochrome P-450 Isozyme in Human Nasal Mucosa: Age-Related Trends
Authors: Getchell Marilyn L. , Chen Ying , Ding Xinxin , Sparks D. Larry , Getchell Thomas V.
Published: October 2014

Immunoperoxidase staining with an antibody to cytochrome P-450 (NMa) was used to investigate the localization of this isozyme in the human nasal mucosa. Olfactory mucosa was identified by staining of olfactory receptor cells with an antibody to olfactory marker protein. Immunoreactivity to NMa was localized in sustentacular cells in the olfactory epithelium, and in Bowman's gland acinar cells and vascular endothelial cells in the lamina propria. In the respiratory mucosa, ciliated epithelial cells, as well as serous gland acinar cells and vascular endothelial cells in the lamina propria, were immunoreactive for this isozyme. An age-related decrement in the intensity and extent of immunoreactivity within these cells was noted in nasal tissue from patients 60 years of age and over when compared with that of patients under 60 years of age. These results identify sites of xenobiotic metabolism or activation in human nasal mucosa.
Bilateral Parotid Duct Fistula
Authors: Kabakkaya Yilmaz , Doǧan Mehmet , Bakan Ebubekir , Yiǧitoǧlu M. Ramazan , Gökçe Gültekin
Published: October 2014

Parotid duct fistulas (PDFs) are rare and have various causes such as gunshot wounds and human and animal bites; they may also be congenital. We have not found previous publications on bilateral PDF. Our patient, although young, also had generalized pigmentation characteristic of aging and thick, dry, wrinkled skin, as well as pyoderma. Biochemical analysis was performed on discharge from the patient's face, and histopathologic and immunologic studies were done. The fistulas were treated by intraoral fistulization. Cephalosporins were given to the patient for 5 days postoperatively to treat the pyoderma.
Difficulties in Endoscopic Removal of Teflon Granulomas of the Vocal Fold
Authors: Ossoff Robert H. , Netterville James L. , Koriwchak Michael J. , Duncavage James A.
Published: October 2014

The difficulties in treating granulomas resulting from Teflon injection into the vocal fold are underreported in the literature. We have reviewed our experience with nine patients undergoing 27 procedures for Teflon granuloma. Two patients required tracheotomy before undergoing endoscopic granuloma removal because of airway compromise, and a third required urgent tracheotomy following endoscopy. One of the patients requiring elective tracheotomy had a granuloma that extended across the midline to the contralateral arytenoid, causing its fixation. Arytenoidectomy was required for decannulation in this patient. In all but one patient the granuloma nearly completely replaced the thyroarytenoid muscle. This extensive involvement often precludes the adequate excision of the granuloma in a single procedure; however, the microflap technique allows mucosal preservation to facilitate future procedures. In some cases the granuloma destroys large amounts of mucosa, and a microflap cannot be elevated and saved. The difficulties of excision are related to the near-total replacement of the thyroarytenoid muscle by granuloma. This paper will help the otolaryngologist—head and neck surgeon understand this destructive process and the resulting difficulties in surgical rehabilitation.
Survival of Scarpa's Ganglion in the Profoundly Deaf Human
Authors: Chiong Charlotte M. , Glynn Robert J. , Xu Wen-Zhuang , Nadol Joseph B.
Published: October 2014

The electrically evoked auditory brain stem response in some cochlear implant patients may be confounded by evoked potentials generated by vestibular neurons. The magnitude of this contribution to the response from the vestibular system is unknown, in part because the survival of cells within Scarpa's ganglion in profoundly deaf humans is unknown. Therefore, we undertook a quantitative study of Scarpa's ganglion in 48 deaf subjects who in life would have been candidates for cochlear implantation and in 5 subjects with normal hearing. The numbers of residual cells in both Scarpa's ganglion and the spiral ganglion in deaf subjects were significantly less than in individuals with normal hearing. Bivariate analysis demonstrated a highly significant positive correlation between cell counts of Scarpa's ganglion and the spiral ganglion. The durations of hearing loss and of profound deafness were negatively correlated with Scarpa's ganglion cell counts. However, in contrast to spiral ganglion cell survival, the cause of profound deafness did not predict the number of Scarpa's ganglion cells. Multiple linear regression analysis using a variety of clinical parameters demonstrated that the best predictor of the number of Scarpa's ganglion cells in profoundly deaf humans was the number of remaining spiral ganglion cells.
Airway Complications in Thyroid Surgery
Authors: Lacoste Louis , Montaz Nicole , Bernit Anne-Françoise , Gineste Damien , Lehuede Marie-Suzanne , Barbier Jacques , Karayan Jérôme , Girault Martine , Fusciardi Jacques
Published: October 2014

Perioperative and postoperative morbidity and mortality were studied in a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patients, although a low rate of dyspnea (2.7%) was observed. In large goiters, some orotracheal intubations were difficult. In such cases, the transtracheal approach can also be difficult, so failure should be anticipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions led to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bilateral palsy was observed in 3 cases with prolonged or extensive surgery. After these short-term orotracheal intubations (114 minutes on average), injuries of the airway caused by the endotracheal tube were found in 4.6% of the patients.
Regeneration of Maxillary Sinus Mucosa following Surgical Removal
Authors: Forsgren Karin , Kumlien Jan , Stierna Pontus , Carlsöö Bengt
Published: October 2014

A rapid regeneration of the epithelium takes place in the maxillary sinus in rabbits after experimental operative removal of the mucosa. Two weeks postoperatively the previously denuded areas have reepithelialized. The subepithelial glands, however, do not seem to regenerate. The normal sinus mucosa contains numerous serous glands in the lamina propria, but in the regenerated mucosa these glands are replaced by dense connective tissue. Atypical glands and polyp formations are sometimes encountered, but goblet cells are sparse. Furthermore, the sinus cavity on the operated side is reduced in size compared with the nonoperated side because of fibrosis and periosteal reactions including bone degradation and neogenesis. This study indicates that although the mucosa is reepithelialized within 2 weeks, the regeneration of the lamina propria is incomplete, and reactive cellular processes such as bone remodeling, fibroblast proliferation, and formation of polyps and “atypical glands” are characteristic of regenerating mucosa.
Tumefactive Fibroinflammatory Lesions of the Head and Neck
Authors: Frankenthaler Robert , Batsakis John G. , Suarez Patricia A.
Published: October 2014

Tumefactive fibroinflammatory lesions of the head and neck are idiopathic, histologically benign, tumor-forming lesions that clinically simulate malignancies. Their histopathologic appearance is nearly identical to that of fibrosclerotic lesions of the mediastinum and retroperitoneum and Riedel's thyroiditis, and in some cases, a congeneric (periarteritis) origin is postulated. There is no optimum treatment, and recurrence and persistence are common. The suggested initial treatment is corticosteroid administration.
Disappearing Recurrent Acoustic Neuroma in an Elderly Woman
Authors: Redleaf Miriam I. , McCabe Brian F.
Published: October 2014

Acoustic neuromas have been shown to grow more slowly, if at all, in the elderly. Reduction of tumor size has been rarely reported in intracranial masses thought to be acoustic neuromas. We present a biopsy-proven acoustic neuroma that involuted completely during a 4-year period of surveillance. Possible mechanisms of involution are discussed.
Pathology Consultation Epithelial Choristomas and Teratomas of the Tongue
Authors: Batsakis John G. , El-Naggar Adel K. , Hicks M. John
Published: October 2014

Nonsalivary choristomas of the oral cavity are rare, have a predilection for the tongue, and are classified according to their generative tissues as gastroenteric, thyroidal, or sebaceous. Only the lingual thyroid choristoma has a malignant counterpart. Lingual teratomas are even rarer. They have been histologically benign.
Classification of Congenital Middle Ear Anomalies Report on 144 Ears
Authors: Teunissen E. Bert , Cremers W. R. J.
Published: October 2014

The surgical findings in 144 successive ears operated on for congenital conductive hearing loss were analyzed, and the results were evaluated in terms of hearing gain. All the patients underwent middle ear surgery at the University Hospital Nijmegen between 1964 and 1990. A classification system was developed to analyze the findings. Class 1 comprises ears with congenital isolated stapes ankylosis. Class 2 comprises ears with congenital stapes ankylosis in combination with a congenital anomaly of the ossicular chain. Class 3 comprises ears with congenital anomalies of the ossicular chain and at least a mobile stapes footplate. Class 4 comprises ears with aplasia or severe dysplasia of the oval window or round window.
Morphology of the Membrana Limitans
Authors: Hara Makoto , Kimura Robert S.
Published: October 2014

The morphology of the membrana limitans (ML) was studied by light and electron microscopy to further understand its functional significance. The ML is a porous shield composed of a few to several layers of tightly packed fibrocytes that separate the perilymphatic space of the cochlea and saccule from that of the utricle and canal system. These fibrocytes are thinner on the side of the vestibule. They show many desmosomes and gap junctions and are interspersed with fibrils. The 3-dimensional reconstruction from celloidin sections shows that the ML, as it is viewed from the anterior side, is rectangular in shape, with various surface curvatures and an invagination toward the internal aperture of the vestibular aqueduct. Horseradish peroxidase, a tracer substance, placed on either side of the ML fails to pass to the opposite side. The ML and trabecular meshwork may be a factor contributing to differential sensitivity of cochlear and vestibular sensory cells in the presence of noxious substances.
Sources of Variability in Posterior Rhinomanometry
Authors: James David S. , Lambert William E. , Stidley Christine A. , Chick Thomas W. , Mermier Christine M. , Samet Jonathan M.
Published: October 2014

Sources of variability in nasal airway resistance measured by posterior rhinomanometry were studied in 5 subjects tested on 5 different days and 56 subjects tested on 2 different days. On each day, a questionnaire on upper airway health and nasal symptoms was completed. The mean individual difference in nasal airway resistance between the 2 test days in the group of 56 subjects was 5.3% (SD 52.7%). Between-subject variability accounted for 74.9% and 72.5% of the total variability in the group of 5 and the group of 56 subjects, respectively. For the 5 subjects, by accounting for a change in upper airway symptoms or upper respiratory tract infection that occurred over the 5 test days, there was a significant decrease in the between-subject variability. The difference in sources of variation due to a change in upper airway symptoms was not seen in the group of 56 subjects. We conclude that the largest source of variability in nasal airway resistance is due to between-subject differences.
Persistent Stapedial Artery: Does it Prevent Successful Surgery?
Authors: Govaerts Paul J. , Marquet Thérèse F. , Cremers W. R. J. , Offeciers F. Erwin
Published: October 2014

Because of the important function of the embryologic stapedial artery, it is taken for granted by many surgeons that the finding of such a persistent artery in postnatal humans during middle ear surgery should urge maximal caution in order not to damage the artery. Often, discontinuation of the surgery is recommended. Yet this attitude is based on theoretic considerations rather than on any clinical evidence of complications following injury to this vessel. The present paper describes the embryology in relation to this specific aspect and reviews the literature on the persistent stapedial artery, emphasizing the papers dealing with injury to this vessel. In addition, we report 4 cases of persistent stapedial artery from the files of almost 20,000 patients in whom tympanotomy was performed. From all these data we conclude that injury to this artery or even complete section probably does not cause major, if any, postoperative sequelae, and that consequently, middle ear surgery is not necessarily hindered by the presence of this vessel.
Function of the Thyroarytenoid Muscle in a Canine Laryngeal Model
Authors: Choi Hong-Shik , Ye Ming , Berke Gerald S. , Kreiman Jody
Published: October 2014

Fundamental frequency is controlled by contraction of the thyroarytenoid (TA) and cricothyroid (CT) muscles. While activity of the CT muscle is known to tense and thin the vocal folds, little is known about the effect of the TA muscle on vocal fold vibration. An in vivo canine laryngeal model was used to examine the role of the TA muscle in controlling phonation. Isolated TA muscle activation was obtained by stimulating sectioned terminal TA branches through small thyroid cartilage windows. Subglottic pressure measures, electroglottographic and photoglottographic signals, and acoustic signals were obtained in 5 mongrel dogs during dynamic and static variations in TA muscle activity. Results indicated that TA muscle activation is a major determinant in sudden shifts from high-frequency to modal phonation. Subglottic pressure increased and open quotient decreased gradually with increasing TA activation.
Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure
Authors: Clevens Ross A. , Hartshorn Duane O. , Esclamado Ramon M. , Lewin Jan S.
Published: October 2014

The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 ± 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 ± 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngeosophageal spasm, a factor limiting voice rehabilitation.
Lightning Injury of the Tympanic Membrane
Authors: Redleaf Miriam I. , McCabe Brian F.
Published: October 2014

A number of cases of otologic injuries by lightning strikes have been described in the otolaryngological literature. The mechanism of these injuries remains uncertain. We report 3 cases of lightning injury that presented to us. Analysis of these cases suggests that the mechanism of injury is direct conduction of electricity from the scalp to the soft tissues of the external auditory canal to the tympanic membrane. The conduits of the electrical surge are the subcutaneous blood vessels, smaller vessels being damaged more than larger vessels. Since the tympanic membrane central vessels are smaller than the canal vessels, the central area of the tympanic membrane would be most vulnerable, and this is seen clinically. A review of the literature supports this proposed mechanism of injury.
Malignant External Otitis in Nondiabetic Patients
Authors: Shpitzer Thomas , Levy Rudy , Stern Yoram , Segal Karl , Cohen Ohad , Feinmesser Raphael
Published: October 2014

The purpose of this study is to point out that contrary to traditional belief, there is a small but significant group of nondiabetic patients with malignant external otitis. Thirty patients with a diagnosis of malignant external otitis were treated and followed up at the Department of Otolaryngology—Head and Neck Surgery, Beilinson Medical Center, between 1987 and 1991. Nine of these patients did not have clinical or laboratory evidence of diabetes. This study analyzes this group and concludes that the diagnosis of malignant external otitis should be considered by the treating physician in nondiabetic patients presenting with a Pseudomonas aeruginosa infection of the external ear canal. Severe pain and edematous closure of the canal, together with typical granulation tissue and failure to respond to medical treatment, are specific characteristics of this group.
Sudden Sensorineural Hearing Loss Associated with Slow Blood Flow of the Vertebrobasilar System
Authors: Yamasoba Tatsuya , Kikuchi Shigeru , O'uchi Toshihiro , Higo Ryuzaburo , Tokumaru Aya
Published: October 2014

To determine the characteristics of sudden deafness associated with slow blood flow (SBF) within the vertebrobasilar arteries, we evaluated 57 patients with sudden deafness using magnetic resonance imaging (MRI). We detected SBF in 12 (21%) patients, predominantly men over 50 years of age. A second MRI performed in 5 patients 2 months after the onset of symptoms showed recovery of blood flow. All 12 patients complained of vertigo. Audiological and neurotologic tests suggested that hearing loss mainly involved the inner ear. Our findings suggest that unless central lesions are detected, headache, hypoesthesia of the external ear canal, and electronystagmographic abnormalities are signs of SBF. Because sudden deafness may recur in patients who have SBF, they should be monitored and treated to prevent recurrence.
Aneurysmal Bone Cyst of the Mandible
Authors: Trent Christopher , Byl Frederick M.
Published: October 2014

The aneurysmal bone cyst is a nonmalignant lesion that by expanding disrupts the architecture of the affected bone and destroys surrounding tissue. Developing rarely in the craniofacial region, and more commonly affecting the long bones and the spine, the lesion has characteristic radiographic features but is definitively diagnosed only by pathologic characteristics. Complete surgical excision is used to treat aneurysmal bone cyst, with either curettage or composite resection. Recurrence is common in incompletely excised lesions. Adjunctive cryotherapy reduces the risk of recurrence, and radiotherapy is reserved for nonresectable lesions. The case we report of a young man seen for a large mandibular aneurysmal bone cyst demonstrates the complexity of diagnosing and treating this condition.