bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Effect of Arachidonic Acid on Inner Ear Blood Flow in Rats with Streptozotocin-Induced Diabetes
Authors: Umemura Kazuo , Takiguchi Yoshiharu , Nakashima Mitsuyoshi
Published: October 2014

The present study was undertaken to clarify the altered effect of arachidonic acid on inner ear blood flow in rats with streptozotocin-induced diabetes by use of the laser-Doppler flowmeter. Drugs were administered intraarterially via the subclavian artery in a dose range that did not affect the systemic blood pressure. Both arachidonic acid and papaverine hydrochloride increased inner ear blood flow dose-dependently. Diabetic rats at 12 weeks, but not at 8 weeks, after the induction of diabetes showed a significant decrease in arachidonic acid response. However, there were no differences in papaverine response between diabetic and control rats. Pretreatment with ONO-3708, a selective thromboxane A2 antagonist, reversed the attenuated response to arachidonic acid found in diabetic rats. An increased response to thromboxane A2, which decreased inner ear blood flow, was also found in 12-week diabetic rats. In electrocochleograms, the latency in 12-week diabetic rats was significantly delayed compared with that in control rats, and this prolonged latency improved with insulin treatment. These results suggest that the responsiveness of inner ear blood flow to prostaglandins may be altered in individuals with diabetes mellitus.
Perinatal Vertical Transmission of Human Papillomavirus and Subsequent Development of Respiratory Tract Papillomatosis
Authors: Smith Elaine M. , Johnson Susan R. , Pignatari Shirley , Cripe Timothy P. , Turek Lubomir
Published: October 2014

This study prospectively examined the potential for human papillomavirus (HPV) to be transmitted vertically to newborns during delivery. Exfoliated cervical cells were extracted from 72 pregnant women during the third trimester and again during labor prior to delivery, and tested for the presence of HPV DNA. These results were compared with HPV DNA specimens from their newborns, who were sampled by exfoliated cells from the oral-pharyngeal cavity and vulva or tissue from the foreskin 24 to 72 hours after delivery. Among the mothers, 18.1% (13 of 72) typed HPV-positive by the ViraPap/ViraType DNA hybridization technique. Two neonates (2.8% or 2 of 72) tested positive from oral-pharyngeal specimens. This finding supports the hypothesis that respiratory tract papillomatosis may develop as a result of perinatal vertical transmission of HPV. Furthermore, this study suggests that neither cesarean section nor prepartum treatment of HPV lesions will always protect against neonatal acquisition of HPV.
Auditory Nerve Compound Action Potentials and Brain Stem Auditory Evoked Potentials in Patients with Various Degrees of Hearing Loss
Authors: Møller Aage R. , Jannetta Peter J. , Møller Margareta B. , Jho Hae Dong
Published: October 2014

Click-evoked compound action potentials recorded in normal-hearing patients through a monopolar electrode placed on the intracranial portion of the eighth nerve were compared with the responses recorded in patients with high-frequency hearing loss or with high- and low-frequency hearing losses. That multiple peaks appear in the compound action potential in patients with hearing loss implies that click sounds elicit successive and separated volleys of neural excitation in the ascending auditory pathway, whereas click sounds in patients with normal hearing mainly give rise to a single volley of neural activity. This difference in the pattern of auditory nerve activity might explain why there are often multiple peaks in the brain stem auditory evoked potentials in patients with hearing loss and that the peaks are often less well-defined than peaks in patients with normal hearing.
Contribution of Increased Endolymphatic Pressure to Hearing Loss in Experimental Hydrops
Authors: Horner Kathleen C. , Cazals Yves
Published: October 2014

After the induction of experimental hydrops there follows a strict sequence of compound action potential (CAP) audiogram changes. Within days a low-frequency loss (below 8 kHz) is detected; within weeks a very high-frequency loss (above 8 kHz) develops; and finally within months the 8-kHz region is also affected. Following the application of excess pressure, presumably to the endolymphatic spaces, via a cannula placed in the endolymphatic duct, a sequence of CAP audiogram changes occurs that is not similar to that observed with hydrops. There is first a very high-frequency loss (above 4 kHz), then a very low-frequency loss (below 4 kHz), and finally the 4 kHz region is also affected and thresholds for all frequencies become even more raised. The data thus suggest that a slow accumulation of endolymph as induced by blockage of the endolymphatic duct does not produce the same disorder as a rapid onset of a high pressure applied at the base of the cochlea. In addition the data suggest that raised endolymphatic pressure is not likely to be significant in early stages of hydrops, but could contribute to the later high-frequency sensitivity losses.
Endoscopic Holmium Laser Laryngotracheoplasty in Animal Models
Authors: April Max M. , Aretz H. Thomas , Rebeiz Elie E. , Shapshay Stanley M.
Published: October 2014

Subglottic stenosis remains a difficult clinical problem with varied management approaches. An accepted procedure has been anterior and posterior cricoid incisions through an external approach for treatment of severe stenoses without a tracheotomy. The holmium:yttrium-aluminum-garnet laser, 2.1 μm wavelength with a pulsed output, is transmissible through standard fibers and ablates soft tissue and cartilage with minimal surrounding damage. This study in in vitro and in vivo animal models shows that this new laser can be used to incise the anterior and posterior cricoid and tracheal cartilages with precise control and may be suitable for endoscopic laryngotracheoplasty.
Complications of Cochlear Implant Surgery in Adults and Children
Authors: Cohen Noel L. , Hoffman Ronald A.
Published: October 2014

Surgery for cochlear prosthesis insertion exposes the patient to several potential risks. We review the surgical complication experience with cochlear implants in the United States. There have been no deaths attributable to these devices, few serious major complications, and relatively few minor complications. Major complications usually have to do with surgical technique and include flap necrosis, improper electrode placement, and rare facial nerve problems. Minor complications include dehiscence of incisions, infection, facial nerve stimulation, dizziness, and pedestal problems with the Ineraid device. Complications were less frequent in children than adults and were more likely to occur in the younger children than those above the age of 7 years. Complications were still fewer in groups of patients operated on within tightly controlled protocols. There was no increased incidence of otitis media in children who received the Nucleus Mini-22 device, and no reported sequelae from such otitis when it occurred.
Indication of a Relation between Speech Perception and Temporal Resolution for Cochlear Implantees
Authors: Cazals Yves , Kasper Andreas , Pelizzone Marco , Montandon Pierre
Published: October 2014

In order to better understand the reasons for success or failure of a cochlear implant system for various patients, it appears necessary to analyze the patients' basic psychophysical capacities in relation to speech perception. Five patients with intracochlear multichannel Ineraid implants were studied in terms of their performance on temporal analysis in relation to their perception of consonants. For temporal analysis we measured the detection of a silent gap in noise and of an interval between two clicks. For consonant perception we established a confusion matrix based on 12 consonants presented in a vowel-consonant-vowel context using the vowel /a/. The results showed a correlation between temporal resolution for two successive clicks at the most basal cochlear electrode used, and the perception of place of articulation of consonants. This finding indicates that delivering fine temporal coding can be crucial for the success of an implant and that for a given subject, optimal capacity for temporal resolution may serve as a criterion for choosing a basal electrode.
Herpes Zoster Oticus: Treatment with Acyclovir
Authors: Uri Nechama , Meyer Walter , Greenberg Elhanan , Kitzes-Cohen Ruth
Published: October 2014

Herpes zoster oticus produces facial paralysis with a low recovery rate. Acyclovir, a specific virostatic drug, was given intravenously in five herpes zoster oticus patients, and in three of them was followed by oral therapy. In follow-ups of 1 to 24 months, one patient had grade I recovery, three patients grade II, and one grade III. These good results encourage the use of acyclovir in herpes zoster oticus patients.
Irradiation-Induced Atherosclerosis: A Factor in Therapeutic Planning
Authors: McGuirt W. Frederick , Feehs Robert S. , Strickland Harriet L. , Bond Gene , McKinney William M.
Published: October 2014

Early primary head and neck cancers (stages I and II) and occult metastatic neck disease have caused debate regarding the choice between surgery and irradiation. The arguments for each are reviewed with a new consideration: the acceleration and/or induction of carotid atherosclerosis in irradiated patients. We present clinical case reports (n = 9), a retrospective clinical evaluation for the occurrence of carotid atherosclerosis in irradiated head and neck cancer patients (n = 57), and a comparison study of the extent and distribution of atherosclerosis in irradiated (n = 29) and nonirradiated head and neck cancer patients controlled for age, blood pressure, and tobacco use. The results show that carotid atherosclerosis is found in a wider anatomic distribution and to a greater extent in irradiated than in nonirradiated patients. We conclude that carotid atherosclerosis is induced and/or accelerated by neck irradiation. The implications as they relate to choice of treatment, to pretreatment evaluations, and to long-term follow-up are discussed.
Collagen in the Developing Larynx
Authors: Cheung David T. , Lian Grace , Cohen Seymour R. , Nimni Marcel E. , Perelman Natasha , Mahnovski Vladimir , Carranza Alfonzo P.
Published: October 2014

The primary purpose of this study was to determine the types of collagen in the developing human larynx that contribute to the structural framework and function of various components of this organ. The infant larynx is much more than a mere miniature of the adult “voice box.” There are many age-related differences that occur in the larynx from the newborn period to the adult period of life. While collagen has been studied in numerous tissues, both normal and diseased, there have been no studies of the whole organ content, types, and/or changes of collagen in the developing human larynx that may account for many of the clinical findings. This study may at least in part explain whether collagen differences may account for the structural changes and responses that are seen in clinical practice.
New Device for Interdental Immobilization
Authors: Divis Boris O.
Published: October 2014

The immobilization of a simple fractured jaw with arch bars is a time-consuming, laborious procedure. The alternative method of immobilization described here uses a precisely threaded, 22-gauge, malleable stainless steel wire and a threaded nylon nut. It affords the surgeon relative safety from accidental puncture trauma and makes the interdental immobilization a precise and speedy procedure.
Kikuchi-Fujimoto Disease of the Neck Update
Authors: García Carlos E. , Girdhar-Gopal Harsha V. , Dorfman David M.
Published: October 2014

Kikuchi-Fujimoto disease (KFD) is a rare entity of uncertain cause that commonly presents with persistently enlarged cervical lymph nodes unresponsive to antibiotic therapy. Although it usually follows a benign course, KFD has been repeatedly misdiagnosed as malignant lymphoma; hence, clinicians and pathologists alike need to be aware of this disease entity. The newest developments regarding the etiology and course of KFD are presented through a review of the literature and a recent illustrative case.
Accumulation of Potassium in Scala Vestibuli Perilymph of the Mammalian Cochlea
Authors: Salt Alec N. , Ohyama Kenji
Published: October 2014

Movements of potassium (K+) were monitored during perfusion of either the scala tympani (ST) or the scala vestibuli (SV) of the guinea pig cochlea with a solution containing 15 mmol/LK+. A highly asymmetric clearance of K+ was observed, with K+ rapidly being taken up from the ST and allowed to accumulate in the SV. Under some conditions the SV K+ concentration could exceed that in the perfused ST. These observations are believed to result from the distortion of passive K+ diffusion by the high circulating current of K+ that is part of the transduction process. Calculations are presented to demonstrate that circulating fluxes are of sufficient magnitude to generate the results observed. The high rate of circulating K+ current is probably also responsible for the difference in physiologic K+ concentration between the ST and SV, in which the ST perilymph K+ concentration is typically found to be half that of the SV. A clearance of K+ from the ST and its eventual accumulation in the SV could play a role in how the ear responds to abnormal ion concentrations, such as may occur in Meniere's disease. It is proposed that an accumulation of K+ in the SV would result in vestibular dysfunction that might contribute to the vestibular symptoms of the disease.
Effect of Oxymetazoline on Nasal and Sinus Mucosal Blood Flow in the Rabbit as Measured with Laser-Doppler Flowmetry
Authors: Åkerlund Anders , Arfors Karl-E. , Bende Mats , Intaglietta Marcos
Published: October 2014

The effect of topical oxymetazoline hydrochloride on the blood flow of the nasal and sinus mucosa of the rabbit was measured by laser-Doppler flowmetry. Oxymetazoline, the active component in clinically used nose drops, induced a dose-dependent decrease of the nasal mucosal blood flow. This effect has previously been shown in humans and suggests the presence of α2–adrenoceptors in the nasal mucosa of the rabbit. Doses of oxymetazoline used clinically in humans induced a 50% reduction of blood flow in rabbits. Rhythmic variations in blood flow were seen in 30% of the rabbits after administration of oxymetazoline. Additionally, oxymetazoline induced a dose-dependent decrease of the mucosal blood flow in the maxillary sinus when the drug was applied in the nose. A vasoconstricting effect of oxymetazoline on the arteries penetrating the maxillary sinus ostium is a possible explanation. This can have positive as well as negative consequences on acute sinus infections.
Esophageal Stricture following Esophageal Atresia Repair: Endoscopic Assessment and Dilation
Authors: Benjamin Bruce , Robb Peter , Glasson Martin
Published: October 2014

A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was that stricture formation did not appear to be related to the size of the “gap” found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.
Incomplete Coverage of Mammalian Bone Matrix by Lining Cells
Authors: Chole Richard A. , Tinling Steven P.
Published: October 2014

A functional “membrane” is thought to exist that separates the general extracellular fluid from the bone extracellular fluid. Many investigators have concluded that bone lining cells form this barrier. It is posited that alterations in this barrier may lead to the recruitment of osteoclasts and contribute to the control of extracellular calcium homeostasis. The present ultrastructural studies, however, demonstrated that significant portions of the resting bone are in contact with the general extracellular fluid. In certain regions of the cochlea, up to 88% of the bone surface is in contact with extracellular fluid. These anatomic observations require a critical reevaluation of current theories of the physiologic roles of bone lining cells in osteoclast recruitment and calcium homeostasis.
Thyroplasty: A New Approach
Authors: Montgomery William W. , Blaugrund Stanley M. , Varvares Mark A.
Published: October 2014

A new type of thyroplasty implant (prosthesis) has been designed to be used as part of a surgical operation that accomplishes medial displacement of a paralyzed vocal cord. The implant is inserted through a rectangular window fashioned in the thyroid lamina on the side of the vocal cord paralysis. Instruments for measuring the location and outline of the window in the thyroid lamina are presented. A thyroplasty saw blade is introduced. By using this blade, a window of precise measurement can be constructed without injury to the underlying perichondrium. The implant is constructed from a biocompatible, medical-grade polymer. Four sizes each are available for the male and female larynges. The proper-size implant can be selected with a measuring device. It is not necessary to alter the implant at the time of surgery; it snaps into place and suturing is not necessary. Once the implant is inserted, its medial or lateral displacement is not possible; on the other hand, the implant can be easily removed if vocal cord function returns, or if a change to a different-size implant is indicated. The design of the implant will close the posterior commissure.
Measurement of Young's Modulus in the in Vivo Human Vocal Folds
Authors: Tran Quang T. , Gerratt Bruce R. , Berke Gerald S. , Kreiman Jody
Published: October 2014

Currently, surgeons have no objective means to evaluate and optimize results of phonosurgery intraoperatively. Instead, they usually judge the vocal folds subjectively by visual inspection or by listening to the voice. This paper describes a new device that measures Young's (elastic) modulus values for the human vocal fold intraoperatively. Physiologically, the modulus of the vocal fold may be important in determining the nature of vocal fold vibration in normal and pathologic states. This study also reports the effect of recurrent laryngeal nerve stimulation on Young's modulus of the human vocal folds, measured by means of transcutaneous nerve stimulation techniques. Young's modulus increased with increases in current stimulation to the recurrent laryngeal nerve. Ultimately, Young's modulus values may assist surgeons in optimizing the results of various phonosurgeries.
Effect of Tension, Stiffness, and Airflow on Laryngeal Resistance in the in Vivo Canine Model
Authors: Bielamowicz Steven , Sercarz Joel A. , Berke Gerald S. , Green David C. , Kreiman Jody , Gerratt Bruce R.
Published: October 2014

This study used an in vivo canine model of phonation to determine the effects of airflow on glottal resistance at low, medium, and high levels of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) stimulation. Static and dynamic trials of changing airflow were used to study the effects of airflow on glottal resistance during phonation. As reported previously, glottal resistance varies inversely as a function of airflow. Increasing levels of RLN stimulation resulted in a statistically significant increase in glottal resistance for each level of airflow evaluated. Variation in SLN stimulation had no statistically significant effects on the relationship between flow and resistance. At airflow rates greater than 590 milliliters per second (mL/s), glottal resistance approached 0.1 mm Hg per mL/s for all levels of RLN and SLN stimulation tested. These data support the collapsible tube model of phonation.
Tracheoscope: An Old Instrument with New Applications
Authors: Parsons David S.
Published: October 2014

The tracheoscope is a bronchoscope without the side ventilating ports at the distal tip. It has been used for decades, implementing diagnostic and therapeutic procedures in the subglottis and cervical and thoracic trachea. The closed tube tracheoscope allows excellent control of the airway with maintenance of continuous anesthesia and ventilation. Flexible fiber—directed lasers, such as the potassium titanyl phosphate laser, can be used with the tracheoscope for laser resection or vaporization of diseased tissue from just below the vocal cords to any level within the trachea. Controlled anesthesia and smoke evacuation are maintained throughout the operation, allowing a relatively safe endoscopic procedure. Disorders such as subglottic hemangioma, subglottic or tracheal webs, papillomatosis, granuloma, and a variety of neoplastic growths can be excised, debulked, or submitted to biopsy by means of this instrument. In the neonatal and infant airway, use of the tracheoscope concomitantly with rigid telescopes has been particularly rewarding.
Temporary Nasosinusal Drainage and Lavage in Chronic Maxillary Sinusitis
Authors: Bertrand Bernard , Eloy Philippe
Published: October 2014

We report on 498 patients suffering from chronic maxillary sinusitis verified by sinusoscopy through the inferior meatus and by computed tomography of the sinuses, which permitted also the diagnosis of coexisting chronic ethmoidal sinusitis. The patients were treated by temporary drainage through a polyethylene drain tube left in place at the end of the antroscopy for daily lavage with saline solution and daily instillation in the sinus of thiamphenicol glycinate hydrochloride (similar to chloramphenicol) and N-acetyl-l-cysteine. We followed up 847 maxillary sinuses during the lavages according to 2 parameters: 1) recovery of a clean washout product at the macroscopic examination and 2) recovery of normal ostial patency as measured by sinusomanometry. We concluded that 1) the association with ethmoidal sinusitis does not significantly modify the treatment duration, and 2) fewer than 4% of the maxillary sinuses are likely to recover normal parameters after the 23rd day of lavage, and it is therefore useless to continue this treatment much longer. Of the maxillary sinuses, 36.25% were not submitted to any surgery. The results gained by the lavage technique have to be protected from recurrence by the treatment of general, focal, or local causes.
Rat Utricular Macula: Blood Flow and Stereological Assessment of Capillary Morphology
Authors: Payman Rami , Lyon Michael J.
Published: October 2014

Vascular compromise has long been proposed as a cause of inner ear disorders. However, the examination of blood flow and its control mechanisms in the vestibular system has been very limited. Combining stereological techniques with the microsphere injection technique, capillary morphology and regional blood flow were determined for the rat utricular macula. Results are as follows: total utricular blood flow 0.158 ± 0.078 μL/min; blood flow to the neuroepithelium (excluding nerve) 0.0995 ± 0.046 μL/min; blood flow per unit volume 7.71 ± 4.31 μL/min per cubic millimeter; neuroepithelial volume 0.01344 ± 0.0018 mm3; absolute capillary surface area 0.159 ± 0.039 mm2; mean capillary diameter 5.84 ± 0.56 μm; absolute capillary length 8.45 ± 1.6 mm; and capillary lumen volume fraction 0.0175 ± 0.004. Comparisons to previous data for the posterior canal ampulla indicate that the capillary diameter in the rat utricular macula is smaller; the capillary length is greater; and the end organs are similar with respect to neuroepithelial volume, capillary surface area, and blood flow. The size of the microsphere used in the present study (9.21 μm), in comparison to the mean capillary diameter (5.84 μm) of the utricular neuroepithelium, would indicate that the blood flow data likely represent a minimum value. These findings indirectly indicate that the utricular macula metabolic rate is greater than that of the posterior canal crista, and that there is variation from end organ to end organ in mean capillary diameter.
Influence on Rabbit Submandibular Gland Injury by Stimulation or Inhibition of Gland Function during Irradiation
Authors: Ahlner Bo H. , Hagelqvist Evy , Lind Magnus G.
Published: October 2014

The loss of salivary gland function after a single dose of 15 Gy was correlated to loss of gland weight and degeneration of seromucous acini and serous tubules at 10 months postirradiation. The serous tubules were degranulated rather early, but regenerated after some months in an abnormal way as adenomatous structures. Striated ducts were mainly unaffected by irradiation. Arterioles showed slight to moderate narrowing of the lumina. There was an increased amount of plasma cells in the gland lobules at 10 months postirradiation. Histologic and morphometric criteria and changes in gland weight showed less pronounced radiation injury in glands irradiated during inhibition of the gland function by biperiden (Akineton) compared to glands irradiated during stimulation of the gland function by pilocarpine. This finding may offer a clinically important means to reduce salivary gland dysfunction after radiation treatment of tumors in the head and neck regions.
Acyclovir in the Treatment of Recurrent Respiratory Papillomatosis
Authors: Endres Donald R. , Burke Diane , Bauman Nancy M. , Smith Richard J. H.
Published: October 2014

Six patients with severe, recalcitrant, juvenile-onset recurrent respiratory papillomatosis were treated with 7 independent trials of acyclovir. In 2 trials, patients received acyclovir in place of interferon-α; the remaining 5 trials were in patients not otherwise receiving chemotherapy. Quantitative analysis of overall disease extent, laryngeal involvement, and degree of glottic obstruction for the 6 months prior to acyclovir administration and during acyclovir administration demonstrated a statistically significant decrease in all parameters evaluated in those patients who were otherwise unmedicated. The 2 patients who discontinued interferon-α immediately prior to beginning acyclovir demonstrated worsening disease, consistent with the well-recognized rebound phenomenon associated with stopping interferon. This study suggests that acyclovir decreases the extent of respiratory papillomatosis in patients with recalcitrant disease. The beneficial effect of acyclovir appears to be insufficient to counteract the rebound of disease when interferon is stopped abruptly.
Extra-Abdominal Desmoid Fibromatosis
Authors: Batsakis John G. , Raslan Wasim
Published: October 2014

Desmoid fibromatosis cannot be considered a biologically benign or innocuous lesion. In the head and neck it may be intraosseous (desmoplastic fibroma) or, more often, in soft tissues, with the highest incidence in the supraclavicular region of the neck. High recurrence and persistence rates, 50% or more, accompany intralesional or marginal excision. Keloids and proliferative scars, while stubborn in their resolution and potentially disfiguring, are reactive proliferative disorders of fibroblastic and myofibroblastic tissues.
Effect of Psychic Stimulation on Plasma Catecholamine Concentrations and Nasal Patency in Patients with Nasal Allergy
Authors: Konno Akiyoshi , Terada Nobuhisa , Nomoto Minoru
Published: October 2014

To compare the degree of sympathoadrenal and nasal vascular response to psychic stimulation between patients with nasal allergy and normal controls, we measured the changes in plasma norepinephrine and epinephrine concentrations and nasal patency elicited by cannulation into the forearm vein and mental arithmetic in 28 patients with nasal allergy and age- and sex-matched normal controls. Ten of the 28 allergy patients had markedly swollen, pale, edematous nasal mucosa and served as a subgroup of nasal allergy patients. Plasma catecholamine levels increased significantly, with a synchronous increase of nasal patency, during stimulation. Among the three groups, no statistical differences were observed in plasma catecholamine levels either at rest or during stimulation. There was no significant difference in extent of increase of nasal patency induced by stimulation in the total group of subjects with nasal allergy compared with normal controls. However, it was significantly smaller in a subgroup of nasal allergy patients having markedly pale, edematous swelling of the nasal mucosa.
Endolymphatic Sac Ballooning Surgery for Meniere's Disease
Authors: Huang Tsun-Sheng , Lin Ching-Chen
Published: October 2014

A newly developed technique (endolymphatic sac ballooning surgery [ESBS]), based on revisional sac surgery observations, was conducted on 135 patients with intractable Meniere's disease. The surgery involves the insertion and fan-folding of a thin Silastic sheet in the endolymphatic sac (ES) lumen to increase its volume. The results of this sac ballooning surgery proved more effective for treatment of incapacitating Meniere's disease symptom complex than did primary ES surgery (ESS) with either the nonballooning sac techniques we employed previously or ESBS revision operations in which primary surgery used nonexpansion techniques. It appears that ESBS, with its preservation of ES integrity and expansion of its lumen, may indeed prevent surgically induced damage and be more efficacious in the drainage of hydropic endolymph. The efficacy of ESS remains controversial because of the failure to understand its pathophysiologic basis. Nevertheless, we are confident that if the ES is definitively delineated, as evidenced by turbid or clear fluid or bubbles when entered, and enlargement of its lumen with maintenance of the sac's integrity is verified during surgery, ESS is undoubtedly efficacious treatment for intractable Meniere's disease. Furthermore, we maintain that equitable judgment may only be rendered when reports evaluating the efficacy of ESS include definitive identification, delineation, and drainage of the sac.
Arytenoid Separation for Impaired Pediatric Vocal Fold Mobility
Authors: Gray Steven D. , Kelly Steven M. , Dove Heather
Published: October 2014

Impaired vocal fold motion may result from cricoarytenoid joint fixation, bilateral vocal fold paralysis, or interarytenoid scarring. Traditional surgical techniques have focused on lateralization or resection of the arytenoid for airway improvement. This paper discusses 3 cases of bilateral reduced vocal fold motion of neurogenic cause treated with posterior cricoid grafting to cause a wider resting position of the vocal folds and arytenoids. Airway improvement occurred in all. The voice results have been encouraging. Advantages of this procedure are that the vocal folds are symmetric, there is no vocal fold or joint scarring, and the larynx remains a candidate for electrical pacing when that becomes available. Acoustic and aerodynamic voice results are presented. The results should be considered preliminary.
Pseudosarcomatous Proliferative Lesions of Soft Tissues
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

The pseudosarcomatous proliferative lesions of soft tissues are fascia-based fibroblastic and myofibroblastic lesions that have the potential to be overdiagnosed as sarcomas. They may be subtyped according to depth of involvement, age at presentation, and certain histologic features. Subtypes are proliferative fasciitis, proliferative myositis, nodular fasciitis, intravascular fasciitis, and cranial fasciitis. They are presumed to be reactive. Recurrences are rare after tissue-sparing surgical excision.
Herpes Simplex Chronic Laryngitis and Vocal Cord Lesions in a Patient with Acquired Immunodeficiency Syndrome
Authors: Yeh Vivian , Goldstein Neal S. , Hopp Martin L. , Meyer Richard D.
Published: October 2014

Chronic laryngitis in patients with acquired immunodeficiency syndrome may be due to infections or tumors, such as Kaposi's sarcoma and non-Hodgkin's lymphoma. We present what we believe to be the first proven case of herpes simplex virus chronic laryngitis in a man positive for human immunodeficiency virus. Direct laryngoscopy showed leukoplakic lesions on both vocal cords. Biopsy of the lesions showed squamous epithelial cells with the characteristic features of herpes simplex virus, which was confirmed by immunohistochemical stains. We discuss the differential diagnosis of chronic laryngitis in a human immunodeficiency virus infection. Herpes simplex viral infection of the vocal cords should be considered in patients with acquired immunodeficiency syndrome presenting with chronic hoarseness and leukoplakic lesions on direct laryngoscopy, especially with no evidence of Kaposi's sarcoma, tumor, or cytomegaloviral or fungal infection elsewhere. Treatment should be acyclovir, except in the face of acyclovir resistance.
Neutrophil Oxygen Metabolite Inhibition of Cultured Chinchilla Middle Ear Epithelial Cell Growth
Authors: Kawana Masahiro , Kawana Chihiro , Juhn Steven K. , Amesara Ryo , Giebink G. Scott
Published: October 2014

Middle ear inflammation in acute bacterial otitis media is characterized by accumulation of neutrophils in middle ear effusion. Since neutrophils release products that may injure surrounding tissues, we studied the effect of neutrophil metabolic products on middle ear epithelial cells (MEECs) in vitro. Chinchilla MEECs were incubated with phorbol myristate acetate (PMA)–activated human neutrophils or with hydrogen peroxide (H2O2). Cell growth, which was measured by 3H-thymidine incorporation, was inhibited by activated neutrophils and by H2O2. Unstimulated neutrophils, PMA alone, and catalase alone did not affect the viability of MEECs. Catalase, an enzyme that reduces H2O2, partially blocked the inhibitory effect of activated neutrophils and completely blocked the inhibitory effect of H2O2. Inhibition of MEEC metabolism by neutrophil-reactive oxygen species may contribute to epithelial injury, which may prolong the middle ear inflammatory response and lead to chronic tissue damage.
Calibration of Endoscopic Images
Authors: Doolin Edward J. , Strande Louise
Published: October 2014

In pediatric airway surgery, endoscopic evaluation of the lesions and treatment is important. However, there are no objective and reproducible methods for measurement. The purpose of this study was to define the optical effects of a Storz-Hopkins system and develop a method of calibration and measurement. Known geometric images (grids and circles) were viewed through the Storz-Hopkins system and recorded. These images were then analyzed morphometrically with a computer image analyzer (Jandel Scientific). The distortion of the endoscope could be identified, and the severity was found to be a function of the distance from the center of the field (r = .962). When this distortion factor (range, 0% to 25% shrinkage) was used mathematically, known circles could be measured by means of an endoscopic image. The error was reduced from 17.6% to 4.3% (p < .003). With morphometric programs the optical distortion of the bronchoscope can be calibrated. This can then be used to correct the measurement of images.
Nonnasopharyngeal Lymphoepitheliomas (Undifferentiated Carcinomas) of the Upper Aerodigestive Tract
Authors: Frank Douglas K. , Cheron Fred , DiCostanzo Damian , Cho Hyun , Sclafani Anthony P.
Published: October 2014

Lymphoepitheliomas are malignant tumors of epithelial origin with various amounts of reactive lymphocytic infiltrate. Although initially described in the nasopharynx (World Health Organization type 3 nasopharyngeal carcinoma), these tumors have been identified in various locations throughout the body. A strong association with Epstein-Barr virus (EBV) infection has been established for the nasopharyngeal type. Outside the nasopharynx, lymphoepitheliomas are exceedingly rare in the upper aerodigestive tract, with only isolated case reports of tumors in the larynx, trachea, and hypopharynx. This article features a rare case of lymphoepithelioma of the pyriform sinus. Furthermore, serologic testing, as well as in situ tumor DNA amplification (using the polymerase chain reaction) and hybridization techniques, demonstrated an association of this lesion with EBV infection. The characteristic histopathologic features common to this disease entity are presented, and the literature is reviewed with regard to lymphoepitheliomas of the upper aerodigestive tract outside the nasopharynx. Association of lymphoepitheliomas with EBV infection will be discussed.
Upper Airway Obstruction in Sturge-Weber and Klippel-Trenaunay-Weber Syndromes
Authors: Reich Debra S. , Wiatrak Brian J.
Published: October 2014

Sturge-Weber syndrome is a rare congenital angiomatosis of unknown cause that is defined by the following triad: facial port-wine stain, leptomeningeal vascular anomalies, and choroidal vascular lesions associated with glaucoma. Klippel-Trenaunay-Weber syndrome is a related disease with questionable hereditary factors diagnosed by the following triad: superficial nevus of the lower extremity, ipsilateral varicose veins, and hypertrophy of the soft and bony tissues of the lower limb. The two conditions rarely have been reported to coexist. Upper airway obstruction is not a prominent feature of either of these two diseases. We present two patients with both of these angiomatoses in whom severe upper airway obstruction necessitated tracheotomy.
Immunohistochemical Markers in the Diagnosis of Neuroendocrine Neoplasms of the Head and Neck
Authors: Milroy Christopher M. , Ferlito Alfio
Published: October 2014

Immunohistochemistry is important in the diagnosis of neuroendocrine neoplasms of the head and neck, particularly in the differential diagnosis of the various neuroendocrine neoplasms, although the results of staining should never be interpreted alone, but together with conventional histopathologic findings. It is emphasized that there are currently no markers capable of distinguishing between benign and malignant tumors. A correct diagnosis is of paramount importance, since treatment depends on the diagnostic accuracy and prognosis is naturally related substantially to the phenotype.
Hydrops-Induced Changes in Cochlear Blood Flow
Authors: Miller Josef M. , Ren Tian-Ying , Golding-Wood David , Laurikainen Esa , Nuttall Alfred L.
Published: October 2014

Laser Doppler flowmetry was used to assess cochlear blood flow (CBF) in the hydropic ear in four experiments. 1) The increase in CBF elicited by local electrical stimulation of the cochlea in the hydropic ear was compared to that observed in normal controls. The magnitude of the evoked CBF change was reduced by approximately 30% in the hydropic ear compared to the normal ear. 2) The reduction in CBF evoked by direct electrical stimulation of the superior cervical ganglion was reduced by approximately one third in the hydropic ear compared to a normal ear. 3) Rhythmic (flux motion or vasomotion) variations in CBF, observed in association with lower blood pressure and thought to extend the autoregulatory range in an organ system, were reduced or eliminated in the hydropic ear. 4) The autoregulatory response to a decreased perfusion pressure, produced by decreased cardiac output, was clearly reduced relative to control in the hydropic ear. These findings represent the first report of significant CBF changes with hydrops. They are consistent with reports of increased sensitivity of the hydropic ear to trauma and stress and may be relevant considerations in the treatment of hydrops in humans.
Congenital Midline Cervical Cleft Case Report and Review
Authors: Maschka Donald A. , Clemons John E. , Janis John F.
Published: October 2014

Congenital midline cervical cleft is a rare disorder with a wide range of presentations. To date, there have been fewer than 35 cases reported in the English-language literature. A rarer finding is the association of bronchogenic cysts or respiratory epithelium with the midline cleft. The clinical presentation of congenital midline cervical cleft with a cephalic skin tab, atrophic cleft, and caudal sinus may distinguish it from other conditions of the midline neck. We present an 18-month-old girl with congenital midline cervical cleft to illustrate its clinical presentation and the proper treatment of this condition.
Epistaxis Balloon Catheter Stabilization of Zygomatic Arch Fractures
Authors: Randall David A. , Bernstein Paul E.
Published: October 2014

Isolated zygomatic arch fractures represent about 10% of facial fractures. Most are easily reduced, but about 7% require fixation. Stabilization with plates, transcutaneous wiring, and various packing materials may involve additional morbidity and other drawbacks. A double balloon epistaxis catheter may be inserted beneath the arch fracture site and inflated for 5 to 7 days as a relatively simple, reliable alternative that involves minimal morbidity.
Evaluation and Management of the Lingual Thyroid Gland
Authors: Williams James D. , Slupchinskij Oleh , Sclafani Anthony P. , Douge Claude
Published: October 2014

Lingual thyroid gland is a rare clinical entity that is due to failure of descent of the gland anlage early in the course of embryogenesis. It may present with symptoms of dysphagia, upper airway obstruction, or even hemorrhage at any time from infancy through adulthood. We present two illustrative cases of lingual thyroid gland along with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment The natural history of the condition is reviewed and a treatment strategy is outlined that focuses on the use of suppressive doses of thyroid hormone as the initial therapy. Surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or ongoing hemorrhage.
Hearing Results following Modified Radical versus Canal-up Mastoidectomy
Authors: Cook James A. , Krishnan Surya , Fagan Paul A.
Published: October 2014

Modified radical mastoidectomy (MRM) provides relatively safe surgical access for the removal of chronic middle ear and mastoid disease and gives reproducible results. However, it has been suggested that hearing may not be as good as that after “intact canal wall mastoidectomy” (ICWM). This paper reviews 153 tertiary referrals suffering from extensive disease who underwent MRM and compares their hearing results with those obtained by other authors using ICWM and MRM and a variety of reconstructive techniques. In this study there were no dead ears and no significant changes in bone conduction despite prolonged drilling and extensive disease. Hearing results after MRM were found to be better after primary surgery than after revision and better in the presence of an intact stapes. No rigid prostheses were used at first-stage surgery. There were no significant differences found between hearing results obtained by MRM in this series and other published results of canal wall down mastoidectomy and ICWM, irrespective of the use of ossicular replacement prostheses.
ND: Yag Laser Treatment for Laryngeal and Hypopharyngeal Hemangiomas: A New Technique
Authors: Yellin Seth A. , Labruna Anthony , Anand Vijay K.
Published: October 2014

The treatment of laryngeal and hypopharyngeal hemangiomas is indicated when they are symptomatic, causing dysphagia, recurrent bleeding, or airway obstruction. These tumors are found in the glottis, supraglottic larynx, and hypopharynx. Histologically, they are considered as mixed or cavernous-type hemangiomas. By utilizing a glass slide to compress the lesion, its thickness and blood flow are reduced. The tumor can then be laser-photocoagulated with less energy, with the glass slide used as a laser platform. These conditions optimize the benefits of laser ablation while minimizing the adverse heat sink effects to the surrounding healthy tissue. We present three patients with hemangiomas of the larynx and hypopharynx who were treated with this technique. The details of the technique in each case will be presented with the objective of improving the care of these unusual and challenging tumors.
Pharyngeal Hypophysis
Authors: Fuller Gregory N. , Batsakis John G.
Published: October 2014

Derived from embryologic remnants of Rathke's pouch and its craniopharyngeal duct, the pharyngeal hypophysis has long been considered to be present in all humans. This thesis has been recently challenged, but the weight of investigative evidence still favors the original premise. The pharyngeal hypophysis is just one product of Rathke's pouch. Others are extracranial pituitary tumors, the very rare craniopharyngioma, pharyngeal hypopharyngeal cysts, and cerebrospinal fluid rhinorrhea.
Computer-Aided Three-Dimensional Reconstruction in Human Cochlear Maps: Measurement of the Lengths of Organ of Corti, Outer Wall, Inner Wall, and Rosenthal's Canal
Authors: Kawano Atsushi , Seldon H. Lee , Clark Graeme M.
Published: October 2014

This paper describes the application of computer-aided three-dimensional reconstruction to measurements of the length of the organ of Corti (mean ± SD, 35.58 ±1.41 mm), scala tympani outer wall (40.81 ± 1.97 mm), scala tympani inner wall (18.29 ± 1.47 mm), and Rosenthal's canal center (15.98 ± 1.33 mm) in eight adult male cochleas. The Rosenthal's canal center ranged between 1 3/4 and 2 turns, did not appear to be linearly related to the organ of Corti, and lay near the basal end of the latter. The length of the organ of Corti measured with three-dimensional reconstruction differed by 7.6% ± 3.2% (“cutting angle difference”) from that derived from traditional two-dimensional reconstruction on the plane perpendicular to the plane of section, and by 2.6% ± 1.7% (“geometric difference”) from that derived from two-dimensional reconstruction on the axial plane at right angles to the modiolar axis.
Nuclear DNA Content of the Tall Cell Variant of Papillary Carcinoma of the Thyroid Gland
Authors: Stern Yoram , Shpitzer Thomas , Medelia Ora , Feinmesser Raphael , Feinmesser Meora , Segal Karl
Published: October 2014

Tall cell carcinoma of the thyroid gland is an aggressive variant of papillary carcinoma. A high nuclear DNA content has been associated with aggressive clinical behavior and an unfavorable prognosis in several malignant human tumors. It was also described in differentiated thyroid carcinoma. Therefore, analysis of the nuclear DNA content may yield information predictive of aggressive behavior. Accordingly, the DNA content of the tall cell variant was measured and compared with that of the usual form of papillary carcinoma by flow cytometry. Although all the aneuploid tumors were in the tall cell variant group, the difference in nuclear content was not statistically significant. We conclude that differences in the clinical behavior of these neoplasms are not related to alterations in DNA ploidy.