bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlating the Clinical Course of Recurrent Croup with Endoscopic Findings: A Retrospective Observational Study
Authors: Hoa Michael , Kingsley Emily L. , Coticchia James M.
Published: October 2014

Objectives:

We sought to correlate endoscopic findings with the clinical course of recurrent croup.

Methods:

Children were classified as having recurrent croup if they had had 2 or more episodes of barky cough, inspiratory stridor, and hoarseness. All study participants underwent direct laryngoscopy and bronchoscopy and were started on an antireflux regimen. A telephone questionnaire assessed the child's symptoms and treatment response.

Results:

Forty-seven children with recurrent croup were seen in our otolaryngology outpatient clinic. Demographics included a male-to-female ratio of 1.6 to 1 and an age range of 1 month to 11 years (median, 20 months). Thirty patients (63.8%) had a medical history of asthma, and 10 (21.3%) came with a prior diagnosis of gastroesophageal reflux. Gastroesophageal reflux–related laryngopharyngeal changes were seen during direct laryngoscopy and bronchoscopy in 87.2%. Of those with survey follow-up, 87.5% had improvement of respiratory symptoms after a 6- to 9-month course of antireflux medications. This finding was further reflected in a decreased number and duration of episodes (p < .0001).

Conclusions:

The underlying narrowing process of recurrent croup can be attributed to gastroesophageal reflux and should be considered in any child with persistent barky cough, inspiratory stridor, and hoarseness. To confirm the diagnosis, diagnostic methods should be correlated with symptom progression after treatment initiation.
Preliminary Study on the Quantitative Analysis of Vocal Loading Effects on Vocal Fold Dynamics Using Phonovibrograms
Authors: Lohscheller Joerg , Doellinger Michael , McWhorter Andrew J. , Kunduk Melda
Published: October 2014

Objectives:

The purpose of the present study was to determine whether high-speed digital imaging with phonovibrogram (PVG) analysis would identify changes in vocal fold vibratory characteristics following prolonged reading (vocal fatigue) in subjects with normal voice to evaluate the voice effects of vocal loading.

Methods:

Three healthy subjects' larynges were examined with an endoscopic high-speed imaging system at 4 different levels of vocal load. Vocal fold dynamics were segmented and processed by PVGs. The PVG images were quantitatively described by a parameter set enabling an individual characterization of vocal fold dynamics. To reveal differences between the subjects, we performed a linear discrimination analysis. Within each subject, the identification of vocal loading effects was performed by statistical analysis (1-way analysis of variance), and 2-tailed paired t-tests were used as a consistency check between left and right vocal fold sides.

Results:

For each subject, the PVG analysis enabled a precise quantification of the entire range of vocal fold dynamics. Independently of the high-speed videos (vocal loads), each subject could be identified by his or her PVG parameters on linear discrimination analysis. In all subjects, the effect of vocal loading was reflected by alterations of PVG parameters representing the posterior opening and closing dynamics. Evaluation within subjects revealed slight asymmetric vibratory behavior between the left and right vocal folds, confirming earlier assumptions.

Conclusions:

Within the investigated subjects, vocal loading does affect the vibratory characteristics of the vocal folds. Left-right vocal fold vibratory asymmetries do occur in healthy voices and can be identified by PVGs. High-speed digital imaging in combination with PVG analysis seems to be a promising tool for investigation of vocal fold fatigue and disorders resulting even from small dynamic changes.
Microendoscopy of Reinke's Space
Authors: Hoffman Henry T. , Bock Jonathan M. , Karnell Lucy Hynds , Ahlrichs-Hanson Janice
Published: October 2014

Objectives:

Contemporary surgical treatment of the superficial layer of the lamina propria or Reinke's space is most commonly performed through an incision in the overlying vocal fold epithelium. This approach may disrupt normal tissue, induce scarring, and allow extrusion of implanted materials. Previously reported external approaches to Reinke's space required either a laryngofissure or a “minithyrotomy” for access. These surgical approaches were performed without direct imaging of Reinke's space. Instruments placed below the vocal fold epithelium via this external approach were visualized through the translucent vocal fold epithelium. We designed this study to identify the feasibility of limited-access surgery of the lamina propria using microendoscopes placed into Reinke's space through an external approach.

Methods:

A cadaveric human larynx was dissected, and microendoscopes were directly advanced into Reinke's space through a subepithelial puncture of the cricothyroid membrane, as well as lateral fenestration through the thyroid cartilage.

Results:

Photodocumentation of the undersurface of vocal fold epithelium, the opposing surface of the vocal ligament, and the intervening Reinke's space was successfully accomplished.

Conclusions:

Advances in both microendoscopes and accompanying instrumentation permit access to the superficial layer of the lamina propria without disrupting the overlying epithelium. This approach to microendoscopy of Reinke's space may allow for more effective surgical treatment of cysts, chronic edema, vascular abnormalities, atrophy, scarring, and sulcus vocalis.
Relationship between Mucosal Inflammation, Computed Tomography, and Symptomatology in Chronic Rhinosinusitis without Polyposis
Authors: Bhattacharyya Neil
Published: October 2014

Objectives:

This study was an attempt to determine whether sinus mucosal inflammation is related to computed tomographic findings and patients' reported symptoms in chronic rhinosinusitis (CRS) without polyposis.

Methods:

I retrospectively reviewed the clinical symptom scores according to the Rhinosinusitis Symptom Inventory (RSI), the radiographic findings, and the histopathologic findings in the paranasal sinus mucosa for a consecutive series of adult patients who underwent endoscopic sinus surgery for CRS. Linear regression analysis was conducted for the relationship between tissue pathology inflammatory severity score graded on a 5-point Likert scale and the RSI symptom domains. A similar analysis was conducted for the relationship between the pathology inflammatory score and the total Lund score.

Results:

The study cohort consisted of 115 adult patients (mean age, 40.2 years). The mean Lund score for the cohort was 8.8 (95% confidence interval, 7.9 to 9.7), and the mean pathology severity score was 2.1 (median, 2.0). The mean total symptom score for the overall cohort was 41.3; the mean total symptom scores for pathology severity grades 0, 1, 2, 3, and 4 were 25.0, 43.8, 41.8, 42.4, and 32.8, respectively. No significant association could be identified between pathology severity and any of the 5 RSI symptom domains (nasal, facial, oropharyngeal, systemic, and total symptoms; all p > .436, linear regression). A statistically significant relationship between total Lund score and pathology severity was identified (p < .001).

Conclusions:

Poor correlation exists between the histopathologic severity of sinonasal inflammation and self-reported symptom scores in CRS. Histopathologic inflammatory grade alone fails to stratify CRS cases according to disease symptom severity. Histopathologic inflammation and computed tomographic findings correlate strongly.
Evaluation of a Deep Brain Stimulation Electrode for Laryngeal Pacing
Authors: Katada Akihiro , Van Himbergen Daniel , Kunibe Isamu , Nonaka Satoshi , Harabuchi Yasuaki , Huang Shan , Billante Cheryl R. , Zealear David L.
Published: October 2014

Objectives:

The purpose of the present study was to evaluate the suitability of a deep brain stimulation electrode for laryngeal pacing. Of interest was whether the smaller and more closely spaced channels could provide sufficient channel redundancy, controlled current distribution, and discrete activation of the posterior cricoarytenoid (PCA) muscle.

Methods:

A study was conducted in dogs under differing states of PCA muscle innervation representing complete denervation to complete synkinetic reinnervation. In 3 animals, stimulated glottal opening was assessed in the innervated state and after chemical denervation by pancuronium bromide. In 3 additional dogs, the left side of the larynx was surgically denervated and compared to the innervated, right side to study an anatomic model of clinical paralysis.

Results:

The thresholds were lower and the maximum level of abduction was greater for the innervated state. The stimulated glottal opening equaled that of a spontaneously breathing animal. Abductory responses were obtained across all channels in the array, demonstrating its anatomic and physiological compatibility for this application. In the denervated state, responses were only 20% of that of the innervated state with a pulse duration of 0.5 ms. The response could be enhanced to 40% and 60% by increasing the pulse duration to 1 and 2 ms.

Conclusions:

A deep brain stimulation electrode could effectively reanimate the PCA muscle to a normal level in a case of synkinetic reinnervation and to as much as 60% of the normal level in a case of complete denervation.
Mucin Gene Expression in Human Laryngeal Epithelia: Effect of Laryngopharyngeal Reflux
Authors: Samuels Tina L. , Handler Ethan , Syring Michael L. , Pajewski Nicholas M. , Blumin Joel H. , Kerschner Joseph E. , Johnston Nikki
Published: October 2014

Objectives:

We sought to document the mucin gene profile in normal human laryngeal epithelium and compare it with that in patients with reflux-attributed laryngeal injury or disease. We also investigated the effect of low pH with or without pepsin on mucin messenger RNA levels in vitro.

Methods:

Laryngeal biopsy specimens were obtained from 3 patients with clinically diagnosed laryngopharyngeal reflux and from 2 control subjects who had no signs or symptoms of reflux. Signs and symptoms were assessed by the Reflux Finding Score and the Reflux Symptom Index, respectively. Reverse transcription–polymerase chain reaction (RT-PCR) was performed to establish the mucin gene profile. Human hypopharyngeal epithelial cells were exposed to pH 7, 5, 4, and 2 with and without pepsin (0.1 mg/mL) for 20 minutes at 37°C, and expression of selected mucins was analyzed via real-time RT-PCR.

Results:

Mucin 1–5, 7, 9, 13, 15, 16, and 18–20 transcripts were detected in normal laryngeal epithelium, whereas mucin 6, 8, and 17 transcripts were not. Mucins 2, 3, and 5 were expressed at reduced levels in patients with reflux-attributed laryngeal injury or disease. These mucin genes were up-regulated after exposure to low pH in vitro (p < 0.005). Pepsin inhibited this up-regulation (p < 0.001).

Conclusions:

Reflux laryngitis is associated with down-regulation of mucin gene expression.
Auditory Skills Development among Children with Developmental Delays and Cochlear Implants
Authors: Wiley Susan , Meinzen-Derr Jareen , Choo Daniel
Published: October 2014

Objectives:

We sought to understand auditory skills outcomes in young children with cochlear implants and developmental delay.

Methods:

Children who received cochlear implants at less than 36 months of age were identified via chart review. Their postimplant auditory skills outcomes were measured with the Auditory Skills Checklist.

Results:

Of 35 children who received cochlear implants before the age of 36 months, 14 children (40%) had additional disabilities or some form of developmental delay. The 12-month postimplant data indicated progress in all groups of children. Children with additional disabilities had the same rate of auditory skills progress as children with no additional disabilities (β = 9.3 versus 9.3; p = 0.5). However, the children with additional disabilities tended to start at a lower baseline skills set (approximately 6 points lower) on the Auditory Skills Checklist. For children with average developmental quotients (at least 80), the rate of progress was twice that of children with a developmental quotient of less than 80, irrespective of a developmental disability (β = 9.9 versus 4.8; p = 0.03). Children with a developmental quotient of less than 80 were less likely to gain skills in discrimination and identification after the first postimplant year.

Conclusions:

Children with additional disabilities make progress in auditory skills, but may not develop higher auditory skills of identification and comprehension within the first 6 months after implantation. Categorizing children according to a cognitive developmental quotient may provide more predictive ability than does categorizing them by disability type.
Prevalence and Characteristics of Preoperative Balance Disorders in Cochlear Implant Candidates
Authors: Krause Eike , Louza Julia P. R. , Hempel John-Martin , Wechtenbruch Juliane , Rader Tobias , Gürkov Robert
Published: October 2014

Objectives:

The aim of this study was to elucidate the frequency and characteristics of preoperative vertigo symptoms in patients who undergo cochlear implantation (CI), in order to differentiate them from CI-related symptoms.

Methods:

In a prospective observational study, 47 adult CI candidates were asked about vertigo problems on a questionnaire. A subdivision into 3 groups was done: Group A (probable otogenic vertigo), group B (possible otogenic vertigo), and group C (not otogenic vertigo). Horizontal semicircular canal function was measured. Patients with vertigo complaints were compared to patients without vertigo with regard to the presence of abnormal vestibular function findings.

Results:

Twenty-five patients (53%) reported preoperative vertigo problems. In 21 (84%), the patient's history suggested a probable (group A) or possible (group B) otogenic origin. Patients with vertigo more often had abnormal findings on vestibular function testing than did patients without vertigo. This difference, however, was not statistically significant.

Conclusions:

A considerable number of CI candidates have preoperative vertigo symptoms. These cannot be explained by horizontal semicircular canal function alone. In order to understand why CI patients develop postoperative vertigo, analysis of prospective preoperative vestibular function test findings and vertigo symptoms is necessary.
Cell Growth Inhibition and Down-Regulation of Survivin by Silibinin in a Laryngeal Squamous Cell Carcinoma Cell Line
Authors: Bang Choong-Il , Paik Soon-Young , Sun Dong-Il , Joo Young-Hoon , Kim Min-Sik
Published: October 2014

Objectives:

Abnormalities in the regulation of apoptotic cell death have been shown to have an important effect on the pathogenesis and progression of cancer. Survivin, which is identified in most cancers and has recently been identified as an inhibitor of apoptosis, is a potential therapeutic target for cancer management. We investigated cell growth, apoptosis, and expression of survivin in laryngeal squamous cell carcinoma cell lines after treatment with the bioactive compound silibinin.

Methods:

Cultured human laryngeal squamous cell carcinoma SNU-46 cells were treated with different concentrations of silibinin, and the degree of cell growth and apoptosis was analyzed. Additionally, survivin protein and messenger RNA were analyzed by Western immunoblotting and reverse transcription–polymerase chain reaction.

Results:

Silibinin inhibited the growth of SNU-46 cells in a both dose- and time-dependent manner (p < 0.01). Upon fluorescence-activated cell sorter analysis, silibinin (200 μmol/L) treatment increased the proportion of apoptotic cells from 7% to 40%. At high concentrations (more than 150 μmol/L), silibinin greatly reduced messenger RNA and protein expression of survivin.

Conclusions:

Our findings demonstrate that silibinin induced apoptosis of laryngeal squamous carcinoma cells by a mechanism involving decreased survivin expression, which suggests the possibility that silibinin may be an effective treatment of laryngeal cancers.
Adjustable Tongue Advancement for Obstructive Sleep Apnea: A Pilot Study
Authors: Hamans Evert , Boudewyns An , Stuck Boris A. , Baisch Alexander , Willemen Marc , Verbraecken Johan , Van de Heyning Paul
Published: October 2014

Objectives:

Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy.

Methods:

Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway.

Results:

The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred.

Conclusions:

Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.
Computerized Scoring System for the Diagnosis of Foreign Body Aspiration in Children
Authors: Kadmon Gili , Stern Yoram , Bron-Harlev Efrat , Nahum Elhanan , Battat Erez , Schonfeld Tommy
Published: October 2014

Objectives:

Foreign body aspiration (FBA) is a life-threatening event in children. The gold standard for diagnosis is bronchoscopy, but there is no consensus regarding indications for the procedure. The aim of this study was to formulate a predictive model for assessing the probability of FBA in suspected cases as an aid in the decision to perform diagnostic bronchoscopy.

Methods:

The files of 150 patients who underwent bronchoscopy for suspected FBA at our center between 1996 and 2004 were reviewed for medical history, physical examination, and radiologic studies. The findings were analyzed by logistic regression.

Results:

Using the file data, we formulated a predictive model wherein each parameter received a numeric coefficient representing its significance in evaluating suspected FBA. The most significant parameters were age 10 to 24 months, foreign body in the child's mouth and severe respiratory complaints during the choking episode, hypoxemia, dyspnea or stridor following the acute event, unilateral signs on lung auscultation, abnormal tracheal radiogram, unilateral infiltrate or atelectasis, and local hyperinflation or obstructive emphysema on chest radiogram.

Conclusions:

In our predictive model, every case of suspected FBA can be assigned a score based on the specific parameters present, which is then entered into a probability formula to determine the likelihood of a positive diagnosis. This model may serve as a useful tool for deciding on the use of bronchoscopy in all children with suspected FBA.
Development of Mucosal Thickening after Radiotherapy in Contralateral Sinuses of Patients with Nasal Cavity and/or Paranasal Sinus Carcinoma
Authors: Wang Jong Hwan , Lee Bong-Jae , Lee Jeong Hyun , Kim In June , Jang Yong Ju
Published: October 2014

Objectives:

The aim of this study was to investigate the development of radiotherapy (RT)–induced mucosal thickening (MT) of the contralateral sinuses in patients with nasal cavity and/or paranasal sinus carcinoma.

Methods:

We retrospectively reviewed the medical records and the initial and follow-up computed tomography (CT) scans of 37 patients with RT and 10 controls without RT. The CT scans were scored on the Lund-Mackay (LM) staging system.

Results:

Fifteen of the 37 patients had MT before RT, and the mean LM score was 0.68. The MT incidence significantly increased, to 72.9% (p = 0.009), and the LM score significantly increased, to 2.84 (p < 0.001), by 3 months after RT, after which the LM score decreased gradually to 1.73 at 36 months after RT. Four of the 10 controls had MT before treatment, and their mean LM score was 0.7. Their MT incidence and LM score had not changed significantly at 3 months after treatment. The pretreatment LM scores of the patient group and the control group were not significantly different, but their posttreatment LM scores were significantly different at the 3-month follow-up (p = 0.033).

Conclusions:

Use of RT in patients with nasal cavity and/or paranasal sinus carcinoma may cause a significant increase in the incidence of MT and in the LM scores in all sites of the paranasal sinuses by 3 months after RT, after which the LM score decreases gradually.
Is There a Need for Positron Emission Tomography Imaging to Stage the N0 Neck in T1-T2 Squamous Cell Carcinoma of the Oral Cavity or Oropharynx?
Authors: Schroeder Ursula , Dietlein Markus , Wittekindt Claus , Ortmann Monika , Stuetzer Hartmut , Vent Julia , Jungehuelsing Markus , Krug Barbara
Published: October 2014

Objectives:

We assess whether negative findings on computed tomography (CT), magnetic resonance imaging (MRI), and/or 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) may contribute to the decision-making process of elective neck dissection (eND) in patients with squamous cell carcinoma of the oral cavity or the oropharynx (oSCC) staged cT1-T2 cN0 cM0.

Methods:

We interpreted CT, MRI, and 18FDG-PET images separately, after combining the data of CT with those of 18FDG-PET and the data of MRI with those of 18FDG-PET. Each set of results was then compared with the histopathologic results of ipsilateral or bilateral eND in a prospective, blinded study.

Results:

The histopathologic examination of 594 lymph nodes revealed 4 metastases less than 4 mm in diameter and 3 micrometastases (less than 2 mm) in 6 of 17 patients. On CT, MRI, and 18FDG-PET, respectively, 5, 5, and 0 cases were true-malignant (true positives) and 4, 10, and 1 cases were false-malignant (false positives). The accuracy was not enhanced by fusing CT with 18FDG-PET or MRI with 18FDG-PET.

Conclusions:

The detectability threshold of occult metastases appears to be below the spatial and contrast resolution of CT, MRI, and 18FDG-PET. The decision for eND in patients with cT1-T2 cN0 cM0 oSCC cannot be based upon cross-sectional imaging at the resolutions currently available.
Immunologic Response of the Laryngeal Mucosa to Extraesophageal Reflux
Authors: Birchall Martin A. , Bailey Michael , Gutowska-Owsiak Danuta , Johnston Nikki , Inman Charlotte F. , Stokes Christopher R. , Postma Gregory , Pazmany Laszlo , Koufman Jamie A. , Phillips Anne , Rees Louisa E.
Published: October 2014

Objectives:

Extraesophageal reflux is common. The treatment costs are high, and there are associations with other diseases, including laryngeal cancer. Our studies of the mucosal immune response to this common inflammatory disease suggest an important role for the nonclassic antigen-presenting molecule CD1d in the response to inflammation. This study was performed to further explore the relationship between the CD1d–NKT cell–iGb3 axis and reflux.

Methods:

We carried out a prospective study of laryngeal biopsies from 12 patients with laryngopharyngeal reflux and 11 controls. Quantitative multiple-color immunofluorescence using antibodies for lymphocytes (CD3, CD161) and classic and nonclassic major histocompatibility complex (I, II, β2m, CD1d) was performed, and univariate and multivariate analysis and co-localization measurements were applied.

Results:

Epithelial major histocompatibility complex class I and II expression was unchanged by reflux, but expression of CD1d increased (p < 0.05; luminal layers) and confidence intervals diminished in the reflux group. Co-localization of NKT cells with CD1d increased in patients (p < 0.01); iGb3 exhibited strong expression throughout all layers of the laryngeal epithelium.

Conclusions:

These data indicate a role for the CD1d–NKT cell–iGb3 axis in response to extraesophageal reflux in humans. This represents a useful target for novel diagnostics and treatments for this common condition.
Validity and Reliability of the Eating Assessment Tool (EAT-10)
Authors: Belafsky Peter C. , Mouadeb Debbie A. , Rees Catherine J. , Pryor Jan C. , Postma Gregory N. , Allen Jacqueline , Leonard Rebecca J.
Published: October 2014

Objectives:

The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10).

Methods:

The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses.

Results:

A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001).

Conclusions:

The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.
Endoscopic Localization of the Anterior and Posterior Ethmoid Arteries
Authors: Han Joseph K. , Becker Samuel S. , Bomeli Steven R. , Gross Charles W.
Published: October 2014

Objectives:

Understanding the endoscopic locations of the anterior and posterior ethmoid arteries is important during endoscopic sinus or endoscopic skull base procedures so that these arteries can be avoided. Therefore, the objective of this study was to define the endoscopic locations of the ethmoid arteries.

Methods:

Twenty-four cadaver heads were used to identify the endoscopic location of the ethmoid arteries via an external incision. An image guidance system was used to record the locations of these arteries. The anterior ethmoid artery was referenced to the axilla of the middle turbinate, and the posterior ethmoid artery to the anterior wall of the sphenoid sinus. The closest lamella to these arteries was identified.

Results:

Forty-eight nasal cavities were dissected. The mean distance from the axilla to the anterior ethmoid artery was 17.5 mm. The anterior ethmoid artery was located immediately anterior to (31%), at (36%), or immediately posterior to (33%) the superior attachment of the basal lamella. The mean distance from the posterior ethmoid artery to the anterior ethmoid artery was 14.9 mm. The mean distance from the posterior ethmoid artery to the anterior wall of the sphenoid sinus was 8.1 mm. The posterior ethmoid artery was either anterior to (98%) or at (2%) the anterior face of the sphenoid sinus.

Conclusions:

Specific endoscopic anatomic relationships and measurements have been presented for the anterior and posterior ethmoid arteries.
Unusual Fibrosclerotic Lesion of the Laryngotracheal Complex Presenting as Subglottic Stenosis
Authors: Johnston Douglas R. , Curry Joseph M. , Rubin Raphael , Rosen Marc R.
Published: October 2014

We present a case report that describes the pathology, presentation, and management complexities of an unusual, destructive fibrosclerotic lesion of the laryngotracheal complex. An otherwise healthy 21-year-old man presented with a 1-year history of progressive shortness of breath and stridor. The initial examination revealed a 3-cm, grade III subglottic stenosis. Nodular fibrosis of the strap muscles, laryngotracheal cartilages, and trachea was evident. Biopsies revealed dense peritracheal desmoplastic reaction with focal erosion of cartilage. However, features diagnostic for relapsing polychondritis, desmoid tumor, or orbital pseudotumor were absent. The disease progressed to involve severe stenosis and thickening of the trachea and main stem bronchi. Surgical and medical management of this unusual fibrosclerotic lesion did not ameliorate the disease process, but a recent encouraging response to tamoxifen citrate has been observed with improvements in vocal fold motion and activity levels. Prognosis and management experience for this unknown pathologic entity are absent in the literature. In this case, diffuse disease progression occurred despite surgical and medical management, but has been halted by tamoxifen therapy. The prospect of a durable response and disease remission is unknown.
Sleep-Related Deglutition in Patients with Sleep Apnea-Hypopnea Syndrome
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

We investigated sleep-related deglutition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods:

Deglutition during sleep was examined in 10 patients with a mean (±SD) age of 48 ± 11 years who had severe OSAHS (apnea-hypopnea index, 66.6 ± 17.6) via time-matched recordings of polysomnography and surface electromyography of the thyrohyoid and suprahyoid muscles.

Results:

During sleep, deglutition was episodic, and was absent for long periods. Deglutition did not occur during apnea or hypopnea periods. The mean number of swallows per hour during the total sleep time was 5.4 ± 3.1. The mean period of the longest absence of deglutition was 43.5 ± 14.7 minutes. Most deglutition occurred in association with respiratory electroencephalographic arousal after apnea or hypopnea. Approximately 70% of swallows were followed by inspiration. Deglutition was related to the sleep stage. The mean number of swallows per hour was 6.2 ± 6.1 during stage 1 sleep, 6.0 ± 3.4 during stage 2 sleep, 3.0 ± 5.2 during stage 3 sleep, and 0 during stage 4 sleep. The deeper the sleep stage, the lower the mean deglutition frequency. The mean number of swallows per hour was 4.5 ± 3.0 during rapid eye movement sleep.

Conclusions:

Deglutition was infrequent and displayed a unique pattern in patients with OSAHS during sleep.
Model of Evoked Rabbit Phonation
Authors: Ge Ping Jiang , French Lesley C. , Ohno Tsunehisa , Zealear David L. , Rousseau Bernard
Published: October 2014

Objectives:

We describe a method for eliciting phonation in an in vivo rabbit preparation using low-frequency, bipolar pulsed stimulation of the cricothyroid muscles with airflow delivered to the glottis.

Methods:

Ten New Zealand White breeder rabbits weighing 3 to 5 kg were used in this study. The cricothyroid muscles were isolated bilaterally, and separate pairs of anode-cathode hooked-wire electrodes were inserted into each muscle. A Grass S-88 stimulator and 2 constant-current PSIU6 isolation units were used to deliver bipolar square wave pulses to each cricothyroid muscle, with airflow delivered to the glottis through a cuffed endotracheal tube.

Results:

Phonation was evoked with a 50-Hz, 4-mA stimulus train of 1-ms pulses delivered to each cricothyroid muscle. The pulse trains were on for 2 seconds and were repeated every 5 seconds over a period of 180 minutes. Airflow was delivered at 143 cm3/s, producing phonation measuring 71 to 85 dB sound pressure level.

Conclusions:

Evoked phonation is feasible in rabbits by use of bipolar stimulation of the cricothyroid muscles with airflow delivered to the glottis. The in vivo rabbit preparation described may provide a useful small animal option for studies of evoked phonation. From the level and consistency of the adduction observed, we hypothesize that current spreading to the underlying adductor muscles and nerves resulted in neural pathway involvement beyond discrete activation of the cricothyroid muscle, providing sufficient approximation of the vocal folds for phonation.
Th2 Cytokine Inhibitor Suplatast Tosilate Inhibits Antigen-Induced Mucus Hypersecretion in the Nasal Epithelium of Sensitized Rats
Authors: Shimizu Shino , Hattori Reiko , Majima Yuichi , Shimizu Takeshi
Published: October 2014

Objectives:

Th2 cytokines such as interleukin (IL) 4 and IL-13 are potential mediators for mucus hypersecretion in allergic inflammation. To elucidate the functions of Th2 cytokines in allergic rhinitis, we examined the in vivo effects of the Th2 cytokine inhibitor suplatast tosilate on mucus hypersecretion and eosinophil infiltration in rat nasal epithelium.

Methods:

We induced hypertrophic and metaplastic changes in goblet cells in the nasal epithelium of ovalbumin-sensitized rats by intranasal challenge with ovalbumin. The effects of orally administered suplatast tosilate on mucus production and eosinophil infiltration were examined.

Results:

Suplatast tosilate (30 and 100 mg/kg) dose-dependently inhibited ovalbumin-induced mucus production and eosinophil infiltration. These suppressions of mucus production and eosinophil infiltration were only effective when suplatast tosilate was given in the effector phase; administration in the induction phase resulted in no effect.

Conclusions:

These results indicate that Th2 cytokines are important mediators of mucus hypersecretion and eosinophil infiltration in allergic rhinitis. Suplatast tosilate may be useful for the treatment of allergic rhinitis by attenuating the inflammation of the effector phase.
Multimodality Education for Airway Endoscopy Skill Development
Authors: Deutsch Ellen S. , Christenson Thomas , Curry Joseph , Hossain Jobayer , Zur Karen , Jacobs Ian
Published: October 2014

Objectives:

Airway endoscopy is a difficult skill to master. A unique practicum was designed to help otolaryngology residents develop endoscopy skills. The learning modalities included lectures, an animal laboratory, high-fidelity manikins, virtual bronchoscopy simulation, and standardized patients. This study compares the relative subjective value of these learning modalities for skill development and realism.

Methods:

Participants used a Likert scale (1 = disagree to 5 = agree) and open responses to anonymously rate the efficacy of 5 learning modalities for teaching airway management, endoscopy skills, and clinical leadership and for providing a realistic experience.

Results:

The results in 2007 were uniformly positive, with mean scores for every category and modality greater than 4 for developing cognitive, psychomotor, and affective skills; managing normal and abnormal conditions; preventing and managing complications; improving endoscopy skills; understanding team process; and experiencing overall and manual “feel” realism. In 2008, the participants were encouraged to more critically evaluate the course. The ratings demonstrated statistically significant differences between the mean scores for 4 of the 9 evaluation categories in 2007 and all 9 categories in 2008.

Conclusions:

Specific learning modalities (eg, lecture, animal laboratory, high-fidelity manikin, virtual bronchoscopy, standardized patient) were perceived to have different values for teaching airway management, developing endoscopy skills, teaching clinical leadership, and providing a realistic experience. We propose that these learning modalities can be used in a complementary manner.
Normal Values for Pharyngeal pH Monitoring
Authors: Chheda Neil N. , Seybt Melanie W. , Schade Robert R. , Postma Gregory N.
Published: October 2014

Objectives:

We performed a prospective study of asymptomatic adult volunteers to establish normative values of pharyngeal pH using a novel pH probe.

Methods:

The Dx-pH probe is a novel pH device capable of measuring liquid and aerosolized acid levels. Twenty asymptomatic patients (Reflux Symptom Index less than 10 and Reflux Finding Score less than 6) underwent simultaneous investigation with this probe placed in the oropharynx and a dual antimony probe placed in the hypopharynx and esophagus. The reflux parameters measured from the oropharyngeal probe included the percentage of time and the number of events in which the pH was less than 5.5, 5.0, 4.5, and 4.0.

Results:

The upper limits of normal (95th percentile) for the number of events below pH of 5.5, 5.0, 4.5, and 4.0 per 24-hour period were 16.6, 10.7, 7.4, and 0.2, respectively. The upper limits of normal (95th percentile) for an acid exposure time below pH of 5.5, 5.0, 4.5, and 4.0 per 24-hour period were 820 seconds, 385 seconds, 75 seconds, and 3 seconds, respectively.

Conclusions:

Normative pharyngeal pH values are presented. Further studies are required to determine clinical relevance.
Tongue Base Ultrasound: A Diagnostic Tool for Predicting Obstructive Sleep Apnea
Authors: Lahav Yonatan , Rosenzweig Eyal , Heyman Zehava , Doljansky Julia , Green Amit , Dagan Yaron
Published: October 2014

Objectives:

We assessed the value of an ultrasound (US) examination in the diagnostic workup of patients with sleep-related breathing disorders by correlating US measurements with known parameters for the presence and severity of obstructive sleep apnea.

Methods:

Forty-one male patients who complained of snoring and/or daytime somnolence participated. The diagnostic protocol included history-taking, physical examination, polysomnography, and transcervical US examination of the tongue. The US results were compared with all of the other parameters.

Results:

The US imaging was reliable for demonstrating anatomic structures of the tongue base, discriminating between muscle, mucosa, and blood vessels. The lingual arteries were clearly visualized entering the tongue base at its lower lateral borders. There was a significant relationship between the severity of sleep-related breathing disorders (measured by polysomnography) and the width of the lower tongue base (measured as the distance between the lingual arteries). The distance between the lingual arteries also correlated with physical examination findings and patient complaints of daytime somnolence and the sensation of choking during the night.

Conclusions:

Tongue base width, measured by US, may influence the severity of obstructive sleep apnea. This is the first demonstration of the possible role of US examination, an inexpensive, noninvasive, and non-irradiating office procedure, in the diagnostic workup for sleep-related breathing disorders.
Effects of Transforming Growth Factor-β1 on Human Vocal Fold Fibroblasts
Authors: Branski Ryan C. , Barbieri Silvia S. , Weksler Babette B. , Saltman Benjamin , Krishna Priya , Kraus Dennis H. , Broadbelt Nalini V. , Chen Jie , Poppas Dix P. , Felsen Diane
Published: October 2014

Objectives:

We studied the effect of transforming growth factor (TGF)–β on immortalized human vocal fold fibroblasts.

Methods:

Normal human vocal fold fibroblasts were subjected to sequential lentiviral transduction with genes for human telomerase (hTERT) and SV40 large T antigen in order to produce an “immortalized” cell line of normal phenotype. After confirmation of vocal fold fibroblast transfection, these cells, referred to as HVOX, were treated with various concentrations of exogenous TGF-β1 and assayed for collagen secretion, migration, and proliferation. In addition, components of the TGF-β signaling pathway were examined in this cell line.

Results:

TGF-β stimulated collagen secretion and migration without altering proliferation of HVOX. HVOX constitutively expressed type I and II TGF-β receptors, as well as messenger RNA for the Smad signaling proteins and for all TGF-β isoforms. Exogenous TGF-β1 induced temporally dependent alterations in Smad2 and Smad3 gene expression. TGF-β increased Smad7 expression at both 4 and 24 hours. Prolonged exposure to TGF-β decreased TGF-β1 gene expression.

Conclusions:

Insight into the underlying pathophysiology of vocal fold fibrosis is likely to yield improved therapeutic strategies to mitigate vocal fold scarring. Our data suggest that TGF-β signaling may be both paracrine and autocrine in this vocal fold fibroblast cell line, and we therefore propose that TGF-β may be a reasonable target for therapies to prevent and/or treat vocal fold fibrosis, given its putative role in both acute and chronic vocal fold injury, as well as its effects on vocal fold fibroblasts.
Radiographic Analysis of Cochlear Nerve Vascular Compression
Authors: Clift Julie M. , Wong Robert D. , Carney Gregory M. , Stavinoha Rose C. , Boyev K. Paul
Published: October 2014

Objectives:

We analyzed whether radiographically demonstrated anterior inferior cerebellar artery (AICA) vascular compression of the cochleovestibular nerve in asymmetric hearing loss could be correlated to either the symptomatic ear or to cochlear nerve diameter.

Methods:

We undertook a retrospective case-control study in which patients were enrolled into a database if audiometry demonstrated asymmetry of 20 dB at one frequency, asymmetry of 10 dB at two frequencies, or a difference of 20% on word recognition scores. If AICA vascular contact was demonstrated on subsequent magnetic resonance imaging of the cerebellopontine angle, patients were included in the study. Patients with vestibular schwannoma or Meniere's disease were excluded. The AICA contact was graded by a blinded neuroradiologist according to criteria proposed by McDermott et al. The cross-sectional area of the cochlear nerve was measured.

Results:

Symptomatic ears could be correlated to a decreased cochlear nerve diameter, but not to the degree of AICA penetration into the internal auditory canal.

Conclusions:

AICA vascular compression of the cochleovestibular nerve does not appear to correlate to hearing loss or to cochlear nerve diameter. The finding of decreased cochlear nerve diameter in symptomatic ears implies an alternative mechanism for asymmetric hearing loss.
Audiometric and Vestibular Features in a Second Dutch DFNA20/26 Family with a Novel Mutation in ACTG1
Authors: de Heer Anne-Martine R. , Huygen Patrick L. M. , Collin Rob W. J. , Oostrik Jaap , Kremer Hannie , Cremers W. R. J.
Published: October 2014

Objectives:

We analyzed the phenotype in a 5-generation DFNA20/26 family with a novel missense mutation in the ACTG1 gene (c.151G>A) and compared the findings to previous reports on DFNA20/26 families.

Methods:

Audiometric data were collected from the family members of a Dutch kindred with the novel ACTG1 mutation. Cross-sectional and/or longitudinal analyses were performed on pure tone and speech audiometry data of the mutation carriers. Age-related typical audiograms were constructed. Vestibular examination was performed in all mutation carriers.

Results:

Overall, high-frequency hearing impairment, most prominent at ages over 30 years, was observed with a progression rate of 1.1 to 2.1 dB/y, increasing with frequency. It ultimately resulted in residual hearing. Speech recognition scores remained good at given pure tone average (1, 2, and 4 kHz) levels, but were slightly poorer than those at similar levels in a group of patients with presbycusis. Vestibular examination did not reveal any consistent, statistically significant abnormalities.

Conclusions:

The audiometric phenotype of the Dutch DFNA20/26 family with a novel mutation in ACTG1 was largely consistent with previous reports on DFNA20/26. Considerable variations were found in audiogram configurations within the family. This is the first known DFNA20/26 family that has experienced tinnitus.
Localization of Recurrent Thyroid Cancer: A Technical Challenge
Authors: Shaha Ashok R.
Published: October 2014

Fletcher et al have described a single case in their article of needle localization for recurrent thyroid cancer in the paratracheal region (“Ultrasound-Guided Needle Localization of Recurrent Paratracheal Thyroid Cancer”). This is an intriguing report of a truly challenging problem recently seen in the management of paratracheal and central compartment recurrence in thyroid cancer.
Utility of Bronchoscopy for Recurrent Croup
Authors: Chun Robert , Preciado Diego A. , Zalzal George H. , Shah Rahul K.
Published: October 2014

Objectives:

We performed a retrospective review to determine the utility of bronchoscopy in patients with recurrent croup (RC).

Methods:

Bronchoscopy was performed on 30 patients with a diagnosis of RC (age, 14 months to 13.9 years) over a 2-year period.

Results:

One third of the patients (33.3%) were found to have airway disorders, including subglottic stenosis (7), subglottic edema (2), and a subglottic cyst (1). Patients with RC who were less than 3 years of age were more likely to have an airway abnormality found on endoscopy (9 of 14 or 64.2%) than were those older than 3 years (1 of 16 or 6.2%; χ2, p < 0.001). There was no statistically significant difference in abnormal findings 1) in patients with RC who had a history of prematurity or prior intubations (χ2, p = 0.17 and p = 0.052, respectively); 2) between infectious and spasmodic croup (χ2, p = 0.794); or 3) by number of croup episodes (χ2, p = 0.300). Two patients required surgical intervention (laryngotracheal reconstruction and marsupialization of a subglottic cyst).

Conclusions:

Of 30 patients who underwent bronchoscopy for RC, 33% had airway disorders — Mostly children less than 3 years old. We suggest a higher index of suspicion for finding airway disorders in children less than 3 years old with RC and having a lower threshold for performing diagnostic bronchoscopy in this population.