bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiotherapy of Early-Stage Glottic Cancer: Analysis of Factors Affecting Prognosis
Authors: Chen Miao-Fen , Chang Joseph Tung-Chieh , Liao Chun-Ta , Tsang Ngan-Ming , Chen Wen-Cheng
Published: October 2014

This study is a retrospective analysis of 134 patients treated with radiotherapy at our hospital. The sample included 88 stage T1 and 46 stage T2 patients. Sixty-two patients had anterior commissure involvement, 37 patients had impaired vocal cord mobility, and 24 patients had supraglottic or subglottic extension. Irradiation was given, with the dose ranging from 60 to 72 Gy. Laryngectomy was the main salvage treatment for local recurrence. The 5-year initial and final local control rates were 71% and 83%, and the 10-year initial and final local control rates were 69% and 80%, comparable to the results of other series. The 5-year rate of overall survival with final larynx preservation was 77%. Multivariate analysis revealed that anterior commissure involvement is prognostic of a poor outcome in patients with T1 glottic cancer. Further subgroup analysis revealed that a fraction size of >200 cGy could overcome the negative impact of anterior commissure involvement and significantly improve the 5-year local control rate in T1 patients (100% at >200 cGy versus 45% at ≤200 cGy; p = .04). Subglottic extension of the glottic cancer predicted poor outcome in T2 patients. The 5-year local control rates of patients with and without subglottic extension were 9% and 77%, respectively (p < .001). According to our results, radiotherapy with a fraction size of >200 cGy is recommended for T1 disease with anterior commissure involvement. For patients with T2 disease and subglottic extension, radiotherapy alone produces poor results. Further improvement of outcomes by other treatment strategies needs to be investigated.
Regeneration of the Vocal Fold Using Autologous Mesenchymal Stem Cells
Authors: Kanemaru Shin-Ichi , Kojima Hisayoshi , Hirano Shigeru , Nakamura Tatsuo , Magrufov Akhmar , Ito Juichi , Omori Koichi , Hiratsuka Yasuyuki , Shimizu Yasuhiko
Published: October 2014

The aim of this study was to regenerate the injured vocal fold by means of selective cultured autologous mesenchymal stem cells (MSCs). Eight adult beagle dogs were used for this experiment. Selective incubation of MSCs from bone marrow was done. These MSCs were submitted to 3-dimensional incubation in 1% hydrochloric acid atelocollagen. Three-dimensional incubated MSCs were injected into the left vocal fold, and atelocollagen only was injected into the right vocal fold of the same dog as a control. Four days after injection, the posterior parts of the vocal folds were incised. The regeneration of the vocal fold was estimated by morphological and histologic evaluations. Our results showed that 3-dimensional incubated MSCs were useful in the regeneration of the injured vocal fold. This study shows that damaged tissues such as an injured vocal fold would be able to be regenerated by tissue engineering.
Dysphagia, Hoarseness, and Unilateral True Vocal Fold Motion Impairment following Anterior Cervical Diskectomy and Fusion
Authors: Baron Eli M. , Soliman Ahmed M. S. , Simpson Lisa , Gaughan John P. , Young William F.
Published: October 2014

The charts of 100 patients who underwent anterior cervical diskectomy with fusion performed at our institution between January 1996 and February 1999 were reviewed. The incidences of hoarseness, dysphagia, and unilateral true vocal fold motion impairment were calculated. Univariate logistic regression was used to estimate the relationship of several patient and technical factors to the rates of occurrence of hoarseness and dysphagia. Patient age was found to be a significant predictor of postoperative dysphagia (p < .006), with an odds ratio of 1.113 (95% confidence limits, 1.04, 1.21) per year of age. Other factors studied were not found to be significant predictors. The overall incidence of these complications from the world literature was also calculated. The overall incidences of dysphagia, hoarseness, and unilateral true vocal fold motion impairment in the literature were calculated as 12.3%, 4.9%, and 1.4%, respectively. We conclude that dysphagia, hoarseness, and unilateral vocal fold motion impairment continue to remain significant complications of anterior cervical diskectomy with fusion. Older patients may be at higher risk for dysphagia.
Tuberculous Otitis Media: Clinical Aspects of 12 Cases
Authors: Nishiike Suetaka , Irifune Morihiro , Osaki Yasuhiro , Doi Katsumi , Kiuchi Nobuo
Published: October 2014

The clinical features of tuberculous otitis media (TOM) have changed. This study was performed to evaluate changing trends in the clinical manifestations of TOM. We reviewed a series of 12 cases of TOM (13 ears) recently treated at Osaka Prefectural Habikino Hospital. The results showed a mean age of 41 years and a male predominance of 1.4 to 1. Central or total perforations of the tympanic membrane were observed in most cases, but none of the patients had multiple perforations. Nine patients (75%) had active pulmonary tuberculosis. Normal lung status or inactive pulmonary tuberculosis was significantly more frequent in the older age group. Diagnosis of primary TOM required more time than that of secondary TOM. Most cases of primary TOM had high infectiousness of the primary lesion. We summarize the clinical features of patients who should be evaluated for TOM.
Shifts in Biochemical Markers Associated with Wound Healing in Laryngeal Secretions following Phonotrauma: A Preliminary Study
Authors: Verdolini Katherine , Branski Ryan C. , Rosen Clark A. , Hebda Patricia A.
Published: October 2014

The current study sought to determine whether shifts in key components of the inflammatory process could be detected from laryngeal secretions sampled before and after vocal loading. a healthy 44-year-old woman served as the subject. The vocal folds were swabbed to collect baseline secretions. Ten and 20 minutes after nearly constant loud phonation for 1 hour, the vocal folds were swabbed again. The findings indicated strong shifts in several key inflammatory mediators: interleukin-1β, tumor necrosis factor a, and matrix metalloproteinase 8. The concentrations of those mediators continued to increase from the 10- to 20-minute postloading time-points. Transforming growth factor β and prostaglandin E2 did not demonstrate clear shifts. In summary, mediators reflecting the acute inflammatory process could be detected from laryngeal secretions in an awake human. The upward slope of the curves at the 20-minute time interval indicates the need for longer follow-up sampling to determine the full biological response of the vocal folds to acute phonotrauma.
Is There a Double Innervation of the Tensor Tympani Muscle in Humans?
Authors: Kierner Antonius C. , Mayer Regina , Adunka Oliver
Published: October 2014

The middle ear muscles and their function have not yet been fully explored. The statement of Lawrence, for example, that the tensor tympani muscle of humans might have a dual innervation has never been proven or disproven. The question is of great interest; in our opinion, it represents one of the key questions in the putative afferent feedback loop of the middle ear muscles in humans. A light microscopic study was performed on 16 tensor tympani muscles taken from 11 cadavers. Six muscles were taken out in toto and stained according to the modified method of Sihler. The remaining 10 muscles were dehydrated and embedded in paraffin. In 5 of these muscles, complete transverse serial sections were made on a microtome at 7 μm and alternately stained by silver impregnation, S-100 protein immunohistochemistry, and ferric oxide. In the remaining 5 muscles, complete longitudinal serial sections were made at 10 μm. These sections were alternately stained by the methods of Cason and Maskar. Neither the surgical microscopic investigation nor the light microscopic investigation revealed any innervation to the human tensor tympani muscle other than the one arising from the mandibular branch of the trigeminal nerve. Our findings, apart from the fact that they clearly refute an unproven hypothesis, might represent another small step toward understanding the innervation of the tensor tympani muscle.
Factors Associated with Postoperative Delirium after Major Head and Neck Surgery
Authors: Wang Soo-Geun , Goh Eui-Kyung , Lee Byung-Joo , Chon Kyong-Myong
Published: October 2014

Postoperative delirium (POD) is an acute change in cognitive status characterized by fluctuating consciousness and is associated with high incidences of morbidity, high complication rates, and long hospitalizations. This study was performed to determine the incidence of POD and the perioperative risk factors in order to predict which patients have an increased risk and thus to prevent POD after major head and neck surgery. The authors retrospectively evaluated 341 patients who underwent laryngectomy or the Commando (combined operation of mouth, mandible, and neck dissection) procedure at Pusan National University Hospital from January 1986 through July 2001. Postoperative delirium developed in 13.8% of the patients who underwent laryngectomy (42 of 304) and 13.5% of the patients who underwent the Commando procedure (5 of 37). A multivariate analysis showed that older age, hypertension, low postoperative 02 saturation, and decreased postoperative hemoglobin levels were risk factors for POD (p < .05). Postoperative delirium is preventable, and its incidence can be decreased by predicting these risk factors during the preoperative and postoperative periods.
Cryptococcal Laryngitis: Case Report and Review of the Literature
Authors: Nadrous Hassan F. , Lewis Jean E. , Ryu Jay H. , Sabri Alain N.
Published: October 2014

Infections caused by Cryptococcus neoformans may range from an asymptomatic illness to lethal systemic disease, especially in immunocompromised hosts. Although cryptococcal infection most commonly involves the lungs or the central nervous system, it can disseminate to virtually any organ. Laryngeal cryptococcal infections are extremely rare — only 5 cases have been reported in the literature. Herein, we describe cryptococcal laryngitis occurring in a 55-year-old man with asthma and allergic fungal sinusitis. He presented with hoarseness and cough. He was treated with itraconazole followed by fluconazole therapy with complete recovery from his laryngeal infection. The patient was disease-free when last seen 10 months after the diagnosis. We present a summary of all reported cases of cryptococcal laryngitis.
Same-Day Discharge for Selected Patients Undergoing Combined Nasal and Palatal Surgery for Obstructive Sleep Apnea
Authors: Kieff David A. , Busaba Nicolas Y.
Published: October 2014

To determine the safety of same-day discharge for patients who undergo combined nasal and palatal surgery for obstructive sleep apnea syndrome, we undertook a retrospective review and analysis of 2 groups of patients (total, 86 patients) who underwent such surgery. The patients with obstructive sleep apnea syndrome who underwent combined nasal and palatal surgery were considered for same-day discharge if they fulfilled the following postoperative criteria: sustained O2 saturation of 94% or greater on room air while asleep, no history of cardiopulmonary disease or diabetes mellitus, adequate oral analgesia and oral intake, hemostasis, and normal vital signs. Twenty-three patients met these criteria and were assigned to group 1. The remaining 63 patients were admitted overnight for monitoring and were assigned to group 2. The data collected included patient demographics, respiratory disturbance index, lowest O2 saturation, body mass index, and postoperative complications. The mean age, respiratory disturbance index, lowest O2 saturation, and body mass index for group 1 were 45.9 years, 36 events per hour, 84.9%, and 28.7 kg/m2, respectively. For group 2, the results were 48 years, 36.5 events per hour, 82%, and 32.5 kg/m2. There were no postoperative complications in group 1, and 3 in group 2. There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period in either group. There were no readmissions for either group. We conclude that same-day discharge for patients who have undergone combined nasal and palatal surgery for obstructive sleep apnea syndrome is relatively safe in selected cases in which significant comorbid diseases are not present. These selected cases would have constituted a minority of the patients studied.
Hearing Preservation after Modified Translabyrinthine Approach Performed to Remove a Vestibular Schwannoma
Authors: Tringali Stéphane , Jacquet Claude , Bertholon Pierre , Prades Jean-Michel , Chelikh Larbi , Martin Christian
Published: October 2014

Hearing preservation after surgical removal of a vestibular schwannoma by a modified translabyrinthine approach was initially reported by McElveen et al in 1991. We report the case of a 46-year-old man from whom a vestibular schwannoma (grade I) was removed by this approach. The patient's hearing was preserved and was stable after 21 months. To the best of our knowledge, this is the first case with satisfactory and long-standing hearing preservation. However, further experimental studies are needed to determine the mechanisms of hearing preservation in order to develop a reliable technique for this approach before using it as an alternative in the management of vestibular schwannoma.
Effect of Platelet Activating Factor with and without Receptor Antagonist (WEB2170) on Morphology of Isolated Cochlear Outer Hair Cells
Authors: Jung Timothy T. K. , John Earnest O. , Park Yong Soo , Park Seong Kook , Rhee Chong-Ku
Published: October 2014

Platelet activating factor (PAF), generated from biologically active phospholipids, has been implicated as a potent inflammatory mediator and has been shown to be involved in many pathological processes, especially in inflammation and allergy. It has been suspected that PAF may be one of the inflammatory mediators in middle ear effusion that can induce sensorineural hearing loss, as observed in chronic otitis media. The PAF receptor antagonist WEB2170 has been studied extensively, and its inhibitory effects against various PAF actions are well proven in otologic systems. The purpose of our study was to determine the effect of superfusion of PAF and WEB2170 on morphological changes in isolated cochlear outer hair cells (OHCs). Isolated OHCs from adult chinchilla cochleas were exposed to albumin-phosphate-buffered saline solution (1 mg/mL), WEB2170 (5 mg/30 mL), PAF (1 μmol/L), or both PAF (1 μmol/L) and WEB2170 (5 mg/30 mL). All experiments were performed at an osmolality of 305 ± 5 mOsm at room temperature for 30 minutes. The cells were observed with an inverted microscope; the images were stored and analyzed on the Image Pro-Plus program. The OHCs exposed to control albumin-phosphate-buffered saline solution or to WEB2170 did not show any significant change in cell shape or length. The cells exposed to 1 μmol/L of PAF showed ballooning and significant shortening of the mean cell length in 15 to 20 minutes. These morphological changes in OHCs can be prevented by pretreating OHCs with WEB2170. This study demonstrated that exposure to PAF causes morphological changes in isolated OHCs that can be prevented by the PAF receptor antagonist WEB2170.
Molecular Characterization of Mutations in Patients with Benign and Aggressive Recurrent Respiratory Papillomatosis: A Preliminary Study
Authors: Pou Anna M. , Weems Justin , Nason Robert , Deskin Ronald W. , Payne Deborah A.
Published: October 2014

This study was performed to determine whether genetic polymorphisms within the human papillomavirus (HPV) can predict the disease course in patients with recurrent respiratory papillomatosis. The HPV type and genomic variations were determined by comparing the sample sequence to a prototypical HPV in the database of the National Center for Biotechnology Information. The results were correlated with the clinical course. Seven children and 6 adults were studied. Six of the 7 children had aggressive disease associated with HPV type 11. The remaining child had HPV type 6. Five of the 6 adult patients had HPV type 6; 1 had a history of juvenile recurrent respiratory papillomatosis. The remaining adult had an aggressive disease course associated with HPV type 11. The HPV type and specific polymorphisms were conserved over time in serial isolates. The age of onset and medical therapy did not appear to affect the polymorphisms present. Future studies may find that the presence of certain polymorphisms is associated with different geographic locations and possibly with the disease course.
Pleomorphic Adenoma of the Nasal Septum
Authors: Mackle Tara , Zahirovic Avdo , Walsh Michael
Published: October 2014

Pleomorphic adenoma may occur in any site in which there is salivary gland tissue. It has rarely been described arising in the nasal cavity. We report a case of septal pleomorphic adenoma and discuss the clinical presentation and surgical management.
Electronystagmographic Findings in Benign Paroxysmal Positional Vertigo
Authors: Korres Stavros G. , Balatsouras Dimitrios G. , Ferekidis Eleftherios
Published: October 2014

The aim of this study was to investigate the electronystagmographic findings in patients with benign paroxysmal positional vertigo. A retrospective review of the records of 168 patients with this disease during the past 3 years was performed. Epidemiological data and results from the audiological and neuro-otologic workup, including electronystagmography, were recorded. One hundred fifty-one patients had involvement of the posterior canal, 14 of the horizontal canal, and 3 of the anterior canal. Seventy-two patients (42.8%) had abnormal findings on the caloric tests. Thirty-seven of them (22%) had canal paresis and 23 (13.7%) had directional preponderance, whereas in 12 patients (7.1%) both unilateral weakness and directional preponderance were found. Finally, 21 patients (12.5%) had spontaneous nystagmus. It may be thus concluded that electronystagmographic abnormalities are quite common in patients with benign paroxysmal positional vertigo. Their presence may be explained according to several mechanisms, which are further discussed herein.
Tremor Laryngeal Dystonia: Treatment of the Lateral Cricoarytenoid Muscle
Authors: Maronian Nicole C. , Robinson Lawrence , Waugh Patricia F. , Hillel Allen D.
Published: October 2014

Tremor laryngeal dystonia is a clinical entity distinct from adductor laryngeal dystonia, according to perceptual, stroboscopic, and fine-wire electromyographic findings. Treatment with botulinum toxin has proven more difficult for tremor laryngeal dystonia than for adductor laryngeal dystonia, yet no treatment variations have been considered that might produce improved clinical results. We present 81 patients with a clinical presentation of tremor laryngeal dystonia who were treated with a variety of approaches with botulinum toxin. On the basis of both fine-wire electromyographic findings and clinical response, currently 44 of those patients are being followed up after at least 3 injections. Twenty-one patients (48%) are maintained on lateral cricoarytenoid injections, and 23 (52%) are maintained on thyroarytenoid muscle injections. The electromyographic findings of this group are presented along with their clinical outcome. According to our findings, the majority of patients with tremor laryngeal dystonia can be successfully treated with botulinum toxin if the practitioner includes injections to the lateral cricoarytenoid muscle as a treatment option.
Combination of Fascia Transplantation and Fat Injection into the Vocal Fold for Sulcus Vocalis: Long-Term Results
Authors: Hsiung Ming-Wang , Kang Bor-Hwang , Su Wan-Fu , Pai Lu , Lin Yaoh-Hsiang
Published: October 2014

Fat injection and fascia transplantation alone have been used to treat patients with sulcus vocalis. No information is available on the effectiveness of these two procedures used in concert to treat sulcus vocalis. The objectives of this study were to conduct the two procedures together and report the long-term results. This article assesses, retrospectively, the effectiveness of the combination treatment of fascia transplantation and fat injection (FTFI) in patients with sulcus vocalis (n = 22). Perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after FTFI treatment in 18 patients. The mean follow-up time was 16.6 months. Sixteen patients had excellent results, 3 reported improvement, and 3 indicated no change. Phonatory function improved significantly in terms of phonation time, grade, roughness (p < .05), and breathiness (p < .001). The videolaryngostroboscopic rating showed significant improvement in vocal fold vibration amplitude and excursion of the mucosal wave (p < .05). Type 3 sulcus responded better to this treatment than did type 2 (sulcus vergeture). No postoperative complications were noted. The FTFI technique consists of an autogenous implant and delivers positive results. It may be considered as an option for patients with sulcus vocalis. It has been demonstrated to achieve excellent results in a majority of patients and to deliver a better prognosis than fat injection alone. Although resorption of fat and fascia is associated with FTFI, the FTFI procedure may be repeated multiple times.
Revision Single-Stage Laryngotracheal Reconstruction in Children
Authors: Younis Ramzi T. , Lazar Rande H. , Bustillo Andres
Published: October 2014

In this report, we discuss indications, technique, outcome, and complications of revision single-stage laryngotracheal reconstruction (SSLTR), formulate guidelines to avoid or prevent procedure failure, and establish a protocol for the management of procedure failure. We retrospectively reviewed the charts of 122 patients between the ages of 8 months and 9 years who underwent SSLTR between January 1992 and September 2001 in 2 tertiary care children's medical centers in different cities and assessed the outcomes of patients who underwent revision SSLTR. A total of 122 patients underwent SSLTR, of whom 48 patients underwent anterior and posterior grafting. Of the 122 patients, 13 had revision SSLTR; 8 of these 13 underwent the initial laryngotracheal reconstruction at another institution. Five patients had anterior grafting laryngotracheal reconstruction without stenting, 7 had anterior and posterior grafting with 1 to 21 days of endotracheal intubation, and 1 had cricotracheal resection and anastomosis. Of the 13 patients, 5 had anterior wall or graft collapse (grade IV stenosis), 4 had subglottic stenosis (grade IV), 2 had circumferential subglottic stenosis (grade III), and 2 had subglottic and glottic stenosis (grade IV). The overall success rate for all patients was 86% (105 of 122). The success rates for the 122 patients were as follows: anterior grafting, 100%; anterior and posterior grafting, 83% (40 of 48); and revision cases, 70% (9 of 13). We conclude that laryngotracheal reconstruction with a costal cartilage rib graft should be considered the procedure of choice for the management of subglottic stenosis. We believe that patients in whom the first procedure fails should have a high chance of success with revision SSLTR if strict guidelines and protocols are followed.
Cellular Neurothekeoma of the Maxilla
Authors: Cohen Noam A. , Pawel Bruce R. , Samadi Daniel S. , Kazahaya Ken
Published: October 2014

Neurothekeomas are uncommon benign soft tissue tumors of nerve sheath origin. They occur predominately in the head and neck or upper trunk of children and young adults. A 15-month-old boy presented with an enlarging mass of the right maxilla. Radiologic imaging demonstrated an expansile lesion of the nasomalar region. An incisional biopsy resulted in the diagnosis of neurothekeoma. This lesion should be considered as part of the differential diagnosis of pediatric soft tissue head and neck masses. We discuss the presentation, evaluation, and treatment of these rare benign lesions.
Surgical Management of Special Cases of Intractable Meniere's Disease: Unilateral Cases with Intact Canals and Bilateral Cases
Authors: Kitahara Tadashi , Okumura Shin-ichi , Kondoh Kazumasa , Mishiro Yasuo , Morihana Tetsuo , Kubo Takeshi
Published: October 2014

If a clinician seeks to allow patients with vertigo to return to work as soon as possible, it is very important to determine the appearance of vestibular symptoms during convalescence just after treatment, as well as the long-term results. Apprehensive patients with vertigo may undergo severe psychological torment if treatment requires long-term rest in bed before they can return to daily life. In this paper, we observed postoperative vestibular symptoms (subjective sensation and objective nystagmus) in 50 patients with intractable Meniere's disease, including cases from our previous preliminary report, during the period of convalescence just after endolymphatic sac drainage and steroid instillation surgery (EDSS). All symptoms were eliminated within 8 days after EDSS. There was no significant difference in the duration of any vestibular symptoms between bilateral (n = 8) and unilateral cases (n = 42). This result indicates that EDSS could be as safe a treatment for bilateral Meniere's disease as for unilateral disease. In unilateral cases with intact semicircular canal function (n = 17), postoperative evoked vestibular sensation, positional, and positioning (Dix-Hallpike) nystagmus disappeared significantly earlier than in those with canal paresis (n = 25). This result indicates that EDSS could keep the vestibular peripheral function of patients with unilateral Meniere's disease with intact canals quite stable after surgery. Therefore, EDSS could be recommended as an initial, less-invasive surgical treatment for intractable Meniere's disease, especially in unilateral cases with intact canals and in bilateral cases.
Effect of Web 2170 Bs, Platelet Activating Factor Receptor Inhibitor, in the Rabbit Model of Sinusitis
Authors: Karasen R. murat , Uslu Celil , Taysi Seyithan , Gundogdu Cemal , Akcay Fatih
Published: October 2014

Platelet activating factor (PAF), a potent inflammatory mediator, is a biologically active phospholipid. Recent studies have shown that PAF may play an important role in the pathogenesis of inflammation. WEB 2170 BS has been shown to be a PAF antagonist both in vitro and in vivo. Nitric oxide (NO) is present in the mammalian nasal airways and originates primarily from the paranasal sinuses. Measurement of NO is thought to be a surrogate marker of upper airway inflammation. In this study, the anti-inflammatory effects of WEB 2170 BS were investigated in a rabbit model of sinusitis. To induce experimental sinusitis, we applied killed Staphylococcus aureus percutaneously to the maxillary sinus of rabbits without occlusion of the natural ostium. Either WEB 2170 BS solution or placebo was administered intraperitoneally 2 hours before sinus inoculation, and this procedure was repeated twice daily for 4 days. The outcome of the treatment was determined by the measurement of NO metabolite levels and NO synthase activity in the samples of sinus mucosa and by histopathologic evaluation of sinus mucosa. The pathological grading was determined by the number of inflammatory cells found in the sinus mucosa. The levels of NO metabolites and NO synthase activity were found to be significantly lower in the WEB 2170 BS-treated group than in the control group. Histopathologic analysis of the sinus mucosa indicated decreased inflammation in the treated group as compared to the controls. These results demonstrate that WEB 2170 BS may produce significant anti-inflammatory effects in this model of sinusitis.
Pharyngeal Wall Collapse and Multiple Synchronous Airway Lesions
Authors: Shatz Anat , Picard Elie , Goldberg Shmuel , Kerem Eitan
Published: October 2014

Pharyngeal wall inspiratory collapse (PWIC) is a dynamic obstruction of the air column proximal to the glottis during inspiration. Our objectives were to assess PWIC's incidence and its contribution to the symptoms of upper airway obstruction (UAO), and to propose indications for intervention. In a retrospective review of consecutive endoscopic evaluations and clinical data of 108 infants with UAO, PWIC was diagnosed in 50 infants (46%). The most common presenting symptom was apnea (52%). The PWIC was accompanied by 2 to 7 synchronous airway abnormalities, most frequently laryngomalacia (78%). Generalized hypotonia was the most common associated systemic finding (80%). Severe PWIC cases required bi-level positive airway pressure (BiPAP). The severity of PWIC, measured by a newly developed classification, was positively correlated to apnea (p < .05) and the need for BiPAP (p < .054). Spontaneous recovery occurred within 36 months. The incidence of PWIC among infants with UAO is high, and its role in UAO deserves greater recognition. Better diagnosis of PWIC will improve the treatment of UAO.
Budesonide-Dependent Modulation of Expression of Macrophage Migration Inhibitory Factor in a Polyposis Model: Evidence for Differential Regulation in Surface and Glandular Epithelia
Authors: Delbrouck Carine , Gabius Hans-Joachim , Kiss Robert , Vandenhoven Guy , Hassid Sergio
Published: October 2014

Macrophage migration inhibitory factor (MIF) is a counterregulatory lymphokine for glucocorticoid action within the immune system. To provide further insights into the way expression of pleiotropically acting MIF is modulated by glucocorticoids, we investigated the influence of the glucocorticoid budesonide on the level of expression of MIF in a model of human nasal polyposis by quantitative immunohistochemical analysis. Ten nasal polyps obtained from surgical resection were maintained for 24 hours in the presence of 3 budesonide concentrations: 10, 50, and 250 ng/mL. As quantitatively demonstrated by computer-assisted microscopy, 50 ng/mL induced an increase in MIF expression in the surface epithelium and a decrease in MIF expression in the glandular epithelium. At the 250 ng/mL dose, the inverse effect was induced. Evidently, surface and glandular epithelia react nonuniformly to the glucocorticoid regarding MIF presence, adding dependence on the cell type to the regulatory network.
Fasciitis Ossificans of the Paranasal Sinus
Authors: Uhe Sylke , von Falkenhausen Uwe , Evert Matthias , Freigang Bernd
Published: October 2014

We report a case of fasciitis ossificans of the nasal cavity and paranasal sinus in an infant who was surgically treated in our department. Fasciitis ossificans is a rare benign reactive lesion and a variant of the more commonly known entity nodular fasciitis. We present the radiographic appearance and discuss the surgical resection, which was performed by a paranasal section, as well as the histologic and immunohistochemical results. To the best of our knowledge, no other case of fasciitis ossificans of the paranasal sinus has yet been reported. It is important to publish cases such as this, because their recognition as benign entities can prevent aggressive surgical procedures.
Bioactive Glass and Turbinate Flaps in the Repair of Nasal Septal Perforations
Authors: Stoor Patricia , Grénman Reidar
Published: October 2014

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft and the use of turbinate flaps in 23 patients with septal perforations. Another 16 patients were treated with mucoperiosteal flaps only. The perforations were successfully closed in 38 of the 39 patients. One patient had a near-total septal perforation due to hypophysial surgery; it could not be closed. No extrusions of the BAG and no BAG-associated infections were seen; the average follow-up period was 28 months. BAG S53P4 seems to be a good interpositional graft in the repair of medium and large nasal septal perforations, and turbinate flaps are also reliable.
Cytologic Aspects of the Nasal Respiratory Epithelium Throughout the Menstrual Cycle
Authors: Maiolino Luigi , Arcidiacono Angelo , Serra Agostino , Farina Marco , Poli Graziella , Ficarra Simona , Caruso Salvatore
Published: October 2014

A prospective study was performed to investigate the changes in nasal cytology that occur in healthy premenopausal women throughout the menstrual cycle. Eighty-eight women with an ovulatory menstrual cycle underwent nasal sampling with a cytobrush by direct vision of the middle and inferior nasal turbinates during the follicular, periovular, and luteal phases of the menstrual cycle, and the specimens were evaluated with the maturation index. Hematoxylin-eosin staining showed the cytologic aspects of the nasal respiratory epithelium and of vaginal smears according to the three different phases of the menstrual cycle. Along with the vaginal cells, the nasal respiratory epithelium is an ovarian steroid target.
Magnesium Treatment for Sudden Hearing Loss
Authors: Nageris Ben I. , Ulanovski David , Attias Joseph
Published: October 2014

Magnesium treatment has been repeatedly shown to reduce the incidence of both temporary and permanent noise-induced hearing loss. We hypothesized that it might also improve the permanent threshold shift in patients with acute-onset hearing loss. In a prospective, randomized, double-blind, placebo-controlled trial, 28 patients with idiopathic sudden sensorineural hearing loss were treated with either steroids and oral magnesium (study group) or steroids and a placebo (control group). Compared to the controls, the magnesium-treated group had a significantly higher proportion of patients with improved hearing (>10 dB hearing level) across all frequencies tested, and a significantly greater mean improvement in all frequencies. Analysis of the individual data confirmed that more patients treated with magnesium experienced hearing improvement, and at a larger magnitude, than control subjects. Magnesium is a relatively safe and convenient adjunct to steroid treatment for enhancing the improvement in hearing, especially in the low-tone range, in patients with sudden sensorineural hearing loss.
Bronchogenic Cysts of the Neck in Adults
Authors: Newkirk Kenneth A. , Krowiak Edward J. , Tassler Andrew B. , Deeb Ziad E.
Published: October 2014

Bronchogenic cysts are congenital sacs that result from maldevelopment of the primitive foregut. Although they occur predominantly in the chest, there are reports of lesions in extrathoracic locations. The majority of reported bronchogenic cysts located in the neck are found in the pediatric population; a review of the literature reveals few reports of bronchogenic cysts of the neck among adults. The diagnosis of a bronchogenic cyst relies on the histology and location of the lesion. Here, we review our experience in the diagnosis and management of 2 adult patients with pathologically proven bronchogenic cysts. Both patients presented with solitary neck masses that proved to be bronchogenic cysts on histologic examination. Our purpose is to define the histopathologic and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. In conclusion, congenital bronchogenic cysts can occur in the neck of adults and should be considered in the differential diagnosis of cystic cervical masses in adults, as well as children.
Splaying of the Carotid Bifurcation Caused by a Cervical Sympathetic Chain Schwannoma
Authors: Wang Cheng-Ping , Hsiao Jong-Kai , Ko Jenq-Yuh
Published: October 2014

Splaying of the carotid bifurcation revealed by an imaging study is usually indicative of a carotid body tumor, but there are other possibilities. To promote awareness of a cervical sympathetic chain schwannoma as another cause of splaying of the carotid bifurcation, we present a case of cervical sympathetic chain schwannoma, with an additional 7 cases in the English-language literature, and discuss the relationship between the great vessels of the neck and a carotid body tumor or a schwannoma of the cervical sympathetic chain or vagus nerve from an anatomic viewpoint. We conclude that splaying of the carotid bifurcation with hypervascularity suggests a carotid body tumor, whereas in cases without hypervascularity, a cervical sympathetic chain schwannoma is another possibility. Vagus nerve schwannomas can separate the internal jugular vein and internal carotid artery, but seldom widen the carotid bifurcation.
Pulsatile Tinnitus Cured by Mastoidectomy
Authors: Duvillard Christian , Redon Emmanuel , Ballester Michel , Romanet Philippe
Published: October 2014

Tinnitus of venous origin is a rare occurrence. It represents roughly half of cases of vascular tinnitus. The choice of treatment is not easy, even when the diagnosis is certain. Reassurance of the patient is often sufficient. Nevertheless, a surgical treatment is sometimes performed — usually ligature of the internal jugular vein. We present the case of a patient with a right venous pulsatile tinnitus and a history of 5 years of ineffective medical and surgical treatments. Ligature of the internal jugular vein was not chosen in this case: a computed tomographic scan showed filled mastoid cells, and mastoidectomy was performed instead. The tinnitus disappeared immediately after surgery and has not recurred during a 2-year follow-up. The bilateral preoperative sensorineural and conductive hearing loss also disappeared. Pulsatile tinnitus of venous origin is usually treated with ligature of the internal jugular vein. Mastoidectomy is an interesting alternative in selected cases.
Surface Electromyographic Activity in Total Laryngectomy Patients following Laryngeal Nerve Transfer to Neck Strap Muscles
Authors: Heaton James T. , Goldstein Ehab A. , Kobler James B. , Walsh Michael J. , Zeitels Steven M. , Gooey John E. , Randolph Gregory W. , Hillman Robert E.
Published: October 2014

Hands-free triggering and pitch control would improve electrolarynx devices, which are inconvenient to use and sound unnatural. The present study tested the strategy of salvaging voice-related neural signals for hands-free electrolarynx control either by transferring cut recurrent laryngeal nerves (RLNs) to denervated neck strap muscles or by preserving strap muscles with their normal innervation. An RLN nerve transfer was performed at the time of total laryngectomy in 8 individuals, and in 5 of these subjects, strap muscles with intact ansa cervicalis innervation were also preserved for comparison. Neck surface electromyography performed over the strap muscles was used periodically for more than 1 year on phonatory and nonphonatory tasks. Signals were eventually obtained in all subjects from both RLN-innervated and ansa-innervated strap muscles that correlated with speech production. After 1 year, RLN-driven signals were larger than ansa-driven signals in magnitude, and their timing appeared better correlated with intended phonation. The results show that neck surface electromyography is an effective control source for hands-free electrolarynx activation, and that RLN transfer may provide the best approach for obtaining phonation-related activity.
Management of Synchronous Subglottic Stenosis and Bronchial Stenosis with a Modified Endotracheal Tube
Authors: Pogodzinski Matthew S. , Flick Randall P. , Thompson Dana M.
Published: October 2014

We present the case of a tracheostomy tube-dependent 6-month-old infant with synchronous airway lesions, including grade III subglottic stenosis and left main bronchomalacia with recurrence of granulation tissue and stenosis. Because the infant was at high risk for complications from the tracheostomy tube, decannulation was the desired outcome. The airway lesions were managed by single-stage laryngotracheal reconstruction and short-term stenting of the subglottis and left main bronchus. The greatest challenge was management of progressive stenosis caused by recurrence of granulation tissue in the left main bronchus. A novel modification of a soft silicone elastic endotracheal tube was devised to provide continued ventilation of both lungs while the corrected lesions healed. The role for this type of stent and the benefits and difficulties associated with its use are discussed.
Role of Anaerobic Bacteria in Infections following Tracheostomy, Intubation, or the Use of Ventilatory Tubes in Children
Authors: Brook Itzhak
Published: October 2014

Colonization of the tracheobronchial tree with microorganisms almost always follows tracheal intubation, tracheostomy, or the use of ventilatory tubes. Infection of the tracheostomy wound site frequently occurs after prolonged use of the tracheostomy. The long-term-ventilated child is at high risk for developing tracheobronchitis or nosocomial pneumonia, generally involving aerobic gram-negative or gram-positive bacteria. Several studies have illustrated the role of anaerobic bacteria in lower respiratory tract and tracheostomy wound site infection in intubated children. The predominant anaerobic bacteria were Peptostreptococcus spp and pigmented Prevotella and Porphyromonas spp. Most of these infections are due to polymicrobial aerobic-anaerobic bacterial flora. Appropriate management of mixed pulmonary aerobic and anaerobic infections requires the administration of antimicrobials that are effective against both the aerobic and anaerobic components of the infection.
Bezold's Abscess following Chronic Mastoiditis in a Newborn
Authors: Schöndorf Hans J. , Roth Bernhard , Streppel Michael
Published: October 2014

Despite the availability of antibiotics, acute otitis media can still lead to major complications. Bezold's abscesses are very rare complications and are usually found only in adults with well-pneumatized mastoid bones. We present the case of a 10-week-old newborn with a Bezold's abscess. It is stressed that acute otitis media can be silent and undetected in infants and can lead to major complications such as Bezold's abscess.
Preserved Otoacoustic Emissions in Postparotitis Profound Unilateral Hearing Loss: A Case Report
Authors: Salvinelli Fabrizio , Firrisi Luca , Trivelli Maurizio , Greco Fabio , D'Ascanio Luca
Published: October 2014

We report a case of a profound unilateral sensorineural hearing loss following epidemic parotitis, with good response of otoacoustic emissions. The patient was a 12-year-old girl who had developed a unilateral hearing impairment 2 weeks after the onset of mumps. Pure tone audiometry confirmed a profound left sensorineural hearing loss. The affected ear showed an absence of auditory brain stem responses, whereas transient evoked otoacoustic emissions and distortion product otoacoustic emissions were preserved. Epidemic parotitis virus is likely responsible for an impairment of inner hair cells, primary afferent fibers or their synapses, or a combination of these areas, and it does not seem to have a specific tropism for cochlear outer hair cells. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.
New Approach for Implantable Hearing Aids: A Feasibility Study
Authors: Sichel Jean-Yves , Freeman Sharon , Eliashar Ron , Fleishman Zvi , Sohmer Haim
Published: October 2014

The objective of this study was to test the feasibility of a new kind of implantable hearing device based on a cerebrospinal fluid hydroacoustic pathway by which sound waves are conducted from the dura mater to the inner ear by cerebrospinal fluid. In this prospective animal study, a piezoelectric bimorph was implanted into 2 guinea pigs and 1 dog between the skull bone and the dura at the parietal area. The bimorph was connected transdermally by wires to a click generator. The auditory brain stem response was recorded after stimulation of the piezoelectric device by the click generator. In the 3 animals, the auditory brain stem response could be recorded in response to a stimulus intensity of 135 dB peak equivalent (pe) sound pressure level (SPL; instrument setting), corresponding to 3.8 V activating the device. The auditory brain stem response disappeared during white noise masking, proving that the origin of the response was in the inner ear. The threshold was 125 and 115 dB pe SPL in the 2 guinea pigs and 135 dB pe SPL in the dog (instrument setting). We conclude that transmission of sound waves by a cerebrospinal fluid hydroacoustic pathway to the inner ear is possible. Such a device would have advantages over more traditional implantable hearing devices: it would not be necessary to couple it to the ossicular chain, and it could be used in patients with infected middle ears.
Effects of Cetirizine on Substance P Release in Patients with Perennial Allergic Rhinitis
Authors: Watanabe Kazumasa , Konno Nobuhiro , Shirasaki Hideaki , Kanaizumi Etsuko , Narita Shin-ichirou , Sato Jun , Himi Tetsuo
Published: October 2014

To evaluate the effect of cetirizine hydrochloride on substance P release in allergic rhinitis, we performed a single-blind placebo-controlled study of 14 patients with perennial allergic rhinitis (7 treated with cetirizine and 7 with placebo). After an initial nasal allergen challenge with lavages, the subjects received treatment with placebo or cetirizine hydrochloride (10 mg by mouth daily) for 1 week, followed by the second nasal allergen challenge with lavages. The levels of albumin, histamine, and substance P in nasal lavages before and after allergen challenge were quantified by enzyme-linked immunosorbent assay. Pretreatment of subjects with cetirizine reduced the level of substance P induced by antigen challenge, but did not significantly reduce levels of histamine. These results suggest that cetirizine may reduce nasal neurogenic inflammation by modulating the release of substance P in allergic rhinitis.
Temperature-Sensitive Sv40-Immortalized Rat Middle Ear Epithelial Cells
Authors: Toyama Katsuhiro , Paparella Michael M. , Kim Youngki , Lin Jizhen
Published: October 2014

The proliferation and differentiation of middle ear epithelial cells are essential in both normal and diseased middle ears. The normal situation involves physiologic growth and renewal of the epithelium, and the diseased situation involves pathological changes of the epithelium such as mucous cell metaplasia and ciliated cell proliferation in otitis media. In this study, we used a temperature-sensitive large T antigen (the SV40 mutant) to transduce and immortalize the primary culture of middle ear epithelial cells. SV40-immortalized middle ear epithelial cells have been cultured for more than 50 passages and are stable morphologically. Their nonimmortalized parent cells died at the second passage. Immortalized middle ear epithelial cells carrying the S V40 mutant show a monolayer, cobblestonelike morphology. The cell line expresses characteristic middle ear mucosal molecules such as mucins, keratins, and collagens. It also responds to temperature changes; namely, cells proliferate at 33°C, when the SV40 antigen is active, and differentiate at 39°C, when the SV40 antigen is inactive. Therefore, we conclude that a temperature-sensitive middle ear epithelial cell line has successfully been established.