bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Value of Accumulated Oropharyngeal Secretions for Aspiration during Video Nasal Endoscopic Evaluation of the Swallow
Authors: Donzelli Joseph , Wesling Michele , Brady Susan , Craney Mary
Published: October 2014

The purpose of this prospective study was to investigate the predictive value of oropharyngeal secretions by use of 5-point and modified 3-point secretion scales for aspiration of food or liquid and diet recommendation outcomes. One hundred consecutive patients and 4 control subjects participated. The 5-point secretion severity scale correlated highly to aspiration (Spearman's ρ = .516, p < .0001) and to diet recommendation outcomes (Spearman's ρ = .72, p < .0001). Patients who received tube feedings were more likely to demonstrate a higher secretion level than patients who received oral feedings (Pearson χ2 analysis value = 25.461, p < .0001). Patients with a tracheotomy tube tended to demonstrate higher secretion levels than patients without a tracheotomy tube (Spearman's ρ = .446, p < .0001). The relationship of the 3-point secretion severity scale level with aspiration was .488, p < .0001 (Spearman's ρ), and that with diet recommendation outcomes was .746, p < .0001 (Spearman's ρ).
Comparison of Resorbable Poly-L-Lactic Acid-Polyglycolic Acid and Internal Palmaz Stents for the Surgical Correction of Severe Tracheomalacia
Authors: Sewall Gregory K. , Connor Nadine P. , Warner Thomas , Hartig Gregory K.
Published: October 2014

Tracheomalacia (TM) is associated with expiratory airway collapse and potentially fatal respiratory distress. Internal and external tracheal stents and, recently, resorbable biopolymers have been used to treat this condition. In this study, the efficacy and biocompatibility of internal Palmaz stents and external poly-l-lactic acid-polyglycolic acid (PLPG) stents were compared in a model of severe TM induced in piglets. The tracheas were repaired with one of Two stenting methods, and the animals survived for up to 16 weeks. Weight gain, adverse respiratory signs and symptoms, tracheal or lung histopathologic changes, and internal and external tracheal diameters were measured. The animals in the PLPG group uniformly were free of respiratory distress and tracheal stenosis or inflammation, whereas all animals in the Palmaz group developed respiratory distress as a result of pneumonia or tracheal stenosis caused by intraluminal granulation tissue. In conclusion, superior efficacy of external, resorbable PLPG stents was found relative to internal Palmaz stents for the surgical repair of severe TM.
Stapedius Muscle Myoclonus
Authors: Golz Avishay , Fradis Milo , Netzer Aviram , Martzu Dan , Joachims Henry Z.
Published: October 2014

Myoclonus of the middle ear is a very rare condition. We present the case of a 20-year-old soldier who was exposed to intense artillery noise during a fierce battle and immediately afterward complained of an incapacitating tinnitus in both ears. Microscopic examination of the ears demonstrated rapid rhythmic movements of the tympanic membrane coinciding with the tinnitus, which was also easily heard by the examiner. There was no evidence of palatal myoclonus, and thus the diagnosis of middle ear myoclonus was made. Exploratory tympanotomy confirmed the diagnosis of stapedial muscle myoclonus. Bilateral sectioning of the stapedial tendons brought immediate relief of the tinnitus to the patient. We review the literature of middle ear myoclonus and discuss the symptoms, evaluation, and management of this rare condition.
Microsurgical Anatomy of the Perigeniculate Ganglion Area as Seen from the Middle Cranial Fossa Approach
Authors: Lee Ho-Ki , Lee Won-Sang
Published: October 2014

The middle cranial fossa approach is useful for decompressing the perigeniculate ganglion area of the facial nerve in patients with serviceable hearing. The present study was designed to investigate the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa. We dissected 20 human temporal bones under a microscope using a middle fossa approach, and measured the angle between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion. These were found to be 22.7° ± 2.2° and 6.5 ± 0.3 mm, respectively. Detailed knowledge about the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa is imperative for facial nerve decompression by a middle cranial fossa approach.
Auditory Brain Stem Response Throughout the Menstrual Cycle
Authors: Serra Agostino , Maiolino Luigi , Messina Agostino , Agnello Carmela , Caruso Salvatore
Published: October 2014

A prospective study was performed to evaluate the changes in the auditory brain stem response (ABR) that occur in healthy premenopausal women throughout the menstrual cycle. Ninety-four women with ovulatory menstrual cycles underwent ABR testing by auditory evoked potentials for wave I, III, and V latencies and for interpeak I-III, I-V, and III-V intervals during the follicular, periovular, and luteal phases of the menstrual cycle. The wave latencies and the interpeak intervals showed shorter values during the periovular phase than during the luteal phase (p < .05) and shorter values during the follicular phase for wave I (p < .05) and interpeak interval I-V (p < .05). The ABR seems to be influenced by the variations of ovarian steroids that occur during the menstrual cycle.
Room Tilt Illusion as a Manifestation of Peripheral Vestibular Disorders
Authors: Malis Didier-David , Guyot Jean-Philippe
Published: October 2014

Room tilt illusion is a subjective distortion of verticality with transient paradoxical rotation of the visual field, usually in the frontal plane. It might result from dysfunction of the vestibular pathways with subsequent contradictory vestibular, visual, and proprioceptive inputs and erroneous cortical integration. It has already been described in association with brain stem and cortical lesions, but reports of cases of peripheral origin are scarce. We report here 23 cases of room tilt illusion, all but 2 occurring in patients with either vestibular peripheral abnormalities or normal assessment findings. A review of the literature is presented, as well as a hypothesis addressing this phenomenon.
Videofluoroscopic and Manometric Evaluation of Swallowing Function in Patients with Multiple System Atrophy
Authors: Higo Ryuzaburo , Tayama Niro , Nitou Takaharu , Watanabe Takeshi , Ugawa Yoshikazu
Published: October 2014

We investigated swallowing function of 29 patients with multiple system atrophy (MSA) by videofluoroscopy and manometry. Abnormal findings in videofluoroscopy were generally consistent with those in Parkinson's disease. Although findings of videofluoroscopy were not correlated with a history of aspiration pneumonia, severity of disease was significantly correlated with a history of aspiration pneumonia. Oropharyngeal and hypopharyngeal swallowing pressures of the patients were decreased to 73.9 ± 48.4 mm Hg and 85.3 ± 42.9 mm Hg, respectively, both of which were significantly different from the pressures of the control group. Incomplete relaxation of the upper esophageal sphincter was seen in 23.1% of the MSA patients, all of whom had had MSA for more than 5 years. In conclusion, patients with MSA are at risk for aspiration pneumonia as disease severity increases, and the swallowing function of patients with more than 5 years' duration of MSA should be routinely followed up with both videofluoroscopy and manometry.
Extension of Nasopharyngeal Lymphoma to the Middle and External Ear
Authors: Gordin Arie , Ben-Arieh Yehudith , Netzer Aviram , Goldenberg David , Golz Avishay
Published: October 2014

We describe a patient with nasopharyngeal lymphoma who was admitted for chemotherapy. At admission, otoscopic examination revealed a large polyp occluding the left external ear canal. The polyp was removed, and histopathologic examination showed the same tumor that was found previously in the nasopharynx. Magnetic resonance imaging showed an infiltrative process that involved the left side of the nasopharynx and extended toward the left middle and external ear. To our knowledge, this is the first case report of a direct extension of nasopharyngeal lymphoma into the middle and external ear.
Blue Rubber Bleb Nevus Syndrome: Immunohistochemical Study
Authors: Villalain Lucas , Díaz Manuel , Junquera Luis M. , González Manuel
Published: October 2014

Blue rubber bleb nevus is a rare entity consisting of distinctive angiomas in the skin and gastrointestinal tract, leading to occult or profound gastrointestinal bleeding and chronic anemia. The efficacy has been documented of systemic treatment with corticoids, interferon, vincristine, and, more recently, subcutaneous octreotide in the presence of active lesion proliferation or disseminated intravascular coagulation. A case of blue rubber bleb nevus syndrome with oral hemangiomas in a 24-year-old woman is reported. The surgical specimens were subjected to immunohistochemical study, which showed all of the hemangiomas to be in an inactive phase.
Acute Edema of the Tongue: A Life-Threatening Condition
Authors: Gadban Hussein , Talmon Yoav , Gilbey Peter , Samet Alvin
Published: October 2014

Acute macroglossia is rare, but may cause upper airway obstruction requiring emergency intervention. The cause of the problem is often obscure. Edema of the tongue may be due to angioedema or to allergy. We present several cases of acute edema of the tongue, in 3 cases causing life-threatening airway obstruction. Among these, we present the first case of acute enlargement of the tongue due to the ingestion of artichoke.
Making Image Guidance Work: Understanding Control of Accuracy
Authors: Berry Julie , Humphries Steve , O'Malley Bert W. , Staecker Hinrich
Published: October 2014

Use of image-guided surgery is becoming increasingly common in both sinus surgery and neuro-otologic applications. The purpose of this study was to determine the effect of fiducial distribution and mean fiducial error on point accuracy. Using a plastic model, we determined that optimal navigation accuracy was achieved by surrounding the operative target with a widespread field of fiducials. True accuracy was always highest when we targeted a surface point. Accuracy was decreased at points removed from the center of the registration target zone created by the fiducials. Inaccurate registration resulted in increased mean fiducial error and lower accuracy at the target point. Understanding the registration process will enhance the utility of image-guided surgery in otolaryngology and skull base surgery.
Immunosuppressive Effect of Irradiation in the Murine Laryngeal Transplantation Model: A Controlled Trial
Authors: Lorenz Robert R. , Dan Olivia , Nelson Marc , Fritz Michael A. , Strome Marshall
Published: October 2014

Since the first successful human laryngeal transplantation in 1998, research continues toward developing less-morbid immunosuppressive protocols. Although irradiation of donor organs is known to decrease acute rejection, the most advantageous method of radiation delivery is still unknown. Using a rat laryngeal transplant model, we sought to determine the most beneficial timing and delivery method of irradiation. A prospective study was undertaken including 16 treatment arms of 10 to 30 animals each (189 transplantations). The animals received 800 cGy before transplantation to the donor larynx in vivo, the donor larynx in vitro, or the recipient animal's neck. The transplantation occurred at 24 hours, 5 days, or 10 days after irradiation. The transplanted larynges were harvested 15 days after transplantation and histologically scored for rejection. Irradiation of allogeneic transplantations demonstrated a strongly protective effect from rejection as compared to no irradiation (p < .001), regardless of the method of radiation delivery or the amount of time between irradiation and transplantation (p = .78). Irradiation of donor larynges between allogeneic rats has a protective effect, reducing the degree of acute rejection when irradiation is used as the single mode of immunosuppression, and is unrelated to either the timing or the mode of delivery of the irradiation.
Expression of Adhesion Molecules by Cultured Spiral Ligament Fibrocytes Stimulated with Proinflammatory Cytokines
Authors: Ichimiya Issei , Suzuki Masashi , Yoshida Kazuhide , Mogi Goro
Published: October 2014

Secondary cultures from murine spiral ligament (SL) fibrocytes were stimulated with proinflammatory cytokines interleukin-1β (IL-1β) and tumor necrosis factor–α (TNF-α), and expression of various adhesion molecules was investigated. Cultures without cytokine stimulation did not show positive immunostaining for vascular cell adhesion molecule–1 (VCAM-1), intercellular adhesion molecule–1 (ICAM-1), or mucosal addressin cell adhesion molecule–1 (MAdCAM-1). Although staining was also negative after stimulation with IL-1β, VCAM-1 and ICAM-1 staining was observed after the cells were stimulated with TNF-α. Reverse transcription-polymerase chain reaction analysis showed messenger RNAs for both VCAM-1 and ICAM-1 expression to be present after fibrocytes were stimulated with TNF-α. These data suggest that activated fibrocytes may cause inflammatory cells to persist in the SL. Given that SL fibrocytes may play a role in homeostasis of cochlear fluid and ion concentrations, prolongation of the inflammatory response could lead to fibrocyte damage that might ultimately result in cochlear malfunction.
Autologous Elastic Cartilage for Laryngoplasty: Histologic Evaluation in a Rabbit Model
Authors: Caballero Miguel , Bernal-Sprekelsen Manuel , Calvo Carlos , Farré Xavier , Alós Llucia
Published: October 2014

A wide range of materials have been used to achieve medialization of the paralyzed vocal fold. Recently, medialization techniques using autologous cartilage have been described, but little information is available on cartilage integration and viability in this situation. In this prospective, experimental, controlled study, right vocal fold paralysis was surgically induced in 30 New Zealand rabbits. An autologous auricular cartilage transplant was inserted in the vocal fold in 15 animals. In the control group, only the laryngeal nerve was sectioned. Each group was divided into two groups with follow-ups of 6 weeks and 6 months, respectively. Histologic studies revealed no inflammatory reaction against the cartilage transplants. There were no differences in the transplant surfaces in the 6-week and 6-month groups. The results show tissue integration and a low level of initial transplant resorption that stabilizes with time. Autologous auricular cartilage appears to be an appropriate material for type I thyroplasty procedures because of the low absorption rate.
Congenital Bilateral Adductor Vocal Cord Paralysis
Authors: Berkowitz Robert G.
Published: October 2014

Bilateral adductor vocal cord paralysis (BAdP), presenting with features of laryngeal incompetence, is a rare form of congenital bilateral vocal cord paralysis, and only 2 small series of BAdP have previously been published. Three cases are reported here. The BAdP occurred as an isolated abnormality in 1 child, and was associated with a recognizable syndrome (Robinow's syndrome and 22q deletion) in the other 2 children. Gastrostomy tube feeding was required in 2 children, who both remain gastrostomy tube–dependent at 26 months and 10 years 9 months of age. The child with Robinow's syndrome received parenteral nutrition until 2 months, but was then able to feed orally after partial improvement in vocal cord function. The global impairment in vocal cord constrictor function observed in these 3 children is consistent with the site of lesion's being at the level of the laryngeal constrictor motoneurons in BAdP.
Morphological Comparison between Neonatal and Adult Human Tongues
Authors: Iskander Andrew , Sanders Ira
Published: October 2014

There are currently no descriptions of neonatal tongue anatomy. Therefore, there have been no reports on the morphological differences between it and the adult tongue that would suggest its suitability for suckling. Serial coronal sections of a neonatal tongue were used to create a 3-dimensional model that was compared to that of the adult tongue. Compared to the adult human tongue, the neonatal tongue was found to contain 1) considerably less fat and soft tissue; 2) a thinner mucosa; 3) relatively enlarged extrinsic musculature; 4) a less-developed superior longitudinal muscle, resulting in a flat dorsal surface; and 5) attachments between the extrinsic muscles and the transverse muscle group that have not been identified in the adult tongue. The particular structure of the neonatal tongue suggests how the neonatal tongue is specialized for suckling.
Tubes of Vascularized Cartilage Used for Replacement of Rabbit Cervical Trachea
Authors: Delaere Pierre R. , Hardillo Jose
Published: October 2014

This study was performed to evaluate the healing process of vascularized cartilage tubes after reconstruction of circumferential tracheal defects in rabbits. Vascularized cartilage was obtained by applying ear cartilage to a vascularized fascia flap in the lateral thoracic area in 10 animals. Five animals (control group) were used to evaluate the viability of the vascularized cartilage after 2 weeks. Circumferential tracheal defects were reconstructed in 5 animals by means of tubes of vascularized cartilage with preservation of the established blood supply around the grafts. The experimental animals were followed until signs of dyspnea became apparent. After follow-up and euthanasia, cartilage viability and regeneration of respiratory epithelium were evaluated. A viable plate of cartilage that was intensely attached to the vascularized fascia flap was found in the control animals. The animals from the experimental group showed dyspnea after a mean follow-up period of 22.6 days because of cartilage necrosis with loss of airway support. Cartilage graft revascularization and remucosalization were limited to 18.1% of the initial surface area of the cartilage tube. Mucosal coverage was seen at the anastomoses, whereas the middle part of the cartilage tube underwent necrosis. We conclude that tubes of autologous cartilage show problematic healing when placed inside the airway. Migration of vascularized connective tissue, migration of respiratory epithelium, and preservation of the viability of the cartilaginous graft were limited to a short segment at the anastomotic sites.
Pediatric Intraparotid Castleman's Disease
Authors: Samadi Daniel S. , Hockstein Neil G. , Tom Lawrence W. C.
Published: October 2014

Castleman's disease (CD) is a rare, benign lymphoepithelial disease of unknown cause that presents most commonly in the mediastinum. There are 2 histologic types of CD: the hyaline vascular type and the plasma cell type. In the head and neck, 98% of these lesions are of the hyaline vascular type. The differential diagnosis of CD includes reactive lymphadenopathy, lymphoproliferative disorders, lymph node metastasis, and other conditions. Approximately 80 cases of CD have been reported in children; head and neck involvement in children is extremely rare. A case of a child with intraparotid CD is presented; the clinical course, histopathologic presentation, radiographic findings, and management of CD are reviewed.
Management of Benign Vocal Fold Lesions: A Survey of Current Opinion and Practice
Authors: Sulica Lucian , Behrman Alison
Published: October 2014

Empirical data are often not available to guide clinical practices in the treatment of benign mucosal lesions of the vocal folds. The purpose of this report is to describe opinions and practices in order to identify areas of consensus and discrepancy and thus guide future inquiry. A 16-item survey mailed to all active US members of the American Academy of Otolaryngology—Head and Neck Surgery (n = 7,321) included questions on the use of voice therapy; diagnostic testing; perioperative use of steroids, antibiotics, and antireflux medications; and use of lasers. Responses used a Likert 5-point scale with end anchors of 1 equaling “never” and 5 equaling “always” and were stratified according to lesion (nodules, polyps, cysts). A 16.5% response rate (n = 1,208) was obtained. A lack of consensus was most evident in the use of voice therapy for lesions other than nodules; antireflux medication; and intravenous steroids. Disagreement was also noted regarding the use of lasers, oral steroids, and antibiotics. Other than voice therapy as initial intervention for nodules, no statistically significant differences by lesion type exist regarding use of voice therapy, laser, or any medication. Prospective clinical trials addressing voice therapy, antireflux medications, steroids, and antibiotics are needed to inform clinical practice. Furthermore, treatment practices appear to be largely independent of lesion type. Therefore, traditional diagnostic categories do not seem to be useful guides to treatment, and may need to be reevaluated in light of improvements in diagnostic technology and surgical technique.
Hamartoma of the Larynx: An Unusual Cause of Dyspnea
Authors: Mäkitie Antti A. , Lehtonen Hannu , Aaltonen Leena-Maija , Bäck Leif , Leivo Ilmo
Published: October 2014

We present a rare case of cartilaginous hamartoma involving the subglottic larynx and presenting as respiratory distress. The symptoms were initially attributed to asthma; however, the clinical picture progressed to stridor with significant airway obstruction. After the airway was secured with a tracheostomy, the tumor was resected with a CO2 laser. We present relevant aspects of this benign airway condition and its surgical management.
Symptoms, Quality of Life, Videolaryngoscopy, and Twenty-Four-Hour Triple-Probe Ph Monitoring in Patients with Typical and Extraesophageal Reflux
Authors: Powitzky Eric S. , Khaitan Leena , Richards William O. , Garrett C. Gaelyn , Courey Mark
Published: October 2014

A prospective study was designed to characterize patients with typical and extraesophageal reflux (EER) symptoms and seek predictive patterns for each group. Fifteen subjects without symptoms, 16 patients with symptomatic gastroesophageal reflux disease (GERD), and 37 patients with symptomatic EER were evaluated with outcomes tools, videolaryngoscopy, and 24-hour triple-probe pH monitoring. Higher symptom scores, Voice Handicap Index scores, and Gastrointestinal Symptom Rating Scale scores, as well as similarly decreased quality of life as measured by the Short Form 36, were noted among the two symptomatic groups. Patients with clinically diagnosed EER were more likely to have multiple abnormalities on laryngoscopy. There was a trend toward more pharyngeal reflux episodes in EER patients (6.9 ± 8.9) as compared to GERD patients (6.0 ± 9) and asymptomatic subjects (1.1 ± 1.9). On the basis of the pH monitoring of asymptomatic subjects, we define pathological pharyngeal reflux as more than 5 episodes in 24 hours. Pharyngeal acid exposure is more common in patients presumed to have EER, but some pharyngeal reflux does occur in asymptomatic subjects. Neither symptom scores nor videolaryngoscopic findings were predictive of pathological EER as indicated by pH monitoring.
Laryngeal Foreign Bodies in Children Revisited
Authors: Berkowitz Robert G. , Lim Wye-Keat
Published: October 2014

To review our experience with inhaled laryngeal foreign bodies in children, we performed a retrospective review of all admissions to our institution between March 1989 and March 2002 with the diagnosis of an inhaled laryngeal foreign body. We included only cases in which the diagnosis was confirmed at endoscopy under general anesthesia. Two children were dead on arrival at our institution as a result of upper airway obstruction following a choking episode and did not undergo endoscopy; they were not included. Nine children (5 male, 4 female) were identified. The age range was 5 months to 13 years 9 months, although only 1 child was older than 32 months. The foreign body was removed within 24 hours of a witnessed choking episode in 4 children, and the diagnosis was delayed in 5 children for a period between 4 days and 2 months, including 2 in whom a history of a choking episode had been initially obtained. One complication occurred in a child in whom the diagnosis was delayed; he developed laryngeal edema after foreign body removal and required endotracheal intubation for 1 week.
Intrasphenoidal Transsellar Encephalocele Repaired by Endoscopic Approach
Authors: Herman Philippe , Guichard Jean-Pierre , Sauvaget Elisabeth , Huy Patrice Tran Ba
Published: October 2014

Spontaneous sphenoidal encephaloceles are rare entities. In the case of intrasphenoidal encephaloceles, most defects are temporosphenoidal and occur in the lateral wall of the sphenoidal sinus. There have been to our knowledge only 7 reports of medial, transsellar encephaloceles in the literature. We report a case of intrasphenoidal transsellar encephalocele that was successfully managed through an endoscopic approach with complementary lumboperitoneal shunting. This disorder presents a challenge in surgical management because of the involvement of opticochiasmatic structures, the hypothalamopituitary axis, and the delicate vasculature of the circle of Willis in and around the encephalocele, besides proximity to the cavernous sinus. Rhinologists should be aware of these malformations, since the optic nerve or chiasma may be totally exposed in the sphenoidal sinus in the course of this disease. This case illustrates the need for magnetic resonance imaging in case of sphenoidal abnormalities, as well as the possibility of endonasal repair without a transcranial approach for large intrasphenoidal encephaloceles.
Histologic Changes in Human Vocal Folds Correlated with Aging: A Histomorphometric Study
Authors: Filho João Aragão Ximenes , do Nascimento Paulo Hilário Saldiva , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara
Published: October 2014

The voice of aged persons is usually different from that of younger adults — a fact indicating that aging induces changes in the human larynx. The aim of this study was to perform a histomorphometric analysis of the vocal fold and of a fragment of skin in order to determine the modifications related to aging and possible differences between genders. Twenty cadavers, 10 men and 10 women, were studied. Stereological methods were used for histologic analysis. In the vocal folds, we observed a reduction of the lamina propria thickness (p < .001) and of epithelial cell density (p < .001) as a function of age. In the skin, there was a reduction of chorion thickness (p = .02) and of epithelial cell density (p = .01). The decrease in the thickness of the lamina propria of the vocal folds with aging may contribute to the vocal pattern present in the elderly. These changes were more evident in men.
Neck Dissection Shoulder Syndrome: Quantification and Three-Dimensional Evaluation with an Optoelectronic Tracking System
Authors: Caversaccio Marco , Nolte Lutz-Peter , Negri Sandro , Zbären Peter
Published: October 2014

Objective 3-dimensional biomechanical changes of the shoulder at rest or during arm elevation were measured by means of a new specific method using an optoelectronic detection system that was developed for computer-aided surgery. Additionally, the shoulder syndrome following neck dissection was evaluated by the recognized orthopedic shoulder Constant score. The statistical evaluation encompassed 12 patients with unilateral radical neck dissection (RND), 12 patients with unilateral modified radical neck dissection (MRND) with preservation of the accessory nerve, and 10 healthy subjects. The healthy shoulders showed normal kinematic behavior, the so-called “scapulohumeral rhythm” (SHR). After MRND, the static scapular position and SHR showed no significant 3-dimensional variations. In contrast, RND produced a highly significant scapular displacement at rest (p < .01) and a near-total abolition of SHR. The Constant scores were significantly lower after RND than after MRND (p < .01). Three-dimensional evaluation of the shoulder syndrome supports the Constant score, quantifying what can be measured objectively.
Efferent System Degeneration in the Human Temporal Bone
Authors: Gacek Richard R.
Published: October 2014

Sense organ deposits have been described in temporal bones from patients with vestibular neuronitis, Meniere's disease, and benign paroxysmal positional vertigo that are not found in a comparable series of temporal bones without vestibulopathy. Because the recurrent vestibulopathies are caused by vestibular ganglionitis and the vestibulocochlear anastomosis was degenerated in these temporal bones, the deposits may represent the end buds of regenerating efferent axons injured in passage through the vestibular ganglion. Such neural buds have been described with transmission electron microscopy in animals after vestibular nerve transection and in a human temporal bone with endolymphatic hydrops. The buds may be visible by light microscopy, because their size is comparable to that of hair cell nuclei and they stain blue with hematoxylin because of their nucleic acid content. The variable location and size of these deposits (buds) in the labyrinthine sense organs is described to aid in the recognition of efferent system injury in human temporal bones.
Leukotriene Receptor Antagonist Pranlukast Suppresses Eosinophil Infiltration and Cytokine Production in Human Nasal Mucosa of Perennial Allergic Rhinitis
Authors: Ueda Tsutomu , Takeno Sachio , Hirakawa Katsuhiro , Furukido Kyosuke , Yajin Koji
Published: October 2014

The purpose of this study was to investigate the influence of pranlukast on eosinophilic inflammation and cytokine production in human nasal mucosa. Twelve patients were treated with pranlukast, and samples were obtained from the nasal mucosa of the inferior turbinate. With respect to cell infiltration, a significant decrease was observed in the percentage of inflammatory cells (secreted eosinophil cationic protein [EG2] and neutrophil elastase) after treatment. The levels of cytokines and chemical mediators (interleukin [IL]–4, IL-5, RANTES [regulated on activation, normal T cell expressed and secreted], cysteinyl leukotrienes, IL-1β, tumor necrosis factor–α, and IL-8) assessed by enzyme-linked immunosorbent assay and enzyme immunoassay were significantly decreased. These results indicate that pranlukast decreased the levels of a majority of the cytokines in nasal mucosa, leading to improvement in subjective nasal symptoms. Furthermore, these results support the hypothesis that pranlukast exerts its therapeutic action primarily by blocking the leukotriene receptors on eosinophils.
Stroboscopic Observation of Vocal Fold Vibration with the Videoendoscope
Authors: Sato Kiminori , Umeno Hirohito , Nakashima Tadashi
Published: October 2014

Asahi Optical Co, Ltd (Tokyo, Japan), has manufactured a trial thin videoendoscope with an instantaneous RGB (red-green-blue) system. We have developed a new laryngostroboscopic system using this videoendoscope. In this article, we report the performance of the clinical trial of this new and useful videoendoscopic system for stroboscopy, and compare it to conventional stroboscopy using a flexible fiberscope or rigid endoscope. This new thin videoendoscope has the following characteristics. A small charge-coupled device (CCD) chip is built into the tip of this endoscope, and an instantaneous RGB system is used. The outer diameters of its tip (4.1 mm) and the insertion tube (3.7 mm) of the videoendoscope are relatively small. The videoendoscope system is compact. Stroboscopic observation was conducted with this videoendoscope in conjunction with a laryngostroboscope. Compared to stroboscopy with a conventional flexible fiberscope or rigid endoscope, this stroboscopic system has several clear advantages. It presents clear dynamic color images on a color video monitor and provides excellent resolution and recording, thus yielding high diagnostic accuracy. The diameter of the videoendoscope is relatively small and results in less discomfort for patients, even for children. The videoendoscope allowed the doctors to perform pernasal endoscopy. Therefore, there is less limitation in the range of subjects for examination. Patients are able to phonate holding a normal head position, and are thereby able to produce varying vocal sounds in the habitual or normal manner during examination. The new stroboscopy system using a videoendoscope is a very useful examination tool that has the advantages of both a conventional flexible fiberscope and a rigid endoscope.
Prevalence and Causes of Severe Taste Loss in a Chemosensory Clinic Population
Authors: Pribitkin Edmund , Rosenthal Marc D. , Cowart Beverly J.
Published: October 2014

Although complete or near-complete olfactory loss has been extensively documented and described, few published reports have documented severe generalized gustatory loss (across qualities and neural fields) with rigorous psychophysical testing, and none have explored the prevalence or causes of such losses in a large clinical population. This study retrospectively reviews our chemosensory clinic's experience of 1,176 patients evaluated for complaints of chemosensory dysfunction in order to address these issues. Our series confirms that despite the complex, bilateral innervation and regenerative capacity of the gustatory system, severe generalized taste loss does occur as a clinical entity, albeit rarely: only 0.85% (n = 10) of our patients evidenced such a deficit, as compared to 32% (n = 371) who were found to have a profound olfactory deficit. Combinations of systemic and/or acute events may underlie many cases of severe taste loss, and in half of our cases, these patients evidenced moderate to complete smell loss as well.
Spirometric and Plethysmographic Assessment of Upper Airway Obstruction in Laryngeal Hemiplegia
Authors: Cantarella Giovanna , Fasano Valter , Domenichini Elena , Bucchioni Enrica , Cesana Bruno M.
Published: October 2014

Laryngeal hemiplegia (LH) is the most common disorder of laryngeal motility. It is deemed not to cause obstruction of the upper airway; in fact, the main symptoms are dysphonia and breathiness, and respiratory impairment is not commonly reported. The aim of this study was to objectively assess upper airway patency in 41 patients affected by LH (mean age, 54.4 ± 15.2 years; 27 female) and 30 controls (mean age, 50.0 ± 16.1 years; 19 female) by means of flow-volume loop spirometry and body plethysmography to measure specific airway resistance (sRaw) at increasing respiratory frequencies. The causes of LH were cervical surgery (28), tumor infiltration (5), and unexplained (8). None of the patients or controls was affected by lower airway disease. Spirometry showed that the patients had inspiratory flows (PIF, FIF50) significantly lower than those of the controls (p < .0001), whereas the expiratory flows (FEV1, FEF50) were normal, with the exception of peak expiratory flow (PEF), which was reduced, especially in female patients. The mean FEF50/FIF50 ratio (about unity in the normal subjects) was >1, as is typical of variable extrathoracic obstruction. Plethysmography showed that the values of sRaw of the LH group were not statistically different from those of the controls at 30 ± 5 breaths per minute, but they progressively and significantly increased at 60 ± 5 (p < .01) and 90 ± 5 breaths per minute (p < .002), whereas no significant sRaw change was observed in the controls. These results show that LH causes obstruction of the upper airway that can be assessed and quantified by means of spirometry and body plethysmography. a dynamic narrowing due to inspiratory medialization of the paralytic vocal fold and flow turbulence during hyperventilation seem to be the causes of patency impairment. The flow-volume loop is an excellent, inexpensive, and easily available means of functionally evaluating upper airway obstruction, but some patients have difficulty in performing an inspiratory test that requires maximal effort, and the flow reduction during forced ventilation may be partially due to the effort dependency of the tests themselves. Plethysmographic assessment of airway resistance may be a valid alternative or complement, as it reveals an increase in sRaw at increasing respiratory frequencies.
Ameloblastoma Revisited
Authors: Junquera Luis , Ascani Giuliano , García-Consuegra Luis , Vicente Juan C. , Roig Primitivo
Published: October 2014

Ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium, the treatment of which is controversial. A review was made of 22 patients treated for histologically diagnosed ameloblastoma between January 1975 and January 2000. We recorded data relating to patient sex, age, site of involvement, histologic type, surgical treatment, and number of recurrences. All ameloblastomas were located in the mandible. The most common histologic patterns were follicular and plexiform lesions. A total of 22.7% of the tumors were unicystic ameloblastomas. Unicystic lesions were seen to affect younger patients than the rest of the histologic types. Eighteen patients were initially treated in our center, and 4 cases were referred to our center for secondary treatment. The number of recurrences was significantly lower in patients initially treated in our center. Primary treatment comprised enucleation and bone curettage in 10 cases and radical surgery in 7. Forty percent of the unicystic lesions and 53.3% of the non-unicystic ameloblastomas of our study presented at least 1 recurrence. Ameloblastoma is a polymorphic neoplasm for which the treatment is conditioned by a number of clinical and histologic factors. An individualized preoperative study is essential for treatment.
Involuntary Expiratory Phonation as a Dose-Related Consequence of L-Dopa Therapy in a Patient with Parkinson's Disease
Authors: Ishii Kosuke , Kumada Masanobu , Yamamoto Masanori , Ueki Akira , Hirose Hajime
Published: October 2014

We report a case of involuntary phonation caused by abnormal vocal cord movements during expiration in a patient with Parkinson's disease. A 60-year-old woman had been treated for parkinsonism at the outpatient clinic of the Department of Neurology since August 1999. She began to groan involuntarily in the daytime in September 2001. She could not eat well while groaning. Stridor was not noted during sleep at night. Endoscopic examination of the larynx revealed insufficient abduction of the bilateral vocal cords, although the glottis was not so small as to cause stridor during inspiration. During expiration, however, the vocal cords adducted, resulting in the involuntary production of voice. Electromyography showed an increase in the activity of the thyroarytenoid and lateral cricoarytenoid muscles. This muscle activity was further enhanced during inspiration. The involuntary phonation disappeared when the patient's dose of l-dopa was decreased, although she had a decrease in her systemic mobility as well. When the dose of l-dopa was increased to the therapeutic level, involuntary phonation recurred, and her voluntary systemic activity improved. In the present case, it was considered that excessive dopaminergic denervation occurred in the nerve innervating the laryngeal adductors. Involuntary voice appeared to be produced by hypertonus of the laryngeal adductors because of a lowering in the threshold level for l-dopa, even though the drug was administered at the usual dose.
Carbon Dioxide Laser Vaporization of the Inferior Turbinate for Allergic Rhinitis: Short-Term Results
Authors: Imamura Shun-Ichi , Honda Hideyuki
Published: October 2014

Carbon dioxide laser vaporization of the turbinate has recently become accepted as a common treatment for allergic rhinitis. Usually, only a single procedure is applied to minimize trauma. However, repeated procedures on separate days are often required to achieve an adequate effect. Therefore, we attempted a new method of vaporization and evaluated the outcome, and also tried to determine which patients have good indications for laser treatment. To widely and deeply vaporize the inferior turbinate, we repeated the procedure 3 times in 1 session after removing the carbon coating from the previous vaporization under nasal endoscopic observation. After the procedure, most patients experienced complete nasal obstruction for 2 or 3 days, but there was no intraoperative or postoperative bleeding or severe pain. All patients obtained improvement of their chief complaints and were satisfied 2 months after the operation. In particular, 60% of the patients were completely relieved of refractory nasal obstruction. Most patients were more satisfied with the effects than are those treated by the usual methods. Completely successful cases (improvement in all symptoms and complete satisfaction obtained) were selected and were compared with other cases. Favorable prognostic factors are more severe complaints, longer symptomatic periods, stronger allergic reactions, and worse nasal resistance and its greater improvement with administration of decongestant nasal drops. This method may be especially accepted by patients with severe complaints, in particular nasal obstruction, who do not experience enough relief with conservative therapies or have enough time to make frequent visits to an outpatient clinic over a period of several weeks.
Endoscopic Management of Anterior Skull Base Encephaloceles
Authors: Boseley Mark E. , Tami Thomas A.
Published: October 2014

Encephaloceles are relatively rare phenomena produced by the protrusion of brain and dura through an anterior skull base defect. Although they can occur as congenital defects, encephaloceles can also present after trauma. The diagnosis is usually made with nasal endoscopy and imaging studies. This report reviews our recent experience repairing 5 encephaloceles in 4 patients. The diagnostic approach and the technical aspects of surgical management are discussed. Although encephaloceles are a rarity, this diagnosis should be considered as part of the differential diagnosis in evaluating a patient with a unilateral polypoid nasal mass, particularly in the setting of recurrent meningitis or cerebrospinal fluid rhinorrhea.
Tissue Maturation during the Growth of Juvenile Nasopharyngeal Angiofibroma
Authors: Sennes Luiz Ubirajara , Butugan Ossamu , Sanchez Tanit Ganz , Del Carlo Bernardi Fabíola , Saldiva Paulo Hilário Nascimento
Published: October 2014

Juvenile nasopharyngeal angiofibroma involves a specific age group and changes from vascular tissue to fibrous tissue. The goal of this study was to investigate the correlation among tumor extension, the histologic characteristics of the tumor, and the patient's age. We performed a prospective study of 43 male patients with untreated juvenile nasopharyngeal angiofibroma (average age, 15.42 years). We correlated the patient's age with the extension of the tumor (analyzing the computed tomographic scan) and the immunohistologic characteristics of the tumor (morphological and morphometric analysis of the central portion of the tumor, the sphenopalatine foramen region). We observed that the larger the tumor, the smaller the number of vessels and cells, but the larger the fibrous component and the higher the grade of maturation of the tissue. The patient's age was not correlated with tumor extension or the histologic characteristics of the tumor. However, the grade of maturation of the tissue in the region of the sphenopalatine foramen was higher in larger tumors.
Resolution of Hoarseness after Endovascular Repair of Thoracic Aortic Aneurysm: A Case of Ortner's Syndrome
Authors: Stoob Katharina , Alkadhi Hatem , Wildermuth Simon , Lachat Mario , Pfammatter Thomas
Published: October 2014

We report the case of a 75-year-old man with a 6-month history of hoarseness due to a left recurrent laryngeal nerve palsy. Investigations revealed a thoracic aortic aneurysm compressing the left recurrent nerve; thus, the diagnosis of Ortner's syndrome, ie, cardiovocal syndrome, could be established. The aortic aneurysm was repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 5 days later, and at the 1-year follow-up visit the hoarseness had resolved completely. This case demonstrates for the first time the reversal of Ortner's syndrome after endoluminal aneurysm repair.
Cricopharyngeal Myotomy in a Patient with Situs Inversus Totalis
Authors: Spector Andrew R. , Shah Samir V.
Published: October 2014

Otolaryngologists must remain vigilant in understanding the complex anatomy of the head and neck and must always be cognizant of deviations from normal anatomy. This text discusses an interesting case that should remind surgeons of the variable course that the recurrent laryngeal nerve takes on either side of the neck and the special consideration that must be taken in performing surgery near the nerve.
Sialolithiasis of an Accessory Parotid Gland
Authors: Bahadir Osman , Bektas Devrim , Caylan Refik , Korkmaz Omer
Published: October 2014

We report a case of sialolithiasis of an accessory parotid gland in the cheek demonstrated by computed tomography and sialography. The accessory parotid gland was located anterolateral to the masseter muscle and was isolated from the main parotid gland. The calculus developed from this accessory parotid gland, and the main parotid gland was free of sialolithiasis and inflammation. To our knowledge, this is the first report concerning sialolithiasis in an accessory parotid gland. The calculus was removed without facial nerve injury or salivary fistula via a peroral approach.
Comparison of Human, Canine, and Ovine Laryngeal Dimensions
Authors: Kim Moon Jung , Hunter Eric J. , Titze Ingo R.
Published: October 2014

Geometric measurement of the laryngeal skeleton is a fundamental step in laryngeal studies, especially in biomechanical modeling. Traditionally, canine larynges have been used as models of the human larynx because of their similarity in size and gross structure, but the search continues for an alternative model because of the diminishing availability of the canine species for research in the United States. In this report, a revised method for defining and labeling laryngeal framework parameters is proposed. Ovine laryngeal cartilages were measured, and the measurements were compared to those of human and canine cartilages previously reported in the literature. The ovine cricoid, thyroid, and arytenoid cartilages were significantly different from the human and canine cartilages. Also, the lack of a definite border between the true and false vocal folds revealed that the ovine model may not always be suitable for a direct comparison to the human larynx in phonation.
Indications for Mastoidectomy in Acute Mastoiditis in Children
Authors: Taylor Matthew F. , Berkowitz Robert G.
Published: October 2014

The objective of this study was to identify clinical features of acute mastoiditis in children that are indicative of the need for mastoidectomy. We performed a retrospective chart review of 40 children (20 male, 20 female) between 2 months and 12 years 9 months of age with a diagnosis of acute mastoiditis who were managed in our institution between July 1998 and June 2002. All patients received intravenous antibiotics; this was the only treatment in 14 patients (35%). Tympanostomy tubes were inserted in 22 patients, together with postauricular needle aspiration in 12 (30%), and incision and drainage of subperiosteal abscess in 10 (25%). Mastoidectomy was performed in 4 cases (10%), and cholesteatoma was found in 3. One other child was subsequently found to have cholesteatoma. We conclude that children who present with acute mastoiditis should undergo mastoidectomy if cholesteatoma is clinically suspected, or if extratemporal suppurative complications have occurred.