bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrastructural Changes in Superior Vestibular Commissural Neurons following Vestibular Neurectomy in the Cat
Authors: Guyot Jean-Philippe , Gacek Richard R. , Lyon Michael J. , Magnin Christine
Published: October 2014

The ultrastructural changes of the feline superior vestibular commissural neurons (CNs) were quantitatively assessed 8 weeks following ipsilateral vestibular neurectomy. Results indicated a slight degeneration of synaptic profiles (SPs; 25%) representing the primary vestibular afferent input onto CN soma. The synaptic vesicles of the remaining SPs, which likely originate from the cerebellum and the contralateral CNs, were smaller and rounder, suggesting a transition from an inhibitory to an excitatory mode of response. The SP loss had little impact on the CNs' capacity for protein synthesis and structural maintenance, since there was no change in the volume fraction of intracellular organelles. These data suggest that CNs do not degenerate and are likely functional after vestibular compensation. These findings support the role of the commissural pathway in vestibular compensation as proposed by Galiana et al, which is based on the assumption that the intervestibular commissural connections remain intact following vestibular neurectomy.
Laryngoscopic Diagnosis of Laryngeal Sarcoid
Authors: Benjamin Bruce , Dalton Christopher , Croxson Glen
Published: October 2014

Sarcoidosis is usually a multisystem granulomatous disease, and it sometimes affects the larynx and causes symptoms of dysphonia, dyspnea, and dysphagia. Laryngeal sarcoid has a characteristic appearance at direct or indirect laryngoscopy: the supraglottic tissues are symmetrically affected with a pale, diffusely swollen appearance somewhat like that of epiglottitis. Five cases of laryngeal sarcoid are presented. Three photographs taken at direct laryngoscopy, and one at indirect laryngoscopy, document and emphasize the typical appearance of the supraglottic tissues. The appearance of this uncommon condition is sufficiently characteristic to suggest the diagnosis, which can finally be confirmed only by biopsy.
Outcomes of Antireflux Therapy for the Treatment of Chronic Laryngitis
Authors: Hanson David G. , Kamel Perry L. , Kahrilas Peter J.
Published: October 2014

This study examined outcomes of antireflux and antacid treatment for the signs and symptoms of chronic laryngitis. Patients from a referral institutional practice with chronic laryngitis symptoms, without other apparent causes of laryngeal inflammation, were followed up and examined at progressive stages of antireflux treatment as a case series outcome study. The cases included unselected individuals with a diagnosis of chronic (>3 months' duration) laryngitis. Patients with chronic throat complaints were treated with nocturnal antireflux precautions, with addition of famotidine 20 mg or omeprazole 20 mg at bedtime for patients who did not respond to antireflux precautions alone. The outcome measures were resolution of symptoms, and change in findings on telescopic laryngoscopy. Chronic throat symptoms of 93 of 182 patients (51%) responded to nocturnal antireflux precautions alone. The complaints of an additional 48 patients resolved with the addition of famotidine 20 mg at bedtime to antireflux precautions (77% response). The symptoms of 34 of the remaining 41 patients responded to treatment with omeprazole 20 mg at bedtime. Therefore, symptoms of 96% of patients responded to treatment aimed at preventing reflux of gastric acid. The remaining patients with refractory symptoms had a partial response or no response or chose fundoplication. Erythema and granular mucositis were the most common laryngoscopic findings. Ulceration and granuloma formation were less common, but also responded to antireflux treatment. Some (7) patients required high doses of omeprazole or fundoplication to achieve symptomatic relief and healing of chronic inflammatory changes of the posterior larynx. Relapse of symptoms was common when treatment was stopped. This experience provides supportive evidence for a hypothesis that gastropharyngeal acid reflux is the underlying cause of posterior chronic laryngitis.
Stress-Strain Response of the Human Vocal Ligament
Authors: Min Young B. , Titze Ingo R. , Alipour-Haghighi Fariborz
Published: October 2014

The longitudinal elastic properties of the human vocal ligament were quantified by stress-strain measurements and by modeling the response mathematically. Human ligaments were obtained from surgery and autopsy cases. They were dissected, mounted, and stretched with a dual-servo ergometer to measure force versus elongation and to convert the results into stress and strain. To calculate a longitudinal Young's modulus, the stress-strain curves were fitted with polynomial and exponential functions and differentiated. Young's modulus was separately defined in the low- and high-strain regions. The mean Young's modulus for the low-strain region was 33.1 ± 10.4 kilopascals. In the high-strain region, A and B parameters for an exponential fit were 1.4 ± 1.0 and 9.6 ± 1.2 kilopascals, respectively. The stress-strain and Young's modulus curves showed the typical hysteresis and nonlinearity seen previously in other vocal fold tissues (muscle and mucosa), but the nonlinearity was most profound for the vocal ligament.
Laryngeal Dysplasia: Epidemiology and Treatment Outcome
Authors: Blackwell Keith E. , Calcaterra Thomas C. , Fu Yao-Shi
Published: October 2014

A retrospective analysis was undertaken of 65 patients with long-term follow-up for laryngeal squamous dysplasia. Based on the degree of dysplasia demonstrated on initial biopsy, 0 of 6 patients showing hyperkeratosis without dysplasia, 3 of 26 patients (12%) showing mild dysplasia, 5 of 15 patients (33%) showing moderate dysplasia, 4 of 9 patients (44%) showing severe dysplasia, and 1 of 9 patients (11%) showing carcinoma in situ eventually progressed to invasive carcinoma. An analysis was made of the impact of various treatment modalities in 33 patients demonstrating moderate dysplasia, severe dysplasia, or carcinoma in situ. Invasive carcinoma developed in 10 of 21 patients (48%) treated endoscopically and 0 of 12 patients treated by more aggressive therapy, including external beam radiotherapy, partial laryngectomy, or total laryngectomy. Of the patients in the endoscopic therapy group who developed invasive carcinoma, all were salvaged successfully. The overall rate of laryngeal preservation was 15 of 21 patients (71%) in the endoscopic treatment group and 11 of 12 patients (92%) in the aggressive treatment group. This difference is not statistically significant. We conclude that there is a moderately high rate of progression to invasive carcinoma in patients undergoing repeated endoscopic therapy for intraepithelial neoplasms of the larynx. However, with close, long-term follow-up, patients undergoing endoscopic therapy have an overall outcome similar to that in patients treated with partial laryngectomy or radiotherapy prior to developing invasive disease.
Improvement of Dysphagia following Cricopharyngeal Myotomy in a Group of Elderly Patients
Authors: Guily Jean Lacau St , Copin Henri , Zhang Kai-Xin , Butler-Browne Gillian S. , Périé Sophie , Barbet J. Patrick
Published: October 2014

Cricopharyngeal myotomy is not effective in all cases of dysphagia. However, it should be the specific treatment in cases of dysphagia caused by a primary cricopharyngeal muscle dysfunction. Of a group of 10 patients with swallowing disorders in the absence of any defined cause, 7 (mean age, 81.6 years) were improved by a myotomy and 3 were not. The cricopharyngeal muscle was studied histologically and biochemically and compared to muscle obtained from nondysphagic subjects. In the muscle of the 7 improved patients, homogeneous histologic abnormalities were demonstrated: connective tissue infiltration, inflammatory cell infiltration, and degenerative changes of the muscle fibers. Conversely, muscles of the nonimproved patients and of the controls did not present the same degree of histologic lesions.
Myringosclerosis Caused by Increased Oxygen Concentration in Traumatized Tympanic Membranes Experimental Study
Authors: Mattsson Cecilia , Magnuson Karin , Hellström Sten
Published: October 2014

The purpose of this study was to elucidate possible relationships between the oxygen concentration of the middle ear cavity and the development of myringosclerosis. Three groups of rats with myringotomized tympanic membranes were exposed to different oxygen concentrations of 10%, 15%, and 40%, respectively, for 1 week. A fourth group was kept in ambient air. Two other groups of rats with myringotomized and intubated tympanic membranes were exposed to oxygen concentrations of 10% and 40%, respectively, for the same period of time. Otomicroscopically, all hyperoxic animals had more numerous myringosclerotic lesions compared with the ambient air group, and also displayed a pronounced hyperplasia of the keratinizing epithelium around the perforation border. By contrast, the hypoxic animals showed less pronounced myringosclerotic lesions or even completely lacked them. It is inferred that an increased oxygen concentration in the middle ear cavity will increase the likelihood of myringosclerotic deposits. The mechanism involved could be related to the formation of oxygen radicals.
Pharyngeal and Pharyngolaryngeal Bands: Report of An Unusual Combination of Congenital Anomalies
Authors: Prescott C. A. J.
Published: October 2014

Multiple abnormal pharyngeal and pharyngolaryngeal bands were present in a child presenting with diffuse interstitial pulmonary fibrosis. The soft palate was fused to the posterior pharyngeal wall. Instead of there being faucial pillars, a muscular band on either side extended from the base of the tongue to the lateral pharyngeal walls. There was neither tonsil nor adenoid tissue present. The epiglottis was tethered to the posterior pharyngeal wall by bands from its lateral aspects. The right arytenoid mound was tethered to the posterior wall of the hypopharynx. It is postulated that these arose from a failure of development of the second branchial pouch.
Use of Oxymetazoline in the Management of Epistaxis
Authors: Krempl Greg A. , Noorily Allen D.
Published: October 2014

The purpose of this study was to determine if use of an intranasal vasoconstrictor (oxymetazoline) could be used to effectively treat epistaxis, avoiding nasal packing. The charts of 60 patients who presented to the emergency room with the diagnosis of epistaxis and who required medical management were reviewed. Sixty-five percent of these patients were successfully managed with oxymetazoline as their sole therapy. An additional 18% were managed successfully with silver nitrate cautery in combination with oxymetazoline. In only 17% of patients was it necessary to use nasal packing as treatment for epistaxis after an initial attempt with oxymetazoline alone or in combination with silver nitrate failed. These data suggest that pharmacologic management may be adequate in the majority of patients with epistaxis, thus avoiding the need for nasal packing with its associated complications.
Surgical Management of Congenital Saccular Cysts of the Larynx
Authors: Ward Robert F. , Jones Jacqueline , Arnold James A.
Published: October 2014

Congenital saccular cysts of the larynx are unusual lesions that commonly present with respiratory obstruction in infants and children. The saccular cyst may result from an atresia of the laryngeal saccule orifice or may represent the retention of mucus in the collecting ducts of submucosal glands located around the ventricle. Traditionally, the treatment of the lesions has been endoscopic unroofing or marsupialization. Frequently, this modality requires multiple procedures as well as concomitant tracheotomy. There also have been reports of acquired subglottic stenosis. We have found that removal of the recurrent saccular cyst can be achieved relatively safely and effectively via a lateral cervical approach to the thyrohyoid membrane. We review our experience with four patients with congenital saccular cysts and detail the evaluation and surgical management of these lesions.
Endoscopic Surgery of Zenker's Diverticula
Authors: Holinger Paul H. , Johnston Kenneth C.
Published: October 2014

summary
Mitochondrial Encephalomyopathy: A Rare Genetic Cause of Sensorineural Hearing Loss
Authors: Donovan Thomas J.
Published: October 2014

A 44-year-old man with a documented 12-year history of progressive sensorineural hearing loss developed a generalized tonic-clonic seizure followed by a visual field deficit and apraxia. Six months later he developed a peripheral neuropathy and muscle fatigue followed by a slowly progressive aphasia and cortical blindness as well as increased seizure activity. A computed tomography scan showed bilateral basal ganglion calcification. The serum lactate level was elevated at 3.4 mEq/dL. A muscle biopsy enabled the diagnosis of mitochondrial myopathy. This disorder is presented as an unusual cause of progressive sensorineural hearing loss in adults.
Immunohistochemical Study of Transforming Growth Factor-α Expression in Normal and Perforated Tympanic Membrane
Authors: Koba Reiko , Kawabata Isuzu
Published: October 2014

An immunohistochemical study of transforming growth factor-α (TGF-α) distribution was carried out to clarify the mechanism responsible for accelerated epidermal cell proliferation after perforation of the rabbit tympanic membrane. In the normal tympanic membrane, TGF-α expression was not observed, whereas after perforation, over the whole tympanic membrane including the margin of the perforation, TGF-α-positive cells appeared and were scattered in the epidermal cell layer. After healing of the perforation, a marked decrease of TGF-α-positive cells in the tympanic membrane was observed. This finding suggests that TGF-α induces proliferation of epidermal cells after the perforation stimulus.
Dendritic Cells in the Normal Human Tympanic Membrane
Authors: Hussl Burkhard , Egg Gisela , Kong Weija , Romani Nikolaus , Schrott-Fischer Annelies
Published: October 2014

Dendritic cells (DCs) are antigen-presenting cells that possess an outstanding capacity to initiate primary immune responses. They reside in the tissues in an immunologically immature state. Upon antigenic challenge in vivo or short-term culture in vitro, they undergo a maturation process and turn into mature “lymphoid DCs.” Langerhans cells (LCs) of the epidermis were identified as members of this DC system. They have been demonstrated in cholesteatoma matrix and in inflamed tympanic membranes, but the normal tympanic membrane was hitherto thought to be devoid of them. To clarify this question, we removed 12 normal tympanic membranes postmortem and processed them for a sheet preparation. The epidermal layers were peeled off and immunostained with the following monoclonal antibodies: HLA-DR, OKT6/CD1 a, and LAG (specific for the Birbeck granules of LCs). Two tympanic membranes were also processed for routine electron microscopy. In all epidermal sheets a dense network of DCs could be demonstrated. They showed a positive immunostaining reaction with HLA-DR, but a negative one with OKT6 and LAG. Thus, they differ in their immunohistochemical properties from typical epidermal LCs. At the ultrastructural level, DCs could also be identified, but without the typical Birbeck granules. This explains the negative reaction with the LAG antibody. These findings were extended and supported by a tissue culture examination of three normal tympanic membranes. After 3 days, typical “veiled” cells (ie, mature DCs), showing positive immunostaining with HLA-DR, could be recovered from the culture medium. In an oxidative mitogenesis assay, these cells displayed strong stimulatory capacity for resting T lymphocytes. The presence of DCs in the normal tympanic membrane is an important clue for a better understanding of the immune status of the middle ear.
Hearing Loss in Behçet's Disease
Authors: Soylu Levent , Soylu Merih , Aydoğan Barlas , Özsahinoğlu Can
Published: October 2014

In order to determine the characteristics and incidence of hearing loss in Behçet's disease, 72 consecutive cases and 72 sex- and age-matched normal subjects were submitted to this study. Detailed audiologic tests were performed in all cases. Twenty patients (27%) showed some degree of hearing loss; but in only 7 patients (9%) was the average of the frequencies between 500 to 4,000 Hz more than 25 dB hearing level, and the cochlear function of 43 patients (59%) was within the 25-dB range in all frequencies. The averaged pure tone audiograms of the two groups showed a statistically significant hearing loss in the Behçet's group. No relationship could be found between hearing loss and other system involvements. There was no correlation between hearing loss and duration of the disease, but the mean age of the Behçet's patients with hearing loss was found to be significantly higher than the mean age of the patients without hearing loss.
Long-Term Result of Vocal Cord Augmentation with Autogenous Fat
Authors: Bauer Carol A. , Valentino Joseph , Hoffman Henry T.
Published: October 2014

The use of autogenous fat for augmentation of the paralyzed vocal fold is a promising substitute for alternate injectable material such as Teflon (polytef paste, polytetrafluoroethylene; Ethicon) and Gelfoam (absorbable gelatin sponge; Upjohn). Long-term histologic evaluation of fat grafts to the larynx has not previously been reported in the literature. We present a case report of autogenous fat augmentation of a paralyzed vocal fold with documentation of persistent fat graft present 5 months after transplant
Pendred's Syndrome: A Study of Patients and Relatives
Authors: Jamal Musa N. , Arnaout Mohammed A. , Jarrar Ribhi
Published: October 2014

Four families, 29 members, with Pendred's syndrome were studied to clarify hearing loss and hormonal status. The ages ranged fro 3 to 50 years. Complete Pendred's syndrome was found in 9 patients. They had bilateral profound hearing loss with residual hearing low frequencies. Goiter was diagnosed at the age of 1 to 14 years with a positive perchlorate discharge test. Twelve of the patient relatives showed partial Pendred's syndrome. Mild sensorineural hearing losses occurred in the low- and medium-range frequencies wi normal perchlorate discharge test results in 6 cases. The other 6 had a slight drop in the perchlorate discharge test results with norm hearing. Five subjects were normal and 3 had normal hormonal and normal perchlorate discharge test results, but were not teste audiologically. This paper shows that patients with Pendred's syndrome may have goiter at birth or develop it between 8 and 14 year that their deafness is bilateral and profound, and that their perchlorate discharge tests are positive. Relatives of Pendred's syndrorr patients showed mild low-frequency sensorineural hearing loss without goiter and normal perchlorate discharge test results in half tl cases, and a slight drop in the perchlorate discharge test results with normal hearing and without goiter in the other half. A correlatic between these findings and genetic studies needs further investigation.
Subglottic Ductal Cysts in the Preterm Infant: Association with Laryngeal Intubation Trauma
Authors: Bauman Nancy M. , Benjamin Bruce
Published: October 2014

Acquired subglottic ductal cysts following prolonged intubation in preterm infants have been reported with increasing frequency during the past two decades. This paper reviews the subglottic ductal cysts diagnosed in 15 pediatric patients between 1989 and 1993 — the largest such review. Eighty percent were observed in preterm low-birth weight infants following prolonged intubation, and all but 3 of the patients had major intubation trauma of the larynx — an association not previously reported. The cysts were usually multiple and arose in the posterolateral subglottis. Most were small and did not cause significant airway obstruction, but associated intubation changes were sufficiently severe to necessitate tracheotomy in 10 patients. The cysts observed in our study did not enlarge and in 4 patients were observed to spontaneously resolve or shrink in size — trends not previously reported. Subglottic ductal cysts noted in preterm infants after prolonged intubation most commonly occur in association with laryngeal intubation trauma and are likely a component of intubation trauma. Although these cysts may resolve without therapy, careful follow-up and treatment of potentially obstructing subglottic ductal cysts is recommended.
Supraglottic Laryngectomy: Functional and Oncologic Results
Authors: Herranz-González Jesús , Martínez-Vidal José , Gavilán Javier , Gavilán César
Published: October 2014

Between January 1980 and December 1989, 110 patients with squamous cell carcinoma of the supraglottis were treated with supraglottic laryngectomy and neck dissection. The stage distribution was stage I 23%, II 34%, III 15%, and IV 28%. Adjuvant radiotherapy (5,000 to 6,500 cGy) was given to all pN+ cases. All patients were followed until death or for a minimum of 36 months, with an average of 65 months. Decannulation was achieved in 96% of the cases, with only 1 patient undergoing total laryngectomy because of aspiration. The average hospital stay was 22 days. Arytenoid edema was a frequent cause of delayed decannulation in patients undergoing radiotherapy. The overall 3-year survival was 78%, with 10 patients dying of unrelated causes. Local control was 94.6% and regional control was 83.6%. No significant difference was found in survival according to T stage, but survival rate was significantly influenced by N stage.
Basaloid Squamous Cell Carcinoma of the Head and Neck: Clinicopathological Features and Differential Diagnosis
Authors: Barnes Leon , MacMillan Christina , Ferlito Alfio , Rinaldo Alessandra , Altavilla Giuseppe , Doglioni Claudio
Published: October 2014

Basaloid squamous cell carcinoma is a recently recognized variant of squamous cell carcinoma. The lesion is histologically distinctive and manifests a predilection for the supraglottis, pyriform sinus, and tongue base. The immunohistochemical profile is discussed. The differential diagnoses include adenoid cystic carcinoma, small cell neuroendocrine carcinoma, basal cell adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma, spindle cell squamous carcinoma, mucoepidermoid carcinoma, and adenoid squamous cell carcinoma. Basaloid squamous cell carcinoma is a biologically high-grade tumor with a propensity for nodal as well as systemic metastases. It is a morphologic and phenotypic entity with a separate prognostic significance.
Relative Prognostic Importance of Histologic Invasion of the Laryngeal Framework by Hypopharyngeal Cancer
Authors: Deleyiannis Frederic W.-B. , Piccirillo Jay F. , Kirchner John A.
Published: October 2014

This study assessed the relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer. The laryngeal specimens and medical records of 55 patients found to have primary hypopharyngeal cancer between 1962 and 1988 were reviewed. Full 3-year follow-up information was obtained for 51 patients. The overall 3-year survival rate was 43% (22/51). The 3-year survival rate was 55% (17/31) without histologic invasion versus 25% (5/20) with invasion (p < .05). To assess how invasion affected survival rates in conjunction with clinical predictors, we divided the cohort into two groups (mild versus severe illness) based on the presence or absence of anemia and comorbidity. Only in the group with mild illness did histologic invasion provide additional prognostic information. These results demonstrate that the inclusion of clinical variables in predictions of prognosis can strikingly alter the prognostic importance of invasion of the laryngeal framework.
Vascular Effects of Sustained-Release Fibroblast Growth Factors
Authors: Hom David B. , Medhi Khawar , Juhn Steven K. , Assefa Girma , Johnston Thomas P.
Published: October 2014

Since the half-life of most angiogenic growth factors is several hours or less, sustained-release delivery would be optimal for their future clinical use. Two fibroblast growth factors, basic fibroblast growth factor (bFGF) and endothelial cell growth factor (ECGF), were delivered in two sustained-released modalities (poloxamer 407 and a gelatin sponge [Gelfoam]) to attempt to increase soft tissue vascularity. In vitro bioactivity of ECGF-poloxamer formulations was also tested on endothelial cell cultures. Among vascular-compromised skin flaps in rabbits, ECGF-poloxamer (N = 26), bFGF-poloxamer (N = 5), ECGF-poloxamer (N = 9, irradiated), and bFGF-Gelfoam flaps (N = 22) did not demonstrate significant differences in viability and vascularity compared to controls (p > .05). Irradiation had a detrimental effect on both flap vascularity and viability (p = .02). Future efforts for sustained delivery of angiogenic proteins are critical in order to make them clinically useful in wound healing.
Effects of Two Breath-Holding Maneuvers on Oropharyngeal Swallow
Authors: Ohmae Yukio , Logemann Jeri A. , Hanson David G. , Kaiser Peter , Kahrilas Peter J.
Published: October 2014

This study quantified the effects of the supraglottic maneuver (SGM) and super supraglottic maneuver (SSGM) on laryngeal and pharyngeal movements before and during swallow. Simultaneous videofluoroscopic and videoendoscopic examinations of oropharyngeal swallowing were performed in eight healthy volunteers with and without maneuvers. Data analysis compared 1) temporal relationships of oropharyngeal events, 2) airway conditions at the time of selected oropharyngeal events, and 3) biomechanical computer analysis of swallowing events. Using these maneuvers, normal subjects produced earlier cricopharyngeal opening, prolonged pharyngeal swallow, some degree of laryngeal valving before swallow, and change in extent of vertical laryngeal position before swallow. These changes are more successful and maintained longer with the SSGM than the SGM. We concluded that breath-holding maneuvers alter not only airway conditions before swallow but also both the temporal relationships and biomechanical events during oropharyngeal swallow.
Endoscopic Laser-Assisted Reshaping of Collapsed Tracheal Cartilage a Laboratory Study
Authors: Wang Zhi , Perrault Donald F. , Pankratov Michail M. , Shapshay Stanley M.
Published: October 2014

Repair of anterior tracheal wall collapse is a common and troublesome problem encountered by the head and neck surgeon. The standard treatment calls for an open procedure with or without stenting, depending on the extent of the damage. To avoid the morbidity of the open procedure, a new concept of endoscopic cartilage reshaping was investigated in a laboratory animal study. It involved the application of a 1.44-μm pulsed neodymium:yttrium-aluminum-garnet (Nd: YAG) laser at relatively low power to restructure without devitalizing cartilage. An in vivo study was done in six dogs to determine appropriate laser dosimetry in a model of tracheal wall collapse created by a tracheotomy. The deformed cartilage was treated endoscopically with a noncontact 1.44-μm Nd: YAG laser, at 2 to 4 W of power with a repetition rate of 20 Hz, in three animals. As a control, three animals had endoscopic cartilage incisions followed by stent placement. Six weeks postoperatively, both groups had an adequate airway lined by healthy mucosa. In the animals with stenting, however, there was stenosis formation due to scarring at both ends of the stent, with significant inflammatory response in the local area. This study shows that it is possible to use low-power laser energy to reshape cartilage without destroying its viability, and to restore the tracheal wall to a normal contour without ablation or vaporization. The reshaped cartilage will tend to retain its shape with functional elastic force, as seen in in vitro studies. These preliminary results are encouraging, and it seems reasonable to consider using the technique in selected clinical cases as an alternative to conventional open surgery.
Aerodigestive Tract Foreign Bodies in the Older Child and Adolescent
Authors: Lemberg Paul S. , Darrow David H. , Holinger Lauren D.
Published: October 2014

This study was undertaken in order to establish the incidence of aerodigestive tract foreign body accidents among older children and adolescents, and to investigate the circumstances surrounding these events. A review of patients treated over a 5-year period identified 367 children from whom aerodigestive tract foreign bodies were removed. Seventeen percent of these patients were 5 years of age or older. Among these children, 88% aspirated nonfood items, half of which were school supplies; 78% of the group 5 years old and under aspirated food items. Among older children with esophageal foreign bodies, 31 % had food impactions, compared with 7% in the younger group; 70% of these children had a history of some anatomic abnormality of the esophagus. These data suggest that older children and adolescents represent a distinct group of patients at risk for foreign body accidents. Pediatricians and parents of children in this age group should discourage the practice of using the oral cavity as a repository for school supplies, and should stress the need for adequate preparation and mastication of food, particularly among children with esophageal abnormalities.
Intralesional Vinblastine for Treating Aids-Associated Kaposi's Sarcoma of the Oropharynx and Larynx
Authors: Friedman Michael , Venkatesan T. K. , Caldarelli David D.
Published: October 2014

Kaposi's sarcoma (KS), the most frequent malignant neoplasm associated with acquired immunodeficiency syndrome, often involves the oropharynx and larynx. This study evaluated the efficacy of intralesional vinblastine sulfate injection in oropharyngeal and laryngeal KS. Twenty-four human immunodeficiency virus-positive patients with a total of 26 KS lesions were treated with injections of 0.1 — or 0.2-mg/mL vinblastine sulfate solution. Subsequent injections were administered at 4- to 5-week intervals if necessary until the lesions resolved or stabilized. Complete regression was achieved in 16 lesions (62%), 20% to 50% reduction in 4 lesions (15%), and less than 20% reduction in 3 lesions (12%). Two lesions (8%) did not respond, and 1 (4%) grew despite the injections. Thirteen patients experienced no adverse effects. Eleven patients reported pain not relieved by acetaminophen; 5 of these 11 also had ulceration secondary to the injection. Both pain and ulceration were self-limiting. We conclude that vinblastine injection is a viable option for treatment of oropharyngeal and laryngeal KS lesions.
Quantitative Videostroboscopic Measurement of Glottal Gap and Vocal Function: An Analysis of Thyroplasty Type I
Authors: Omori Koichi , Slavit David H. , Kacker Ashutosh , Blaugrund Stanley M.
Published: October 2014

The goal of surgical medialization of the vocal fold is to attain complete glottic closure. The purpose of this study is to quantify the glottal gap and to examine the relationship between glottal gap and vocal function perioperatively in thyroplasty type I. Glottal gap area was measured in 20 patients at the point of maximum closure of vocal fold vibration in digitized laryngeal stroboscopic images and was normalized by the square of vocal fold length. Glottal gap area thus measured was correlated with results obtained from well-accepted acoustic, aerodynamic, and perceptual measures of vocal function. The glottal gap was significantly reduced after thyroplasty type I. In patients with small preoperative glottal gaps, the amplitude of vocal fold vibration was significantly improved. This study verifies that quantitative videostroboscopic measurement of the glottal gap is a useful means of objective evaluation of glottic incompetence and of the results of thyroplasty type I.
Spontaneous Otogenic Pneumocephalus
Authors: Maier Wolfgang , Fradis Milo , Scheremet Rudolf
Published: October 2014

A very rare case of otogenic pneumocephalus in a healthy 24-year-old man with a widely pneumatized right mastoid, precipitated by forceful Valsalva's maneuver, is reported. When a pneumocephalus is suspected, computed tomography scans are mandatory. The pertinent literature is discussed and the potential mechanisms causing spontaneous pneumocephalus are described. To the best of our knowledge, only two other similar cases have been reported up to now.
Laryngotracheal Reconstruction Using a Vitallium Alloy Miniplate
Authors: Weisberger Edward C. , Nguyen Charly T.
Published: October 2014

When stenosis of the larynx and trachea involves loss of anterior support, this is usually corrected by an autograft of costochondral cartilage or of hyoid bone anchored with suture material. This paper describes an alternative technique employing a Vitallium alloy miniplate placed anterior to the airway as a means for providing support. This is placed over a fascial or auricular cartilage graft. Together, they provide a smooth scaffold for mucosal migration. Thirteen patients were treated at Indiana University Medical Center between 1991 and 1993 by means of this technique. Ten of the 13 patients (77 %) achieved an adequate airway to allow decannulation. There have been no significant complications related to the use of the miniplate, and specifically, there have been no instances of infection or extrusion. It has been unnecessary to remove any of the miniplates. The Vitallium alloy miniplate offers unique advantages in laryngotracheal reconstruction in that it not only accurately approximates tissues, but it also provides external support to the airway.
Mucosal Adenoid Squamous Cell Carcinoma of the Head and Neck
Authors: Ferlito Alfio , Devaney Kenneth O. , Milroy Christopher M. , Rinaldo Alessandra , Carbone Antonino
Published: October 2014

Adenoid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. The lesion is histologically distinctive and it is usually localized on the skin of the head and neck region; it only rarely involves the mucosal sites. The differential diagnoses include adenosquamous carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, basaloid squamous cell carcinoma, and metastatic adenocarcinoma. Surgery is the treatment of choice. The biologic behavior of this neoplasm is more aggressive when it involves mucosal areas, and the prognosis seems worse than that of conventional squamous cell carcinoma.
Quality of Life after Acoustic Neuroma Surgery
Authors: Van Leeuwen Joseph P. P. M. , Meijer Henk , Braspenning Johanna C. C. , Cremers W. R. J.
Published: October 2014

A questionnaire was sent to 134 patients who had undergone surgery for a unilateral acoustic neuroma between 1980 and 1993, to obtain data on the consequences on their quality of life, physical condition, social life, employment, and use of medical facilities. Distinctions were made between the translabyrinthine-transotic approach, the suboccipital approach, the tumor size, and the number of operations per patient. We found that the patients' reported state of health after surgery was poorer than that in a group of comparable nonoperated patients. Recuperation after an operation took many months and did not always result in full recovery. Surgery had various effects on preoperative symptoms such as hearing loss, tinnitus, vertigo, and facial nerve dysfunction: improvement, no change, or deterioration. Surgery had severe consequences on social life and occupation, but far less effect on income. Almost one third of the patients required postoperative home help, and a proportion were declared unfit to work. The surgical approach, tumor size, and reoperations had a definite influence on the study parameters. After suboccipital surgery, there were more reports of pain, more declarations of incapacity to work, poorer facial nerve function, and more frequent visits to the general practitioner. The translabyrinthine-transotic approach was associated with more severe pain and more complaints of postoperative vertigo. A greater proportion of the patients with larger tumors were declared unfit to work. The general state of health after suboccipital reoperations was better than after the initial operation; there was no reasonable explanation for this. Facial nerve function deteriorated after reoperation(s).
Don't Confuse Dental Soft Tissues with Odontogenic Tumors
Authors: Suarez Patricia A. , Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Surgical pathologists are cautioned against the misinterpretation of immature dental tissues (dental papillae and follicles) and dental pulp as odontogenic tumors, especially odontogenic myxomas and fibromas. The close histologic similarity of the immature tissues to tumors may require a clinical-radiologic correlation with the histopathologic specimen in order to distinguish the locally aggressive tumors from innocuous dental tissues
Acoustic Measurement of Subglottic Stenosis
Authors: Czaja Judith M. , McCaffrey Thomas V.
Published: October 2014

A device that determines cross-sectional area (CSA) of the airway by acoustic ref lections (Hood, Inc) was used to measure subglottic area. Airway models were made from Plexiglas rings with known internal dimensions similar to clinically encountered stenoses of various lengths and diameters. Acoustic measurements of airway area were made and compared to actual CSA. There is a strong correlation between CSA measured acoustically and the actual area of simulated stenoses. However, when the CSA of the stenosis was <0.64 cm2, the signal was impaired, resulting in overestimation of the stenotic CSA. In simulated stenoses with a CSA of <0.38 cm2, acoustic measurement of the CSA beyond the stenotic segment was unreliable. Determination of the origin of stenosis was accurate with this method. The CSA of cadaver airways was also measured acoustically. The CSA 2.0 cm below the glottis of normal airways in males ranged from 1.28 to 2.74 cm2 and in females 0.87 to 1.43 cm2, with means of 2.16 and 1.09 cm2. It appears that acoustic measurement of CSA of subglottic stenosis is a feasible clinical technique that yields dimensions of the airway in situations in which direct measurements are impossible. It was suggested that this technique be used for assessment of subglottic stenosis and evaluation of the efficacy of treatment of subglottic stenosis.
Repeatedly Successful Closure of the Larynx for the Treatment of Chronic Aspiration with the Use of Botulinum Toxin A
Authors: Pototschnig Claus A. , Eckel Hans E. , Schneider Imma , Thumfart Walter F.
Published: October 2014

Botulinum toxin A was used preoperatively to temporarily paralyze the intrinsic laryngeal muscles to hinder movements during the healing period after operation. In addition, toxin was injected into the cricopharyngeal muscle to allow a better passive drainage of the saliva into the esophagus. We treated six patients. Three suffered from chronic aspiration problems after multiple lower cranial nerve lesions, and three patients were apallic (after stroke and major brain injury). Two weeks before scheduled operation, we injected the toxin into the posterior cricoarytenoid muscles, the aryepiglottic muscles, and the vocalis muscle on both sides, as well as the cricopharyngeal muscle. The amount of injected toxin varied between 1.0 and 1.4 mL, equal to 200 to 280 units of botulinum toxin A (Dysport). After a complete palsy of these muscles (controlled by direct electromyography), a closure of the larynx was performed. After laminotomy and exposure of the intralaryngeal structures, the false vocal cords were mobilized and adapted with sutures. Because involuntary movements of the intralaryngeal musculature were absent, primary healing without complications occurred in all cases. Aspiration and related complications disappeared in all patients. In addition, the intensity of patient care could be considerably reduced. Preoperative use of botulinum toxin A allows sufficient laryngeal closure. This procedure is especially useful in the treatment of children and young adults, preserving the ability of later speech rehabilitation because of the return of voluntary movements of the intrinsic laryngeal muscles 6 months after the injection. Furthermore, this technique, as minimal surgical intervention, can be performed in high-risk patients.
Videoendoscopic Analysis of Laryngeal Function during Laughter
Authors: Yanagisawa Eiji , Citardi Martin J. , Estill JO
Published: October 2014

Although commonly encountered in all human cultures, laughter remains poorly understood. In order to examine laryngeal function during laughter, telescopic and fiberscopic videolaryngoscopy was performed on five subjects, who laughed in the different vowels, at various frequencies, and in several voice qualities. During laughter, the vocal folds were found consistently to undergo rhythmic abduction and adduction. At the end of these specific phonation tasks, all subjects were able to gain voluntary control of paramedian vocal fold positioning. This study better defined laryngeal function during laughter. These results have important clinical implications. Voluntary vocal fold positioning has important applications in speech therapy for dysphonias, such as vocal fold nodules, in which the primary cause is vocal fold hyperadduction. Patients suffering from these hyperadductive dysphonias may be able to utilize laughter to correct them.
Pediatric Tracheobronchial Foreign Bodies: Historical Review from the Johns Hopkins Hospital
Authors: Hughes C. Anthony , Baroody Fuad M. , Marsh Bernard R.
Published: October 2014

We investigated changing trends in pediatric tracheobronchial foreign body removal and resident experience from 1939 to 1991. We retrieved the records of 234 cases of tracheobronchial foreign body removal at Johns Hopkins. The mean number of cases per year was 5.9. The most common foreign bodies removed were peanuts, accounting for 38.9%. The average yearly incidence of pediatric tracheobronchial foreign bodies remained relatively constant during the period studied. Our data suggested little change in outcome or complications with the advent of optical telescopes in the mid-1970s, despite their great value in improved visualization. Resident experience and training were evaluated by the number of cases attended by each resident during his or her training. The number varied from 1 to 8 cases, not including experience acquired at our sister institutions. Although complete data could not be obtained in many of the older medical records, our review suggests that despite the advantage offered by the optical forceps technology, proper training and experience in traditional rigid endoscopic techniques is still crucial to optimize outcome and minimize the risk of complications in pediatric tracheobronchial foreign body removal. Chevalier Jackson's recommendation that residency training include an animal laboratory course in foreign body removal still applies.
Onlay Bone Augmentation with an Osteoinductive Implant
Authors: Hetherington Hugh E. , Morris Michael R. , Hollinger Jeffrey O. , Panje William R.
Published: October 2014

The repair of contour defects of craniofacial bone can be accomplished by several methods, including autogenous bone grafts, demineralized bone, and alloplastic materials. The objective of this study was to assess a biodegradable, xenogeneic, osteoinductive implant for craniofacial onlay bone augmentation. Twelve New Zealand White rabbits each had craniofacial onlays consisting of three experimental materials: 1) autograft; 2) allogeneic, demineralized block implant; and 3) partially purified osteoinductive protein (osteogenin) with allogeneic collagen and 50:50 poly(DL-lactide-co-glycolide). Implants with host bone were recovered after 20 weeks and assessed by histomorphometric methods. There was no evidence of adverse local reaction to the three treatments. No significant difference in bone replacement or bone density resulting from each of the implant types was demonstrated. In conclusion, the osteoinductive implants were well tolerated, and over the 20-week period they appeared to maintain their contour as onlays.
Endonasal Endoscopic Closure of Cerebrospinal Fluid Fistulas at the Anterior Cranial Base
Authors: Gjuric Mislav , Keimer Henning , Goede Ulrich , Wigand Malte Erik
Published: October 2014

This study reports our indications and limits for endonasal endoscopic closure of dural defects with a cerebrospinal fluid (CSF) leak at the anterior cranial base, and demonstrates our surgical technique. Fifty-three patients with CSF rhinorrhea were reassessed for the success rate of closure of the CSF leak. Surgery was successful in 98%, and 68% of fistulas were closed endoscopically. A free graft of autogenous mucoperiosteum of the inferior turbinate was the most frequently used tissue for defect closure. The endonasal endoscopic route proved relatively safe for the closure of dural tears, irrespective of the cause, up to about 10 × 10 mm. It is characterized by minimal morbidity because of the preservation of sinus ventilation and bony structures, supraorbital nerves, and olfactory fibers. Defects larger in size, predominantly of traumatic origin, were closed via the transfacial approach. The decision on the surgical approach was additionally based on the extent of the facial soft tissue injuries and the localization of the leak.
HLA Class II-Associated Genetic Susceptibility in Idiopathic Progressive Sensorineural Hearing Loss
Authors: Thonnard Joëlle , Philippe Marianne , Cao Ming-Yu , Deggouj Naïma , Osselaer Jean-Claude , Gersdorff Michel , Tomasi Jean-Paul
Published: October 2014

To investigate the association between genes in the major histocompatibility complex and inner ear disease susceptibility at the DNA level, high-resolution genotyping for HLA class II (HLA-DR, -DQ, -DP) was performed by polymerase chain reaction-sequence-specific oligonucleotide reverse dot blot and polymerase chain reaction-restriction fragment length polymorphism analysis in 34 patients with idiopathic progressive sensorineural hearing loss (PSHL) and in 214 controls. The frequencies of DRB1*0301, DRB3*0101, DQB1*0201, and DPB1*0401 were significantly increased in patients with idiopathic PSHL compared with controls. The DQB1*0301 allele was significantly decreased in the patients. A linkage disequilibrium was probably responsible for the concomitant increase of both DRB1*0301 and DRB3*0101 alleles in patients. The increase of DQB1*0201 in patients was associated with the DRB1*0301 allele. In addition, the telomeric DPB 1*0401 allele may act as an independent risk factor. The DQB1*0301 allele may have a protective role in the pathogenesis of idiopathic PSHL. These results suggest that the specific HLA class II gene products may confer susceptibility or resistance to idiopathic PSHL.
Secretory Otitis Media in Adults: I. The Role of Mastoid Pneumatization as a Risk Factor
Authors: Sade Jacob , Fuchs Camil
Published: October 2014

We analyzed clinically 102 ears with secretory otitis media (SOM) belonging to 72 adult patients who during their adult life had not suffered previously from ear disease. As in children, most of the cases (63%) could be traced directly to an upper respiratory tract infection. The most striking finding was the preponderance of poorly pneumatized mastoids—which were measured planimetrically — among our SOM cohort. This was found in adult SOM ears compared to contralateral healthy ears (4.59 versus 7.88 cm2), as well as when all 102 SOM ears were compared with values of the normal population (5.41 versus 12.9 cm2). This study showed that poorly pneumatized mastoids are a significant risk factor as far as adult SOM is concerned.