bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Cholesteatoma Isolated to the Mastoid
Authors: Luntz Mlchal , Telischi Fred , Ress Bradford , Bowen Brian , Balkany Thomas
Published: October 2014

From the Department of Otolaryngology, Jackson Memorial Hospital and the University of Miami Ear Institute (Luntz, Telischi, Ress, Balkany), and the Department of Radiology, Section of Neuroradiology, University of Miami School of Medicine (Bowen), Miami, Florida. Dr Luntz is currently in the Department of Biomedical Engineering, Tel-Aviv, Israel.
Clinicopathological Consultation Human Immunodeficiency Virus-1 Infection of the Lymphoid Tissues of Waldeyer's Ring
Authors: Frankel Sarah S. , Wenig Bruce M. , Ferlito Alfio
Published: October 2014

Human immunodeficiency virus-1 (HIV-1) infection is a fatal retroviral infection that may first present clinically as enlargement of the lymphoid tissues of Waldeyer's ring. These tissues are a major site of viral replication. The presence of the virus in these tissues causes a unique constellation of diagnostic histopathologic features, including florid follicular hyperplasia, follicle lysis, and productively HIV-1-infected multinucleated giant cells of probable dendritic cell origin. Serologic evaluation is confirmatory of HIV infection. With the recent advances in antiretroviral chemotherapy, the early institution of which may significantly prolong life and disease-free interval, the recognition of the clinical and pathologic parameters of HIV-related enlargement of Waldeyer's ring tissues is essential.
Electrical Impedance of the Cochlear Implant Lubricants Hyaluronic Acid, Oxycellulose, and Glycerin
Authors: Mens Lucas H. , Hombergen Godfried C. J. H. , Oostendorp Thom F. , Van Den Broek Paul
Published: October 2014

Hyaluronic acid (Healon), oxycellulose (hydroxypropyl methylcellulose), and glycerin are lubricants used in cochlear implant surgery for atraumatic deep insertion of the electrode array into the scala tympani. The electrical impedances of these three lubricants were measured to assess possible effects on intraoperative evoked response measurements, such as the electrically evoked stapedius reflex and auditory brain stem response. The impedances of hyaluronic acid, oxycellulose, and saline were very similar and independent of frequency (20 Hz to 1 MHz). Glycerin had an excessively high impedance at low frequencies. A film of hyaluronic acid or oxycellulose around the electrode array immersed in saline did not have any measurable effect on the impedance; a film of glycerin resulted in a strongly reactive polarized layer. However, neither the far-field current spread nor the impedance between stimulated electrodes was affected by any of the lubricants applied as a thin film. This suggests that none of these lubricants affect intraoperative responses, when applied as a thin film.
Clinicopathologic Study of Leptomeningeal Carcinomatosis Involving the Temporal Bone
Authors: Imamura Shun-Ichi , Imamura Mayumi , Nozawa Izuru , Murakami Yoshihiko
Published: October 2014

The temporal bone pathology of a 71-year-old man with bilateral sensorineural hearing loss and facial paralysis caused by diffuse metastatic leptomeningeal carcinomatosis is described. The origin of this malignant disease was an extremely rare entity, a transitional cell carcinoma of the renal pelvis. Histopathologic study of the temporal bone demonstrated that tumor cells filled the internal auditory meatus, infiltrated into the Rosenthal's canals, and reached the scala tympani of the basal turn of the bilateral cochleas. The vestibulocochlear nerve and facial nerve trunks in the internal auditory meatus had been destroyed by the bilateral tumor invasion. Case reports of temporal bone metastases of leptomeningeal carcinomatosis published since 1965 were reviewed. In leptomeningeal carcinomatosis, it is suggested that tumor cells infiltrate the internal auditory meatus of both ears simultaneously from the cerebrospinal fluid, involving the seventh and eighth nerve trunks, and then cause bilateral sensorineural hearing loss and facial paralysis.
Origin and Distribution of NADPH Diaphorase-Positive Nerves in Rat Nasal Mucosa
Authors: Jeon Seayuong , Kim Jinpyeong , Hwang Euigee
Published: October 2014

The aim of this study was to localize the distribution of (reduced) nicotinamide-adenine dinucleotide phosphate (NADPH) diaphorase-positive nerves in the rat nasal mucosa by NADPH diaphorase histochemistry, and to determine its origin by utilizing retrograde tracing with Fluoro-Gold (FG). Fine varicosities of NADPH diaphorase-positive nerve fibers were distributed around blood vessels (arterioles in particular), submucosal glands, and the subepithelial layer of the nasal mucosa. Most of the ganglion cells and nerve fibers in the sphenopalatine ganglion, and a few ganglion cells in the trigeminal ganglion, were stained by NADPH diaphorase, but no NADPH diaphorase-positive ganglion cells were found in the superior cervical ganglion. Retrograde tracing with FG and co-localization of NADPH diaphorase demonstrated that the FG-labeled ganglion cells in the sphenopalatine ganglion were NADPH diaphorase-positive, but the FG-labeled ganglion cells in both the trigeminal and the superior cervical ganglia were NADPH diaphorase-negative. In conclusion, NADPH diaphorase-positive nerves distribute around blood vessels, around submucosal glands, and in the subepithelial layer of the rat nasal mucosa, and their origin is the sphenopalatine ganglion. These findings imply that nitric oxide may be co-localized to the cholinergic innervation and be involved in vasomotor and secretomotor control of the nasal mucosa.
Clinicopathological Consultation Barrier between the Supraglottis and the Glottis: Myth or Reality?
Authors: Ferlito Alfio , Olofsson Jan , Rinaldo Alessandra
Published: October 2014

Controversial opinions on the existence of a “barrier” between the supraglottic and glottic regions of the larynx are reported. Even if the two areas have different embryological derivations, there is no anatomic evidence of a “barrier” that could prevent supraglottic cancer from extending downward to the glottis. Numerous adequate pathologic studies, including whole organ sections, confirm that for advanced cancers, anatomic compartments delimiting the spread of the neoplastic process from the supraglottis to the glottis do not exist. Therefore, supraglottic laryngectomy should be performed not on the basis of embryological considerations, but on the basis of the actual extension of the neoplastic lesion.
Electrophysiologic Changes in Preterm Neonates: Auditory Brain Stem Response and Distortion Product Otoacoustic Emissions
Authors: Quiñónez Rafael E. , Crawford Margie R.
Published: October 2014

The purposes of this investigation were to determine 1) if auditory peripheral maturity is present in the newborn; 2) if not, at what age maturational changes occur in the peripheral auditory system from preterm to full-term; and 3) how results of tests used to identify auditory dysfunction in neonates, such as distortion product otoacoustic emissions (DPEs) and auditory brain stem responses (ABRs), change during this period. Longitudinal DPE amplitude and ABR wave I latency measurements were obtained from a single ear of 18 preterm neonates. The DPEs were evoked at f2s of 2, 3, 4, and 5 kHz. The longitudinal data revealed that in general, DPE amplitude increased and ABR wave I latency decreased as a function of postconceptional age. These findings suggest that 1) the peripheral auditory system has not reached maturity in the preterm neonate; 2) maturational changes continue from preterm to full-term; and 3) these changes are reflected in ABR and DPE measurements.
Middle Ear Gas Composition in Pathologic Conditions: Mass Spectrometry in Otitis Media with Effusion and Atelectasis
Authors: Hergils Leif , Magnuson Bengt
Published: October 2014

It is generally assumed that the gas enclosed in the middle ear and mastoid air cell system is subject to continuous absorption, and that partial pressures for oxygen and carbon dioxide equal those of “mixed venous blood.” We previously determined the concentrations in 10 adults with healthy ears by means of mass spectrometry. The results showed that the value for oxygen was in the expected range, but that the value for carbon dioxide was higher than in “mixed venous blood.” The aim of the present investigation was to measure the gas concentrations with the same technique in diseased ears, to see if there are any differences in middle ear gases between healthy and diseased ears. In terms of group means, the present measurements in 13 ears of children with otitis media with effusion or atelectasis did not differ from the values previously obtained for healthy ears of adults for any of the gases.
Efficacy of Sinus Irrigation versus Sinus Irrigation Followed by Functional Endoscopic Sinus Surgery
Authors: Hartog Bert , Prins Ludo C. , van Benthem Peter-Paul G. , Hordijk Gert-Jan
Published: October 2014

Sinus irrigation is the traditional treatment for chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) restores aeration and allows secretions to be removed from an infected sinus. This study compares the efficacy of sinus irrigation with that of sinus irrigation followed by FESS in 89 patients. We measured the effects by way of sinus radiographs, nasendoscopic findings, and patient complaints. When we analyzed the data in terms of intent to treat, we found significantly favorable results for sinus irrigation followed by FESS at the end point, though only for loss of smell and purulent rhinitis. Treatment consisting of sinus irrigation alone prevented surgery in 58% of all patients for 1 year. Both treatment methods were combined with a 10-day course of loracarbef, which might have contributed to the outcome. We conclude that a good option for treatment of chronic maxillary sinusitis seems to be sinus irrigation in combination with a broad-spectrum antibiotic followed by FESS.
A Perspective Jaws Revisited: Costen's Syndrome
Authors: Michael Ludwig A.
Published: October 2014

Although James Costen was not the first to ascribe ear pain, tinnitus, impaired hearing, and even dizziness to temporomandibular joint dysfunction, he developed an integrated and systematic approach ascribing the symptoms to dental malocclusion. He wrote extensively on it, and a few years after his original article, the term Costen's syndrome came into general use. Recently, the use of the eponym has decreased, as dental malocclusion has assumed a lesser role in explaining many of the symptoms formerly ascribed to it.
Reversibility of Medialization Laryngoplasty an Experimental Study
Authors: Paniello Randal C. , Dahm J. David
Published: October 2014

Medialization laryngoplasty has become a routine procedure for cases of unilateral vocal fold paralysis. In certain clinical situations, it may become desirable to reverse the procedure and remove the implant. This process was studied experimentally in eight dogs in a chronic model of induced canine phonation. A silicone polymer implant was inserted to medialize one normal vocal fold for a period of 1 month, after which it was removed. Motion of the cricoarytenoid (CA) joint and induced phonation were studied weekly while the implant was in place, and for another month following implant removal. Significant abnormalities were found even with this relatively short period of implantation. With the implant in place, impairment of CA joint mobility was found in seven of the eight dogs, precluding phonation. A dense fibrous capsule rapidly developed around the implant, making its removal technically difficult. Following implant removal, a gradual return to normal function was found in only three of the eight dogs. One of the animals had evidence of neural injury, while four had intact neural function but impaired mobility or fixation of the CA joint. Medialization laryngoplasty should not be considered a reversible procedure. The clinical implications of these findings are discussed.
Slide Tracheoplasty in the Management of Congenital Tracheal Stenosis
Authors: Dayan Steven H. , Dunham Michael E. , Mavroudis Constantine , Backer Carl L. , Holinger Lauren D.
Published: October 2014

Long-segment congenital tracheal stenosis (LSCTS) is a rare condition. Originally, it was felt to be uniformly fatal; however, advances in technique have made surgical repair and survival possible. Our objective is to report results and technique of slide tracheoplasty for the treatment of LSCTS in the context of the overall experience at the Children's Memorial Hospital in Chicago. We reviewed 37 cases of infants and children with LSCTS. Thirty of the 37 infants underwent surgical intervention. Slide tracheoplasty resulted in survival in 1 of 2 infants, and pericardial patch tracheoplasty resulted in survival in 21 of 28 (75%). Of the 30 patients who had surgical repair, 7 (23%) have died, and 1 has been lost to follow-up (3%). Follow-up has ranged from 6 months to 13 years. Slide tracheoplasty is a satisfactory adjunct to existing techniques. With early diagnosis and appropriate management of LSCTS, survival is possible in a majority of patients.
Pretreatment Pathologic Prognostic Factors in Head and Neck Squamous Cell Carcinoma
Authors: Devaney Kenneth O. , Ferlito Alfio , Hunter Brian C. , Rinaldo Alessandra
Published: October 2014

Squamous carcinomas of the head and neck region are a common problem for the otolaryngologist; surgeons are obliged to draw together disparate lines of evidence — from physical examination, pathology, and radiology — to plan optimal therapy for their patients. This article explores some of the ways in which pathologic analysis of a biopsy specimen in the past (determination of extent of invasion and degree of differentiation), present (including an analysis of the pattern of infiltration and the tumor's DNA content), and, perhaps, the future (possibilities including cytogenetics and analysis of discrete steps in the cell cycle) plays a role in this process.
Telescopic Laryngeal and Pharyngeal Surgery
Authors: Richtsmeier William J. , Scher Richard L.
Published: October 2014

Surgery of the hypopharynx and larynx has traditionally been performed with either direct, unaided vision or the operating microscope. We proposed to extend the surgical capability provided by angled Hopkins telescopes to the larynx and hypopharynx. Forty-eight cases in which rigid telescopes were employed primarily for intervention were reviewed. We found significant advantages of the telescopic system when performing procedures on surfaces that were not 90° from the observer, such as the walls of the hypopharynx, the petiole of the epiglottis, the ventricle, and the posterior commissure. Both 30° and 70° telescopes were found useful, but required complementary instruments. The potassium titanyl phosphate laser's flexible fiber provided a distinct advantage in resecting lesions that presented on vertical surfaces. Telescopes also permitted the use of large instruments designed for intraperitoneal and intrathoracic surgery that blocked the view of the operating microscope. Telescopic pharyngeal and laryngeal visualization allowed surgical procedures complementary to more traditional forms of endoscopic surgery.
Laryngotracheoesophageal Clefts
Authors: Moungthong Greetha , Holinger Lauren D.
Published: October 2014

This article reviews laryngeal cleft anomalies from the Laryngeal Development Laboratory at Children's Memorial Hospital in Chicago and includes a discussion of the classification of laryngotracheoesophageal clefts based on previous work and the information presented herein. Of the 115 laryngeal specimens obtained between 1975 and 1995, 11 have laryngeal cleft anomalies. Eight have a submucous laryngeal cleft. There is 1 laryngotracheoesophageal cleft, type II (partial cricoid cleft); and there are 2 laryngotracheoesophageal clefts, type III (complete cricoid cleft). The histopathologic findings are presented in detail and the literature is reviewed. Photomicrographs and drawings illustrate the pathology and classification. Clinical presentation, diagnosis, evaluation, and management are discussed, as is the embryology.
Utility of Helical Computed Tomography in the Study of Arytenoid Dislocation and Arytenoid Subluxation
Authors: Lyons George D. , Nuss Daniel W. , Alexander Albert E. , Fazekas-May Mary A. , David Lisa , Rigby Peter L. , Williams Kevin
Published: October 2014

Conventional computed tomography (CT) has been considered a mainstay in the evaluation of the larynx. A major difficulty with utilizing this modality, especially in the study of the arytenoid, is the time necessary to perform a thin-slice examination through a structure that has a propensity to move with respiration and swallowing. Helical CT not only significantly reduces the time necessary to study the larynx, but enables one to perform multiple high-resolution multiplanar reconstructions. Eleven patients with arytenoid abnormalities documented by strobovideolaryngoscopy or direct laryngoscopy were imaged with helical CT. A comprehensive radiographic examination illustrating the cricoarytenoid relationship in all of the subjects was completed in less than 20 seconds by using axial reconstructions in 2-mm-thick slices at 1-mm intervals, with subsequently derived sagittal and coronal reconstructions. Helical CT may be a useful adjunct in the diagnosis of arytenoid subluxation or dislocation.
Rate and Extent of Early Axonal Degeneration of the Human Facial Nerve
Authors: Bendet Erez , Maranta Christian , Vajtai Istvan , Fisch Ugo
Published: October 2014

Electrophysiologic and histologic studies on a severed human facial nerve have shown that 1) response to stimulation by electroneuronography was lost on the sixth day following injury, 2) wallerian degeneration progressed in a nonuniform “front,” leaving some of the distal stump axons still viable and responsive to intraoperative stimulation 2 days following injury, and 3) the extent of proximal retrograde degeneration was far greater than to the next node of Ranvier. These findings are discussed in light of the current knowledge regarding peripheral nerve degeneration, and explanations are suggested.
Arterial Blood Gas Abnormalities in Patients with Dizziness
Authors: Morinaka Setsuko , Nakamura Hiroyuki
Published: October 2014

Arterial blood gases were analyzed in 121 patients with dizziness. Sixty-one showed arterial blood gas abnormalities in the dizziness period. An increase in bicarbonate was seen in 57, increases in both bicarbonate and arterial carbon dioxide pressure in 8, and a low arterial oxygen pressure in 22 patients. The frequency of the abnormalities was significantly higher in those with central-peripheral diseases than in those with Meniere's disease. Arterial blood gases were also checked at random in the remission period in 22 patients. The frequency of dizziness recurrence was significantly higher in patients with the abnormalities in the remission period than in patients without them. These results indicate that approximately half of the patients with dizziness tend to have arterial blood gas abnormalities in the dizziness period. It is suggested that arterial blood gas abnormalities cause temporary vestibular dehabituation that increases the frequency of dizziness in central-peripheral diseases and Meniere's disease.
Maxillary Sinus Atelectasis with Enophthalmos
Authors: Boyd James H. , Yaffee Karen , Holds John
Published: October 2014

Chronic maxillary sinusitis may present as atelectasis of the sinus with changes to surrounding structures. Several mechanisms have been proposed for this problem. Chronic obstruction of the sinus ostium, with resultant retention of secretions and osteitic bone resorption, may account for these changes. Enophthalmos is one manifestation that may require corrective treatment. Titanium micromesh reconstruction of the orbital floor, with or without onlay concha cartilage, has reliably resolved the enophthalmos. Reconstruction of the orbital floor and ventilation of the obstructed sinus ostium may be carried out relatively safely in a single operation. The standard endoscopic technique of uncinate removal and middle meatal antrostomy should be modified to prevent orbital penetration. This report reviews our series of 6 patients with this problem, as well as a comprehensive review of the literature. Recommendations for management of both the obstruction and the secondary orbital manifestations are presented.
Nasal Mucociliary Clearance of Chronic Sinusitis in Relation to Rheological Properties of Nasal Mucus
Authors: Atsuta Satsuki , Majima Yuichi
Published: October 2014

The role of the viscosity (η′) and elasticity (G′) of nasal mucus in nasal mucociliary clearance (MCC) in chronic sinusitis (CS) was studied. The nasal mucus was collected from 17 patients with CS, and both η′ and G′ were determined by an oscillating sphere magnetic rheometer. Following the nasal mucus collection, nasal MCC was measured by a radioisotope method in the patients and 22 normal subjects. Nasal MCC in the patients was significantly reduced compared with that in the normal subjects (p <.05). No significant correlation was noted between nasal MCC and η′, or between nasal MCC and G′. The results suggest that factors other than η′ and G′ of nasal mucus may control nasal MCC in CS.
Botulinum Toxin Type a for Frey's Syndrome: A Preliminary Prospective Study
Authors: Laccourreye Ollivier , Muscatelo Luca , Naude Carole , Bonan Brigitte , Brasnu Daniel
Published: October 2014

Fourteen patients with severe Frey's syndrome (occurring after conservative parotidectomy) managed with intracutaneous injection of botulinum toxin type A were prospectively evaluated. Results were analyzed for effectiveness, complications, and adverse effects. Complications were not encountered. The only adverse effect noted was a temporary and slight partial paresis of the upper lip of 3 months' duration in 2 patients. Permanent paresis was not encountered. Frey's syndrome was always controlled within 2 days following the intracutaneous injection of botulinum toxin A. Frey's syndrome recurrence was not encountered with a follow-up duration that varied from 3 to 9 months (mean follow-up 7 months). This preliminary report confirmed that in patients who have Frey's syndrome after conservative parotidectomy, the intracutaneous injection of botulinum toxin is a valuable treatment option that should be further investigated.
Acute Laryngeal Trauma in the Pediatric Patient
Authors: Merritt Robert M. , Bent John P. , Porubsky Edward S.
Published: October 2014

We reviewed the evaluation and management of pediatric laryngeal trauma, focusing on the unique characteristics of the immature airway as they affect functional results. The study was based on 91 cases of acute laryngeal trauma managed by the senior author (E.S.P.) from 1973 to 1996. Patients over 15 years old were considered physically mature and excluded. The remaining 10 cases (mean age 9.7) were reviewed in detail and compared to the adult series. Intervention ranged from level I (observation) to level III (open repair with stent placement). Outcome measure was by functional evaluation of swallowing, voice, and airway. Injuries were rated from group 1 (minor trauma) to group 4 (massive laryngeal injury with multiple fractures). Sixty percent fell into group 1 or 2. Conservative management in these patients produced excellent results as measured by decannulation (100%), functional speech (100%), and normal deglutition (100%). Conversely, 2 of the 4 patients with group 3 or 4 injuries had persistent airway and/or voice complications despite more aggressive intervention. As the pediatric larynx is protected by pliable cartilage and a more craniad location in the neck, traumatic laryngeal injuries in children tend to be less severe than those in the adult population. Group 1 or 2 injuries respond well to conservative treatment. However, children with extensive laryngeal injuries may have more long-term sequelae.
Influence of Age on Laryngeal Carcinoma
Authors: Quer Miquel , De Juan Manuel , León Xavier , Agudelo Dario , Diez Santiago , López-Pousa Antonio , Burgués Joaquim
Published: October 2014

The constant increase in human life expectancy has led to a higher proportion of oncologic patients of advanced age. The clinical characteristics of 272 patients with laryngeal carcinoma diagnosed when they were 70 or older are compared with those of a group of younger patients with the same kind of tumor. The advanced age group showed a higher proportion of women, less tobacco and alcohol use, a predominance of glottic location, and a higher previous morbidity. The T category was similar in both groups, but the advanced age group had a higher proportion of N0 tumors. The planning of treatment was similar in the two groups of patients, except for less use of both chemotherapy and partial larynx surgery in the advanced age group. Results in terms of local and regional control, distant metastasis, and 5-year adjusted survival were similar in both groups of patients. The results suggest that advanced age is not a determining factor when considering radical treatment in a patient with laryngeal carcinoma.
Oropharyngeal Fatty Infiltration in Obstructive Sleep Apnea Patients: A Histologic Study
Authors: Zohar Yuval , Schwartz Ariel , Sabo Reni , Gal Rivka , Strauss Michael , Oksenberg Arie
Published: October 2014

It has been suggested that due to fatty infiltration, obstructive sleep apnea (OSA) patients have a narrower pharyngeal airway than normal persons. To identify potential fatty infiltration of pharyngeal tissues that may contribute to OSA, a histologic study of the distal soft palate was performed. Histologic sections of 46 oropharyngeal specimens were evaluated. This included 25 overweight OSA patients (25/31), 6 normal-weight OSA patients (6/31), and a control group of 15 healthy (non-OSA) individuals. A semiquantitative analysis of the fatty tissue was performed. In all 31 OSA patients an excess of fatty infiltration was found in the histologic oropharyngeal specimens in comparison to the control group. No correlation was found between the pharyngeal fatty infiltration degree, the body mass index, and the apnea index. Irrespective of their body weight, in none of the patients without OSA was excessive fatty infiltration seen. It is suggested that excessive pharyngeal fatty infiltration plays a role in upper airway obstruction in OSA and that it can be associated with the development of apnea.
Binaural Application of the Bone-Anchored Hearing Aid
Authors: Snik Ad F. M. , Beynon Andy J. , van der Pouw Catharina T. M. , Mylanus Emmanuel A. M. , Cremers Cor W. R. J.
Published: October 2014

Most, but not all, hearing-impaired patients with air conduction hearing aids prefer binaural amplification instead of monaural amplification. The binaural application of the bone conduction hearing aid is more disputable, because the attenuation (in decibels) of sound waves across the skull is so small (10 dB) that even one bone conduction hearing aid will stimulate both cochleas approximately to the same extent. Binaural fitting of the bone-anchored hearing aid was studied in three experienced bone-anchored hearing aid users. The experiments showed that sound localization, and speech recognition in quiet and also under certain noisy conditions improved significantly with binaural listening compared to the monaural listening condition. On the average, the percentage of correct identifications (within 45°) in the sound localization experiment improved by 53% with binaural listening; the speech reception threshold in quiet improved by 4.4 dB. The binaural advantage in the speech-in-noise test was comparable to that of a control group of subjects with normal hearing listening monaurally versus binaurally. The improvements in the scores were ascribed to diotic summation (improved speech recognition in quiet) and the ability to separate sounds in the binaural listening condition (improved sound localization and improved speech recognition in noise whenever the speech and noise signals came from different directions). All three patients preferred the binaural bone-anchored hearing aids and used them all day.
Evidence of Potential Regulation by Interleukin-4 of the Soluble Intercellular Adhesion Molecule 1 Level in Patients with Seasonal Allergic Rhinitis under Provocation by a Small Amount of Natural Allergen
Authors: Kato Masashi , Hattori Taku , Liu Wei , Nakashima Izumi
Published: October 2014

Interleukin-4 (IL-4) and intercellular adhesion molecule 1 (ICAM-1) are assumed to be involved in the pathogenesis of allergic disease. In this study, we examined the potential link between IL-4 and soluble ICAM-1 (sICAM-1) levels in patients with allergic rhinitis. The levels of sICAM-1 and IL-4 in sera and in nasal epithelial lining fluids (ELF) from 12 patients with Japanese cedar pollinosis were measured preseason through postseason, and the results were compared with those from 7 healthy subjects. In sera from the allergic subjects, the levels of sICAM-1 were upregulated during the early part of the season and downregulated during the middle of the season, with upregulation of the IL-4 levels. Moreover, a negative correlation was found between the serum sICAM-1 levels and serum IL-4 levels during the middle (r = –.80) and late (r = –.73) parts of the season. In ELF from allergic subjects, the levels of sICAM-1 were significantly upregulated during the early and middle parts of the season, and began to be downregulated during the late part of the season, with upregulation of the levels of IL-4. In conclusion, IL-4 possibly acts as a potential suppressor of sICAM-1 in the pathogenesis of seasonal allergic rhinitis, at least under provocation by a small amount of natural allergen.
Endoscopic Management of Pediatric Posterior Glottic Stenosis
Authors: Rimell Frank L. , Dohar Joseph E.
Published: October 2014

Open laryngofissure with posterior cartilage grafting is advocated by some as the main treatment for posterior glottic stenosis in children. Endoscopic arytenoidectomy has been tried and recommended for bilateral vocal cord paralysis in children, but little published experience exists in its use for the treatment of pediatric posterior glottic stenosis. We describe our experience with this technique in 11 children ages 2 to 12 years, 6 of whom were under the age of 5 years. Nine of 11 patients at the initial surgery were tracheotomy-dependent; 2 others had previous laryngofissure with cartilage grafting, but continued to suffer from severe airway limitations. Modified carbon dioxide laser arytenoidectomies resulted in decannulation in 5 of 9 children and marked improvements in the 2 children without tracheotomies, as documented by flow volume loops and symptoms. Endoscopic arytenoidectomy, in our experience, is not as successful as open techniques described in previously published series of children, and requires multiple procedures due to the regrowth of granulation tissue. However, endoscopic repair is a viable option for low-grade stenosis and does not preclude an open repair in the future. It is also useful as an adjunctive procedure to augment the repair from an open approach.
Method for Removing Endobronchial Beads
Authors: Good Garth M. , Deutsch Ellen S.
Published: October 2014

The development of rigid bronchoscopes, Hopkins rod telescopes, and optical forceps has increased the efficacy and safety of removing endobronchial foreign bodies. These instruments have become the method of choice for managing the majority of foreign bodies. Spherical foreign bodies, such as beads, remain difficult to manage. Securing the foreign body by passing a Fogarty catheter through the lumen, inflating the balloon, and trapping the foreign body between the balloon and the bronchoscope allows controlled removal.
Role of Superoxide Dismutase in Otitis Media with Effusion
Authors: Shigemi Hideo , Egashira Toru , Kurono Yuichi , Mogi Goro
Published: October 2014

The concentration of superoxide dismutase (SOD) in middle ear effusion (MEE) was measured by the electron spin resonance trapping method in order to clarify the role of SOD in otitis media with effusion (OME) in children. The SOD levels in mucoid MEEs were significantly higher than those in serous and purulent MEEs. There was no significant difference in the levels of SOD between neutrophil-dominant MEEs and mononuclear cell-dominant MEEs, and the levels were negatively correlated with the number of neutrophils in the MEEs. Moreover, the levels were significantly increased in patients having recurrence of MEE within 3 months compared with patients without recurrence of MEE. Although it is known that SOD plays an important role in protecting the host from oxygen radicals, the findings in this study suggest that SOD might be related to the chronicity of OME.
Verrucous Carcinoma of the Larynx
Authors: McCaffrey Thomas V. , Witte Mark , Ferguson M. Troy
Published: October 2014

Verrucous carcinoma is a well-differentiated squamous cell carcinoma with minimal cytologic atypia. Characteristically, the surface shows papillary fronds with prominent hyperkeratosis. Its benign appearance makes diagnosis difficult and often delays treatment. This is a review of 52 histologically confirmed cases of verrucous carcinoma of the larynx treated at the Mayo Clinic between 1960 and 1987. The follow-up ranged from 2 to 304 months. The most common primary treatment modality was surgery. Two patients died of laryngeal cancer. In both cases, the recurrence was a high-grade carcinoma histologically distinct from the original verrucous carcinoma. The T stage, clinical stage, and type of surgical excision failed to predict survival. The presence of extensive leukoplakia surrounding the exophytic tumor approached statistical significance (p =.08) in predicting recurrence. Four patients were treated with radiotherapy — in each, to control residual disease. One of these patients developed a local recurrence. None of the irradiated tumors in this series showed anaplastic dedifferentiation, and none of the irradiated patients died of uncontrolled local or regional disease. We conclude that verrucous carcinoma of the larynx should be treated by conservative surgical resection when possible. Radiotherapy can be effectively used for disease that cannot be resected with preservation of laryngeal function. Total laryngectomy should be reserved for recurrent disease or the rare case of anaplastic transformation.
Revision Surgery for Chronic Otitis Media: A Learning Experience
Authors: Veldman Jan E. , Braunius W. Weibel
Published: October 2014

The objective of this study was to evaluate, during a long-term follow-up period, the results of revision surgery for chronic otitis media with or without cholesteatoma. Intact canal wall and canal wall down procedures were performed. The surgical history of every patient was assessed before the operation. A dry, relatively safe, and disease-free ear was created in 90% of the reoperated ears (N = 389). The recurrence rate of cholesteatoma was 5% for the total group. Reperforations of the tympanic membrane occurred in 10%, and persistent or recurrent otorrhea was present in 10% of cases. The functional hearing results were quite satisfactory. A residual air-bone gap of ≤30 dB was reached in 70.3% of the cases after revision tympanoplasty only (N = 41). Revision mastoidectomy with revision tympanoplasty as a one-stage procedure led subsequently, in 76% of intact canal wall procedures (N = 113) and 55% of canal wall down procedures (N = 98), to a residual air-bone gap of ≤30 dB.
Cochlear Implantation in Children with Inner Ear Malformations
Authors: Woolley Audie L. , Lusk Rodney P. , Jenison Virginia , Bahadori Robert S. , Stroer Barbara S. , Wippold Franz J.
Published: October 2014

We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programing of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.
Age-Related Changes in the Human Laryngeal Glands
Authors: Sato Kiminori , Hirano Minoru
Published: October 2014

The present study was conducted to determine age-related changes in the human laryngeal glands by means of excised human adult larynges. Scanning and transmission electron microscopic observations were made. The results obtained are summarized as follows. 1) Granular endoplasmic reticulum and Golgi apparatus were sparse in the cytoplasm of serous and mucous cells. 2) Secretory granules in serous cells had decreased in number. 3) Secretory granules were less electron-dense compared to those in younger adult specimens, but were electron-lucent. 4) Mucigen droplets in mucous cells were not as numerous as those in younger adults. 5) Discharge of secretory granules and mucigen droplets had decreased. 6) Age-related morphologic changes in the laryngeal glands influenced not only the amount but also the quality of secretions. 7) The above changes lessened lubrication of the vocal folds, thus causing aging of the voice to some extent. 8) Local immunity and mucociliary transport were also affected. 9) Age-related changes in the laryngeal glands partially altered laryngeal function.
Three-Dimensional Reconstruction and Measurement Study of Human Eustachian Tube Structures: A Hypothesis of Eustachian Tube Function
Authors: Sudo Masaharu , Sando Isamu , Suzuki Chiaki
Published: October 2014

Histologic sections from nine temporal bones with eustachian tubes (ETs) attached were analyzed with a computer-aided three-dimensional reconstruction method to determine the curvature and tilt of the ET and the anatomic relationships between the medial lamina of the ET cartilage, the levator veli palatini muscle (LVPM), and Rosenmüller's fossa. It was found that the ET is convex superomedially and is tilted medially. The LVPM is located inferolateral to the inferior margin of the medial lamina of the anterior ET cartilage. The LVPM is inferior to the medial lamina of the posterior ET cartilage. These findings suggest that the LVPM opens the anterior cartilaginous portion of the ET by rotating the medial lamina with increased dimension of the muscle body when it contracts. Rosenmüller's fossa extends along the ET with rich lymphoid tissues as far as approximately one half the total length of the ET and very close to the skull base.
Otologic Wegener's Granulomatosis with Facial Nerve Palsy
Authors: Dagum Paul , Roberson Joseph B.
Published: October 2014

Wegener's granulomatosis, characterized by necrotizing granulomas and vasculitis of the respiratory tract and kidney, frequently first presents with otologic symptoms. We report a case of primary otologic Wegener's granulomatosis in a patient who presented with symptoms of acute otomastoiditis and associated facial nerve palsy. The patient subsequently developed neuropathies of various cranial nerves. The patient underwent urgent mastoidectomy with facial nerve decompression. Nonspecific inflammatory disease of the mastoid mucosa delayed the correct diagnosis of Wegener's granulomatosis, which was confirmed by an elevated level of cytoplasmic-pattern antineutrophil cytoplasmic antibody (cANCA). We contrast the specificity of middle ear mucosal disease and cANCA serum levels in the diagnosis of Wegener's granulomatosis.
Epithelial Damage of Nasal Mucosa in Nasal Allergy
Authors: Watanabe Kensuke , Kiuna Chôsei
Published: October 2014

Epithelial alterations arising from moderate nasal allergy to house dust were examined and compared to findings in epithelia from nonallergic controls. Biopsy specimens were taken during natural allergen exposure from two different sites: 1) the anterior tip of the inferior turbinate and 2) 2 cm behind it. The tissues were examined by both electron and light microscopy. In the allergic group, epithelial damage was found to be remarkable in the anterior nasal mucosae, where nonciliated cells were prevalent, but minor in the posterior nasal mucosae comprising ciliated and goblet cells. In the anterior nasal mucosae, conspicuous intercellular edema, epithelial shedding, and clusters of eosinophils in the epithelial layer were observed, whereas only a little epithelial shedding and edema in the basal area of the epithelium was noted in the ciliated areas. In controls, pathologic changes were not observed, although a little epithelial shedding was seen in the anterior turbinate. Although there are arguments for and against epithelial shedding in nasal allergy, this study confirms its presence even in patients with moderate allergy.
Revision Surgery of a Stenotic Speaking Shunt in Near-Total Laryngectomy Patients
Authors: Su Chih-Ying
Published: October 2014

A near-total operation to create a speaking shunt is generally considered a suitable option in most T3 laryngopharyngeal cancer cases. However, some of these cases incur postoperative problems, including aspiration and shunt stenosis. In this 8-year study, 15 of 60 patients who had received near-total laryngectomies could not speak well with their shunts. Revision surgery was performed on 11. Under local anesthesia, the lumen of the stenotic segment of the shunt was opened. A 4-F silicone tube was stented in the shunt. Then, for mildly stenotic cases, the small mucosal defect of the shunt was covered by a sternohyoid myofascial flap. For moderate to severe cases, the larger mucosal defect was reconstructed with a free skin graft. Thereafter, a sternohyoid muscle flap was used to cover the skin graft, which would finally form the inner lining of the new speaking shunt. The outcome was that 9 of the 11 patients acquired intelligible shunt speech. These results demonstrate that the augmentation procedures described herein have considerable potential for restoring the function of a stenotic speaking shunt in a near-total laryngectomee.
Current Evaluation of Pseudohypacusis: Strategies and Classification
Authors: Qiu William W. , Stucker Fred J. , Yin Shengguang S. , Welsh Louis W.
Published: October 2014

Some cases of pseudohypacusis may involve medicolegal aspects and require a confirmed and quantitative diagnosis. These challenging cases must be identified, and then evaluated with basic audiologic and sophisticated electrophysiologic tests. Data on 64 patients with pseudohypacusis collected over a 4-year period are reported. A classification system was developed from an analysis of these cases and is presented for clinical evaluation and diagnosis. In many cases, conventional audiologic evaluation involving pure tone and speech audiometry may be adequate and sufficient for diagnosis. In more complex cases, evoked otoacoustic emissions (EOAEs) and auditory brain stem responses (ABRs) are needed for confirmation of peripheral auditory sensitivity. We found that EOAEs were the most rapid, economical, and objective method, and confirmed the diagnosis of hearing loss in 78.1 % of cases. Fifteen percent of subjects required ABRs to substantiate the diagnosis. The reliability of basic audiologic tests based on previous clinical investigations and data from the literature are discussed. We conclude that a thorough knowledge and understanding of pseudohypacusis is essential to verify the existence of pseudohypacusis, to determine its type, and to quantify the auditory thresholds.
Conservative Approach to Inflammatory Nasofrontal Duct Disease
Authors: Jacobs Joseph B. , Lagmay Victor M. , Lebowitz Richard A. , Damiano Angela
Published: October 2014

Endoscopic data reveal that mucosal disease frequently recurs following the surgical treatment of chronic diffuse hyperplastic frontal sinus and nasofrontal duct disease. However, this group of patients often remains asymptomatic. We present 40 patients who underwent endoscopic sinus surgery with a 4-year mean follow-up. Postoperative endoscopy revealed mucosal disease within the frontal recess in 39 of the 40 (97.5%) patients; however, only 3 of the 40 (7.5%) were symptomatic. Of these 3 patients, 1 underwent revision surgery. Historical information demonstrates the potential for significant nasofrontal duct stenosis associated with such revision surgery. On the basis of our initial results, endoscopic observation and medical therapy seem to be successful in controlling the symptoms associated with this disease process.
Carbon Dioxide Laser Microsurgery for Early Supraglottic Carcinoma
Authors: Ambrosch Petra , Kron Martina , Steiner Wolfgang
Published: October 2014

Forty-eight untreated patients with early supraglottic carcinoma (12 patients stage I and 36 patients stage II) had primary carbon dioxide laser microsurgery between 1979 and 1994 with the intent of complete tumor removal with preservation of functionally important structures of the larynx. Ninety-six percent of the patients were treated exclusively by surgery; 4% had laser microsurgery and postoperative radiotherapy. With a median follow-up of 55 months, the 5-year local control rate with the first treatment was 100% for pT1 cases and 89% for pT2 cases. The ultimate local control rate with voice preservation, including patients successfully salvaged after a local recurrence, was 97% for pT2 carcinomas. Five (10%) patients died of tumor (TNM)–related deaths. The 3-year recurrence-free rate and 3-year overall survival rate (Kaplan-Meier) were 87% and 85%; the 5-year recurrence-free rate and 5-year overall survival rate were 83% and 76%, respectively. The results achieved with transoral laser microsurgery in early supraglottic carcinoma are comparable to those of open supraglottic laryngectomy with respect to local control and survival. The functional results are superior, since clinically relevant aspiration did not occur.
Mucocele of the Sphenoid Sinus: A Late Complication of Transsphenoidal Pituitary Surgery
Authors: Herman Philippe , Marianowski Rémi , Lot Guillaume , Assayag Michel , Guichard Jean-Pierre , Huy Patrice Tran Ba
Published: October 2014

In an 18-month period, 3 cases of sphenoidal mucocele following pituitary surgery were diagnosed at our institution. Only 1 case of this late-onset disorder has yet been reported as a pitfall of the transsphenoidal route. Symptoms include recurrent headache and visual complications. Diagnosis was delayed because of misinterpretation of the magnetic resonance imaging findings, which actually showed the development of a sphenoid mucocele long before clinical symptoms occurred. These 3 cases suggest that attention should be focused not only on the sella turcica, but also on the sphenoid sinus, in analyzing the magnetic resonance imaging data. The treatment consists of endoscopic transnasal marsupialization, since the mucocele is lined by normal epithelium with an inflammatory reaction that will heal with drainage. At the time of surgery, prevention would require either endoscopic control of the mucosal remnants, in case of sinus exclusion, or leaving the sphenoid sinus air-filled under a sealed sella.