bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Papillary Adenomas Endolymphatic Sac Tumors?
Authors: Pollak Anita , Spycher Max , Böhmer Andreas , Fisch Ugo
Published: October 2014

Papillary adenomas of the temporal bone have been considered as originating from the endolymphatic sac. The radiologic, surgical, and pathologic findings in a patient suffering from von Hippel—Lindau disease with bilateral papillary adenomas of the temporal bone cast some doubt on this site of origin. Radiologically, the center of tumor growth was at the top of the jugular bulb. Intraoperatively, the tumor was found to have reached the lateral wall of the endolymphatic sac, but the lumen was tumor-free. Both ciliated and nonciliated tumor cells were found in the resected tumor, resembling the ultrastructure of normal epithelial lining in the human mastoid. A strong positive immunohistochemical reaction for keratin and negative reactions for vimentin, glial fibrillary acidic protein, and S-100 protein in the tumor tissue of this patient are typical for middle ear mucosa. Therefore, the described papillary adenoma originated from the mucosa of the pneumatic spaces surrounding the jugular bulb, and the theory that the endolymphatic sac is the origin of all papillary-cystic tumors (adenocarcinomas) should be questioned.
Effect of Otitis Media on the Vestibular System in Children
Authors: Casselbrant Margaretha L. , Rubenstein Elaine , Furman Joseph M. , Mandel Ellen M.
Published: October 2014

Forty-one children with otitis media (OM) were evaluated by moving platform posturography (Equitest, NeuroCom) before and after insertion of tympanostomy tubes, and were compared to children with no ear disease (N=50). Velocity of sway increased with increasing difficulty of test conditions (I-VI) for both groups of children (p < .001), and children less than 7 years of age had a higher velocity than children 7 years old or older (p < .001). Children with OM had a higher velocity than normal children (p < .05). For children tested less than 30 days after insertion of tympanostomy tubes, the velocity for condition VI was significantly lower than before insertion (p < .05). Also, that the 6 children who had fallen on all trials on condition V or VI were able to stand on these trials after insertion of tympanostomy tubes indicates an improvement. These findings indicate that episodes of OM may affect balance, leaving children more clumsy and accident-prone, and possibly impairing motor development.
β-Amyloid Peptide and Amyloid Precursor Proteins in Olfactory Mucosa of Patients with Alzheimer's Disease, Parkinson's Disease, and down Syndrome
Authors: Crino Peter B. , Greenberg Barry , Martin John A. , Lee Virginia M.-Y. , Hill William D. , Trojanowski John Q.
Published: October 2014

Dystrophic neurites are present in olfactory epithelium (OE) of patients with Alzheimer's disease (AD), Parkinson's disease (PD), and Down syndrome (DS) and occasionally in normal individuals. Cultured olfactory neuroblasts from AD patients generate carboxy terminal amyloid precursor protein (APP) fragments that contain β-amyloid (Aβ), but it is not known if deposits of Aβ and/or APP fragments occur in the OE of individuals with or without AD, PD, or DS. To determine if Aβ accumulates in the OE in situ, we probed postmortem samples of olfactory mucosa from patients with AD, PD and AD (PD/AD), and DS and AD (DS/AD), as well as from controls, using polyclonal and monoclonal antibodies to Aβ and flanking sequences in APPs. Samples of OE also were examined by thioflavin-S and electron microscopy. Labeling of Aβ was observed in 10 of 12 AD cases, 2 of 3 PD/AD cases, 3 of 4 DS/AD cases, 3 of 10 adult controls, and 4 of 6 fetal cases. The Aβ staining was seen in the basal third of the OE, in axons projecting through the lamina propria, and in metaplastic respiratory epithelium within the OE. Antibodies to other APP domains stained the OE of patients and controls. Thioflavin-S staining was present in the basal third of the OE of 8 of 9 AD patients and several PD/AD and DS/AD patients, but only in rare cells of 3 controls. Electron microscopy did not reveal amyloid fibrils in the OE. These data suggest that deposition of Aβ occurs in a variety of circumstances and is not restricted to patients with AD, PD, or DS.
Bacillary Angiomatosis
Authors: Batsakis John G. , Ro Jae Y. , Frauenhoffer Elizabeth E.
Published: October 2014

The acquired immunodeficiency syndrome and other causes of immunosuppression have ushered in a variety of opportunistic infections. One of these is bacillary angiomatosis, a vasoproliferative lesion whose principal causative agent is Rochalimaea henselae. Bacillary angiomatosis, while preponderantly a cutaneous affliction, can be systemic, including involvement of the head and neck mucous membranes. Molecular technology and epidemiologic studies used to identify the bacterial agent of bacillary angiomatosis have also uncovered R henselae as the organism responsible for most cases of cat-scratch disease. Why the same organism promotes two different histopathologic lesions, as seen in bacillary angiomatosis and cat-scratch disease, is unknown.
Analysis of Expression of Matrix Metalloproteinases-2 and −9 in Hypopharyngeal Squamous Cell Carcinoma by in Situ Hybridization
Authors: Miyajima Yoshimi , Nakano Ryuji , Morimatsu Minoru
Published: October 2014

The gene expression of two type IV collagenases (matrix metalloproteinase [MMP]-2, a 72 kd type IV collagenase, and MMP-9, a 92 kd type IV collagenase) was investigated in carcinomas of the hypopharynx. We examined 27 cases operated on in our hospital by an in situ hybridization technique to detect their messenger RNA signals in cancer cells and surrounding stroma. Both signals were detected in all cancer nests and in stromal cells in the same specimens. Clinicopathologic studies showed a significant relationship between MMP-2 expression in the primary cancer and the outcome of treatment. Our present study suggests that hypopharyngeal squamous cell carcinoma producing MMP-2 has a high potential for invasion and metastasis and a poor outcome. The analysis of MMPs will be useful for treatment planning in hypopharyngeal carcinoma and for prognosis.
Retest Stability of the Tinnitus Handicap Questionnaire
Authors: Newman Craig W. , Wharton Jeanne A. , Jacobson Gary P.
Published: October 2014

The test-retest stability of the Tinnitus Handicap Questionnaire was assessed for a sample of 32 tinnitus patients. The questionnaire is a self-report measure that quantifies the physical, emotional, and social consequences of tinnitus (factor 1), the interfering effects of tinnitus on the hearing ability of the patient (factor 2), and the patients' view of tinnitus (factor 3). Retest stability estimates were obtained in order to determine the applicability of using the questionnaire as an outcome measure following tinnitus management. High test-retest correlations emerged for factors 1 and 2, whereas factor 3 yielded inadequate retest reliability. Therefore, it is recommended that only factors 1 and 2 be used for documenting changes in self-perceived tinnitus handicap following medical, surgical, or rehabilitative intervention.
Adult Respiratory Papillomatosis: Human Papillomavirus Type and Viral Coinfections as Predictors of Prognosis
Authors: Pou Anna Maria , Rimell Frank L. , Jordan Jeanne A. , Barua Pierre , Shoemaker David L. , Post J. Christopher , Johnson Jonas T. , Ehrlich Garth D.
Published: October 2014

Pathologic material and the records of 29 patients with laryngeal papillomatosis were reviewed. The relationship between the type of human papillomavirus (HPV) and the presence of viral coinfections was correlated with clinical outcome. Using polymerase chain reaction, paraffin-embedded specimens were analyzed for the presence of HPV, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV). The HPV type could be identified in 24 patients' specimens. Twenty-one patients were infected with HPV type 6. The other 3 were infected with HPV type 11 or 16. Three patients developed squamous cell carcinoma, of whom 2 had HPV type 11 or 16. We found HSV, EBV, and CMV in 50%, 12.5%, and 0% of specimens, respectively. An aggressive clinical course was observed in 17 patients. Evidence of coinfection with other viruses was identified in 11 (65%) of these patients. In contrast, a benign clinical course was observed in 7 patients, of whom 2 (29%) had viral coinfections. We conclude that the HPV type and the presence of viral coinfections may be predictive of an aggressive clinical course.
Quality of Life after Surgical Treatment of Cancer of the Larynx
Authors: DeSanto Lawrence W. , Olsen Kerry D. , Rohe Daniel E. , Perry William C. , Keith Robert L.
Published: October 2014

The purpose of the study was to assess the quality of life of patients after surgical treatment for cancer of the larynx. Three groups of patients were identified according to surgical treatment: total laryngectomy, 111 patients; near-total laryngectomy, 38 patients; and partial laryngectomy, 23 patients. The impact of successful surgical treatment on their life roles was analyzed in terms of work, activities, familial and spousal relationships, sexuality, and psychologic features such as stress and anxiety. Two questionnaires were used: the Psychosocial Adjustment to Illness Scale (PAIS) and the Mayo Clinic Postlaryngectomy Questionnaire. With the PAIS questionnaire, no difference was found in role adjustment between the total laryngectomy and near-total laryngectomy groups, with one exception. In the work domain, the total laryngectomy patients who were working had better adjustment than the near-total laryngectomy patients. The overall adjustment of both groups was less favorable than that of a comparison group of patients with nonlaryngeal cancer. The patients who had the classic conservation operations adjusted in all domains more favorably than the patients with permanent tracheostomas. The partial operation patients adjusted better than the nonlaryngeal cancer patients. We conclude that the stoma has a negative impact on adjustment postoperatively and that it may have a more serious impact on life adjustment than voice alteration. Further investigation and standardization of measurement tools are needed.
Mycobacterial Disease of the Head and Neck: Current Perspective
Authors: Cleary Karen R. , Batsakis John G.
Published: October 2014

The worldwide increase in mycobacterial diseases, tuberculous and nontuberculous, and their association with human immunodeficiency virus infection has had and will continue to have an impact on the practice of otolaryngologist—head and neck surgeons. Epidemiologic and ecologic changes in tuberculosis and nontuberculous mycobacterial diseases tend to blur former clinicopathologic distinctions among these groups, especially in immunocompromised hosts. Diagnosis depends on objective identification of the mycobacterium, a process facilitated by molecular diagnostics.
Bilateral Maxillectomy and Midfacial Reconstruction
Authors: Panje William R. , Hetherington Hugh E. , Lavelle William E. , Toljanic Joseph , Fyler Ann
Published: October 2014

Extensive bilateral midfacial defects including the upper jaw, palate, and sinuses present a formidable reconstructive challenge. Prosthetic restorations require a solid anchor point to be successful, since orofacial motion would otherwise cause instability of the prosthesis. We report on a series of eight patients who underwent transmalar placement of a Steinmann pin at the time of definitive tumor resection. The Steinmann pin was used immediately to securely anchor a prosthesis to the skull base. The maximum follow-up time is 9 years. The Steinmann pin has remained firmly anchored without significant loosening in six of these eight patients, and no major complications have resulted from its use. In conclusion, the transmalar Steinmann pin is an effective and immediate single-stage method of permanently retaining a midface prosthesis.
NA,K-Atpase in the Cochlear Lateral Wall of Human Temporal Bones with Endolymphatic Hydrops
Authors: Keithley Elizabeth M. , Horowitz Steve , Ruckenstein Michael J.
Published: October 2014

Meniere's disease has traditionally been thought to arise from a disruption in longitudinal endolymphatic flow. This view has been brought into question by recent experimental studies that have focused attention on derangements of cochlear fluid and electrolyte homeostatic mechanisms in Meniere's disease, including abnormalities in Na,K-ATPase enzymes found in the cochlear lateral wall. The current study examined the immunohistochemical labeling pattern of the major ion-transporting enzyme of the stria vascularis, Na,K-ATPase, in archival sections of hydropic and nonhydropic human temporal bones for increased density of label that could indicate overproduction of fluid. The results showed good labeling of the stria vascularis in the celloidin sections. The hydropic ears tended to have darker label, but the difference was not statistically significant. The findings are consistent with normal functioning of the stria vascularis in cases of Meniere's disease.
External Ear Canal Cholesteatoma
Authors: Hartley Christopher , Birzgalis Andrew R. , Lyons Timothy J. , Hartley Ruskin H. , Farrington William T.
Published: October 2014

External ear canal cholesteatoma is a rare condition in otologic practice. A case in a 43-year-old woman is presented in which despite the extensive nature of the lesion, minimal symptoms and absence of signs delayed diagnosis. The cause of the lesion and its treatment are discussed.
Comparison of Rabbit Facial Nerve Regeneration in Nerve Growth Factor-Containing Silicone Tubes to that in Autologous Neural Grafts
Authors: Spector J. Gershon , Derby Albert , Lee Patty , Roufa Dikla G.
Published: October 2014

Previous reports suggest that nerve growth factor (NGF) enhanced nerve regeneration in rabbit facial nerves. We compared rabbit facial nerve regeneration in 10-mm silicone tubes prefilled with NGF or cytochrome C (Cyt C), bridging an 8-mm nerve gap, to regeneration of 8-mm autologous nerve grafts. Three weeks following implantation, NGF-treated regenerates exhibited a more mature fascicular organization and more extensive neovascularization than Cyt C-treated controls. Morphometric analysis at the middle of the tube of 3- and 5-week regenerates revealed no significant difference in the mean number of myelinated or unmyelinated axons between NGF- and Cyt C-treated implants. However, when the numbers of myelinated fibers in 5-week regenerates were compared to those in their respective preoperative controls, NGF-treated regenerates had recovered a significantly greater percentage of myelinated axons than Cyt C-treated implants (46% versus 18%, respectively). The number of regenerating myelinated axons in the autologous nerve grafts at 5 weeks was significantly greater than the number of myelinated axons in the silicone tubes. However, in the nerve grafts the majority of the axons were found in the extrafascicular connective tissue (66%). The majority of these myelinated fibers did not find their way into the distal nerve stump. Thus, although the number of regenerating myelinated axons within the nerve grafts is greater than that of axons within silicone tube implants, functional recovery of autologous nerve graft repairs may not be superior to that of intubational repairs.
Comparison of Endolymph Cross-Sectional Area Measured Histologically with that Measured in Vivo with an Ionic Volume Marker
Authors: Salt Alec N. , Demott John E. , Kimura Robert S.
Published: October 2014

In order to establish how endolymph volume is regulated, it is essential to be able to measure endolymph volume or cross-sectional area in vivo. We have developed methods to accomplish this by injecting the volume marker ion hexafluoroarsenate (AsF6) into endolymph by iontophoresis. For an injection at a constant rate, the endolymph concentration is inversely dependent on the cross-sectional area of the scala into which injection occurred. Marker concentrations were monitored by inserting ion-selective microelectrodes into endolymph near the injection site. In a previous study we quantified the degree of hydrops in animals following ablation of the endolymphatic sac. In the present study we validated the technique by comparing the endolymphatic cross-sectional area measured in vivo with AsF6 with that measured by established histologic procedures. The correlation between the two measures was good, with a coefficient of .903, although the area measured histologically was a little lower than that measured in vivo.
Innominate Artery Compression of the Trachea: Diagnosis and Treatment by Anterior Suspension a 25-Year Experience
Authors: Adler Stephen C. , Isaacson Glenn , Balsara Rohinton K.
Published: October 2014

Suspension of the innominate artery to the sternum has been a widely accepted therapy for the relief of tracheal compression. Recently, reimplantation of the innominate artery has been advocated as a superior operative procedure. While generally successful, arterial transfer carries the risk of early bleeding and stroke, and the potential for late stenosis at the anastomotic site. Between 1969 and 1994, 25 infants and children at our institution received diagnoses of innominate artery compression and were treated by anterior suspension. All presented with stridor and one third had a history of suspected or proven apnea. Twenty-four children had excellent results, while 1 required resuspension after stridor returned. There were no major complications. Our series strongly supports the belief that anterior suspension of the innominate artery is a successful and reliable operation with minimal morbidity and mortality. More complex procedures are rarely indicated.
Abnormalities in Long Latency Responses to Superior Laryngeal Nerve Stimulation in Adductor Spasmodic Dysphonia
Authors: Ludlow Christy L. , Yamashita Toshiyuki , Schulz Geralyn M. , Deleyiannis Frederic W.-B.
Published: October 2014

Sensorimotor responses to repeated electrical stimulation of the superior laryngeal nerve were compared in 8 patients with adductor spasmodic dysphonia (ADSD) and 11 normal controls to determine if adductor response disinhibition occurred in ADSD. Pairs of electrical pulses were presented at interstimulus intervals varying from 100 to 5,000 milliseconds (ms). Three responses were measured in thyroarytenoid muscles: ipsilateral R1 responses at 17 ms and ipsilateral and contralateral R2 responses between 60 and 75 ms. Conditioned response characteristics, the percent occurrence and percentage amplitude of initial responses, were measures of response inhibition. As a group, the patients had reduced response inhibition: their conditioned ipsilateral R1 response amplitudes were increased, as was the frequency of their conditioned contralateral muscle responses (p ⩽ .002) compared to normal. However, the patients' initial responses were normal in latency and frequency characteristics, demonstrating that the brain stem mechanisms for these responses were intact. These results suggest a central disinhibition of laryngeal responses to sensory input in ADSD.
Salvage Laryngectomy for Unsuccessful Larynx Preservation Therapy
Authors: Kraus Dennis H. , Harrison Louis B. , Zelefsky Michael , Spiro Ronald H. , Bosl George J. , Pfister David G. , Strong Elliot W. , Shah Jatin P.
Published: October 2014

From 1983 to 1991,31 patients underwent salvage laryngectomy for persistent or recurrent squamous carcinoma of the larynx (14), hypopharynx (15), or oropharynx (2) as part of a larynx preservation protocol. Laryngectomy was performed as a consequence of poor response to induction chemotherapy in 13 and for recurrent disease after completion of chemotherapy and irradiation in 18. Postoperative pharyngocutaneous fistula occurred in 39%, resulting in prolonged hospitalization. Local control was achieved in 68%, more often in patients with laryngeal as opposed to nonlaryngeal primaries (86% versus 53%; p = .05). The overall actuarial survival and disease-specific survival at 2 years were 32% and 38%, respectively. Disease-specific survival at 2 years was better in patients with laryngeal as compared to nonlaryngeal primaries (56% versus 24%; p = .02). There were no long-term survivors among the nonlaryngeal primary patients. In selected patients in whom larynx preservation failed, salvage laryngectomy was associated with acceptable local control and survival. Palliation was obtained in patients who were not cured by their laryngectomy. Future investigation will focus on identification of factors predicting complications and strategies to reduce the incidence and severity.
Reappraisal of the Monothermal Warm Caloric Screening Test
Authors: Jacobson Gary P. , Calder Jaynee A. , Rupp Katheryn A. , Shepherd Valerie A. , Newman Craig W.
Published: October 2014

The usefulness of a monothermal warm caloric screening test (MWST) for predicting alternate binaural bithermal test abnormalities has been reexamined. Previously, researchers have reported false-negative rates for the MWST ranging from 0% to over 35%. Alternate binaural bithermal test data from 504 consecutive patients were evaluated with MWST failure criteria of 24.5% and 29%, with and without the addition of failure criteria from subtests of the electronystagmography examination. Sensitivity of the MWST alone was high, and improved with additional failure criteria. The specificity levels were correspondingly high. Results support the use of the MWST with adjunctive failure criteria when patients have otherwise normal electronystagmography findings.
Pneumomediastinum after Rigid Bronchoscopy
Authors: Redleaf Miriam I. , Fennessy John J.
Published: October 2014

The accumulation of extrapulmonary air is a well-known complication of airway endoscopic procedures. However, pulmonic disease alone can predispose toward pneumomediastinum and pneumothorax, without iatrogenic manipulation. In this case, a portable chest radiograph diagnosed the cause of the sudden accumulation of extrapulmonary air after rigid bronchoscopy as alveolar rupture, rather than iatrogenic airway perforation. The pathophysiology of pneumothorax and pneumomediastinum and the interpretation of chest radiographs in these situations is reviewed.
Oral Squamous Cell Carcinoma and the Mandible
Authors: Cleary Karen R. , Batsakis John G.
Published: October 2014

Of the various oral carcinoma subsites, the carcinomas related to the mandibular region (alveolar ridge, floor of mouth, lower retromolar area, lower buccal sulcus) are among those with the highest rate of recurrences. Neoplastic invasion of the mandible is one of the factors promoting the recurrences, Determining the presence and extent of bony involvement is therefore critical in the management of patients. The surgeon has several methods to aid in the determination of margins of invasion: radiology, gross clinical inspection, and intraoperative frozen section. Each has its deficiences and in the end, it is a combination of the methods, tempered by clinical judgment, that produces the best result.
Respiratory Manifestations of Gastroesophageal Reflux Disease in Pediatric Patients
Authors: Bauman Nancy M. , Sandler Anthony D. , Smith Richard J. H.
Published: October 2014

Respiratory manifestations of gastroesophageal reflux disease (GERD) are being recognized with increasing frequency. We present the evaluation and management of four infants and children with unusual respiratory symptoms attributed to GERD. The advantages and disadvantages of diagnostic studies of GERD are discussed, and an evaluation and treatment protocol is presented. Treatment must be tailored to the nature and severity of the patient's presenting symptoms and includes conservative, pharmacologic, and/or surgical management.
Vertical Plane Short and Middle Latency Vestibular Evoked Potentials in Humans
Authors: Rodionov Vladimir , Elidan Josef , Nitzan Meir , Sela Mordechai , Sohmer Haim
Published: October 2014

In order to determine whether short and middle latency vestibular evoked potentials (VsEPs) can be recorded in humans in response to angular acceleration stimuli in the vertical plane, a drum, head-holder, and stepper motor were designed to deliver upward acceleration impulses of 10,000°/s2 (1.8° displacement) to the human head. Forehead and mastoid electrodes recorded electrical activity that was filtered, differentially amplified, and averaged in short (12.7 milliseconds) and middle (63.5 milliseconds) latency time frames. Control recordings were used to eliminate various types of artifact. Recordings were conducted in 7 normal subjects and in 4 control patients with congenital, profound hearing loss and absence of caloric responses. Short and middle latency VsEPs with high intrasubject and intersubject consistency were recorded in normal subjects and not in control patients. The middle latency responses were larger in amplitude than the short latency responses. The effects of stimulus intensity and repetition rate on VsEP waveform, latency, and amplitude were studied. Experiments have shown that the responses are not electrical artifact, nor are they contaminated by auditory, somatosensory, or passive eye movement potentials.
Acute Otitis Media and Facial Paralysis in Children
Authors: Elliott Clark A. , Zalzal George H. , Gottlieb Wendy R.
Published: October 2014

We reviewed 10 children who presented with facial paralysis after the onset of acute otitis media. The objective of the study was to examine the outcome of facial paralysis in children with acute otitis media treated without facial nerve decompression. Two groups were identified: 8 patients with incomplete paralysis and 2 with complete paralysis. Seven of the 8 patients with incomplete paralysis had rapid return of function after myringotomy and intravenous antibiotics. The eighth patient had delayed recovery requiring 9 months before complete return of function. The 2 patients with complete paralysis required mastoidectomy to control otorrhea and fever after initial myringotomy and antibiotics. Both patients had a prolonged recovery requiring 3 and 7 months for complete recovery. Patients with incomplete paralysis generally show rapid improvement following wide myringotomy and antibiotic treatment. A more protracted recovery may be expected in patients with complete paralysis; excellent return of function is expected when mastoidectomy without facial nerve decompression is employed.
Lack of Effect of Hot, Humid Air on Response to Nasal Challenge with Histamine
Authors: Desrosiers Martin , Proud David , Naclerio Robert M.
Published: October 2014

We have previously shown that whole body exposure of human subjects to environmental conditions of 37°C and 90% relative humidity (RH) prior to and during nasal challenge with antigen decreases the early response. In this study, we evaluated 1) whether the decreased responses observed resulted from decreased end organ sensitivity to histamine and 2) whether the effect of hot, humid air persisted after the subject exited the hot, humid environment. Ten asymptomatic seasonal allergic subjects and 11 nonallergic subjects were randomized to environmental chamber conditions of either 20°C, 30% RH or 37°C, 90% RH for 1 hour prior to and during performance of a nasal challenge with histamine. Twenty-two hours after exiting the environmental chamber, the allergic subjects were challenged with antigen. During both chamber conditions, histamine challenge was associated with a significant increase in all measured parameters compared to sham challenge, except for the sensations of pruritis and congestion. The response to histamine challenge was not different under the two experimental conditions or between allergic and nonallergic subjects. Following both exposure conditions, allergen challenge was associated with an increase in all measured parameters compared to sham challenge, with no significant difference between the two conditions. Exposure to 37°C, 90% RH minimally affects the response to nasal challenge with histamine, and thus, the previously reported decreases in the early nasal response to antigen may primarily result from reduction in mast cell activation. The effect on antigen does not persist 22 hours after exposure.
Delayed and Progressive Hearing Loss after Microvascular Decompression of Cranial Nerves
Authors: Fuse Takeo , Møller Margareta B.
Published: October 2014

An unusual case of unilateral delayed and progressive hearing loss following a microvascular decompression operation on cranial nerves V, VII, and VIII on the left side is reported. Preoperative and postoperative audiologic evaluation revealed a mild high-frequency hearing loss for both ears, normal thresholds for the acoustic middle ear reflex response, and normal brain stem auditory evoked potentials. Three years after this microvascular decompression procedure, the patient noticed slowly decreasing hearing in her left ear, and subsequent serial audiograms revealed a progressive sensorineural hearing loss and a decrease in her speech discrimination score. Brain stem auditory evoked potentials showed progressive changes. Because of the patient's increasing symptoms of vertigo and tinnitus in the left ear, reexploration of the eighth cranial nerve was performed 5½ years after the initial procedure. This second operation revealed reactive tissue around the eighth cranial nerve that was atrophic and yellow. We interpret the delayed and progressive hearing loss to be a result of reactive scar tissue and progressive atrophy of the auditory nerve.
Orofacial Granulomatosis and Crohn's Disease
Authors: Cleary Karen R. , Batsakis John G.
Published: October 2014

Orofacial granulomatosis is a clinical entity of either unknown or specific causation. Specific causes include sarcoidosis, chronic infective granulomas, and Crohn's disease. The remainder of cases are idiopathic, but the clinical presentations of orofacial swellings and intraoral mucosal lesions are similar. So, too, are the histopathologic findings of noncaseating granulomas, edema, and chronic lymphoproliferative infiltrate. Crohn's disease is not responsible for all forms of orofacial granulomatosis, but the orofacial manifestations of the disease may herald its diagnosis.
Pediatric Exercise-Induced Laryngomalacia
Authors: Bent John P. , Miller Dee Ann , Kim John W. , Bauman Nancy M. , Wilson Jeff S. , Smith Richard J. H.
Published: October 2014

Laryngomalacia is a well-recognized cause of airway obstruction and inspiratory stridor in infants. As children grow and become more active, laryngomalacia may manifest in different, unexpected ways. Otherwise healthy athletes may generate enough inspiratory force to draw the aryepiglottic folds into the endolarynx, causing a subtotal glottic obstruction. This problem may be overlooked or attributed to asthma, lack of fitness, or functional abnormalities. The purpose of this report is to review the prevalence, diagnosis, and treatment of exercise-induced laryngomalacia (EIL) in children and young adults. To study the incidence and diagnosis of this disorder, we examined 10 healthy volunteers. Fiberoptic laryngoscopy was used to videotape each subject's larynx during active exercise on a stationary bicycle. All volunteers demonstrated altered laryngeal dynamics with exercise, and 1 of the 10 volunteers developed laryngomalacia. Anatomically, it appears that the aryepiglottic fold serves as the critical point of obstruction. When symptomatic, laryngomalacia may be treated with supraglottoplasty. We have had experience with 2 EIL patients in the last 12 months who have undergone carbon dioxide laser microlaryngoscopy with supraglottoplasty. Both patients benefited significantly from surgery. We conclude that EIL is underdiagnosed but responds well to treatment.
Vocal Fold Atrophy and its Surgical Treatment
Authors: Isshiki Nobuhiko , Shoji Kazuhiko , Kojima Hisayoshi , Hirano Shigeru
Published: October 2014

The effectiveness of surgical treatment for vocal fold atrophy of various causes was examined. Type I thyroplasty was performed on 31 patients with vocal fold atrophy, often bilaterally and occasionally combined with type III thyroplasty. Of these 31 patients, 3 patients underwent the operation twice, for a total of 34 operations. The surgery was found to be effective in improving the voice quality and the ease of phonation. When a scar or sulcus was present, the results were not as satisfactory. The intraoperative decision-making process as to which procedure to perform is extremely important for achieving an optimal voice, and should be based on the intraoperative voice quality, fiberoptic findings, and manual tests. In operations for vocal fold atrophy in which the vocal folds are mobile, a silicone shim should be firmly fixed to prevent migration. Overcorrection is generally recommended. No complications were encountered. It was often the increased ease of phonation rather than the improved voice quality that patients appreciated after surgery.
Sulcus Vocalis: A Rational Analytical Approach to Diagnosis and Management
Authors: Ford Charles N. , Inagi Katsuhide , Khidr Aliaa , Bless Diane M. , Gilchrist Kennedy W.
Published: October 2014

The term sulcus vocalis has been applied to a spectrum of disorders ranging from minor vocal fold indentations to destructive lesions causing severe dysphonia. To clarify the pathophysiology and to develop a more rational approach to treatment, we report a series of sulcus patients including 20 surgical cases. Clinical and histopathologic analysis produced a clinically useful classification: type 1 is a physiologic variant accentuated by atrophy but with intact lamina propria; types 2 (sulcus vergeture) and 3 (sulcus vocalis) are characterized by severe dysphonia, loss of vibratory activity, and destruction of the functional superficial lamina propria. These latter cases respond favorably to microsurgery designed to remove destroyed tissue, release scar contracture, and promote mucosal redraping by regional undermining. Further study of the extracellular matrix of the superficial lamina propria (Reinke's space) might indicate a common pathway in the pathogenesis of sulcus deformities and other related benign vocal fold lesions.
Postural Changes in Respiratory Airflow Pressure and Resistance in Nasal, Hypopharyngeal, and Pharyngeal Airway in Normal Subjects
Authors: Tvinnereim Magne , Cole Philip , Mateika Susan , Haight James , Hoffstein Victor
Published: October 2014

We investigated the effect of posture on nasal and pharyngeal resistance in 12 healthy subjects studied during wakefulness. Airway pressure and airflow were measured with subjects seated and in dorsal and left lateral recumbency, during inspiration and expiration. We found that pharyngeal resistance was approximately four to six times lower than the nasal resistance. Only pharyngeal resistance was significantly increased upon assumption of a supine posture, from 0.02 ± 0.01 Pa/mL per second when seated to 0.06 ± 0.05 Pa/mL per second in dorsal recumbency and to 0.05 ± 0.04 Pa/mL per second in left lateral recumbency. Mean nasal and pharyngeal resistances doubled upon assumption of a supine posture, but this difference was not statistically significant. There was no significant difference in pharyngeal resistance beween inspiration and expiration. Finally, there was a strong linear relationship between pharyngeal pressure and pharyngeal resistance (r = .98, p < .0001). We concluded that in normal awake subjects 1) pharyngeal resistance increases with assumption of a supine posture, 2) the walls of the pharynx are not compliant enough to alter their resistance in response to inspiratory and expiratory pressure changes, and 3) it may be possible to infer pharyngeal resistance from measurements of pressure alone, without measurement of airflow.
Schneiderian-Type Mucosal Papillomas of the Middle Ear and Mastoid
Authors: Wenig Bruce M.
Published: October 2014

Five cases of schneiderian-type mucosal papillomas arising in the middle ear space are reported. The patients were all women, ranging in age from 19 to 57 years (median, 31 years). Clinical complaints — unilateral conductive hearing loss, pain, or otorrhea — ranged from those lasting several months to recurrent problems spanning 20 years. All of the patients had a history of chronic otitis media predating the development of the papillomas; none of the patients had a history of sinonasal or nasopharyngeal schneiderian-type papillomas. Clinically, three patients had intact tympanic membranes, while the other two patients had perforated tympanic membranes through which a bulging polypoid mass was identified. Radiographic studies showed opacification of the middle ear space without evidence of osseous destruction. The intraoperative findings were of polypoid lesions filling the middle ear space, including involvement of the eustachian tube orifice. Histologically, the tumors were identical to sinonasal schneiderian papillomas. Immunohistochemical evaluation for human papillomavirus was negative. Surgical excision is the treatment of choice. In four of the patients, recurrent tumor was identified, necessitating additional surgery. In only one patient did the initial surgery result in complete ablation of the tumor. All patients are alive and free of recurrent disease over periods ranging from 6 months to 120 months (median, 84 months).
Laryngeal Pleomorphic Rhabdomyosarcoma a Critical Review of the Literature
Authors: Da Mosto M. Cristina , Rinaldo Alessandra , Marchiori Carlo , Ferlito Alfio
Published: October 2014

A case report of pleomorphic rhabdomyosarcoma of the larynx is presented. It is the first case in which the diagnosis is supported by immunohistochemical investigation. A critical review of the literature follows, evaluating the clinicopathologic features of this rare malignancy.
Carcinoma of the Anterior Commissure of the Larynx: I. Embryological and Anatomic Considerations
Authors: Gammarota Lucio , Rucci Lucio , Cirri Maria Bruna Borghi
Published: October 2014

In this study we attempt to define the organization of the anterior region of the adult larynx, on the basis of its development. For this purpose, we have studied the development of the anterior commissure region on serial sections of human larynges from embryos, fetuses, and adults. Our findings indicate that all the structures of this region derive from a single median mesenchymal band, first evident at 7 to 8 weeks of gestation, between the lateral laminae of the thyroid cartilage. This band of mesenchyme gives rise to all the structures along the midline of the thyroid cartilage and immediately beyond, including the intermediate lamina of the thyroid cartilage, the median process, and the connective tissue that connects the latter with the conoid ligament. We provide, for the first time, evidence that Broyles' ligament (commissural tendon) derives from the dorsal part of the median process and becomes intimately connected with the surrounding structures, including the insertion fibers of the vocal muscles, from early in development. On the basis of this finding we identify an independent anterior commissure region in the adult larynx, which comprises the intermediate lamina, Broyles' ligament, the connective tissue between the Broyles' and conoid ligaments, and the insertion fibers of the vocal muscles. The interpretation of all these structures as a unified region can explain the peculiar progression pathways and evolution of commissural and cordo-commissural tumors.
Demonstration of the Nasal Septal Branches of the Sphenopalatine Artery by Use of a New Intravascular Injection Method
Authors: Fujii Mayumi , Moriyama Hiroshi , Goto Noboru , Kikuchi Kyozo , Shimada Kazuyuki , Kida Akinori
Published: October 2014

We injected a new injection material into the external carotid artery using a new method, which led to the successful demonstration of the nasal septal branches of the sphenopalatine artery in human cadavers. The result shows the trunk of the artery divided into three main branches, the upper two of which run toward Little's area. We believe that the knowledge of septal branches, shown in a photograph, is very useful, not only for nasal treatment, but also for anatomic demonstration to students.
Postoperative Care following Single-Stage Laryngotracheoplasty
Authors: Bauman Nancy M. , Kao Simon C. S. , Oyos Tanya L. , Biavati Michael J. , Murray David J. , Smith Richard J. H.
Published: October 2014

Single-stage laryngotracheoplasty (SSLTP) provides a method of correcting mild-to-moderate laryngotracheal stenosis while avoiding the risks of prolonged laryngeal sten ting. Pediatric patients are orally intubated for 5 to 7 days postoperatively to ensure an adequate airway while edema resolves and healing begins. During this period, continuous neuromuscular blockade has been advocated in infants and young children to avoid endotracheal tube trauma to the fresh graft and potentially life-threatening accidental decannulation. Pulmonary atelectasis is the most common morbidity associated with prolonged neuromuscular blockade. Neuromuscular weakness also may follow prolonged paralysis and prolong hospitalization. This paper compares the postoperative course of 17 patients who underwent 18 SSLTP procedures by the senior author. The first 8 patients received continuous neuromuscular blockade in the early postoperative period. To reduce perceived morbidity, the last 9 patients were managed with a protocol that incorporated daily 4- to 8-hour “interruptions” of paralysis. Seven patients tolerated this protocol modification. As a group, these patients had less postoperative pulmonary atelectasis prior to extubation (p < .05) and were extubated sooner than patients receiving continuous neuromuscular blockade (p < .05) without compromising the surgical success of the procedure. Intermittent paralysis permitted for more accurate assessment of pain control and protected against accidental drug accumulation. Although self-extubation did not occur, diligent nursing care with adequate sedation and analgesia is necessary to avoid the risk of accidental extubation.
Inflammatory Myopathy Causing Pharyngeal Dysphagia: A New Entity
Authors: Shapiro JO , Degirolami Umberto , Martin Sandra , Goyal Raj
Published: October 2014

Seven patients presented to our swallowing center with solid food dysphagia. The age range at presentation was 69 to 90 years. All patients had normal findings on neurologic evaluation, and in those patients undergoing electromyography and nerve conduction studies, results of all such tests were also normal. Pooling of saliva in the pharyngeal recesses was noted on fiberoptic laryngoscopy in most cases. The swallowing videofluoroscopy findings were strikingly similar. All patients had a prominent cricopharyngeus muscle, and some had a prominence in a more proximal portion of the inferior constrictor muscle. All patients had decreased epiglottic tilt and moderate or severe residue in the pharyngeal recesses. Three patients underwent pharyngoesophageal sphincter myotomy. Biopsies of the omohyoid and cricopharyngeus muscles showed inflammatory myopathy with no evidence of inclusion bodies. This is a distinct clinical entity defined by isolated pharyngeal dysphagia in elderly patients with a unique videofluoroscopic appearance and pharyngeal myopathy.
Vocal Fold Submucosal Infusion Technique in Phonomicrosurgery
Authors: Kass Erik S. , Hillman Robert E. , Zeitels Steven M.
Published: October 2014

Phonomicrosurgery is optimized by maximally preserving the vocal fold's layered microstructure (laminae propriae). The technique of submucosal infusion of saline and epinephrine into the superficial lamina propria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the submucosal infusion technique was used to enhance the surgery in 75 of 152 vocal fold procedures that were performed over the last 2 years. The vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from cancer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radiotherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissection in the SLP was necessary. The infusion enhanced the surgery by vasoconstriction of the microvasculature in the SLP, which improved visualization during cold-instrument tangential dissection. Improved visualization facilitated maximal preservation of the SLP, which is necessary for optimal pliability of the overlying epithelium. The infusion also improved the placement of incisions at the perimeter of benign, premalignant, and malignant lesions, and thereby helped preserve epithelium uninvolved by the disorder.
Reconstruction of the Rabbit Trachea with Vascularized Auricular Perichondrium
Authors: Naficy Saman , Esclamado Ramon M. , Clevens Ross A.
Published: October 2014

Success in laryngotracheal reconstruction has been limited, in part, by the lack of an ideal grafting material. Perichondrium is thin, pliable, and highly vascularized and has the ability to generate new cartilage providing rigid support. These qualities make vascularized perichondrium potentially the ideal grafting material for circumferential airway stenosis. A pedicled vascularized flap of auricular perichondrium was used in a rabbit model (n = 39) to reconstruct a near-circumferential tracheal defect without a tracheostomy. A stent was used to support the reconstructed airway for 6 weeks, after which time it was removed by direct laryngoscopy. Animals were observed for an additional 6 weeks prior to sacrifice. Qualitative and quantitative histologic analysis of neochondrogenesis is reported. Vascularized perichondrium and periosteum show promise as potential grafts for reconstruction of circumferential tracheal defects.
Carcinoma of the Anterior Commissure of the Larynx: II. Proposal of a New Staging System
Authors: Rucci Lucio , Gammarota Lucio , Gallo Oreste
Published: October 2014

On the basis of embryology and clinical experience, we have defined here an anterior commissure (AC) subsite of the human larynx and have addressed the issue as to whether the degree of involvement of this subsite is related to the outcome of glottic cancer, in terms of local control within 5 years of therapy. Retrospective analysis of 534 patients included 1) classification of patients according to the TNM, 2) actuarial evaluation of the outcome, 3) reclassification of patients according to the involvement of the AC subsite, and 4) ree valuation of the outcome according to this latter classification. The results showed that the outcome was not well correlated with TNM classification, whereas patients with progressively heavier involvement of the AC subsite had a progressively worse outcome. On the basis of these data, we suggest that TNM classification of cancer involving the AC be implemented by an AC classification, in order to better forecast the prognosis and design specific conservative surgery.