bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic Evaluation of Children with Nasopharyngeal Obstruction Due to the Adenoid
Authors: Kemaloglu Yusuf K. , Inal Erdogan , Goksu Nebil , Akyildiz Necmettin
Published: October 2014

The adenoidal-nasopharyngeal ratio (ANR) was proposed as a convenient and practical method to evaluate adenoidal enlargement. We analyzed cephalometric radiographs of 150 children divided into 6 subgroups according to clinical assessment (possible adenoidectomy candidates [PACs] and controls) and age. Our purpose was to investigate the predictive reliability of different ANRs calculated on the same reference line. Each of the ANRs described in this study presented statistically significant differences between PACs and control groups, and highly significant correlations with clinical symptoms of nasal obstruction. Further, the mean adenoidal depth was significantly larger in PACs than in normals, and it was found that the adenoidal depth in PACs did not show a significant decrement with age, in contrast to normals. On the other hand, although nasopharyngeal depth was not different between PACs and normals, an age-dependent increment was observed in PACs, in contrast to normals. Thus, it could be said that the ANR is a more reliable method for determining whether adenoidal hyperplasia is clinically significant or not, rather than the size of the adenoid or nasopharynx.
Titanium Vocal Fold Medializing Implant: Introducing a Novel Implant System for External Vocal Fold Medialization
Authors: Friedrich Gerhard
Published: October 2014

With the increasing worldwide spread of the Isshiki technique for external vocal fold medialization, some disadvantages and limitations have also emerged, and an increasing demand for a ready-made and standardized implant system can be observed. For this reason, I started experimental and clinical investigations with the goal of replacing the silicone with a safer material, and also simplifying and standardizing the surgical procedure. In particular, the danger of implant dislocation should be excluded with greater certainty. As a result, I have developed an implant made of medical-grade titanium. My surgical experiences in 20 patients with this newly developed titanium vocal fold medializing implant revealed that vocal fold medialization could be performed easily and that no perioperative complications occurred in any case. The major advantage was a significant reduction of operative time due to the preformed implant. This is not only more convenient for both the surgeon and the patient, but is also critical for obtaining optimal results due to the reduced intralaryngeal swelling and hematoma. The reduction of the glottic gap by the operation was statistically significant. Significant improvement of all voice parameters was achieved and demonstrated by a statistically significant reduction of the voice dysfunction index. Compared to the current techniques and implant systems, I see the following additional advantages: 1) titanium is a relatively safe implant material with excellent biocompatibility; 2) the design of the implant ensures optimal fixation and stabilization; 3) the implantation technique and handling is simple and time-saving; 4) the titanium sheet is easy to shape and adapt to the individual situation; and 5) only 2 sizes of implants, and no expensive instruments, are required.
Diagnostic and Therapeutic Management of Bilateral Carotid Artery Occlusion Caused by Near-Suicidal Hanging
Authors: Maier Wolfgang , Malatskey Shelton , Fradis Milo , Krebs Annette
Published: October 2014

In cases of attempted suicide by hanging, a combination of mechanisms causing local destruction of the pharynx, larynx, vessels, and spine, as well as neurologic complications, has to be considered. We present a case of hanging in which a deeply unconscious patient without any palpaple pulsation of the carotid arteries was referred to our otolaryngology department. Computed tomography and angiography showed parapharyngeal air, complete obstruction of both common carotid arteries, and a compensatory circulation through the vertebral arteries. Three hours after the trauma, surgical exploration with resection of the enrolled intima of both carotid arteries and repair of the pharynx was performed. The patient awoke with an infarct of the right hemisphere with incomplete left hemiparesis the next day, but symptoms slowly declined during the following months, and the patient learned swallowing again perfectly. We conclude from our experience that in near-hanged patients a prompt onset of adequate diagnostic and therapeutic measures is mandatory, as good neurologic and functional results may occur even in cases with coma and severe destruction of the carotid arteries and pharyngeal and laryngeal structures. Surgical repair of blunt carotid lesions is recommended and may be crucial for a good outcome.
Patulous Eustachian Tube in Long-Term Survivors of Nasopharyngeal Carcinoma
Authors: Cheng Po-Wen , Young Yi-Ho , Lou Pei-Jen
Published: October 2014

This article reports on 21 long-term (10 years) survivors of nasopharyngeal carcinoma, divided into 2 groups: those subjected to an inflation-deflation test and a clearance function test in a longitudinal study, and those receiving sonotubometry in a cross-sectional study. On the inflation-deflation test, 12 (55%) out of 22 ears had a patulous eustachian tube, and on sonotubometry, 10 (50%) out of 20 ears also revealed a patulous eustachian tube. Except for 4 ears with chronic otitis media, the ears had resolved to a normal eardrum appearance at 10 years postirradiation. The phenomenon might be attributed to both restoration of the impaired tubal function and the development of a patulous tube.
Three-Dimensional Quantification of “Still” Points during Normal Facial Movement
Authors: Coulson Susan E. , Croxson Glen R. , Gilleard Wendy L.
Published: October 2014

This study investigated the 3-dimensional displacement of points on the face that were thought to be still during facial movement. These points are currently used to measure displacement of moving facial regions during assessment of normal facial movement and treatment interventions following facial nerve paralysis. It is, however, unknown if these places are “still” points. The Expert Vision Motion Analysis System was used to collect and analyze data on 42 normal subjects during facial movement. No point on the face was found to be still during facial expression. However, several points were present with very small movements for each individual expression. These were termed “reference” points. These small movements may be the result of system noise, physiological tremor, skin movement, or head-holder movement during facial expressions. Future studies of the displacement of the markers during facial movement in both normal subjects and patients with facial nerve paralysis may take into account the contribution of the “reference” point displacements to the overall facial movement.
Immune Response to Fusobacterium Nucleatum and Prevotella Intermedia in Patients with Chronic Maxillary Sinusitis
Authors: Brook Itzhak , Yocum Paula
Published: October 2014

Our objective was to study the immune response to 2 anaerobic bacteria in patients with chronic maxillary sinusitis. Immunoglobulin G class antibody titers to Fusobacterium nucleatum and Prevotella intermedia were measured by enzyme-linked immunosorbent assay. Serum levels in the patients were determined on the day sinus aspiration for culture was done, and 75 to 90 days later, after completion of antimicrobial therapy, Prevotella intermedia was isolated from 16 aspirates, and F nucleatum from 12. Median antibody levels at day 1 for F nucleatum and P intermedia were significantly higher in patients whose serum aspirates harbored these organisms than at days 75 to 90 in those who were cured (p < .05). However, the levels stayed elevated in the 5 patients who did not improve. The elevated antibody levels to F nucleatum and P intermedia, known oral pathogens, suggest a potential pathogenic role for these organisms in chronic maxillary sinusitis.
Double-Blind Comparative Trial of Ciprofloxacin versus Clarithromycin in the Treatment of Acute Bacterial Sinusitis
Authors: Clifford Kevin , Tosiello Robert , Huck Werner , Echols Roger M. , Shan Michael , Heyd Allen ,   And The Sinusitis Infection Study Group
Published: October 2014

This multicenter, randomized, double-blind trial compared the efficacy and safety of ciprofloxacin (CIP; 500 mg twice daily for 10 days, placebo for 4 days) to those of clarithromycin (CLARI; 500 mg twice daily for 14 days) in 560 adults with clinically documented and radiologically confirmed acute sinusitis. Of 457 efficacy-valid adults (236 CIP, 221 CLARI), clinical resolution plus improvement at the end of therapy was 84% for CIP-treated patients compared to 91% of CLARI recipients (CI95 = −0.131, −0.013). At the 1-month follow-up, more than twice as many CLARI-treated patients, 18 (10%), experienced a relapse, compared to 7 (4%) CIP-treated patients. The combined clinical response analyses (end of therapy and 1-month follow-up) demonstrated that CIP and CLARI were statistically equivalent (CI95 = −0.106, 0.044). Diarrhea, nausea, headache, and dizziness were the most frequently reported drug-related adverse events in both treatment groups; diarrhea and taste perversion were reported more frequently among CLARI recipients. In summary, the combined end of therapy and follow-up clinical evaluation analyses revealed that CIP and CLARI were equally effective in the management of acute sinusitis, although twice as many relapses were reported among CLARI recipients.
Utility of Radiographs in the Evaluation of Pediatric Upper Airway Obstruction
Authors: Walner David L. , Donnelly Lane F. , Ouanounou Serge , Cotton Robin T.
Published: October 2014

The evaluation of children with airway obstruction always involves a history and physical examination. The definitive diagnosis is most often made with microlaryngoscopy and bronchoscopy (MLB), and in cases of extrinsic compression, information is gained from magnetic resonance imaging. Although plain radiographs of the airway are often used as a primary diagnostic modality in children with airway obstruction, the accuracy of plain radiographs in predicting specific airway abnormalities has not previously been evaluated. This study was designed to correlate the findings of plain airway radiographs with the diagnosis made at the time of MLB. Medical records from 1991 to 1996 were reviewed to identify patients that had MLB and airway radiographs within 2 days of one another. One hundred forty-four cases were identified and divided into diagnostic categories. Statistical analysis showed a high sensitivity (>86%) for the accuracy of the radiologic diagnoses of exudative tracheitis, airway foreign body, and innominate artery compression. Laryngomalacia and tracheomalacia had a much lower sensitivity (5% and 62%, respectively). We believe that plain radiographic evaluation of the airway provides important information to the diagnostician. However, plain radiographs can be inaccurate and must be considered along with a history, physical examination, and clinical suspicion. Microlaryngoscopy and bronchoscopy remains the ultimate diagnostic test for airway disorders.
Quantitative Study of Germinal Center Area in Normal and Diseased Tonsils Using Image Analysis
Authors: Gorfien Janet L. , Hard Robert , Noble Bernice , Brodsky Linda
Published: October 2014

The aim of this study was to measure the germinal center area of secondary follicles in a consistent and unbiased manner using image analysis. Tonsil specimens were obtained from children with clinical evidence of recurrent tonsillitis and/or idiopathic tonsillar hypertrophy. Normal control biopsy specimens were obtained from children with no history of ear, nose, or throat infections. The results show a significant increase in the germinal center area in tonsils exhibiting hypertrophy when compared to normal controls (p < .002). Image analysis is an important tool for making quantitative size comparisons in lymphoid tissues.
Severe Combined Immunodeficiency: Otolaryngological Presentation and Management
Authors: Stocks Rose Mary S. , Thompson Jerome W. , Kun Sheila , Church Joseph A. , Simms Erin
Published: October 2014

In order to increase the awareness of otolaryngologists of severe combined immunodeficiency syndrome (SCIDS) so they may contribute to an earlier diagnosis of this disorder, we performed a retrospective chart review of a multicenter series from 2 children's hospital medical centers. Eighteen cases were identified, and 14 had an otolaryngological presentation. The average age of presentation was 3.3 months, and 72% were males. Most cases were inherited in an X-linked fashion. Five patients had thrush; 4 had recurrent otitis media. Other otolaryngological presentations included cough, mouth ulcers, pharyngitis, mastoiditis, and bilateral neck abscess. The most severe form of immunodeficiency, SCIDS is a rare condition that involves a disorder in both T and B cell functions. The manifestations involving the head and neck include recurrent upper respiratory tract infections, otitis media, thrush, oral ulcers, and abscesses. It is important that SCIDS be considered in any infant with recurrences of these common infections.
Antibiotics in Chronic Suppurative Otitis Media: A Bacteriologic Study
Authors: Indudharan R. , Haq J. Ashraful , Aiyar Subramania
Published: October 2014

Conservative medical management of chronic suppurative otitis media (CSOM) is an important step in achieving a dry ear. Topical antibiotic ear drops and aural toilet form the mainstay of medical management of noncholesteatomatous CSOM. This study analyzes the causal organisms and their sensitivity to various antibiotics. Out of 382 swabs examined, the major organisms isolated were Pseudomonas aeruginosa (27.2%), followed by Staphylococcus aureus (23.6%). The sensitivity of P aeruginosa was 100% to ceftazidime, 98.9% to ciprofloxacin, 96.3% to gentamicin, and 95.4% to polymyxin B, whereas the sensitivity of S aureus was 98.6% to ciprofloxacin, 97.4% to cloxacillin sodium, 96.5% to cotrimoxazole, and 90.7% to gentamicin. Pseudomonas aeruginosa was almost completely resistant to ampicillin (97.6%) and chloramphenicol (96.6%), whereas S aureus was almost completely resistant to ampicillin (73.8%) and polymyxin B (98.3%). Among the available topical antibiotic preparations for use in the ear, we found that ciprofloxacin and gentamicin are the best choices.
Twenty-Four—Hour Oscillations of Facial Electroneurography Parameters and Their Relationship to Body Temperature
Authors: Paz Adrian , Kronenberg Yehuda , Ashkenazi Israel
Published: October 2014

The purpose of the present study was to assess the temporal variation of the facial electroneurography (ENoG) parameters recorded from the nasolabial crease and to compare it to the temporal oscillations of oral and facial cutaneous temperatures. Twelve healthy individuals were examined at 4-hour intervals for 2 consecutive days. Twenty-four-hour rhythms of oral and facial cutaneous temperatures were found in all subjects (troughs on average at 4:20 and 4:00 am, respectively). Significant 24-hour oscillations of ENoG amplitude were found in all subjects, which were positively correlated to the oscillations of oral and facial cutaneous temperatures (trough on average at 2:40 am). The compound action potential (CAP) latency fluctuated during the day and was negatively correlated with local temperatures. However, these fluctuations and correlations did not reach statistical significance. We also found a significant reduction of ENoG amplitude in 5 patients with artificial cooling of the face near the facial nerve. Also, there was a small increase in CAP latency with facial cooling. Interpreting ENoG recordings in accordance with oral temperature and recording time of day reduce the intertest variation.
Sinusitis with Contiguous Abscess Involvement of the Clivus and Petrous Apices; Case Report
Authors: Hoistad Dick L. , Duvall Arndt J.
Published: October 2014

A wide spectrum of diseases may involve the clivus, such as primary neoplasms, metastatic disease, and inflammatory, vascular, hematopoietic, and infectious processes. Of these, osteomyelitis of the skull base and/or clival-petrous abscess are unusual, but may occur as a result of contiguous spread from the paranasal sinuses, namely, the posterior ethmoid and sphenoid, as was demonstrated by this patient. In this case report we discuss the pertinent anatomy, imaging studies, pathogenesis, and medical and surgical management of this case.
Flow Cytometric Analysis of Bhrf1 Expression Prohibiting Apoptosis Induced by Radiation
Authors: Pan Xinghua , Yu Long , Huang Hai , Zhou Shuimiao , Kong Xiantao , Li Zhaoji , Zheng Qiping
Published: October 2014

The Epstein-Barr virus gene BHRF1 has homology with proto-oncogene bcl-2, which can protect cells from apoptosis. In order to investigate the effect of BHRF1 expression on the anti-apoptotic ability of nasopharyngeal carcinoma (NPC) cells after irradiation, a high—BHRF1 expression vector was constructed and transfected into the NPC cell line CNE2. Then, the alteration of proliferation and apoptosis in the cells was tested by flow cytometry after cobalt 60 irradiation. The results showed that BHRF1 expression could increase G1 delay and decrease the cell percentage in S phase before irradiation, and reduce the apoptotic rate of CNE2 cells and increase the cell percentage in S phase after irradiation. The results suggest that BHRF1 expression is able to alter the cell cycle and protect CNE2 cells from apoptosis induced by radiation.
Glandular Carcinoma of the Larynx: The Ucla Experience
Authors: Alavi Sassan , Calcaterra Thomas C. , Namazie Ali , Blackwell Keith E.
Published: October 2014

Glandular carcinomas of the larynx are rare tumors that constitute less than 1 % of all laryngeal malignancies. A retrospective case review of 12 patients with glandular carcinomas of the larynx is presented to identify patient and tumor characteristics, therapeutic modalities, and treatment outcomes. Ten patients underwent surgical excision of the primary tumor, by either supraglottic laryngectomy, vertical partial laryngectomy, or total laryngectomy. Seven of these patients also received postoperative radiotherapy. After a median follow-up period of 23 months, 7 of the 12 patients (58.3%) died as a result of uncontrolled locoregional disease or distant metastases. The 5-year survival rate was 57% in patients who underwent combination therapy versus 50% for those patients who received surgery alone. Surgical resection is the primary treatment modality used in the majority of cases. Neck dissection is reserved for patients with clinically apparent adenopathy, adenocarcinoma, or high-grade mucoepidermoid carcinoma. Combination therapy with surgical resection and radiotherapy may be more effective in achieving tumor remission than is surgical resection alone.
Relationship of the Utriculus and Sacculus to the Stapes Footplate: Anatomic Implications for Sound- and/or Pressure-Induced Otolith Activation
Authors: Backous Douglas D. , Aboujaoude Edward S. , Minor Lloyd B. , Nager George T.
Published: October 2014

One hundred thirty human temporal bones that were sectioned in the vertical plane were examined to evaluate the relationship between the stapes footplate and the otolith organs. The shortest distance between the footplate and the utriculus was 0.58 ± 0.10 mm in the posterior third of the oval window, 1.04 ± 0.20 mm in the middle third, and 1.51 ± 0.20 mm in the anterior third. The distance from the sacculus to the footplate was 1.33 ± 0.20 mm in the middle third of the oval window and 1.31 ± 0.18 mm in the anterior third. Membranous connections extending between the utriculus and the footplate were found in 26% of temporal bones. These membranous connections in coexistence with additional anatomic factors such as stapes hypermobility and/or dehiscence of bone within labyrinthine structures may predispose patients to sound- and/or pressure-induced otolith activation. The findings may have implications for different causes of the Tullio phenomenon.
Efficacy of an Antiallergic Drug on Otitis Media with Effusion in Association with Allergic Rhinitis; An Experimental Study
Authors: Suzuki Masashi , Kawauchi Hideyuki , Kerakawauchi Hideomi , Mogi Goro
Published: October 2014

The effect of an antiallergic drug on the evacuation of middle ear effusion (MEE) from the tubotympanum was investigated by means of an animal model with both otitis media with effusion (OME) and allergic rhinitis. Azelastine hydrochloride (AZ), an oral antiallergic drug, was administered and the presence of MEE was investigated. Serous MEE was seen in 12 of the 13 untreated control animals on the 11th day after the experimental OME was induced, whereas MEE was detected in 9 of the 13 animals administered 1 mg/kg of AZ, but only in 4 of the 13 animals administered 2 mg/kg of AZ. In addition, the effect of AZ on MEE production was also examined in an experimental OME animal model without allergic rhinitis. Middle ear effusion was observed in all OME animals that received 2 mg/kg AZ for 5 consecutive days, before and 3 days after the experimental OME was induced. Results of the present study indicate that AZ promotes the evacuation of MEE from the tubotympanum in the OME animal model associated with nasal allergy. These data suggest that an antiallergic drug may contribute to the therapy of OME patients in association with nasal allergy indirectly, by promoting evacuation of MEE due to inhibition of type I allergic reactions in the nasopharynx.
Objective Evaluation of Normal Facial Function
Authors: Scriba Henning , Stoeckli Sandro J. , Veraguth Dorothe , Pollak Anita , Fisch Ugo
Published: October 2014

The aim of this investigation was the assessment of normal facial movements using the objective computer-assisted OSCAR method. Computerized black-and-white video images of 20 healthy volunteers were recorded with the face at rest, maximal wrinkling of the forehead, forced eye closure, and forced smiling. The mean regional symmetry index was found to be 91% (SD 6%; range 80% to 99%) for wrinkling of the forehead, 93% (SD 5%; range 82% to 100%) for forced eye closure, and 91% (SD 5%; range 79% to 98%) for maximal smiling. Clinical weighting gave a global symmetry index of 92% (SD 3%; range 88% to 96%). The presented results show that the physiological dynamic asymmetry of the normal face is 7% to 9%. No dominant facial side could be found. The comparison of the results obtained with the OSCAR method with those of the subjective House-Brackmann and Fisch grading systems showed that the physiological asymmetry of facial movements can only be accurately determined with a computer-assisted objective method.
Fat Implantation into Reinke's Space: A Histologic and Stroboscopic Study in the Canine
Authors: Woo Peak , Rahbar Reza , Wang Zhi
Published: October 2014

The scarred vocal fold is a cause of persistent dysphonia after laryngeal trauma, microsurgery, and tumor resection. The loss of Reinke's space with scar and stiffness is the primary cause. This study explores the technical aspects of endoscopic implantation of fat as an autologous implant for restoring the bulk and pliability of the vocal folds. Fat from the buccal area was harvested and prepared in 6 dogs. A mucosal flap submucosal pocket was prepared by means of microlaryngoscopy instrumentation. The fat implant was placed into the submucosal pocket. The mucosal flap was sutured endoscopically. Six weeks later, the larynx was harvested and mounted, and vocal fold oscillation was studied while driven by a humidified flow source. The vibratory patterns were studied by stroboscopy. Histologic sections of the vocal folds were made in the coronal plane. All 6 specimens had histologic evidence of viable implanted fat and/or fibrous tissue at the implant site. The site of implantation was in the superior aspect of the vocal fold, but contributed to mass in vocal fold bulk. This increase in bulk histologically corresponded to stroboscopic evidence of increased mass. On stroboscopy, the implant side continued to demonstrate good vibratory function. The study shows that fat implantation can be carried out as an endoscopic procedure. Fat implantation may be useful as a surgical procedure for restoration of Reinke's space. It may be applicable in patients with scars, sulcus vocalis, or vocal fold atrophy.
Immunohistochemical Distribution of Extracellular Matrix Components and Keratin in Experimentally Induced Otitis Media
Authors: Harada Teruhiko , Kim Youngki , Juhn Steven K. , Sakakura Yasuo
Published: October 2014

The distribution of collagen types I, III, and IV and of laminin, fibronectin, and keratin was studied in otitis media experimentally induced by Streptococcus pneumoniae in the chinchilla. The expression of interstitial collagen types I and III and of fibronectin was increased in the subepithelial space that was thickened by inflammation in the acute period of infection. The expression of collagen type IV in the subepithelial space could be seen in the early period. The epithelial cells in the middle ear changed from flat cuboidal to pseudostratified columnar in pneumococcus-inoculated ears, and the number of keratin-positive epithelial cells in the middle ear increased remarkably after infection. These results indicate that changes in epithelial cell differentiation effected by the extracellular matrix correlate with changes in expression of keratin. It is proposed that the extracellular matrix may contribute to tissue repair in the middle ear after bacterial infection by interfering with cell proliferation of epithelial cells and fibroblasts.
Nitric Oxide Synthase Type 3 is Increased in Squamous Hyperplasia, Dysplasia, and Squamous Cell Carcinoma of the Head and Neck
Authors: Bentz Brandon G. , Haines G. Kenneth , Lingen Mark W. , Pelzer Harold J. , Hanson David G. , Radosevich James A.
Published: October 2014

The implication of nitric oxide (NO) in the multistep process of carcinogenesis prompted us to examine the expression of endothelial constitutive nitric oxide synthase (NOS3) in head and neck squamous cell carcinoma (HNSCCa). Eleven paraffin-embedded samples of normal oral mucosa, 3 reactive oral lesions, 13 samples of squamous dysplasia, and 120 specimens of HNSCCa were immunostained with an anti-NOS3 monoclonal antibody and graded on a 0 to 4+ scale of intensity. Normal squamous mucosa demonstrated very little NOS3 expression. Areas of normal mucosa, reactive mucosa, and dysplastic lesions associated with inflammation tended to demonstrate regional expression of NOS3. Reactive mucosal lesions, squamous dysplasia, and HNSCCa demonstrated a significant (p < .0001) increase in global expression of NOS3. Therefore, NOS3 is expressed very little in histologically normal squamous mucosa, while squamous hyperplasia, dysplasia, and HNSCCa express significantly more NOS3. Regional variation in NOS3 expression appears to be associated with perilesional inflammation.
Quantitative Glycohistochemical Characterization of Normal Nasal Mucosa, and of Single as Opposed to Massive Nasal Polyps
Authors: Choufani Georges , Danguy Andre , Hassid Sergio , Nagy Nathalie , Gabius Hans-Joachim , Kaltner Herbert , Kiss Robert
Published: October 2014

A series of 41 nasal polyps (23 single and 18 massive) and 6 normal nasal mucosa specimens was glycohistochemically investigated. Five plant lectins were used, ie, the peanut agglutinin (PNA), the wheat germ agglutinin (WGA), the gorse seed agglutinin (UEA-I), the Maackia amurensis agglutinin (MAA), and the elderberry bark agglutinin (SNA). A neoglycoconjugate and 2 animal lectins (CL-14 and CL-16) were also used. Three quantitative features were calculated by means of computer-assisted microscopy: the percentage of tissue area specifically stained by the histochemical probe, the staining intensity, and the heterogeneity level of the staining distribution. The results show that with respect to sialic acid-glycoprotein binding characteristics as determined by SNA, MAA, and WGA probes, the normal nasal mucosa differed markedly (p < .00001) from the polyposal one. The single nasal polyps exhibited glycohistochemical characteristics that differed markedly (p = .0004) from those exhibited by the massive ones. These differences related mainly to the UEA-I, PNA, and the Thomsen-Friedenreich antigen—exposing neoglycoprotein binding characteristics. In conclusion, the present study shows unambiguously that polyposal mucosa, whether of the single or the massive type, exhibits markedly distinct glycohistochemical characteristics when compared to normal nasal mucosa, and that single nasal polyps also differ markedly from massive ones.
Esophageal Contractility Synchronous with Expiration
Authors: Mohri Mitsuhiro , Ohtsuki Naoki , Amatsu Mutsuo
Published: October 2014

On the basis of our previous finding that the cervical esophagus was closed during tracheoesophageal phonation, we postulated that the muscle of the cervical esophagus actually contracted during expiration and speculated on its possible regulation by the recurrent laryngeal nerve. Electromyography of the esophageal musculature and fluoroscopy of the esophagus were performed in laryngectomees to demonstrate whether the esophagus contracted during expiration or not. Electromyography, performed in 2 subjects, revealed a burst of discharges synchronous with expiration. Fluoroscopy during tracheoesophageal phonation was performed in 13 subjects to investigate the influence of resection of the esophageal branch of the recurrent nerve on esophageal motor activity. Among 13 subjects, 4 subjects who underwent paratracheal dissection (PTD) at the time of laryngectomy showed a lower superior limit of esophageal closure than did the 9 subjects without PTD, indicating that the cervical esophagus in PTD loses its contractility with the sacrifice of the esophageal branch of the recurrent nerve. We concluded that the cervical esophagus is closed by muscle contraction synchronous with expiration, preventing air entry into the stomach during deep expiration or phonation, and that the esophageal branch of the recurrent nerve is involved.
Management of the Neck in Cancer of the Larynx
Authors: Myers Eugene N. , Fagan Johannes J.
Published: October 2014

In the Department of Otolaryngology at the University of Pittsburgh School of Medicine, cancer of the larynx is usually treated by primary surgery. Radiotherapy is used as adjuvant treatment in certain patients who have cancer that has adverse histologic features such as perineural, vascular, and/or cartilage invasion. With this approach, patients rarely develop local recurrence. Patient survival is therefore unlikely to be improved by changes to the management of the primary tumor. Survival may, however, be improved by reducing the incidence of recurrence in the neck, as well as distant. Hence, we have adopted an aggressive surgical approach to the cN+ as well as the NO neck. The theoretical basis for this aggressive surgical approach to the neck will be considered under the following headings: staging, regional control, distant metastasis, survival, choice of neck dissection, and the pathologically positive elective neck dissection.
Subglottic Stenosis: Correlation between Computed Tomography and Bronchoscopy
Authors: Cook Raymond D. , Rosbe Krishna W. , Jewett Brian S. , Johnson Kenneth l. , Mukherji Suresh K. , Logan Thomas C. , Shockley William W.
Published: October 2014

The evaluation of subglottic stenosis has been limited by the lack of standardized methods for determining the cross-sectional area and length of the stenotic segment. A rabbit model was used to prospectively evaluate the correlation between computed tomography (CT) and bronchoscopy in the evaluation of this disease. Subglottic stenosis was produced in 39 New Zealand White rabbits by a transoral endoscopic technique. The animals were evaluated 3 weeks later with spiral CT, rigid bronchoscopy, and open laryngotracheal exploration. Spiral CT was performed with the location, degree, and length of subglottic stenosis being determined by a blinded observer. Each animal then underwent rigid bronchoscopy and open laryngotracheal exploration for determination of the same measurements. Data were analyzed to determine the correlation between the radiographic and surgical techniques in evaluating the airway stenosis. With regard to the degree of stenosis, 94% of the rabbits were determined to have CT and bronchoscopic measurements that were within 15% (Pearson correlation .94, p < .05). With regard to the length of stenosis, 94% of animals had a measurement on CT that was within 2 mm of that observed upon open exploration (Pearson correlation .81, p < .05). The CT evaluation of subglottic stenosis correlated well with the currently used method of visual inspection at bronchoscopy in evaluating tracheal stenosis in this animal model. These data suggest that CT could serve as a useful adjunct in the evaluation of tracheal stenosis, especially when serial examinations are required.
Expression of Epstein-Barr Virus Latent Membrane Proteins Leads to Changes in Keratinocyte Cell Adhesion
Authors: Farwell D. Greg , McDougall James K. , Coltrera Marc D.
Published: October 2014

Epstein-Barr virus (EBV) has 3 latent membrane proteins (LMPs) — LMP1, LMP2a, and LMP2b — which are expressed in nasopharyngeal carcinoma. Using keratinocyte cell lines expressing LMP2a and LMP2b and coexpressing LMP1/LMP2a, we grew organotypic raft cultures to analyze changes in morphology and expression of the cell adhesion molecule ICAM-1; α2, α3, α5, β1, and α6β4 integrins; laminin 5; E-cadherin; and desmoplakin. Cells expressing LMP2a or LMP2b were defective in their ability to mature and progress through normal squamous stratification when compared to the parental cell lines. Cells coexpressing LMP1/LMP2a additionally demonstrated “pseudoinvasion” into the raft dermal equivalent. There was a consistent and dramatic up-regulation in the suprabasal expression of laminin 5 and α6β4 and β1 integrins in the LMP-expressing cell lines. ICAM-1, not expressed in the control cell lines, was up-regulated in the LMP-expressing cell lines. Expression of α3 and α5 integrins was also up-regulated in the LMP-expressing cell lines, while α2 demonstrated a loss of the normal basal layer expression. E-cadherin and desmoplakin expression patterns were essentially unchanged. We conclude that LMP2a and LMP2b singly, and LMP1/LMP2a coexpressed, are capable of altering keratinocyte cell adhesion molecule expression consistent with nasopharyngeal carcinoma.
Otalgia and Aversive Symptoms in Temporomandibular Disorders
Authors: Bush Francis M. , Harkins Stephen W. , Harrington Walter G.
Published: October 2014

The term Costen's syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with “generalized” psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders. The present study investigated whether some somatic complaints, particularly tinnitus and dizziness, were pathognomonic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, while dizziness loaded with complaints of altered taste and smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus.
Otoendoscopy for Improved Pediatric Cholesteatoma Removal
Authors: Good Garth M. , Isaacson Glenn
Published: October 2014

Our objective was to determine the usefulness of intraoperative rigid endoscopy in detecting incompletely removed cholesteatomas, and to learn whether “second-look” procedures are still needed in children. We used 30°, 2.7-mm endoscopes to evaluate the middle ears of 14 children (29 procedures) with cholesteatomas once all visible disease had been removed under the operating microscope. If residual cholesteatoma was seen, removal continued until all disease visualized with the endoscope was removed. If the cholesteatoma was not removed intact, planned exploratory surgery was performed. The rigid endoscope detected incompletely removed cholesteatomas at surgery in 7 of the 29 cases (24%). In 2 of the 11 cases (18%) judged free of cholesteatoma by both otomicroscopy and otoendoscopy, residual disease was found at planned exploratory procedures. While otoendoscopy is clearly useful in detecting incompletely removed cholesteatoma, a substantial rate of residual disease following “complete” removal suggests the continued need for planned exploratory procedures.
Management of Abducens Palsy in Patients with Petrositis
Authors: Minotti Americo M. , Kountakis Stilianos E.
Published: October 2014

Our objective was to discuss the management and outcome of abducens nerve palsy in patients with Gradenigo's syndrome. In a retrospective analysis of patients with Gradenigo's syndrome at a tertiary-care center in Houston, Texas, from 1987 to 1995, we identified 2 patients with Gradenigo's syndrome, both female. One had bilateral involvement, so that the total was 3 ears. Both patients had complete recovery of their abducens nerve palsy. In 2 ears with chronic mastoiditis, sixth nerve palsies failed to respond to medical therapy alone, but resolved after mastoidectomy with drainage of the petrous apex. We recommend that patients with Gradenigo's syndrome and evidence of chronic mastoiditis be treated with aggressive medical and surgical care.
Cervical Vertebral Anomalies in Patients with Anomalies of the Head and Neck
Authors: Manaligod Jose M. , Menezes Arnold H. , Bauman Nancy M. , Smith Richard J. H.
Published: October 2014

Congenital head and neck anomalies can occur in association with vertebral anomalies, particularly of the cervical vertebrae. While the former are easily recognized, especially when part of a syndrome, the latter are often occult, thereby delaying their diagnosis. The presence of vertebral anomalies must be considered in pediatric patients with head and neck abnormalities to expedite management of select cases and to prevent neurologic injury. We present our experience with 5 pediatric patients who were referred to the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa with a variety of syndromic anomalies of the head and neck. Each patient was subsequently also found to have a vertebral anomaly. The relevant embryogenesis of the anomalous structures is discussed, with highlighting of potential causes such as teratogenic agents and events and germ-line mutations. A review of syndromes having both head and neck and vertebral anomalies is presented to heighten awareness of otolaryngologists evaluating children with syndromic disorders. Finally, the findings on radiographic imaging studies, particularly computed tomography, are discussed to facilitate the prompt diagnosis of vertebral anomalies.
Comparison of Upper Esophageal Sphincter Opening in Healthy Asymptomatic Young and Elderly Volunteers
Authors: Kern Mark , Hofmann Candy , Bardan Eytan , Ren Junlong , Arndorfer Ronald , Shaker Reza
Published: October 2014

Deglutitive upper esophageal sphincter opening (UES) in the elderly has been incompletely studied. Our aim was to determine in the elderly the temporal and dimensional characteristics of deglutitive UES opening; anterior and superior hyoid and laryngeal excursions as measures of distracting forces imparted on the UES; and hypopharyngeal intrabolus pressure (IBP). Fourteen healthy elderly and 14 healthy young volunteers were studied by concurrent videofluoroscopy and hypopharyngeal manometry during swallowing of 5- and 10-mL barium boluses. The anteroposterior UES diameter, as well as the anterior hyoid bone and laryngeal excursion, was significantly smaller in the elderly compared to the young (p < .05) for 5-mL barium boluses, but not for 10-mL boluses. The lateral diameter of UES opening was similar between groups for all boluses. The IBP for 5- and 10-mL swallows in the elderly was significantly higher than that in the young (p < .05). We conclude that anteroposterior deglutitive UES opening and hyoid bone and thyroid cartilage anterior excursion are reduced in the elderly. These changes are associated with increased IBP, suggesting a higher pharyngeal outflow resistance in the elderly compared to the young.
Management of no Neck in T1-T2 Unilateral Supraglottic Cancer
Authors: Güney Ercìhan , Yiğitbasi O. Gazi
Published: October 2014

Early-stage supraglottic cancers (stage I and II) are treated with several different programs. Previously reported data have led us to design a therapeutic protocol in treatment of patients with early-stage squamous cell carcinoma of the supraglottic larynx. From 1991 to 1996, 39 patients with unilateral supraglottic carcinoma were treated according to this protocol. All patients underwent unilateral functional neck dissection and resection of the primary carcinoma in an en bloc fashion. Histopathologic studies showed that 9 (23%) of them had positive nodes, and they received planned adjuvant radiotherapy. None of the 30 patients with histopathologically NO necks received either adjuvant irradiation or contralateral neck dissection. The mean follow-up period was 34 months. All patients are alive, and none have developed any recurrence in either dissected or undissected sides of the neck. This treatment policy seems satisfactory and will avoid unnecessary therapeutic interventions. Routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic laryngeal cancers.
Education in Laryngology: Rising to Old Challenges
Authors: Sataloff Robert T.
Published: October 2014

Education in laryngology has been a subject of interest at least since Louis Elsberg's address to the first meeting of the American Laryngological Association in 1879. Remarkable scientific, technological, and clinical advances during the 1980s and 1990s have elevated the standard of laryngological care. It is essential for training programs to promulgate these important advances through well-planned, comprehensive curricula. Such training should also foster an appreciation for the kinds of creative thought, interdisciplinary collaboration, and imaginative clinical practice that have been responsible for many of the recent dramatic advances in the field of laryngology.
Inhibition of Subglottic Stenosis with Mitomycin-C in the Canine Model
Authors: Reinisch Lou , Deriso Walter , Correa Alex J. , Sanders David L. , Duncavage James A. , Huang Shan , Garrett C. Gaelyn
Published: October 2014

The objective of this randomized, prospective study was to study the efficacy of topical mitomycin-C in the inhibition of subglottic stenosis in a canine model. Subglottic stenosis was elicited with the carbon dioxide laser in 10 mongrel dogs. Radial incision and serial dilation of the subglottic airway were then carried out. The animals were randomized to receive a topical solution of 1% mitomycin-C to the dilated area for a 5-minute duration or no further treatment. Weekly direct microlaryngoscopy and photodocumentation were performed during the 6-week study. Airway distress developed in 4 of the 5 control dogs, requiring early sacrifice, while all treatment group animals survived the duration of the study (p ≤ .006). Morphometric analysis of the subglottic photographs confirmed a greater than 100% increase in the percentage of relative airway at sacrifice in the treatment group (p ≤ .049). A statistically significant (p ≤ .015) decrease in collagen formation in the subglottic scar of dogs treated with topical mitomycin-C was documented. Mitomycin-C favorably altered the clinical progression of subglottic stenosis, improved quantified airway patency, and reduced the amount of subglottic collagen formation in the canine model.
Effect of Pharmacological Sympathectomy on Osteoclastic Activity in the Gerbilline Auditory Bulla in Vivo
Authors: Sherman Bret E. , Chole Richard A.
Published: October 2014

Bone destruction causes hearing loss in various middle ear disorders. The mechanisms of such pathological remodeling are unknown. Unilateral surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone. Explanation of the cause of this effect, however, may be confounded by hemodynamic changes induced by hemicranial sympathectomy and by uncertainty as to the neuroanatomical origins of sympathetic fibers. In this study, gerbils were infused with guanethidine sulfate (GS) to evaluate the in vivo effects of systemic sympatholysis on auditory bone remodeling. In addition, to discount any direct osteolytic effect, GS was assessed of its bone resorbing activity in vitro by means of the calvarial calcium release assay. The in vitro study revealed GS to have no effect on calcium release. The in vivo study revealed GS to increase both the osteoclast surface and number. Guanethidine-induced sympathectomy has thus been shown to increase remodeling in gerbilline auditory bone, while no direct osteolytic effect could be measured in vitro.
Pediatric Type I Thyroplasty: An Evolving Procedure
Authors: Link Dana Thompson , Willging J. Paul , Rutter Michael J. , Myer Charles M. , Liu James H. , Cotton Robin T.
Published: October 2014

The treatment of vocal fold paralysis by type I thyroplasty in the pediatric age group has not been reported. From 1990 to 1998, 12 type I thyroplasty procedures were performed on 8 patients between 2 and 17 years of age. The most common cause of vocal fold paralysis was neurologic, followed by vagal injury from a cardiac procedure. The most common indications for the procedure were aspiration and dysphonia. In our early thyroplasty experience, adult techniques and measurements adapted after Isshiki or Netterville were used. Postoperative laryngoscopy showed that in most cases, the placement of the implant was too high. There were variable outcomes in aspiration and dysphonia with this technique. These findings appear to be independent of thyroplasty approach or of implant design type. We conclude that the standard approach for vocal fold medialization in the adult cannot be applied accurately in the pediatric population. In performing pediatric thyroplasty, the anatomically lower position of the vocal fold must be taken into consideration. We have since modified our technique to adjust for accurate identification of the vocal fold line and medialization. The modified approach for vocal fold medialization in the pediatric population is discussed.
Maturation of the Pediatric Tracheostomy Stoma: Effect on Complications
Authors: Park John Y. , Suskind Dana L. , Muntz Harlan R. , Prater Debbie , Lusk Rodney P.
Published: October 2014

The pediatric tracheostomy stoma can be matured via a technique that places 4-quadrant sutures from the tracheal cartilage to the dermis. This has the potential of decreasing the risk of accidental decannulation and the formation of granulation tissue. A retrospective analysis of 149 tracheostomies performed between January 1989 and December 1996 was done for the following factors: age, underlying diagnosis, indication for tracheostomy, type of tracheal incision, maturation of stoma, duration of tracheostomy, and early and late (>7 days) complications. Maturation of the stoma was performed in 88 (59.1%) of the 149 tracheostomies. There was an overall complication rate of 21.5% (32/149, not including granulation tissue formation). There were 9 (6.0%) early complications and 23 (15.4%) late complications. The overall incidence of tracheocutaneous fistulas occurred in 11 (11.2%) of the 98 decannulated patients: 6 (10.2%) of the 59 matured stomas and 5 (12.8%) of the 39 nonmatured stomas. Granulation tissue was found on subsequent laryngoscopy in 24 (27.3%) of the 88 matured stomas versus 23 (37.7%) of the 61 nonmatured stomas. There were no tracheostomy-related mortalities. Maturing the tracheostomy stoma resulted in a decreased morbidity from accidental decannulations and did not increase the incidence of tracheocutaneous fistulas or granulation tissue formation.