bluuebunny/crossref_metadata_2025 huggingface dataset:
Imported Acute and Isolated Glottic Paracoccidioidomycosis
Authors: Laccourreye Ollivier , Mirghani Haitham , Brasnu Daniel , Badoual Cécile
Published: October 2014

The current report documents the rare clinical presentation of an imported acute and isolated glottic paracoccidioidomycosis. We discuss the diagnosis, pathogenesis, and treatment of this laryngeal disease, emphasizing the role of modern antifungal treatment, and review the relevant literature.
Mucosal Bridge and Pitting of the True Vocal Fold: An Unusual Complication of Cidofovir Injection
Authors: Man Li-Xing , Statham Melissa M. , Rosen Clark A.
Published: October 2014

We describe a unique complication of intralaryngeal cidofovir injection and present the case of a patient with recurrent respiratory papillomatosis in whom both a mucosal bridge and a pit of the true vocal fold developed after intralaryngeal cidofovir injection. A 40-year-old man presented with laryngeal papillomatosis 19 years after being treated with surgery and adjuvant radiotherapy for leiomyosarcoma of the cervical esophagus. The patient underwent 5 papillomatosis excisions combined with subepithelial injections of cidofovir to the bilateral true vocal folds at a concentration of 5 mg/mL without any complications. He subsequently received 2 higher-dose cidofovir treatments 6 weeks apart because of a poor response to the previous treatments. Two months later, there was evidence of a large mucosal bridge along the free edge of the right vocal fold and a deep pit in the lateral aspect of the same vocal fold. We conclude that repeated high-dose intralesional injection of cidofovir may result in significant morphological changes to the vocal fold, most likely due to mucosal injury.
Age Sensitivity in the Acquisition of Lexical Tone Production: Evidence from Children with Profound Congenital Hearing Impairment after Cochlear Implantation
Authors: Lee Kathy Y. S. , van Hasselt Charles Andrew , Tong Michael C. F.
Published: October 2014

Objectives:

This study investigated the effects of implant experience and age at implantation on the Cantonese tone production of children with cochlear implants. The study also examined whether there was a particular age at which children were more responsive to acquiring tones.

Methods:

The study included 45 children who had received unilateral cochlear implants at a mean age of 65.56 months. The subjects were grouped according to their age at cochlear implantation and were assessed annually for 5 years thereafter. A picture-naming task was used to measure their tone production performance.

Results:

A simple effect of age at implantation was significant at all testing intervals except at the preoperative data point. Children who were younger than 4 years of age when they received their implants scored significantly higher than did the 2 older groups at various testing intervals. A significant simple effect of implant experience was also found. Progress was most striking in children who received their implants before the age of 4 years.

Conclusions:

For the most effective acquisition of Cantonese lexical tones, children should undergo early cochlear implantation. For children who receive implants before the age of 4 years, benefits are noted in tone production ability in terms of a faster rate of improvement within a shorter period of time.
Tracheal Non-Hodgkin's Lymphoma Masquerading as Benign Granulation Tissue: A Report of Two Cases
Authors: Gill Matthew T. , Cotelingam James D. , Lowery-Nordberg Mary , Nathan Cherie-Ann O.
Published: October 2014

Primary tracheal non-Hodgkin's lymphoma (NHL) is rare, with fewer than 30 cases reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of tracheal NHL mimicking granulation tissue. The first patient was a 67-year-old man with myelodysplastic syndrome and Crohn's disease who had a recurring lesion of the proximal trachea causing significant airway obstruction. The second patient was a 47-year-old man with a history of multiple intubations who presented with dyspnea and stridor due to circumferential tracheal stenosis. In both cases, bronchoscopy revealed abundant granulation tissue, and the initial biopsy results indicated benign disease. However, after requests from the diagnostic team to rule out lymphoma, additional immunohistochemical stains and polymerase chain reaction testing confirmed NHL. Radiotherapy was initiated. The first patient responded well and remains disease-free after 4 years. The second patient died of airway obstruction due to severe distal tracheal stenosis. Recurrent granulation tissue should raise the suspicion of malignancy and prompt further tissue evaluation for evidence of lymphoma. Steroids for airway compromise may cause progression to mature stenosis as prednisone is used in the treatment of lymphoma. Localized disease involving the central airways may be treated successfully with limited chemotherapy and radiotherapy.
Myiasis of the External and Middle Ear
Authors: Hatten Kyle , Gulleth Yusuf , Meyer Tanya , Eisenman David J.
Published: October 2014

Aural myiasis is a rare otolaryngological disease typically seen in poor hygienic conditions and medically disabled patients. We present a case of aural myiasis in a healthy woman who had no apparent risk factors for infestation and required extensive surgical intervention. We also discuss the literature of documented otolaryngological cases of myiasis and effective therapies. In our patient, symptoms of otalgia, otorrhea, and tinnitus resolved after multiple attempts at extraction resulted in successful eradication of larvae. The patient required tympanoplasty to reconstruct the damaged external and middle ear. Physicians should have a clinical suspicion of aural myiasis in patients with a travel history and an atypical presentation of acute otalgia and otorrhea.
Bone-Anchored Hearing Aids in Patients with Acquired and Congenital Unilateral Inner Ear Deafness (Baha CROS): Clinical Evaluation of 56 Cases
Authors: Hol Myrthe K. S. , Kunst Sylvia J. W. , Snik Ad F. M. , Bosman Arjan J. , Mylanus Emmanuel A. M. , Cremers Cor W. R. J.
Published: October 2014

Objectives

We performed an evaluation of the audiological and subjective benefits of the bone-anchored hearing aid (Baha) as a device for transcranial routing of sound (Baha CROS) in 56 patients with unilateral inner ear deafness.

Methods

We performed a prospective clinical follow-up study in a tertiary referral center. Previously reported results of 29 patients were supplemented with a second series of 30 patients with unilateral inner ear deafness; 3 patients dropped out during the evaluation. Audiometric measurements were taken before and after Baha CROS fitting. Subjective benefits were quantified with 4 different patient questionnaires.

Results

The sound localization results in a well-structured test setting were not differentiable from chance. The 5 patients with congenital hearing loss showed better scores in the unaided sound localization measurements. Overall, most patients reported some subjective improvement in their capacity to localize sounds with the Baha CROS in daily life. The main effect of the Baha CROS was to alleviate the head shadow effect during the speech-in-noise test.

Conclusions

Poor sound localization in this larger series of patients confirms the findings of previous studies. Improvements in the speech-in-noise scores corroborated the efficacy of the Baha CROS in alleviating the head shadow effect. The 4 different patient questionnaires revealed subjective benefit and satisfaction in various domains.
Postoperative Complications of Powered Intracapsular Tonsillectomy and Monopolar Electrocautery Tonsillectomy in Teens versus Adults
Authors: Johnston Douglas R. , Gaslin Michael , Boon Maurits , Pribitkin Edmund , Rosen David
Published: October 2014

Objectives

This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).

Methods

In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and 379 patients more than 19 years of age. These outcome measures in teens were compared to those in adults who had tonsillectomy by the same technique (101 teens who underwent PIT compared to 117 adults who underwent PIT, and 99 teens who underwent MET compared to 262 adults who underwent MET). Outcome measures were also compared within the PIT and MET groups based on the indication for surgery (chronic tonsillitis, tonsillar hypertrophy, or both).

Results

In comparing teens to adults who underwent the same technique (PIT versus PIT, or MET versus MET), no statistically significant differences existed in the incidence of hemorrhage, dehydration, or postoperative tonsillitis. Greater hemorrhage rates for adults who underwent MET compared to teens, however, almost met statistical significance (p = 0.053). Analyzing complication rates by indication within the PIT and MET groups exclusively revealed higher rates of hemorrhage in adults who underwent the MET technique for the indication of chronic tonsillitis. Within the PIT comparison, no significant differences were found on the basis of indication for surgery.

Conclusions

Teenage patients who undergo tonsillectomy should be considered unique as far as complication rates are concerned. Comparison of technique-specific complication rates between adults and teens showed no significant differences in either the PIT or MET groups, although adults who underwent MET had greater hemorrhage rates that almost met significance (p = 0.053). Adults who were undergoing tonsillectomy for chronic tonsillitis were more likely than teens to encounter postoperative hemorrhage if they underwent the MET technique.
Outcome of Adenotonsillectomy for Obstructive Sleep Apnea Syndrome in Children
Authors: Ye Ji , Liu Hui , Zhang Ge-Hua , Li Peng , Yang Qin-Tai , Liu Xian , Li Yuan
Published: October 2014

Objectives:

We evaluated the outcome of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children using polysomnography (PSG) data and a quality-of-life (QOL) instrument.

Methods:

We enrolled children (4 to 14 years of age) who had OSAS diagnosed by overnight PSG and who underwent both adenoidectomy and tonsillectomy between January 2003 and February 2008. All of them had completed postoperative PSG and a paired Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire (OSA-18) survey. The statistical analyses were performed with a statistical software package.

Results:

The study included 84 children with a mean age of 7.1 years. The mean preoperative apnea-hypopnea index (AHI) for the study population was 24.6, and the mean postoperative AHI was 3.8 episodes per hour. The percentage of children who had normal PSG parameters after adenotonsillectomy ranged from 69.0% to 86.9% because of fluctuation of the criteria used to define OSAS. Nine children (30%) with severe preoperative OSAS had persistent OSAS (an AHI of at least 5) after surgery. Improvements in QOL were comparable in the cured and not-cured groups (p > 0.05). Risk factors for persistent OSAS were obesity and a high preoperative AHI, on multiple logistic regression analysis.

Conclusions:

Adenotonsillectomy is associated with improvements in PSG, behavior, and QOL in children with OSAS. However, it may not resolve OSAS in all children. The efficacy and role of additional therapeutic options require more study.
Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial
Authors: Paniello Randal C. , Edgar Julia D. , Perlmutter Joel S.
Published: October 2014

Objectives:

The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia.

Methods:

Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument.

Results:

Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles.

Conclusions:

These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.
Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma
Authors: Huang Johnson , Sacks Raymond , Forer Martin
Published: October 2014

Objectives:

A 2-surgeon technique has been proposed that allows resection of juvenile nasopharyngeal angiofibroma (JNA) with extension into the infratemporal fossa by utilizing a septal incision for passage of a retracting instrument from the opposite nostril. This technique, however, does not overcome the problem of limited space within the nasal cavity for the tumor to be retracted. Therefore, the tumor has to be divided to allow for its removal. We are proposing a different 2-surgeon technique as an alternative operative technique for the resection of JNA.

Methods:

A new technique of endoscopic resection of JNA involves a transseptal posterior perforation. This perforation allows retraction of the tumor into the opposite nasal cavity by the second surgeon. The retraction of the tumor creates space for its resection.

Results:

Nineteen patients (all male) underwent this 2-surgeon technique for resection of JNA. The follow-up period ranged up to 9 years, and no recurrence was recorded.

Conclusions:

Longer-term follow-up is needed to assess recurrence rate and morbidity with this technique. However, in our small series, the 2-surgeon technique via posterior septal perforation was associated with low morbidity and recurrence rates.
Change of External Auditory Canal pH in Acute Otitis Externa
Authors: Kim Jin Kook , Cho Jae Hoon
Published: October 2014

Objectives:

We investigated 1) the correlation between the degree of acute otitis externa (AOE) and a change of pH and 2) the recovery of pH after acidification compared to an antibiotic otic solution in AOE. A change of pH in the external auditory canal (EAC) is very important for the pathogenesis of otitis externa. Therefore, not only an antibiotic otic solution, but also acidification, is known to be a good treatment for AOE. However, pH has only been investigated in chronic otitis externa, and not in AOE.

Methods:

This was a prospective randomized control study. Forty adult patients (56 ears) with AOE and 40 normal control subjects (80 ears) participated in this study. The severity of disease was graded as mild, moderate, or severe. The pH of each EAC was then measured. The patients were randomly assigned into 2 groups: One for vinegar irrigation and the other for topical antibiotics. The pH of the diseased ears was measured at 1 and 2 weeks after the treatment.

Results:

The mean (±SD) pH for the normal control subjects was 5.4 ± 0.48, and the EAC lost its acidity proportionately to the degree of disease (p < 0.05). For both the vinegar irrigation and topical antibiotic groups, the acidity was restored dramatically (p < 0.05) at 1 and 2 weeks for the moderate and severe grades of otitis, but not for the mild grade. There was no difference in recovery between the 2 groups.

Conclusions:

The EAC lost its acidity proportionately to the degree of disease in AOE. Vinegar irrigation and topical antibiotics were equally effective for restoration of pH.
Atelocollagen Sponge as a Stem Cell Implantation Scaffold for the Treatment of Scarred Vocal Folds
Authors: Ohno Satoshi , Hirano Shigeru , Tateya Ichiro , Kanemaru Shin-Ichi , Umeda Hiroo , Suehiro Atsushi , Kitani Yoshiharu , Kishimoto Yo , Kojima Tsuyoshi , Nakamura Tatsuo , Ito Juichi
Published: October 2014

Objectives:

Treatment of vocal fold scarring remains a therapeutic challenge. Our group previously reported the efficacy of treating injured vocal folds by implantation of bone marrow—derived stromal cells containing mesenchymal stem cells. Appropriate scaffolding is necessary for the stem cell implant to achieve optimal results. Terudermis is an atelocollagen sponge derived from calf dermis. It has large pores that permit cellular entry and is degraded in vivo. These characteristics suggest that this material may be a good candidate for use as scaffolding for implantation of cells. The present in vitro study investigated the feasibility of using Terudermis as such a scaffold.

Methods:

Bone marrow—derived stromal cells were obtained from GFP (green fluorescent protein) mouse femurs. The cells were seeded into Terudermis and incubated for 5 days. Their survival, proliferation, and expression of extracellular matrix were examined.

Results:

Bone marrow—derived stromal cells adhered to Terudermis and underwent significant proliferation. Immunohistochemical examination demonstrated that adherent cells were positive for expression of vimentin, desmin, fibronectin, and fsp1 and negative for beta III tubulin. These findings indicate that these cells were mesodermal cells and attached to the atelocollagen fibers biologically.

Conclusions:

The data suggest that Terudermis may have potential as stem cell implantation scaffolding for the treatment of scarred vocal folds.
Anatomy-Based Algorithms for Detecting Oral Cancer Using Reflectance and Fluorescence Spectroscopy
Authors: McGee Sasha , Mardirossian Vartan , Elackattu Alphi , Mirkovic Jelena , Pistey Robert , Gallagher George , Kabani Sadru , Yu Chung-Chieh , Wang Zimmern , Badizadegan Kamran , Grillone Gregory , Feld Michael S.
Published: October 2014

Objectives:

We used reflectance and fluorescence spectroscopy to noninvasively and quantitatively distinguish benign from dysplastic/malignant oral lesions. We designed diagnostic algorithms to account for differences in the spectral properties among anatomic sites (gingiva, buccal mucosa, etc).

Methods:

In vivo reflectance and fluorescence spectra were collected from 71 patients with oral lesions. The tissue was then biopsied and the specimen evaluated by histopathology. Quantitative parameters related to tissue morphology and biochemistry were extracted from the spectra. Diagnostic algorithms specific for combinations of sites with similar spectral properties were developed.

Results:

Discrimination of benign from dysplastic/malignant lesions was most successful when algorithms were designed for individual sites (area under the receiver operator characteristic curve [ROC-AUC], 0.75 for the lateral surface of the tongue) and was least accurate when all sites were combined (ROC-AUC, 0.60). The combination of sites with similar spectral properties (floor of mouth and lateral surface of the tongue) yielded an ROC-AUC of 0.71.

Conclusions:

Accurate spectroscopic detection of oral disease must account for spectral variations among anatomic sites. Anatomy-based algorithms for single sites or combinations of sites demonstrated good diagnostic performance in distinguishing benign lesions from dysplastic/malignant lesions and consistently performed better than algorithms developed for all sites combined.
Epiglottis is Not Essential for Successful Swallowing in Humans
Authors: Leder Steven B. , Burrell Morton I. , Van Daele Douglas J.
Published: October 2014

Controversy has continued for well over 100 years regarding the role of the epiglottis in deglutition. We describe the effect of isolated epiglottectomy on swallowing success in a case series of 3 adult human subjects with isolated epiglottectomy due to trauma, surgery, or cancerous erosion. The patients were 42, 51, and 70 years of age, and swallowing was analyzed objectively with videofluoroscopy. All subjects exhibited successful swallowing with all food types: Thin liquid, puree, and solid food. Specifically, the patient with traumatic epiglottectomy exhibited rapid swallowing success, the patient with surgical epiglottectomy exhibited a short period of dysphagia due to postoperative edema, followed by swallowing success, and the patient with epiglottectomy due to cancerous erosion of the entire epiglottis exhibited long-term adaptation, with successful swallowing maintained. We conclude that the epiglottis is not essential for successful swallowing in humans, because individuals can readily adapt to isolated epiglottectomy and avoid tracheal aspiration.
Mutations in TMC1 are a Common Cause of DFNB7/11 Hearing Loss in the Iranian Population
Authors: Hildebrand Michael S. , Kahrizi Kimia , Bromhead Catherine J. , Shearer A. Eliot , Webster Jennifer A. , Khodaei Hossein , Abtahi Rezvan , Bazazzadegan Niloofar , Babanejad Mojgan , Nikzat Nooshin , Kimberling William J. , Stephan Dietrich , Huygen Patrick L. M. , Bahlo Melanie , Smith Richard J. H. , Najmabadi Hossein
Published: October 2014

Objectives:

We investigated the cause of autosomal recessive nonsyndromic hearing loss (ARNSHL) that segregated in 2 consanguineous Iranian families.

Methods:

Otologic and audiometric examinations were performed on affected members of each family. Genome-wide parametric multipoint linkage mapping using a recessive model was performed with Affymetrix 50K GeneChips or short tandem repeat polymorphisms. Direct sequencing was used to confirm the causative mutation in each family.

Results:

In 2 Iranian families, L-1651 and L-8600606, with ARNSHL that mapped to the DFNB7/11 locus, homozygosity for a reported splice site mutation (c.776+1G>A), and a novel deletion (c.1589_1590delCT; p.S530) were identified in the TMC1 gene, respectively.

Conclusions:

Consistent with the previously reported phenotype in DFNB7/11 families, the 2 Iranian families had segregated congenital, profound hearing impairment. However, in family L-1651, one affected family member (IV:3) has milder hearing impairment than expected, suggesting a potential genetic modifier effect. These results indicate that DFNB7/11 is a common form of genetic hearing loss in Iran, because this population is the source of 6 of the 29 TMC1 mutations reported worldwide.
Angioedema: A Review of 367 Episodes Presenting to Three Tertiary Care Hospitals
Authors: Tai Stephen , Mascaro Miguel , Goldstein Nira A.
Published: October 2014

Objectives:

We evaluated the clinical characteristics of patients treated for angioedema, and determined the factors associated with the clinical course.

Methods:

We performed a chart review of 367 episodes presenting from 1997 through 2008.

Results:

The mean (±SD) age was 51.8 ± 20.1 years; 65.7% of the episodes occurred in female patients; 62.4% of the episodes were in African American patients. The patients were on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for 49.1% of the episodes, and an inciting factor (diet change, minor trauma, or exposure to fumes) was present for 21.5%. We found that 75.7% of the episodes were type 1 angioedema, 5.7% were type 2, 1.4% were type 3, and 17.2% involved multiple sites; 58% of the episodes required admission. For 3.3% of the episodes, the patients were intubated, and in 0.3% of the episodes, the patients required a tracheostomy. Logistic regression identified non–African American race, allergies, alcohol use, use of ACE inhibitors or ARBs, multiple sites, and age as associated with the need for admission. Bivariate analysis identified age, multiple affected sites, stridor, hoarseness, dysphagia, and drooling as associated with intubation or tracheostomy.

Conclusions:

The novel findings of this study are lower rates of airway intervention than reported previously and the fact that multiple affected sites were associated with admission and intubation or tracheostomy, particularly when the edema involved the larynx or hypopharynx.
Influence of Gender on Pharyngeal Airway Length in Obese Adolescents
Authors: Sawnani Hemant , Murugappan Shanmugam , Gutmark Ephraim , Donnelly Lane F. , Amin Raouf , Mylavarapu Goutham , Mihaescu Mihai , Khosla Sid , Kalra Maninder
Published: October 2014

Objectives:

Although pharyngeal airway length has been implicated in an increased male predisposition for obstructive sleep apnea (OSA) in adults, data in obese children and adolescents are lacking. Our objective was to determine the influence of gender on pharyngeal airway length in obese adolescents, and to apply computational simulations to better understand the effect of pharyngeal airway length on the airway's predisposition to collapse in this select group.

Methods:

Obese subjects without OSA were recruited from our Sleep Center. Their pharyngeal airway length was measured on midline sagittal magnetic resonance images as the distance between the hard palate and the base of the epiglottis. Computational fluid dynamics analysis was used to study the effect of pharyngeal airway length on airflow characteristics. The gender groups were compared for anthropometric measurements and pharyngeal airway length by an unpaired Student's t-test.

Results:

Our study group included 18 female and 16 male obese adolescents with a mean (±SD) age of 14.7 ± 2.3 years and a mean body mass index of 38.9 ± 6.9 kg/m2. The groups did not differ in age, body weight, or normalized pharyngeal airway length (0.44 ± 0.08 mm/cm in girls versus 0.44 ± 0.11 mm/cm in boys; p = 0.9). The computational fluid dynamics simulation indicated that the 3-dimensional flow field and airway wall pressures were not significantly affected by pharyngeal airway lengthening of up to 10 mm.

Conclusions:

Our results indicate that in obese adolescents, there is no influence of gender on pharyngeal airway length, and pharyngeal airway length alone does not significantly affect the airway's predisposition to collapse. These findings suggest that pharyngeal airway length may not explain the increased male gender predisposition for OSA in this select group.
Carbon Dioxide Laser—Assisted Endoscopic Cricopharyngeal Myotomy with Primary Mucosal Closure
Authors: Ho Allen S. , Morzaria Sanjay , Damrose Edward J.
Published: October 2014

Objectives:

Carbon dioxide laser–assisted endoscopic cricopharyngeal myotomy (ECPM) has emerged as a viable therapy for dysphagia. The risks of the procedure include pharyngoesophageal perforation and mediastinitis, which may discourage adoption of this technique. To address these complications, we examined outcomes of ECPM with primary mucosal closure.

Methods:

A case series of 7 patients who underwent ECPM between 2006 and 2008 were reviewed for length of operation, length of hospitalization, postoperative complications, and outcomes by use of the M. D. Anderson Dysphagia Index (MDADI) and the Functional Outcome Swallowing Scale (FOSS). The results were compared to those of a control group of 7 patients treated during the same period via open cricopharyngeal myotomy.

Results:

All patients who had ECPM were treated successfully without complications. The operative times averaged 128 minutes. The hospitalization averaged 2.1 days. Statistically significant improvements in swallowing were seen (MDADI score from 51.3 to 77.7, p < 0.0006; FOSS score from 3.7 to 1.3, p < 0.0005), and were similar to those in the patients who had the open procedure (FOSS score from 3.0 to 1.0, p < 0.006). Trends toward decreased blood loss, a shorter hospital stay, and a lower complication rate were observed in the patients who had ECPM.

Conclusions:

ECPM is beneficial as a primary treatment for cricopharyngeal dysfunction. Closure of the mucosal defect may help reduce the incidence of postoperative cervical emphysema and mediastinitis, and does not appear to compromise functional outcome.
Unusual Ciliary Abnormalities in Three 9/11 Response Workers
Authors: McMahon James T. , Aslam Rizwan , Schell Stephen E.
Published: October 2014

After the 9/11 terrorist attacks on the World Trade Center in New York in 2001, thousands of response workers were exposed to complex mixtures of toxins, pollutants, and carcinogens. Many developed illnesses involving the respiratory tract. We report unusual ultrastructural ciliary abnormalities in 3 response workers that corresponded to their respiratory and ciliary functional abnormalities. Each patient had respiratory cilia biopsies that were evaluated for motility and ultrastructural changes. Impaired ciliary motility was seen in 2 of the 3 patients. Each of the patients showed monomorphic ultrastructural abnormalities. Two of the patients showed identical triangular disarray of axonemal microtubules with peripheral doublets 1, 4, and 7 forming the corners of the triangle and doublet 9 always more medially displaced than doublets 2, 3, 5, 6, and 8. Two workers had cilia in which axonemes were replaced by homogeneously dense cores. One of these also had cilia with triangular axonemes as previously described. The other had cilia with a geometric triangular to pentagonal shape. The ciliary abnormalities described here may represent a new class of primary ciliary dyskinesia in which abnormalities may have a genetic basis and a phenotypic expression that is prompted at the cellular level by local environmental conditions.
Laryngeal Regeneration Using Tissue Engineering Techniques in a Canine Model
Authors: Kitani Yoshiharu , Kanemaru Shin-Ichi , Umeda Hiroo , Suehiro Atsushi , Kishimoto Yo , Hirano Shigeru , Nakamura Tatsuo , Ito Juichi
Published: October 2014

Objectives:

We previously reported that polypropylene mesh covered with collagen sponge is a useful material for the regeneration of the trachea and the cricoid cartilage. The aim of this study was to regenerate larynges after partial hemilaryngectomy with this new biomaterial.

Methods:

A left partial hemilaryngectomy was performed on 12 adult beagles. The defect size was about 1.8 × 1.0 cm. Both sides of polypropylene mesh were coated with either 1% or 3% collagen sponge. This scaffold was wrapped in fascia lata harvested from the left thigh and then fixed in place over the defect. Endoscopic examinations were performed periodically. Six months after treatment, 3-dimensional computed tomographic scanning was performed. Vibratory examinations were also performed with excised larynges.

Results:

In the 1% collagen group, exposure or dislocation of the mesh was found in 3 of 6 cases, but in the 3% group, no exposure of the mesh was seen. The morphological findings in the vocal fold were better in the 3% group than in the 1% group, but a difference in the vertical levels of the vocal folds was found in both groups.

Conclusions:

This study suggests that 3% collagen–coated polypropylene mesh wrapped with autologous fascia is a useful material for laryngeal regeneration.
Pediatric Head and Neck Extramedullary Hematopoietic Disease: Case Series and Review of the Literature
Authors: Morrison Aaron R. , Smith Matthew A. , Bennett Erica C.
Published: October 2014

We review 3 pediatric cases of extramedullary hematopoietic disease occurring in the orbit, ethmoid sinuses, and parotid gland, and present a review of the literature. Each of the 3 patients was taken to the operating room, and the biopsy specimens obtained were successful in establishing the diagnosis in every case. Head and neck manifestations of extramedullary hematopoietic disease are rare, indeed. However, these cases demonstrate that it is important for otolaryngologists, pediatricians, primary-care physicians, radiologists, and pathologists to maintain a high index of suspicion for extramedullary presentations of hematopoietic disease in the head and neck. A coordinated multidisciplinary approach, including the appropriate surgical approach for biopsy, will facilitate determination of the diagnosis and treatment plan.
Central Giant Cell Granuloma of the Jaws: A Clinical Study of 17 Cases and a Review of the Literature
Authors: Triantafillidou Katherine , Venetis Grigoris , Karakinaris George , Iordanidis Fotis
Published: October 2014

Objectives:

The aim of this prospective study was to evaluate the outcome of treatment of a group of 17 patients with central giant cell granuloma (CGCG) who were treated in our clinic.

Methods:

A group of 17 patients with CGCG were treated in the Clinic of Oral and Maxillofacial Surgery of the “G. Papanikolaou” hospital in Thessaloniki. The age range was from 7 to 60 years. Eight patients were male and 9 patients were female. Because most of our patients (11) were less than 30 years old, the aim of the treatment was to eradicate the lesions without functional problems. All of the patients were treated by excision via curettage without a continuity defect and peripheral osteotomy. For 2 patients, the treatment was continued (after the first recurrence) with salmon calcitonin.

Results:

The follow-ups ranged from 1 to 15 years. All of the patients were free of the disease, without features of recurrence and without functional or aesthetic problems.

Conclusions:

Surgery has usually been considered to be the best method of treatment for CGCG. Most authors have proposed conservative surgical procedures (excision via curettage), especially for young patients. For aggressive lesions, supplementary treatment with calcitonin would provide good results.
Assessment of Canine Vocal Fold Function after Injection of a New Biomaterial Designed to Treat Phonatory Mucosal Scarring
Authors: Karajanagi Sandeep S. , Lopez-Guerra Gerardo , Park Hyoungshin , Kobler James B. , Galindo Marilyn , Aanestad Jon , Mehta Daryush D. , Kumai Yoshihiko , Giordano Nicholas , d'Almeida Anthony , Heaton James T. , Langer Robert , Herrera Victoria L. M. , Faquin William , Hillman Robert E. , Zeitels Steven M.
Published: October 2014

Objectives:

Most cases of irresolvable hoarseness are due to deficiencies in the pliability and volume of the superficial lamina propria of the phonatory mucosa. By using a US Food and Drug Administration–approved polymer, polyethylene glycol (PEG), we created a novel hydrogel (PEG30) and investigated its effects on multiple vocal fold structural and functional parameters.

Methods:

We injected PEG30 unilaterally into 16 normal canine vocal folds with survival times of 1 to 4 months. High-speed videos of vocal fold vibration, induced by intratracheal airflow, and phonation threshold pressures were recorded at 4 time points per subject. Three-dimensional reconstruction analysis of 11.7 T magnetic resonance images and histologic analysis identified 3 cases wherein PEG30 injections were the most superficial, so as to maximally impact vibratory function. These cases were subjected to in-depth analyses.

Results:

High-speed video analysis of the 3 selected cases showed minimal to no reduction in the maximum vibratory amplitudes of vocal folds injected with PEG30 compared to the non-injected, contralateral vocal fold. All PEG30-injected vocal folds displayed mucosal wave activity with low average phonation threshold pressures. No significant inflammation was observed on microlaryngoscopic examination. Magnetic resonance imaging and histologic analyses revealed time-dependent resorption of the PEG30 hydrogel by phagocytosis with minimal tissue reaction or fibrosis.

Conclusions:

The PEG30 hydrogel is a promising biocompatible candidate biomaterial to restore form and function to deficient phonatory mucosa, while not mechanically impeding residual endogenous superficial lamina propria.
Activation of the Transforming Growth Factor Beta Pathway in Bacterial Otitis Media
Authors: Lee Yun-Woo , Chung Yunju , Juhn Steven K. , Kim Youngki , Lin Jizhen
Published: October 2014

Objectives:

Granulation tissue is common in otitis media (OM), yet little is known about the signaling pathways in the formation of granulation tissue in response to infections. In this study, we sought to investigate the activation of the transforming growth factor beta (TGF-β) signaling pathway in the formation of granulation tissue in response to middle ear pathogens.

Methods:

Rat OM models were made by inoculating pneumococcus type 6A or nontypeable Haemophilus influenzae into the middle ear cavity or by obstructing the eustachian tube. Various pathway activities in the middle ear mucosa were analyzed with microarrays.

Results:

The TGF-β signaling pathway was highly regulated in the middle ear cleft with bacterial OM, but not in the ears with eustachian tube obstruction. In ears with bacterial OM, the TGF-β signaling pathway products were higher in Haemophilus-infected ears than in pneumococcus-infected ears.

Conclusions:

Bacterial OM triggers granulation tissue to thrive in the middle ear cleft of rats. Nontypeable H influenzae is more potent than pneumococcus type 6A in the formation of granulation tissue. Eustachian tube obstruction alone did not contribute to granulation tissue formation in the middle ear.
Prevalence of Insomnia and Impact on Quality of Life among Community Elderly Subjects with Tinnitus
Authors: Lasisi Akeem O. , Gureje Oye
Published: October 2014

Objectives:

We sought to determine the prevalence of insomnia and its impact on the quality of life (QoL) among community elderly subjects (at least 65 years of age) with subjective tinnitus.

Methods:

After household selection with multistage stratified area probability sampling, face-to-face interviews were used to obtain self-reports of subjective tinnitus and insomnia, and QoL was assessed with the WHOQoL-Bref instrument.

Results:

Among 1,302 elderly subjects, there were 183 subjects (109 female and 74 male) with tinnitus. Among those with tinnitus, insomnia was encountered in 95 (51.9%) and was found to be significantly more common among those with tinnitus than among those without (378 of 1,119, or 33.8%; p = 0.002). The insomnia symptoms included difficulty in maintaining sleep in 73.4% of subjects, difficulty in falling asleep in 70.0%, early morning wakefulness in 64.3%, non-restorative sleep in 35.1%, and daytime sleepiness in 34.7%. Univariate analysis revealed difficulty with falling asleep (p = 0.01) and early morning wakefulness (p = 0.05) to be significantly associated with tinnitus among the symptoms. Student's t-test and logistic regression analysis revealed significant deterioration in the total QoL and in the physical, psychological, social, and environmental QoL domains among elderly subjects who had tinnitus with insomnia as compared with those without insomnia.

Conclusions:

We believe that insomnia is significantly more common among elderly subjects with tinnitus than among those without, and that its presence further depreciates the QoL in these elderly individuals.
Potential Nerve Damage following Contact with a Piezoelectric Device
Authors: Salami Angelo , Mora Renzo , Crippa Barbara , Gentile Raffaella , Dellepiane Massimo , Guastini Luca
Published: October 2014

Objectives:

The aim of the study was to assess the extent of the potential nerve damage following prolonged contact with a piezoelectric device.

Methods:

The study was conducted with 30 patients; all of the patients had cervical metastatic lymph nodes at levels II, III, and IV (N2b) and a negative evaluation for metastatic disease (M0). The patients underwent radical neck dissection. After its skeletonization, the spinal nerve was exposed directly to ultrasonic activation with a piezoelectric device for various times (5, 10, and 20 seconds) and with different inserts (OP3 insert and OT7 insert). The axonal damage was graded from 0 to 3 as follows: 0, no damage; 1, minor axonal damage; 2, severe axonal damage but not covering the entirety of the nerve fascicles; 3, severe axonal damage covering the entirety of the nerve fascicles.

Results:

Histologic examination showed no evidence of damage to the perineurium and axons after 5 and 10 seconds of exposure to ultrasonic activation with each insert.

Conclusions:

Our histologic data highlight the selective action of the piezoelectric device, which reduces the risk of accidental nerve damage in otolaryngological bone surgery.
Olfactory Ensheathing Cells in a Rat Model of Laryngeal Reinnervation
Authors: de Corgnol Anne-Christine , Guérout Nicolas , Duclos Célia , Vérin Eric , Marie Jean-Paul
Published: October 2014

Objectives:

Olfactory ensheathing cells have been used successfully for recovery of nervous system lesions. The aim of our study was to determine whether olfactory ensheathing cells from the olfactory bulb or olfactory mucosa were able to improve functional recovery in a laryngeal reinnervation animal model.

Methods:

Fifty-nine rats were divided into 6 groups. A group without nerve section (group 1; n = 10) and a group without anastomosis (group 2; n = 11) served as controls. Right vagus nerve section and immediate anastomosis (nonselective reinnervation) was performed in 4 other groups, as follows. In group 3 (n = 10), there was selective reinnervation without any addition of substance; groups 4 (n = 10), 5 (n = 10), and 6 (n = 8) received, on the section and anastomosis site, and at the same time, cultivated olfactory bulb, cultivated olfactory mucosa, and noncultivated olfactory mucosa from inbred rats, respectively. Three months later, videolaryngoscopy with vocal fold movement measurements, electromyography, and histologic examination were performed.

Results:

The best right vocal fold angular movement (3.05° ± 1.14°) was observed in group 5 with cultivated olfactory mucosa, versus group 3 (–0.28° ± 1.51°; p = 0.06). The relative angular vocal fold movement was better in group 5 (p = 0.05). The mobility score was 0.6 ± 0.27 for group 3 and 1.4 ± 0.31 for group 5 (p = 0.07). Less synkinesis was observed in the reinnervated groups with cell addition, particularly with noncultivated olfactory mucosa (group 6; p = 0.05).

Conclusions:

Olfactory ensheathing cells obtained from olfactory mucosa cultures seem to improve functional laryngeal reinnervation in a rat model of nonselective vagus nerve section and anastomosis.
Long-Term Effects of Hearing Aids on Word Recognition Scores
Authors: Song James E. , Tanaka Sara M. , Pinto Jayant M. , Rasmussen Beth , Ferro Lia M. , Saadia-Redleaf Miriam I.
Published: October 2014

Objectives:

The purpose of this study was to retrospectively examine how monaurally fitted hearing aids affected word recognition scores in patients with bilateral symmetric sensorineural hearing loss.

Methods:

Sixty-six patients from 2 separate institutions were included in this study. In addition to having bilateral symmetric sensorineural hearing loss due to presbycusis, each patient had to have worn a single hearing aid for at least 5 months and have valid pre-aid and post-aid audiograms. Word recognition scores were analyzed with a table of confidence levels generated by Thornton and Raffin that determined the probability of differences between word recognition scores.

Results:

Hearing aids did not improve or preserve word recognition scores to the degree that has been previously reported in the literature. The unaided (control) ear demonstrated a decrease in word recognition scores over time, as was expected from previous studies. The aided ears demonstrated a similar decline in word recognition scores when compared to the unaided ears. When the conventional confidence level of 0.05 was used, the aided ears showed no advantage over the unaided (control) ears.

Conclusions:

These findings are not consistent with the acclimatization first reported by Silman et al in 1993. Such a discrepancy in the results calls for further studies to evaluate just how effective unilateral hearing aids are in patients with bilateral symmetric sensorineural hearing loss.
Effect of Type I Tympanoplasty on the Quality of Life of Children
Authors: Habesoglu Tulay Erden , Habesoglu Mehmet , Deveci Ildem , Kulekci Semra , Kalaycik Cigdem , Gokceer Tanju , Egeli Erol
Published: October 2014

Objectives:

Quality-of-life issues related to chronic otitis media (COM) include physical symptoms, emotional symptoms, hearing loss, speech symptoms, social symptoms, and parents' emotional symptoms. In this study we evaluated the effects of tympanoplasty on the quality of life of pediatric patients.

Methods:

In a questionnaire-based outcome study, we reviewed 56 of 78 pediatric patients with COM who were treated with type I tympanoplasty at our institution between December 2008 and February 2010. All patients were asked to fill out the COM-5 questionnaire with their parents, before operation and 6 months after operation. Preoperative and postoperative total ear scores, preoperative and postoperative ear scores with an intact tympanic membrane, preoperative and postoperative ear scores with a perforated tympanic membrane, and preoperative and postoperative audiological results were assessed.

Results:

After type I tympanoplasty, 45 patients (80.3%) had successful closure of the tympanic membrane, but 11 patients (19.7%) had unsuccessful closure of the tympanic membrane. There was a significant decrease in physical suffering, hearing loss, emotional distress, activity limitations, and caregiver's concerns scores in patients with intact tympanic membranes after operation (p < 0.01).

Conclusions:

Children with COM had a significant increase in their quality of life after successful tympanoplasty. Our results also suggested that tympanoplasty was successful in pediatric patients with COM.
Incremental Health Care Utilization and Expenditures for Chronic Rhinosinusitis in the United States
Authors: Bhattacharyya Neil
Published: October 2014

Objectives:

I determined incremental increases in health care expenditures and utilization associated with chronic rhinosinusitis (CRS).

Methods:

Patients with a reported diagnosis of CRS were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. The patients with CRS were then compared to patients without CRS to determine differences in health care utilization (office visits, emergency facility visits, and prescriptions filled), as well as differences in health care expenditures (total health care costs, office visit costs, prescription medication costs, and self-expenditures) by use of demographically adjusted and comorbidity-adjusted multivariate models.

Results:

An estimated 11.1 ± 0.48 million adult patients reported having CRS in 2007 (4.9% ± 0.2% of the US population). The additional incremental health care utilizations associated with CRS relative to patients without CRS for office visits, emergency facility visits, and number of prescriptions filled were 3.45 ± 0.42, 0.09 ± 0.03, and 5.5 ± 0.8, respectively (all p ≥ 0.001). Similarly, additional health care expenditures associated with CRS for total health care expenses, office-based expenditures, prescription expenditures, and self-expenditures were $772 ± $300, $346 ± $130, $397 ± $88, and $90 ± $24, respectively (all p ≥ 0.01).

Conclusions:

Chronic rhinosinusitis is associated with a substantial incremental increase in health care utilization and expenditures due to increases in office-based and prescription expenditures. The national health care costs of CRS remain very high, at an estimated $8.6 billion per year.