bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustic Neuroma Ingrowth in the Cochlear Nerve: Does it Influence the Clinical Presentation?
Authors: Forton Glen E. J. , Cremers Cor W. R. J. , Offeciers F. Erwin
Published: October 2014

We examined the clinical presentation in patients with a histologically proven ingrowth of the cochlear nerve by acoustic neuroma to see whether this differs from what is known from large acoustic neuroma series. In total, 85 acoustic neuromas had an en bloc dissection to study histologically the relation between the cochlear nerve and the acoustic neuroma. In 21 of these 85 specimens, there was histologic proof of invasion of the cochlear nerve by the tumor. For 13 of these 21 tumors, sufficient clinical data could be retrieved to describe the clinical presentation in these patients. We collected clinical data such as age, sex, presenting symptoms, duration of symptoms, tone audiograms, tumor size measurements and volumetric calculations, and latency interval data I-V of brain stem evoked response audiometry and calculated whether there was any correlation among those data. We also compared these clinical data with the data from some large acoustic neuroma series. No clear difference could be shown between the clinical presentation of acoustic neuroma patients with cochlear nerve ingrowth and the clinical presentations in large acoustic neuroma series. This outcome favors the theory that the hearing impairment in acoustic neuroma patients is mainly the result of compression on the vessels of the cochlea and/or on the cochlear nerve.
Midline Maxillary Odontogenic Keratocyst
Authors: Kerr Julie T. , Steger Jamie , Sorensen Douglas
Published: October 2014

Odontogenic keratocysts are odontogenic cysts of the jaw, usually the mandible. We present a recurrent case in the maxilla. Immunohistochemical staining is necessary to distinguish the entity from other cystic lesions of the jaw, and aggressive surgical management is required.
Tracheal and Laryngeal Rupture in Neonates: Complication of Delivery or of Intubation?
Authors: Mahieu Hans F. , de Bree Remco , Sibarani-Ponsen Renate D. , Ekkelkamp Seine , Haasnoot Krijn
Published: October 2014

Neonatal tracheal or laryngeal rupture is a rare but life-threatening condition that is attributable to traumatic endotracheal intubation or traumatic delivery. We present a review of the literature and 6 new cases of laryngeal or tracheal rupture following complicated delivery. High-risk groups were identified as 1) low-birth weight neonates, for intubation trauma, and 2) extremely high-birth weight neonates with shoulder dystocia, for trauma due to delivery. Two specific types of ruptures can be distinguished. The less-rare type involves a partial anterior rupture in the subglottic area, which can occur after traumatic intubation or traumatic delivery. The rarer type involves a distal circumferential tracheal rupture that gives rise to ventilatory problems, usually after a delay of several days. This type of rupture was only observed following traumatic delivery. Early diagnosis, optically guided orotracheal intubation, and timely treatment can reduce the risks of mortality and morbidity.
Serial Office-Based Intralesional Injection of Cidofovir in Adult-Onset Recurrent Respiratory Papillomatosis
Authors: Co Johanna , Woo Peak
Published: October 2014

Intralesional injection of cidofovir is used in the treatment of recurrent respiratory papillomatosis as an adjuvant therapy after microsurgical excision and CO2 laser therapy. This is conventionally done in the operating room with the patient under general anesthesia. We report our experience with 5 patients with adult-onset recurrent respiratory papillomatosis who were treated with intralesional injections of cidofovir after recurrence of their papillomatosis. These injections were given monthly in the office without the use of general anesthesia. Before cidofovir injection, all patients required repeated CO2 laser treatments at intervals of less than 5 months. We injected 7.5 mg/mL of cidofovir transorally into the papillomas under office telescopic control. These injections were given monthly for 3 consecutive months. The patients were then followed up for 2 to 10 months after therapy to monitor the size of the papillomas. In all 5 patients, partial remission of the laryngeal papillomatosis was noted during the follow-up period. Their need for repeat microsurgery was delayed, and their vocal function improved. Intralesional injection of cidofovir in an office setting appears to be safe and effective. It might be more convenient and cost-effective than performing the same procedure in the operating room with the patient under general anesthesia.
A New Electromyographic Definition of Laryngeal Synkinesis
Authors: Maronian Nicole C. , Waugh Patricia , Robinson Larry , Hillel Allen D.
Published: October 2014

Laryngeal synkinesis involves the misdirected reinnervation of an injured recurrent laryngeal nerve to vocal fold abductor and adductor musculature. The resultant laryngeal dyscoordination can cause vocal fold immobility and airway compromise. Although this entity is sometimes considered in the differential diagnosis, it is only demonstrable with laryngeal electromyography (EMG). We propose a new EMG definition of synkinesis to assist in its identification during workup of vocal fold immobility. A retrospective chart review from 1992 to 1997 in the Voice Disorders Clinic identified 10 patients with laryngeal synkinesis. Five patients had bilateral immobility, and 5 had unilateral immobility. Monopolar EMG was performed on all patients. Fine-wire EMG was performed when monopolar EMG did not elucidate the cause of the immobility. The EMG studies revealed synkinetic reinnervation in all subjects. On the basis of the EMG results, 7 of the 10 patients were treated with botulinum toxin to weaken the undesired reinnervation. Three of the 7 patients had benefit from this therapy. Laryngeal synkinesis should be considered as part of the differential diagnosis of vocal fold immobility. Awake laryngeal EMG is the only method to demonstrate synkinesis of the larynx. The diagnosis of synkinesis is clinically significant in cases of immobility to identify patients who might benefit from botulinum toxin therapy. Additionally, the presence of synkinesis in cases of unilateral immobility may be a contraindication to laryngeal reinnervation procedures. The benefit of botulinum toxin therapy is likely greater in the treatment of bilateral as opposed to unilateral immobility.
Cochlear Implants and Health Status: A Comparison with other Hearing-Impaired Patients
Authors: Mo Birger , Harris Sten , Lindbæk Morten
Published: October 2014

Eighty-four adult cochlear implant (CI) users were compared with 3 other groups of severely to profoundly hearing impaired adults concerning quality of life (QOL): 1) 19 CI candidates who were accepted as candidates for implantation, but who were not operated on; 2) 16 CI candidates whose impairment was not severe enough for implantation; and 3) 60 users of acoustic hearing aids. Generic and disease-specific QOL questionnaires were used. The CI group scored significantly better than the CI candidates who met the criteria for implantation, but who were not operated on, on 2 of 6 categories of a disease-specific QOL measure. The CI patients had significantly less anxiety and depression than the unoperated CI candidates who met the criteria for implantation. Validation and reliability testing of 2 disease-specific QOL measures were performed by factor analyses.
Elevated Expression of Cyclooxygenase-2 in Adenocarcinoma of the Parotid Gland: Insights into Malignant Transformation of Pleomorphic Adenoma
Authors: Sakamoto Takashi , Kondo Kenji , Sugasawa Masashi , Yamasoba Tatsuya , Kaga Kimitaka
Published: October 2014

Pleomorphic adenoma, the most common type of tumor of the parotid gland, may transform into a malignant tumor. In the current study, we investigated whether the expression of cyclooxygenase-2 (COX-2) is elevated in adenocarcinoma as compared to pleomorphic adenoma. Ten pleomorphic adenomas and 10 adenocarcinomas were examined. The tumor specimens were immunohistochemically stained with antibodies against COX-2 and Ki-67. The labeling indices of COX-2 in pleomorphic adenoma and adenocarcinoma were 6.0% ± 4.1% and 16.1% ± 4.6%, respectively, and those of Ki-67 in pleomorphic adenoma and adenocarcinoma were 0.77% ± 0.62% and 6.9% ± 6.6%, respectively. The labeling indices of both COX-2 and Ki-67 were significantly greater (p < .001) in adenocarcinoma than in pleomorphic adenoma. Together with the biological effects of COX-2, these results suggest that overexpression of COX-2 plays a crucial role in the pathogenesis of malignant transformation of pleomorphic adenoma in the parotid gland.
Functional Impairments Due to Unilateral Deafness
Authors: Welsh Louis W. , Rosen Laurie F. , Welsh John J. , Dragonette Joseph E.
Published: October 2014

The authors investigated the impact of unilateral listening upon two central auditory functions: speech discrimination in a noisy environment, and the ability to process and clearly recognize modestly accelerated speech by 30% compression (shortened exposure). We determined that the negative impact of listening to speech in the milieu of noise was individually variable. The data revealed a wide range of impairment, from mild to relatively severe (ie, 0% to 60% [mean, 34%]; normative data, 4% to 36% [mean, 14%]). The performance scores for recognition of compressed sentences were not markedly influenced by unilateral deafness, but the functional results of the residual ear were correlated with a loss of high-frequency sensitivity (mean of 54% correct in severe unilateral deafness with an associated high-frequency loss versus 93% correct in normal controls). Reorganization of the central nervous system by “plasticity” or biological maturation over time failed to improve the performance of monaural listening. The currently recommended methods of remediation for this sensory deficit are discussed, and newer technologies under investigation are examined.
Vestibular Evoked Myogenic Potentials and Distortion-Product Otoacoustic Emissions Combined with Glycerol Testing in Endolymphatic Hydrops: Their Value in Early Diagnosis
Authors: Magliulo Giuseppe , Cianfrone Giancarlo , Cuiuli Giuseppe , Gagliardi Mario , D'Amico Raffaello
Published: October 2014

The present investigation was specifically designed to evaluate the ability of the glycerol test combined with pure tone audiometry, distortion-product otoacoustic emissions (DPOAEs), and vestibular evoked myogenic potentials (VEMPs) to diagnose endolymphatic hydrops early and to identify cases that may evolve toward Meniere's disease. This investigation consisted of 29 consecutive patients with mild dizziness or vertigo who received no treatment. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with both DPOAEs and VEMPs. It is interesting to note that in 7 and 8 of the 29 cases, the VEMPs and DPOAEs, respectively, showed an improvement after glycerol administration that had not been shown on traditional audiometry. A further element worthy of consideration emerges from an analysis of the VEMP results compared to the DPOAE results that divided the patients into 4 groups. The first group had a postglycerol improvement with both methods, which would seem to suggest hydrops in both the anterior and posterior parts of the labyrinth. In the second and third groups, there was an improvement only either with VEMPs or DPOAEs, and this finding seems to indicate that only one endolymphatic compartment might be involved. In the last group, all patients had a positive glycerol test with positive DPOAEs on one side and with positive VEMPs on the other. Although endolymphatic hydrops can only be proven after death, a combination of VEMPs and DPOAEs with the glycerol test may permit early diagnosis of endolymphatic hydrops. These results clearly imply that these methods should be permanently included in the diagnostic protocol of patients with vestibular and audiological symptoms.
Synovial Sarcoma of the Nasal Septum
Authors: Yildirim Altan , Tosun Fuat , Alaomeroglu Melih
Published: October 2014

No case of synovial sarcoma of the nasal septum has so far been reported. We present a patient with synovial sarcoma of the nasal septum and review the related literature. The patient underwent local excision without adjuvant therapy. There was no local recurrence or distant metastasis in the 18-month follow-up period.
Audiological Features and Mitochondrial DNA Sequence in a Large Family Carrying Mitochondrial A1555G Mutation without Use of Aminoglycoside
Authors: Matsunaga Tatsuo , Kumanomido Hiroshi , Goto Yu-ichi , Shiroma Masae , Usami Shin-ichi
Published: October 2014

To elucidate the pathophysiological and genetic mechanisms of hearing loss associated with the homoplasmic mitochondrial A1555G mutation in the absence of aminoglycoside exposure, we conducted audiological and genetic analyses on 67 maternally related members of a large Japanese family carrying this mutation. A consistent pattern was evident in the audiograms, with features of sensory presbycusis, cochlear origin at all levels of hearing loss, and a high degree of vulnerability of outer hair cells. That the degree of hearing loss was similar in affected subjects within the same sibling group but differed between sibling groups suggests the involvement of nuclear modifier genes. Total mitochondrial DNA sequences were completely identical among subjects with various levels of hearing loss, and lacked additional pathogenic mutations. For the diagnosis of sensorineural hearing loss, the mitochondrial A1555G mutation should be considered when these features are present even in the absence of aminoglycoside exposure.
Bile-Induced Laryngitis: Is There a Basis in Evidence?
Authors: Sasaki Clarence T. , Marotta James , Chow Jen , Hundal Jagdeep , Eisen Richard N.
Published: October 2014

Most agree that bile reflux occurs with regularity in an otherwise healthy population and that biliary and acid reflux may play a synergistic role in damaging esophageal mucosa. But to what extent is laryngeal mucosa at risk? We constructed a saline-controlled rat model (n = 40) in which active component solutions of bile — taurocholic acid and chenodeoxycholic acid — were applied to intact laryngeal mucosa at various pH levels. Histologic sampling of the laryngeal mucosa allowed inflammation scores to be generated by a pathologist blinded to the solutions used. Both taurocholic acid at acid pH and chenodeoxycholic acid at basic pH preferentially induced statistically greater inflammation scores than did the saline control, approaching or exceeding inflammation scores attributed to hydrochloric acid at pH 1.2. These observations may clarify reasons for failure to uniformly control laryngeal injury by adequate suppression of gastric acid alone and may further justify alternative methods of laryngeal protection in patients refractory to adequate acid control.
Postauricular Needle Aspiration of Subperiosteal Abscess in Acute Mastoiditis
Authors: Lahav Jonathan , Handzel Ophir , Yehuda Moshe , Gertler Reuven , Halperin Doron
Published: October 2014

To test the hypothesis that subperiosteal abscess, a complication of acute mastoiditis, can be treated equally well by needle aspiration as by cortical mastoidectomy, we performed a retrospective analysis of 78 pediatric patients hospitalized between 1995 and 2003 and performed an analysis of published data on types and outcomes of treatment approaches for acute mastoiditis. Postauricular pus aspiration resolved the subperiosteal abscess in 14 of 17 patients. The length of the hospital stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. We conclude that postauricular pus aspiration, a simple and minimally invasive procedure, is an effective treatment modality for subperiosteal abscess. Mastoidectomy should be reserved for nonresponsive cases or those with more serious complications. Broad-spectrum antibiotics, myringotomy with daily toilet of the ear, and postauricular aspiration, when required, minimize the indications for surgery and reduce the hospital stay.
Fixation of Soft Tissue Surrounded by Bone with Microwave Irradiation: Electron Microscopic Observation of Guinea Pig Inner Ear
Authors: Tatsumi Atsuyoshi , Watanabe Kensuke
Published: October 2014

When electron microscopy is performed on organs such as the inner ear that cannot be removed immediately after decapitation of animals, it is necessary to fix the target organ or tissue by systemic or regional perfusion fixation. However, such methods of fixation can increase vascular pressure or perilymphatic pressure, making it difficult to perform precise morphological observation of the vascular endothelial cells and membranous labyrinth. We recently attempted fixation of the cochlea by microwave irradiation. Guinea pigs were decapitated. The bullas were then removed from each animal and fixed in a mixture of 2% paraformaldehyde and 0.5% glutaraldehyde. Microwave (300 W) irradiation was then applied to the specimen for 1 minute. The fixative was immediately replaced with new fixative (4°C). This sequence of manipulations was repeated 10 times, for a cumulative microwave irradiation time of 10 minutes. During the microwave irradiation period, the fixative temperature was kept at about 30°C. After the last round of irradiation, the specimens were kept immersed in the fixative for 1 hour. After a small slit was created in the bone on the lateral wall of the cochlea, the specimens were post-fixed in osmic acid and embedded in Epon 812. Each specimen was cut into halves along the plane containing the modiolus of the cochlea. After the bone on the lateral wall of the cochlea was cut off under a stereoscopic microscope, ultrathin sections were prepared for observation under a transmission electron microscope. With this technique, the stria vascularis and the organ of Corti were fixed to a degree comparable to or better than that achieved with the conventional method of fixation. Fixation with microwave irradiation is relatively simple and can solve the problems associated with perfusion fixation, and thus provides an excellent means of fixation. This technique appears to be particularly promising for fixation for soft tissue surrounded by bone.
Use of the Pediatric Quality of Life Inventory to Assess the Health-Related Quality of Life in Children with Recurrent Respiratory Papillomatosis
Authors: Lindman Jonathan P. , Lewis Linda S. , Accortt Neil , Wiatrak Brian J.
Published: October 2014

Objectives:

The objective of this study was to use the Pediatric Quality of Life Inventory (PedsQL), a 23-question modular instrument designed to measure the health-related quality of life (HRQOL) in children and adolescents, to compare the HRQOL in children with recurrent respiratory papillomatosis (RRP) with the HRQOLs reported for healthy children and children with other chronic medical conditions.

Methods:

The PedsQL version 4.0 Generic Core Scales consist of 23 questions in 4 subscales (Physical, Emotional, Social, and School Functioning) for parent-proxy reporting on the HRQOL in children ages 2 to 4 years, parent reporting for children 5 to 18 years, and child self-reporting for ages 5 to 7 years (age-adjusted questions and rating scales) and 8 to 18 years. The questionnaires were administered in person or by telephone to 22 children with RRP and (or, for children 2 to 4 years of age) one parent recruited from a tertiary pediatric otolaryngology practice. The results were compared with validated norms for healthy children and scores for children whose parents reported a chronic medical condition.

Results:

Compared with healthy controls, the children 5 to 18 years of age with RRP self-reported a significantly (p < .05) worse HRQOL as measured by the PedsQL Total Score, Psychosocial Health score (a combination of Emotional, Social, and School Functioning Scores), and Social Functioning and School Functioning scores. Self-reported scores for the children 5 to 18 years of age with RRP compared with children with other chronic illnesses followed the same trend, and the difference approached statistical significance (p = .05) for the School Functioning Subscale scores. The parent-proxy report (for children 2 to 18 years of age) scores for children with RRP were significantly lower (p < .0001) on every scale and in total compared with scores for healthy children. Compared with scores of children with other chronic medical conditions, the parent-proxy report scores were significantly lower for psychosocial health (p = .005) and school functioning (p<.0001).

Conclusions:

Children with RRP report a lower quality of life than do those who are healthy, and a quality of life similar to that of those who have other chronic medical problems. The parent reports also reflect a lower quality of life for children affected by this disease, as compared with healthy children. The PedsQL demonstrated a statistically significant low HRQOL in children with RRP; however, the clinical implications of this finding appear trivial. A distinct, disease-specific survey for RRP, if developed, would have enhanced responsiveness and sensitivity to change (due to the natural course of the disease and/or surgical treatments).
Myonuclear Addition to Uninjured Laryngeal Myofibers in Adult Rabbits
Authors: Goding George S. , Al-Sharif Kais I. , McLoon Linda K.
Published: October 2014

Objectives:

In normal mature limb skeletal muscle, satellite cells are quiescent and myonuclei do not divide after formation of their associated myofibers in the absence of injury. The possibility of myonuclear addition in uninjured laryngeal myofibers of adult rabbits was investigated in an immunohistochemical pilot study.

Methods:

Bromodeoxyuridine (brdU), a marker for cell division, was administered by intraperitoneal injection over a 12-hour period in rabbits. The number of brdU-positive myonuclei per myofiber was determined on cross sections through the thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles.

Results:

In the TA muscle, 0.13% ± 0.03% (mean ± SEM) of the myofibers counted had a brdU-positive nucleus. In the PCA muscle, 0.13% ± 0.01% of the myofibers counted had a brdU-positive nucleus. Approximately 0.2% and 0.3% of the myofibers of the TA and PCA muscles, respectively, had brdU-positive satellite cells associated with them. Tibialis anterior and pectoralis major muscle controls were negative for brdU-positive myonuclei.

Conclusions:

These data support the possibility of continuous remodeling in uninjured adult laryngeal myofibers and accentuate the distinct nature of laryngeal muscle relative to limb skeletal muscle in the rabbit model.
Penetrating Foreign Body Mimicking Supraglottic Carcinoma
Authors: Bolzoni Andrea , Peretti Giorgio , Piazza Cesare , Pedruzzi Barbara , Nicolai Piero
Published: October 2014

Penetrating trauma to the neck is a rare observation. We report the first case of laryngeal myofibroblastic tumor due to a persistent splinter of glass in the preepiglottic space, which presented with recurrent mild hemoptysis and cough, and mimicked supraglottic carcinoma. The clinical and imaging evaluations are herein reported. Finally, medical and surgical options in the management of this unusual observation are discussed.
Oral Melanoacanthoma: A Case Report, a Review of the Literature, and a New Treatment Option
Authors: Andrews Brian T. , Trask Douglas K.
Published: October 2014

Objectives:

Oral melanoacanthoma is a rare condition that presents as a pigmented, painful lesion, most commonly on the buccal mucosa. Argon plasma coagulation is a new treatment option for benign oral lesions and is hypothesized to be efficacious for this rare mucosal disorder.

Methods:

Treatment of a case and a review of the English-language literature were performed.

Results:

One patient received a diagnosis of oral melanoacanthoma, and argon plasma coagulation treatment resulted in ablation of the lesion with excellent mucosal healing. A review of the literature demonstrated that this lesion is most commonly associated with black (90.9%), adult female (69.7%) patients and is most commonly located on the buccal mucosa (64.7%).

Conclusions:

Oral melanoacanthoma is a rare, benign mucosal lesion that may require surgical intervention for symptomatic relief. Argon plasma coagulation is a relatively safe and effective means of treating this lesion. Argon plasma coagulation treatment may be expanded to include other benign, superficial lesions of the oral mucosa.
Platelet Gel for Endoscopic Sinus Surgery
Authors: Pomerantz Jonathan , Dutton Jay M.
Published: October 2014

Objectives:

New techniques are being utilized to improve outcomes for endoscopic sinus surgery, including newer forms of packing. Platelet gel is an innovative technique that holds many advantages, including comfort, hemostasis, and growth factors that may improve wound healing. This report discusses the theoretical advantages of this packing material and describes the initial results in a cohort of patients who underwent endoscopic sinus surgery.

Methods:

A cohort of patients who underwent endoscopic sinus surgery were interviewed and evaluated after the placement of platelet gel. A quality of life study was also administered for further understanding.

Results:

None of the patients in the study had postoperative epistaxis that required additional packing, and there were no instances of synechia formation or exuberant granulation tissue. Although not statistically significant because of a small population, the quality of life scores did show improvement over the control group.

Conclusions:

Platelet gel used as a packing material after endoscopic sinus surgery offers efficient hemostatic properties, as well as growth factors that can advance the healing process. The quality of life of the patient may be improved by the use of platelet gel packing.
Hemorrhage following Coblation Tonsillectomy
Authors: Windfuhr Jochen P. , Deck Jens C. , Remmert Stephan
Published: October 2014

Objectives:

We performed a prospective study to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) in adults and children who underwent Coblation tonsillectomy (CTE) under general anesthesia.

Methods:

The data of 63 adults and children (mean age, 21.8 years) were analyzed.

Results:

There were 7 episodes of considerable bleeding (11.1%) that required surgical treatment under general anesthesia in 6 patients, of whom 5 experienced secondary bleeding (>24 hours). Moreover, bleeding and massive swelling of the pharynx required surgical treatment and prolonged intubation (35 hours) in 1 patient. None of the patients received blood transfusions. There was no case with a lethal outcome. Less intense bleeding (clots; blood-tinged sputum) was observed in 17 patients (27%) who required readmission or prolonged inpatient observation, 1 of whom had previously undergone surgical treatment of PTH. However, these 17 patients had an uneventful clinical course. In total, 22 patients experienced minor or major forms of PTH (34.9%).

Conclusions:

At least in our hands, CTE dramatically increased the frequency of PTH. The high rate of secondary bleeding contrasts with our documented experience using conventional methods, ie, cold dissection and suture ligation, to achieve hemostasis (7.9% with CTE versus <0.8% with conventional methods). Therefore, at our institution, tonsillectomy with conventional instruments remains the method of choice.
Inside-Out Complete Tonsillectomy: Extended Intracapsular Tonsillectomy for Severe Sore Throat
Authors: Isaacson Glenn
Published: October 2014

Objectives:

This consecutive case series is presented to describe inside-out complete tonsillectomy and to assess its effects on postoperative pain and bleeding and its initial effectiveness in controlling recurrent sore throat and peritonsillar abscess formation.

Methods:

Bipolar electrosurgical scissors are used for bloodless resection of 90% of the tonsillar mass. During controlled resection, tonsil tissue is intentionally left at the superior and inferior poles and at the deepest part of the tonsillar fossa to provide coverage for nutrient arteries and the tonsillar plexus of veins. This tissue is then electrodesiccated and removed under direct vision and indirect mirror guidance to achieve complete tonsillectomy.

Results:

One hundred eighty-three consecutive tonsillectomies were performed by a single surgeon in a 16-month period, 47 of which were for the indication of recurrent sore throat (44) or recurrent peritonsillar abscess (3). Among these 47 children, there were 2 readmissions for dehydration. There were no immediate or delayed bleeding episodes. The average child required 4 days of narcotic pain medication. The mean annualized number of severe sore throats decreased from 5.24 before operation to 0.36 after operation (p <.0001, Student's paired t-test). There were no recurrent peritonsillar abscesses.

Conclusions:

Inside-out complete tonsillectomy achieves the surgical goal of complete tonsillectomy with the smallest possible wound and minimal injury to the surrounding tissue. The perioperative morbidity is markedly decreased compared to that of historical controls. The initial results suggest effectiveness similar to that of extracapsular tonsillectomy.
Study of Cyfra 21–1, a Tumor Marker, in Head and Neck Squamous Cell Carcinoma
Authors: Céruse Philippe , Rabilloud Muriel , Charrié Anne , Dubreuil Christian , Disant François
Published: October 2014

Objectives:

We performed a prospective study to determine the cutoff value and the prognostic value of Cyfra 21–1, a serum tumor marker, in head and neck squamous cell carcinoma (HNSCC).

Methods:

The serum concentration of Cyfra 21–1 was measured in a group of 300 patients (group 1) with HNSCC, in a control group of 71 healthy subjects (group 2), and in a group of 73 patients with a nonmalignant tumor or inflammatory disease (group 3). The concentrations were compared between the various groups and subgroups; the cutoff value was calculated with a receiver operating characteristic curve. Furthermore, the serum concentrations of Cyfra 21–1 before treatment in the group of 300 patients were compared with the stage of the disease and with the evolution of the overall survival rate and the disease-free survival rate. Finally, to determine whether Cyfra 21–1 is an independent prognostic factor, we compared the concentrations, by a Cox model, with the classic prognostic factors of HNSCC.

Results:

At the cutoff value of 1 ng/mL, the specificity was 94% and the sensitivity was 72%. The serum concentrations of Cyfra 21–1 were statistically correlated with the stage of the disease. The overall survival rate and the disease-free survival rate were lower in patients with high serum concentrations, and these differences were statistically significant (p <.001). The Cox model allows us to conclude that Cyfra 21–1 is a prognostic marker that is independent of other classic prognostic factors.

Conclusions:

Cyfra 21–1 is an interesting tumor marker that could be proposed for the early detection of HNSCC with a cutoff value of 1 ng/mL. Furthermore, Cyfra 21–1 can be considered an independent prognostic marker.
Nitrotyrosine in Otitis Media with Effusion
Authors: Hisamatsu Ken-Ichi , Inoue Hajime , Makiyama Kiyoshi , Homma Masami
Published: October 2014

Objectives:

Our purpose was to investigate mucosal cell injury due to the nitric oxide (NO)-superoxide system in otitis media with effusion.

Methods:

We determined the levels of nitrotyrosine (NT) and NO and the activities of superoxide dismutase (SOD) and lactic dehydrogenase (LDH) in 90 middle ear fluid samples.

Results:

The NT concentration was significantly higher in group A (<16 years old) than in group C (>50 years old; p <.05), and significantly higher in the acute group than in the chronic group (p <.05). The NO concentration did not show a significant difference among the groups. The activity of SOD showed significant correlations with the concentrations of NT and NO and with LDH activity (p <.05). The LDH activity was significantly greater in group A than in group C (p <.05).

Conclusions:

Our results indicate involvement of the NO-superoxide system in the pathogenesis of otitis media with effusion, showing evidence of protein and/or cell injury in the middle ear.
Western Blot Immunoassay for HSP-70 Antibodies in Idiopathic Tinnitus: A Preliminary Report
Authors: Savastano Marina , Celadin Marilena , Pittoni Marina , Plebani Mario , Marioni Gino
Published: October 2014

Objectives:

Our preliminary study investigated the role of nonspecific immunologic tests and immunoassay for heat shock protein 70 (HSP-70) in supporting the possibility of an autoimmune inner ear process determining idiopathic tinnitus.

Methods:

Thirty-six consecutive patients with idiopathic tinnitus without other otologic or autoimmune diseases and 20 healthy blood donor subjects underwent determinations of circulating immune complexes (CICs) and other nonspecific immunologic factors and immunoassay for HSP-70.

Results:

The mean CIC values were 4.2 μg/mL in the tinnitus patients and 0.9 μg/mL in the control group (p = .012). Thirteen of the 36 tinnitus patients and none of the control group were HSP-70-positive. Ten of the 13 HSP-70-positive patients had CIC values higher than normal. In the tinnitus group, the mean CIC values were 6.9 μg/mL and 2.6 μg/mL in the HSP-70-positive and –negative subgroups, respectively (p = .024).

Conclusions:

It may be hypothesized that in a significant number of cases, idiopathic tinnitus could be induced by immune response to inner ear–specific HSP-70.
Human Adult Deglutition during Sleep
Authors: Sato Kiminori , Nakashima Tadashi
Published: October 2014

Objectives:

Clearance of the pharynx by deglutition is important in protecting the airway. The pattern of deglutition during sleep was investigated.

Methods:

Deglutition during sleep was examined in 8 normal human adults via time-matched recordings of polysomnography and surface electromyography (EMG) of the thyrohyoid and suprahyoid muscles.

Results:

During sleep, deglutition was episodic, and was absent for long periods. The mean number of swallows per hour (±SD) during the total sleep time was 2.9 ±1.3. The mean period of the longest absence of deglutition was 50.6 ± 10.2 minutes. Most deglutition occurred in association with spontaneous electroencephalographic arousal in rapid eye movement (REM) sleep and non-REM sleep. Deglutition was related to sleep stage. The mean number of swallows per hour was 7.2 ± 3.5 during stage 1 sleep and 2.0 ± 0.7 during stage 2 sleep. There was little deglutition during stages 3 and 4. The deeper the sleep stage became, the lower the mean deglutition frequency became. The mean number of swallows per hour was 2.7 ± 2.2 during REM sleep. The EMG amplitude dropped to the lowest level of recording and hypotonic EMG activity increased during REM sleep.

Conclusions:

Deglutition, a vital function, is infrequent during sleep.
Cysteinyl Leukotriene 1 Receptor Expression in Nasal Polyps
Authors: Chao Siew-Shuen , Graham Scott M. , Brown Christopher L. , Kline Joel N. , Hussain Iftikhar
Published: October 2014

Objectives:

The pathogenesis of nasal polyps, thought to involve complex interactions between different factors, is currently not fully understood. Recent studies have suggested the involvement of cysteinyl leukotrienes (CysLTs) in nasal polyp development. To further understand the role of CysLTs in polyp pathogenesis, we studied the expression of CysLT1 receptors in nasal polyps.

Methods:

The study group comprised polyps removed endoscopically from 20 consecutive patients. Samples of ethmoid mucosa from 4 patients who underwent orbital decompression for Graves' ophthalmopathy were used as controls. The presence of CysLT1 receptors was determined with a rabbit anti-human anti–CysLT1 receptor polyclonal antibody. Cells with and without CysLT1 receptor expression were counted within the epithelial layer and stroma by means of light microscopy (40× magnification).

Results:

There were significantly more cells expressing CysLT1 receptors in the stroma than in the epithelium in both nasal polyps and control specimens. The stroma of polyps also contained more CysLT1 receptor–expressing cells than did controls (29 × 103 ± 7 × 103 versus 3 × 103 ± 3 × 103 cells per square millimeter; p > .01). In the epithelium of polyps, there was significantly higher expression of CysLT1 receptors than in controls (7 × 103 ± 3 × 103 versus 0 cells per square millimeter; p = .02). No significant differences in polyps were found between patients with and patients without Samter's triad and asthma.

Conclusions:

The significant up-regulation of CysLT1 receptors we found in both the stroma and the epithelium of nasal polyps suggests the presence of an inflammatory component in the pathogenesis of polyps, and possibly explains the efficacy of leukotriene modifiers in their treatment.
Short-Duration Enzymatic Treatment Promotes Integration of a Cartilage Graft in a Defect
Authors: Janssen Luuk M. , der Maur Caroline D. In , Bos P. Koen , Hardillo Jose A. , van Osch Gerjo J. V. M.
Published: October 2014

Objectives:

Surgical manipulation of cartilage tissue is associated with chondrocyte death in the wound edges that hinders integration. The objective of this study was to evaluate the effect of a short course of treatment of a cartilage graft with a combination of hyaluronidase and collagenase on chondrocyte density and integrative capacity.

Methods:

Cartilage explants were treated with enzymes for various time periods and at various concentrations. A central core was punched out of a larger explant, treated with enzymes, reimplanted, and placed subcutaneously in athymic mice. The number of chondrocytes in the wound edges was counted, and the integrative capacity of the grafts was evaluated by histology.

Results:

Treatment with collagenase for 48 hours led to a significant increase in the number of vital chondrocytes and restored it to normal after 14 days of culture. Treatment with hyaluronidase and collagenase for 48 hours further increased chondrocyte densities to supranormal values. Shortening the treatment to 1 hour restored the chondrocyte density to normal after 14 days of culture. In vivo integration experiments showed increased chondrocyte densities in treated wound edges and extracellular matrix fibers crossing over from enzyme-treated parts to untreated parts.

Conclusions:

Short-duration treatment of a cartilage graft with a combination of hyaluronidase and collagenase increases cell density at wound edges and promotes integrative repair.
Preoperative Corticosteroid Oral Therapy and Intraoperative Bleeding during Functional Endoscopic Sinus Surgery in Patients with Severe Nasal Polyposis: A Preliminary Investigation
Authors: Sieskiewicz Andrzej , Olszewska Ewa , Rogowski Marek , Grycz Ewa
Published: October 2014

Objectives:

The aim of the study was to investigate whether orally administered steroids might improve surgical field conditions during functional endoscopic sinus surgery.

Methods:

Total blood loss and visualization of the surgical field during the surgical procedure were compared in 2 groups of 18 patients each with severe nasal polyposis. The groups were similar in respect to age, body mass index, general health status, incidence of allergy, bronchial asthma, aspirin triad, and stage of disease. One group received 30 mg of prednisone daily for 5 consecutive days before the operation. The second group served as a control.

Results:

Although the total blood loss was only slightly less in the steroid group, the visual conditions of the surgical field improved significantly.

Conclusions:

Better surgical field conditions were the results of the powerful anti-inflammatory and antiedematous activity of the drug, which facilitated blood and secretion evacuation from the operated area and prevented the optic system from staining.
Prognostic Factors in Sudden Sensorineural Hearing Loss: Our Experience and a Review of the Literature
Authors: Narozny Waldemar , Kuczkowski Jerzy , Kot Jacek , Stankiewicz Czeslaw , Sicko Zdzislaw , Mikaszewski Boguslaw
Published: October 2014

Objectives:

We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL).

Methods:

Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant.

Results:

Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring.

Conclusions:

A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.
Voice-Related Quality of Life in T1 Glottic Cancer: Irradiation versus Endoscopic Excision
Authors: Cohen Seth M. , Garrett C. Gaelyn , Dupont William D. , Ossoff Robert H. , Courey Mark S.
Published: October 2014

Objectives:

Several studies have explored posttreatment voice outcomes for early glottic cancer with varying results. To further clarify the voice-related quality of life (QOL) of T1 glottic cancer patients treated by external beam radiotherapy (EBRT) compared to endoscopic carbon dioxide laser excision (CLE), we performed a meta-analysis.

Methods:

We performed a meta-analysis review for the years 1966 to 2005 for the Voice Handicap Index (VHI), laryngeal cancer, voice outcome, voice quality, and quality of life. Studies in which the VHI was assessed at least 3 months after treatment for T1 glottic cancer were identified and analyzed by meta-analysis techniques.

Results:

Six studies with 208 patients (6 T1b and 202 T1a) treated with CLE and 91 patients (6 T1b and 85 T1a) treated with EBRT were identified. The posttreatment VHI scores were similar for the EBRT- and CLE-treated patients (p = .1, Wilcoxon rank sum test).

Conclusions:

We conclude that CLE and EBRT provide comparable levels of voice handicap for patients with T1 glottic cancer.
Thyrohyoid Approach for Vocal Fold Augmentation
Authors: Amin Milan R.
Published: October 2014

Objectives:

I performed a retrospective chart review to evaluate the patient tolerance and clinical results of a new technique for office-based vocal fold augmentation.

Methods:

Ten patients undergoing the thyrohyoid approach for vocal fold augmentation were asked to rate their tolerance of the procedure using a 10-point rating scale (1 = “no problem” and 10 = “very uncomfortable”). The patients also filled out a quality-of-life survey (Voice Handicap Index-10) immediately before and 1 month after the procedure. I reviewed the preprocedure and postprocedure stroboscopic findings. The findings analyzed included changes in wave symmetry and glottal closure, and evidence of implant migration.

Results:

All patients successfully underwent the procedure. The mean patient tolerance score was found to be 2.1. The average score on the Voice Handicap Index-10 improved from 21.3 before the procedure (SD, 9.23) to 7.5 after the procedure (SD, 5.77). These values were compared by use of a paired t-test, and the difference was found to be significant, with a p value of .01. The analysis of stroboscopic results revealed “improvement” or “no change” in the wave symmetry, “improvement” in glottal closure, and “no evidence of migration” after the procedure in all cases.

Conclusions:

The study findings demonstrate that the thyrohyoid approach can be used successfully in patients who need vocal fold augmentation, and that it is generally well tolerated.
Does Obstructive Sleep Apnea Affect Aerobic Fitness?
Authors: Guillermo Louis Q. , Gal Thomas J. , Mair Eric A.
Published: October 2014

Objectives:

We sought to determine whether patients with obstructive sleep apnea (OSA) had an objective change in aerobic fitness during cycle ergometry compared to a normal population. The most accurate test of aerobic fitness is measurement of maximum oxygen consumption (V̇O2max) with cycle ergometry.

Methods:

We performed a retrospective cohort analysis (247 patients with OSA) of V̇O2max from annual cycle ergometry tests compared to a large control group (normative data from 1.4 million US Air Force tests) in a tertiary care setting.

Results:

Overall, individuals with OSA had increased V̇O2max when compared to the normalized US Air Force data (p > .001). Patients with an apnea-hypopnea index of greater than 20 demonstrated a decreased V̇O2max as compared to normalized values (p > .001). No differences in V̇O2max were observed after either medical or surgical therapy for OSA.

Conclusions:

Overall, in a US Air Force population, OSA does not predict a decrease in aerobic fitness as measured by cycle ergometry. However, patients with an apnea-hypopnea index of greater than 20 have a statistically significant decrease in aerobic fitness compared to the normal population. This study demonstrates the effects of OSA on aerobic fitness. Further correlation of fitness testing results with OSA severity and treatment is needed.