bluuebunny/crossref_metadata_2025 huggingface dataset:
Induction of Antigen-Specific IgA-Forming Cells in the Upper Respiratory Mucosa
Authors: Watanabe Noritake , Kato Hirofumi , Mogi Goro
Published: October 2014

We investigated the actual processes for activating respiratory mucosal immunity. Hartley guinea pigs were immunized with particulate antigen of dinitrophenylated ovalbumin into the duodenum (group A), trachea (group B), and nasal cavity (group C) 1 week after systemic priming with the soluble antigen. The control animals (group D) received only systemic priming. Immunoglobulin A antibody titers in nasal secretions and saliva from groups A and B significantly exceeded those of groups C and D (p<.01). Many antigen-specific IgA-forming cells were detected in the respiratory and gastrointestinal mucosae of groups A and B. Following duodenal immunization, the appearance of antigen-specific IgA-forming cells in Peyer's patches preceded those in mesenteric and hilar lymph nodes, while they simultaneously appeared in the lymphoid tissues after tracheal immunization. These findings suggest that intratracheal immunization mainly stimulates bronchus-associated lymphoid tissue as a source of IgA precursors, as intraduodenal immunization stimulates gut-associated lymphoid tissue.
High Antibody Levels against Mouse Laminin with Specificity for Galactosyl-(α1–3)Galactose in Patients with Inner Ear Diseases
Authors: Klein Reinhild , Timpl Rupert , Plester Dietrich , Zanetti Fortunato R. , Berg Peter A.
Published: October 2014

Sera of 413 patients with inner ear diseases were examined for ELISA binding to mouse laminin and compared to a normal group. Strongly enhanced antilaminin antibody reactions were observed in a large number of patients with sensorineural hearing loss (68%), tinnitus (60%), and sudden deafness (46%), but not in those with Meniere's disease (14%) or normal individuals (8%). Absorption experiments demonstrated that these antibodies are also responsible for the antisarcolemmal antibody pattern in the immunofluorescence test and for the reaction with pig kidney microsomes in the ELISA. Immunochemical studies showed that laminin binding of high or low titer in sera from patients and normal individuals is due to the Galα1-3Gal epitope present in N-linked oligosaccharides of mouse laminin. No reactions were observed with human laminin, which lacks this epitope. The findings suggest that high levels of antibodies against carbohydrate structures are triggered by persistent infections, providing some new insights about the possible cause of these diseases.
Effect of Eyelid Closure and Vocalization upon the Vestibulo-Ocular Reflex during Rotational Testing
Authors: Weissman Barbara M. , Ekelman Barbara L. , DiScenna Alfred O. , Leigh R. John
Published: October 2014

During rotational testing of the vestibulo-ocular reflex (VOR), eyelid closure is known to reduce both VOR gain and nystagmus frequency. We tested the effect of vocalization, such as counting aloud, on the VOR in ten healthy normal subjects. Velocity-step and sinusoidal stimuli were applied in complete darkness under three test conditions: 1) eyes open, performing mental arithmetic; 2) eyes closed, performing mental arithmetic; and 3) eyes closed and vocalizing. With velocity-step stimuli, eyelid closure significantly reduced VOR gain (peak eye velocity/head velocity) and nystagmus duration, but vocalization reversed these effects and resulted in the highest gain values. Similar results were obtained for VOR gain during sinusoidal stimulation. This study demonstrates that when eyelid closure is necessary or unavoidable during VOR testing, continuous vocalization ensures responses that are comparable to or better than those with eyes open in darkness.
Epithelioid Sarcoma
Authors: Batsakis John G.
Published: October 2014

Epithelioid sarcomas are histogenetically and often biologically peculiar soft tissue malignancies that may be either primary or metastatic in the head and neck. The sarcomas have high recurrence and metastatic rates and a sometimes torpid course but nonetheless poor survival.
External and Middle Ear Malformations: Autosomal Dominant Genetic Transmission
Authors: Oliveira Carlos A. , Pinheiro Luis C. F. , Gomes Miriam R.
Published: October 2014

Congenital malformations of the external and middle ear are relatively frequent anomalies (one to five cases in 20,000 live births). They are part of genetic syndromes such as Treacher Collins and Goldenhar's syndromes, but most cases are isolated and sporadic. A few cases of familial incidence of isolated external and middle ear malformations with autosomal recessive, autosomal dominant, and sex-linked modes of transmission have been described. We report on two siblings with almost identical anomalies of the external and middle ear and no other congenital defects. Their father had similar malformations, but nobody else in his large sibship presented ear malformations. The defects were also absent in two previous generations. We discuss the possibility, not previously mentioned in the literature, that these congenital malformations could have appeared by spontaneous mutation in the father and transmitted themselves as an autosomal dominant trait to his children.
Progressive Hearing Loss in Usher's Syndrome
Authors: Karjalainen Seppo , Pakarinen Leena , Kääriäinen Helena , Teräsvirta Markku , Vartiainen Eero
Published: October 2014

In 18 patients with Usher's syndrome, progressive hearing loss was verified audiologically in eight cases. Despite poor auditory threshold values and low speech discrimination scores, there was only one patient who could not communicate with speech. The possibility of hearing impairment being mainly progressive in Usher's syndrome is discussed.
Total Cervical Tracheal Stenosis: Treatment by Laser, Dilation, and Stenting
Authors: Shapshay Stanley M. , Beamis John F. , Dumon Jean-Francois
Published: October 2014

Twelve patients with total cervical tracheal stenosis were treated by endoscopic laser excision (neodymium:yttrium aluminum garnet or carbon dioxide laser), bronchoscopic dilation, and prolonged stenting with a silicone T-tube. All patients had previous traumatic or prolonged endotracheal intubation requiring a tracheotomy and presented with aphonia as the major complaint. Multiple laser and dilation treatments were necessary in ten patients. Average duration of T-tube placement was 6 months. Excellent results (decannulation and good voice) were achieved in eight patients with a follow-up of 9 months to 6 years. Persistent granulation tissue and some degree of fibrosis were the most common complications (eight of 12 patients). Two patients died of medical complications. A high success rate with this endoscopic technique justifies this approach as our initial therapy, with open surgical techniques reserved for failure.
Osteosarcoma of the Larynx
Authors: van Laer Carl G. , Atkinson Mark W. A. , Helliwell Timothy R. , Stell Philip M.
Published: October 2014

A case of laryngeal osteosarcoma in a 75-year-old man is described. The osteosarcoma probably arose by dedifferentiation of a chondrosarcoma of the cricoid cartilage. Laryngeal osteosarcoma is rare: The literature is reviewed and management discussed.
Dermal Eccrine Cylindroma
Authors: Batsakis John G.
Published: October 2014

Certain dermal appendage tumors have a striking histologic and clinical homology with some tumors arising from the salivary duct system. The dermal eccrine cylindroma is an exemplar. Arising from the eccrine ducts, this neoplasm is only occasionally found outside the head and neck, has a recurrence rate of over 40%, and in its malignant form is a high-grade carcinoma. Its counterpart in salivary glands the dermal analogue tumor, manifests a histologic similarity, if not identity, also has a relatively high recurrence rate, and can also undergo malignant change.
Staging for Cholesteatoma in the Child, Adolescent, and Adult
Authors: Schuring Arnold G. , Rizer Franklin M. , Lippy William H. , Schuring Linda T.
Published: October 2014

A closed tympanomastoidectomy with subsequent staged surgical procedures leading to the excision of cholesteatoma was validated as described. All elements of staging with a 10-year experience of 354 patients are covered according to categories of child (0 to 9 years), adolescent (10 to 15 years), and adult. The child differed from the adolescent and adult in the following manner: More recurring cholesteatomas, greater ossicular necrosis, poorer hearing results, less aggressive residual cholesteatoma, and significantly poorer results with pars flaccida cholesteatoma than pars tensa cholesteatoma. After the end stage, 90% of the cases remained closed, with acceptable hearing in 60% of the patients.
Photoradiation Therapy of Animal Tumors and Nasopharyngeal Carcinoma
Authors: Tao Zheng-De , Yang Yuan-Hua , Zhao Su-Ping , Xiao Jian-Yun , Zeng Qing-Shan , Peng Yong-Yang , Liu Zheng-Wei
Published: October 2014

Both animal tumors and human nasopharyngeal carcinoma were submitted to a photoradiation therapy (PRT) trial in order to determine the efficacy and side effects of PRT, as well as to elucidate its mechanism of cytotoxicity. In animal tumors, the inhibition rate was 70%, and of 20 patients, eight achieved complete remission, and ten, significant remission, with an overall response rate of 90%. The blood picture and the values of serum IgG, IgM, IgA, and C3 all remained stable post-PRT. Only three patients developed mild generalized skin photosensitive reactions, and these did not affect subsequent treatment. There was no immunosuppressive effect as evidenced by a tritium-labeled thymidine–incorporated lymphocytoblast transformation assay performed both before and after PRT. Ultrastructural studies at different time intervals after PRT highly suggested that the mitochondria and rough endoplasmic reticulum were among the first organelles to be damaged.
Ligneous Conjunctivitis: An Ophthalmic Disease with Potentially Fatal Tracheobronchial Obstruction
Authors: Cohen Seymour R.
Published: October 2014

Ligneous conjunctivitis is a rare disease of unknown cause characterized by pseudomembranous, fibrous, woody, plaquelike deposits on the conjunctiva. The disease appears to be hereditary and/or familial. Deposits similar to those found in the eye occur in the larynx, tracheobronchial tree, nose and nasopharynx, and vagina. When these lesions occur in the larynx and tracheobronchial tree, voice change and potentially life-threatening obstruction and pulmonary disease may occur. This paper reports the findings in a child with ligneous conjunctivitis who was followed for l½ years and who had laryngeal and tracheobronchial involvement with voice change and airway obstruction. The literature is reviewed and the histopathologic findings and endoscopic findings and management of the patient are documented. Because the patient had multiple papillomata of both hands, a possible association with human papillomavirus was suspected but never confirmed.
Immunoglobulin E and Circulating Immune Complexes in Endolymphatic Hydrops
Authors: Hsu Lee , Zhu Xiao-Nong , Zhao Ying-Shi
Published: October 2014

Levels of circulating immune complexes (CICs) in 59 patients with Meniere's disease and total serum immunoglobulin E (IgE) levels in a subgroup of 42 of the 59 were determined quantitatively for possible abnormalities of humoral immunity. Significant differences in average IgE levels between the 42 patients with Meniere's disease and 18 normal control subjects were not determined; however, five (11.9 %) of the 42 patients were found to have obviously raised IgE levels. Elevated CIC levels were found in 19 (32.2 %) of the 59 patients with Meniere's disease and in one (2.3 %) of the 43 control subjects. This difference was statistically significant. The possible mechanisms of immune-mediated endolymphatic hydrops are discussed.
Severe Upper Airway Obstruction in Children Secondary to Lingual Tonsil Hypertrophy
Authors: Guarisco J. Lindhe , Littlewood Steven C. , Butcher R. Brent
Published: October 2014

Lingual tonsil hypertrophy in children is a rarely reported disorder. Two cases of severe upper airway obstruction in pediatric patients secondary to marked lingual tonsil enlargement are reported. Both children were effectively treated with lingual tonsillectomy. The surgical technique, using an insulated Bovie tip, is described.
Bronchial Foreign Bodies: An Uncommon Way of Entry
Authors: Aprigliano Flavio
Published: October 2014

The author describes two cases of bronchial foreign bodies that were not inhaled. One of them was found in the right lower bronchus after having penetrated through a wound in the chest wall. The other was lodged in the right main bronchus after penetration through a wound in the soft tissue of the neck. Both foreign bodies were successfully removed with the bronchoscope.
Immuno-Electron Microscopic Study of Keratin Distribution in the Cochlea Using Monoclonal Antibody
Authors: Shi Shan-Rong , Kobari Michio , Ohtani Iwao , Aikawa Tohru
Published: October 2014

Keratin distribution in the cochlea has been studied immuno–electron microscopically by both pre-embedding and postembedding methods. Keratin immunoreactivity in the guinea pig cochlea was clearly demonstrated in Hensen's cells, the reticular lamina surrounding both outer and inner hair cells, outer and inner pillar cells, Claudius' cells, inner and external sulcus cells, interdental cells of the spiral limbus, Reissner's membrane, border cells, inner phalangeal cells, Deiters' cells, and spiral prominence cells. Keratin expression at the ultrastructural level showed a nonfilamentous keratin system in the cytoplasm of cochlear supporting cells.
Electrosurgery-Induced Endotracheal Tube Ignition during Tracheotomy
Authors: Aly Al , McIlwain Mark , Duncavage James A.
Published: October 2014

Electrosurgery was the most common source of ignition for operating room fires prior to the advent of lasers. When combined with volatile anesthetic mixtures, electrosurgery has caused ignition of plastic, rubber, paper, enteric gases, and combustible preparation solutions. We report on an intubated patient whose polyvinyl chloride endotracheal tube ignited during a tracheotomy performed with an electrosurgical unit. The oxygen-rich environment, the polyvinyl chloride tube, and the heat generated by the electrosurgical unit combined to produce a fire. Since otolaryngologists are called upon often to perform tracheotomies on intubated patients, it is imperative that they understand the factors involved in the development of such a fire. This case is presented with an explanation of why this type of fire occurs. A brief review of the literature is included. Different kinds of electrosurgical units, precautions as to their use, and the management of electrosurgery-induced endotracheal tube fires are also discussed.
Cochlear Implants as a Contraindication to Magnetic Resonance Imaging
Authors: Portnoy William M. , Mattucci Kenneth
Published: October 2014

Magnetic resonance imaging poses little risk to the majority of patients undergoing scanning. However, cochlear implantation should pose a contraindication to this imaging process. This conclusion is based on several findings of in vitro testing of three cochlear implants: The 3M/House and 3M/Vienna designs and the Nucleus device. Specifically, tremendous torques are generated by each of these devices when they are introduced into the coil of a magnetic resonance imager; in addition, the 3M products not only were noted to induce an electrical current, but also were significantly magnetized and rendered afunctional. The clinical implications are discussed.
Three-Dimensional Analysis of 61 Human Endolymphatic Ducts and Sacs in Ears with and without Meniere's Disease
Authors: Hebbar Gopal Krishna , Rask-Andersen Helge , Linthicum Fred H.
Published: October 2014

We used light microscopy and computerized graphic reconstruction techniques to examine the endolymphatic duct and sac in 20 pairs of bones from patients with Meniere's disease and 21 bones from controls. The diameters of the endolymphatic duct and the proximal portion of the vestibular aqueduct were significantly smaller in Meniere's disease ears than in controls. Graphic reconstructions showed the Meniere's sacs to be smaller and to have fewer tubular epithelial structures in the intraosseous portion than in the control ears. The median volume of the sac in the Meniere's disease side was substantially lower than in the contralateral ear. The width of the external aperture of the vestibular aqueduct was significantly smaller in Meniere's disease ears than in controls. These findings indicate that the size not only of the vestibular aqueduct but also of the sac is reduced in Meniere's disease. The results may suggest that the endolymphatic sac is pathologically changed in Meniere's disease and that a reduced resorptive capacity of a small endolymphatic sac could result in endolymphatic hydrops.
Keratins as Molecular Markers of Epithelial Differentiation: Differential Expression in Crypt Epithelium of Human Palatine Tonsils
Authors: Mischke Dietmar , Genka Tomohiro , Lobeck Hartmut , Wille Gabriele , Wild Artur G.
Published: October 2014

The expression of keratins in the stratified squamous nonkeratinizing epithelium lining the surface and the crypts of human palatine tonsils was analyzed by high-resolution gel electrophoresis, immunoblotting, and immunohistochemical techniques. In contrast to the superficial epithelium, which showed a fairly constant keratin composition consisting of the neutral-to-basic keratins K4, K5, K6, and K8 and the acidic keratins K13, K14, K16, and K19, the keratin profiles of tonsillar crypt epithelial cells were found to be more variable, particularly with respect to the expression levels of K4 and K13. These were identical to those of surface epithelium, reduced, or abolished. Since K4 and K13 characterize the mature stage of differentiation in squamous nonkeratinizing epithelia, their decrease is indicative of an incomplete epithelial differentiation. Immunohistochemical analyses confirmed this hypothesis and allowed us, furthermore, to correlate the expression of K13 with the morphologic alterations of tonsillar crypt epithelium in the course of reticulation.
Low Incidence of Point Mutation at Codon 12 of K-Ras Proto-Oncogene in Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Authors: Hirano Toshikazu , Steele Paul E. , Gluckman Jack L.
Published: October 2014

Forty-two cases of squamous cell carcinoma arising in the upper aerodigestive tract were examined to determine the incidence and type of point mutation in codon 12 of the c-K- ras gene by using the polymerase chain reaction and oligonucleotide hybridization techniques on DNA extracted from paraffin blocks. DNA sequencing, in addition, was performed in 4 cases. No point mutation was detected in codon 12 of c-K- ras in the 42 squamous cell carcinomas we examined. According to the results of DNA sequencing of 4 cases, codon 13 also revealed no point mutation. Thus, point mutational activation of codon 12 of c-k- ras oncogene is an uncommon event in human upper aerodigestive tract squamous cell carcinoma.
Zinc in the Management of Tinnitus
Authors: Paaske Peter B. , Kjems Gunnar , Pedersen Christian Brahe , Sam Ian Law Kung
Published: October 2014

To assess any possible beneficial effect from zinc on tinnitus we performed a placebo-controlled, randomized, double-blind investigation. Forty-eight patients with tinnitus were randomized to either placebo or the administration of zinc sulfate as sustained-release tablets of 22 mg Zn++ (Zinklet). The tablets were administered three times daily for 8 weeks. Every week the patients stated the severity of tinnitus on a number scale from 0 to 10. The levels of zinc and albumin in serum were determined both before and after treatment. Of 48 patients with tinnitus, hypozincemia was found in only one patient. The zinc level increased significantly in the patients treated with zinc. We could not demonstrate any beneficial effect from zinc on tinnitus. One of the essential reasons for this finding could be that the zinc levels in serum were in the normal range previous to treatment.
Bilateral Vocal Fold Motion Impairment: Pathophysiology and Management by Transverse Cordotomy
Authors: Kashima Haskins K.
Published: October 2014

Although bilateral vocal fold paralysis (BVFP) is an uncommon disorder, bilateral vocal fold motion impairment (BVFMI) resulting from a variety of laryngeal derangements is encountered with increasing frequency. Moreover, pure BVFP accounts for only a small proportion of BVFMI. When antecedent factors associated with BVFP are absent, recognition of BVFMI is often delayed and frequently overlooked. The requirements for assessment and successful management of BVFMI are 1) recognition of its presence, 2) identification of the constituent factors restricting vocal fold motion, 3) objective assessment of airway patency, and 4) selection of a reliable management plan. More often than not, two or more BVFMI-causing factors are present; only rarely is BVFMI attributable to a single vocal fold motion-limiting cause. The clinical and endoscopic examinations should evaluate the relative contributions of vocal fold paralysis, cricoarytenoid joint fixation, infiltrative disorders, and webs and synechiae that cause restricted vocal fold motion. The flow-volume loop examination documents airflow rate and volume and the site, nature, and severity of the obstructing lesion(s). This presentation describes the evaluation and rationale for management in BVFMI. The surgical techniques currently used to address BVFMI are compared to determine their respective merits and drawbacks, depending upon the constituent factors causing vocal fold motion limitation.
Ethmoid Surgery Complications and Their Avoidance
Authors: Sogg Alan , Eichel Berkley
Published: October 2014

The purpose of this report is to review the complications that two experienced operators have encountered during the past 20 years. The techniques employed by the authors are similar. Three thousand intranasal nonendoscopic procedures accumulated between the coauthors were further evaluated to explain why complications could occur. There were five dural injuries in this series that were managed conservatively. Periorbital ecchymoses were seen in 9% of the cases with no permanent adverse sequelae. Approximately 0.5% of the patients had postoperative bleeding. Conclusions that the authors reached were as follows. 1) A complication as a result of ethmoid sinus surgery can occur with any technique and in the hands of any surgeon. 2) Training and experience plus knowledge of the ethmoid anatomy may help reduce the absolute number of complications. 3) Early recognition of a complication and its appropriate management can help decrease the relative severity of the complication. 4) The surgeon should terminate a procedure when visualization and localization are compromised.
Intracochlear Potential Distribution with Intracochlear and Extracochlear Electrical Stimulation in Humans
Authors: Kasper Andreas , Pelizzone Marco , Montandon Pierre
Published: October 2014

Intracochlear potential distributions were measured from subjects implanted with the Ineraid multichannel cochlear implant. The electrode array provided direct accessibility for obtaining measurements. Different modes of stimulation were used. The findings with intracochlear monopolar stimulation seem to confirm that significant low-resistance pathways, in which currents can flow into or out of the cochlea, are located in the basal turn. The results with extracochlear stimulation only show small intracochlear potential gradients. This finding suggests that no substantial currents flow along the auditory nerve fibers when extracochlear stimulation is used. These results concur with the electrically evoked auditory brain stem responses, in that intracochlear stimulation consistently elicited auditory brain stem responses, whereas responses elicited at or near the round window by extracochlear stimulation were weak or absent.
Utricle, Saccule, and Cochlear Duct in Relation to Stapedotomy
Authors: Pauw Bernard K. H. , Pollak Anita M. , Fisch Ugo
Published: October 2014

This study was performed to determine the area in which and the circumstances under which stapedotomy can be relatively safely performed. Measurements were made from central areas of the medial surface of the stapedial footplate to the utricle, the saccule, and the cochlear duct in 10 normal and 11 otosclerotic temporal bones. The mean distances to the utricle ranged from 1.9 to 2.4 mm, and those to the saccule from 1.7 to 2.1 mm. The minimal distance to the utricle was measured from the posterior (0.58 mm) and superior (0.62 mm) borders of the stapedial footplate. The minimal distances to the saccule were from the anterior (0.76,0.86, and 1.00 mm) border of the stapedial footplate. All other measurements were of more than 1 mm. The shortest distance between the cochlear duct and the inferior border of the footplate was 0.2 mm. Statistical analysis has shown no significant differences for the mean values obtained in normal and otosclerotic temporal bones. Fathoming of the vestibule below the central and inferior thirds of the footplate surface has shown that there is no likely danger to the vestibular end organs or cochlear duct if manipulations are carried out no deeper than 1 mm below the surface. The safest place for a stapedotomy opening is in the central and inferior-central thirds of the footplate. A stapedotomy piston of 0.4 mm in diameter can be introduced relatively safely to a depth of 0.5 mm in the vestibule over the entire surface of the stapedial footplate.
Bone Destruction Mechanisms in Chronic Otitis Media with Cholesteatoma: Specific Production by Cholesteatoma Tissue in Culture of Bone-Resorbing Activity Attributable to Interleukin-1 Alpha
Authors: Kurihara Atsushi , Yuasa Ryo , Toshima Masaru , Takasaka Tomonori
Published: October 2014

To clarify specific mechanisms underlying cholesteatoma-induced bone destruction, surgical specimens of middle ear inflammatory granulation tissue with or without cholesteatoma were maintained in vitro and the bone-resorbing activity in their culture supernatants was analyzed by means of calcium release from mouse calvaria. Almost the same levels of bone-resorbing activity and prostaglandin (PG) E2 were found in the supernatants of both types of tissue. By contrast, aural polyp tissue yielded hardly any such activity or PGE2. Under the influence of indomethacin, however, only tissue with cholesteatoma produced considerable bone resorption activity, whereas PGE2 production was suppressed completely. Such activity in the cholesteatoma culture supernatant was not due to contamination of endotoxin and proved to be blocked by the introduction of anti-interleukin (IL)-1α antibody into the calvarial assay system. Anti-IL-1β antibody had no effect on such activity. Interleukm-1α was detected only in cholesteatoma tissue culture supernatants by means of enzyme-linked immunosorbent assay and by bioassay. These data suggest that the bone destruction in otitis media with cholesteatoma may be attributed to IL-1α in addition to PGE2.
Further Morphologic Studies on Collagen Injected into Canine Vocal Folds
Authors: Remacle Marc , Marbaix Etienne
Published: October 2014

We compared the morphologic fate of three types of soluble bovine collagen injected into vocal folds of dogs: 1) Zyderm collagen implant containing 35 mg/mL of collagen (ZCI I), 2) Zyderm collagen implant containing 65 mg/mL of collagen (ZCI II), and 3) GAX collagen containing 35 mg/mL of collagen minimally cross-linked with 0.0075% glutaraldehyde. Light and electron microscopy showed good host tolerance and a long-term persistence of the three types of collagen at the site of injection. The collagen implants were progressively colonized by fibroblasts and capillaries accompanied by host collagen deposition. No inflammatory process or foreign body reaction occurred, in contrast to the typical host reaction to injected Teflon. The colonization of GAX collagen was slower than for ZCI I and ZCI II. No other significant difference was evident among the three types of injectable collagen. All three appear to be very suitable materials for laryngeal implants; moreover, they seem to best meet accepted requirements for a good implant: they are easy to inject, they are well tolerated, and they persist for a long time. We prefer GAX collagen for clinical use because of its lower reactivity and higher stability, and because overinjection is not necessary (GAX shrinks less than ZCI I and ZCI II).
Serial Culture and Characterization of the Chinchilla Middle Ear Epithelium
Authors: Nakamura Akihiko , DeMaria Thomas F. , Arya Gajra , Lim David J. , van Blitterswijk Clemens
Published: October 2014

We have successfully cultured a fibroblast-free chinchilla middle ear epithelium up to the 10th passage by using conditioned medium or using irradiated 3T3 cells as feeder cells. The cultured epithelial cells assumed a polygonal shape with a cobblestone appearance, indicating tight junction formation. A small number of the cells began to show abnormal morphology, such as indistinct cell boundaries, fibroid appearance, or giant cell formation, as the passage increased, particularly after the 5th passage. These morphologically transformed cells showed positive labeling with an anticytokeratin antibody, which indicated the epithelial origin of these cells. Neither ciliated nor secretory cells were observed in the serially cultured cells. The rate of cell growth slowed after the 7th passage, and after the 11th passage the cells no longer proliferated. Even with the above limitations, these cultured cells can be used for a number of in vitro experiments.
Stensen's Duct Carcinomas
Authors: Raymond A. Kevin , Batsakis John G.
Published: October 2014

Stensen's duct is rarely a primary site for a salivary neoplasm (11 examples in the English-language literature from 1927 to 1984). Bereft of myoepithelium, the neoplasms are histologically malignant and have been of mucoepidermoid, squamous, or undifferentiated types. Surgical management is predicated on the location and stage of the carcinoma.
Complications of Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients
Authors: Gibson Sharon E. , Wenig Barry L. , Watkins James L.
Published: October 2014

Percutaneous endoscopic gastrostomy (PEG) has been shown to benefit patients with resectable carcinoma of the head and neck. In order to determine whether patients with existing tumor or postresection anatomic changes of the upper respiratory tract can undergo this procedure with an acceptably low complication rate, 349 patients with attempted PEG were studied. The PEG procedure was successful in 114 of 122 carcinoma patients, as compared to 220 of 227 patients in a control group (patients with neurologic disease). Intraoperative complications preventing PEG placement included pharyngeal or esophageal obstruction, inadequate transillumination of the abdominal wall, and respiratory distress and occurred in 7% of carcinoma patients and 3% of controls. The incidence of airway obstruction during endoscopy was equal between groups (1%). Postoperative complications related to the gastrostomy tube were more frequent in the nonhead and neck cancer group (14% versus 5%). Younger age, fewer concomitant medical problems, and better nutritional status may account for this difference. These findings suggest that preoperative, postoperative, and unresectable head and neck cancer patients are appropriate candidates for PEG, and postgastrostomy performance appears superior to that in other patient populations.
Comparison of New Telescopic Video Microlaryngoscopic and Standard Microlaryngoscopic Techniques
Authors: Yanagisawa Eiji , Yanagisawa Ken , Horowitz Jay B. , Mambrino Lawrence J.
Published: October 2014

A new approach to microlaryngeal surgery using a specially designed video microlaryngoscope with a rigid endoscopic telescope and an attached video camera was introduced by Kantor et al in 1990. The ability to video document and perform surgery of the larynx by viewing a high-resolution television image was demonstrated. This method was recommended over the standard microscopic technique for increased visibility with greater depth of field, unimpeded instrument access, instant documentation, and superior teaching value. The authors tried this new method and the standard microscopic technique at the same sitting on a series of patients. This paper will compare these two different techniques and discuss their advantages and disadvantages. Although the new method has many advantages, the standard microscopic technique remains as a valuable method in laryngeal surgery.
Effects of Aerosolized Dexamethasone on Acute Subglottic Injury
Authors: Kryzer Thomas C. , Gonzalez Carlos , Burgess Lawrence P. A.
Published: October 2014

Aerosolized dexamethasone was used in a two-phase study to determine the possible effects on acute subglottic injury in the ferret animal model. In phase 1, equivalent subglottic injuries were made in 10 animals by using the brush technique, and the animals were divided into two groups. The treatment group received aerosolized dexamethasone at 2, 4, and 6 hours postinjury. All animals were examined 2, 4, 6, and 24 hours after the injury. The clinical condition of each animal was evaluated and their airways were measured. The animals were then painlessly killed and the larynges were frozen, sectioned, and photographed at 1-mm intervals. A computer-linked digitizer pad was used to measure the subglottic dimensions. The results show a trend for the treated animals to have a larger subglottic airway as compared to the untreated (control) group. The phase 1 study suggests that there may be an improvement in the subglottic airway when treated acutely with aerosolized dexamethasone. In phase 2, 20 additional animals were studied by using the same methods of injury and treatment as in phase 1. The subglottic airways of these animals were evaluated with histomorphometric analysis on fixed histologic sections. A statistically significant difference was found between the subglottic airways of the treated and untreated animals favoring treatment with aerosolized dexamethasone. Aerosolized dexamethasone appears to be beneficial in preserving the subglottic airway after injury, possibly secondary to decreasing the edema associated with injury.
Dysphagia following Various Degrees of Surgical Resection for Oral Cancer
Authors: Hirano Minoru , Matsuoka Hidetaka , Kuroiwa Yasunao , Sato Kiminori , Tanaka Shinzo , Yoshida Tetsuji
Published: October 2014

Postoperative swallowing problems were investigated in 20 patients who had undergone various degrees of surgical resection for oral cancer. The swallowing problems were evaluated on the basis of type of food, degree of aspiration, and duration of postoperative nasogastric tube feeding. Two patients with tongue cancer who had had hemiglossectomy without reconstruction ate normal food without aspiration within a week after operation. Eight patients who had undergone two- to three-quarter glossectomy for tongue cancer ate gruel with no or occasional liquid aspiration. Among 4 patients who had had near-total or total glossectomy for tongue cancer, 3 ate thin gruel or liquid with occasional aspiration. The other could not eat orally because of consistent severe aspiration. One patient with mouth floor cancer underwent resection of the mouth floor in combination with hemiglossectomy and she ate gruel without aspiration. Among 5 patients with mouth floor cancer who had had surgical removal accompanied by near-total or total glossectomy, 3 ate gruel with no or occasional liquid aspiration, 1 ate thin gruel with no aspiration, and the other could not eat orally. A diagnosis of T4 lesions, extensive removal of the tongue base, removal of the geniohyoid and mylohyoid muscles, and removal of the lateral pharyngeal wall were significantly related to poor swallowing function.
Conservative Medical Management of Traumatic Pharyngoesophageal Perforations
Authors: Dolgin Sanford R. , Kumar Narendra R. , Wykoff Thomas W. , Maniglia Anthony J.
Published: October 2014

Traditionally, surgical treatment has been the acceptable management for perforation of the pharyngoesophageal tract secondary to blunt and penetrating trauma. From July 1983 to June 1990, we managed 10 patients with this type of lesion by a conservative medical management approach. Mirror or fiberoptic flexible laryngoscopy was performed in the majority of cases to ascertain the nature of the injury. An esophagogram is very helpful to locate and evaluate the extent of the injury. All patients were treated with broad-spectrum intravenous antibiotic therapy and no oral feeding. There were no complications or need for surgical treatment in any of the cases. The head and neck surgeon, in selected cases, should consider the possibility of using conservative management of pharyngoesophageal perforations. This approach has proven in our hands to be relatively safe and cost-effective, resulting in no disability or prolonged hospitalization of our patients. This study involves two institutions (two affiliated hospitals of Case Western Reserve University School of Medicine) with different surgeons selecting appropriate antibiotic therapy. It is a retrospective review. No controls were made by random selection of cases treated surgically. These cases, if not properly managed, may lead to fatal outcomes.
Cricopharyngeal Myotomy: Indications and Technique
Authors: McKenna Jeffrey A. , Dedo Herbert H.
Published: October 2014

Available diagnostic tests evaluating cricopharyngeal dysmotility are expensive, uncomfortable, and unreliable for predicting the results of cricopharyngeal myotomy. Cricopharyngeal myotomy should be performed as a diagnostic test when a patient has “block” dysphagia (in which the food bolus stops rather than the swallow's being painful) localized to the cricoid level, and when no cancer is seen on esophagram. An effective surgical technique relies on the muscular distention provided by the inflated balloon cuff of a large endotracheal tube, and requires cutting the muscle fibers of the upper esophagus, the cricopharyngeus, and the hypopharynx in the posterior midline from a point 1 cm below the cricoid cartilage to the level of the thyrohyoid membrane. The cricopharyngeal limits are indistinct until the muscle fibers have been cut. Bougies, esophagoscopes, and cuffless endotracheal tubes insufficiently distend these muscle fibers. A “peanut” sponge in a Kelly clamp is used to identify and separate the last muscle fibers from the mucosa so they can be divided. These techniques minimize the risks of esophageal perforation and incomplete muscular transection. Our experience performing 54 cricopharyngeal myotomies is reported.
Angiolithiasis and Sialolithiasis in the Head and Neck
Authors: Raymond A. Kevin , Batsakis John G.
Published: October 2014

Of the two principal forms of macrolithiasis and microlithiasis in the head and neck, that occurring in salivary glands (sialoliths) is much more prevalent than intravascular lithiasis (angioliths). Sialoliths are also more often symptomatic, particularly when formed in the preponderant gland of involvement, the submandibular gland. Angiolithiasis is always coincidental with vascular stasis: in hemangiomas or varices. Both forms of lithiasis share several radiographic features and have a similar basis of formation. For sialoliths, secretory stasis forms a nidus for mineralization. Thrombus formation in vessels is the formative “nucleus” for an angiolith.
Labyrinthine Enhancement on Gadolinium-Enhanced Magnetic Resonance Imaging in Sudden Deafness and Vertigo: Correlation with Audiologic and Electronystagmographic Studies
Authors: Mark Alexander S. , Chapman Joseph C. , Seltzer Sharon , Fitzgerald Dennis C. , Nelson-Drake Janice , Gulya A. Julianna
Published: October 2014

Sudden deafness with or without vertigo presents a difficult diagnostic problem. This article describes 12 patients with enhancement of the cochlea and/or vestibule on gadolinium–diethylenetriamine pentaacetic acid–enhanced magnetic resonance imaging (MRI), correlating the enhancement with the auditory and vestibular function. All patients were studied with T2-weighted axial images taken through the whole brain, enhanced 3-mm axial T1-weighted images taken through the temporal bone, and enhanced T1-weighted sagittal images taken through the whole brain. Cochlear enhancement on the side of hearing loss was found in all the patients. The vestibular enhancement correlated with both subjective vestibular symptoms and objective measures of vestibular function on electronystagmography. In 2 patients, the resolution of symptoms 4 to 6 months later correlated with resolution of the enhancement on MRI. No labyrinthine enhancement was seen in a series of 30 control patients studied with the same MRI protocol. Labyrinthine enhancement in patients with auditory and vestibular symptoms is a new finding and is indicative of labyrinthine disease. While abnormalities on electronystagmograms and audiograms are nonspecific and only indicate a sensorineural problem, enhanced MRI may separate patients with retrocochlear lesions, such as acoustic neuromas, from those in whom the abnormal process is in the labyrinth or the brain.
Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review
Authors: Ochi James W. , Evans John N. G. , Bailey C. Martin
Published: October 2014

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. One hundred forty-nine operations consisting of 75 laryngotracheoplasties and 74 laryngotracheal reconstructions with costal cartilage grafting were performed. The Cotton grading scheme of preoperative stenosis was useful in predicting likelihood of decannulation. In all, 90 patients (83%) were decannulated.
Rapid Voice Tremor, or “Flutter,” in Amyotrophic Lateral Sclerosis
Authors: Aronson Arnold E. , Winholtz William S. , Ramig Lorraine Olson , Silber Sandra R.
Published: October 2014

In an attempt to clarify the origin and frequency characteristics of a rapid voice tremor, or “flutter,” in patients with amyotrophic lateral sclerosis (ALS), eight patients (four men and four women; ages 42 to 70 years) who had ALS and rapid voice tremor and an age-and sex-matched control group of eight subjects were asked to sustain the vowel /a/ and their voices were recorded for later analysis. Each segment of phonation was demodulated into amplitude and frequency components. From each subject's 8-second amplitude and frequency signals, a fast Fourier transform analysis was done on a 1-second segment previously identified perceptually as having the most apparent tremor or flutter. The results showed that patients with ALS had multiple combinations of levels and frequencies for amplitude and frequency modulations in comparison with control subjects, who had consistently low levels of modulations. In an attempt to quantify the tremor or flutter in ALS, amplitude and frequency modulations were not clearly or predominantly represented at one point along the spectrum. Nevertheless, these frequency and amplitude modulations are more prominent in patients with ALS than in normal subjects. The origins of these aberrant frequency and amplitude modulations in ALS patients remain obscure, although speculation is that they are of peripheral rather than central nervous system origin.
Tracheobronchial Obstruction from Esophageal Carcinoma: Bronchoscopic Treatment with Neodymium:Yttrium-Aluminum-Garnet Laser
Authors: Rebeiz Elie E. , Vergos Konstantinos , Beamis John F. , Shapshay Stanley M.
Published: October 2014

Tracheobronchial obstruction resulting from esophageal carcinoma is uncommon. Patients with advanced esophageal carcinoma with tracheobronchial obstruction usually present with severe dyspnea or hemoptysis or both and may die of suffocation. The Lahey Clinic experience using laser bronchoscopy for the palliation of symptoms of airway obstruction in patients with esophageal carcinoma is presented. From 1982 to 1990, nine patients were treated in 13 procedures using the neodymium:yttrium-aluminum-garnet laser. Of the patients, seven had undergone previous treatment of the primary tumor. Tumors were located in the trachea in seven patients and in the main stem bronchi in three patients. Improvement of the airway caliber was achieved in all patients with relief of the dyspnea. The mean hospital stay was 2 days. One patient lived 4 years after laser treatment with no recurrence of tumor, and one patient died 1 week after treatment as a result of his poor general condition. The rest of the patients lived 3 to 41 weeks, with a median survival of 35 weeks. No complications were related to the procedures, and in particular, no tracheoesophageal fistulas developed. Our experience indicates that bronchoscopic application of this laser in conjunction with other treatment modalities can improve the quality and duration of life in selected patients with esophageal carcinoma that invades and obstructs the trachea.
Meniere's Syndrome Inherited as an Autosomal Dominant Trait
Authors: Oliveira Carlos A. , Braga Ana Maria
Published: October 2014

Brown in 1941 reported on five families having two members with Meniere's syndrome. In 1949 she reported on three siblings (children of first cousins) and two identical twins bearing the syndrome. Bernstein in 1965 reported on seven families having two or more members afflicted by the symptoms. All these reports showed association between Meniere's syndrome and migraine headaches. None provided detailed pedigree studies in order to clarify the mode of genetic transmission. We report on a father, three daughters, and one son with typical Meniere's syndrome and paroxysmal headaches. The pedigree strongly suggests autosomal dominant transmission. After studying this family we have been paying close attention to family histories of Meniere's syndrome patients. It is not at all uncommon to hear about other members of the family with the syndrome, but it is difficult to document all of the cases for logistical reasons.
Vestibular Pathophysiologic Changes in Experimental Perilymphatic Fistula
Authors: Nomura Yasuya , Young Yi-Ho , Hara Makoto
Published: October 2014

An animal model of experimental perilymphatic fistula (EPLF) was developed in the guinea pig in order to study vestibular pathophysiology. In experimental animals, 4 μL of perilymph was suctioned from one cochlea via the round window membrane. Changes in vestibular function were as follows. 1) During the acute stage (5 hours postoperatively), spontaneous nystagmus directed toward the normal side was noted in 57.4% of the EPLF animals. This lasted less than 24 hours. 2) One week postoperatively, direction-fixed positional nystagmus toward the lesioned ear was present in 22.7% of the EPLF animals, especially when the lesioned ear was positioned inferiorly. 3) With the ice water caloric test, no response was present in 58.1% of the EPLF animals and an irregular response was found in 22.6% of them, 1 week postoperatively. These results tend to indicate that tests of vestibular function may differentiate between patients with Meniere's disease and those with perilymphatic fistula. Histologic findings indicate that a floating labyrinth is the cause of positional nystagmus and caloric irregularity. The absence of caloric responses was associated with collapse of the vestibular labyrinth.
Corneal Autoimmunity in Cogan's Syndrome?
Authors: Majoor Maarten H. J. M. , Albers Frans W. J. , Gmelig-Meyling Frits , van der Gaag Ruth , Huizing Egbert H.
Published: October 2014

Autoimmune reactivity against corneal antigens is described in two patients with Cogan's syndrome, a nonsyphilitic deep interstitial keratitis with vestibuloauditory symptoms. In both cases corneal antibodies were found at the beginning or during an exacerbation of the disease. After administration of high doses of corticosteroids the corneal antibodies diminished. Interstitial keratitis can generally be controlled by local or systemic corticosteroids. The effect of corticosteroid therapy on the audiovestibular symptoms is variable. The possibility of an autoimmune pathogenesis of Cogan's syndrome is discussed.