bluuebunny/crossref_metadata_2025 huggingface dataset:
Melatonin: Can it Stop the Ringing?
Authors: Hurtuk Agnes , Dome Claudia , Holloman Christopher H. , Wolfe Kelly , Welling D. Bradley , Dodson Edward E. , Jacob Abraham
Published: October 2014

Objectives:

We sought to report the efficacy of oral melatonin as treatment for chronic tinnitus and to determine whether particular subsets of tinnitus patients have greater benefit from melatonin therapy than others.

Methods:

This was a prospective, randomized, double-blind, crossover clinical trial in an ambulatory tertiary referral otology and neurotology practice. Adults with chronic tinnitus were randomized to 3 mg melatonin or placebo nightly for 30 days followed by a 1-month washout period. Each group then crossed into the opposite treatment arm for 30 days. The tests audiometric tinnitus matching (TM), Tinnitus Severity Index (TSI), Self Rated Tinnitus (SRT), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were administered at the outset and every 30 days thereafter to assess the effects of each intervention.

Results:

A total of 61 subjects completed the study. A significantly greater decrease in TM and SRT scores (p < 0.05) from baseline was observed after treatment with melatonin relative to the effect observed with placebo. Male gender, bilateral tinnitus, noise exposure, no prior tinnitus treatment, absence of depression and/or anxiety at baseline, and greater pretreatment TSI scores were associated with a positive response to melatonin. Absence of depression and/or anxiety at baseline, greater pretreatment TSI scores, and greater pretreatment SRT scores were found to be positively associated with greater likelihood of improvement in both tinnitus and sleep with use of melatonin (p < 0.05).

Conclusions:

Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.
Are Postural Restrictions Necessary for Management of Posterior Canal Benign Paroxysmal Positional Vertigo?
Authors: De Stefano Alessandro , Dispenza Francesco , Citraro Leonardo , Petrucci Anna Grazia , Di Giovanni Pamela , Kulamarva Gautham , Mathur Navneet , Croce Adelchi
Published: October 2014

Objectives:

An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC.

Methods:

Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM — Either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: Group A, with postural restrictions, and group B, without postural restrictions. The statistical analysis was performed with χ2 tests and t-tests.

Results:

No patients in either group showed positional nystagmus in the posttreatment evaluation under infrared videonys-tagmoscopy. No patients had symptoms of vertigo after the therapy. The results of follow-up vestibular tests were normal in both groups.

Conclusions:

In our experience, postural restrictions do not enhance the beneficial effect of the CRMs. They do not seem to have any protective role and therefore should not be recommended as an adjunct to the treatment of PSC BPPV.
Removal of Tracheobronchial Foreign Bodies via Suspension Laryngoscope and Hopkins Telescope in Infants
Authors: Lei Wen-Bin , Su Zhen-Zhong , Zhu Xiao-Lin , Xiong Guan-Xia , Chai Li-Ping , Chen De-Hua , Chen Feng-Hong , Feng Xia , Liu Ke-Xuan , Wen Wei-Ping
Published: October 2014

Objectives:

Tracheobronchial foreign body aspiration is a life-threatening accident in infants, and is still a formidable clinical emergency to both otorhinolaryngologists and anesthesiologists. In this study, we attempted to assess the safety and ease of tracheobronchial foreign body removal in infants via suspension laryngoscopy and Hopkins telescopy under general anesthesia with endotracheal intubation.

Methods:

The retrospective clinical study from 2006 to 2010 included 50 infants with foreign body aspiration, of whom 35 underwent suspension laryngoscopy and Hopkins telescopy and the other 15 underwent rigid bronchoscopy. All of the procedures were under general anesthesia with endotracheal intubation.

Results:

All of the patients underwent temporary extubation. The foreign body was successfully removed in 46 cases and was not found in the other 4 cases. The mean operation time in the rigid bronchoscopy group was 13.20 ± 9.01 minutes, and that in the Hopkins telescopy group was 5.79 ± 3.54 minutes. The oxygen saturation level was below 90% in 17 cases, of which 7 were in the rigid bronchoscopy group and 10 were in the Hopkins telescopy group. The vital signs, including the partial pressure of carbon dioxide in expiratory gas and the heart rate, were stable in all cases.

Conclusions:

Foreign body removal in infants via suspension laryngoscopy and Hopkins telescopy under general anesthesia with endotracheal intubation should be promoted, since it is relatively safe and easy for both anesthesiologists and otorhinolaryngologists to perform and has a remarkable success rate.
Effects of Levobupivacaine versus Bupivacaine Infiltration on Postoperative Analgesia in Pediatric Tonsillectomy Patients: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: Özmen Süay , Özmen Ömer Afşin , Kasapoğlu Fikret
Published: October 2014

Objectives:

We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain.

Methods:

Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45 ± 2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60 ± 2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85 ± 2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGrath's face scale.

Results:

The postoperative pain scores at 1 and 5 hours were similar among the groups (p > 0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p < 0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p > 0.017). There was no difference between the levobupivacaine and bupivacaine groups (p > 0.017).

Conclusions:

Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.
Prevalence and Significance of High-Frequency Hearing Loss in Subjectively Normal-Hearing Patients with Tinnitus
Authors: Kim Dong-Kee , Park Shi-Nae , Kim Hyung Min , Son Hye Rim , Kim Nam-Gyun , Park Kyoung-Ho , Yeo Sang Won
Published: October 2014

Objectives:

We investigated the incidences of high-frequency hearing loss (HFHL; above 2 kHz) and extended high-frequency hearing loss (EHFHL; above 8 kHz) in patients with tinnitus and subjectively normal hearing, and evaluated their effects on the clinical and audiological features of the patients.

Methods:

The sample included 85 patients with sensorineural tinnitus who had normal hearing sensitivity in the frequencies from 250 Hz to 2 kHz, and who had undergone extended high-frequency audiometry between July 2009 and February 2010. We investigated the incidences of HFHL and EHFHL in these patients and analyzed the significance of the hearing losses.

Results:

The incidence of HFHL or EHFHL was 88%. The proportion of patients with EHFHL, among the patients who had normal hearing sensitivity up to 8 kHz, was about 74%. The patients with normal hearing sensitivity at all test frequencies were significantly younger, had larger otoacoustic emissions, and had tinnitus that was less loud as measured by tinnitus matching than did the subjects with HFHL and/or EHFHL. However, other comparisons of clinical factors in the three groups did not show any differences.

Conclusions:

Even if patients with tinnitus do not have any subjective hearing impairment, most of them have HFHL and/or EHFHL. The effects on the clinical features of the patients are still vague.
Chronic Esophageal Foreign Bodies and Secondary Mediastinitis in Children
Authors: Cole Stephanie , Kearns Donald , Magit Anthony
Published: October 2014

Objectives:

The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children.

Methods:

A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported.

Results:

Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients.

Conclusions:

It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.
NUT Midline Carcinoma Mimicking Tonsillitis in an Eight-Year-Old Girl
Authors: Rutt Amy L. , Poulik Janet , Siddiqui Abdul Hafeez , Konski Andre , Kalaf Majid , Madgy David N. , Wang Zhihong J.
Published: October 2014

We review a unique case of NUT midline carcinoma that presented in a young girl with an initial diagnosis of tonsillar abscess. We stress the importance of assaying poorly differentiated carcinomas in young patients for the t(15;19) translocation. Our patient presented with tonsillar enlargement and cervical lymphadenopathy mimicking acute tonsillitis. The clinical suspicion for malignancy arose after an aspirate from the tonsil did not yield any pus, and biopsy of a cervical lymph node demonstrated undifferentiated carcinoma. Further analysis by fluorescence in situ hybridization was positive for rearrangements in both BRD4 and NUT genes consistent with NUT carcinoma. In addition, fluorodeoxyglucose—positron emission tomography (FDG-PET) revealed a very high standard uptake value in both the primary tumor and metastatic foci, suggesting that FDG-PET could be a useful tool in the staging and follow-up of NUT midline carcinoma.
Lung Volumes Used during Speech Breathing in Tracheoesophageal Speakers
Authors: Bohnenkamp Todd A. , Forrest Karen M. , Klaben Bernice K. , Stager Joel M.
Published: October 2014

Objectives:

The purpose of this study was to determine how tracheoesophageal (TE) speakers manipulate lung volumes to meet speech demands and how respiratory compromise (chronic obstructive pulmonary disease [COPD]) and task variables influence these behaviors.

Methods:

The lung volumes of 9 male TE speakers (4 with COPD, 5 without) during tidal breathing, spontaneous speech, and reading were investigated. Repeated-measures multivariate analyses of variance were used to compare lung volumes and utterance length across speech tasks and by respiratory health. A one-way analysis of variance was used to compare aerodynamic measures and intelligibility by COPD diagnosis.

Results:

There was a significant main effect of task and a significant interaction effect of COPD and task on lung volumes at initiation and termination of speech. The TE speakers terminated speech exclusively below the resting expiratory level (REL) in both speech tasks because of elevated RELs, which are often present after laryngectomy. There were no main effects of COPD on any lung volume measures and no significant group differences in utterance length, aerodynamic measures, or intelligibility.

Conclusions:

Intelligibility and aerodynamic measures were not influenced by lung volumes and were comparable to findings of previous research. Speaking past the REL might be a compensation to optimize expiratory control for speech in a compromised system and a marker for the increased effort often anecdotally described by TE speakers.
Congenital Mastoid Cholesteatoma: Case Series, Definition, Surgical Key Points, and Literature Review
Authors: Giannuzzi Anna Lisa , Merkus Paul , Taibah Abdelkader , Falcioni Maurizio
Published: October 2014

Objectives:

We evaluate 3 new cases of congenital cholesteatoma confined to the mastoid process, and compare them with cases presented in the literature in order to better define this rare lesion.

Methods:

We performed a retrospective chart analysis of all congenital cholesteatomas treated surgically in a tertiary referral and skull base center. We performed a complete analysis (history, radiologic, and surgical) of all patients with congenital cholesteatoma confined to the mastoid process; we then performed a literature review and compared our findings with the presented cases.

Results:

The results of preoperative imaging were in line with the surgical findings. The most important surgical issue in this type of lesion was the management of the sigmoid sinus and the jugular bulb. Half of the cases previously reported in the literature appeared not to fulfill the definition criteria of a congenital cholesteatoma of the mastoid process.

Conclusions:

Congenital cholesteatoma confined to the mastoid process is a rare lesion, and is even more exceptional upon critical review of the literature. Symptoms are often lacking or nonspecific, and although cases have a congenital origin, the diagnosis often is not made until adulthood. A combined congenital cholesteatoma group with middle ear and mastoid features seems to fill in the gap in the definition. Management of the sigmoid sinus and the jugular bulb is the most demanding surgical key point.
Light and Electron Microscopic Observation of Regenerated Fungiform Taste Buds in Patients with Recovered Taste Function after Severing Chorda Tympani Nerve
Authors: Saito Takehisa , Ito Tetsufumi , Narita Norihiko , Yamada Takechiyo , Manabe Yasuhiro
Published: October 2014

Objectives:

The aim of this study was to evaluate the mean number of regenerated fungiform taste buds per papilla and perform light and electron microscopic observation of taste buds in patients with recovered taste function after severing the chorda tympani nerve during middle ear surgery.

Methods:

We performed a biopsy on the fungiform papillae (FP) in the midlateral region of the dorsal surface of the tongue from 5 control volunteers (33 total FP) and from 7 and 5 patients with and without taste recovery (34 and 29 FP, respectively) 3 years 6 months to 18 years after surgery. The specimens were observed by light and transmission electron microscopy. The taste function was evaluated by electrogustometry.

Results:

The mean number of taste buds in the FP of patients with completely recovered taste function was significantly smaller (1.9 ± 1.4 per papilla; p < 0.01) than that of the control subjects (3.8 ± 2.2 per papilla). By transmission electron microscopy, 4 distinct types of cell (type I, II, III, and basal cells) were identified in the regenerated taste buds. Nerve fibers and nerve terminals were also found in the taste buds.

Conclusions:

It was clarified that taste buds containing taste cells and nerve endings do regenerate in the FP of patients with recovered taste function.
Dysphonia Associated with Lingual Thyroid Gland and Hypothyroidism: Improvement after Lingual Thyroidectomy
Authors: Orbelo Diana , Ekbom Dale C. , Thompson Dana M.
Published: October 2014

We present a unique and medically complex case of improved voice after lingual thyroidectomy. A 10-year-old boy with multifactorial dysphonia presented with bilateral vocal fold lesions and sulci in the context of hypothyroidism as a result of a congenital lingual thyroid gland. Despite hormone replacement, medical treatment for asthma, allergy, cough, and possible reflux, as well as voice therapy, the dysphonia persisted. Significant improvement in both subjective and objective voice measures was achieved after surgical removal of the lingual thyroid gland, which allowed for maintenance of a consistent euthyroid state. Lingual thyroidectomy is typically reserved for cases of bleeding and dysphagia. This case supports dysphonia as a possible additional indication for lingual thyroidectomy.
Prediction of Vestibular Schwannoma Growth: A Novel Rule Based on Clinical Symptomatology
Authors: Timmer Ferdinand C. A. , Artz Janneke C. J. M. , Beynon Andy J. , Donders Rogier T. , Mulder Jef J. S. , Cremers W. R. J. , Graamans Kees
Published: October 2014

Objectives:

The aim of this study was to formulate a predictive rule for vestibular schwannoma growth during the initial observation period after diagnosis.

Methods:

Logistic regression models were fitted, with tumor growth in the first year as the dependent variable and patient characteristics as the independent variables. Backward selection was used to eliminate superfluous predictors. The area under the receiver operating characteristic curve was taken as a measure of the model's discriminative power.

Results:

Eventually, the model or rule consisted of 4 significant growth predictors: Localization (if extrameatal, +1; if intrameatal, 0), sudden sensorineural hearing loss (if present, −1; if absent, 0), balance symptoms (if present, +1; if absent, 0), and complaints of hearing loss for less than 2 years (if present, +1; if absent, or present for more than 2 years, 0). A higher score indicates a higher likelihood of tumor growth during the period of observation after diagnosis. If the total score is 0 or less, the likelihood of tumor growth during the first year after diagnosis is less than 10%. If the score is 3, the likelihood of growth during the first year after diagnosis is more than 70%.

Conclusions:

We were able to create a useful rule to predict vestibular schwannoma growth during the first year after diagnosis.
Histopathology of the Temporal Bone in a Case of Superior Canal Dehiscence Syndrome
Authors: Teixido Michael , Kung Brian , Rosowski John J. , Merchant Saumil N.
Published: October 2014

Objectives:

We describe the histopathologic findings in the temporal bones of a patient who had, during life, received a diagnosis of superior canal dehiscence (SCD) syndrome.

Methods:

The patient was found to have SCD syndrome at 59 years of age. She became a temporal bone donor, and died of unrelated causes at 62 years of age. Both temporal bones were prepared in celloidin and examined by light microscopy.

Results:

The patient developed bilateral aural fullness, pulsatile tinnitus, and difficulty tolerating loud noises after minor head trauma at 53 years of age. The symptoms were worse on the right. She also had Valsalva-induced dizziness and eye movements, as well as sound-induced dizziness (more prominent on the right). Audiometry showed a small air-bone gap of 10 dB in the right ear. Vestibular evoked myogenic potential testing showed an abnormally low threshold of 66 dB on the right, and a computed tomography scan showed dehiscence of the superior canal on the right. Histopathologic examination of the right ear showed a 1.4 × 0.6-mm dehiscence of bone covering the superior canal. Dura was in direct contact with the endosteum and the membranous duct at the level of the dehiscence. No osteoclastic process was evident within the otic capsule bone surrounding the dehiscence. The left ear showed thin but intact bone over the superior canal. Both ears showed focal microdehiscences of the tegmen tympani and tegmen mastoideum. The auditory and vestibular sense organs on both sides appeared normal. No endolymphatic hydrops was observed.

Conclusions:

The findings were consistent with the hypothesis put forth by Carey and colleagues that SCD may arise from a failure of postnatal bone development, and that minor trauma may disrupt thin bone or stable dura over the superior canal.
Functional Outcomes after Lateral Crural J-Flap Repair of External Nasal Valve Collapse
Authors: Tan Susan , Rotenberg Brian
Published: October 2014

Objectives:

We evaluated the lateral crural J-flap technique in the surgical repair of external nasal valve collapse with standardized and validated outcome measurements.

Methods:

Prospective data were gathered on consecutive cases, performed by a single surgeon between 2007 and 2010, of adult patients who underwent a lateral crural approach to repair of external nasal valve collapse. Data were collected on diagnosis, surgical outcomes, and complications. Outcome measures included the Nasal Obstructive Symptom Evaluation and the Rhinoplasty Outcome Evaluation.

Results:

Fifteen patients were included in the study. Their follow-ups ranged from 9 to 13 months. All patients had statistically significant improvements in Nasal Obstructive Symptom Evaluation scores. There was no significant change in perceived nasal appearance after surgery as measured by the Rhinoplasty Outcome Evaluation. There were no surgical complications.

Conclusions:

The lateral crural J-flap approach to repair of external nasal valve collapse is a technically straightforward and relatively safe procedure. The efficacy is excellent at the 1-year follow-up examination.
Risk Factors for Deterioration of Bone Conduction Hearing in Cases of Labyrinthine Fistula Caused by Middle Ear Cholesteatoma
Authors: Ikeda Ryoukichi , Kobayashi Toshimitsu , Kawase Tetsuaki , Oshima Takeshi , Sato Toshinori
Published: October 2014

Objectives:

We evaluated the risk factors and outcomes of bone conduction (BC) hearing in cases of labyrinthine fistulas treated under the basic principle of complete removal of the cholesteatoma matrix.

Methods:

A total of 47 patients with labyrinthine fistulas were analyzed. The fistulas were classified into smaller (no more than 3 mm) and larger fistulas (more than 3 mm). The fistulas were classified by depth into 3 stages. Preoperative symptoms and postoperative results with special reference to BC hearing were analyzed.

Results:

Total preoperative loss of BC hearing was found in 3 of 36 ears (9%) in the smaller-fistula group and 4 of 11 ears (36%) in the larger-fistula group; this was a statistically significant difference. The BC hearing was preserved after operation in 30 of 31 ears (97%) in the smaller-fistula group and 5 of 7 ears (71%) in the larger-fistula group; this difference was also significant. The stage (depth) of the fistula did not correlate with the postoperative BC hearing.

Conclusions:

In smaller labyrinthine fistulas, complete removal of the cholesteatoma matrix can be relatively safely performed. However, in patients with larger fistulas, there is a potential for a complete loss of BC hearing.
Postoperative Results of Tympanoplasty with Mastoidectomy in Elderly Patients with Chronic Otitis Media
Authors: Ahn Joong Ho , An Yun Suk , Bae Ji Sun , Kim Do Yoon
Published: October 2014

Objectives:

We evaluated the long-term results of tympanoplasty with mastoidectomy in elderly patients with chronic otitis media (COM).

Methods:

We included 192 patients with intractable COM who underwent both tympanoplasty and mastoidectomy from the same surgeon between January 2003 and December 2006 and were followed up for more than 3 years. The patients were divided into two groups: An “old COM group” of 83 patients (more than 65 years of age) and a “young COM group” of 109 patients (between 21 and 40 years of age). We compared the preoperative and postoperative levels of hearing, the types of tympanoplasty and mastoidectomy, and the postoperative complications of the two groups.

Results:

Among the old COM group, 11 patients (13.3%) showed temporary postoperative complaints without serious sequelae. Between the old and young COM groups, there were no significant differences in the rates of associated cholesteatoma, middle ear swab culture results, or type of tympanoplasty, ossiculoplasty, and mastoidectomy. In the comparison of postoperative hearing improvement, both the old and young COM groups showed a significant decrease in air-bone gap, although the old COM group showed a significantly worse preoperative air-bone gap. There were no significant differences in the rates of re-perforation of the tympanic membrane or of reoperation between the two groups.

Conclusions:

From this study, we conclude that there is no reason to withhold surgery for COM on the assumption that older patients do not have good results or that the procedure is too risky.
Subepithelial Vocal Fold Infusion: A Useful Diagnostic and Therapeutic Technique
Authors: Burns James A. , Friedman Aaron D. , Lutch Matthew J. , Zeitels Steven M.
Published: October 2014

Objectives:

Preservation of the maximum amount of subepithelial superficial lamina propria (SLP) remains an important goal during microlaryngoscopic surgery of phonatory mucosa. Volume expansion of the SLP (Reinke's space) with subepithelial infusion of saline solution has been widely adopted since its introduction in 1991. This technique has evolved so that it is currently used to assist with determining the depth of vocal fold disease, defining residual pliable SLP, enhancing microsurgical precision, and identifying unrecognized disease. The purpose of this investigation was to examine the indications, methods, and benefits of subepithelial infusion of saline solution as an adjunct technique during phonomicrosurgery.

Methods:

In a prospective case series, we collected data on 280 consecutive microlaryngoscopy procedures performed over a 12-month period. Subepithelial infusion of saline solution was included in 178 procedures.

Results:

New disease was identified in 20 of the 178 patients (scar in 15, sulcus in 4, and a mucosal bridge in 1). The depth of needle placement varied depending on the specific disease: 118 of the 178 infusions were done just below the epithelial basement membrane, and 60 infusions were performed deeper within the SLP, just superficial to the vocal ligament. The infusion technique provided surgical assistance in multiple ways, including identifying residual SLP (130 patients), defining the SLP-lesion interface (65 patients), lifting scar (60 patients), providing tension for cordotomy (47 patients), expanding the SLP volume to protect against laser damage (45 patients), and providing hydrostatic compression of vascular ectasias or varices for photoangiolysis (7 patients). The microlaryngoscopy procedures during which infusion was not performed (102 of 280 procedures) were primarily for nonglottic cancer (46 patients), stenosis (30 patients), or arytenoid granuloma (13 patients).

Conclusions:

Subepithelial infusion of the SLP with saline solution is a useful microsurgical adjunct during diagnosis and treatment of phonatory mucosal lesions.
Regeneration of Tracheal Epithelium Using a Collagen Vitrigel—Sponge Scaffold Containing Basic Fibroblast Growth Factor
Authors: Tani Akiko , Tada Yasuhiro , Takezawa Toshiaki , Imaizumi Mitsuyoshi , Nomoto Yukio , Nakamura Tatsuo , Omori Koichi
Published: October 2014

Objectives:

Our group has had good results in tracheal mucosal regeneration using a collagen vitrigel–sponge scaffold in an animal model. In this study, the effectiveness of this scaffold with the application of basic fibroblast growth factor (b-FGF) was investigated.

Methods:

A collagen vitrigel–sponge scaffold was fabricated with simultaneous addition of b-FGF. Three types of collagen vitrigel–sponge scaffolds were made: No b-FGF, 10 ng of b-FGF, and 100 ng of b-FGF. At 3, 5, 7, and 14 days after implantation in rats, the tracheas were removed and histologically evaluated. The regeneration of mucosal epithelium and the subepithelial layer was evaluated.

Results:

Mucosal epithelium, including pseudostratified epithelium and ciliated cells, regenerated earlier in the scaffolds when b-FGF was applied than when b-FGF was not applied. Regeneration of the subepithelial layer, infiltration of inflammatory cells and fibroblasts, and angiogenesis were promoted earlier in the scaffolds with b-FGF application.

Conclusions:

Our technique for tracheal reconstruction using collagen vitrigel–sponge scaffolds with b-FGF application affords a feasible approach for accelerating the regeneration of the intraluminal surface and subepithelial layer of tracheal tissue.
Bilateral Carcinoma in Situ of Wharton's Duct after Chronic Obstructive Sialadenitis: Inflammation as the Cause of Malignancy?
Authors: Gallego Lorena , Junquera Luis , Calvo Nicolás , Fuente Eduardo , Rosado Pablo
Published: October 2014

A case of bilateral carcinoma in situ of Wharton's duct after chronic sialadenitis is reported. The patient, a 54-year-old man, complained of recurrent pain and swelling in the left lower submandibular region. Computed tomography showed large stones in the hilar area of both submandibular glands. The patient underwent bilateral submandibular excision. Histologic and immunohistochemical examination revealed squamous metaplasia with areas of carcinoma in situ in both right and left ducts adjacent to the calculus. To the best of our knowledge, this is the first case report in the literature describing an association between obstructive sialadenitis and carcinoma in situ of Wharton's duct. We discuss etiologic factors and chronic inflammation as a possible cause of malignancy.
Neuromuscular Basis for Ventricular Fold Function
Authors: Young Nwanmegha , Wadie Mikhail , Sasaki Clarence T.
Published: October 2014

Objectives:

We sought to examine the neuromuscular basis for ventricular fold function. The primary function of the ventricular folds is to assist in the regulation of intra-abdominal and intrathoracic pressure. They also influence phonation in the setting of vocal fold paralysis or ventricular dysphonia, or after partial laryngectomy. The neuromuscular basis of true vocal fold function has been well studied; however, its neuromuscular correlates in the ventricular folds are ambiguous. The literature is unclear as to whether ventricular fold contraction is passive or active. The musculature and innervation responsible for this action also have not been well defined. The aim of this study was to provide clarity in regard to these mechanisms.

Methods:

We examined a whole-organ section of a human larynx from a patient with unilateral vocal fold paralysis. The region of the ventricular folds was compared on both the paralyzed and normal sides. Electrophysiological examination was performed in a porcine model. The superior laryngeal nerve was stimulated, and recording electrodes in both ventricular folds measured the electrical activity. The recurrent laryngeal nerve was then severed, and the experiment was repeated.

Results:

The histologic slides from the patient with unilateral vocal fold paralysis demonstrated atrophied ventricularis and thyroarytenoid muscles on the paralyzed side. On the unaffected side, these muscles were of normal size. The electrophysiological examination in the porcine model demonstrated findings consistent with innervation of the ventricularis muscle by the recurrent laryngeal nerve. An association of ventricularis muscle activity with ventricular fold contraction also was demonstrated.

Conclusions:

Ventricular fold adduction appears to be a result of ventricularis muscle contraction that is mediated by the recurrent laryngeal nerve.
Analysis of Clinical Negligence Claims following Tonsillectomy in England 1995 to 2010
Authors: Mathew Rajeev , Asimacopoulos Eleni , Walker David , Gutierrez Tatiana , Valentine Peter , Pitkin Lisa
Published: October 2014

Objectives:

We determined the characteristics of medical negligence claims following tonsillectomy.

Methods:

Claims relating to tonsillectomy between 1995 and 2010 were obtained from the National Health Service Litigation Authority database. The number of open and closed claims was determined, and data were analyzed for primary injury claimed, outcome of claim, and associated costs.

Results:

Over 15 years, there were 40 claims of clinical negligence related to tonsillectomy, representing 7.7% of all claims in otolaryngology. There were 34 closed claims, of which 32 (94%) resulted in payment of damages. Postoperative bleeding was the most common injury, with delayed recognition and treatment of bleeding alleged in most cases. Nasopharyngeal regurgitation as a result of soft palate fistulas or excessive tissue resection was the next-commonest cause of a claim. The other injuries claimed included dentoalveolar injury, burns, tonsillar remnants, and temporomandibular joint dysfunction. Inadequate informed consent was claimed in 5 cases.

Conclusions:

Clinical negligence claims following tonsillectomy have a high success rate. Although postoperative bleeding is the most common cause of negligence claims, a significant proportion of claims are due to rare complications of surgery. Informed consent should be tailored to the individual patient and should include a discussion of common and serious complications.
Intraoral Metal Contact Allergy as a Possible Risk Factor for Oral Squamous Cell Carcinoma
Authors: Weber Megan E. , Yiannias James A. , Hougeir Firas G. , Kyle Amber , Noble Brie N. , Landry April M. , Hinni Michael L.
Published: October 2014

Objectives:

Intraoral exposure to dental restorations can cause contact allergy that may induce carcinogenesis. We investigated the relationship of intraoral metal contact allergy to epithelial carcinogenesis.

Methods:

The prevalence of positive patch test reactions to dental restoration metals in 65 prospectively enrolled patients with newly or previously diagnosed oral squamous cell carcinoma (SCC) was compared to that in 48 control patients. The relative risk of oral SCC was estimated by calculating odds ratios for exposure to dental metals resulting in allergy.

Results:

Of the 65 patients with oral SCC, 34% were allergic to at least 1 adjacent metal. They were 1.57 times as likely as control patients to have metal contact allergy (odds ratio, 1.57; 95% confidence interval, 0.65 to 3.80) and more than 3 times as likely to react to mercury (odds ratio, 3.20; 95% confidence interval, 0.42 to 33.20).

Conclusions:

Patients with oral SCC who have metal dental restorations should undergo patch testing and possible removal of the restorations if their reactions are positive.
Detecting Nasopharyngeal Reflux: A Novel pH Probe Technique
Authors: Brunworth Joseph D. , Garg Rohit , Mahboubi Hossein , Johnson Brandon , Djalilian Hamid R.
Published: October 2014

Objectives:

We sought to ascertain the normal pH values in the aerosolized environment of the nasopharynx in healthy subjects and utilize a novel pH probe that allows measuring acidity in a nonliquid environment.

Methods:

Between November 2009 and February 2011, healthy volunteers without a history of reflux or eustachian tube dysfunction were enrolled in the prospective study. A total of 20 subjects had a Dx–pH Measurement System Probe (Respiratory Technology Corp) placed near the torus tubarius. The pH probe records the pH throughout the 24-hour study. A pH below 5.5 while the subject was upright or below 5.0 while the subject was supine was used as a criterion to determine a reflux event. Recording was stopped during meals.

Results:

For normal individuals with no history of reflux or eustachian tube dysfunction, the pH values obtained from the nasopharynx ranged from 6.10 to 7.92. The average pH was 7.03 (SD, 0.67). Eight subjects (40%) had at least 1 reflux event during the 24-hour pH study.

Conclusions:

By utilizing a novel self-condensing pH probe, we were able to perform a 24-hour pH study in the nasopharynx of 20 healthy individuals. In our study, the average pH for individuals without symptomatic reflux or eustachian tube dysfunction was 7.03. Interestingly, 8 control subjects had at least 1 episode of pH below 5.5 while awake or below 5.0 while asleep, which was considered to be a reflux event in our study.
Aberrant Expression Levels of MTA1 and RECK in Nasopharyngeal Carcinoma: Association with Metastasis, Recurrence, and Prognosis
Authors: Deng Yan Fei , Zhou Dong Ni , Ye Chun Sheng , Zeng Liang , Yin Ping
Published: October 2014

Objectives:

We investigated the expression and clinical value of MTA1 and RECK genes in patients with nasopharyngeal carcinoma (NPC).

Methods:

We examined MTA1 and RECK expression in nasopharyngeal tissue from patients with chronic nasopharyngitis, lymph nodes with metastasis of NPC, and primary NPC tumor tissue by means of in situ hybridization and analyzed their correlation with the clinicopathologic features of NPC.

Results:

The positive expression of MTA1 in the NPC tissues and metastatic lymph nodes was significantly higher than that in the chronic nasopharyngitis tissues (p < 0.05). The positive expression of RECK in the NPC tissues and metastatic lymph nodes was significantly lower than that in the chronic nasopharyngitis tissues (p < 0.05). The RECK expression level was inversely correlated with the MTA1 expression level in the NPC tissues (p < 0.05). The increased MTA1 and decreased RECK expressions in the NPC tissues had no association with gender, age, T-stage, or clinical stage (p > 0.05). However, they had a positive correlation with cervical lymph node metastasis, tumor recurrence, and 5-year overall survival rate of the patients with NPC (p < 0.05). Moreover, multivariate analysis showed that MTA1 and RECK expressions were independent prognostic factors for survival (p < 0.05).

Conclusions:

The conversely abnormal expression levels of MTA1 and RECK may be collectively involved in progression of malignancies and may serve as molecular predictors for metastasis, recurrence, and prognosis of NPC.
Trade-off between Survival and Laryngeal Preservation in Advanced Laryngeal Cancer: The Otorhinolaryngology Patient's Perspective
Authors: Laccourreye Ollivier , Malinvaud David , Holsinger F. Christopher , Consoli Silla , Ménard Madeleine , Bonfils Pierre
Published: October 2014

Objectives:

We performed a prospective study to evaluate, from the patient's perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy.

Methods:

Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables.

Results:

We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of cure that patients agreed to trade to preserve their larynx.

Conclusions:

In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patient's attitude toward both laryngeal preservation and survival.
Impact of Endoscopic Stapling of Zenker's Diverticulum on Patient Health Status as Assessed by the Glasgow Benefit Inventory
Authors: Leong Samuel C. , Wilkie Mark D. , Webb Christopher J.
Published: October 2014

Objectives:

The aim of this study was to measure the effect of endoscopic stapling of Zenker's diverticulum on the health status of patients.

Methods:

We used the Glasgow Benefit Inventory (GBI) tool to ascertain patients' perceived experience.

Results:

The study demonstrated a positive health impact following endoscopic stapling of the Zenker's diverticulum. The mean total GBI score was +18.9 (95% confidence interval, ±11.2). The impact of endoscopic stapling was positive for all three subsets of the GBI. The GBI scores were comparable to those obtained after other common otorhinolaryngological procedures such as tonsillectomy, rhinoplasty, and middle ear surgery.

Conclusions:

These data should improve our ability to counsel patients regarding important therapeutic decisions and expectations of surgical outcome.
Etiology of Nasal Polyps in Cystic Fibrosis: Not a Unimodal Disease
Authors: Steinke John W. , Payne Spencer C. , Chen Philip G. , Negri Julie , Stelow Edward B. , Borish Larry
Published: October 2014

Objectives:

The objective was to determine whether the polyp subtypes observed in cystic fibrosis (CF)–related sinusitis were similar to those observed in non–CF-related sinusitis.

Methods:

Polyp and mucus samples were collected from CF patients who presented for sinus surgery. The polyps underwent histologic and cytochemical evaluation for the presence of lymphocyte cell populations and their respective cytokine markers. The mucus samples were evaluated for DNA content.

Results:

Of the polyps, 42% had an eosinophilic infiltrate, of which 80% had an additional mixed neutrophilic infiltrate. Of the remaining polyp samples, 42% did not have a granulocytic infiltrate, consistent with non-eosinophilic polyps. All samples had CD138-positive plasma cells. The mucus samples from the patients with CF showed higher extracellular DNA concentrations than did the mucus samples from patients with non-CF sinus disease.

Conclusions:

Cystic fibrosis–related polyps demonstrated an eosinophil-based dichotomy similar to that of idiopathic non–CF-related polyps. Many also demonstrated neutrophilic infiltrate, indicating that chronic mucus stasis and infection complicate the disease. Agents capable of reducing extracellular DNA may help manage sinusitis in CF patients.
Safety and Dosing of Bevacizumab (Avastin) for the Treatment of Recurrent Respiratory Papillomatosis
Authors: Best Simon R. , Friedman Aaron D. , Landau-Zemer Tali , Barbu Anca M. , Burns James A. , Freeman Mason W. , Halvorsen Yuan-Di , Hillman Robert E. , Zeitels Steven M.
Published: October 2014

Objectives:

Increasing evidence supports the use of laryngeal injections of the antiangiogenic agent bevacizumab (Avastin) for the adjuvant treatment of recurrent respiratory papillomatosis (RRP). A recent prospective open-label investigation, approved by the US Food and Drug Administration, employing 12.5 mg of sublesional bevacizumab demonstrated single-site efficacy without complications; however, the safety of multiple-site injections and higher dosing has not yet been reported. The primary objective of this study was to report on the safety of increased doses of bevacizumab for the treatment of RRP.

Methods:

Two cohorts of adult patients were evaluated. In the first group, a prospective analysis was performed on patients with a diagnosis of laryngeal RRP after their participation in the initial clinical trial with a single-site lower dose (7.5 to 12.5 mg). They received higher doses of sublesional laryngeal bevacizumab (15 to 50 mg total) with detailed physiologic, hematologic, and serum chemistry measurements performed before and after each bevacizumab injection. A second cohort of patients received sublesional laryngeal injections of bevacizumab (15 to 88 mg total) without physiologic measurements and underwent a retrospective analysis of reported complications.

Results:

One hundred consecutive laryngeal injection sessions (office, 87; operating room, 13) with bevacizumab were performed in 43 patients, with a mean dose of 30 mg total per treatment (range, 15 to 88 mg). Sixty-three of the 100 sessions were accompanied by KTP laser photoangiolysis of the papilloma prior to bevacizumab injections. Eighteen patients (cohort 1) underwent detailed physiologic assessment, and no dysfunction was observed. There were no local or systemic complications of bevacizumab administration. The second group of 25 patients (cohort 2) also reported no significant local or systemic complications. Neither patient group was observed to have a local wound problem in the larynx.

Conclusions:

This investigation provides evidence that higher doses of bevacizumab are relatively safe in adult patients with laryngeal RRP. Further refinements in pharmacologic concentration and drug delivery will determine the optimal treatment regimens in the future.
Relationship between the Branches of the Recurrent Laryngeal Nerve and the Inferior Thyroid Artery
Authors: Kulekci Mehmet , Batıoglu-Karaaltın Aysegul , Saatci Ozlem , Uzun Ibrahim
Published: October 2014

Objectives:

The relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) is an important and helpful landmark for isolating the RLN and its branches during surgery. In the present study, we aimed to define and classify in detail all of the possible relationships between the two anatomic structures and their branches.

Methods:

We examined 100 specimens (200 sides) from cadavers of 76 men and 24 women who were between 16 and 90 years of age at the time of death. After anatomic dissection was performed, the relationship between the RLN and the ITA was noted for each side and documented in the form of high-resolution photographs.

Results:

The relationships of both structures and their branches were classified into 6 types. Details were verified regarding the relationships between the main trunks, between the trunks and branches, and between the branches, as follows: Type A (ITA trunk to RLN trunk); type B (ITA branches to RLN trunk); type C (ITA trunk to RLN branches); type D (ITA branches to RLN trunk and RLN branches); type E (ITA branches to RLN branches); and type F (others).

Conclusions:

Despite the various anatomic and surgical studies already performed, in the present study we tried to demonstrate all types of relationships between the RLN and the ITA and their branches and devise a new, detailed classification of the possible relationships between the two structures.