bluuebunny/crossref_metadata_2025 huggingface dataset:
Advantage of Accelerated Fractionation Regimens in Definitive Radiotherapy for Stage II Glottic Carcinoma
Authors: Nomiya Takuma , Nemoto Kenji , Wada Hitoshi , Takai Yoshihiro , Yamada Shogo
Published: October 2014

Objectives:

We evaluated the prognostic factors for local control of T2 glottic cancer and verified the efficacy of accelerated fractionation regimens such as hyperfractionation and accelerated hyperfractionation.

Methods:

A total of 86 patients with T2 NO MO glottic squamous cell carcinoma, who were treated with definitive radiotherapy, were analyzed retrospectively by multivariate analysis.

Results:

Overall treatment time of radiotherapy (p = .0003) and total dose (p = .0036) were the significant prognostic factors for local control on multivariate analysis. The group with a higher total dose (>67 Gy versus <67 Gy) showed a favorable prognosis (5-year local control rate of 91% versus 60%, respectively; p = .0013, log-rank test). Likewise, the group with a shorter overall treatment time of radiotherapy (<54 days versus >54 days) showed a favorable prognosis (5- year local control rate of 87% versus 71%, respectively; p = .023).

Conclusions:

A radiotherapy total dose of >67 Gy delivered for a shorter period is required for T2 glottic cancer. The fractionation regimens of hyperfractionation and accelerated hyperfractionation are more effective than conventional fractionation in terms of shortening overall treatment time and delivering a high total dose with acceptable toxicity.
Expression and Distribution of CD44 and Hyaluronic Acid in Human Vocal Fold Mucosa
Authors: Sato Kiminori , Sakamoto Kikuo , Nakashima Tadashi
Published: October 2014

Objectives:

Expression of CD44 (a cell surface receptor for hyaluronic acid) and the distribution of hyaluronic acid were examined in the human vocal fold mucosa.

Methods:

Light microscopic investigation was carried out on 10 normal larynges of newborn, infant, younger adult, and older adults with Alcian blue staining, a hyaluronidase digestion study, and immunohistochemistry for CD44.

Results:

Before the appearance of hyaluronic acid in the newborn vocal fold mucosa, CD44 was expressed on the stellate cells in the macula flava and on the fibroblasts in Reinke's space. During infancy, hyaluronic acid appeared and was distributed in the vocal fold mucosa. Many more stellate cells in the macula flava showed CD44 expression, and a large amount of hyaluronic acid was present around the infant stellate cells; however, the fibroblasts in Reinke's space expressed little CD44. During adulthood, hyaluronic acid was distributed in the vocal fold mucosa. Almost all of the stellate cells in the macula flava showed CD44 expression, and much hyaluronic acid existed around the stellate cells in the adult macula flava. However, fibroblasts in the adult Reinke's space expressed little CD44, and hyaluronic acid density in that space was lower than that in the macula flava.

Conclusions:

Stellate cells in the macula flava and CD44 cooperatively play important roles in maintaining hyaluronic acid in the human vocal fold mucosa as a vibrating tissue.
Outcome of Endoscopic Management of Extensive Laryngotracheal Stenosis
Authors: Kim Young-Ho , Baek Seung Jae
Published: October 2014

Objectives:

When performing endotracheal intubation or tracheotomy in unconscious patients in emergent situations, one should consider the possibility of the later complication of laryngotracheal stenosis, which can result in difficulties with decannulation. We analyzed the clinical features of laryngotracheal stenosis to search for its possible etiologic factors and its proper preventive methods.

Methods:

The medical records of 249 cases of laryngotracheal stenosis out of 2,208 patients who underwent tracheotomy in our hospital during the past 12 years were retrospectively reviewed regarding several parameters, such as the duration of endotracheal intubation, site of tracheostoma, site of stenosis, treatment method, and so forth.

Results:

Non-otolaryngologists had a tendency to place the tracheostoma at a higher level of the trachea. We identified technical precautions that should be taken into consideration in performing an emergency tracheotomy. Bronchoscopic evaluation and tracheal stent insertion was the most commonly used treatment method. Successful decannulation was achieved in about 70%, and was especially frequent in patients whose endotracheal intubation was less than 20 days.

Conclusions:

It is desirable that the duration of endotracheal intubation be limited to less than 20 days. A database of patients who undergo tracheotomy should be submitted to careful follow-up to diagnose early development of laryngotracheal stenosis and to prevent long-term complications.
Leaving a Lasting Impression: Ear Mold Impressions as Middle Ear Foreign Bodies
Authors: Jacob Abraham , Morris Targhee J. , Welling D. Bradley
Published: October 2014

Objectives:

We describe a series of otologic complications from impression material used to make hearing aid molds.

Methods:

We examined a retrospective case series of patients presenting to a tertiary care academic medical center.

Results:

The presentation, clinical course, and treatment outcomes of 6 patients with complications related to ear molds are discussed. These patients had preexisting abnormalities in their aural anatomy, including tympanic membrane perforations, retraction pockets, and mastoidectomy cavities.

Conclusions:

Although the majority of patients who have ear canal impressions taken experience no adverse outcomes, hearing aid dispensers should perform a thorough history-taking and physical examination to discern those with abnormal anatomy at risk for complications. These patients may benefit from evaluation in conjunction with an otolaryngologist.
Hands-on Training Methods for Vocal Fold Injection Education
Authors: Amin Milan , Rosen Clark A. , Simpson C. Blake , Postma Gregory N.
Published: October 2014

Objectives:

Vocal fold injection (VFI) in the office setting and in the operating room is becoming increasingly popular. Most training programs fail to educate residents in performing these injections. In this report, we describe novel and effective teaching tools that provide real-life simulation of VFI for the education of residents and otolaryngologists in practice.

Methods:

Equipment was developed to allow the use of excised fresh cadaver larynges to simulate peroral VFI in a life-sized model of the human head and neck. A separate setup was also developed for use of a laryngoscope holder and cadaver larynges to simulate microlaryngoscopy VFI. Each of these VFI training setups allows the student to perform and practice VFI in a simulated setting with physical and anatomic constraints and laryngeal anatomy similar to those of real-life VFI. The use of fresh cadaver larynges allows the user to have a realistic feel of actual injection. A visual analog scale was used to measure the participants' comfort levels with the peroral and microlaryngoscopic injection techniques before and after the workshop.

Results:

Pre-workshop and post-workshop surveys were collected from 22 of the VFI course participants. The mean comfort levels for VFI prior to the workshop were 22 for peroral VFI and 69 for microlaryngoscopy VFI (0 = not comfortable at all and 100 = very comfortable). The post-workshop comfort levels were 52 for peroral VFI and 85 for microlaryngoscopy VFI. The differences in the pre- and post-workshop comfort level scores for each VFI technique were significant (microlaryngoscopy, p = .001; peroral, p <0001).

Conclusions:

The use of VFI simulations appears to improve surgeon comfort level with injection techniques. The described training simulations may be useful for allowing residents and practicing otolaryngologists to learn VFI before attempting these techniques on actual patients.
Directional Asymmetry in the Measured Nitrous Oxide Time Constant for Middle Ear Transmucosal Gas Exchange
Authors: Doyle William J. , Yuksel Sancak , Banks Juliane , Alper Cuneyt M.
Published: October 2014

Objectives:

Simple, 2-compartment mathematical models of middle ear (ME) transmucosal gas exchange reproduce observed ME pressure behavior. These models require input of an experimentally determined, lumped-parameter exchange constant for each represented gas species. Previous model applications assumed directional asymmetry for those parameters, which has not been experimentally validated.

Methods:

As a surrogate for the inert gas nitrogen (N2), for which exchange is too slow to be measurable, the nitrous oxide (N2O) transmucosal exchange constant for 16 ears of 8 monkeys was measured for positive and negative ME blood N2O gradients.

Results:

The paired exchange constants for each ear were highly correlated, but the ME-blood/blood-ME exchange constant ratio was approximately 13. Modeling shows this asymmetry to depend on the value of the arterial-venous/arterial-ME ratio, a variable in the exchange constant for perfusion-limited gases.

Conclusions:

These results support an asymmetric rate of transmucosal N2O and, by extension, N2 exchange for the ME. Because the primary controlling parameter for ME pressure behavior in the absence of eustachian tube opening is the rate of transmucosal N2 exchange, this effect needs to be incorporated into the simple 2-compartment exchange models for predictive accuracy. The gradient ratio dependence suggests that parameter-free modeling may require treating the ME mucosa as having a distributed gradient for certain gas species.
Effects of Corticosteroids on Expression of Interleukin-18 in the Airway Mucosa of a Mouse Model of Allergic Rhinitis
Authors: Kim Si Whan , Jeon Yoon Kyung , Won Tae Bin , Dhong Hun-Jong , Min Jin-Young , Shim Woo Sub , Min Yang-Gi
Published: October 2014

Objectives:

In this study, we aimed to investigate the release and response of interleukin (IL)-18 to steroid treatment in a mouse model of allergic rhinitis.

Methods:

BALB/c mice were sensitized systemically by intraperitoneal injection of ovalbumin and locally by ovalbumin inhalation. Dexamethasone sodium phosphate was given by intraperitoneal injection in the steroid treatment group. Symptom scores, eosinophil counts, and IL-18 concentrations in the nasal and lung lavage fluids were analyzed.

Results:

The symptom scores and eosinophil counts of the negative control and steroid treatment groups were significantly lower than those of the positive control group (p < .01). The mean IL-18 concentrations in the nasal lavage fluid were not significantly different among the three groups (56.68 ± 9.57, 63.39 ± 8.93, and 64.47 ± 6.83 pg/mL, respectively). The IL-18 concentrations in the lung lavage fluid were significantly different between the positive control group and the steroid treatment group (430.75 ± 154.54 and 69.94 ± 14.26 pg/mL, respectively, p = .028).

Conclusions:

The IL-18 concentration was found to be increased in the lung lavage fluid, but not in the nasal lavage fluid, in a mouse model of allergic rhinitis. Increased IL-18 concentrations returned toward the previous concentrations after steroid treatment. These results suggest that the roles of IL-18 may be different in the pathogenesis of allergic rhinitis and the pathogenesis of asthma.
Gene Therapy for Laryngeal Paralysis
Authors: Shiotani Akihiro , Saito Koichiro , Araki Koji , Moro Kazuhisa , Watabe Kazuhiko
Published: October 2014

Objectives:

The surgical options for laryngeal paralysis only achieve static changes of vocal fold position. Laryngeal reinnervation procedures have had little impact on the return of dynamic laryngeal function. The development of a new treatment for laryngeal paralysis, aimed at the return of dynamic function and neurologic restoration and regeneration, is necessary.

Methods:

To assess the possibility of gene therapy for laryngeal paralysis aiming for the return of dynamic laryngeal function, we investigated the therapeutic effects of gene therapy using rat laryngeal paralysis models.

Results:

In a rat vagal nerve avulsion model, we transferred glial cell line-derived neurotrophic factor (GDNF) gene into the nucleus ambiguus using an adenovirus vector. Two and 4 weeks after the GDNF gene transfer, a significantly larger number of surviving motoneurons was observed. These neuroprotective effects of GDNF gene transfer were enhanced by simultaneous brain-derived neurotrophic factor gene transfer. In a rat recurrent laryngeal nerve crush model, we transferred GDNF gene into recurrent laryngeal nerve fibers after crush injury. Two and 4 weeks after GDNF gene transfer, we observed significantly faster nerve conduction velocity and better vocal fold motion recovery.

Conclusions:

These results indicate that gene therapy could be a future treatment strategy for laryngeal paralysis. Further studies will be necessary to demonstrate the safety of the vector before clinical application.
Aerodynamic and Acoustic Effects of False Vocal Folds and Epiglottis in Excised Larynx Models
Authors: Alipour Fariborz , Jaiswal Sanyukta , Finnegan Eileen
Published: October 2014

Objectives:

The purpose of this study was to examine the aerodynamic and acoustic effects of the false vocal folds and the epiglottis on excised larynx phonation.

Methods:

Several canine larynges were prepared and mounted over a tapered tube that supplied pressurized, heated, and humidified air. Glottal adduction was accomplished either by using two-pronged probes to press the arytenoids together or by passing a suture to simulate lateral cricoarytenoid muscle activation. First, the excised larynx with false vocal folds and epiglottis intact was subjected to a series of pressure-flow experiments with longitudinal tension and adduction as major control parameters. Then, the epiglottis and finally the false vocal folds were removed and the experiment was repeated. The subglottal pressure and the electroglottographic, flow rate, audio, and sound pressure signals were recorded during each experiment. Glottal flow resistance was calculated from the pressure and flow signals. The electroglottographic signal was used to extract the fundamental frequency.

Results:

It was found that the false vocal folds and the epiglottis offer a positive contribution to the glottal resistance and sound intensity of the larynx. Also, vocal fold elongation and glottal medial compression caused an increase in glottal resistance. The pressure-flow relationships were approximately linear regardless of the structure.

Conclusions:

The addition of the supraglottic laryngeal structures has a significant impact on both aerodynamic and acoustic characteristics of excised larynges.
Bilobed Zenker's Diverticula
Authors: Tanna Neil , Patel Alpen A. , Eisler Lindsay S. , Goding George , Maisel Robert
Published: October 2014

A bilobed Zenker's diverticulum is an uncommon finding. Given the rarity of these bilobed pharyngeal pouches, their management can pose a clinical dilemma. We advocate transoral endoscopic division and stapling of the larger lobe as the management of choice for this clinical finding. We present 2 patients, each with a bilobed Zenker's diverticulum. To our knowledge, these 2 cases represent the first reported bilobed pharyngeal pouches treated successfully with division and stapling of only the larger lobe.
Initial Surgical Treatment for Chronic Frontal Sinusitis: A Pilot Study
Authors: Becker Samuel S. , Han Joseph K. , Nguyen Thuy-Anh , Gross Charles W.
Published: October 2014

Objectives:

The initial surgical treatment for chronic frontal sinusitis is not well defined. Our objective was to determine the effectiveness of anterior ethmoidectomy for chronic frontal sinusitis.

Methods:

Patients with chronic frontal sinusitis who underwent anterior ethmoidectomy as initial surgical treatment were reviewed. Data were collected from computed tomography scans with use of the Lund-Mackay scale. Data on demographics, comorbidities, management, postoperative recovery, and follow-up were collected.

Results:

Seventy-seven patients representing 121 diseased frontal sinuses met the inclusion criteria. The respiratory comorbidities were asthma alone (8.3%), asthma and polyps (6.6%), aspirin triad (5.8%), and cystic fibrosis (0.8%). Nineteen of 121 frontal sinuses (15.7%) belonged to smokers. Fourteen of 121 frontal sinuses (11.5%) exhibited postoperative evidence of disease. Of these 14 frontal sinuses, 10 (8.3%) underwent revision surgery. Frontal sinuses of patients with aspirin triad, with both nasal polyposis and asthma, or with inter-frontal sinus septal cells were more likely to fail Draf I surgery (p < .05).

Conclusions:

Anterior ethmoidectomy for drainage of frontal sinuses appears to be effective initial surgical treatment for chronic frontal sinusitis. Patients with aspirin triad, both asthma and polyposis, or inter-frontal sinus septal cells are more likely to fail this procedure.
Etiology of Stridor in Infants
Authors: Zoumalan Richard , Maddalozzo John , Holinger Lauren D.
Published: October 2014

Objectives:

We undertook to identify data that facilitate determination of an accurate diagnosis of the cause of stridor in infants and to develop a framework to conceptualize the problem.

Methods:

We reviewed medical records of patients less than 1 year of age with the presenting symptom of stridor who were initially evaluated in the outpatient setting of a tertiary children's hospital. Infants with obvious congenital syndromes, cerebral palsy, or hypotonia were excluded. All infants underwent history-taking, physical examination, and when symptoms were mild, office flexible laryngoscopy. With moderate or severe stridor, a more complete endoscopic evaluation was undertaken in the operating room.

Results:

Of 202 patients, 119 (59%) were boys and 83 (41%) were girls. Their ages ranged from 3 days to 11 months; 175 (87%) were 6 months of age or younger. Congenital anomalies were diagnosed as the cause of stridor in 170 (84%). Congenital laryngeal anomalies caused stridor in 157 (78%); congenital tracheal abnormalities were the cause in 13 (6%). The most common congenital laryngeal anomaly was laryngomalacia (94%). Forty-two (21%) of the 202 patients had at least 1 other anomaly that contributed to airway compromise. Half of all patients had laryngopharyngeal reflux, the most common associated condition. Of patients referred with a presumptive diagnosis by non-otolaryngologists, 28 of 94 (30%) were referred with erroneous presumptive diagnoses for which they were being treated, the most common of which was tracheomalacia.

Conclusions:

A standard, rational approach to the evaluation of stridor in infants facilitates management. A framework for evaluation is presented.
Granuloma of the Membranous Vocal Fold: An Unusual Complication of Microlaryngoscopic Surgery
Authors: Sulica Lucian , Simpson C. Blake , Branski Ryan , McLaurin Colby
Published: October 2014

Objectives:

We describe the clinical features of granuloma of the membranous vocal fold (as opposed to granuloma of the vocal process, or “contact granuloma”), a poorly recognized sequela of microlaryngoscopic surgery. Membranous vocal fold granuloma may mimic the initial lesion in appearance, and thus be mistaken for recurrence.

Methods:

We performed a retrospective review of cases from 2 institutions.

Results:

Fifteen cases of membranous vocal fold granuloma from 2 institutions were identified. In all but 1 case, granuloma developed in the early postoperative period, within 8 weeks. Of the 15 cases, 10 followed laser resection of carcinoma. Five were noted following cold steel resection of benign lesions (2 papillomas, 2 cysts, 1 Reinke's edema). Technical aspects of these cases suggest that membranous vocal fold granulomas result from surgical violation of deep tissue planes and/or epithelial defects. All patients were treated with proton pump inhibitors. In 12 cases, the granulomas proved self-limited, resolving over weeks to months following surgery. Three patients underwent surgical removal of the lesion, which confirmed the diagnosis. One of these cases recurred and was treated nonsurgically.

Conclusions:

Granuloma should be suspected when a mass lesion appears at the surgical site early in the postoperative course. Surgical excision is generally not necessary and may provoke further growth of granulation tissue.
Intranasal Fungi and Chronic Rhinosinusitis: What is the Relationship?
Authors: Tosun Fuat , Hidir Yusuf , Saracli Mehmet A. , Caliskaner Zafer , Sengul Ali
Published: October 2014

Objectives:

The aim of this study was to investigate the effects of intranasal fungi on chronic rhinosinusitis (CRS).

Methods:

Forty-one patients with CRS were included in the study. The patients were put into 2 groups, with and without intranasal fungi as detected by polymerase chain reaction, and were compared in terms of different laboratory and clinical parameters of CRS. A χ2 test was used to analyze statistical differences between the 2 groups.

Results:

Serum eosinophilia, eosinophilia in the nasal mucus, prick and intradermal test positivity for fungi, elevated total IgE, fungal-specific IgE, prevalence of symptoms, frequency of bronchial asthma, aspirin sensitivity, and nasal polyposis did not differ significantly between the 2 groups of patients (p < .05).

Conclusions:

The findings of this study failed to reveal a clear correlation between the presence of fungi in the nasal passage and various factors that are assumed to be involved in the pathogenesis or clinical course of CRS. If fungi have a role in the pathogenesis of CRS, it may be via other mediators and reactions rather than IgE and type I hypersensitivity. However, the sample size was relatively small, and further studies with more cases are needed on the same topic.
Arytenoid Abduction for Dynamic Rehabilitation of Bilateral Laryngeal Paralysis
Authors: Woodson Gayle , Weiss Todd
Published: October 2014

Objectives:

Bilateral laryngeal paralysis results in airway obstruction, but the voice is often nearly normal. Tracheotomy provides an airway and preserves voice. Surgical procedures to statically enlarge the glottis can permit decannulation, but do so at the expense of the voice. Motion analysis in cadaver larynges has demonstrated that adductor and abductor muscles rotate the arytenoid cartilage around different axes. We sought to determine whether external rotation of the arytenoid cartilage could enlarge the airway without abolishing residual phonatory adduction.

Methods:

We performed arytenoid abduction in 6 patients with obstructing laryngeal paralysis. A suture was placed in the muscular process and posterior-inferior traction was applied, anchoring the suture to the inferior cornu of the thyroid cartilage. Outcomes were evaluated by assessing airway symptoms, by assessing the voice, and by documentation of laryngeal motion via videolaryngoscopy.

Results:

Three patients with severe stridor had marked relief of symptoms, and 2 of the 3 tracheotomy-dependent patients were decannulated. Three patients had good voices, 2 had mild breathiness, and 1 was very breathy.

Conclusions:

Arytenoid abduction is a promising treatment for relieving airway obstruction in patients with laryngeal paralysis. It has the potential to preserve voice in patients with residual phonatory adduction.
Isolated Cochlear Nerve Hypoplasia with Various Internal Auditory Meatus Deformities in Children
Authors: Ito Ken , Ishimoto Shin-Ich , Karino Shotaro
Published: October 2014

Objectives:

We report neuro-otological findings in isolated congenital cochlear nerve hypoplasia with various bony deformities and evaluate relationships between functional impairment and the radiologic dimensions of the internal auditory meatus (IAM).

Methods:

We performed imaging and functional analyses on consecutive juvenile or adolescent patients between 2001 and 2005 with “isolated” unilateral hypoplasia of the cochlear nerve, without inner ear anomaly or other deformities.

Results:

Among 20 patients with unilateral profound deafness who underwent imaging studies, 10 (50%) passed the inclusion criteria. In all affected ears, auditory brain stem responses were absent and the speech discrimination score was very poor (0% to 5%). Distortion product otoacoustic emissions were good in 2 ears, fair in 1 ear, and poor in 7 ears. Caloric responses were absent in 2 ears, reduced in 3 ears, and normal in 5 ears. Inferior vestibular nerve function and facial nerve function were normal in all ears. Distortion product otoacoustic emissions and caloric responses tended to be better in ears with less severe narrowing of the IAM.

Conclusions:

The risk of co-involvement of the inner ear and superior vestibular nerve functions is higher in the presence of a narrower bony IAM. Cochlear nerve hypoplasia is proposed as one of the most important causes of juvenile unilateral deafness because of its unexpectedly high incidence.
Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study
Authors: Yetiser Sertac , Karapinar Ugur
Published: October 2014

Objectives:

A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed.

Methods:

Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05.

Results:

Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports.

Conclusions:

Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.
Up-Regulation of Protease-Activated Receptor 2 in Allergic Rhinitis
Authors: Lee Heung-Man , Kim Hyo Yeol , Kang Hee Joon , Woo Jeong Soo , Chae Sung Won , Lee Sang Hag , Hwang Soon Jae
Published: October 2014

Objectives:

We compared the patterns of PAR-2 messenger RNA (mRNA) and protein expression in the nasal mucosa of subjects with and without allergic rhinitis.

Methods:

Biopsy specimens were obtained from 10 patients with allergic rhinitis and 10 normal controls. RNA was extracted from the nasal mucosa, and semiquantitative reverse transcription-polymerase chain reaction was performed for PAR-2. Tissue sections were immunostained for PAR-2 by use of specific antibody.

Results:

The expression levels of PAR-2 mRNA in allergic rhinitis nasal mucosa were significantly up-regulated as compared with those in normal nasal mucosa. PAR-2 immunoreactivity was observed in the epithelium and submucosal glands in both normal controls and subjects with allergic rhinitis. Stronger immunoreactivity for PAR-2 was observed in allergic rhinitis nasal mucosa as compared with normal nasal mucosa.

Conclusions:

These results suggest that PAR-2 may be involved in allergic nasal inflammation.
Contribution of Vision to Balance in Children Four to Eight Years of Age
Authors: Casselbrant Margaretha L. , Mandel Ellen M. , Sparto Patrick J. , Redfern Mark S. , Furman Joseph M.
Published: October 2014

Objectives:

The use of sensory feedback for postural control develops throughout childhood. The aim of this study was to determine how children use cues from anterior-posterior optic flow for balance from 4 to 8 years of age.

Methods:

One hundred forty-eight children were enrolled. The subjects had yearly otologic and posturographic examinations between the ages of 4 and 8 years. Balance was assessed only if the subject had no evidence of middle ear effusion. The subject stood for 30 seconds with eyes open without optic flow and for 30 seconds while viewing 0.1, 0.25, and 0.4 Hz anterior-posterior optic flow. The center of pressure (COP) was recorded from the force platform. The root-mean-square of the COP during the periods of quiet stance and with optic flow was computed.

Results:

The root-mean-square COP was significantly larger during the optic flow stimulation as compared with during quiet stance. The subjects had a significant decrease in COP during optic flow from year 5 to year 6 of life (p = 005).

Conclusions:

A change in the response to optic flow was seen from age 5 to age 6. This change is consistent with transitional changes in postural responses that have been observed during quiet standing.
Anatomy of the Bony Portion of the Eustachian Tube in Tubal Stenosis: Multiplanar Reconstruction Approach
Authors: Yoshida Haruo , Takahashi Haruo , Morikawa Minoru , Kobayashi Toshimitsu
Published: October 2014

Objectives:

We sought to clarify possible pathological conditions of the bony portion of the eustachian tube (ET) in patients with ET stenosis.

Methods:

We measured the total length, the cross-sectional area of the bony frame, and the air space of the ET lumen at an interval of 1 mm on the reconstructed computed tomographic images of the ET using a multiplanar reconstruction method on 20 normal subjects (control group) and 25 patients with stenotic ET judged by the inflation test (stenotic group).

Results:

In the cross-sectional areas, both the bony frame and air space were significantly smaller in the stenotic group than in the control group. The soft tissue ratio was significantly greater in most parts of the mid-bony portion and the tympanic orifice of the stenotic group than in those of the control group. At the anterior tip of the bony portion, only the bony frame was found to be significantly smaller in the stenotic group than in the control group.

Conclusions:

We suggest that a smaller framework of the bony ET may possibly be related to the pathogenesis of ET stenosis.
Invasive Tracheal Aspergillosis Treated Successfully with Voriconazole: Clinical Report and Review of the Literature
Authors: Warman Meir , Lahav Jonathan , Feldberg Edit , Halperin Doron
Published: October 2014

Objectives:

Invasive tracheal aspergillosis is a rare and highly fatal fungal infection that manifests as a progressive airway obstruction in immunocompromised patients. Otolaryngologists should be familiar with the entity of invasive necrotizing tracheal aspergillosis.

Methods:

In this report we describe a young patient with acute myeloid leukemia who was affected by invasive tracheal aspergillosis. This entity and the relevant literature are reviewed.

Results:

On the basis of the presented clinical report, we discuss the clinical and pathologic characteristics of invasive tracheal aspergillosis as an opportunistic infection. The classic symptoms are of progressive dyspnea in an immunosuppressed patient. Diagnosis is via pathological evidence of fungal hyphae invading the endoluminal upper respiratory tree. The present patient was successfully treated with an azole antifungal agent, combined with tracheostomy for airway control.

Conclusions:

Invasive tracheal aspergillosis is a life-threatening fungal infection that affects immunosuppressed patients. Because the mortality rate is high, awareness of this entity is essential for early diagnosis and treatment. A favorable outcome in this type of invasive aspergillosis correlates with resolution of the bone marrow suppression and early antifungal medical therapy combined with aggressive surgical intervention for airway control, if needed.
Prediction of Difficult Laryngoscopy: Does Obesity Play a Role?
Authors: Hekiert Adrianna M. , Mick Rosemarie , Mirza Natasha
Published: October 2014

Objectives:

This study was intended to 1) identify preoperative predictors of difficult laryngoscopy and 2) determine the role of obesity in difficulty of obtaining adequate laryngeal exposure.

Methods:

A prospective study was undertaken of 63 patients who were undergoing elective direct laryngoscopy. Thirty-six patients met the obesity criteria (body mass index of at least 30 kg/m2). Measurements of height, weight, and neck circumference and Mallampati and Cormack-Lehane scores were obtained. The ease of laryngeal exposure was recorded by the attending surgeon on a visual analog scale (VAS; 1 to 10). Difficult laryngeal exposure (DLE) was defined as a VAS score of at least 3. The candidate morphological predictors were investigated.

Results:

Obesity and Mallampati score were found to be predictors of DLE (p < .001). The VAS score was positively correlated with body mass index (p = .007), weight (p = .05), Mallampati score (p < .001), and Cormack-Lehane score (p < .001). Among obese patients, the VAS score was correlated with the Cormack-Lehane score (p = .01), whereas in nonobese patients the VAS score showed a significant association with both the Mallampati (p = .02) and Cormack-Lehane (p = .01) scores.

Conclusions:

Obese patients and those with a Mallampati score of at least 2 posed a significantly higher risk of DLE. Preoperative identification of a potentially difficult airway may aid surgical planning and allow more effective communication with a collaborating anesthesiologist.
Acoustic Rhinometry in Healthy Humans: Accuracy of Area Estimates and Ability to Quantify Certain Anatomic Structures in the Nasal Cavity
Authors: Cankurtaran Mehmet , Çelik Huseyin , Coşkun Mehmet , Hizal Evren , Cakmak Ozcan
Published: October 2014

Objectives:

We evaluated the accuracy of acoustic rhinometry (AR) measurements in healthy humans and assessed the ability of AR in quantifying the dimensions of the paranasal sinuses and certain anatomic structures in the nasal cavity.

Methods:

Twenty nasal passages of 10 healthy adults were examined by AR and computed tomography (CT) before and after decongestion. Actual cross-sectional areas of the nasal cavity and actual locations of the nasal valve, the head of the inferior turbinate, the head of the middle turbinate, the ostia of the frontal and maxillary sinuses, and the choana were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage.

Results:

The AR-measured cross-sectional areas in the anterior nasal cavity were in reasonable agreement with the corresponding areas determined from CT, whereas AR consistently overestimated the passage areas at locations posterior to the paranasal sinus ostia. The nasal valve was identified as a pronounced minimum on the AR area-distance curve. However, AR did not discretely identify the head of the inferior turbinate, the head of the middle turbinate, or the choana.

Conclusions:

The local minima on the AR area-distance curve beyond the nasal valve are caused by acoustic resonances in the nasal cavity, and do not correspond to any anatomic structure. The AR area overestimation beyond the paranasal sinus ostia is due to the interaction between the nasal cavity and the paranasal sinuses, rather than to sound loss into the sinuses. Acoustic rhinometry provides no quantitative information on ostium size or sinus volume in either non-decongested or decongested nasal cavities.
Aberrant Methylation of the HRPT2 Gene in Parathyroid Carcinoma
Authors: Hewitt Kimberly M. , Sharma Pramod K. , Samowitz Wade , Hobbs Maurine
Published: October 2014

Objectives:

The incidence of parathyroid carcinoma in hyperparathyroidism–jaw tumor syndrome (HPT-JT) is reported to be as high as 15%. We used a methylation-specific polymerase chain reaction (MS-PCR) technique to investigate whether hypermethylation is one mechanism of HRPT2 gene inactivation in parathyroid tumors.

Methods:

DNA was extracted from samples of parathyroid tumors embedded in paraffin. MS-PCR was performed on 11 parathyroid carcinomas, 37 sporadic parathyroid adenomas from control subjects, and 6 parathyroid adenomas from 3 patients with HPT-JT. Methylated and unmethylated PCR products from 2 tumors (Nos. 2 and 6) were cloned. Clones containing inserts were sequenced.

Results:

Two of 11 (18%) parathyroid carcinomas showed amplification patterns consistent with methylation, compared to 0 of 37 sporadic parathyroid adenomas, and 1 of 6 (17%) parathyroid tumor samples from 3 HPT-JT patients. These results were confirmed by sequencing multiple clones from each of these samples.

Conclusions:

There is increasing evidence that loss of HRPT2 gene expression is strongly associated with parathyroid carcinomas. Our data indicate that methylation of the HRPT2 promoter may be another mechanism by which HRPT2 gene inactivation gives rise to parathyroid carcinomas.
Sensorineural Hearing Impairment in Children with Chiari I Malformation
Authors: Simons Jeffrey P. , Ruscetta Melissa N. , Chi David H.
Published: October 2014

Objectives:

We describe the prevalance of Chiari I malformation in children presenting to a pediatric tertiary care hearing loss clinic, characterize the phenotype of hearing loss in children with Chiari I malformation, and discuss the potential pathophysiology of sensorineural hearing impairment (SNHI) related to Chiari I malformation.

Methods:

This study was a retrospective case series of patients seen in a pediatric tertiary care hearing loss clinic affiliated with an academic medical center. We considered 481 patients with SNHI who had radiographic imaging as part of the evaluation for the cause of their hearing impairment. Hearing impairment was determined by behavioral audiogram and/or auditory brain stem response testing. Radiographic imaging was performed with computed tomography and/or magnetic resonance imaging.

Results:

Six children with SNHI also had a diagnosis of Chiari I malformation. Four of these 6 children had unilateral hearing impairment. One child had asymmetric bilateral impairment; 1 child had symmetric bilateral impairment. The severity of hearing impairment varied from mild to profound. All children were referred to the neurosurgery department. None underwent surgical decompression.

Conclusions:

Chiari I malformation may be associated with SNHI. Central nervous system imaging for the evaluation of children with SNHI may be indicated, particularly in individuals with negative results on temporal bone computed tomography and genetic testing.
Photoangiolytic Laser Treatment of Early Glottic Cancer: A New Management Strategy
Authors: Zeitels Steven M. , Burns James A. , Lopez-Guerra Gerardo , Anderson R. Rox , Hillman Robert E.
Published: October 2014

The 532 nm pulsed KTP (potassium titanyl phosphate) laser and the 585 nm pulsed dye laser (PDL) are photoangiolytic lasers that have been demonstrated to be effective for managing vocal fold dysplasia. The putative mechanism of action is selective photoangiolysis of the sublesional microcirculation. On the basis of this experience, early glottic cancers were treated by selectively targeting the intralesional and sublesional microvasculature. This approach was derived from Folkman's concepts of neoplastic growth resulting from tumor angiogenesis. Staged microlaryngeal treatment was adopted, because it facilitated optimal functional results, and was considered safe, because early glottic cancer rarely metastasizes. Furthermore, intercurrent disease during conventional incremental radiotherapy is typical in treating early glottic cancer. A pilot group of 22 patients with early glottic cancer (13 T1, 9 T2) were treated with a fiber-based angiolytic laser. Eleven of the 22 had unilateral disease and were entirely treated by laser photoangiolysis as a sole modality. Eleven of the 22 had bilateral disease; 5 of the 11 were treated entirely (bilaterally) by laser photoangiolysis, and 6 of the 11 only underwent laser treatment of the less involved vocal fold, with conventional resection being done on the dominant side of the cancer. The initial 8 of the 22 were treated with the PDL, and the latter 14 of the 22 were treated with the pulsed KTP laser. No patient has cancer presently, and none have undergone posttreatment radiotherapy or open surgery. The mean follow-up is 27 months, 13 of the 22 patients have at least 2 years of follow-up, and the first patient was treated just over 5 years ago. Objective measures of vocal function revealed that photoangiolytic treatment of early glottic cancer resulted in significant postoperative improvements despite the fact that half of the patients had bilateral disease. Angiolytic lasers effectively involuted early glottic cancer, with microsurgically directed nonionizing radiation of the dense neoplastic blood supply resulting in complete tumor regression. This approach is conceptually attractive, because it is repeatable, it preserves all conventional cancer treatment options, and it results in excellent vocal function by improving phonatory mucosal wave vibration. Observations from this investigation suggest that this new and novel cancer treatment strategy is effective; however, larger patient cohorts, longer follow-up, and multi-institutional confirmation will be necessary to establish incontrovertible oncological efficacy.
Endoscopic Removal of a Giant Fibrovascular Polyp of the Esophagus
Authors: Pham Annette M. , Rees Catherine J. , Belafsky Peter C.
Published: October 2014

Objectives:

Giant fibrovascular polyps of the esophagus are rare benign tumors originating from the proximal esophagus. These pedunculated lesions can grow to “giant” proportions. Asphyxiation from aspiration of the regurgitated polyp is a well-described cause of death. Traditional excision has involved a transcervical vertical esophagotomy. This report describes the successful endoscopic removal of a giant fibrovascular polyp of the esophagus.

Results:

A 63-year-old man with dwarfism and obstructive sleep apnea was referred for evaluation of an esophageal mass that was intermittently regurgitated into the hypopharynx. Office esophagoscopy demonstrated a 10-cm giant fibrovascular polyp originating just below the cricoid cartilage. During endoscopic removal, the base of the lesion was exposed with a Weerda bivalved laryngoscope. Bipolar cautery combined with a snare was used to transect the base with excellent hemostasis. No esophageal leak was noted on an esophagogram on postoperative day 3. The patient then resumed a liquid diet and was discharged home, resuming a regular diet within a week.

Conclusions:

Giant fibrovascular polyps of the esophagus are life-threatening because of potential airway obstruction. This report describes the successful endoscopic removal of a giant fibrovascular polyp, avoiding the potential morbidity associated with a transcervical vertical esophagotomy.
In Situ Tissue Engineering of the Cricoid and Trachea in a Canine Model
Authors: Omori Koichi , Nakamura Tatsuo , Kanemaru Shinichi , Magrufov Akhmar , Yamashita Masaru , Shimizu Yasuhiko
Published: October 2014

Objectives:

The purpose of the current study was to demonstrate the efficacy of in situ tissue engineering of the cricoid and trachea in a canine model.

Methods:

Marlex mesh tube reinforced with polypropylene threads and covered by collagen sponge was used as a tissue scaffold for airway regeneration in 9 beagle dogs. The anterior half of the cricoid cartilage was resected in 5 dogs, whereas the cricoid cartilage and cervical trachea were simultaneously resected in 4 dogs. The tissue scaffold was implanted into the resultant defect.

Results:

Endoscopic examination showed no airway obstruction for a postoperative period of 3 to 40 months in all dogs. Granulation tissue was observed in 2 dogs, and slight mesh exposure in 1 dog, although all were asymptomatic. Light microscopy and electron microscopy showed the endolaryngeal and endotracheal lumen to be covered by ciliated epithelium. According to strain-force measurement, the framework was firmly supported by regenerated tissue, as well as the normal cricoid and trachea.

Conclusions:

Our current tissue scaffold provides a rigid framework for the airway, and the collagen coating invites tissue regrowth around the tube. This study presents the possibility of successful reconstruction of the cricoid and trachea with epithelial regeneration by means of in situ tissue engineering.
Abnormal Deviation of Subjective Visual Horizontal in Patients with Vestibular Schwannoma
Authors: Ushio Munetaka , Iwasaki Shinichi , Chihara Yasuhiro , Murofushi Toshihisa
Published: October 2014

Objectives:

This study was aimed to examine the correlation between the results of subjective visual horizontal (SVH) and other vestibular function tests in patients with untreated unilateral vestibular schwannoma (VS).

Methods:

The subjects comprised 40 consecutive patients (17 men, 23 women) with VS who underwent vestibular function tests before surgery and had surgically and histopathologically confirmed unilateral VS. The vestibular function tests included SVH, caloric, and vestibular evoked myogenic potential (VEMP) tests.

Results:

Of the 40 patients, 31 (77.5%) showed deviation of the SVH toward the affected side down. Especially in 8 patients (20.0%), abnormal deviation (more than 2.2°) toward the affected side down was seen. None of the patients showed abnormal deviation toward the unaffected side down. On the caloric test, the proportion of absent caloric responses and the percent canal paresis in patients with an abnormal SVH was significantly higher than those in patients with a normal SVH. The proportion of abnormal VEMP responses was higher and the percent VEMP asymmetry was smaller in patients with an abnormal SVH than in patients with a normal SVH; however, the differences were not significant.

Conclusions:

Abnormal results on the caloric test and/or VEMP test were more frequently seen in VS patients with abnormal deviation of the SVH.
Effect of Hepatocyte Growth Factor on Gene Expression of Extracellular Matrix during Wound Healing of the Injured Rat Vocal Fold
Authors: Ohno Tsunehisa , French Lesley C. , Hirano Shigeru , Ossoff Robert H. , Rousseau Bernard
Published: October 2014

Objectives:

We performed a prospective, sham-controlled animal study to investigate the effects of hepatocyte growth factor (HGF) manipulation of the extracellular matrix on vocal fold gene expression during acute injury.

Methods:

Bilateral vocal fold wounds were created in 40 rats. The rats were randomly assigned to 1 of 2 groups (sham treatment or HGF treatment) and received treatment of the injured area at the time of wounding and on alternate post-treatment days. The injured vocal fold specimens were harvested on post-treatment days 1, 3, 7, and 14. We used real-time reverse transcription polymerase chain reaction to quantify messenger RNA expression of transforming growth factor (TGF)–β1, procollagen types I and III, hyaluronan synthase (HAS)–1, HAS–2, and HAS-3.

Results:

A multivariate analysis of variance revealed a significant interaction between treatment group and post-treatment day for TGF-β1, procollagen type I, procollagen type III, and HAS-2. Post hoc testing revealed significantly lower expression of procollagen type III and significantly higher expression of HAS-2 on post-treatment day 14 in the HGF treatment group than in the sham treatment group.

Conclusions:

Results provide evidence of HGF treatment effects on procollagen type III and HAS-2 gene expression pathways.