bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Clarithromycin on Rheological Properties of Nasal Mucus in Patients with Chronic Sinusitis
Authors: Majima Yuichi , Jinn Tae-Hoon , Rhee Chae-Seo , Arima Shinobu , Min Yang-Gi , Jung Ha-Won , Sakakura Yasuo
Published: October 2014

Macrolide antibiotics have a variety of actions along with antimicrobial action. To determine the effects of oral administration of clarithromycin (CAM) on rheological properties, we measured the spinability, dynamic viscoelasticity, and solid composition of human nasal mucus from 18 patients with chronic sinusitis before and after administration of CAM for 4 weeks. After administration of CAM, the spinability and percent solid composition of nasal mucus increased from 26.5 ± 12.2 mm to 40.2 ± 18.7 mm and 7.86% ± 3.47% to 13.90% ± 3.67% (p < .05), respectively, whereas the ratio of the viscosity to the elasticity (η′/G′) of nasal mucus after the administration of CAM decreased in all of the mucus samples. These results suggest that treatment with CAM may modulate the rheological properties of nasal mucus in patients with chronic sinusitis.
Human Uvula: Characterization of Resident Leukocytes and Local Cytokine Production
Authors: Olofsson Katarina , Hellström Sten , Hammarström Marie-Louise
Published: October 2014

Upper airway infections often lead to macroscopic changes in the architecture of the uvula. Using immunomorphometric analysis, we investigated the frequency and distribution of immune cells and of cytokine-producing cells in uvular samples. Tissue macrophages, αß T cells, γδ T cells, and B cells were, in declining order, the main cell populations. γδ T cells and B cells exhibited reciprocal localization, with almost all γδ T cells residing in the vicinity of the epithelium, and all B cells in the glandular area. The presence of cells expressing the suppressor phenotype CD8+CD28− αβ T cells is suggested. Fifteen to twenty-five percent of the immune cells expressed the down-regulatory cytokine tumor growth factor ß. Most macrophages were located subepithelially, in the vicinity of the basal lamina. The composition and cytokine profile of leukocytes in the tissue suggest that the uvula may be a site, additional to the jejunal mucosa, for induction of mucosal tolerance to inhaled and ingested antigens. Concomitantly, the uvula appears to be protected from invasion of microbial pathogens by a subepithelial barrier of macrophages and γδ T cells.
Estimated Subglottic Pressure in Normal and Dysphonic Subjects
Authors: Giovanni Antoine , Demolin Didier , Heim Corinne , Triglia Jean-Michel
Published: October 2014

The objective of this report was to study the clinical interest of estimated subglottic pressure (ESGP) with measurements of intraoral pressure according to the “airway interrupted method.” Twenty healthy female subjects and 27 dysphonic female patients were included and asked to produce sounds under different conditions of pitch and intensity. The ESGP increased with intensity and slightly with pitch in both patients and controls. a comparison between patients and controls showed significantly higher values of ESGP in patients under all conditions of intensity and pitch. For normal intensity and usual pitch, ESGP has been found to be 6.1 hectopascals (hPa) in control subjects and 8.25 hPa in patients (p = .002). Discriminant analysis of all the measured data showed that data recorded for low intensity (lowest possible intensity without whispering) and high pitch (9 semitones above the usual pitch) were the most discriminant. The authors concluded that ESGP allows good discrimination between dysphonic patients and control subjects and might be included in the basic clinical set of objective parameters.
Three-Dimensional Anatomic Characterization of the Canine Laryngeal Abductor and Adductor Musculature
Authors: Mineck Corey W. , Chan Roger , Tayama Niro , Titze Ingo R.
Published: October 2014

The biomechanics of vocal fold abduction and adduction during phonation, respiration, and airway protection are not completely understood. Specifically, the rotational and translational forces on the arytenoid cartilages that result from intrinsic laryngeal muscle contraction have not been fully described. Anatomic data on the lines of action and moment arms for the intrinsic laryngeal muscles are also lacking. This study was conducted to quantify the 3-dimensional orientations and the relative cross-sectional areas of the intrinsic abductor and adductor musculature of the canine larynx. Eight canine larynges were used to evaluate the 3 muscles primarily responsible for vocal fold abduction and adduction: the posterior cricoarytenoid, the lateral cricoarytenoid, and the interarytenoid muscles. Each muscle was exposed and divided into discrete fiber bundles whose coordinate positions were digitized in 3-dimensional space. The mass, length, relative cross-sectional area, and angle of orientation for each muscle bundle were obtained to allow for the calculations of average lines of action and moment arms for each muscle. This mapping of the canine laryngeal abductor and adductor musculature provides important anatomic data for use in laryngeal biomechanical modeling. These data may also be useful in surgical procedures such as arytenoid adduction.
Idiopathic Sudden Sensorineural Hearing Loss: Temporal Bone Histopathologic Study
Authors: Vasama Juha-Pekka , Linthicum Fred H.
Published: October 2014

We microscopically examined the temporal bones of 12 ears with idiopathic sudden sensorineural hearing loss (iSSNHL), 10 ears with presbycusis, 11 ears with normal hearing, and 8 unaffected contralateral ears of patients with iSSNHL. The degeneration of the spiral ligament, vascular stria, hair cells, dendrites, and apical spiral ganglion cells was greater in ears with iSSNHL than in the other groups. The apical ganglion cells were significantly more affected than the basal ganglion cells, and the spiral ganglion cell loss increased as a function of duration of iSSNHL. Cochlear ossification was found in 1 ear with iSSNHL, and hydrops in 2. These findings suggest a viral rather than a vascular or ruptured inner ear membrane origin for iSSNHL.
Mathematical Model Explaining the Sources of Error in Certain Estimates of the Gas Exchange Constants for the Middle Ear
Authors: Doyle William J.
Published: October 2014

Mover-Lev and colleagues reported a carbon dioxide-oxygen time-constant ratio of 3.9 for transmucosal gas exchange in guinea pigs under conditions of a large positive oxygen pressure gradient and a negative carbon dioxide gradient. That ratio is much less than the value of 19 reported previously for monkeys and used in predictive models of middle ear pressure regulation. In this report, the mathematics that underlie models of transmucosal gas exchange are developed and the conditions that allow accurate estimation of time constants are defined. The results demonstrate that the experimental and analytic methods used by Mover-Lev et al do not control for certain confounding effects or concurrently measure all required system parameters. Under the most realistic conditions, their ratio of 3.9 represents a significant underestimation of a true value on the order of 10. Also, their expectation of nonvarying, transmucosal time constant ratios for pairings that include reactive gases is simplistic and true only for identical experimental contexts.
Airway Flow Dynamics and Voice Acoustics after Autologous Fascia Augmentation of Paralyzed Vocalfold
Authors: Saarinen Antti , Lehikoinen-Söderlund Sari , Rihkanen Heikki , Sovijärvi Anssi R. A.
Published: October 2014

The aim of this study was to assess the effect of vocal fold medialization, accomplished by injection of autologous fascia, on airflow dynamics and voice acoustics. Ten patients with unilateral vocal fold paralysis were included. Flow-volume spirometry, body plethysmography, and acoustic analysis of voice were performed within 1 week before injection of autologous fascia and 4 to 14 months after operation. Medialization of the paralyzed vocal fold decreased the mean peak inspiratory flow (PIF) from 4.63 L to 4.10 L (p = .012). The acoustic characteristics of the voice improved: the values of jitter, shimmer, and mean noise-to-harmonics ratio decreased significantly (p = .006, p = .017, and p = .047, respectively), and the mean maximal phonation time almost doubled (p = .002). Changes in PIF and shimmer showed a negative correlation (r = −.857, p = .007). In conclusion, injection of autologous fascia improves voice acoustics, but induces a slight abnormal limitation on PIF. The results also suggest that improvement in voice acoustics is most prominent in subjects with the least deterioration in inspiratory airflow.
Pharyngeal Pressure Analysis by the Finite Element Method during Liquid Bolus Swallow
Authors: Kim Sung Min , McCulloch Timothy M. , Rim Kwan
Published: October 2014

The human pharynx is unique, acting as a complex interchange between the oral cavity and the esophagus, and between the nasal cavity and the lungs. It is actively involved in the transport of food and liquid, producing the forces that guide the bolus into the upper esophagus and away from the adjacent larynx and lungs. This study developed a biomechanical computer model of the human pharynx, utilizing a finite element method (FEM). Control 2-dimensional cine computed tomography images were obtained during 10-mL barium paste swallows at 8 levels extending from the tongue base to the cricopharyngeal level in order to encompass the entire pharynx. Three-dimensional finite element models of the pharynx were reconstructed from the geometric information obtained from the images at each level. Using an inverse dynamic approach with the addition of known tissue properties, we analyzed the 8 models under estimated pressure histories during swallow. Within each model, changes in the cross-sectional intraluminal area were calculated and compared with the area from the computer-generated FEM model. Area matching allowed estimation of intraluminal pressure gradients during swallow. The estimated pressure gradients were distributed through a range from 10 to 55 mm Hg, varying from one region to another and showing different patterns for the upper 4 levels and the lower 4 levels. The contraction velocity for the upper 4 levels was much higher than that for the lower 4 levels. The higher contraction velocities and pressure gradients in the upper levels are consistent with the bolus velocities required for efficient swallow.
Laryngeal Diversion and Tracheotracheal Speech Fistula for Chronic Aspiration
Authors: Wang Desheng , Dulguerov Pavel
Published: October 2014

Intractable aspiration is a life-threatening problem and often requires a procedure for blocking or separating the larynx from the bronchial tree. The disadvantage of these techniques is a compromise of phonation. We report the use of a speech fistula after laryngotracheal diversion to restore voice. It allows for the definitive treatment of aspiration, while maintaining the use of the vocal folds for phonation.
Actinomycosis Imitating Nasopharyngeal Carcinoma
Authors: Chiang Ching-Wen , Chang Yih-Leong , Lou Pei-Jen
Published: October 2014

The incidence of nasopharyngeal actinomycosis is exceedingly rare. To our knowledge, only 1 case has been reported previously. This article presents 4 cases of actinomycosis involving the nasopharynx that imitated nasopharyngeal carcinoma. Acidic gas exposure and farming of aquatic products are possibly involved in the pathogenesis of nasopharyngeal actinomycosis. Patients in the case studies completely recovered after 4 weeks of oral antibiotic treatment. We recommend including actinomycosis in the differential diagnosis of nasopharyngeal neoplasms.
Effect of a Beta-Stimulant on the Inner Ear Stria Vascularis
Authors: Ishii Kosuke , Zhai Wei Gang , Akita Masumi
Published: October 2014

In vivo and in vitro experiments were conducted to investigate the effect of α-isoproterenol on the inner ear stria vascularis with intracellular cytochrome oxidase activity used as an index. Intraperitoneal injection of α-isoproterenol (5 mg/kg) was performed in 10 rats, and that of physiological saline in 4 rats, for 21 consecutive days. After the 3-week treatment, bilateral cochleas were excised for frozen sections and stained for cytochrome oxidase. The staining density of the stria vascularis for the enzyme was analyzed with a computer. Electron microscopic observation was also performed for some specimens. As for the in vitro experiments, bilateral cochleas from 6 normal rats were excised for cell culture. Cochlear cells from the right ear were cultured with medium containing α-isoproterenol (10-μmol/L concentration), and those from the left ear with medium alone. After 3-day culture, the enzyme activity of cytochrome oxidase in the stria vascularis was quantified by the same method used for the in vivo experiments. Cytochrome oxidase activity was markedly elevated in the α-isoproterenol group. The activity tended to be higher in the lower turns of the cochlea. Electron microscopy revealed that numerous mitochondria were present in marginal cells that protruded into the endolymphatic space. The enzyme activity was also elevated in the stria vascularis from cochlear specimens in the α-isoproterenol group of the in vitro experiment. The above results suggest that α-isoproterenol accelerated the metabolic activity of the cells that constitute the stria vascularis. The increase in activity was probably attributable to direct pharmaceutical effects of the β-stimulant, rather than an increase in blood flow. It is possible that the cells that constitute the stria vascularis may have β-receptors.
Recurrent Laryngeal Nerve Monitoring during Cricotracheal Resection
Authors: Cavanaugh Kevin , Park Albert H.
Published: October 2014

Cricotracheal resection has been advocated in the management of severe subglottic stenosis. One of the possible complications of this procedure is injury to the recurrent laryngeal nerve (RLN). We describe a new technique in which electrodes are placed directly through the thyroid cartilage to monitor the RLN intraoperatively. Nine cats' left vocal cords were monitored, and 3 cats had unilateral vocal cord injury postoperatively: 1 right cord and 2 left cords. Even though this technique was efficacious, our ability to monitor the RLNs was difficult secondary to difficulty interpreting the nerve monitor's wave morphologies. The future use of RLN nerve monitoring during cricotracheal resection will depend upon the ability to distinguish true stimulation from artifact. Monitoring of the RLN could be beneficial in patients with previous operations for subglottic stenosis.
Morphological and Functional Study of Regenerated Chorda Tympani Nerves in Humans
Authors: Shibamori Yoshiyuki , Yamamoto Takehito , Saito Takehisa , Manabe Yasuhiro , Ohtsubo Toshio , Yamagishi Takahiro , Saito Hitoshi
Published: October 2014

It is still unclear whether the chorda tympani nerves in humans regenerate after being severed during middle ear surgery, although functional studies have demonstrated recovery of taste 1 to 2 years after surgery. To date, 12 cases of regenerated chorda tympani nerves have been found in our series of patients during secondary surgery. The regenerated nerves of 3 cases of the 12 were removed as samples during secondary surgery to detect regenerated myelinated axons. All regenerated nerves were in the submucosal connective tissue layer of the reconstructed eardrum. In the regenerated nerves, myelinated nerve fibers existed in a small fascicle or in connective tissue, but the number of myelinated axons was low compared with that in normal subjects (1,752 ± 78; n = 3), and the distribution was sparse. The total number of regenerated myelinated axons varied from 141 (8.3%) to 979 (55.9%). From a functional study using electrogustometry, incomplete recovery of electrogustation was observed in all 3 cases before secondary surgery, suggesting that chorda tympani nerves actually regenerate in the middle ear and do function.
Acquired Tracheoesophageal Fistula in Critically Ill Patients
Authors: Wolf Michael , Segal Eran , Yellin Alon , Faibel Meir , Talmi Yoav P. , Kronenberg Jona
Published: October 2014

Acquired benign tracheoesophageal fistula (TEF) is an infrequent complication of prolonged intubation and tracheostomy. Not infrequently, it is associated with severe circumferential malacia of the trachea and a need for concomitant correction of both. Controversy exists as to whether this should be performed in a single-stage or a 2-stage procedure. Four patients with acquired TEF underwent operation in a tertiary referral medical center between 1995 and 1997. The operations were performed through either an anterior (3) or a lateral (1) neck approach. Three patients underwent closure of the fistula with tracheal resection and anastomosis in a single stage and are doing well. One patient with complete subglottic stenosis underwent closure of the TEF and was planned for tracheal reconstruction in a second stage. This patient died in the early postoperative period. The complications included aspiration of blood leading to pneumonia (2), spontaneously resolving pneumomediastinum (1), subcutaneous emphysema (2), and cardiac arrhythmia (1). Residual fistula, noted in 1 patient, was treated conservatively and resolved spontaneously within several weeks. We conclude that acquired TEF is amenable to repair through a cervical approach. A single-stage correction of the TEF with reconstruction of the trachea is suitable and successful in most patients. Several stages seem justified when concurrent laryngotracheal reconstruction is needed.
Perceptual Characteristics of Adductor Spasmodic Dysphonia
Authors: Langeveld Ton P. M. , Drost Harm A. , Zwinderman Aeilko H. , Frijns Johan H. M. , De Jong Robert J. Baatenburg
Published: October 2014

The evaluation of perceptual symptoms is one of the mainstays in the diagnostic workup of adductor spasmodic dysphonia (ADSD). The most widely used perceptual rating system is the GRBAS scale. However, with this system, not all audible features of ADSD can be described. Therefore, we extended the GRBAS system by 6 parameters. The aim of this study was assessment of the perceptual characteristics of ADSD with the “extended” GRBAS system and evaluation of its reproducibility. Seventy-seven patients were scored independently by 3 experienced observers quantifying the voice sound profile. Cluster analysis distinguished 4 different voice types. Intraobserver and interobserver agreement among 8 less-experienced observers appeared fair-to-good. This study demonstrates that the “extended” GRBAS system is suitable for perceptual characterization of ADSD. On the grounds of the fair-to-good interobserver variability, it is appropriate for clinical use. Moreover, 4 different voice clusters of ADSD were identified, with significant differences in voice and demographic parameters.
CD34+ Immune Suppressive Cells in the Peripheral Blood of Patients with Head and Neck Cancer
Authors: Pandit Rajiv , Lathers Deanne M. R. , Garrity Thomas , Beal Nicole M. , Young M. Rita I.
Published: October 2014

Patients with head and neck squamous cell carcinoma (HNSCC) have profound defects in their immune defenses. Using immu-nofluorescent staining and flow cytometric analysis, we found that most patients with HNSCC have increased levels of CD34+ cells within their peripheral blood. These circulating CD34+ cells contribute to the depressed functional competence of the peripheral blood T-lymphocytes. This was demonstrated by the increased level of proliferative responsiveness to interleukin-2 by the patients' peripheral blood T-cells after depletion of CD34+ cells. These results show the importance of CD34+ cells in contributing to the depression of T-lymphocyte function in patients with HNSCC and suggest that strategies designed to reduce the levels of circulating CD34+ cells may enhance the immune reactivity of the patients' circulating T-lymphocytes against the HNSCC.
Objective Comparison of Shoulder Dysfunction after Three Neck Dissection Techniques
Authors: Cheng Pao-Tsai , Lin Yang-Hua , Hao Sheng-Po , Yeh Albert Re-Ming
Published: October 2014

A prospective study with subjective evaluation of shoulder pain and objective evaluation of shoulder muscle strength by isokinetic testing and electromyographic and electroneurographic studies of spinal accessory nerve function was performed on patients who had undergone neck dissection procedures. Twenty-one patients with head and neck cancer were enrolled in this study. Three types of neck dissection were performed: 7 selective neck dissections, 9 modified radical neck dissections, and 5 radical neck dissections. All patients who underwent radical neck dissection had shoulder pain, and 80% of them had shoulder droop after the operation. In the patients who underwent selective neck dissection, the electromyographic findings of the spinal accessory nerve were relatively normal. Their shoulder strength was sometimes decreased at 1 month after operation, but it had returned to preoperative strength by the 6-month follow-up visit. These findings suggested that patients who underwent selective neck dissection had the least damage to spinal accessory nerve function and the least shoulder disability after neck dissection.
Massive Epistaxis after Rupture of Intracavernous Carotid Artery Aneurysm
Authors: Sudhoff Holger , Stark Thomas , Luckhaupt Horst , Knorz Siegfried , Borkowski Gerd
Published: October 2014

We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.
Experience with Percutaneous Dilational Tracheostomy
Authors: Lim Jessica W. , Friedman Michael , Lazar Amy , Tanyeri Hasan , Caldarelli David D.
Published: October 2014

Percutaneous dilational tracheostomy (PDT) has gained popularity among critical care specialists in the past 10 years. The initial studies in our specialty resulted in essentially banning the procedure as a dangerous substitute for standard operative tracheostomy. Despite this action, more than 1,100 cases of percutaneous tracheostomy have been reported with details on complications. We reviewed all published data and studied 311 patients of our own. A prospective study was performed in 3 groups of patients: 1) 50 patients scheduled for PDT performed in the operating room by a head and neck surgeon (group 1); 2) 50 patients who underwent standard operative tracheostomy performed by the same surgeon (group 2); and 3) 211 patients who underwent bedside PDT by critical care physicians (group 3). The intraoperative complication rates were 0% in group 1, 2% in group 2, and 4% in group 3; the postoperative complication rates were 13%, 4%, and 12%, respectively. There were 2 deaths in group 3, and none in groups 1 or 2. The statistically significant differences among the groups were the superiority of group 1 over group 3 in intraoperative complications, as well as the lower postoperative complication rate of the standard tracheostomy group. These results show that PDT can be performed with acceptable morbidity rates in relation to published complication rates of standard tracheostomy, but it has no advantage over standard tracheostomy with respect to postoperative morbidity. When they are performed by a head and neck surgeon, the morbidity associated with both standard and percutaneous tracheostomies can be reduced.
Prevention of Accidental Childhood Strangulation a Clinical Study
Authors: Stevens Ryan R. , Stool Daniel , Lane Geoffrey A. , Rider Gene , Milkovich Scott M. , Stool Sylvan E.
Published: October 2014

Accidental Strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.
Outcomes Assessment following Treatment of Spasmodic Dysphonia with Botulinum Toxin
Authors: Courey Mark S. , Garrett C. Gaelyn , Portell Melissa D. , Billante Cheryl R. , Smith Tim L. , Stone R. Edward , Netterville James L.
Published: October 2014

Spasmodic dysphonia (SD), a disabling focal dystonia involving the laryngeal musculature, is most commonly treated by the intramuscular injection of botulinum toxin (BTX). Although the treatment is well tolerated and generally produces clinical voice improvement, it has never been statistically shown to alter the patient's perception of voice quality or general health. Declining resources for medical care mandate that treatment outcomes be documented. A prospective analysis of the effects of BTX on the patient's perception of voice and general health was undertaken. The Voice Handicap Index (VHI) and Short Form 36 (SF-36) surveys were administered to patients before treatment and 1 month after. Pretreatment and posttreatment scores were analyzed with a Student's t-test. On the VHI, improvements in the patients' perception of their functional, physical, and emotional voice handicap reached statistical significance (p ≤ .0005). On the SF-36, patients had statistically significant improvements in mental health (p ≤ .03) and social functioning (p ≤ .04). Treatment of SD with BTX significantly lessened the patients' perception of dysphonia. In addition, it improved their social functioning and their perception of their mental health. These outcome measures justify the continued treatment of SD with BTX.
Photography of Severe Laryngeal Obstruction
Authors: Benjamin Bruce
Published: October 2014

Thirty-five-millimeter photography using rigid rod lens telescopes at direct laryngoscopy is the most versatile and reliable method of laryngeal documentation. Photography of severe laryngeal obstruction, whether in pediatric or adult patients, mandates a method of anesthesia chosen for maximum patient safety, a laryngoscope selected for optimal exposure, confidence in controlling the airway, and a technique that does not jeopardize the safety of the patient.
Argon Plasma Coagulation for Inferior Turbinate Reduction
Authors: Bergler Wolfgang , Götte Karl , Riedel Frank , Hörmann Karl
Published: October 2014

Surgical reduction of the inferior turbinate remains a widely used therapy for nasal obstruction caused by hyperplastic turbinates. Current methods are costly and time-consuming, require nasal packing, and cause extended postoperative swelling. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngological surgery that is based on high-frequency electrical current. The current is transmitted through ionized argon gas (plasma) contact-free to the tissue surface and creates a coagulation and devitalization zone with limited penetration. Forty-five patients with nasal obstruction were treated under local anesthesia for reduction of the inferior turbinates with APC. Seventy-six percent of the patients reported an improvement of postoperative swelling within the first week. After 3 months, 86% reported having better nasal airflow than they had before the operation. Macroscopically, after 4 weeks the turbinate was covered by normal mucosa in 51% of the patients. Crust formation was minimal, and no bleeding occurred. Turbinate reduction with APC is an alternative technique with many advantages, and the results are comparable to those of standard techniques. Ninety-five percent of the patients were satisfied with the operation.
Facial Nerve: Vascular-Related Anatomy at the Stylomastoid Foramen
Authors: Bourdon Nicolas , Babin Emmanuel , Moreau Sylvain , Salame Ephrem , Valdazo André , De Rugy Marc Goullet , Delmas Pierre
Published: October 2014

We dissected 30 facial nerves in fresh cadavers after arterial casting with red latex to provide specific information about the arterial-related anatomy of the trunk of the facial nerve from the stylomastoid foramen to its bifurcation. We found that a wide anatomic variability does exist. The trunk of the facial nerve was in proximity to the stylomastoid artery, which originated from the posterior auricular artery in 70% of the specimens (21/30), from the occipital artery in 20% (6/30), and directly from the external carotid artery in 10% (3/30). The stylomastoid artery passed medially to the trunk of the facial nerve in 63 of the specimens (19/30) and laterally in 37% (11/30). Among these 11 specimens, 8 were large-caliber stylomastoid arteries. During parotid surgery, the main trunk of the facial nerve may be difficult to identify, because a large-caliber stylomastoid artery can mask it. Therefore, it is important to dissect this artery with caution.
Artifactual Thickening of the Sinus Walls on Computed Tomography: A Phantom Model and Clinical Study
Authors: Sichel Jean-Yves , Gul-Aksoy Fatma , Dangoor Eric , Dano Itzhak , Eliashar Ron , Gomori Moshe
Published: October 2014

Measuring sinus wall thickness on computed tomography may be important for distinguishing between acute and chronic inflammation of the paranasal sinuses or in cases of a suspected neoplasm. The objective of this study was to investigate the effects of opacified and aerated sinuses on the appearance of sinus wall thickness. A phantom model consisting of a skull half-immersed in water was scanned, and various slice thicknesses and different windows were used. The sinus walls of the water-immersed side appeared to be thicker than those of the aerated side. Bone windows did not completely eliminate this partial volume effect. It was concluded that comparison between a fluid- or tissue-filled sinus and an air-filled counterpart is not accurate enough for evaluating sinus wall thickness. Bone windows do not completely eliminate the artifactual thickening of the bony wall of a filled sinus.
Management of Large Mohs Defects
Authors: Becker Gary D. , Adams Lawrence A.
Published: October 2014

This study was performed to determine the appropriateness and relative merits of closing Mohs defects of the head and neck at the time of surgery or after surgery, in contrast with allowing defects to heal spontaneously. For 185 patients who had large Mohs wounds of the head and neck (scalp, nose, cheek, forehead, lip, chin, ear, or neck) that healed spontaneously and who underwent postoperative reconstruction as required, we recorded wound location, size, and depth. We then evaluated the cosmesis and functional result periodically and >6 months after operation by chart review, interview, or both. We found that large wounds of the scalp, neck, and ear (except through-and-through defects) often heal spontaneously with acceptable cosmesis. Large defects of the nose usually require prompt reconstruction. Large defects of the central cheek, lip, and chin usually heal spontaneously with poor cosmesis. However, we often reserve surgery for an unacceptable cosmetic result, because repairing a small scar is often less complex than reconstructing a large Mohs defect. We conclude that spontaneous healing of selected Mohs wounds of the head and neck can result in satisfactory cosmesis and function, thus obviating or minimizing the need for complex surgical repair. Surgeons can select management of Mohs wounds effectively and efficiently by accurately predicting the final cosmetic and functional result of spontaneous healing, thus reserving surgery for unfavorable cosmetic or functional results.
Multidisciplinary Airway Stent Team: A Comprehensive Approach and Protocol for Tracheobronchial Stent Treatment
Authors: Mair Eric A. , Lyon Robert D. , Jones Loren M. , Fitzpatrick Thomas M. , Feuerstein Irwin M.
Published: October 2014

Tracheobronchial stents are being used with increasing frequency to treat major airway obstruction from both malignant and benign processes. Traditionally, stents have been placed via rigid bronchoscopy, flexible bronchoscopy, or fluoroscopy by members of various individual disciplines. We describe a novel multidisciplinary airway stent team (MAST) protocol for tracheobronchial stent placement and endoscopic management of major airway obstruction. A patient with symptoms of airway obstruction is generally first evaluated with a computed tomography scan and a videotaped flexible bronchoscopy. These studies are reviewed by the team otolaryngologist, pulmonologist, and interventional radiologist. A treatment plan, including the type and location of stents and the need for adjuvant therapies, is formulated. Stent placement is performed in the operating room under general anesthesia. Rigid bronchoscopy, with flexible bronchoscopy and fluoroscopy as needed, allows precise stent placement and the best use of various therapeutic methods. The MAST protocol combines the skills, knowledge, and unique therapeutic options of specialists from otolaryngology, pulmonology, and interventional radiology. This approach allows optimal stent placement and the use of other endobronchial therapies, including laser ablation, balloon dilation, photodynamic therapy, cryotherapy, and brachytherapy. A protocol with representative case reports is presented, along with a review and comparison of several of our most commonly used stents. Otolaryngologists who practice bronchoesophagoscopy, by virtue of their operative skill and knowledge of airway management, are well equipped to become leaders of MASTs and are encouraged to initiate MASTs at their institutions.
Age- and Gender-Related Collagen Distribution in Human Vocal Folds
Authors: Hammond Thomas Hale , Gray Steven D. , Butler John E.
Published: October 2014

The composition of the lamina propria in human vocal folds has been shown to affect vocal performance. Collagen plays a significant role in the biomechanical effects of the lamina propria. Specifically, it lends tensile strength to the rapidly oscillating fold. We obtained from a state medical examiner 38 larynges from men and women in infant, adult, and geriatric age groups. We stained the vocal folds for collagen using a picric acid stain and studied them using an image analysis system. Distributions of collagen were measured from the superficial to deep layers (from epithelium to vocalis muscle) within the lamina propria. The data showed an increase in collagen content from infant to adult stages. Infant folds had about 51 % of the collagen found in all adults and in geriatric patients (p < .001). There was no significant difference between adult and geriatric folds (p < .16). There was, however, a gender difference in the amount of collagen in both adult and geriatric specimens. Female adult and geriatric folds had about 59% of the collagen found in male adult and geriatric folds (p < .001). The distribution pattern of collagen showed that most of the collagen was present in the deep layer. From these data we conclude that there are age-related and gender-related differences between male and female infant, adult, and geriatric vocal folds. Stress-strain performance studies need to be correlated with histologic findings to better study the phonetic implications of these findings.
Effects of Intralaryngeal Carbon Dioxide and Acetazolamide on the Laryngeal Chemoreflex
Authors: Heman-Ackah Yolanda D. , Goding George S.
Published: October 2014

Sudden infant death syndrome is the leading cause of death in infants in the United States. The laryngeal chemoreflex (LCR) is thought to contribute to its pathogenesis. In adult animals, increasing levels of intralaryngeal CO2 result in a decrease in ventilatory activity. Intravenous acetazolamide (AZ) abolishes this response. The purpose of this study was to determine the effects of intralaryngeal CO2 and AZ on the LCR and respiratory physiology of piglets under normoxic and hypoxic conditions. We applied 0% or 10% CO2 in a randomized order to the larynx of 26 piglets. Intubation via tracheotomy prevented inhalation of the gas mixtures. Laryngeal stimulation was performed under normoxic conditions (Pao2 of >70 mm Hg) in 15 animals and under hypoxic conditions (Pao2 of 50 to 65 mm Hg) in 11 animals both with and without intravenous AZ (5 mg/kg). Respiratory and cardiovascular response data were recorded. Ten percent intralaryngeal CO2 has no significant effect on mean baseline respiratory rate, systemic Paco2 or Pao2 levels, or apnea duration (p > .05). The use of AZ (versus no AZ) resulted in significantly higher baseline respiratory rates (64 versus 51 breaths per minute; p = .016), a decreased baseline systemic Paco2 level (38.8 versus 45.9 mm Hg; p < .001), a higher baseline Pao2 level (97.9 versus 82.8 mm Hg; p < .001), shorter mean apnea durations (15.5 versus 24.8 seconds; p = .001), a higher lowest O2 saturation level after the stimulus (78.0% versus 68.4%;p = .003), and fewer profound apneas (10 of 90 versus 41 of 90 trials; p < .001). We conclude that 10% intralaryngeal CO2 does not decrease ventilatory activity in piglets and has no significant effect on the LCR. Acetazolamide, however, appears to have a protective effect against the LCR, resulting in shorter and less severe apneas. The protective effect of AZ against the LCR appears to be related to its ability to stimulate the respiratory drive and increase oxygenation at baseline.
Sensitivity of the Endocochlear Potential Level to Cochlear Blood Flow during Hypoventilation
Authors: Yamamoto Hirofumi , Makimoto Kazuo
Published: October 2014

To study the relationship between endocochlear DC potential (EP) and cochlear blood flow (CoBF) under hypoxic conditions, we recorded the EP and CoBF from the basal turn of the cochlea in 21 guinea pigs. Hypoventilation for 10 minutes was induced by reducing the respiratory rate and volume. During hypoventilation, the EP declined in most of the cases to an intermediate level of the positive range in a few minutes. At the midpoint of the 10-minute hypoventilation, angiotensin II (5 μg/kg or 1 mL/kg) was infused for 60 seconds to raise the systemic blood pressure. In this experimental manipulation of systemic blood pressure, the CoBF and EP generally rose transiently. We determined the sensitivity of the EP to a CoBF change (Δ) by calculating the ΔEP/ΔCoBF. More specifically, we analyzed the relationship between the ΔEP/ΔCoBF and the EPi (EP level just before angiotensin II infusion). The ΔEP was equal to the maximum EP level after angiotensin II infusion minus the EPi. The ΔCoBF was equal to the maximum CoBF value after angiotensin II infusion minus the CoBF value just before infusion. The ΔEP/ΔCoBF increased most in the range near 70% of the EPi. That is, the ΔEP/ΔCoBF was greater and the EPi was lower in the range above 70% of the EPi. To elucidate this linear correlation in the range above 70% of the EPi, we must consider several factors. In the supplementary experiments for blood gas analysis using 11 guinea pigs, most of the data of the EPi in the range above 70% were found to be obtained under conditions of a Pao2 of more than 12 mm Hg. As to the sensitivity increase of the EP to the ΔCoBF above mentioned, we propose that among several factors in the stria vascularis during hypoxemia, the activation of glycolysis in aerobic metabolism may be involved. As another possible factor, we postulate the increase in the reactive rate of the enzymatic activities that are linked with EP production and respond to the elevated cyclic adenosine monophosphate activity induced by the sympathicotonic state due to hypercapnia.
Vertical Partial Laryngectomy versus Supracricoid Partial Laryngectomy for Selected Carcinomas of the True Vocal Cord Classified as T2N0
Authors: Laccourreye Ollivier , Gutierrez-Fonseca Raimundo , Laccourreye Laurent , Brasnu Daniel , Garcia Dominique , Weinstein Gregory
Published: October 2014

From an inception cohort of 204 patients with squamous cell carcinoma of the true vocal cord classified as T2N0 and a minimum of 3 years of follow-up, the authors compare the oncological and functional outcomes following vertical partial laryngectomy (group 1; 85 patients) and supracricoid partial laryngectomy (group 2; 119 patients). The 10-year actuarial survival estimate was 46.2% for group 1 and 66.4% for group 2. Survival was statistically more likely to be reduced (p = .019) in group 1 than in group 2. The 10-year actuarial local control estimate was 69.3% for group 1 and 94.6% for group 2. Local recurrence was statistically more likely to occur (p < .0001) in group 1 than in group 2. Salvage treatment resulted in an overall 94.1% local control rate and a 78.1% laryngeal preservation rate for group 1 and an overall 99.2% local control rate and a 94.9% laryngeal preservation rate for group 2. The 10-year actuarial nodal control estimate was 81.7% for group 1 and 93.7% for group 2. Nodal recurrence was statistically more likely to occur (p = .028) in group 1 than in group 2. The 10-year actuarial estimate for patients without distant metastasis was 84.6% for group 1 and 95.1% for group 2. Distant metastasis was statistically more likely to occur (p = .05) in group 1 than in group 2. The hospital mortality rate was 1.2% for group 1 and 0.8% for group 2. The incidence of permanent gastrostomy was 0% for group 1 and 2.4% for group 2. The incidence of permanent tracheostomy was 1.2% for group 1 and 2.4% for group 2. The incidence of completion laryngectomy due to functional problems was 1.2% for group 1 and 0.8% for group 2.
Pediatric Fiberoptic Endoscopic Evaluation of Swallowing
Authors: Hartnick Christopher J. , Miller Claire , Hartley Benjamin E. J. , Willging J. Paul
Published: October 2014

Pediatric dysphagia is the presenting feature of many underlying diagnoses. Between July 1993 and July 1999, 643 fiberoptic endoscopic evaluations of swallowing (FEES) were performed on 568 patients. The median age of the population was 2.5 years (range, 3 days to 21 years). The principal medical and surgical diagnoses of the patients at the time of presentation to the FEES clinic were prospectively recorded: 36% of the patients presented with a diagnosis of structural abnormalities of the upper aerodigestive tract or airway; 26% with neurologic diagnoses; 12% with gastroenterological disorders; 8% with genetic syndromes; 7% with pulmonary dysfunction; 5% with prematurity; 3% with cardiovascular anomalies; and 2% with metabolic problems. The patients were classified according to the following feeding regimens: 9% normally fed; 38% orally fed with limitations; 13% orally fed, but with required supplemental tube feedings; and 40% prohibited from taking nutrition orally. The FEES enabled the following classification of feeding abnormalities: 15% had normal feeding; 56% exhibited behavioral abnormalities, including sensory-based feeding disorders; 15% exhibited structural abnormalities; 16% exhibited neurologic abnormalities; 1.5% exhibited metabolic abnormalities; and 0.5% exhibited cardiorespiratory abnormalities. The unique aspects of pediatric dysphagia are highlighted, and the role of FEES in the workup of this challenging aspect of pediatric otolaryngology is discussed.
Optimized Speech Understanding with the Continuous Interleaved Sampling Speech Coding Strategy in Patients with Cochlear Implants: Effect of Variations in Stimulation Rate and Number of Channels
Authors: Kiefer Jan , von Ilberg Christoph , Hubner-Egner Jutta , Rupprecht Vittoria , Knecht Rainald
Published: October 2014

The purpose of this study was to investigate the effect of systematic variations in stimulation rate and number of channels on speech understanding in 13 patients with cochlear implants who used the continuous interleaved sampling speech coding strategy. Reducing the stimulation rate from 1,515 to 1,730 pulses per second per channel to 600 pulses per second per channel resulted in decreased overall performance; the understanding of monosyllables and consonants was more affected than the understanding of vowels. Reducing the number of active channels below 7 or 8 channels decreased speech understanding; the identification of vowels and monosyllables was most affected. We conclude that vowel recognition with the continuous interleaved sampling strategy relies on spectral cues more than on temporal cues, increasing with the number of active channels, whereas consonant recognition is more dependent on temporal cues and stimulation rate.
Effect of Adenovirus Type 1 and Influenza a Virus on Streptococcus Pneumoniae Nasopharyngeal Colonization and Otitis Media in the Chinchilla
Authors: Tong Hua Hua , Kosunick Gregory M. , Fisher Lisa M. , DeMaria Thomas F.
Published: October 2014

Considerable evidence has implicated respiratory tract virus potentiation of bacterial adherence, colonization, and superinfection as a significant factor contributing to the pathogenesis of otitis media (OM). Influenza A and B viruses, adenovirus, and respiratory syncytial virus are the primary respiratory tract viruses associated with this disease. Investigations have established a dramatic increase in the development of experimental OM in chinchillas co-inoculated with influenza A virus and Streptococcus pneumoniae (Spn). The mechanism underlying this phenomenon was suggested to involve, in part, viral compromise of eustachian tube mucosal integrity and function. This study was designed to assess and compare the effect of adenovirus and influenza A virus infection on adherence, the kinetics of colonization, and invasion of the middle ear by Spn in the chinchilla model of OM. Cohorts were inoculated intranasally with adenovirus type 1 or influenza A virus, and then inoculated intranasally 7 days later with Spn 6A. All cohorts were observed over a 14-day period after challenge with Spn, and the incidence and severity of OM were assessed by several methods, including culture of the nasopharynx and middle ear effusions. The data indicated that influenza A virus promotes a significant increase in nasopharyngeal colonization by Spn, an increased incidence and severity of OM, and a sustained presence of Spn in the effusions. Adenovirus infection, however, did not enhance colonization by Spn or result in an increased incidence or severity of OM.
Proliferation Markers, Proliferating Cell Nuclear Antigen, Ki67, 5-Bromo-2′-Deoxyuridine, and Cyclin D1 in Mouse Olfactory Epithelium
Authors: Ohta Yasushi , Ichimura Keiichi
Published: October 2014

We immunohistochemically identified proliferating cells in the olfactory epithelium of mice, using an anti–proliferating cell nuclear antigen (PCNA) antibody, an anti-Ki67 antibody, an anti–5-bromo-2′-deoxyuridine (BrdU) antibody, and an anti–cyclin D1 antibody. Positive cells stained by the 4 antibodies were identified mainly in the basal layer. The mean numbers of positive cells stained by the 4 antibodies in 500 olfactory epithelium cells from each animal were as follows: PCNA-positive cells 42, Ki67-positive cells 23, BrdU-positive cells 13.7, and cyclin D1–positive cells 9.2. PCNA may be detected in both proliferating and resting cells. Ki67 is an intranuclear antigen expressed in proliferating, but not resting, cells. Anti-BrdU antibodies might stain proliferating cells only following the S-phase, but not the G1-phase. Cyclin D1 is a protein that works during the G1-phase of the cell cycle. When we stain proliferating cells using proliferating cell markers, it is important to consider the cell cycle phases during which each marker stains.