bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Auditory Brain Stem Response with Lidocaine Injection into the Cerebrospinal Fluid in Rats
Authors: Yamada Katsushi , Tsuzuku Toshihiro , Kaga Kimitaka , Uno Akira
Published: October 2014

Auditory brain stem response (ABR) was recorded in 10 rats with total spinal anesthesia induced by injection of 2% lidocaine hydrochloride into the subarachnoid space through the skull. The ABR disappeared immediately (within 4 minutes) after the injection of 13.3 to 40.0 mg/kg lidocaine. The disappearance started with the later waves of the ABR. After cessation of the injection, the ABR reappeared and recovered progressively from wave I to wave IV. The effect of lidocaine on the ABR was reversible and extended in the acoustic nerve to the midbrain.
Effect of Subglottic Pressure on Fundamental Frequency of the Canine Larynx with Active Muscle Tensions
Authors: Solomon Nancy Pearl , Liu Kang , Hsiao Tzu-Yu , Luschei Erich S. , Fu Tsu-Ching , Titze Ingo R. , Hsu Mow-Ming
Published: October 2014

The relation between subglottic pressure and the fundamental frequency of vocal fold vibration was studied by means of evoked phonation in an in vivo canine model. The evoked-phonation model involved electrical stimulation of the midbrain that resulted in consistent responses by respiratory and laryngeal musculature, accompanied by phonation. The dynamic stiffness properties of the vocal folds, especially the “cover,” were investigated by delivering various amounts of air pressure to the larynx from an opening in the trachea. The fundamental frequency of vocal fold vibration increased linearly with subglottic pressure. The slopes ranged from 22.4 to 118.7 Hz per kilopascal in 7 animals. The results indicated that the dependence of fundamental frequency on subglottic pressure is a passive mechanical phenomenon.
Two Perplexing Skin Tumors: Microcystic Adnexal Carcinoma and Keratoacanthoma
Authors: Batsakis John G. , El-Naggar Adel K. , Weber Randal S.
Published: October 2014

Microcystic adnexal carcinoma and keratoacanthoma have a marked predilection for the skin of the head and neck. The adnexal carcinoma continues to be underrecognized, and the consequences for the patient are locally aggressive recurrences. The keratoacanthoma, on the other hand, may be inappropriately overdiagnosed, causing squamous cell carcinoma of the skin to be missed. In the instance of the solitary keratoacanthoma a conservative complete excision is recommended.
Primary Closure of Persistent Tracheocutaneous Fistula in Children
Authors: Bressler Kyle L. , Dunham Michael E. , Kaiser Peter C. , Holinger Lauren D.
Published: October 2014

Thirty-six patients with persistent tracheocutaneous fistula (TCF) after pediatric tracheotomy were managed at Children's Memorial Hospital in Chicago between June 1987 and July 1992. Persistent TCF was managed with surgical excision and primary closure. The mean patient age was 5 years 7 months, and the mean duration between decannulation and fistula closure was 21 months. There were no major complications and four minor complications. While most surgeons advocate other techniques, we feel that excision with primary closure is the preferred method for persistent TCF. The technique requires an airtight tracheal closure with loose closure of the peristomal soft tissue. Careful preoperative evaluation, postoperative monitoring, and wound drainage are stressed.
Lymphoma Involving the Esophagus
Authors: Orvidas Laura J. , McCaffrey Thomas V. , Lewis Jean E. , Kurtin Paul J. , Habermann Thomas M.
Published: October 2014

Fewer than 1% of all lymphomas involve the esophagus; however, lymphoma of the esophagus represents an important cause of dysphagia. This study reviewed all cases of biopsy-proven lymphoma involving the esophagus presenting at our institution between 1945 and 1992. Twenty-seven cases were identified. Three were primary esophageal lymphomas. Eleven percent of the cases represented Hodgkin's disease. Eighty-nine percent were non-Hodgkin's lymphoma. Eighty-nine percent of the patients experienced dysphagia. Eleven lymphomas (41%) were located at the gastroesophageal junction, while the other 17 were in the esophagus proper. Seven of these cases occurred at relapse. Three had mediastinal adenopathy with secondary esophageal involvement Morbidity included tracheoesophageal fistula in 22%, and surgical repair was performed in half of these cases. Vocal cord paralysis occurred in 22%, with minimal sequelae. Esophageal stricture was present in 30%, usually necessitating dilation. The presentation, diagnosis, and management of this problem are multidisciplinary.
Metastatic Calcification of the True Vocal Cords as a Cause of Hoarseness
Authors: Belser Robert B. , Stepnick David W. , Setrakian Sabouh , Hricik Donald E.
Published: October 2014

Visceral soft tissue calcification is common in patients with end-stage renal disease. However, metastatic calcification of the true vocal cords has not been described. We present a patient with chronic renal failure and hoarseness in whom an exophytic true vocal cord mass was diagnosed as a metastatic calcification.
Cordectomy versus Arytenoidectomy in the Management of Bilateral Vocal Cord Paralysis
Authors: Eckel Hans E. , Thumfart Monika , Vössing Martin , Wassermann Klaus , Thumfart Walter F.
Published: October 2014

Our objective was to assess the effectiveness of transoral laser cordectomy and laser arytenoidectomy and to compare the results with a view to respiratory and phonatory function and deglutition. Twenty-eight patients with bilateral vocal cord paralysis were included in a prospective study. Eighteen patients had cordectomy, and 10, arytenoidectomy. Lung function tests and voice analysis were performed preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of both surgical methods. How volume spirograms documented equally improved flow rates in both groups. The final voice evaluation revealed that maximum phonation time, peak sound pressure levels, and frequency range were reduced in all 28 patients, but the phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four of 6 previously tracheostomized patients were decannulated within 2 weeks after surgery, while the other 22 patients had no perioperative tracheostomies. We conclude that transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Phonatory outcome is not predictable with either surgical procedure. Cordectomy is easier and faster to perform, and subclinical aspiration is not encountered with this procedure.
Estimation of the Benefit of Bone-Anchored Hearing Aids
Authors: Browning George G. , Gatehouse Stuart
Published: October 2014

Implantable bone conduction hearing aids are a valuable alternative to conventional aids for those who cannot use a conventional air conduction aid or find it difficult to use because of an aural discharge, most commonly due to chronic otitis media. Previously reported series of the use of a bone-anchored hearing aid (BAHA) come from the originators of this device, and an independent report of their benefit and use, especially in previous air conduction aid users, would be of value. Twenty-three patients were evaluated at least 6 months after implantation of a BAHA. All 7 previous bone conduction aid users were delighted with their BAHA, reporting increased comfort and hearing benefit that was backed by audiometric evidence. Of the 16 individuals who previously used an air conduction aid, 11 (69%) were delighted users of their BAHA. Unfortunately, the other 5 (31%) reverted to solely using their air conduction aid. There was no obvious predictor as to how these individuals might have been identified prior to implantation. In particular, their pure tone thresholds, especially the bone conduction thresholds, were no different from those of the 11 BAHA users. However, in free field audiometry, the users gained superior benefit from their BAHA compared to their air conduction aid, whereas the nonusers did not. In conclusion, in all series to date, previous users of a conventional bone conduction aid have been delighted users of a BAHA and have gained superior audiometric benefit. This is not necessarily the case with previous air conduction aid users. As most patients rate hearing ability to be more important than absence of an aural discharge, it is important to develop methods that might predict benefit from a BAHA prior to implantation.
Effect of Corticosteroid Treatment on Salicylate Ototoxicity
Authors: Park Yong-Soo , Choi Duk-Joo , Jung Timothy T. K. , Rhee Chung-Ku
Published: October 2014

Our previous studies showed that salicylate ototoxicity is associated with decreased levels of prostaglandins (PGs) and elevated levels of leukotrienes (LTs) in the perilymph. The purpose of this study was to determine whether or not pretreatment with corticosteroid, which suppresses both PGs and LTs in arachidonic acid metabolism, prevents salicylate ototoxicity. Salicylate ototoxicity was induced in chinchillas with or without treatment with dexamethasone. Hearing thresholds were measured by auditory brain stem response, and perilymph samples were assayed by high-performance liquid chromatography. Dexamethasone pretreatment, given by either systemic or local round window membrane application, partially prevented salicylate-induced hearing loss. Prevention of salicylate ototoxicity by dexamethasone seems to be correlated with increased PG levels and decreased LT levels in the perilymph. This is another piece of evidence that salicylate ototoxicity may be mediated by abnormal arachidonic acid metabolism in the inner ear.
Sinonasal Lymphomas
Authors: Cleary Karen R. , Batsakis John G.
Published: October 2014

Advances in immunocytochemical phenotyping and molecular genetics have nearly resolved the histopathologic and therapeutic quandaries brought about by a diagnostic nomenclature that provided little guidance in the management of midfacial necrotizing lesions. Gone are terms like midline granuloma syndrome, lethal midline granuloma, polymorphic reticulosis, lymphomatoid granulomatosis, midline destructive granuloma, and idiopathic midline destructive disease. They have been replaced by the appreciation that the majority of the lesions are lymphomas of the sinonasal tract. The lymphomas are of B- or T-cell lineage and have a broad biologic spectrum from low to high grade. Still to be addressed are apparent geographic differences in biologic behavior, the epidemiologic significance of a preponderance of T-cell nasal lymphomas in the Orient, and optimum therapeutic regimens.
Endoscopic Resection of the Intranasal Frontal Sinus Floor
Authors: Close Lanny Garth , Leach Joseph L. , Lee Norris K. , Manning Scott C.
Published: October 2014

The current accepted treatment for chronic frontal sinus disease unresponsive to medical management and endoscopic surgery is an external approach to either obliterate the sinus or restore communication to the nasal cavity. Here reported is an endoscopic approach for resection of the intranasal frontal sinus floor, a modification of a procedure first described by Lothrop in 1899. Eleven patients underwent this operation from April 1993 to December 1993. One complication, a cerebrospinal fluid leak treated successfully endoscopically, has occurred. Of the 7 patients followed up 3 months or longer after surgery, only 1 has developed symptoms of recurrent frontal sinusitis. On the basis of this limited preliminary experience, the endoscopic Lothrop procedure shows promise as an effective operation designed to establish a physiologic communication between the frontal sinus and the nasal cavity in selected patients who would otherwise be candidates for an external approach.
Healing of Incisions in the Tongue: A Comparison of Results with Milliwatt Carbon Dioxide Laser Tissue Welding versus Suture Repair
Authors: Debias Domenic A. , Dorf Bryan , Greene Charlotte H. , Henderson Maryanne J. , Radin Alex L. , Fair-Covely Rosemary , Young-Seidman Wanda L.
Published: October 2014

The healing of carbon dioxide laser weld closures produced by two commercial instruments of differing design were compared. Healing after laser welding was also compared to healing following conventional suture closure. Healing was evaluated histologically and by measurement of tensile strength over time. No histologic differences were found between closures produced by different lasers; however, in all cases suture closure resulted in slower healing times consistent with a foreign body reaction prolonging the healing process. Tensile strength measurements were performed at intervals over the first 21 days after the operation. Laser repair was found to be equivalent to or stronger than suture repair at every interval measured. The clinical use of the carbon dioxide laser for tissue welding of oral injuries should be investigated further, since it appears to be a good alternative to suture repair.
Human Olfactory Receptor Neurons Express Heat Shock Protein 70: Age-Related Trends
Authors: Getchell Thomas V. , Krishna N. S. Rama , Sparks D. Larry , Dhooper Nimrat , Getchell Marilyn L.
Published: October 2014

Immunocytochemical methods were used to investigate the cellular distribution and age-related trends in the expression of constitutive and/or inducible forms of heat shock protein (hsp) 70 in the human nasal mucosa of 22 subjects who ranged in age from 16 weeks prenatal to 90 years, including 3 subjects with Alzheimer's disease. The olfactory mucosa was characterized by the presence of olfactory marker protein—immunoreactive olfactory receptor neurons. The hsp 70 immunoreactivity was localized in olfactory receptor neurons and the supranuclear region of sustentacular cells in the olfactory epithelium, and in the acinar cells of the Bowman's glands in the lamina propria. A systematic age-related decrement in the expression of hsp 70 immunoreactivity was observed in the olfactory receptor neurons. This trend was not apparent in sustentacular cells and Bowman's glands. A marked decrement in hsp 70 immunoreactivity was also noted in the olfactory receptor neurons of subjects with Alzheimer's disease when compared to age-matched controls. These results suggest that the age-dependent decrease in hsp 70 in olfactory receptor neurons of older subjects and those with Alzheimer's disease may be attributable to their greater susceptibility to stress.
Lower Skull Base: Anatomic Study with Surgical Implications
Authors: Saleh Essam , Naguib Maged , Cokkeser Yasar , Aristegui Miguel , Sanna Mario
Published: October 2014

With advances in the lateral approaches to the skull base and the increasing success of the management of jugular foramen lesions, a thorough knowledge of the anatomy of this region is needed. The purpose of the present work is to study the detailed microsurgical anatomy of the lower skull base and the jugular foramen area as seen through the lateral approaches. Forty preserved skull base specimens and 5 fresh cadavers were dissected. The shape of the jugular bulb and its relationship to nearby structures were recorded. The different venous connections of the bulb were noted. The hypoglossal canal was identified and its contents were observed. The lower cranial nerves were studied at the level of the upper neck, at their exit from the inferior skull base, and in the jugular foramen. The results of the present study showed the complex and variable anatomy of this area. The classic compartments of the jugular foramen were not always present. Cranial nerves IX through XI followed different patterns while passing through the jugular foramen, being separated from the jugular bulb by bone, thick fibrous tissue, or thin connective tissue.
Laryngeal Hamartoma: A Rare Congenital Abnormality
Authors: Fine Edward D. , Dahms Beverly , Arnold James E.
Published: October 2014

Hamartoma is a rare congenital abnormality of the larynx that must be considered in the differential diagnosis of benign lesions of the larynx. Presenting symptoms may include changes in voice, eating, and activity levels, and respiratory complaints. We treated a 2 1/2-year-old boy with an 8-month history of upper airway compromise. Radiographic studies showed a rounded, right-sided, supraglottic soft tissue mass. Direct laryngoscopy revealed a well-mucosalized, encapsulated, firm 3 × 2.5-cm mass that originated from the right supraglottic structures. The mass was excised endoscopically. Histologic examination revealed a hamartoma. At 18 months, the patient has had an uneventful postoperative course.
Head and Neck Manifestations of Eosinophllia-Myalgia Syndrome
Authors: Levine Brett , Ficco Ann , Lanza Donald C. , Freundlich Bruce
Published: October 2014

Eosinophilia-myalgia syndrome (EMS) is a multisystemic disease that occurs in patients who have consumed products containing l-tryptophan. Prominent features include incapacitating myalgias, arthralgias, neuropathies, and eosinophilia. Despite the frequent association of dysphagia, dyspnea, and the potential for aspiration, the otolaryngology literature is devoid of information on EMS. In order to determine the frequency of otolaryngic symptoms, questionnaires were distributed to patients with EMS in 33 different US states. Among the 28 various head and neck manifestations studied, 70% of EMS patients complained of generalized muscle spasms, 66% xerostomia, 62% dyspnea, and 56% dysphagia. In addition, the epidemiology, clinical presentation, diagnostic criteria, and treatment options are discussed. This paper assesses the frequency of otolaryngic manifestations of EMS, as well as introduces this syndrome to the otolaryngologist—head and neck surgeon. It is important for the otolaryngologist to be aware of EMS and its manifestations and treatments so that patients with this potentially lethal disease can receive appropriate evaluation and expeditious treatment.
Surface Morphology of the Endolymphatic Duct in the Rat a Scanning Electron Microscopy Study
Authors: Qvortrup Klaus , Rostgaard Jørgen , Bretlau Poul
Published: October 2014

Following intracardiac vascular perfusion fixation of 8 rats with glutaraldehyde in a buffered and oxygenated blood substitute, the vestibular aqueduct and endolymphatic duct were opened by microsurgery of the resulting 16 temporal bones. Optimum preservation of the epithelium for scanning electron microscopy was attained by coating of the specimens with osmium tetroxide and thiocarbohy drazide followed by a continuous dehydration procedure. This technique permitted, for the first time, an investigation of the surface morphology of the epithelial cells in the endolymphatic duct. Three types of cells were identified with the scanning electron microscope. A polygonal and oblong epithelial cell was observed in the largest number throughout the duct, and in the juxtasaccular half of the duct, two additional types of epithelial cells were observed. The scanning electron microscopic observations are compared and discussed with reference to previous transmission electron microscopic studies of the endolymphatic duct.
Peritonsillar Abscess: An Unlikely Cause of Necrotizing Fasciitis
Authors: Greinwald LCDR John H. , Wilson Joseph F. , Haggerty Patrick G.
Published: October 2014

Cervical necrotizing fasciitis is a devastating polymicrobial soft tissue infection characterized by gas formation and extensive necrosis of subcutaneous fat and fascia with extension to skin and muscle. Involvement of the head and neck is rare and is typically dental in origin. Despite broad-spectrum antibiotics, mortality rates for this disease remain high. We report a successfully treated case of necrotizing fasciitis arising from a peritonsillar abscess. Review of the literature reveals only 6 other cases, with 3 successful outcomes. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical debridement are the cornerstones of therapy. The pathophysiology is typically a mixed aerobic and anaerobic infection. Supportive treatment options such as hyperbaric oxygen therapy and high-calorie supplemental nutrition may be of benefit. a comprehensive literature review of craniocervical necrotizing fasciitis is presented. Factors associated with poor outcomes include diabetes mellitus, mediastinitis, cardiovascular disease, and peritonsillar abscess.
In Situ Analysis of the Immune Microenvironment of the Adenoid in Children with and without Secretory Otitis Media
Authors: Forsgren Joachim , Rynnel-Dagöö Britta , Christensson Birger
Published: October 2014

Using monoclonal antibodies and immunohistochemistry, we compared adenoid tissue from 35 children with or without secretory otitis media. Numerous cells infiltrating the reticular crypt epithelium expressed HLA-DR, as did <10% of the epithelial cells. Of the antigen-presenting cells, CD1a+ dendritic cells showed intraindividual and interindividual variations; CD68+ macrophages and CD22+ B cells were uniformly distributed. The relative frequencies of CD4+ and CD8+ cells were 6.6 ± 2.0 versus 2.3 ± 1.2 (p < .001) in the reticular crypt epithelium and 18 ± 4.5 versus 1.5 ± 0.9 (p < .001) in the germinal centers. The IL-2 receptor was expressed on <0.1% of CD3+ T cells. Over 90% of intraepithelial CD3+ T cells were of the CD45RO+ memory phenotype. The proliferation marker Ki67 was almost exclusively found in the germinal centers. That the analyzed parameters showed a similar pattern in both clinical groups suggests that the presence of secretory otitis media may not correlate to specific alterations in the immune microenvironment of the adenoid.
Gender-Specific Vocal Dysfunctions in Parkinson's Disease: Electroglottographic and Acoustic Analyses
Authors: Hertrich Ingo , Ackermann Hermann
Published: October 2014

Electroglottographic (EGG) and acoustic recordings were obtained during sustained vowel production in men and women suffering from Parkinson's disease (PD). The computed EGG spectrograms allowed us to differentiate various kinds of phonatory disturbances: intervals with subharmonic energy (“low-frequency segments”), “noise-like regions,” and abrupt shifts of fundamental frequency (F0). Female PD subjects presented with a significantly increased portion of subharmonic segments and with significantly more abrupt F0 shifts as compared to both controls and male PD subjects. Presumably, these alterations in spectral energy distribution reflect different oscillatory modes of the glottal source. Thus, PD seems to have a differential impact on phonation in men and women. Conceivably, these gender-specific vocal dysfunctions are determined by the well-known sexual dimorphism of laryngeal size.
Epidermal Cell Migration and Healing of the Tympanic Membrane: An Immunohistochemical Study of Cell Proliferation Using Bromodeoxyuridine Labeling
Authors: Koba Reiko
Published: October 2014

A monoclonal antibody against bromodeoxyuridine (BrdU) was used to investigate cell proliferation in the tympanic membrane of white rabbits. The BrdU-labeled cells were observed mainly in the epidermis of the annulus, around the malleus handle, and in the anterior and posterior superior quadrants of the normal rabbit tympanic membrane at 2 hours after BrdU injection. At 5 days the localization of the BrdU-labeled cells had changed centrifugally from the malleus handle toward the annulus. This change in the distribution of BrdU-labeled cells suggested that epidermal cell migration is caused by cell proliferation and insertion of newly proliferated epidermal cells at the proliferation center. Immunohistochemical observation of BrdU-labeled cells in the artificially perforated tympanic membrane suggested that the process of healing of the perforation may be as follows. Epidermal cell proliferation in the whole tympanic membrane is accelerated by the perforation stimulus. Then the proliferated epidermal cells migrate to the edge of the perforation. In contrast, proliferation of connective tissue cells and mucosal cells is stimulated only around the perforation, and cooperates with the proliferated epidermal cells to close the perforation.
Effect of HA-1A Monoclonal IGM Antibody on Endotoxin-Induced Proliferation of Cultured Rat Middle Ear Epithelium
Authors: Grote Jan J. , Tjebbes Gerben J. M. , Hesseling Saco C. , Van Blitterswijk Clemens A.
Published: October 2014

The effect of human monoclonal antibody HA-1A (Centoxin) on the effect of endotoxin on cultured rat middle ear epithelium was investigated. The addition of endotoxin to the standard culture medium revealed a concentration-related proliferative effect on cultured rat middle ear epithelium, leading to cobblestone cells, cell tracks, and stratification of epithelium, whereas rat middle ear epithelium cultured in standard medium grew as a monolayer composed of flat polygonal cells. Addition of HA-1A to standard medium supplemented with endotoxin gave rise to a statistically significant suppression of the proliferative effects of endotoxin on these cells. The morphology of rat middle ear epithelium cultured in the presence of HA-1A and endotoxin showed that these cells still had a tendency to form cobblestone-like cells and cell tracks, but to a substantially lower degree. The present results support the hypothesis that HA-1A suppresses the proliferative and morphological effects of endotoxin on rat middle ear epithelium and may play an important role in the pathogenesis of otitis media.
Atypical Myosin Heavy Chain in Rat Laryngeal Muscle
Authors: DelGaudio John M. , Carroll William R. , Sciote James J. , Esclamado Ramon M.
Published: October 2014

The myosin content of rat posterior cricoarytenoid and thyroarytenoid muscles was described by means of histochemical, immunohistochemical, and electrophoretic techniques. Laryngeal muscles were dissected and frozen, together with other muscles (extraocular, diaphragm, extensor digitorum longus, and soleus) for comparative purposes, then sectioned serially and stained: 1) histochemically for myofibrillar adenosine triphosphatase reactivity and 2) immunohistochemically for myosin heavy chain (MHC) content with six different antibodies. Other portions of the muscle samples were electrophoresed by a glycerol sodium dodecyl sulfatepolyacrylamide gel electrophoresis technique that separates the MHC protein into its specific isoforms. In electrophoretic comparison it limb muscles, the laryngeal muscles contained an additional MHC band we designated as type IIL (type II laryngeal) MHC. On histochemical and immunohistochemical staining, no fibers from the thyroarytenoid muscle and few fibers from the posterior cricoarytenoid muscle could be classified according to the standard fiber type categories established for limb muscles (types I, IIA, IIB, and IIX). These laryngeal muscle fibers appear to represent an atypical fiber type.
Endoscopic Vocal Fold Microflap: A Three-Year Experience
Authors: Courey Mark S. , Stone R. Edward , Gardner Glendon M. , Ossoff Robert H.
Published: October 2014

Surgical techniques for the removal of vocal fold (VF) disorders that arise within the lamina propria must permit the preservation and/or restoration of VF vibratory characteristics. The endoscopic VF microflap is designed to do such. A retrospective study was undertaken to evaluate the efficacy of this procedure. Forty microflaps (7 bilateral, 1 revision) were performed on 32 patients. Charts and surgical pathology findings were reviewed. Preoperative and 3-month postoperative video recorded voice samples and stroboscopic examination results were compared. Findings on perceptual voice analysis did not significantly change. Stroboscopic examinations revealed improved postoperative VF closure in 27 of 29 patients with impaired preoperative closure and return of mucosal wave in 18 of 24 VFs operated on for the excision of cysts or polyps. When present preoperatively (6 patients), the mucosal wave was preserved. Most patients (28 of 30) rated themselves as clinically improved. The endoscopic VF microflap is efficacious in the treatment of selected VF disorders. The surgical technique is discussed.
Positron Emission Tomography in the Evaluation of Laryngeal Carcinoma
Authors: Greven Kathryn M. , Watson Nat E. , McGuirt W. Frederick , Keyes John W. , Geisinger Kim R. , Williams Daniel W. , Cappellari James O.
Published: October 2014

Positron emission tomography (PET) is a relatively new radiologic imaging technique based on glucose analog uptake and metabolism in tumor tissue. In this study, PET was used in evaluating 38 patients with laryngeal cancer. Twenty-five patients were examined with PET prior to treatment to study the reliability of PET in identifying the primary tumor and assessing regional nodal status; 13 patients who had previously received irradiation with curative intent and who represented differential diagnostic problems were imaged to differentiate between irradiation effects and recurrent or residual cancer. Findings for both groups were compared to results of clinical evaluation and those of computed tomography (CT) and magnetic resonance imaging (MRI). The PET results were essentially identical to those of CT, MRI, and clinical evaluation in identifying metastatic lesions (82% correct), and were as reliable as CT and MRI for correctly identifying primary tumors (88%). Positron emission tomography was most helpful in differentiating recurrent tumor from postirradiation tissue sequelae. However, its lack of anatomic detail made PET less valuable for primary staging and therapeutic planning. It may enhance the diagnostic accuracy of CT and MRI where anatomic distortions occur or where diagnostic criteria for CT and MRI are ambiguous.
Vocal Cord Palsy: Possible Late Complication of Radiotherapy for Head and Neck Cancer
Authors: Stern Yoram , Marshak Gideon , Segal Karl , Shpitzer Thomas , Feinmesser Raphael
Published: October 2014

Cranial nerve palsies are uncommon complications of radiotherapy for head and neck cancer. A review of the literature reveals that cranial nerve damage after radiotherapy has been reported for the optic, oculomotor, trigeminal, abducens, cochlear, vagus, spinal accessory, and hypoglossal nerves. The hypoglossal nerve appears to be the most commonly affected, and the recurrent laryngeal nerve is seldom involved. The case histories of three patients who developed vocal cord palsy from 21 to 34 years after a course of curative or postoperative radiotherapy for carcinoma of the head and neck are presented. Two patients had bilateral palsy, and in the third patient, bilateral damage cannot be excluded. Physical examination and radiographic investigations on admission and on follow-up did not demonstrate any evidence of tumor recurrence, cervical or distant metastases, or second primary tumors. The distinction between irradiation-induced palsy and that due to malignancies is emphasized.
Sutton's Disease (Periadenitis Mucosa Necrotica Recurrens)
Authors: Laccourreye Ollivier , Durand Hervé , Fadlallah Jean-Pierre , Brasnu Daniel , Pages Jean-Christophe , Lowenstein William
Published: October 2014

Sutton's disease is characterized by giant necrotizing ulcers around minor salivary glands and is of unknown cause. We report a case, review the medical literature, and discuss the treatment of this affliction.
Measurements of the Stapes Superstructure
Authors: Àwengen Daniel F. , Kurokawa Hironobu , Nishihara Shinsei , Goode Richard L.
Published: October 2014

Ten human stapes from fresh temporal bones were measured to obtain relevant distances of the stapes superstructure. The dimensions of the parts of the superstructure are as follows: 1) stapes head 1.14 mm (range, 0.91 to 1.49) in diameter parallel to the axis of the footplate and 0.83 mm (range, 0.65 to 1.08) perpendicular to it; 2) stapes head to shoulders 0.93 mm (range, 0.81 to 1.07), head to foramen 1.26 mm (range, 1.15 to 1.39), and head to lateral surface of stapes footplate 3.19 mm (range, 2.91 to 3.45); 3) neck width parallel to the axis of the footplate 1.18 mm (range, 0.88 to 1.47) and 0.64 mm (range, 0.48 to 0.88) perpendicular to it; 4) anterior cms 0.58 mm wide (range, 0.41 to 0.74) at the shoulder of the arch and 0.51 mm (range, 0.39 to 0.65) closer to the stapes footplate; 5) posterior cms 0.65 mm wide (range, 0.46 to 0.77) at the shoulder of the arch and 0.55 mm (range, 0.38 to 0.75) closer to the stapes footplate; and 6) maximum width of entire superstructure near footplate 2.48 mm (range, 2.06 to 2.98).
“Inflammatory Pseudotumor”: What is it? How Does it Behave?
Authors: Batsakis John G. , Luna Mario A. , El-Naggar Adel K. , Goepfert Helmuth
Published: October 2014

Inflammatory pseudotumor, as a histologic diagnosis and carrying with it the prospect of a benign clinical course, is rather firmly entrenched as a pulmonary lesion. Extrapulmonic forms, however, are farraginous and, as reported, have included lesions having few, or even none, of the histologic features of those in the lungs. For those more closely aligned with the fibroblastic or myofibroblastic phase of the lung lesions, their biologic behavior can belie their histology in that they can be locally aggressive and metastasize as sarcomas. For those tumors in the upper airway, and especially in the abdomen, pathologists should be very circumspect in the use of inflammatory pseudotumor as a diagnosis, and clinicians should not be lulled into denying the extrapulmonic forms their due respect.
Contact Endoscopy during Microlaryngeal Surgery: A New Technique for Endoscopic Examination of the Larynx
Authors: Andrea Mario , Dias Oscar , Santos Alberto
Published: October 2014

By means of a microcolpohysteroscope during microlaryngoscopy, the cells of superficial layers of the vocal cord epithelium, previously stained with methylene blue, were observed in vivo and in situ. Several parameters were evaluated: regularity of the epithelium, dimensions and color of the nucleus, nucleus-cytoplasm ratio, nucleus and cytoplasm contours, and presence of the nucleolus, mitosis, cytoplasmic inclusions, keratosis, and koilocytes, among others. The normal squamous epithelium of the vocal cord has a homogeneous cell arrangement, with a spheroid and isochromic nucleus, and a uniform nucleus-cytoplasm ratio. Specific cellular epithelial patterns in different disorders were observed, namely, chronic laryngitis, keratosis, dysplasia, papilloma, and malignant tumor. The present study on contact endoscopy during microlaryngeal surgery reports our first results with this original technique, performed in 68 patients.
Clinical Measurement of Mucosal Wave Velocity Using Simultaneous Photoglottography and Laryngostroboscopy
Authors: Hanson David G. , D'Agostino Mark , Jiang Jack , Herzon Garrett
Published: October 2014

Simultaneous glottal transillumination or photoglottography (PGG), electroglottography (EGG), and video laryngostroboscopy were used to measure the traveling wave velocity of the vibrating vocal folds during phonation in human subjects. The duration of travel was calibrated from the PGG signal, while the displacement of the upper and lower lips of the vibrating vocal folds was calibrated from parallel laser beams projected onto the vocal folds. The mucosal wave velocity varied with the portion of the glottal cycle. The amplitude of displacement correlated positively with the intensity of phonation and negatively with the fundamental frequency and was decreased for breathy and pressed phonation modes. The velocity of the opening phase segment of the PGG signal directly correlated with the top lip displacement of the vibrating vocal fold, and bottom lip displacement correlated with the closing phase of the PGG signal. Therefore, with suitable calibration, the effects of mucosal lateral displacement may be measured from a PGG signal. Simultaneous measures of PGG, EGG, and stroboscopy provide a three-dimensional representation of glottal vibration that can be numerically analyzed.
Middle Ear Gas Composition and Middle Ear Aeration
Authors: Sadé Jacob , Luntz Michal , Levy Dalia
Published: October 2014

Partial pressures of the gases in the middle ears of 14 guinea pigs were measured continuously on-line with a specially designed mass spectrometer. The average values were carbon dioxide 67.55 mm Hg, oxygen 48.91 mm Hg, and nitrogen 596.54 mm Hg. These values confirm earlier measurements and show that the gas composition of the middle ear differs basically from that of air and resembles that of venous blood. These findings are indicative of bilateral diffusion between the middle ear cavity and the blood. We propose that under physiologic as well as under pathologic (ie, atelectatic) conditions, the gas content of the middle ear is also controlled by diffusion. This mechanism fits well with the fluctuating character of atelectatic ears. Thus, a negative middle ear pressure could be secondary to excessive loss of gases through increased and excessive diffusion, although additional mechanisms are probably also involved. A likely contributing factor is poor pneumatization of the mastoid, with consequent absence of a physiologic pressure regulation mechanism by its pneumatic system.
Effect of Histamine on Nasal Epithelial Permeability to Horseradish Peroxidase in Allergic Guinea Pigs
Authors: Kawaguchi Shinya , Jin Chun Shun , Ukai Kotaro , Sakakura Yasuo
Published: October 2014

The effect of histamine and antigen on the permeability of nasal mucosa to macromolecules in allergic guinea pigs was investigated with a histochemical technique using horseradish peroxidase (HRP). We found that the ratio of intercellular spaces penetrated by HRP to the total number of intercellular spaces of the nasal epithelium in nonallergic groups was increased by histamine challenge dose-dependently. The HRP reaction products in the intercellular spaces in allergic groups were significantly increased by challenge with histamine at 5.4 × 10−4 mol/L and 5.4 × 10−2 mol/L, in contrast to nonallergic groups. We conclude that histamine increases nasal mucosal permeability, and this effect is most likely mediated by a functional change in the epithelial tight junctions.
Gender Differences in Cancer of the Larynx
Authors: Kokoska Mimi S. , Piccirillo Jay F. , Haughey Bruce H.
Published: October 2014

Gender differences in the incidence and mortality rates for cancers of the lung, colon, and larynx have previously been noted. The goal of this project was to identify gender differences in prognostic variables for survival and recurrence for patients with cancer of the larynx. The medical records of 193 patients with cancer of the larynx treated initially between 1973 and 1985 were examined retrospectively. A total of 151 men and 42 women were included. A majority of men developed glottic cancers, whereas a majority of women developed supraglottic cancers. Age was prognostically important for both genders; however, comorbidity, symptom severity, anatomic subsite, and TNM stage all had different impacts on survival and recurrence in men and women. No gender difference in initial treatment was found. This study suggests that when designing and analyzing the results from clinical studies of cancer of the larynx, it is important to employ stratification based on gender.
Recovery of Caloric Function in Experimental Perilymph Fistula
Authors: Young Yi-Ho , Nomura Yasuya
Published: October 2014

Twenty of 46 guinea pigs with experimental perilymph fistula that showed canal paresis on an ice water caloric test during the first week after operation were studied on the following days to observe the progression and final outcome of the caloric test. Two weeks after operation, 12 animals showed persistent canal paresis, whereas 8 animals developed a normal caloric response. Resolution of the caloric response progressed from canal paresis, via caloric irregularity, to a final return of normal caloric response. Morphological study of animals with recovery of caloric function shows healing of the previously ruptured membrane, with preservation of the contour of the membranous labyrinth in the lateral semicircular duct, and intact sensorineural elements. Recovery of caloric function may serve not only as an important diagnostic sign in patients with healed perilymph fistula, even without surgical proof, but also as an expectation for the recovery of hearing loss.
Predicting Recurrence and Survival in Patients with Laryngeal Cancer by Means of DNA Cytometry, Tumor Front Grading, and Proliferation Markers
Authors: Welkoborsky Hans-J. , Dienes Hans-P. , Hinni Michael , Mann Wolf J.
Published: October 2014

The cure rates for squamous cell carcinoma of the larynx have improved little over the past few decades. Despite the large number of therapeutic and histopathologic studies that have been performed, there are currently no morphologic or cytologic markers available to predict outcome in patients with laryngeal cancer. In an attempt to create such a system, tissues from 40 patients who underwent surgery for carcinoma of the larynx were examined for this pilot study. The examinations included routine histology, morphologic grading at the tumor front, immunohistochemical identification of the proliferation markers proliferating cell nuclear antigen (PCNA) and Ki67, and quantitative DNA analysis. By means of the stepwise multivariate Cox regression analysis with forward selection, factors that were highly correlated to the development of recurrent disease and survival were determined. We found that the results of the DNA analysis (ie, 2c deviation index, DNA malignancy grade), along with the morphologic tumor front grading and Ki67 score, were closely related to prognosis (p < .01). All of these factors reflect tumor biology. No correlation was found for the Broders grading or for any other clinical parameter. With the test battery used in this preliminary study, patients at high risk for developing tumor recurrences could be recognized. The advantages of this technique are that it is an objective assessment of the tumor and that it can be performed on preoperative biopsy specimens. This might influence decisions regarding therapeutic management and could eventually lead to more appropriate and individualized therapy.
Duration and Frequency Characteristics of Speech and Voice following Supracricoid Partial Laryngectomy
Authors: Laccourreye Ollivier , Biacabe Bernard , Crevier-Buchmann Lise , Laccourreye Henri , Weinstein Gregory , Brasnu Daniel
Published: October 2014

Selected characteristics were compared in the speech and voice of 28 patients treated with a supracricoid partial laryngectomy (SCPL) and of 14 normal adult laryngeal (NAL) speakers. Tape-recorded speech samples were measured for durational features with a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and a multidimensional voice program. The SCPL speech proved comparable to NAL speech in average fundamental frequency. The SCPL speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise to harmonics ratio, maximum phonation time, speech rate, and phrase grouping. The completion of an arytenoid cartilage resection did not statistically modify the duration and frequency features of SCPL speakers. Among SCPL speakers 1) the average fundamental frequency was statistically higher (p = .02) in patients who underwent a cricohyoidoepiglottopexy when compared to patients who underwent a cricohyoidopexy, 2) the maximum phonation time was statistically related to the patient's age (p = .002), and 3) the jitter and shimmer values were statistically related (p = .01 and p = .005) to the time elapsed since SCPL completion. Explanations and implications of these findings are discussed.
Exercise-Induced Laryngomalacia
Authors: Smith Richard J. H. , Kramer Michael , Bauman Nancy M. , Smits William L. , Bent John P. , Ahrens Richard C.
Published: October 2014

Exercise-induced laryngomalacia (EIL) is characterized by severe dyspnea, stridor, and mild wheezing unresponsive to prophylactic treatment with β-agonists and cromolyn sodium. Symptoms develop with extreme exertion, but resolve quickly as the degree of exercise is decreased. Diagnosis requires flexible fiberoptic laryngoscopy before, during, and after exercise. If the diagnosis of EIL is confirmed by laryngoscopy during maximal exercise, laser epiglottoplasty is effective in alleviating symptoms and improving the airway. However, because symptoms develop only during maximal exertion, EIL is unlikely to produce symptoms or functional disability in persons who lead relatively sedentary lives.
Head Extension Effect in Static Posturography
Authors: Norré Marcel E.
Published: October 2014

The effect of head extension on the standing position has been studied by analysis of recordings made by static posturography type III (SPGIII), a set of six tests of posturography for sensory interaction. The head extension effect in posturography was evaluated by comparing the results of testing with head extension on a stable platform and on foam rubber to testing with a normal head position. In normal subjects head extension increased the postural sway, but there was no more effect on foam rubber than on the stable platform. For patients with peripheral vestibular disorders the head extension effect on the measured postural sway was evaluated by the difference from the normal condition. This difference could be positive, zero, or negative on the stable platform as well as on foam rubber. In both patients and normal subjects, foam rubber had no more effect than the stable platform. The several types of results could be seen in each category of peripheral vestibular disorders. Only minor nuances could be observed: positive differences were more pronounced in benign paroxysmal positional vertigo, whereas negative ones were more obvious in unilateral vestibular deficits. These findings, moreover, deny that head extension in SPGIII should be considered a condition revealing vestibular dysfunction, as has been supposed. As head extension has an influence on the neck proprioceptor as well as on the position of the otoliths, its effect is ambiguous, which makes the interpretation rather difficult. A neck proprioceptive as well as an otolithic explanation appears to have some clinical support.
Cholesteatoma Surgery: The Individualized Technique
Authors: Bhatia Sanjaya , Taibah Abdelkader , Karmarkar Sandeep , Saleh Essam , Russo Alessandra , DeDonato Giuseppe , Sanna Mario
Published: October 2014

A retrospective analysis of 433 cholesteatoma cases, surgically treated at the Gruppo Otologico, Piacenza, Italy, over a 7-year period, is reported. The purpose of this study was to delineate actual indications for individualizing open and closed procedures and to compare their results as regards residual or recurrent disease and hearing. The total incidences of residual and recurrent cholesteatoma in the open cavity procedures were 10% and 2.38%, respectively, while the closed procedures showed higher incidences of residual and recurrent cholesteatoma: 31.22% and 11.16%, respectively. The problem of a persistently discharging cavity was encountered in only 1 case of an open procedure, while 2 patients had persistent otorrhea among the closed cavity cases. The hearing results, although slightly better in the closed procedures, were not significantly different from those in the open procedures.
Microvascular Decompression by the Retrosigmoid Approach for Idiopathic Hemifacial Spasm: Experience with 300 Cases
Authors: Zhang Kai-wen , Shun Zi-ting
Published: October 2014

Three hundred patients with idiopathic hemifacial spasm who underwent microvascular decompression through the retrosigmoid approach are reported. Vascular compression was found in every patient on operation. The results of 1 to 6 years of follow-up show that 276 patients are free of the symptom, 4 patients have markedly diminished spasms and a decreased episode rate, 10 patients have no significant relief from the operation, and 9 have had recurrences of the symptom since the operation. The cure rate in this group is 92%. Complications were sensorineural hearing loss in 13 patients (7 temporary cases, 6 permanent), tinnitus in 7 (4 temporary cases, 3 permanent), temporary postoperative facial weakness in 16, and postoperative meningitis in 10 (9 cases were controlled with antibiotics and 1 patient died).