bluuebunny/crossref_metadata_2025 huggingface dataset:
Transforming Growth Factor β and Wound Healing in Human Cholesteatoma
Authors: Huisman Margriet A. , de Heer Emile , Dijke Peter Ten , Grote Jan J.
Published: February 2009

Objective: Cholesteatoma is a nonmalignant, destructive lesion of the temporal bone that gradually expands and causes complications by the erosion of the adjacent bony structures. The consequences can be as severe as facial paralysis and intracranial complications. Until now, surgery has been the only treatment of choice. The pathogenesis of cholesteatoma remains controversial. Current concepts postulate that cholesteatoma may be a wound‐healing process, although formal proof is lacking as of yet. Several reports provide evidence for the involvement of transforming growth factor (TGF)β in both normal and abnormal wound healing.

Study Design: The expression of TGFβ, the activated form of its intracellular effector, phosphorylated‐Sma‐Mad (pSmad)2, its natural inhibitor, Smad7, and target gene extra domain A‐positive fibronectin (EDA‐FN) were examined.

Methods: Quantitative immunohistochemical analysis was performed using an image analysis system.

Results: In 12 cholesteatoma and control samples, protein expressions showed consistent relationships among TGFβ, nuclear pSmad2, and Smad7. We found concordant expressions of TGFβ and nuclear pSmad2 in cholesteatoma epithelium and its control. Epithelial Smad7 expression was significantly reduced in cholesteatoma when compared with control epithelium (P = .04). In cholesteatoma extracellular matrix (ECM), a significantly increased TGFβ, and nuclear pSmad2 was demonstrated (P < .01). Smad7 expression in the ECM was comparable in cholesteatoma and its control. EDA‐FN deposition in cholesteatoma ECM was excessive, whereas EDA‐FN expression was absent in controls.

Conclusion: Our results confirm reports of in vitro experiments and support the concept that cholesteatoma behaves as a chronic wound healing process.
Feasibility of Flap Reconstruction in Conjunction With Intraoperative Radiation Therapy for Advanced and Recurrent Head and Neck Cancer
Authors: Most Michael D. , Allori Alexander C. , Hu Kenneth , Urken Mark L. , Persky Mark S. , Sessions Roy B. , Nussbaum Moses , Harrison Louis B. , Frank Douglas K. , Smith Mark L.
Published: February 2009

Background: Radiation is a known risk factor for poor wound healing. Patients undergoing intraoperative radiation therapy (IORT) typically receive higher cumulative doses to their wound beds than patients treated with conventional radiation therapy. We review our experience with IORT in patients undergoing resection of head and neck cancer and flap reconstruction. Logistics of delivery and outcomes are discussed.

Methods: A retrospective chart review was performed on all patients at Beth Israel Medical Center who underwent IORT for head and neck cancer between 2000 and 2007. Twenty‐one patients receiving 22 treatments involving flap reconstruction were identified. The results of these reconstructions were evaluated for complications and functional outcome.

Results: All patients had complex surgical wounds of the face, upper aerodigestive tract, or neck who received IORT in conjunction with pedicled or free flap closure. Twenty‐five flaps in 21 patients were performed in the setting of IORT. All patients received between 10 and 15 Gy of IORT administered directly to the wound bed. There were no perioperative mortalities. Wound breakdown occurred in three cases, all of which were treated successfully by operative revision. Functionally, most patients did well and performed similarly to historic controls for their type of reconstruction.

Conclusions: Reconstruction using flaps in the context of IORT can be achieved with expectation of good wound healing in the majority of cases despite heavy cumulative doses of radiation to recipient wound beds.
Preparation Techniques for the Injection of Human Autologous Cartilage: An Ex Vivo Feasibility Study
Authors: Noordzij J Pieter , Cates Justin M. , Cohen Seth M. , Bennett Marc L. , Ries W M. Russell , Russell Paul T. , Haynes David , Garrett C Gaelyn , Ossoff Robert H.
Published: February 2009

Objectives: To determine the optimum donor site and preparation technique for injecting human autologous cartilage as a potentially permanent implant material for vocal fold medialization.

Study Design: Prospective ex vivo experimental model.

Methods: Human nasal septal and auricular cartilage was obtained from eight surgical cases after institutional review board approval. The auricle and nasal septum were chosen as potential donor sites because of ease of accessibility, volume of cartilage potentially available, and minimal subsequent cosmetic deformity after the tissue harvesting procedure. Various preparation techniques readily available in most operating rooms were tested for their efficacy in generating an injectable cartilage slurry. The various cartilage slurries were injected through sequentially smaller needles and examined cytologically.

Results: The best injection properties for both nasal septal and auricular cartilage were obtained by drilling the cartilage down with a 5 mm otologic cutting bur, which allowed free passage through an 18 gauge needle. Cytologic examination of drilled septal cartilage showed good uniformity of cartilage pieces with a mean largest dimension of 0.44 ± 0.33 mm, and 33% of lacunae contained viable‐appearing chondrocytes. Cytologic examination of drilled auricular cartilage was similar, exceptonly 10% of lacunae were occupied by chondrocytes. Other techniques tested (knife, morselizer, and cartilage crusher) did not yield injectable cartilage slurries.

Conclusions: Both nasal septal and auricular cartilage can be prepared for injection via an 18 gauge needle using a cutting otologic bur. Further testing of in vivo viability and long‐term volume retention is needed.
Characterization of Mucosal Biofilms on Human Adenoid Tissues
Authors: Kania Romain E. , Lamers Gerda E. M. , Vonk Marcel J. , Dorpmans Esmee , Struik Joyce , Tran Huy Patrice , Hiemstra Pieter , Bloemberg Guido V. , Grote Jan J.
Published: February 2009

Objectives: To demonstrate the presence of mucosal biofilm in adenoid tissue using double staining for visualization of both the bacterial matrix and the bacterial cells. To identify bacterial species present on the surface of the studied adenoids.

Study Design: Prospective study.

Methods: A total of 39 specimens of adenoidectomy were removed from children with chronic and/or recurrent otitis media. The specimens were prepared for light microscopy using Gram staining, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Double staining was performed with CLSM to visualize both the bacteria and the glycocalyx matrix. Nine adenoids on which bacterial biofilms were visualized with CLSM were used for identification of bacterial species by 16S‐DNA polymerase chain reaction (PCR) amplification and homology analysis.

Results: Of the 39 adenoids investigated, 22 (54%) showed evidence of mucosal biofilms. Gram staining, SEM and CLSM showed the presence of bacterial cells, organized in bacterial microcolonies. CLSM with double staining demonstrated mucosal biofilms by showing the presence of both bacteria and the glycocalyx. The use of 16S‐DNA polymerase chain reaction (PCR) amplification and subsequent sequence analyses identified the presence of Corynebacterium argentoratense, Streptococcus salivarius, Micrococcus luteus, and Staphylococcus aureus.

Conclusions: This study demonstrates that adenoid tissue in children with chronic or/and recurrent otitis media contains mucosal biofilms in 54% of the cases. The existence of living bacteria has been demonstrated. Further studies are required to describe the panel of bacteria that can be harbored in the biofilms present in adenoids and the mechanisms involved in the physiopathology of otitis prone children.
The Effect of Surface Electrical Stimulation on Vocal Fold Position
Authors: Humbert Ianessa A. , Poletto Christopher J. , Saxon Keith G. , Kearney Pamela R. , Ludlow Christy L.
Published: February 2009

Objectives/Hypothesis: Closure of the true and false vocal folds is a normal part of airway protection during swallowing. Individuals with reduced or delayed true vocal fold closure can be at risk for aspiration and may benefit from intervention to ameliorate the problem. Surface electrical stimulation is currently used during therapy for dysphagia, despite limited knowledge of its physiological effects.

Design: Prospective single effects study.

Methods: The immediate physiological effect of surface stimulation on true vocal fold angle was examined at rest in 27 healthy adults using 10 different electrode placements on the submental and neck regions. Fiberoptic nasolaryngoscopic recordings during passive inspiration were used to measure change in true vocal fold angle with stimulation.

Results: Vocal fold angles changed only to a small extent during two electrode placements (P ≤ .05). When two sets of electrodes were placed vertically on the neck, the mean true vocal fold abduction was 2.4 degrees; while horizontal placements of electrodes in the submental region produced a mean adduction of 2.8 degrees (P = .03).

Conclusions: Surface electrical stimulation to the submental and neck regions does not produce immediate true vocal fold adduction adequate for airway protection during swallowing, and one position may produce a slight increase in true vocal fold opening.
Endoscopic Anatomy of the Pterygopalatine Fossa and the Transpterygoid Approach: Development of a Surgical Instruction Model
Authors: Fortes Felipe S. G. , Sennes Luis U. , Carrau Ricardo L. , Brito Rubens , Ribas Guilherme C. , Yasuda Alexandre , Rodrigues Aldo J. , Snyderman Carl H. , Kassam Amin B.
Published: February 2009

Introduction: The pterygopalatine fossa (PPF) is a narrow space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Endonasal approaches using rod lens endoscopes, however, provide better visualization of this area and are associated with less morbidity than external approaches. Our aim was to develop a simple anatomical model using cadaveric specimens injected with intravascular colored silicone to demonstrate the endoscopic anatomy of the PPF. This model could be used for surgical instruction of the transpterygoid approach.

Methods: We dissected six PPF in three cadaveric specimens prepared with intravascular injection of colored material using two different injection techniques. An endoscopic endonasal approach, including a wide nasoantral window and removal of the posterior antrum wall, provided access to the PPF.

Results: We produced our best anatomical model injecting colored silicone via the common carotid artery. We found that, using an endoscopic approach, a retrograde dissection of the sphenopalatine artery helped to identify the internal maxillary artery (IMA) and its branches. Neural structures were identified deeper to the vascular elements. Notable anatomical landmarks for the endoscopic surgeon are the vidian nerve and its canal that leads to the petrous portion of the internal carotid artery (ICA), and the foramen rotundum, and V2 that leads to Meckel's cave in the middle cranial fossa. These two nerves, vidian and V2, are separated by a pyramidal shaped bone and its apex marks the ICA.

Conclusion: Our anatomical model provides the means to learn the endoscopic anatomy of the PPF and may be used for the simulation of surgical techniques. An endoscopic endonasal approach provides adequate exposure to all anatomical structures within the PPF. These structures may be used as landmarks to identify and control deeper neurovascular structures. The significance is that an anatomical model facilitates learning the surgical anatomy and the acquisition of surgical skills. A dissection superficial to the vascular structures preserves the neural elements. These nerves and their bony foramina, such as the vidian nerve and V2, are critical anatomical landmarks to identify and control the ICA at the skull base.
Localization by Postlingually Deafened Adults Fitted With a Single Cochlear Implant
Authors: Grantham D Wesley , Ricketts Todd A. , Ashmead Daniel H. , Labadie Robert F. , Haynes David S.
Published: February 2009

Objective: The main purpose of the study was to assess the ability of adults with unilateral cochlear implants to localize noise and speech signals in the horizontal plane.

Design: Six unilaterally implanted adults, all postlingually deafened and all fitted with MED‐EL COMBI 40+ devices, were tested with a modified source identification task. Subjects were tested individually in an anechoic chamber, which contained an array of 43 numbered loudspeakers extending from –90° to +90° azimuth. On each trial, a 200 millisecond signal (either a noise burst or a speech sample) was presented from one of nine active loudspeakers, and the subject had to identify which source (from the 43 loudspeakers in the array) produced the signal.

Results: The relationship between source azimuth and response azimuth was characterized in terms of the adjusted constant error (Ĉ). Ĉ for three subjects was near chance (50.5°), whereas Ĉ for the remaining three subjects was significantly better than chance (35°–44°). By comparison, Ĉ for a group of normal‐hearing listeners was 5.6°. For two of the three subjects who performed better than chance, monaural cues were determined to be the basis for their localization performance.

Conclusions: Some unilaterally implanted subjects can localize sounds at a better than chance level, apparently because they can learn to make use of subtle monaural cues based on frequency‐dependent head‐shadow effects. However, their performance is significantly poorer than that reported in previous studies of bilaterally implanted subjects, who are able to take advantage of binaural cues.
Compensative Shuttling of Merlin to Phosphorylation on Serine 518 in Vestibular Schwannoma
Authors: Lü Jingrong , Zou Jing , Wu Hao , Cai Lihui
Published: February 2009

Background: Vestibular schwannoma (VS) is a benign tumor with malignant biological consequence because of its special location, and its occurrence is highly related to merlin. Cell culture studies have demonstrated that merlin acts as a molecular linker between the cytoskeleton and specific membrane proteins and is linked to cell cycle control. Therefore, we sought to detect the expression of endogenous merlin and its subcellular distribution using cyclin D1 as a cell cycle marker in VS.

Methods: To confirm endogenous merlin protein expression in abiogenous VS cells, in situ hybridization, immunohistochemistry, and Western blot was performed in tumor tissues surgically resected from patients. Merlin's subcellular distribution linked cell cycle in VS was analyzed and compared with cyclin D1 expression evaluated with confocal microscopy.

Results: We found that merlin appeared in 98% of the VS tissue samples, with a mean cellular positivity of 46.66 ± 5.75%. Merlin is inversely correlated with cyclin D1 in regard to subcellular localization. Merlin locates in the cytoplasm during G0/G1 phase, moves to the nucleus at S phase, and accumulates in the cytoplasm at S phase after phosphorylation on serine 518 (S518).

Conclusion: In line with the pathologic characteristic of VS as a benign tumor, merlin compensates for the malignant effect of S518 phosphorylation by limiting the loss of contact inhibition of growth and controlling proliferation. S518 phosphorylation can trigger re‐entry into the cell cycle, failing to control transcription because of mislocalization and an inability to interact with the cytoskeleton.
Tactile Dysgeusia: A New Clinical Observation of Middle Ear and Skull Base Surgery
Authors: Chen Joseph M. , Bodmer Daniel , Khetani Justin D. , Lin Vincent V. Y.
Published: February 2009

Objective: To describe a new clinical observation of “tactile dysgeusia,” a phenomenon associated with otologic and skull base surgery likely caused by injury to the chorda tympani nerve (CTN) or the nervus intermedius (NI) with subsequent aberrant cross‐innervation with somatosensory fibers in the surgical field.

Study Design: Descriptive case series.

Setting: Tertiary university referral center.

Method: Eight patients described a sensation of touch‐evoked dysgeusia after surgery. Seven patients underwent a variety of middle ear procedures including stapedotomies and mastoidectomies. One patient had a large cerebellopontine angle meningioma excised through a translabyrinthine approach. There were no preoperatively sensory symptoms of any kind.

Results: In five of seven patients who had an otologic procedure, the CTN nerve was transected, whereas in the remaining two, the nerve was preserved but stretched. In the meningioma patient, the facial nerve was preserved without clear identification of the NI; the facial nerve function was normal postoperatively.

All of the otologic patients experienced symptoms of dysgeusia and sensory alteration triggered by touching various parts of the outer ear. One also has a secondary trigger in the V2 dermatome. In the meningioma patient, taste and sensory alteration was induced by stimulating the ipsilateral V2 and V3 dermatome. In all patients, the symptom was located in the lateral aspect of the ipsilateral hemitongue.

Conclusion: Tactile dysgeusia is an unusual complication after otologic and neurotologic procedures. It is likely related to aberrant re‐innervation of the special sensory fibers within the CTN nerve or the NI with somatosensory fibers. Postoperative “tactile dysgeusia” may not be so rare; its true incidence could only be ascertained through a more rigorous postoperative assessment.
Connexin 26 and 30 Genes Mutations in Patients with Chronic Rhinosinusitis
Authors: BuSaba Nicolas Y. , Cunningham Michael J.
Published: February 2009

Objectives: Connexin proteins play an important role in cell‐to‐cell communication. Mutations in the genes that encode for these connexins may potentially lead to dysfunction in mucociliary clearance predisposing to chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). The objective of this study was to assess for the presence of connexin 26 and 30 gene mutations in patients with CRS and RARS.

Study Design: Prospective case series.

Methods: Forty‐six consecutive patients who were diagnosed with CRS or RARS at a single tertiary care facility were included in the study. Patients with known dysfunction in mucociliary clearance were excluded. The following clinical data were collected: age, gender, duration of disease and age at onset, personal history of otitis media and/or sensorineural hearing loss (SNHL), and family history of paranasal sinus disease and SNHL. Buccal swab deoxyribonucleic acid (DNA) specimens were sequenced for connexin 26 and 30 genes.

Results: The study group consisted of 32 females and 14 males, 8 children and 38 adults. Adequate sequencing of connexin 30 gene was possible in all 46 specimens, but in only 19 specimens for connexin 26 gene. Connexin 30 gene mutations were not detected in any of the 46 specimens. Two of the 19 specimens had heterozygous mutations in the connexin 26 gene; there was one V371 mutation and one 35dG mutation. Both patients were adults; the patient with 35dG mutation had SNHL.

Conclusion: Mutations in connexin 26 and 30 genes are rare in patients with CRS or RARS and do not seem to play a contributory role in the pathogensis of these disorders.
Combined VSV Oncolytic Virus and Chemotherapy for Squamous Cell Carcinoma
Authors: Sung Chih‐Kwang , Choi Bryan , Wanna Georges , Genden Eric M. , Woo Savio L. C. , Shin Edward J.
Published: February 2009

Objectives: Vesicular stomatitis virus (VSV) is a negative‐strand ribonucleic acid (RNA) virus that replicates specifically in tumor cells and has oncolytic effects in a variety of malignant tumors. We previously demonstrated recombinant VSV vectors incorporating viral fusion protein (rVSV‐F) and interleukin 12 (rVSV‐IL12) to have significant antitumor effects against squamous cell carcinoma (SCC) in a murine model. Here we evaluate the potential to combine a potent chemotherapeutic agent for SCC (cisplatin) with rVSV‐F and rVSV‐IL12 to improve efficacy.

Study Design: In vitro, three SCC cell lines were tested using rVSV‐F and rVSV‐IL12 with cisplatin, monitoring viral replication and cell survival. In an orthotopic floor of mouth murine SCC model, intratumoral injections of virus combined with systemic cisplatin were tested for tumor control and animal survival.

Results: In vitro, virus and cisplatin combination demonstrated rapid replication and enhanced tumor cell kill. Human keratinocytes were unaffected by virus and cisplatin. In vivo, combined rVSV‐F with cisplatin reduced tumor burden and improved survival (P = .2 for both), while rVSV‐IL12 monotherapy had better tumor control (P = .06) and survival (P = .024) than combination therapy.

Conclusions: Addition of cisplatin did not affect the ability of either virus to replicate in or kill murine SCC cells in vitro. In vivo, combination therapy enhancedrVSV‐F antitumor activity, but diminished rVSV‐IL12 antitumor activity. Combination therapy may provide useful treatment for SCC with the development of more efficient viral vectors in combination with different chemotherapy agents or immunostimulatory agents.
Waist Circumference and Sleep Disordered Breathing
Authors: Davidson Terence M. , Patel Minal R.
Published: February 2009

Objectives/Hypothesis: To explore how the different metrics of obesity, specifically body mass index (BMI), Mallampati, neck circumference, waist circumference, and waist‐hip ratio, correlate with metrics of sleep disordered breathing (SDB), specifically the apnea/hypopnea index (AHI), and which is/are the most likely to predict and correlate with SDB.

Study Design and Methods: Four hundred fourteen patients presenting to the University of California San Diego Head and Neck Surgery Clinic for SDB had a sleep evaluation including a history and physical examination assessing the markers of obesity and a sleep test. Data comparing AHI with BMI, neck circumference, waist circumference, waist‐hip ratio, and Mallampati were analyzed by means, standard deviations, and Pearson's correlations.

Results: The mean AHI for males was 34, and the mean AHI for females was 24. The mean age was 48 for both sexes. The mean waist circumference for males was 104 cm (41 inches) and for females 99 cm (39 inches). In males and females, waist measurement was most strongly correlated with SDB (males: r = 0.366, P = .00; females: r = 0.445, P = .00). The mean neck circumference for males and females was 43 cm (17 inches) and 38 cm (15 inches) (males: r = 0.358, P = .00; females: r = 0.38, P = .00). The mean waist‐hip ratio for males and females was 0.94 and 0.87 (males: r = 0.359, P = .00; females: r = 0.254, P = .03). The mean BMI for males and females was 31 kg/m2 (males: r = 0.325, P = .00; females: r = 0.40, P = .00), and the mean Mallampati for males and females was 2.84 and 2.92 (males: r = 0.176, P = .012; females: r = 0.149, P = .16). A linear regression demonstrated that waist and neck circumference were better correlates of SDB than BMI.

Conclusion: Obesity correlates with SDB severity. Waist circumference is a better measure than BMI or neck circumference to predict SDB. Men and women are anthropometrically different. Even with an AHI of 5 or more, only half of SDB patients in this study were clinically obese. An abnormal waist circumference for men and women is 102 cm (40 inches) or more.
Hoarseness: Is It Really Laryngopharyngeal Reflux?
Authors: Cohen Seth M. , Garrett C Gaelyn
Published: February 2009

Objective/Hypothesis: This study will test the hypothesis that proton pump inhibitor (PPI) use is prevalent among patients referred for hoarseness and will assess the ultimate diagnosis and factors associated with patients' voice outcomes.

Study Design: Retrospective review of patients in a tertiary care voice clinic.

Methods: Patients with a primary diagnosis of hoarseness, who were taking or had taken PPIs in the previous 2 months and referred to a tertiary care voice clinic, were identified. The dosage and length of PPI administration, patient report of gastroesophageal reflux (GER), presence of findings suggesting muscle tension dysphonia (MTD), patient demographics, diagnosis, chronicity of symptoms, interventions, follow‐up, and outcome were determined.

Results: Of 299 patients, 264 met the inclusion criteria. The mean age was 47.2 years, with a range of 18 to 89 years, with 26.7% male and 73.3% female. Among patients referred for voice problems, 148 (56.1%) had previously tried PPIs or were currently on PPI treatment; 44 (29.7%) stopped taking their PPI because of continued hoarseness, and 104 (70.3%) had persistent hoarseness and associated throat complaints despite continued PPI treatment. Among patients who quit taking their PPI because of continued voice complaints, 79.5% did not have traditional GER symptoms of heartburn or regurgitation. The most common treatment after referral was voice therapy, with an overall voice therapy response rate of 62.7%.

Conclusions: PPI use is prevalent among patients referred because of persistent hoarseness. Whether patients have GER or MTD may influence patients' voice outcomes in response to PPI treatment.
Expression of Matrix Metalloproteinase‐9 in High‐Grade Salivary Gland Carcinomas is Associated With Their Metastatic Potential
Authors: de Vicente Juan C. , Lequerica‐Fernández Paloma , López‐Arranz Juan Sebastián , Esteban Isabel , Fresno Manuel Florentino , Astudillo Aurora
Published: February 2009

Objective: The aim of this study was to investigate the role of matrix metalloproteinase (MMP)‐9 protein in high‐grade malignant tumors of salivary gland origin as well as its utility as a prognostic marker.

Methods: Four micrometer sections from 27 malignant salivary neoplasms were immunostained using a specific antibody against MMP‐9. The staining results (proportion of the stained tumor cells and intensity of tumor stainings) were correlated with the clinical data and with patient outcomes.

Results: Immunostaining for MMP‐9 was observed in 17 cases, predominantly localized in the tumor cells and occasionally in the inflammatory stroma cells. MMP‐9 protein expression correlated with N (P = .04), M (P = .02), and TNM stages (P = .03). MMP‐9 expression was prognostic for shortened survival (P = .01). Our results show that the invasiveness and prognosis of high‐grade salivary gland cancers may depend on their MMP‐9 expression profile.
Evolution in the Assessment and Management of Trigeminal Schwannoma
Authors: Guthikonda Bharat , Theodosopoulos Philip V. , van Loveren Harry , Tew John M. , Pensak Myles L.
Published: February 2009

Educational Objective: At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas.

Objectives: 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm.

Study Design: Retrospective review of 23 cases.

Methods: Chart review.

Results: From 1984 to 2006, of 23 patients with trigeminal schwannoma (10 males and 13 females, ages 14–77 years), 15 patients underwent combined transpetrosal extirpation, 5 patients underwent stereotactic radiation, and 3 were followed without intervention. Of the 15 who underwent surgery, total tumor removal was achieved in 9 patients. Cytoreductive surgery was performed in six patients; of these, four received postoperative radiation. One patient who underwent primary radiation therapy required subsequent surgery. There were no deaths in this series. Cranial neuropathies were present in 14 patients pretreatment and observed in 17 patients posttreatment. Major complications included meningitis (1), cerebrospinal fluid leakage (2), major venous occlusion (1), and temporal lobe infarction (1).

Conclusions: Trigeminal schwannomas are uncommon lesions of the skull base that may occur in the middle fossa, posterior fossa, or both. Moreover, caudal extension results in their presentation in the infratemporal fossa. Contemporary diagnostic imaging, coupled with selective use of both surgery and radiation will limit mor‐bidity and allow for the safe and prudent management of this uncommon lesion.
Outcomes of Treatment of Partial Deafness With Cochlear Implantation: A DUET Study
Authors: Lorens Artur , Polak Marek , Piotrowska Anna , Skarzynski Henryk
Published: February 2009

Objectives: To compare speech test performance of adults with partial deafness cochlear implantation (PDCI) with that of adults with cochlear implant (CI). Based on the results, our objective is to determine the efficacy of the two applications of cochlear implantation, the first characterized by a shallow electrode insertion and preservation of low‐frequency natural hearing for partial deafness, and the second characterized by a very deep electrode insertion used in subjects with severe to profound deafness. All the PDCI participants in this study were fitted with a recently upgraded DUET Hearing System from Med‐El Corporation, Innsbruck, Austria.

Study Design: This is a two‐group comparison study. Eleven experienced PDCI adults and 22 postlingually deafened CI adults participated in this study. Subjects were implanted with either COMBI 40+ or PULSAR cochlear implant.

Methods: Subjects were tested with monosyllable and sentence tests in Polish in quiet and under various signal‐to‐noise ratio (SNR) in the conditions of DUET only, CI only, DUET hearing aid (HA) only, and best aided (DUET plus contralateral hearing). CI subjects were tested with their CI.

Results: PDCI subjects performed significantly better than CI subjects did. Speech tests demonstrated the best results in the conditions of best aided and DUET only. The poorest results were obtained in the condition DUET HA only. Results show a greater benefit for the PDCI group of subjects fitted with the DUET, compared to the CI alone group.

Conclusions: The shallow electrode array insertion with preserved low‐frequency hearing is a highly effective method for the treatment of partial deafness. The combination of HA and CI processor, i.e., the DUET, is beneficial in noise and in quiet.
Paradoxical Vocal Fold Motion: A Sensory‐Motor Laryngeal Disorder
Authors: Cukier‐Blaj Sabrina , Bewley Arnaud , Aviv Jonathan E. , Murry Thomas
Published: February 2009

Objectives: The purpose of this study is to determine the laryngeal sensitivity (LS) thresholds and the ratings of laryngopharyngeal reflux symptoms in patients with paradoxical vocal fold motion (PVFM).

Methods: This is a chart review following Institutional Review Board approval of 75 patients from January 2006 to June 2007. The patients were diagnosed with PVFM following case history, transnasal flexible laryngoscopy and spirometric testing. The data analyzed consisted of the reflux symptom index (RSI) and laryngopharyngeal sensitivity (LS). Laryngeal sensitivity and RSI were graded according to mild, moderate, or severe.

Results: There were 12 (16%) patients with normal RSI scores, 37 patients (49.3%) with moderate RSI (RSI 11–22), and 26 patients (34.7%) with severe RSI (RSI >22). The right LS was normal in 11 patients (14.7%), moderately impaired in 16 patients (21.3%), and severely impaired in 48 (64%) patients. The left LS showed normal sensation in 11 patients (14.7%), moderately impaired LS in 13 patients (17.3%), and severe impairment in 51 patients (68%). Only one patient had both normal sensation and normal RSI, and 70.4% of patients had abnormal RSI and sensation thresholds.

Conclusions: Patients diagnosed with PVFM had a high prevalence of symptoms related to LPR and markedly reduced LS. These findings suggest that PVFM may be triggered by reduced peripheral sensation or laryngeal inflammation.
Tracheal Stenosis After Placement of Percutaneous Dilational Tracheotomy
Authors: Christenson Thomas E. , Artz Greg J. , Goldhammer Jordan E. , Spiegel Joseph R. , Boon Maurits S.
Published: February 2009

Objectives: Percutaneous dilational tracheotomy procedures have been used successfully as a bedside alternative to open surgical tracheotomy. At our institution, we have seen patients with tracheal injuries following this procedure. In this paper, we review those cases to demonstrate that tracheal stenosis is a potential long‐term complication of percutaneous dilational tracheotomy.

Study Design: Case series.

Methods: Patients were evaluated with computed tomography and operative endoscopy. Inpatient and outpatient records were reviewed retrospectively.

Results: Nine patients were referred to our practice for management of tracheal stenosis after percutaneous dilational tracheotomy between 2003 and 2006. Presence of anterior tracheal ring compression and destruction or lateral wall collapse was noted in each case. Endoscopy revealed stenosis secondary to anterior tracheal wall injury in all cases. In eight of nine cases, operative intervention was needed to correct the stenotic segment.

Conclusions: It has been demonstrated in the literature that with 20 years of experience, the percutaneous dilational tracheotomy procedure is more affordable, faster to perform, and a generally safe procedure when performed under appropriate conditions. Most case series of percutaneous dilational tracheotomy reveal an equal or lower risk of short‐term complications than open tracheotomy. This series demonstrates that tracheal stenosis is a potential long‐term complication. Longitudinal follow‐up of patients undergoing percutaneous dilational tracheotomy is indicated.
Long‐Term Quality of Life After Total Laryngectomy and Postoperative Radiotherapy Versus Concurrent Chemoradiotherapy for Laryngeal Preservation
Authors: Boscolo–Rizzo Paolo , Maronato Francesca , Marchiori Carlo , Gava Alessandro , Da Mosto Maria Cristina
Published: February 2009

Objective: To compare the quality of life (QoL) of patients who underwent total laryngectomy with voice prosthesis insertion and postoperative radiotherapy (PORT) with those receiving concurrent chemoradiation for laryngeal preservation.

Study Design: Retrospective, cross‐sectional study in a tertiary academic center.

Methods: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaires were used to assess long‐term QoL in 67 patients treated for laryngeal cancer.

Results: The scores of functional scales for physical (P < .000), social (P = .001), and role functioning (P = .043) were more favorable in the chemoradiation group. The global QoL score was higher in the nonsurgical group (P = .016). Surgical patients reported on sleep disturbance (P < .000), dyspnea (P = .001), and pain (P = .003), with a higher scores and greater difficulties with the senses (P < .000), social contact (P = .002) and speech (P = .010). The chemoradiation group reported greater problems with dry mouth (P < .000) and sticky saliva (P = .005).

Conclusion: We found better long‐term QoL scores in patients undergoing concurrent chemoradiation. This appears to be mainly because of better physical functioning, social functioning, and social contact and smaller problems with pain, respiration, speech, the senses, and sleep disturbances.
Temporal Relationship Between Antitumor Necrosis Factor‐α Antibody Therapy and Recrudescence of Head and Neck Squamous Cell Carcinoma
Authors: Engel Samuel H. , Hullar Timothy E. , Adkins Douglas R. , Thorstad Wade L. , Sunwoo John B.
Published: February 2009

Tumor necrosis factor (TNF)‐α inhibitors have been used effectively to treat rheumatoid arthritis and inflammatory bowel disease. Although the role of TNF‐α in tumor development is not well understood, an increased risk of malignancies with anti‐TNF‐α therapy has been suggested. We report an instructive case of a patient, treated for Crohn's disease with infliximab, who presented with a neck abscess diagnosed to be head and neck squamous cell carcinoma. The patient's clinical course illustrates a temporal relationship between reappearance of his cancer after a complete response to therapy and the resumption of infliximab for worsening Crohn's disease.
Tonsil T Cell Immunity to Human Papillomavirus in the Absence of Detectable Virus in Healthy Adults
Authors: Hobbs Christopher G. L. , Groves Eleanor , Davenport Victoria , Bailey Michael , Williams Neil A. , Birchall Martin A. , Heyderman Robert S.
Published: February 2009

Background: Human papillomavirus (HPV) is known to infect the epithelium of the upper aerodigestive tract; however, major questions regarding prevalence and persistence of infection, and their relation to local immune response, remain unanswered.

Objectives: To evaluate the tonsil T cell immune response to HPV and compare this to the frequency of detectable virus at this site.

Study Design: A cross‐sectional study of cancer‐free adults undergoing routine tonsillectomy.

Methods: Mucosal immune responses to recombinant HPV16 L2E6E7 and HPV6 L2E7 antigens were measured by tonsillar T‐lymphocyte proliferation assay in 13 subjects. HPV deoxyribonucleic acid (DNA) was assessed by PCR and reverse line‐blot hybridization in an expanded population of 44 subjects.

Results: Proliferative T‐cell responses to HPV16 and HPV6 were identified in all patients. The presence of a CD45RO+ T cell population responsive to HPV6 L2E7 was confirmed in three of six subjects tested. There were no CD45RO+ responses to HPV16 L2E6E7 and no evidence of current or latent HPV infection of the tonsil.

Conclusions: T cell memory to human papillomavirus can be identified in tonsil tissue from an adult population in the absence of concurrent HPV infection. How novel HPV vaccines might augment this preexisting cell‐mediated immunity is an essential area for investigation.
Tympanic Membrane Collagen Fibers: A Key to High‐Frequency Sound Conduction
Authors: O'Connor Kevin N. , Tam Majestic , Blevins Nikolas H. , Puria Sunil
Published: February 2009

Objective: To investigate the significance of tympanic membrane collagen fiber layers in high frequency sound transmission.

Study Design: Human cadaver temporal bone study.

Methods: Laser Doppler vibrometry was used to measure stapes footplate movement in response to acoustic stimulation. The tympanic membrane was altered by creating a series of slits and applying paper patches to isolate the effects of specifically oriented collagen fibers. Three groups of membrane alterations were evaluated: 1) circumferentially oriented slits involving each quadrant to primarily disrupt radial fibers, made sequentially within superior‐anterior, inferior‐anterior, inferior‐posterior, and superior‐posterior quadrants; 2) the same slits made in the reverse order; and 3) radially oriented slits from the umbo to the annulus to primarily disrupt circumferential fibers. For each group, measurements of the middle‐ear cavity pressure, ear canal pressure, and stapes velocity were made each time the tympanic membrane was altered.

Results: Regardless of the order in which the circumferentially oriented slits were made, there was a consistent decrease in stapes velocity above 4 kHz for the third and fourth cuts compared to the control. The mean decrease in the range of 4 to 12.5 kHz was 11 dB for the third patched slit and 14 dB for the fourth patched slit (P < .01). Radially oriented slits appear to produce smaller effects.

Conclusions: Radial collagen fibers in the tympanic membrane play an important role in the conduction of sound above 4 kHz.
Adenocarcinoma of Ethmoid: A GETTEC Retrospective Multicenter Study of 418 Cases
Authors: Choussy Olivier , Ferron Christophe , Védrine Pierre‐Olivier , Toussaint Bruno , Liétin Béatrice , Marandas Patrick , Babin Emmanuel , De Raucourt Dominique , Reyt Emile , Cosmidis Alain , Makeiff Marc , Dehesdin Danièle , GETTEC Study Group
Published: February 2009

Objective: To determine risk factors and evaluate the treatment of ethmoid adenocarcinoma. Epidemiologic data were recorded and compared with the literature.

Materials and Methods: A multicenter and retrospective study. The medical records of 418 patients who had presented with ethmoid adenocarcinoma at 11 French hospitals from 1976 to 2001 were analyzed to determine the clinical characteristics and treatment of the disease.

Results: The gender ratio was 2.8 men per 1 woman. Toxic exposure was classic for this lesion, exposure to wood and leather for most cases. The mean age was 63 years (range 31–91). Symptoms were nonspecific and based on clinical rhinologic signs. Nasal endoscopy after mucosal retraction was found useful to evaluate the extension of the lesion and to perform biopsies. Computed tomography scan and magnetic resonance imagery must be carried out prior to treatment to define extra nasal extension. The survival rate was significantly influenced by the size of the lesion (T4, N+) and extension to brain or dura. Surgery with postoperative radiotherapy remains the treatment of choice. Total excision must be a major priority, as confirmed in our series.

Conclusion: This retrospective study was, to our knowledge, the largest ever reported in the literature. This series confirmed the risk factor of this lesion as well as the lesion's influence on the survival rate. Surgery is the most important part of the treatment. Local recurrences were responsible for the poor prognosis of this lesion.
Functional Recovery of Rabbit Maxillary Sinus Mucosa in Two Different Experimental Injury Models
Authors: Kim Yong Min , Lee Chul Hee , Won Tae‐Bin , Kim Si Whan , Kim Jeong‐Whun , Rhee Chae‐Seo , Min Yang‐Gi
Published: February 2009

Objective/Hypothesis: Ciliary wave disorder (CWD) is essential for effective mucociliary transport. The purpose of this study was to investigate morphologic and functional restoration in recovered sinus mucosa after 12 weeks of experimentally induced rhinosinusitis and regenerated sinus mucosa after mechanical injury.

Study Design: Prospective study with animal models.

Methods: Ten New Zealand white rabbits weighing between 2.5 and 3 kg were used for this experiment. In the recovered mucosa group (n = 5), the natural ostium of the maxillary sinus was closed with a synthetic sponge and removed 2 weeks later. In the regenerated sinus mucosa group (n = 5), maxillary sinus mucosa was stripped off through the anterior wall. Left sinus mucosae were used as controls. Twelve weeks postoperatively, ciliary beat frequency (CBF) and CWD were measured using an image analysis system. Morphologic changes in cilia were also observed using a scanning electron microscope (SEM).

Results: The average CBFs in control, recovered, and regenerated mucosa were 13.21 ± 3.66 Hz, 13.20 ± 3.53 Hz, and 14.16 ± 3.87 Hz, respectively. The average CWDs in these groups were 8.46 ± 4.4, 21.04 ± 14.73, and 24.43 ± 19.2, respectively. SEM showed that loss of cilia and irregularities of ciliary arrangements were prominent in regenerated sinus mucosa.

Conclusion: Although 12 weeks is enough for morphologic regeneration of the ciliated epithelium after experimental sinusitis in rabbit maxillary sinuses, it does not appear long enough for full functional recovery. Restoration of CBFs does not equate to concurrent CWD restoration.
3 Tesla Delayed Contrast Magnetic Resonance Imaging Evaluation of Ménière's Disease
Authors: Carfrae Matthew J. , Holtzman Adrian , Eames Fred , Parnes Steven M. , Lupinetti Allison
Published: February 2009

Objective: To determine whether 3 Tesla (T) magnetic resonance imaging (MRI) with delayed contrast imaging has sufficient anatomic resolution to image the intracochlear fluid spaces (i.e., the scala tympani, scala media, and scala vestibuli) of the inner ear and identify endolymphatic hydrops in vivo.

Study Design: Four normal subjects underwent 3T MRI scanning after the administration of gadodiamide intravenous (IV) contrast. MRI region of interest signal intensity was used to determine the diffusion of gadodiamide into the perilymphatic fluid spaces over time. Seven subjects with unilateral Ménière's disease underwent 3T MRI 4 hours after administration of gadodiamide IV contrast agent.

Results: All four normal subjects demonstrated perilymphatic enhancement by 4 hours postinjection. Loss of definition of the membranous cochlea was noted in five of the seven subjects with Ménière's disease. Precise definition of the scala media could not be achieved with this imaging protocol.

Conclusion: Delayed contrast imaging of the inner ear with 3T MRI revealed in vivo changes of the membranous labyrinth consistent with unilateral Ménière's disease.
Quantification of Myosin Heavy Chain RNA in Human Laryngeal Muscles: Differential Expression in the Vertical and Horizontal Posterior Cricoarytenoid and Thyroarytenoid
Authors: Horton Michael J. , Rosen Clark , Close John M. , Sciote James J.
Published: February 2009

Background: Human laryngeal muscles are composed of fibers that express type I, IIA, and IIX myosin heavy chains (MyHC), but the presence and quantity of atypical myosins such as perinatal, extraocular, IIB, and α (cardiac) remain in question. These characteristics have been determined by biochemical or immunohistologic tissue sampling but with no complementary evidence of gene expression at the molecular level. The distribution of myosin, the main motor protein, in relation to structure‐function relationships in this specialized muscle group will be important for understanding laryngeal function in both health and disease.

Objectives: We determined the quantity of MyHC genes expressed in human posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscle using real‐time quantitative reverse‐transcriptase polymerase chain reaction in a large number of samples taken from laryngectomy subjects. The PCA muscle was divided into vertical (V) and horizontal (H) portions for analysis.

Results and Conclusions: No extraocular or IIB myosin gene message is present in PCA or TA, but IIB is expressed in human extraocular muscle. Low but detectable amounts of perinatal and α gene message are present in both of the intrinsic laryngeal muscles. In H‐ and V‐PCA, MyHC gene amounts were β greater than IIA greater than IIX, but amounts of fast myosin RNA were greater in V‐PCA. In TA, the order was β greater than IIX greater than IIA. The profiles of RNA determined here indicate that, in humans, neither PCA nor TA intrinsic laryngeal muscles express unique very fast‐contracting MyHCs but instead may rely on differential synthesis and use of β, IIA, and IIX isoforms to perform their specialized contractile functions.
Helicobacter pylori Colonization in the Larynges of Patients With Hoarseness
Authors: Fang Tuan‐Jen , Lee Li‐Ang , Li Hsueh‐Yu , Yang Chun , Huang Chung‐Guei
Published: February 2009

Objectives: Vocal nodules and polyps are two common noninfectious causes of hoarseness. Patients with persistent hoarseness often require microscopic laryngeal surgery to excise mass lesions of the larynx despite extensive voice resting and modification of voice use behavior. Helicobacter pylori has recently been reported to present in the upper aerodigestive tract. This study applies the rapid urease test to determine the colonization of Helicobacter pylori in surgical specimens of patients with vocal nodules and polyps.

Methods: In this prospective study, 53 consecutive patients with vocal nodules (n = 20) or vocal polyps (n = 33) were investigated from November 2004 to July 2005. Microscopic laryngeal surgery was performed in all cases. Tissue specimens harvested from the larynx were analyzed using the rapid urease test.

Results: The study population consisted of 33 females and 20 males with a mean age of 43.1 ± 9.9 years. Thirteen (24.5%) of the 53 patients revealed Helicobacter pylori colonization, and all were histopathologically diagnosed with vocal polyps. The difference in incidence of Helicobacter pylori colonization between vocal nodules and vocal polyps was statistically significant (0% [0/20] vs. 39.4% [13/33], P = .001).

Conclusions:
Helicobacter pylori often colonizes in the larynxes of patients with vocal polyps. These results indicate the involvement of Helicobacter pylori in vocal polyps. However, the presence of Helicobacter pylori as an etiologic factor in vocal polyps remains inconclusive.