bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Neutrophil Elastase in Endotoxin-Induced Mucus Hypersecretion in Rat Nasal Epithelium
Authors: Shimizu Takeshi , Takahashi Yukimitsu , Majima Yuichi , Takeuchi Kazuhiko , Sakakura Yasuo
Published: October 2014

In the present study, hypertrophic and metaplastic changes of goblet cells were induced in rat nasal epithelium by intranasal instillation of endotoxin or elastase. A significant increase in the amount of intraepithelial mucosubstance was observed after 24 hours during 3 days of instillation. The elastase-induced mucus production was not inhibited in neutrophil-depleted rats, but the endotoxin-induced change was significantly inhibited. Intranasal instillation of the neutrophil elastase inhibitor ONO-5046 partially inhibited the endotoxin-induced mucus production. Epithelial mucus secretion was evaluated by the temporary decrease in the amount of intraepithelial mucosubstance. The endotoxin-induced mucus secretion peaked 3 to 6 hours after intranasal instillation, coinciding with the peak of the intraepithelial neutrophil infiltration. The elastase-induced mucus secretion peaked 1 to 3 hours after intranasal instillation; intraepithelial neutrophil infiltration was not induced by elastase. These results indicate that neutrophil elastase is an important mediator of the intraepithelial mucus synthesis and secretion induced by endotoxin.
Laryngeal Histologic Findings in Infants with Palatal Defects with or without Craniofacial Malformations
Authors: Zarzur Ana Paula , Hughes C. Anthony , Holinger Lauren D. , DiVenere Scott W. , Gonzalez-Crussi Frank
Published: October 2014

The objective of this study was to determine whether specimens from infants with palatal defects (PDs) with or without craniofacial malformations (CFMs) exhibit aberrant laryngeal histologic findings compared with specimens from normal infants. Ten laryngeal specimens from infants with PDs with or without CFMs were histologically compared with 7 laryngeal specimens defined as normal from the same collection. Both groups were similar in terms of demographics and airway manipulation. All infants were prelingual. Comparisons were made at 3 levels: supraglottic, glottic, and subglottic. Histologically, no significant differences in primary laryngeal structures were found between the PD with or without CFM group and the group defined as normal. Acquired and intubation-type injuries, such as inflammation, ulceration, capillary congestion, and scar tissue, were more prevalent and severe in the study group. The primary laryngeal histologic findings of specimens from individuals with PDs with or without CFMs do not differ substantially from those from normal individuals; however, individuals with PDs do appear to be somewhat more susceptible to intubation injury and other acquired laryngeal injury. Meticulous airway management is essential.
Clinical Experience with Beta-Trace Protein as a Marker for Cerebrospinal Fluid
Authors: Bachmann Gregor , Michel Olaf
Published: October 2014

β-Trace protein is an immunological marker for the detection of cerebrospinal fluid traces. The aim of the study was to evaluate the predictive value of the β-trace protein test. We investigated 145 specimens for cerebrospinal fluid using β-trace protein. All case notes were retrospectively reviewed and tabulated for indication and procedure with focus on outcome. The specimens were analyzed by Immunoelectrophoresis. β-Trace protein was detected in 62 specimens and was absent in 83. In correlation with the clinical course, the clinical findings, the results of high-resolution computed tomography of the paranasal sinuses or petrous bone, computed tomographic cisternography, magnetic resonance imaging, indium 111–pentetic acid radionuclide cisternography, intraoperative findings, and visualization using sodium-fluorescein, there were no false-positive results. In 6 cases, a false-negative result occurred. The overall accuracy was 95.68%. The β-trace test has a specificity of near 100% and a sensitivity of 91.17%. Analysis of β-trace protein is a valuable test and has some advantages in comparison with the β2-transferrin assay.
Unique Case of Pulsatile Tinnitus
Authors: Harris Jeffrey P. , Horlbeck Drew M. , Brew Kristen Hepler
Published: October 2014

Tinnitus is a common symptom encountered by otolaryngologists. Pulsatile tinnitus is rare and can present a diagnostic challenge. Establishing a diagnosis is important, because pulsatile tinnitus may indicate serious intracranial or extracranial disease. A unique case of pulsatile tinnitus caused by cervical artery dissection is presented, along with the differential diagnosis and treatment.
Total Inferior Turbinectomy: Operative Results and Technique
Authors: Talmon Yoav , Samet Alvin , Gilbey Peter
Published: October 2014

The internal nasal structures, including the turbinates, regulate the nasal airflow. The surgical treatment of turbinate hypertrophy remains controversial. A wide variety of surgical procedures is performed, with universally unsatisfactory results. Interference with nasal physiology and possible postoperative complications have been the main reasons for the objection to total inferior turbinectomy. Over a 6-year period, 357 total inferior bilateral turbinectomies were performed at our institution. We present the results of these procedures and describe our surgical technique. We conclude that even in a hot and dusty climate, total inferior turbinectomy is an effective and relatively safe procedure.
Cartilage Generation Using Alginate-Encapsulated Autogenous Chondrocytes in Rabbits
Authors: Park Dong-Joon , Park Sang-Yoo , Bong Jeong-Pyo , Hong Ki-Soo
Published: October 2014

In this study, we investigated the possible use of calcium alginate as a matrix for cartilage generation with autogenous chondrocytes, and examined whether the generated cartilage could keep its original volume over time when used as an implant for filling and contour restoration in the host body. Biodegradable, biocompatible, and injectable calcium alginate impregnated with isolated autogenous chondrocytes from the auricle was injected into the gluteus muscle of 12 New Zealand White rabbits. The volume of injected calcium alginate was always 3 mL, and the density of chondrocytes was 10×106 cells per milliliter. At 4 weeks (short-term period, n=6) and 20 weeks (long-term period, n=6) after injection, the histologic findings and the volume of the generated cartilaginous nodules were analyzed. At the time of harvest, 10 of the 12 specimens revealed findings characteristic of natural cartilage. However, histologic examination demonstrated scanty vascular and fibrous tissue ingrowth. Many osteoid matrices, including marrow-like cells, were noted in the vicinity of the neocartilage. The approximate original volume of the injected material was maintained over 20 weeks. These results suggest that although complete cartilage replacement was not always achieved, calcium alginate-autogenous chondrocytes may represent an injectable implant that can generate new autogenous fibro-osteo-cartilaginous tissue for volume augmentation.
Effect of in Vitro Irradiation of Donor Larynges on Cyclosporine Requirements and Rejection Rates in Rat Laryngeal Transplantation
Authors: Barthel Steven W. , Myles Jonathan , Dan Olivia , Strome Marshall
Published: October 2014

Total lymphoid irradiation is an acknowledged adjunctive immunosuppressant in whole organ transplantation in humans and animals. Local irradiation administered for a similar purpose is at best controversial. We evaluated in vitro donor larynx irradiation immediately preceding laryngeal transplantation as an immunomodulator. Each donor larynx was pretreated with 7.34 Gy of radiation in vitro. After transplantation, cyclosporine was administered in doses of 5 mg/kg per day, 2.5 mg/kg per day, and 1 mg/kg per day for trial lengths of 15 days and 30 days. Each of these 6 groups consisted of 10 rats per group. Earlier data have shown cyclosporine dosed at 5 mg/kg per day, without irradiation, administered for 1 month to have varied efficacy. Established histologic criteria were used to determine rejection patterns. All recipient rats survived the 15-day and 30-day trials. In all 10 rats receiving 5 mg/kg per day of cyclosporine for 15 days, the harvested transplanted larynges were viable without evidence of meaningful rejection (mild rejection). In 9 of the 10 rats receiving 5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). In 9 of the 10 rats receiving 2.5 mg/kg per day of cyclosporine for 15 days, the transplanted larynges displayed no meaningful rejection (mild rejection). One rat receiving 2.5 mg/kg per day of cyclosporine for 15 days had a transplanted larynx that displayed moderate rejection. In all 10 rats receiving 2.5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). At 15 days, 5 rats treated with 1 mg/kg per day of cyclosporine displayed mild rejection, 2 displayed moderate rejection, 2 displayed advanced to moderate rejection, and 1 displayed severe rejection. At 30 days, 4 rats treated with 1 mg/kg per day of cyclosporine displayed moderate rejection, 2 displayed advanced to moderate rejection, and 4 displayed severe rejection. We conclude that pretransplantation in vitro irradiation of donor larynges has immunomodulatory effects, allowing reduced cyclosporine immunosuppression with less rejection.
Effect of Mitomycin-C on Vocal Fold Healing in a Canine Model
Authors: Garrett C. Gaelyn , Soto Joseph , Billante Cheryl R. , Riddick John , Reinisch Lou
Published: October 2014

For evaluation of the effect of topical mitomycin-C on vocal fold healing and return of function after surgical excision of mucosa, 6 dogs underwent suspension microlaryngoscopy with bilateral microflap excision of vocal fold mucosa. Topical mitomycin-C, a chemotherapeutic agent and a fibroblast inhibitor, was applied randomly to one side, with the contralateral side serving as the control. Laryngeal videostroboscopy (LVS) was performed on each animal before the operation, at 2 weeks, and before sacrifice at 4 weeks. Both functional analysis with LVS and histologic analysis were performed in a blinded fashion to determine the effect of mitomycin-C on healing. Histologic analysis was augmented with computer morphometries. The LVS revealed diminished mucosal wave vibration in the vocal folds treated with mitomycin-C, as well as a more atrophic appearance to the vibratory surface. The vocal folds treated with mitomycin-C showed fewer fibroblasts and less collagen within the superficial layer of the lamina propria than the control vocal folds (p < .05, Student's f-test, paired analysis). Inflammatory infiltrate was not significantly different between the two sides. Consistent with the known suppression of fibroblast proliferation by mitomycin-C, the treated vocal folds showed less connective tissue response to the surgical injury. In contrast to the reported positive effects of mitomycin-C on tracheal and glottic stenosis, the observed decrease in the healing response in the present study had negative consequences on the vocal fold vibratory pattern.
Intraoperative Assessment of Stapes Movement
Authors: Huber Alexander , Linder Thomas , Dillier Norbert , Ferrazzini Mattia , Stoeckli Sandro , Schmid Stephan , Fisch Ugo
Published: October 2014

A method is described that allows, for the first time, intraoperative vibration modes assessment of the acoustically stimulated stapes by means of scanning laser Doppler interferometry (LDI). The study was designed to answer the following questions: 1) Is LDI practical for taking measurements during surgery? 2) Are the results comparable to the findings in temporal bone preparations? and 3) Do the vibration characteristics of the stapes change after the posterior incudal ligament is detached from the incus? Seven patients with profound bilateral hearing loss who were undergoing cochlear implantation were included in the study. The measurement system was easily applicable for intraoperative measurements and allowed contact-free analysis with very high accuracy. No major differences in the results from the live human subjects and temporal bone preparations were observed. The stapes movement was predominantly pistonlike at the lower frequencies and became complex at higher frequencies. Sacrificing the posterior incudal ligament had no statistically significant effect on stapes vibration.
Globosal Basal Cells are Identified as Proliferating Cells in Mouse Olfactory Epithelium
Authors: Ohta Yasushi , Ichimura Keiichi
Published: October 2014

Although anti-bromodeoxyuridine (BrdU) antibodies are used for detecting proliferating cells, they may stain proliferating cells in phases following the S-phase, except for G1. Anti-Ki67 antibodies are widely used for detecting proliferating cells in all phases of the cell cycle (G1-, S-, G2-, and m-phase), but not in resting cells (GO-phase). Anti—cyclin D1 antibodies are used to detect proliferating cells in the G1-phase. The present study investigated the olfactory epithelium of mice by double immunostaining using antibodies to BrdU, Ki67, cyclin D1, and cytokeratin 14 (CK14). The cells positive to the anti-BrdU antibody, the anti-Ki67 antibody, and the anti—cyclin D1 antibody differed from the cells positive to the anti-CK14 antibody. Thus, we confirmed that the proliferating cells in all the phases of the cell cycle, including the G1 -phase, were globosal basal cells, which were the precursors of the olfactory cells.
Effects of Transglottal Pressure on Fundamental Frequency of Phonation: Study with a Rubber Model
Authors: Kataoka Hideyuki , Kitajima Kazutomo , Owaki Shigehiro
Published: October 2014

The fundamental frequency of phonation (F0) change per unit change in transglottal pressure (dF/dP) was studied at different extension lengths and masses of the vibrating part of a rubber model. The dF/dP was decreased when the vibrating part was extended, and also when the mass of the vibrating part was increased. In the former, the F0 was increased, and in the latter, the F0 was decreased. In humans, we have noticed that when the F0 was increased, the dF/dP first decreased and then increased, taking a V-shaped curve as a function of the F0. The present study reveals the mechanism underlying the V-shaped curve observed in humans.
Nitric Oxide Mediates Platelet Activating Factor-Induced Microvascular Leakage in Rat Airways
Authors: Jeon Sea-Yuong , Kim Jin-Pyeong , Kim Eun-Ah , Jung Tae-Gee , Ma Yong-Woon , Hwang Eui-Gee
Published: October 2014

Platelet activating factor (PAF), a highly potent chemical mediator in inflammation and allergic reactions, induces microvascular leakage in several tissues. In rat airways, PAF-induced microvascular leakage is probably mediated by an endothelial cell receptor in the microvessels. Nitric oxide (NO), first identified as endothelium-derived relaxing factor, has been suggested to be a mediator of airway microvascular leakage. However, the role of NO in PAF-induced microvascular leakage in the airways has not yet been established. The aim of this study was to investigate the role of NO in PAF-induced microvascular leakage in rat nasal mucosa and trachea. We injected PAF (1 μg/kg) intravenously, and the amount of PAF-induced microvascular leakage was measured with extravasation of Evans blue dye (30 mg/kg, injected intravenously 5 minutes before the injection of PAF) by means of spectrophotometry and fluorescence microscopy. Five Sprague-Dawley rats were pretreated with NG-nitro-L-arginine methyl ester (l-NAME; 10 mg/kg, intravenously injected 1 hour before the injection of PAF) to inhibit NO synthase, and control rats (n = 4) were pretreated with normal saline solution. The average amount of extravasated Evans blue dye was significantly lower in the l-NAME–pretreated rats than in the control rats ( t-test, p<.01). Tissue sections of the l-NAME-pretreated rats clearly showed a decreased extravasation of Evans blue dye on fluorescence microscopy. In conclusion, pretreatment with l-NAME clearly inhibited PAF-induced microvascular leakage in the nasal mucosa and trachea of rats. This finding implies that PAF may activate the constitutive endothelial NO synthase in the microvessels, and that activated endogenous NO may mediate PAF-induced microvascular leakage in rat airways.
Volumetric and Dimensional Analysis of the Guinea Pig Inner Ear
Authors: Shinomori Yusuke , Jones Diane d. , Spack Debra S. , Kimura Robert S.
Published: October 2014

The objective of this study was to provide accurate volumetric data on the fluid spaces and soft tissue in the guinea pig inner ear by measuring all histologic serial sections by means of Metamorph Imaging Software at 400× to 1,000× magnification. The total endolymph volume of the inner ear was 4.691 mm3, of which 1.501 mm3 was in the cochlea, 3.090 mm3 in the vestibular labyrinth, and 0.100 mm3 in the endolymphatic duct and sac. The total perilymph volume was 15.938 mm3, of which 8.867 mm3 was in the cochlea and 7.071 mm3 in the vestibular labyrinth. The volume of the organ of Corti per millimeter length increased toward the apex, but the volumes of the stria vascularis, spiral ligament, and spiral limbus decreased. The volume of the macula utriculi was larger than that of the macula sacculi. The measurement of the luminal surface area of the stria vascularis was 3.944 mm2, and that of the vestibular dark cells was 5.772 mm2.
Hearing Improvement after Therapy for Hyperlipidemia in Patients with Chronic-Phase Sudden Deafness
Authors: Kojima Yoshimasa , Ito Shigehiko , Furuya Nobuhiko
Published: October 2014

Hearing in patients with chronic-phase sudden deafness and associated hyperlipidemia tends to improve with therapy for hyperlipidemia. We studied 12 patients with unilateral sudden deafness and hyperlipidemia in whom more than 1 month had elapsed since the onset of the hearing disturbance. The disturbance was considered to be irreversible without therapy. The 4 men and 8 women ranged in age from 32 to 73 years, with a mean age of 54.3 years. The hearing disturbance was evaluated by measuring the air conduction thresholds at 125 to 8,000 Hz with pure tone audiometry. Hyperlipidemia was diagnosed when the total blood cholesterol level was 230 mg/dL or greater. The therapy for hyperlipidemia consisted of diet therapy and the administration of antilipemic agents. The hearing level was measured both before therapy and when the total blood cholesterol level had decreased to less than 230 mg/dL. After therapy, the mean hearing level had improved significantly (Wilcoxon's test, p <.05) at each of 125, 250, 500, and 2,000 Hz, but the changes in the level were not significant at 1,000, 4,000, or 8,000 Hz. Our results suggest that with therapy for hyperlipidemia, hearing tends to improve in patients with chronic-phase sudden deafness and associated hyperlipidemia, even when more than 1 month has elapsed since the onset of the presumably otherwise-irreversible hearing disturbance.
Effects of Exposing the Opened Endolymphatic Sac to Large Doses of Steroids to Treat Intractable Meniere's Disease
Authors: Kitahara Tadashi , Takeda Noriaki , Mishiro Yasuo , Saika Takanori , Fukushima Munehisa , Okumura Shin-Ichi , Kubo Takeshi
Published: October 2014

To enhance the effect of treatment for intractable Meniere's disease, we exposed the opened endolymphatic sac to high concentrations of steroids. This technique — endolymphatic sac drainage and steroid instillation surgery — involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into a sac lumen opened and expanded with a bundle of absorbable gelatin film. These sponges are also placed around the sac and coated with biochemical adhesive so that the medicine is slowly delivered into the sac over a prolonged period of time by means of a natural sustained-release vehicle. The short-term results (6 to 14 months) in 12 patients with Meniere's disease, including those in stage IV, treated by the above techniques showed that definitive spells were completely controlled in all cases. Hearing was improved, and annoyance due to tinnitus was decreased in all cases except one.
Changes in Permeability of Strial Vessels following Vibration Given to Auditory Ossicle by Drill
Authors: Seki Morihiro , Miyasaka Hiroe , Edamatsu Hideo , Watanabe Kensuke
Published: October 2014

We produced drill-induced damage of the auditory ossicles of guinea pigs to study changes over time in the permeability of the blood vessels of the stria vascularis to horseradish peroxidase (HRP). In group A, the stimulus was applied for 10 seconds after intravenous injection of HRP In group B, it was applied for 30 seconds, and in group C, for 60 seconds. The cochlea was fixed with 2% glutaraldehyde perfused through the round window, and the guinea pigs were then decapitated. The stria vascularis of the basal and third turns was examined. The leakage of HRP from the blood vessels of the stria vascularis significantly increased in relation to the duration of the stimulus in both the basal and third turns. The damage to intermediate cells also tended to be in relation to the duration of the stimulus. Extravascular permeation of HRP took place through the tubules in the endothelial cytoplasm. The vibratory stimulation presumably opened channels that are not normally open.
Long-Term Study of Endonasal Duraplasty and Review of the Literature
Authors: Schick Bernhard , Ibing Rainer , Brors Dominik , Draf Wolfgang
Published: October 2014

Many different techniques have been proposed to repair frontobasal dura mater lesions. Because of its low mocthe anterior skull base. This article presents a retrospective evaluation of 136 endonasal duraplasties (126 patients) performed between July 1980 and May 1998 at a tertiary care facility. Follow-up consisted of clinical examinations including nasal endoscopy, objective measures, and telephone interviews. The following measures were used to evaluate the results of these duraplasties: postoperative nasal fluorescein endoscopy in 71 cases, computed tomographic cisternography in 2, nasal fluorescein endoscopy with computed tomographic cisternography in 19, magnetic resonance imaging in 6, and nasal fluorescein endoscopy with magnetic resonance imaging in 1. Tight closure was accomplished in 129 dural lesions (94.9%) on the first attempt. In 3 cases, recurrence of cerebrospinal fluid leakage was treated successfully by I endonasal revision, and in I case, a tight duraplasty was achieved after 2 endonasal revisions. Its high success rate, low rate of morbidity, and good long-term results recommend endonasal duraplasty as a primary treatment modality for frontobasal dural lesions. For extended frontobasal dural lesions, for which intracranial dural repair is the preferred approach, the endonasal approach should be used to close additional dural leaks of the sphenoid sinus.
Loss of Secondary Esophageal Peristalsis is Not a Contributory Pathogenetic Factor in Posterior Laryngitis
Authors: Ulualp Seckin O. , Toohill Robert J. , Gu Chengming , Shaker Reza
Published: October 2014

Secondary esophageal peristalsis helps prevent the entry of gastric acid into the pharynx by clearing the refluxed gastric contents back into the stomach. Because the loss of this mechanism may contribute to the pathogenesis of reflux-induced laryngeal disorders, our aim was to study the frequency of stimulation and parameters of secondary esophageal peristalsis in patients with posterior laryngitis (PL). We studied 14 patients (45 ± 5 years) with PL documented by videolaryngoscopy and 11 healthy controls (46 ± 6 years). The upper esophageal sphincter (UES) pressure was monitored by a sleeve assembly incorporating an injection port 5 cm distal to the sleeve. The esophageal body and lower esophageal sphincter (LES) pressures were measured by an LES sleeve assembly. Primary esophageal peristalsis was induced by 5-mL water swallows. Secondary esophageal peristalsis was induced by abrupt injection of volumes of air, incrementally increased by 5 mL, into the esophagus. Secondary esophageal peristalsis could not be elicited by injection of any volume (up to 60 mL) in 3 PL patients and 2 controls. These 5 subjects had normal primary peristalsis. The threshold volume of air required to stimulate secondary esophageal peristalsis in PL patients (median, 15 mL) was similar to that of controls (median, 10 mL). The parameters of the secondary esophageal peristaltic pressure wave were similar in both groups, and in both groups, they were similar to those of primary peristalsis. The UES response to the injection of the threshold volume that induced secondary esophageal peristalsis in PL patients was contraction in 58% of the trials, partial relaxation in 3%, and no response in 39%. The findings were similar to those in the controls. The LES response to injection of the threshold volume was complete relaxation in both the PL patients and the controls. We conclude that the integrity of secondary esophageal peristalsis is preserved in PL patients.
Retropharyngeal Autologous Fat Transplantation for Congenital Short Palate: A Nasometric Assessment of Functional Results
Authors: Dejonckere Philippe H. , van Wijngaarden Hans A.
Published: October 2014

Seventeen patients (4 to 24 years old; mean, 9.7 years) with mild velopharyngeal insufficiency were treated in our department during the period 1996 to 1999 with augmentation of the posterior pharyngeal wall with autologous fat. The main disorder was a congenital short palate without a cleft, in most cases revealed by adenoidectomy. Four patients had previously undergone pharyngoplasty, and I had already been injected in the posterior pharyngeal wall with Teflon paste. All patients had been exhaustively treated with speech therapy, and the result remained unsatisfactory. The functional outcome of the surgical procedure was quantified by acoustic nasometry. The decrease of the nasalance percentage for a standardized spoken passage was significant I to 3 months after the fat transplantation, and there was a slight tendency to further reduction of nasality at the late follow-up visit, more than 6 months (average, 9.4 months) after the intervention. The mean value of the nasalance score for the “normal passage” (running speech) then reached the limit of normal values. A long-term follow-up (average, 24.3 months) by telephone questionnaire confirmed the persistence of the beneficial results. Autologous fat seems an excellent alternative for Teflon in this indication. Acoustic nasometry allows a precise quantitative assessment of functional velopharyngeal surgery.
Quantitative Assessment of the Pharyngeal Airway by Dynamic Magnetic Resonance Imaging in Obstructive Sleep Apnea Syndrome
Authors: Ogura Masaki , Higano Shuichi , Hida Wataru , Ikeda Katsuhisa , Oshima Takeshi , Takahashi Shoki , Matsuoka Hiroo , Suzuki Hideaki , Kurosawa Hajime , Takasaka Tomonori
Published: October 2014

Dynamic changes in the pharyngea airway of patients with obstructive sleep apnea syndrome (OSAS) were evaluated by quantitating the findings of real-time imaging performed during wakefulness and spontaneous sleep by means of dynamic magnetic resonance imaging (MRI). Six patients with OSAS and 3 non-OSAS subjects, selected prospectively and randomly, underwent polysomnography and dynamic MRI. The cross-sectional areas of the soft palate and oropharynx and the anterior-posterior airway dimensions seen during wakefulness and spontaneous sleep were calculated by US National Institutes of Health imaging software. On the basis of a case control study, comparisons were made with age-matched and body mass index—matched obese non-OSAS snorers. Spontaneous sleep caused significant obstruction and narrowing of various sites of the pharyngeal airway in the OSAS patients, but not in the non-OSAS subjects. During wakefulness, the non-OSAS subjects showed no marked narrowing of the pharyngeal airways, whereas a transient but significant narrowing was observed in the OSAS patients. The mean values of both the cross-sectional area and the anterior-posterior diameter at the soft palate were significantly reduced by spontaneous sleep in the OSAS patients. Dynamic MRI in awake OSAS patients shows promise as a routine diagnostic tool for localizing the upper airway collapse for appropriate selection of surgical therapy.
Bifid Epiglottis Associated with Joubert's Synd
Authors: Sung Myung-Whun , Kim Jeong-Whun , Kim Kwang Hyun
Published: October 2014

This report presents the case of a 2-year-old boy who had a bifid epiglottis associated with Joubert's syndrome. He had episodic tachypnea and apnea, inspiratory stridor, aspiration, and growth and mental retardation. Direct laryngoscopy demonstrated agenesis of the right half of the epiglottis and hypertrophied mucosa over the arytenoid cartilage. After the hypertrophied mucosa was partially vaporized with a CO2 laser, the inspiratory stridor soon improved and the aspiration was alleviated. Brain magnetic resonance imaging showed cerebellar vermian agenesis and enlargement of the fourth ventricle.
Elective Extracorporeal Membrane Oxygenation: An Improved Perioperative Technique in the Treatment of Tracheal Obstruction
Authors: Connolly Kieran M. , McGuirt William F.
Published: October 2014

The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extracorporeal membrane oxygenation (ecmo) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ecmo at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ecmo provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.
Long-Term Monitoring of Respiration with a Mediastinal Pressure Sensor in Dogs
Authors: Goding George S. , Eisele David W. , Schwartz Alan R. , Christopherson Mark A. , Testerman Roy L.
Published: October 2014

The ability of an implanted mediastinal pressure sensor to produce a stable respiratory signal that could be used to trigger stimulation of upper airway muscles was examined. In 6 dogs, a pressure sensor was secured to the manubrium (4 by wires and 2 by transmanubrial placement). In 6 other dogs, the pressure sensor was placed in the upper anterior mediastinum. The animals were monitored for a minimum of 8 weeks (2 transmanubrial sensors for 12 months). Sensors that were able to maintain a midline position, high in the mediastinum, had the best signals. A caudal sensor position or abutment against an intrathoracic structure caused signal inversion (unusable signals). Transmanubrial placement resulted in a stable signal for 1 year. We conclude that long-term monitoring of respiration with a mediastinal pressure sensor can be successfully performed in dogs, providing an adequate signal for nerve-muscle stimulation. Separation from cardiovascular structures improves signal quality.
Mucosa-Associated Lymphoid Tissue in Middle Ear and Eustachian Tube
Authors: Kamimura Masami , Balaban Carey D. , Sando Isamu , Haginomori Shin-Ichi
Published: October 2014

The presence of mucosa-associated lymphoid tissue (MALT) was investigated histopathologically in every 20th section from 99 vertically cut, celloidin-embedded temporal bone—eustachian tube (ET) specimens. Among specimens from infants and children between 1 month and 7 years of age, MALT was found in 22 of 44 (50%). However, in 26 adults over 18 years of age, MALT was found in only 2 specimens (7.7%), a significantly lower incidence than that in infants and children. Moreover, MALT did not appear in any of the 21 neonates under the age of 1 month. All 99 specimens were classified into 2 groups: 41 specimens with otitis media (OM) and 58 specimens without OM. The presence of MALT was significantly higher in specimens with OM (43.9%) than in specimens without OM (13.8%). Mucosa-associated lymphoid tissue was found in the ET, middle ear, and mastoid process in 18 specimens (43.9%), 5 specimens (12.2%), and 1 specimen (2.4%) with OM, respectively, and in 8 (13.8%), 0, and 0 specimens without OM. In regard to the distribution of MALT, it occurred more frequently in the pharyngeal half of the cartilaginous portion of the ET than in the rest of the ET, middle ear, and mastoid; the presence was significantly greater in the inferior half of the cartilaginous portion of the ET than in the superior half. Inflammatory cell infiltration in the cartilaginous and bony portions of the ET was significantly greater in specimens with OM than in specimens without OM with no MALT. However, even in some specimens without OM, inflammatory cells were found in the ET, particularly in the pharyngeal half of the cartilaginous portion of the ET. These findings suggest that MALT has a close relationship to OM and that it may be a local response to repeated infection.
Bilateral Laryngeal Pseudoparalysis in Xanthoma Disseminatum Treated by Endoscopic Laser Medial Arytenoidectomy
Authors: Cantarella Giovanna , Marzano Angelo Valerio , Neglia Cesare Bartolomeo , Ottaviani Antonio
Published: October 2014

Xanthoma disseminatum is a rare non-Langerhans' cell histiocytosis, characterized by papular cutaneous eruption, possible mucosal involvement, and frequent association with vasopressin-sensitive diabetes insipidus. Herein we report a case of xanthoma disseminatum with pharyngolaryngeal involvement. In this patient, mucosal xanthomas involving the arytenoid cartilages and the interarytenoid area resulted in laryngeal stenosis and severe impairment of both cricoarytenoid joints' motility. Endoscopic CO2 laser medial arytenoidectomy, according to the technique described by Crumley (1993), and vaporization of interarytenoid xanthomas were successfully performed, thus reestablishing bilateral cordal motility and the laryngeal airway. Four years later, a CO2 laser revision was necessary because of recurrence of xanthomas in the posterior larynx. Two years after the latter operation, the patient has no signs of laryngeal obstruction and has a normal voice quality. This case report suggests that endoscopic medial arytenoidectomy may be successfully used in the treatment of bilateral laryngeal pseudoparalysis secondary to xanthoma disseminatum.
Long-Term Changes in Off-Lesion Endocochlear Potential after Induction of Localized Lesions in the Lateral Wall
Authors: Wu Rong , Hoshino Tomoyuki
Published: October 2014

Localized lesions were produced in various turns of the guinea pig cochlea by means of a photochemical reaction between systemically administered rose bengal dye and green light illumination. The endocochlear potential (EP) was measured at various off-lesion sites, and a morphological examination was performed. In a previous study, this same investigation was done at 3 days, at which time all sites apical to the lesion showed significant EP depression, and damage to the stria vascularis at the lesion was ongoing. In the present 2-week study, the apical EP values were not different from the basal values, and all experimental values were essentially the same as the EP values found in control animals. Morphological examination revealed that the previously damaged structures were greatly repaired. Localized damage and early apical EP depression followed by damage repair and eventual EP recovery could account for the clinical course of certain cases of idiopathic sudden hearing loss involving low-tone deafness.
Idiopathic Progressive Subglottic Stenosis: Findings and Treatment in 52 Patients
Authors: Dedo Herbert H. , Catten Michael D.
Published: October 2014

Rarely, patients develop severe idiopathic subglottic stenosis. In 34 years, we have observed this disorder in 52 patients. All but 1 of the patients were female — a finding that suggests a hormonal cause. Without treatment, the airway progressively narrows — in some cases, until the patient requires tracheotomy. Laser submucosal resection and rotation mucosal flaps open and stabilize the airway and provide effective palliation. However, unlike traumatic subglottic stenosis, which has been cured with this technique, the idiopathic form causes submucosal fibrosis that regenerates spontaneously. Thus, treatment helps, but does not cure, the patient. The characteristic pathological finding is of submucosal dense fibrotic tissue with evidence of chronic inflammation. The clinical findings and treatment are here discussed.
Stellate Cells in the Human Vocal Fold
Authors: Sato Kiminori , Hirano Minoru , Nakashima Tadashi
Published: October 2014

Cells have been discovered that are star-like in appearance and that actively synthesize extracellular matrices in the human adult vocal fold mucosa. These cells have no nomenclature and are thus designated as vocal fold stellate cells (VFSC) in this study. Light and electron microscopic investigation of VFSC in the human vocal fold mucosa was carried out on excised human adult larynges. A comparison between VFSC and conventional fibroblasts was made. The results are summarized as follows. 1) The VFSC are distributed in human adult maculae flavae. 2) The VFSC are irregular and stellate in shape, possessing slender cytoplasmic processes. 3) Lipid droplets are present in the cytoplasm. 4) The VFSC have a small nucleus-cytoplasm ratio and well-developed rough endoplasmic reticulum, suggesting active protein synthesis in these cells. 5) No basal lamina is present, and filaments can be seen in the cytoplasm. 6) The VFSC show strong cytoplasm staining with periodic acid-Schiff stain and type III collagen. 7) The VFSC actively synthesize collagenous fibers, including reticular fibers, as well as other extracellular matrices, such as elastic fibers and glycosaminoglycan (hyaluronic acid). 8) The VFSC, first demonstrated in this study, actively synthesize extracellular matrices in the human adult vocal fold mucosa under normal conditions. 9) The VFSC participate in the metabolism of the extracellular matrices essential for the viscoelastic properties of the lamina propria of the human adult vocal fold mucosa as a vibrating tissue.
Non-Inflatable Sterile Sheath for Introduction of the Flexible Nasopharyngolaryngoscope
Authors: Silberman Harvey D.
Published: October 2014

Since the inception of the flexible nasopharyngolaryngoscope, sterility has been a primary concern. The increased incidence of hepatitis, tuberculosis, and acquired immunodeficiency syndrome has raised the fear of cross-contamination. Sterilization requires the use of ethylene oxide, which is economically disadvantageous, forcing most practitioners to disinfect rather than sterilize their nasopharyngolaryngoscopes. A presterilized, disposable sheath was designed in 1993. The system was cumbersome, because it required an air pump. Thus, it was not adopted by the majority of physicians. As a result, the manufacturer developed a new system, which I evaluated. It is cost-effective, smoother-surfaced, 70% thinner-walled, and much simpler to use. The disposable, single-use sheath is sterile, with no need for a pump or any additional device, and can be used anywhere at any time. I believe it will become the standard method for sterile introduction of the nasopharyngolaryngoscope.
Transforming Growth Factor and Neutralizing Antibodies in Subglottic Stenosis
Authors: Dillard David G. , Gal Anthony A. , White Stephen , Roman-Rodriguez Jesse , Jacobs Ian N.
Published: October 2014

Transforming growth factor beta 1 (TGF-β1), which is implicated in the pathogenesis of fibrotic diseases such as interstitial fibrosis, may be associated with subglottic stenosis. To study this hypothesis, we measured TGF-β1 expression sequentially in 28 rats after posterior cricoid injury, using both standard immunohistochemistry and reverse transcriptase-polymerase chain reaction. In addition, an osmotic pump infused TGF-β1 in 18 rats, normal saline solution in 9 rats, and neutralizing antibodies in 9 rats. Specimens were stained for fibronectin and procollagen at 1, 7, and 21 days and underwent optical density analysis. In the injured airway, TGF-β1 expression peaked at 1 day and returned to baseline by 21 days. The TGF-β1 infusion led to an increase in the expression of extracellular matrix proteins relative to controls. In contrast, neutralizing antibodies led to a decrease in extracellular matrix protein expression. These findings suggest that TGF-β1 may possibly play a role in the pathogenesis of subglottic stenosis.
Assessment of Posterior Cricoarytenoid Botulinum Toxin Injections in Patients with Abductor Spasmodic Dysphonia
Authors: Bielamowicz Steven , Bidus Kimberly , Squire Shrita , Ludlow Christy L.
Published: October 2014

In this study, we compared 2 techniques for injection of botulinum toxin type A (Botox) into the posterior cricoarytenoid (PCA) muscle for the treatment of abductor spasmodic dysphonia (ABSD). Fifteen patients with ABSD were enrolled in a prospective randomized crossover treatment trial comparing the 2 injection techniques. The PCA muscle was injected with 5 units on each side, with the injections staged 2 weeks apart, via either a percutaneous posterior-lateral approach or a transnasal fiberoptic approach. Eleven patients reported some benefit with the injections; however, the patient-perceived benefits were not related to changes in symptoms on blinded counts by speech pathologists. No significant reductions in the numbers of breathy breaks occurred with either technique, and no differences were found between techniques. Although patients perceived a benefit, blinded symptom counts did not substantiate these benefits. Thus, PCA muscle injections of Botox provided limited benefits to patients with ABSD, demonstrating the need for a more effective therapy for these patients.
Duration of Stenting in Single-Stage Laryngotracheal Reconstruction with Anterior Costal Cartilage Grafts
Authors: Hartley Benjamin E. J. , Gustafson L. Mark , Hartnick Christopher J. , Liu James H. , Cotton Robin T.
Published: October 2014

In single-stage laryngotracheal reconstruction (ss-LTR), the endotracheal tube is used as a stent. The optimal duration of stenting is not known. The stenting period requires a stay in the intensive care unit, as the patient is intubated. Sedation and, rarely, paralysis may be required. An analysis from a prospectively collected database was performed to investigate the effect of length of stenting on the outcome of ss-LTR. The outcomes used were reintubation rate and postoperative tracheostomy rate. Patients with anterior costal graft ss-LTR were selected, as they had undergone similar procedures and have similar stenosis types and grades. In 101 patients, the duration of stenting ranged from 2 to 14 days (mean, 7 days; SD, 2.6 days). No significant correlation was found between the number of days stented and the reintubation rate or the postoperative tracheostomy rate. Patients stented for longer than 1 week were an average of 15 months younger than those stented for less than 1 week; however, the stenosis grades for the two populations were equivalent. The differences in rates of reintubation (p = .68) and postoperative tracheostomy (p = .52) in these 2 groups were not significant. For patients undergoing ss-LTR with anterior costal cartilage grafts, no correlation was found between the number of days stented (intubated) and the reintubation rate or the postoperative tracheostomy rate.
Fine Structure of the Human Newborn and Infant Vocal Fold Mucosae
Authors: Sato Kiminori , Hirano Minoru , Nakashima Tadashi
Published: October 2014

This study was carried out to determine the fine structure of the membranous portion of the human newborn and infant vocal fold mucosae and to clarify how the human vocal fold mucosa begins to grow after birth. Light and electron microscopic observations were made on the vocal fold mucosae excised from human newborn and infant larynges. Our findings are summarized as follows. 1) Reinke's space of the newborn vocal fold is a loose structure composed of ground substance and sparse fibers. 2) Ground substance is abundant and glycoproteins (fibronectin) are present in the lamina propria. 3) In the maculae flavae of newborn vocal folds, fibroblasts begin to form collagenous, reticular, and elastic fibers. 4) In the infant maculae flavae, fibroblasts are activated to become stellate in shape and synthesize extracellular matrices such as collagenous and reticular fibers. 5) After birth, the collagenous and reticular fibers synthesized in the maculae flavae extend toward the middle of the membranous portion of the vocal fold mucosa. 6) Glycoprotein (fibronectin) determines the orientation of collagenous and reticular fiber deposition. 7) Glycoprotein (fibronectin) decreases with the increase of the fibrous components in Reinke's space. 8) Elastic fibers increase after collagenous and reticular fibers appear in Reinke's space. 9) Much hyaluronic acid (glycosaminoglycan) is actively produced in the infant maculae flavae. 10) The collagenous and reticular fibers serve as stabilizing scaffolds for the other extracellular matrices, such as elastic fibers and glycosaminoglycan. During infancy, the extracellular matrices synthesized in the maculae flavae appear in the membranous portion of the vocal fold, each at a different time, so as to initiate the 3-dimensional formation of the vocal fold mucosa.
Histopathology of Submandibular Glands Removed for Sialolithiasis
Authors: Marchal Francis , Becker Minerva , Kurt Anne-Marie , Oedman Michaela , Dulguerov Pavel , Lehmann Willy
Published: October 2014

We reviewed the clinical history of 48 consecutive patients who underwent submandibular gland removal for radiologically proven sialolithiasis. The specimens were examined by a pathologist blinded to the clinical data. A histopathologic classification into 1 of 3 grades was established by evaluating the degrees of atrophy, fibrosis, and inflammation. A correlation between the clinical and pathological variables was sought in order to define clinical variables that would predict abnormal submandibular glands that required extirpation. A significant percentage of the submandibular glands exhibited normal histologic findings. The patients with normal submandibular glands had a clinical evolution similar to that of other patients with severely damaged glands. The only clinical variable that correlated with increased histopathologic alteration was the patient's age. In view of the newly available diagnostic and therapeutic techniques for sialolithiasis, a conservative attitude to submandibular gland resection appears justified.