bluuebunny/crossref_metadata_2025 huggingface dataset:
Simple on-Line Endotracheal Cuff Pressure Relief Valve
Authors: Somri Mostafa , Fradis Milo , Vaida Sonia , Malatskey Shelton , Gaitini Luis
Published: October 2014

Ischemic injury of the tracheal mucosa in the endotracheally intubated patient is directly proportional to the tracheal tube cuff pressure. At a cuff pressure of 30 cm H2O, the tracheal mucosal blood flow becomes partially obstructed, and at a pressure of 45 cm H2O, the obstruction to the tracheal mucosal blood becomes total, leading to tracheal mucosal damage and subsequent complications. In our institute, we have developed a simple and very inexpensive method to gauge the cuff pressure. We use a regular 20-mL syringe attached in line with the connector of the endotracheal tube cuff. In this manner, we monitored the intracuff pressure in 120 patients who underwent ear or neck surgery. The syringe was connected to the tube cuff and inflated with 15 mL of air. The syringe was left constantly connected to the cuff. In addition, the cuff pressure was measured with the Mallinckrodt Hi-Lo aneroid pressure gauge at the beginning of surgery and hourly thereafter for the duration of surgery. At the same time, a check for leakage around the cuff was made by auscultation with a stethoscope above the sternal notch. Multiple comparisons between the repetitive intracuff pressure measurements revealed that there were no significant differences in the intracuff pressure values measured at the different times of surgery. These results indicate that there was an adequate venting of the excess intracuff pressure and also that there was no leakage around the cuff.
Association of Epstein-Barr Virus and Nasopharyngeal Carcinoma in Caucasian Patients
Authors: Plaza Guillermo , Manzanal Ana I. , Fogué Luis , Santón Almudena , Martínez-Montero Juan Carlos , Bellas Carmen
Published: October 2014

We evaluated the association of nasopharyngeal carcinoma (NPC) and Epstein-Barr virus (EBV) in Spanish patients, and studied the expression of EBV products (latent membrane protein–1 [LMP-1] and ZEBRA proteins) by NPC cells and its possible prognostic value. In situ hybridization (ISH) for EBV-encoded nonpolyadenylated RNAs (EBERs) and immunohistochemical expression of LMP-1 and ZEBRA proteins by immunohistochemistry were examined in formalin-fixed, paraffin-embedded NPC specimens from 30 patients, and a survival analysis was done by the Kaplan-Meier method. We detected EBERs by ISH in 96.67% of the NPC cases, and detected expression of LMP-1 in 43.33% of the NPC cases and expression of ZEBRA protein in 6.67% of the NPC cases. We conclude that ISH for expression of EBERs is an adequate method for detection of EBV in NPC. LMP-1 is not frequently expressed in NPC cells (43.33%). Most NPC cells carry a latent EBV infection. LMP-1 expression might have worsened the prognosis of NPC in our series.
Topical Estrogens Combined with Argon Plasma Coagulation in the Management of Epistaxis in Hereditary Hemorrhagic Telangiectasia
Authors: Bergler Wolfgang , Sadick Haneen , Riedel Frank , Götte Karl , Hörmann Karl
Published: October 2014

The aim of this study was to assess the value of topically applied estrogens in patients with hereditary hemorrhagic telangiectasia. Twenty-six patients with this disorder were treated with argon plasma coagulation and randomized into 2 groups: group A, which had postoperative application of estriol ointment (n = 14), and group B, which had postoperative application of dexpanthenol ointment (n = 12). Over a period of 12 months, the frequency and intensity of bleeding, the patient's satisfaction, and the success of the treatment were evaluated with a questionnaire. Before the operation, more than 90% of the patients in both groups complained of daily episodes of epistaxis. Twelve months after treatment, the frequency and intensity of bleeding had significantly decreased in group A as compared to group B. Of the patients in group A, 93% were satisfied with the treatment. Of the patients in group B, only 42% were satisfied with the treatment. In both groups, more than 90% of the patients were willing to undergo the same treatment again. The combined treatment approach with argon plasma coagulation and topical estriol enables us to significantly prolong the hemorrhage-free interval.
Malleus Fixation: Clinical and Histopathologic Findings
Authors: Mehta Ritvik P. , Harris Jeffrey P. , Nadol Joseph B.
Published: October 2014

The goals of this study were to review important clinical and histopathologic features of malleus fixation. Ten clinical cases and 10 histopathologic cases of malleus fixation were identified. For the clinical cases, preoperative clinical data, surgical findings, and preoperative and postoperative audiometric findings were reviewed. Ninety percent of the clinical cases achieved significant reduction of the air-bone gap after operation. Two thirds of these cases had an air-bone gap of 10 dB or less, and the remainder had air-bone gaps between 20 and 28 dB after operation. For the temporal bone cases, clinical data, histopathologic findings, and other otologic diagnoses were reviewed. Malleus fixation can be idiopathic or a result of trauma, chronic otitis media, or developmental anomalies. It is a cause of hearing loss that is likely to be more common than the number of diagnoses would indicate. Certain audiometric findings may lead one to suspect the diagnosis. The surgical approach used depends on the individual anatomy, and surgery is usually highly effective in improving hearing.
Longitudinal and Cross-Sectional Phenotype Analysis in a New, Large Dutch DFNA2/KCNQ4 Family
Authors: De Leenheer Els M. R. , Huygen Patrick L. M. , Coucke Paul J. , Admiraal Ronald J. C. , Van Camp Guy , Cremers Cor W. R. J.
Published: October 2014

We analyzed hearing thresholds, speech recognition scores, and vestibular responses in 32 affected persons in a large family with DFNA2/ KCNQ4-related hearing impairment caused by a W276S missense mutation. Linear regression analysis of individual longitudinal data revealed significant threshold progression (1 dB/y) and offset (at age zero). The mean offset thresholds were 5, 21, 40, 39, 31, and 51 dB hearing level (HL) at 0.25, 0.5, 1, 2, 4, and 8 kHz, respectively. Cross-sectional analysis of last-visit thresholds against age produced less-steep slopes and higher offset thresholds. Nonlinear regression analysis of last-visit phoneme recognition scores against age in 25 cases showed that speech recognition did not deteriorate before the third decade. a hyperactive vestibulo-ocular reflex was found in 3 of 11 cases; 2 persons were especially susceptible to motion sickness. Persons with this KCNQ4 mutation showed congenital, progressive high-frequency impairment without substantial loss of speech recognition during the first decades of life.
Analysis of Local Recurrence in Patients with Selected T1–3N0M0 Squamous Cell Carcinoma of the True Vocal Cord Managed with a Platinum-Based Chemotherapyalone Regimen for Cure
Authors: Laccourreye Ollivier , Ménard Madeleine , Veivers David , Brasnu Daniel , Bassot Vincent , Laccourreye Henri
Published: October 2014

Based on an inception cohort of 35 patients with T1–3N0M0 squamous cell carcinoma of the true vocal cord who had a complete clinical response after a platinum-based induction chemotherapy regimen and a minimum of 3 years of follow-up, the current retrospective study documented the long-term results and consequences of local recurrence following the use of a platinum-based chemotherapy—alone regimen for cure. During the years 1985 to 1996, 231 patients with invasive squamous cell carcinoma of the true vocal cord classified as T1–3N0M0 were managed at our department with a platinum-based induction chemotherapy regimen. A complete clinical response was achieved in 77 patients. Thirty-five of the 77 patients with complete clinical response were managed at our institution with a platinum-based chemotherapy—alone regimen. The statistical analysis of data on survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier product limit method. Univariate analysis was performed for potential statistical relation between local recurrence and various variables. The 3- and 5-year actuarial survival estimates were 91.4% and 88.6%, respectively. Overall, the causes of death were intercurrent disease in 6 patients and metachronous second primary tumor in 4 patients. The 3- and 5-year actuarial local control estimate was 64.8%. No significant statistical relation could be demonstrated between the incidence for local recurrence and the variables under analysis. Salvage treatment in patients with local recurrence yielded a 100% local control rate and laryngeal preservation rate. The 3- and 5-year actuarial lymph node control estimate was 97.1%. The 3- and 5-year actuarial estimate for patients with distant metastasis was 0%. The 5- and 10-year actuarial estimates for patients with metachronous second primary tumor were 9.7% and 28.1%, respectively. Although local recurrence was noted in almost a third of patients with complete clinical response who were managed with a platinum-based chemotherapy-alone regimen, it did not appear to be detrimental, as none of the patients who had local recurrence ultimately died from their disease or lost their larynx.
Effect of Chronic Electrical Stimulation of Laryngeal Muscle on Voice
Authors: Billante Cheryl R. , Courey Mark S. , Zealear David L. , Netterville James L.
Published: October 2014

Conventional surgical therapies for bilateral laryngeal paralysis sacrifice voice to enlarge the airway. Electrical pacing of the posterior cricoarytenoid (PCA) muscle to restore glottal opening and allow ventilation offers a new treatment approach. The purpose of this investigation was to determine whether long-term stimulation of the PCA muscle altered perceptual, acoustic, and aerodynamic parameters of voice. Two patients underwent implantation of a Medtronic Itrel II laryngeal pacemaker. Voice evaluation was performed before surgery and at monthly postoperative sessions with the pacemaker off. Months of PCA stimulation did not change perceptual descriptors of voice quality. Measures of fundamental frequency and intensity, upper and lower limits of the dynamic frequency and intensity range, and phonatory flow rates were largely unaltered. The results indicated that there was no effect of laryngeal pacing on voice.
Airflow Resistance of Heat and Moisture Exchange Filters with and without a Tracheostoma Valve
Authors: Verkerke Gijsbertus Jacob , Geertsema Albert Anne , Schutte Harm K.
Published: October 2014

Rehabilitation of laryngectomees has been furthered by the introduction of heat and moisture exchange (HME) filters, placed over a tracheostoma or on a tracheostoma valve (TSV). The airflow resistance of HME filters is an important factor with regard to the comfort of the patient. The goal of this study was to determine the airflow resistance (defined as the pressure drop over the device divided by the squared airflow through the device) of 4 commercially available HME filters with and without a TSV. The pressure drop over and the airflow through the devices were measured in vitro. Distinct differences among the devices were found. The mean airflow resistance of the HME filters ranged from 135 to 346 Pa • s2/L2, that of TSVs was between 66 and 297 Pa • s2/L2, and that of the combination was between 263 and 454 Pa • s2/L2. The Stom-Vent 2 HME filter and the Adeva Window TSV with an Adeva filter had the lowest airflow resistance of the devices measured in this study.
Distal Renal Tubular Acidosis Associated with Isolated Large Vestibular Aqueduct and Sensorineural Hearing Loss
Authors: Berrettini Stefano , Ravecca Francesca , Forli Francesca , Massimetti Mauro , Franceschini Stefano Sellari , Neri Emanuele
Published: October 2014

Distal renal tubular acidosis (dRTA) is characterized by a defect in urinary acidification with various degrees of metabolic acidosis; it can be inherited either as an autosomal dominant trait or as a recessive trait. The recessive form is associated in about one third of cases with progressive sensorineural hearing loss (SNHL). We performed a neuroradiological study in 3 consecutive unrelated pediatric patients affected with sporadic dRTA and progressive SNHL that disclosed an enlarged vestibular aqueduct (VA) and endolymphatic sac (ES) in each. The presence of an enlarged VA in our patients with dRTA and SNHL could contribute to the development, or at least the progression, of the hearing impairment. We suppose that the same molecular defect present in both the kidney and the inner ear could be the cause of dRTA and of the development of the enlarged VA and ES.
Quinine Affects the Response Properties of Compound Action Potentials Elicited by Periodic Click Trains
Authors: Ochi Kentaro , Kenmochi Mutsumi , Ohashi Toru , Kikuchi Hitoshi , Kinoshita Hirotsugu , Nishino Hirohito
Published: October 2014

The effects of systemically applied quinine on the compound action potential (CAP) were investigated in 5 guinea pigs. A dose of 200 mg/kg body weight of quinine hydrochloride was administered intramuscularly, and CAPs were recorded at the round window before and after administration. The CAP thresholds of the animals were elevated by 5 to 25 dB approximately 30 minutes after administration, and thresholds recovered in some animals during the experimental session. The CAP waveform elicited by the click train stimulus was abnormal after administration of quinine. The amplitude of the CAPs elicited by the second click was larger than that of those elicited by the first click. These changes may be induced by an abnormally broadened N1 response to the first click in the click train following quinine administration. In contrast, the CAP waveforms elicited by the second click and by the following clicks in the click train appeared normal.
Effects of Adding Steroids, in Vitro Irradiation, or Both to Cyclosporine Immunosuppression in the Murine Laryngeal Transplantation Model
Authors: Lorenz Robert R. , Haug Marcus , Dan Olivia , Strome Marshall
Published: October 2014

Adding oral prednisone or in vitro organ irradiation to an immunosuppressive regimen for laryngeal transplantation may allow cyclosporine dosage to be decreased without compromising organ rejection rates. Using an established rat laryngeal transplant model, we sought to determine whether combined immunosuppressive regimens decreased rejection rates. Twenty-two treatment groups of 10 animals each were studied. Cyclosporine was administered at 2 different historically low dosages (1.5 and 2 mg/kg per day) alone, in combination with prednisone, and with in vitro irradiation of the harvested larynx. At 15 days after transplantation, cyclosporine combined with prednisone did not significantly alter the mean severity of rejection. At 30 days after transplantation, rats treated with a combination of cyclosporine 2 mg/kg and prednisone 1 mg/kg showed the least amount of rejection. Rejection rates were significantly higher with 2 mg/kg cyclosporine alone (p < .00024). Irradiation did not significantly decrease the severity of rejection. These results demonstrate that at 1 month after transplantation, a combined steroid and cyclosporine regimen reduces the severity of rejection after laryngeal transplantation in an animal model. Our findings suggest that laryngeal transplant patients may be treated with low cyclosporine doses without experiencing organ rejection if steroids are added to the immunosuppressive regimen.
New-Generation Pulsed Carbon Dioxide Laser: Comparative Effects on Vocal Fold Wound Healing
Authors: Garrett C. Gaelyn , Reinisch Lou
Published: October 2014

We investigated wound healing of vocal fold mucosal excisions using a canine model, comparing cold steel, the continuous wave (CW) carbon dioxide (CO2) laser, and a new, microsecond-pulsed CO2 laser. The thermal injury to the surrounding normal tissues produced by the laser increases the risk for scar formation and poor functional voice outcome. This injury may be reduced with a pulsed CO2 laser. Acute, 2-week, and 6-week studies of 15 dogs were made with blinded observers and nonparametric statistical analyses. Histologic comparison showed less thermal injury and scar formation in the vocal folds treated with the pulsed CO2 laser than with the CW CO2 laser. Functional outcomes as studied with laryngeal videostroboscopy revealed better vibratory characteristics with the pulsed CO2 laser as compared with the CW CO2 laser. No differences were seen on these measures between the pulsed laser and cold techniques. Pulsed CO2 lasers may offer the ease of laser laryngology and the superior wound healing of cold steel.
585-NM Pulsed Dye Laser Treatment of Glottal Papillomatosis
Authors: Franco Ramon A. , Farinelli William A. , Zeitels Steven M. , Anderson R. Rox
Published: October 2014

Treatment of recurrent respiratory papillomatosis of the glottis is often challenging. The surgeon and patient must cooperatively balance decisions regarding airway safety, effects of multiple general anesthesias, employment disturbance, and vocal dysfunction. A pilot study was done in 41 adult cases (23 patients; 78 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-μs pulse width; fluence of 38 to 255 J/cm2; 1- to 2-mm spot size) in the treatment of this disorder. Thirty-seven of the 41 cases (90%) were bilateral disease. Twenty-six of the 41 cases (63%; including 20 cases with involvement of the anterior commissure) were treated by bilateral photocoagulation of the lesions' microcirculation without microflap resection of tissue. Clinical observation revealed that irradiated but unresected disease involuted without development of an anterior commissure web. In the initial 13 of the 41 cases (32%), PDL treatment was followed by cold instrument microflap resection. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. The PDL at 585 nm was less effective in the management of exophytic lesions because of its limited depth of penetration (approximately 2 mm). In this initial trial, the PDL was a relatively safe and efficacious treatment for glottal recurrent respiratory papillomatosis. Since the lesions involute without complete resection of the diseased epithelium, the anterior commissure can be treated to minimize the number of procedures. To study patterns of recurrence will require longer follow-up.
Electronic Analysis of Intrinsic Laryngeal Muscles in Canine Sound Production
Authors: Broniatowski Michael , Nelson David R. , Shields Robert W. , Grundfest-Broniatowski Sharon , Dessoffy Raymond , Strome Marshall
Published: October 2014

This study explores the relationship between voice production and intrinsic laryngeal muscle (ILM) activities as expressed by orderly recruitment of their specific motor units. In 5 dogs, both the recurrent laryngeal nerve (RLN) and the vagus nerve (cranial nerve X) were stimulated via tripolar electrodes with stimulating frequencies (Fs) of 10 to 60 Hz and 0 to 7 mA during application of symmetric 600 Hz, 7 to 0 mA blocking currents. The fundamental frequency (F0) and the intensity (I) of sounds generated by tracheal insufflation of humidified air were recorded while electromyograms of the cricothyroideus (CT), thyroarytenoideus (TA), and posterior cricoarytenoideus (PCA) were obtained via surface electrodes. Contractions of the CT were concurrently induced by stimulating the superior laryngeal nerve (SLN). The recruitment rates were highly specific and were affected by which nerve was stimulated. For the RLN, PCA ramping was lowest for Fs of ≤50 Hz. For Fs of 10 to 30 Hz, the recruitment rate of the TA was significantly steeper than that for the other ILMs, and the CT had the highest rate for Fs of 40 to 50 Hz. Conversely, for the vagus nerve, PCA recruitment was highest for Fs of ≥30 Hz. The average F0 was significantly higher with the RLN than with the vagus nerve. When the TA recruited faster than the CT (ie, via the RLN, but not the vagus nerve), the F0 was higher. While only CT ramping was significantly related to changes in sound intensity, there was a trend toward a decrease when PCA ramping was higher than CT ramping, as occurred when only the vagus nerve was stimulated. Stimulation of the SLN always increased F0 and loudness. We conclude that changes in F0 occur mainly through RLN-mediated CT and TA contraction. Loudness is controlled by the CT. The PCA exerts reciprocal coupling on both functions via the vagus nerve, and they are boosted across the board by the SLN. These findings may allow artificial manipulation of voice.
Therapeutic Methods Used for Otolaryngological Problems during the Byzantine Period
Authors: Ramoutsaki Ioanna A. , Ramoutsakis Ioannis A. , Papadakis Chariton E. , Helidonis Emmanuel S.
Published: October 2014

Evidence of herbal, animal, and chemical substances from the natural world used in medicines for otolaryngological problems, including opium, hyoscyamus, barley, honey, dried beans and peas, olives, fruits, Agaricus, castoreum, cassia, and afronitron, was traced in the Byzantine medical treatises, mainly from the 4th century ad to the 15th century ad. The texts of Antyllus, Orivasios of Pergamos, Aetios of Amida, Alexander of Tralles, Paul Aeginitis, Leon Iatrosophistis, Theophanis Nonnos, Nickolaos Myrepsos, Michael Psellos, and others strongly suggest the influence of ancient Greek and Roman medicine, but at the same time stress original medical thought. The main otolaryngological problems encountered in that period were loss of hearing, purulent otitis, rupture of the tympanic membrane, pharyngitis, laryngitis, rhinitis, acute tonsillitis, seasickness, vertigo, fracture of the nose, and cancers of the ear, larynx, nose, and oral cavity. The tradition stating that remedies were the final products of substance combinations, started in the classical period (5th and 4th centuries bc), is presented clearly and in detail in Byzantine prescriptions related to otolaryngology.
Induction of Endolymphatic Hydrops by Directly Infused Monoclonal Antibody against Type Ii Collagen CB11 Peptide
Authors: Matsuoka Hiroshi , Kwon Soon Seog , Barbieri Marco , Yazawa Yoshiro , Yoo T. J.
Published: October 2014

Autoimmune ear disease induced by type II collagen has been investigated by Yoo et al. In the present study, we investigated the effects of direct chronic infusion of type II collagen-specific monoclonal antibodies into guinea pig cochlea. Type II collagen fragment CB11 peptide-specific monoclonal antibodies (anti-CB11 Mabs) were infused directly into the scala tympani of guinea pigs with an Alzet mini-osmotic pump (anti-CB11 Mab group). As a control, normal mouse serum was infused by the same method (control group). To evaluate the auditory function, we recorded brain stem auditory-evoked potentials (BAEPs). In the anti-CB11 Mab group, 80% of the animals showed an increased hearing threshold of more than 25 dB at 7 days after infusion. The hearing threshold shift observed in the guinea pigs of the control group was minimal (15 dB or less). To detect the structural changes, we performed histopathologic studies using hematoxylin and eosin staining. Inflammatory cell migration was detected mainly in the scala tympani of the guinea pigs of both groups. In the anti-CB11 Mab group, endolymphatic hydrops was also observed. The results of this experiment suggest that type II collagen autoimmunity is responsible for the production of hearing loss and endolymphatic hydrops.
Digital Photography of the Larynx
Authors: Benjamin Bruce
Published: October 2014

Digital photographic technology has ushered in a new era in medical documentation. The author's method of still digital photography for direct and indirect laryngeal photodocumentation using a single-lens-reflex camera and rigid rod-lens telescopes is described, and the results are presented. The advantages and disadvantages of different systems using still or video photography are discussed, and the importance of storing the archival image securely is emphasized. It is concluded that digital photography is convenient and versatile and gives good-quality images. It is the way of the future.
Lemon-Flavored Cod Liver Oil and a Multivitamin-Mineral Supplement for the Secondary Prevention of Otitis Media in Young Children: Pilot Research
Authors: Linday Linda A. , Shindledecker Richard D. , Dolitsky Jay N. , Pippenger C. E.
Published: October 2014

We measured blood levels of fatty acids, vitamin A, and trace metals in children undergoing ambulatory surgery for placement of tympanostomy tubes and a comparison group having other ambulatory surgical procedures. We then performed a small, outpatient, secondary prevention study using nutritional supplements chosen on the basis of those blood levels. The study subjects had lower levels of red blood cell eicosapentaenoic acid (EPA) than did adult controls. Consistent with previous reports, the levels of vitamin A were ≤40 μg/dL for 69% of our subjects, and the plasma selenium levels for children were lower than published values for adults. We then studied one otitis media (OM) season; 8 children (0.8 to 4.4 years of age) received 1 teaspoon of lemon-flavored cod liver oil (containing both EPA and vitamin A) and 1 half-tablet of a selenium-containing children's chewable multivitamin-mineral tablet per day. During this OM season, study subjects received antibiotics for OM for 12.3% ± 13.4% (SD; p < .05) fewer days during supplementation than before supplementation. Larger, controlled trials are warranted to assess the utility of cod liver oil (of acceptable purity and taste) and a children's multivitamin-mineral preparation containing selenium, both for the prevention of OM and for the acceptance of delayed prescription of antibiotics for this disorder.
Comparison of Surgical Outcomes in Primary Endoscopic Dacryocystorhinostomy with and without Silicone Intubation
Authors: Unlu H. Halis , Aslan Asim , Toprak Baris , Guler Cenap
Published: October 2014

The surgical outcome of endoscopic endonasal dacryocystorhinostomy was analyzed in 30 cases of postsaccal stenosis. Intubation with silicone tubing was used in 14 cases (46.7%) and not used in 16 cases (53.3%). Surgical success was evaluated subjectively and objectively. The patients' complaints were improved in 85.7% of cases in the intubation group, and in 81.3% of the group in which no stent was used. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 11 cases without intubation (68.8%) and 9 cases with intubation (64.3%). Six patients in the intubation group (42.9%) had granulation tissue at the rhinostomy site. Four patients (28.6%) had complaints regarding the intubation. Considering the similar surgical success rates, and the granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal canal.
Temporal Bone Morphometric Study on the Eustachian Tube and its Associated Structures in Patients with Chromosomal Aberrations
Authors: Miura Makoto , Sando Isamu , Haginomori Shin-Ichi , Balaban Carey D. , Orita Yorihisa
Published: October 2014

This study characterized phenotypic anomalies of the eustachian tube (ET) and its associated structures in individuals with various chromosomal aberrations (trisomies 13, 18, 21, and 22 and inversion of chromosome 1). The morphological characteristics of the ET and its accessory structures from 10 temporal bone-ET specimens, obtained from 10 individuals with chromosomal aberrations who ranged from the 26th gestational week to 1 year in age, were compared with the same structures from 21 age-matched control subjects without anomalies. The subjects with chromosomal aberrations had a significantly smaller volume of the lateral lamina (LL) of the ET cartilage, a reduced attachment of the tensor veli palatini muscle (TVPM), and, in some cases, a reduced volume of the lumen of the cartilaginous ET. The volume of the medial lamina (ML) of the ET cartilage was normal at birth, but smaller in specimens more than 2 months of age; this finding suggests that the prenatal development was normal, but that the postnatal growth was retarded. The subjects with chromosomal aberrations also displayed a smaller ratio of the volume of the LL to that of the ML (LL/ML ratio). Our results suggest that individuals with various chromosomal aberrations have rather similar anomalies of the ET and its associated structures. We speculate that these anomalies might be closely related to ET dysfunction in these patients.
Evaluation of Vertigo by Auditory Brain Stem Response
Authors: Welsh Louis W. , Welsh John J. , Rosen Laurie G.
Published: October 2014

The authors examined the hypothesis that abnormal patterns of the auditory brain stem response (ABR) could supplement the neuro-otological evaluation and assist in localizing the site of vestibulocerebellar dysfunction. This project is based upon the fact that the sources of waves I through V have been regionally identified. Absent or delayed patterns can be referenced to the normal data, and the site of a lesion generating vertigo can be established. We found absence of waves or prolonged interpeak latencies in 25% of the vertiginous subjects with normal hearing and magnetic resonance images of the brain. We conclude that in selected cases, lesions affecting the vestibular system can influence the ABR, and the electrophysiological tests of audition may suggest regionalization of the dysfunction in the hindbrain and midbrain.
Cisplatin-Induced Ototoxicity and Pharmacokinetics: Preliminary Findings in a Dog Model
Authors: Sockalingam Ravi , Charles Bruce , Filippich Lucio , Murdoch Bruce
Published: October 2014

The early effects of a clinical dose of cisplatin (100 mg/m2) on distortion-product otoacoustic emissions (DPOAE) thresholds and the relationship between DPOAE threshold shifts and changes in plasma concentrations of filterable and total platinum (Pt) following infusion of cisplatin in a dog model were investigated. The DPOAE thresholds (based on input-output function) were measured 2 days before a single high dose of cisplatin administration, and compared with measurements recorded 2 and 4 days after infusion. The results revealed DPOAE thresholds to be elevated by 4 days after the administration of cisplatin. However, this elevation could not be correlated with plasma concentrations of filterable and total Pt, which showed little variation over the 48-hour postinfusion period between animals. The present study demonstrated that DPOAE thresholds have the potential to be used as an indicator of cisplatin-induced ototoxicity, and cisplatin-induced ototoxicity could not be explained by plasma Pt kinetics in individual animals.
Congenital Implantation Cholesteatomas of the Occipitoparietotemporal Junction
Authors: Canalis Rinaldo F. , Lufkin Robert , Shapiro Nina , Becker Donald P.
Published: October 2014

Two cases of cranial cholesteatomas centered at the occipitoparietotemporal junction are presented, and 12 similar cases reported as diploic cholesteatomas involving the temporal bone are reviewed. Among the reported diploic cholesteatomas, 3 involved the occipitoparietotemporal junction and had the same clinical characteristics as the ones presented here. These 5 lesions did not produce expansion of the cranial tables, they had a predominantly intracranial growth, and their matrix was bonded to the dura, so that their complete excision was prevented. It is proposed that cranial cholesteatomas involving the occipitoparietotemporal junction arise, not from within the tables of the skull, but from squamous cells trapped during closure of the mastoid fontanelle and formation of the suture. Hence, they should be recognized as having an origin different from that of diploic lesions, and termed congenital implantation cholesteatomas.
Fiberoptic Laryngeal Surgery for Vocal Process Granuloma
Authors: Hirano Shigeru , Tateya Ichiro , Kojima Hisayoshi , Ito Juichi
Published: October 2014

We developed a technique of fiberoptic laryngeal surgery for the treatment of vocal process granulomas. In this system, the granuloma can be removed relatively easily and repeatedly under topical anesthesia on an outpatient basis. We treated 27 patients for a total of 4 intubation granulomas and 23 contact granulomas. Ten of the 23 contact granulomas recurred after the initial surgery, but the intubation granulomas did not recur. Most of the recurrent lesions were resolved by fewer than 3 procedures, and all patients were finally cured. Although conservative therapies such as voice therapy and proton pump inhibitors have recently prevailed, surgical removal remains useful in treating vocal process granulomas. Fiberoptic laryngeal surgery facilitates repeated surgical procedures.
Impact of Activities OF NA+,K+-Atpase and CA2+-Atpase in the Cochlear Lateral Wall on Recovery from Noise-Induced Temporary Threshold Shift
Authors: Hsu Chuan-Jen , Yeh Te-Huei , Chen Yuh-Shyang , Lee Shiann-Yann , Shau Wen-Yi , Lin-Shiau Shoei Yn
Published: October 2014

The present study was designed to investigate the relationship between the noise-induced temporary threshold shift (TTS) and the specific activities of sodium potassium adenosine triphosphatase (Na+,K+-ATPase) and calcium adenosine triphosphatase (Ca2+-ATPase) in the cochlear lateral wall. The specific activities of these enzymes were quantified by microcolorimetric assay. Changes in auditory brain stem response (ABR) thresholds were compared with the quantitative alterations of the specific activities of Na+,K+-ATPase and Ca2+-ATPase in the cochlear lateral wall of guinea pigs with a noise-induced TTS. In the majority of those noise-exposed ears with complete recovery of ABR thresholds, the specific activities of both enzymes returned to at least 70% of the mean specific activity of the control group. Although other factors may be involved, reversible inactivation of Na+,K+-ATPase and Ca2+-ATPase in the cochlear lateral wall may be one component of the TTS. Our present findings could drive further studies on the molecular basis of noise-induced hearing loss.
Treatment of Vocal Fold Scarring: Rheological and Histological Measures of Homologous Collagen Matrix
Authors: Thibeault Susan L. , VanGroll Patrick J. , Kriesel Kevin J. , Chan Roger W. , Bless Diane M. , Suzuki Tatsutoshi , Ford Charles N.
Published: October 2014

The current treatment options for dysphonia secondary to vocal fold scarring are limited. Few studies address changes in the lamina propria, which is critical to vocal fold biomechanical properties and voice production. Using rheological and histological measures of homologous collagen matrix (HCM)–injected vocal folds, we assessed HCM's potential for providing bulk and restoring biomechanical performance. Twenty rabbits underwent bilateral vocal fold scarring. After 10 weeks of scar maturation, the rabbits had unilateral injections of HCM or saline solution. Ten weeks after the injections, histological studies revealed well-defined collagen globules distributed throughout the lamina propria and underlying muscular tissue. Significantly more procollagen was observed in the HCM-treated group. No significant differences in elastic shear modulus or dynamic viscosity were found between the treatment groups. This study demonstrates that HCM is an inert, relatively stable injectate that may serve well for medialization but does not appear to improve the dynamic properties of the lamina propria.
Induction of Growth Factor Expression is Reduced during Healing of Tympanic Membrane Perforations in Glucocorticoid-Treated Rats
Authors: Ishimoto Shin-Ichi , Ishibashi Toshio
Published: October 2014

The participation of growth factors in wound healing of tympanic membranes (TMs) is established. To determine the possible role of these growth factors in normal healing, we examined the regulation of keratinocyte growth factor (KGF), transforming growth factor–α (TGF-α), and basic fibroblast growth factor (bFGF) messenger RNA (mRNA) expression in wounded TMs of glucocorticoid-treated rats; these rats have severe wound healing abnormalities. Induction of KGF, TGF-α, and bFGF mRNA expression after TM injury was significantly reduced in these rats. Moreover, we found that the average number of bromodeoxyundine-positive cells in a glucocorticoid-treated group was significantly lower than that in controls. The data suggest that reduced expression of these genes might be partially responsible for the wound healing defects seen in these animals. These results provide a possible explanation for the beneficial effect of exogenous KGF, TGF-α, or bFGF in treatment of wound healing disorders of the TM.
Complications of Suspension Laryngoscopy
Authors: Klussmann Jens Peter , Knoedgen Robert , Damm Michael , Wittekindt Claus , Eckel Hans Edmund
Published: October 2014

Although suspension laryngoscopy (SL) is routinely used in operative laryngology, no prospectively gathered data on the complications of this procedure have so far been available. We prospectively analyzed 339 consecutive procedures for ***intervention-related complications. The survey included preoperative dental status and assessment of postoperative dental, mucosal, and nerve injuries. Minor mucosal lesions were found in 75% of all patients. All healed spontaneously within a few days. Dental injuries occurred in 6.5% of all patients. These were more frequent in therapeutic laryngoscopy than in diagnostic procedures (6.8% versus 6.0%). Highly significant correlations were found between dental injury rate and preoperative dental disease (p < .04) and grade of periodontitis (p < .001). Temporary nerve lesions were observed in 13 patients (9 of the lingual nerve and 4 of the hypoglossal nerve). Although minor complications frequently occur during SL, it is a relatively safe procedure with a low risk of significant morbidity.
Sudden Sensorineural Hearing Loss: Supporting the Immunologic Theory
Authors: Berrocal José Ramón García , Ramírez-Camacho Rafael
Published: October 2014

Sudden deafness constitutes a diagnostic challenge. Classically, 2 causes, viral and vascular, are considered in the origin of idiopathic sudden hearing loss. More recently added to the list of possibilities are rupture of the membranous labyrinth and immune-mediated sensorineural hearing loss. The latter can be either primary and localized to the inner ear or, in perhaps fewer than one third of cases, secondary to generalized systemic autoimmune disease. The purpose of the present review is to define immune-mediated sudden sensorineural hearing loss as a distinctive entity, on the basis of clinical, immunologic, and pathological findings, and suggest a profile of the typical patient.
Electrophysiological Findings in Two Bilateral Cochlear Implant Cases: Does the Duration of Deafness Affect Electrically Evoked Auditory Brain Stem Responses?
Authors: Thai-Van Hung , Gallego Stéphane , Veuillet Evelyne , Truy Eric , Collet Lionel
Published: October 2014

Bilateral cochlear implantation provides an interesting model for in vivo study of the effect of long-term profound deafness on neural transmission. We present electrophysiological observations on 2 patients implanted with the MXM Binaural Digisonic Convex system. This uncommon design consists of 2 electrode arrays placed bilaterally into the scala tympani and controlled by a single speech processor. In both patients, the duration of deafness before cochlear implantation clearly differed from one ear to the other. Electrically evoked auditory brain stem responses (EABRs) were measured and the EABRs from the ear with the longer deafness duration showed a lengthening of wave V latency. In 1 patient, recordings from this ear also showed a lack of reproducibility of wave III. The data suggest that neural responsiveness in the peripheral and intermediate auditory pathways is adversely affected by deafness duration. Poor EABRs on one ear possibly result from the total duration of deafness in this ear and/or compensation by the other ear.
DNA Ploidy Status as a Prognostic Marker and Predictor of Lymph Node Metastasis in Laryngeal Carcinoma
Authors: Takes Robert P. , van Blommestein Roelof , van Krieken Han H. J. M. , de Jong Robert J. Baatenburg , Hermans Jo , Cornelisse Cees J.
Published: October 2014

In patients with laryngeal carcinoma, nodal metastasis, recurrence after radiotherapy, and prognosis are important factors in clinical decision-making. Parameters such as tumor stage are considered insufficient for predicting these important items. The DNA ploidy status of the tumor may be a useful additional marker. The DNA ploidy status of 38 laryngeal cancers was determined by flow cytometry. Correlations were studied with TNM stage, differentiation, survival rate, relapse risk, recurrence after radiotherapy, and nodal metastasis. A positive correlation of DNA ploidy status with the development of lymph node metastases was found for diploid and peridiploid versus aneuploid tumors (DNA index, <1.4 versus ≥1.4; p = .007). No correlation was found between ploidy status and recurrence after radiotherapy. The overall survival rate (p = .01), but not the disease-specific survival rate or the relapse risk, showed a correlation with the ploidy status. The DNA ploidy status may be a useful marker for metastatic behavior in head and neck squamous cell carcinoma and may therefore be helpful in decision-making concerning elective treatment of the neck.
Postoperative Olfaction in Chronic Sinusitis: Smokers versus Nonsmokers
Authors: Matsuda Toshi , Hashiba Motoyuki , Sugiyama Kazuko , Kondo Hiroko , Murakami Shingo , Mitsuya Shoji , Baba Shunkichi
Published: October 2014

In order to study the efficacy of surgical intervention, as well as the influence of cigarette smoking on olfaction in clinical states, we examined olfactory ability by means of the University of Pennsylvania Smell Identification Test (UPSIT). We enrolled 37 patients 21 to 60 years of age who underwent surgery for chronic sinusitis. Normosmia was defined as an UPSIT score of 30 or more. Among these patients, 31 had a disturbance in their smelling ability in the preoperative stage, and the improvement rate, defined as a rise in score of 4 or more points after surgery, was 64.5%; 11 were well healed. However, all 7 patients who were more than 40 years old at the time of surgery, and currently smoking cigarettes, had a significant deficit in olfaction in the preoperative stage and even in the postoperative stage. This study demonstrated that cigarette smoking has adverse effects on olfactory ability, especially for older patients.
New Treatment Options for Lymphangioma in Infants and Children
Authors: Giguère Chantal M. , Bauman Nancy M. , Smith Richard J. H.
Published: October 2014

Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.
Effects of Nimodipine on Salicylate Ototoxicity
Authors: Ochi Kentaro , Kinoshita Hirotsugu , Nishino Hirohito , Kenmochi Mutsumi , Ohashi Toru
Published: October 2014

The purpose of this study was to examine the effects of nimodipine on salicylate ototoxicity in guinea pigs. The compound action potential (CAP) was recorded at the round window, and the cochlear blood flow (CBF) was measured simultaneously from the lateral wall of the basal turn of the cochlea by laser Doppler flowmetry. After administration of salicylate (100 mg/kg), the CAP thresholds were significantly elevated, by 5 to 20 dB (p < .05), and the CBF was significantly decreased (p < .05). After administration of nimodipine (2 mg/kg), the CAP thresholds were unchanged, but the CBF had increased significantly (p < .05), while systemic blood pressure had decreased significantly (p < .05). Simultaneous administration of both salicylate (100 mg/kg) and nimodipine (2 mg/kg) resulted in significant elevation of the CAP thresholds (p < .05), while the CBF did not decrease. These results suggest that nimodipine prevents the decrease in CBF induced by salicylate, but that nimodipine does not prevent the deterioration in the CAP.
Hearing Loss in Usher Syndrome Type II is Nonprogressive
Authors: Reisser Christoph F. V. , Kimberling William J. , Otterstedde Christian R.
Published: October 2014

Usher syndrome is an autosomal recessive disorder characterized by sensorineural hearing loss and progressive visual loss secondary to retinitis pigmentosa. In the literature, a possible progression of the moderate to severe hearing loss in Usher syndrome type II (Usher II) is controversial. We studied the development of the hearing loss of 125 patients with a clinical diagnosis of Usher syndrome type II intraindividually and interindividually by repeatedly performing complete audiological and neuro-otologic examinations. Our data show a very characteristic slope of the hearing curve in all Usher II patients and no clinically relevant progression of the hearing loss over up to 17 years. The subjective impression of a deterioration of the communicative abilities of Usher II patients must therefore be attributed to the progressive visual loss. The patients should be reassured that changes in their hearing abilities are unlikely and should be provided with optimally fitted modern hearing aids.
Osteocartilaginous Differentiation of Mucosal Melanoma in the Sinonasal Cavity
Authors: Takeshita Hajime , Miwa Takaki , Furukawa Mitsuru
Published: October 2014

We present a very rare case of mucosal melanoma with osteocartilaginous differentiation (MMOD). This is the first report of MMOD originating in the sinonasal cavity. Preoperative diagnosis of this tumor from specimens resected for biopsy alone is very difficult, because it has 2 histopathologic components: a primary melanoma site and the part of the melanoma with osteocartilaginous differentiation. The immunohistochemical technique is useful in histopathologic diagnosis of this tumor. Malignant melanoma usually shows reactivity with MelanA (melanoma tumor antigen) and S-100 proteins. We diagnosed this case as MMOD because both regions in this tumor were stained with MelanA and S-100 proteins. Magnetic resonance imaging provides the best clinical ability to detect malignant melanoma in the sinonasal region. In this case, the melanotic melanoma site in the posterior ethmoid sinus appeared hyperintense to gray matter on T1-weighted image magnetic resonance imaging. Thus, it would have been possible to diagnose this case as MMOD before operation, even though we could not obtain a biopsy specimen from the posterior ethmoid sinus lesion.