bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasopharyngeal Mass: A Manifestation of Inflammatory Otologic Disease
Authors: Metson Ralph , Fleming Gregory , Oye Robert K.
Published: October 2014

A nasopharyngeal mass with cranial neuropathies usually indicates an advanced neoplastic process. We present three patients with these findings and concurrent invasive Pseudomonas otitis in whom repeated nasopharyngeal biopsies were negative for tumor. All of the nasopharyngeal masses resolved following treatment of the otitis. Mechanisms of disease spread from the temporal bone to the nasopharynx are discussed. Clinicians may choose to modify diagnostic and therapeutic approaches to the nasopharyngeal mass in patients with concurrent invasive otologic disease.
Endotracheal Tube Safety with the Erbium: Yttrium Aluminum Garnet Laser
Authors: Gonzalez Carlos , Smith Michael , Reinisch Lou
Published: October 2014

The erbium: Yttrium aluminum garnet (Er:YAG) laser operates in the infrared spectrum at a wavelength of 2.94 μm. The absorption coefficient for water at this wavelength is approximately 10 times that of the carbon dioxide laser. It is anticipated that this laser will produce more precise surgical ablation with decreased surrounding tissue destruction. The results of impacting endotracheal tubes with the Er:YAG laser are presented. The CO2 laser was used as a reference. Metallic tape that was not perforated by the CO2 laser after 240 seconds of continuous exposure at 20 W was perforated by the Er: YAG laser with use of 15 pulses of 1 J per pulse. Silver foil tape with a Merocel lining was resistant to perforation by both the CO2 laser and the Er: YAG laser. As new laser wavelengths become available and are applicable to otolaryngology, modification of current safety standards will be necessary.
Malignant Transformation in a Laryngeal Hemangioma
Authors: McRae R. Duncan R. , Jones Robin F. McNab , Gatland David J. , Khan Santanu
Published: October 2014

Laryngeal angiosarcoma is uncommon, with only 19 previously reported cases. Malignant transformation in nonirradiated hemangiomas is extremely rare, with only five equivocal cases reported, all of which occurred in the skin. We report the first documented case of malignant transformation in a laryngeal hemangioma, and review the literature.
Quantification of the Relation between Electrophysiologic and Morphologic Changes in Experimental Endolymphatic Hydrops
Authors: Klis Sjaak F. L. , Buijs Jacqueline , Smoorenburg Guido F.
Published: October 2014

The degree of hydrops in guinea pig ears that had undergone unilateral endolymphatic sac and duct obliteration was quantified. For 15 guinea pigs from a prior study, the correlation between the degree of hydrops and several electrophysiologic measures of the functional state of the cochlea was determined. A significant correlation between the degree of hydrops and a reduction in the low-frequency cochlear microphonic evoked by a 29-Hz tone was found. No correlation was found between the degree of hydrops and the magnitude of the summating potential evoked by 8-kHz probes. A weak correlation was found between the degree of hydrops and a reduction in the compound action potential evoked by 2-kHz probes. Possible differences in the way the endolymphatic duct obliteration exerts its effect on the different cochlear potentials are discussed.
Beta-Adrenoceptor Control of Peroxidase Synthesis in Nasal Glands
Authors: Watanabe Kensuke , Harada Hiromi
Published: October 2014

Endogenous peroxidase activity was observed in the cisternae of the rough-surfaced endoplasmic reticulum (r-ER), including the nuclear envelope, Golgi complex, and secretory granules of the cat's nasal glands. A single injection of propranolol resulted in a decrease of peroxidase-positive secretory granules, an increase of electron-lucent granules, and no change in the level of peroxidase activity in the r-ER and Golgi complex at either 5 or 9 hours after the injection. Continuous administration of propranolol over 7 hours led to the disappearance of peroxidase activity from the r-ER and secretory granules. These data would indicate that propranolol inhibits only the synthesis of peroxidase. Twenty minutes after a single injection of isoproterenol, the rate at which the granule content containing the peroxidase reaction product was discharged into the acinar lumen increased sharply. However, 60 minutes after the injection, the secretion rate of peroxidase-positive granules decreased. The same experiment then was repeated, but this time before the isoproterenol was injected, propranolol was administered to the cats. This time no change in peroxidase activity appeared in the acinar cells. It was concluded, therefore, that the stimulation of β-receptors enhances the synthesis of peroxidase.
Nasopharyngeal Craniopharyngioma
Authors: Byrne Maria N. , Sessions Donald G.
Published: October 2014

Craniopharyngioma is an intracranial tumor that occurs rarely in the infrasellar region. Eight patients with craniopharyngioma located within the nasopharynx have been reported previously. These cases originated in the nasopharynx and involved the sella turcica (6), the sphenoid sinus (1), and the vomer (1). Craniopharyngioma usually originates intracranially. When there is no evidence of sellar involvement, the tumor most likely arises along the path of the craniopharyngeal duct. According to the neurosurgical literature, the optimal treatment consists of total surgical excision. Incomplete tumor removal is supplemented by adjunctive radiotherapy, which has been shown to significantly increase the survival rate. A patient with craniopharyngioma of the nasopharynx and paranasal sinuses who presented with nasal obstruction is reported. Radiographic studies were employed for tumor evaluation, and biopsy was done to establish the histopathologic diagnosis. Treatment included a combination of surgical excision and irradiation.
Melanosis of the Larynx
Authors: Har-El Gady , Borderon Marie , Ladinsky Sakiko , Santos Vladimir
Published: October 2014

A case of laryngeal melanosis is presented. This is followed by the analysis of the total of nine cases reported in the English literature. Patients are men in their sixth to eighth decade of life who present with hoarseness. Histopathologic findings include pigment deposits in the basal layer of the laryngeal epithelium. The possible relation of this lesion to carcinoma of the larynx is discussed.
Cervical Necrotizing Fasciitis: An Uncommon Sequela to Dental Infection
Authors: Moss Richard M. , Kunpittaya Sumet , Sorasuchart Acharee
Published: October 2014

Necrotizing fasciitis is a soft-tissue infection, usually polymicrobial, that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle. Although it more commonly involves the groin, abdomen, and extremities, it may also occur in the head and neck, usually secondary to dental infection. We report a case of cervical necrotizing fasciitis arising from a dental infection and review the cause, pathophysiology, diagnosis, and treatment of this potentially lethal entity. Early detection and intervention is emphasized. Extensive surgical debridement remains the mainstay of treatment. In addition, a clarification of the various eponyms it has gone under in the past is offered.
Histamine Stimulation of Mucociliary Activity in the Rabbit Maxillary Sinus
Authors: Dolata Jan , Lindberg Sven , Mercke Ulf
Published: October 2014

The in vivo effect of histamine on mucociliary activity in the rabbit maxillary sinus was investigated by injecting histamine into the maxillary artery and recording the responses with a photoelectric technique. Histamine stimulated the mucociliary activity dose-dependently in the dose range 10 to 1,000 μg/kg. The maximum response was 31.6% ± 3.7% at a dose of 50 μg/kg. The histamine-induced stimulation of the mucociliary activity was characterized by a short latency with a peak response within 1 to 2 minutes and a slow decline lasting about 5 minutes. The response displayed tachyphylaxis. Cholinergic blockade with atropine did not affect the response to histamine. Blockade of H1 receptors with pyrilamine abolished the response to histamine, whereas blockade of H2 receptors with cimetidine was without effect. The H2 agonist dimaprit failed to stimulate the mucociliary activity. It is concluded that histamine stimulates the mucociliary activity in the rabbit maxillary sinus via H1 receptors.
Vascular Injury following Foreign Body Perforation of the Esophagus
Authors: Scher Richard L. , Tegtmeyer Charles J. , McLean W. Copley
Published: October 2014

Esophageal perforation resulting from foreign body ingestion is a rare occurrence. Most of the complications associated with this event, such as retroesophageal abscess, mediastinitis, pericarditis, pneumothorax, and pneumomediastinum, are widely recognized. However, little attention has been directed to the possibility of vascular injury caused by the perforating object. Isolated case reports have described significant morbidity and mortality subsequent to major vascular trauma resulting from an esophageal foreign body, usually emphasizing the presence of a “signal” hemorrhage from the gastrointestinal tract as a key to diagnosis. This report describes a case of esophageal perforation caused by an ingested fishbone that resulted in significant aerodigestive hemorrhage, possibly as the result of an unusual isolated vascular injury. The literature on vascular trauma following foreign body perforation of the esophagus is reviewed, and suggestions for the diagnosis and treatment of these dreaded complications are made.
Diagnosis and Management of Cleft Larynx
Authors: Eriksen Christopher , Zwillenberg David , Robinson Nancy
Published: October 2014

Laryngeal cleft is a rare congenital laryngeal anomaly that has been recognized more frequently in recent years. It can be a serious problem, consisting of separation of the arytenoids with a fissure resulting from a defect in the fusion of the posterior cricoid cartilage lamina. Dysphagia with aspiration of food is commonly seen with resultant bouts of pneumonia. Surgical repair has been successful in a handful of cases. This communication will review our institution's recent handling of a case successfully treated. The epidemiology, embryology, classification, diagnosis, and suggested treatment regimen for laryngeal cleft will also be outlined.
Results of Microvascular Decompression of the Eighth Nerve as Treatment for Disabling Positional Vertigo
Authors: Møller Margareta B.
Published: October 2014

A total of 41 patients who underwent microvascular decompression to relieve disabling positional vertigo in one 12-month period were studied. At follow-up examinations 2½ to 3½ years after the operation, 30 patients had total relief of their symptoms or were considerably improved, to the point that they could resume normal work or other activities in which they were not able to engage before the operation. Two of the 41 patients had mild improvement, and the final 9 patients had no change in their symptoms. One patient, who had had a previous vestibular nerve section without improvement, underwent microvascular decompression of the stump as well as decompression of the opposite side with no relief; 3 of these 9 patients had clear signs of bilateral vestibular nerve compression, but elected not to undergo a second procedure at that time. One patient lost hearing as a result of the operation, and 1 who had a second operation suffered a hearing loss and subsequently underwent vestibular nerve section with improvement of the symptoms. Two patients had transient deficits related to cranial nerves IV and X. The remaining patients had no complications from the operation.
Interpreting the Sounds of Swallowing: Fluid Flow through the Cricopharyngeus
Authors: Hamlet Sandra L. , Nelson Richard J. , Patterson Robin L.
Published: October 2014

The sounds of swallowing in normal subjects were recorded by means of a miniature accelerometer on the throat, simultaneously with videofluoroscopy of a modified barium swallow. Consistent correspondence was found between a rapid change in the acoustic spectrum of the accelerometer signal (the appearance of a region of energy prominence above 1,000 Hz) and bolus flow through the cricopharyngeus.
Laryngeal Framework Reconstruction with Miniplates
Authors: Woo Peak
Published: October 2014

Defects of the laryngeal framework after trauma, cancer, and thyroplasty have been reconstructed with mini-reconstruction plates. Six patients had miniplates used to repair the thyroid cartilage defect after type I thyroplasty to prevent lateralization of the Silastic implant; three patients had miniplates used after hemilaryngectomy to bridge the thyroid cartilage remnants, resulting in better deglutition after hemilaryngectomy; and three patients had miniplates used to repair laryngeal fractures. The plates were tolerated well by the patients; there were no major complications. Rigid fixation using miniplates for laryngeal reconstruction has unique advantages over the use of wires. It offers the advantages of rigid and immediate stabilization with the ability to bridge large defects. It can be an alternative to existing techniques of laryngeal reconstruction.
Immunohistochemical Interpretation of Early Epithelial Disorders of Pyriform Sinus
Authors: Murakami Yasushi , Saito Yuko
Published: October 2014

Expression of cytokeratins (CKs) was investigated immunohistochemically by use of monospecific monoclonal anti-CK antibodies in normal epithelia of pyriform sinus and epithelial lesions such as simple hyperplasia, different degrees of dysplasia, in situ carcinoma, and invasive carcinoma. In normal epithelium, strong expression of CK-19 was consistently observed only in the basal layer as basic CK, while expression of CK-13 showed a completely reverse pattern, being expressed only in suprabasal layers as stratification-related CK. Characteristic changes in expression pattern of these two CKs were observed in accordance with the degree of epithelial disorders and differentiation of carcinoma. Cytokeratin 1, as keratinization-associated CK, was observed only in keratinized cells of hyperplastic epithelia and well-differentiated carcinomas. These findings may be useful in evaluating epithelial disorders and classifying carcinomas more objectively, and may assist earlier detection of carcinoma when used with standard histologic techniques.
Cochlear Implant Flap Complications
Authors: Wang Robert C. , Chute Patricia M. , Parisier Simon C. , Hellman Sharon A. , Weiss Michael H. , Sauris Edward
Published: October 2014

In a series of 52 patients who received cochlear implants, 4 patients suffered flap complications (7.7%). The problems encountered involved the postauricular flap and were usually minor in nature. None required explantation as a direct result of these complications. Flap ischemia in a patient with Cogan's syndrome and vasculitis, two cases of suture extrusion with one having exposure of the implant, and a case of receiver unit magnet extrusion repaired with a vascularized pericranial flap based upon temporalis muscle are presented. Flap design in patients who have had postauricular incisions demands special consideration. Principles useful for avoiding complications as well as their management are discussed.
Further Studies on the Effects of Magnetic Resonance Imaging Fields on Middle Ear Implants
Authors: Applebaum Edward L. , Valvassori Galdino E.
Published: October 2014

We investigated the effects of magnetic resonance imaging (MRI) fields on 21 stapedectomy prostheses and other middle ear implants and two different receiver-stimulator modules from 22-channel cochlear implants. None of the middle ear implants was displaced by the magnetic field, except for one platinum–stainless steel stapedectomy piston. Magnetism was not induced in any of the middle ear implants subjected to prolonged exposure in the MRI scanner. We conclude that MRI could pose a hazard to patients who have had stapedectomy using certain platinum–stainless steel piston prostheses and to patients with cochlear implants. Magnetic resonance imaging should pose no hazard to patients who have had the other middle ear implants reported on in this and our previous investigation.
Vestibular Recruitment in Meniere's Disease
Authors: Furman Joseph M. R. , Hyre Rick , Durrant John D. , Kamerer Donald B.
Published: October 2014

The aim of this study was to search for vestibular recruitment in a sample of patients with Meniere's disease. Recruitment was defined as an abnormal growth of response with increasing stimulus intensity. Twenty-nine patients were tested with sinusoidal rotation of three different magnitudes at four different frequencies. We also searched for auditory recruitment in each patient via tests of auditory brain stem responses, acoustic reflexes, and loudness balance and discomfort level. Analysis of vestibular responses indicated, on average, a linear relationship between stimulus magnitude and response magnitude, ie, doubling the stimulus magnitude resulted in twice the response magnitude. Meniere's patients did not yield results significantly different (although they were more variable) from those of the normal subjects. The vestibular responses of patients with auditory recruitment did not differ systematically from those of patients without auditory recruitment. We conclude that vestibular recruitment, if it exists in patients with Meniere's disease, is not demonstrated by sinusoidal rotational testing.
Identification and Characterization of Middle Ear Vascular Leakage Sites in Experimental Otitis Media
Authors: Goldie Pamela , Hellström Sten
Published: October 2014

The site of leakage in middle ear vessels was determined and characterized in experimental otitis media in rats. Middle ear effusion was induced by intravenous administration or local application in the tympanic bulla of substance P (SP), acetylcholine, and histamine. In another experiment, a 14°C airstream was blown into the external auditory canal. Colloidal carbon was used to trace leakage sites at the light and electron microscopic levels. All mediators tested and the 14°C airstream resulted in an increased number of leaking vessels in the pars flaccida and the middle ear mucosa. The leakage sites were restricted to capillaries and postcapillary venules. Increased numbers of degranulated pars flaccida mast cells were observed for SP only. Interendothelial gaps formed in leaking vessels after administration of mediators and stimulation of the external auditory canal with a 14°C airstream. Also, cytoplasmic vesicle-like structures within the endothelial cells increased in number following SP and histamine treatment, suggesting that an increased permeability in experimental otitis media does not occur exclusively through interendothelial gaps.
Delayed Endolymphatic Hydrops and its Relationship to Meniere's Disease
Authors: Schuknecht Harold F. , Suzuka Yuko , Zimmermann Corinna
Published: October 2014

Delayed endolymphatic hydrops (EH) can be characterized as having ipsilateral and contralateral types. They are similar in that both have early and late phases of otologic symptoms and that the early phase is a profound hearing loss in one ear. The late phases differ, however, in that the ipsilateral type develops the symptoms of EH (episodic vertigo) in the deaf ear and the contralateral type develops the symptoms of EH (fluctuating hearing loss and/or episodic vertigo) in the hearing ear. In more than half the cases of both types of delayed EH, the profound hearing losses in the early phase are simply discovered to be present in early childhood without a known time of onset. The temporal bones of two patients with contralateral delayed EH show pathologic changes in the deaf ears that are similar to those known to occur in mumps and measles labyrinthitis, whereas the pathologic changes in the hearing ears are similar to those known to occur in Meniere's disease. These observations support the proposition that Meniere's disease may occur as a delayed sequela of inner ear damage sustained during an attack of subclinical viral labyrinthitis occurring in childhood.
Dimensions of the Scala Tympani in the Human and Cat with Reference to Cochlear Implants
Authors: Hatsushika Shin-Ichi , Shepherd Robert K. , Tong Yit C. , Clark Graeme M. , Funasaka Sotaro
Published: October 2014

The width, height, and cross-sectional area of the scala tympani in both the human and cat were measured to provide dimensional information relevant to the design of scala tympani electrode arrays. Both the height and width of the human scala tympani decrease rapidly within the first 1.5 mm from the round window. Thereafter, they exhibit a gradual reduction in their dimension with increasing distance from the round window. The cross-sectional area of the human scala tympani reflects the changes observed in both the height and width. In contrast, the cat scala tympani exhibits a rapid decrease in its dimensions over the first 6 to 8 mm from the round window. However, beyond this point the cat scala tympani also exhibits a more gradual decrease in its dimensions. Finally, the width of the scala tympani, in both human and cat, is consistently greater than the height.
Morphometry of Ampullar Dark Cells
Authors: ten Cate Wouter J. F. , Rarey Kyle E.
Published: October 2014

The morphologic characteristics of rat ampullar dark cells were analyzed quantitatively. Four parameters were measured: Cell area per micron baseline length, membrane surface density, volume density of intercellular space, and volume density of vacuoles. No statistically significant difference was observed for any parameter, either between dark cell regions of the superior, lateral, and posterior ampullae or between different regions of dark cells within a given ampulla. The membrane surface density of the ampullar dark cells was similar to that reported for principal cells of the cortical collecting duct in the kidney. The volume density of the intercellular spaces of the dark cells was very constant, unlike that reported for epithelia involved in isotonic fluid transport. Vacuoles were found to comprise only a small portion of protoplasm in the dark cells. This new morphometry provides a basis on which to examine the response of ampullar dark cells to differing experimental conditions.
Tracheotomy in the First Year of Life
Authors: Gianoli Gerard J. , Miller Robert H. , Guarisco J. Lindhe
Published: October 2014

Much has been written concerning complications of pediatric tracheotomies, but few studies have reviewed the complication rates of tracheotomies performed in the first 12 months of life. We reviewed the records of 60 patients who underwent tracheotomy in the first year of life between 1976 and 1988. This study includes 30 full-term infants and 30 premature infants, 16 of whom were very low birth weight preterm infants (≤ 32 weeks' gestation and < 1,500 g birth weight). Overall complication rates were 3 % intraoperative, 13 % early postoperative, and 38% late postoperative. The early postoperative complication rate in preterm infants was nearly double that of full-term infants. The late postoperative complication rate of patients undergoing tracheotomy for airway obstruction was more than double that of patients requiring tracheotomy for pulmonary indications. Duration of tracheotomy, however, was felt to be the most important factor in the development of a late postoperative complication.
Systems Architecture for Quantification of Dynamic Myoelectric and Kinematic Activity of the Human Vocal Tract
Authors: Schaefer Steven D. , Freeman Frances , Roark Rick M. , Kondraske George , Butsch Robert W. , Watson Ben , Dembowski James
Published: October 2014

This paper describes a systems architecture useful for scientific investigations that require the acquisition and analysis of multiple, time-synchronous signals in large volume. The architecture has recently been developed by this group to enhance our capability to research and quantify central nervous system function in the production of normal and pathologic speech. The architecture utilizes modern advances in desktop microcomputers and has been designed so that vocal motor control laboratories (or similar settings) with modest funding can more fully participate in comprehensive investigations of speech production. Research experiments organized with this architecture may involve many more subjects and measures than previously possible without significant increases in time and personnel resources. This paper will demonstrate the technique and practicality of this architecture as it is being used to successfully guide research to map hierarchic central nervous system regions of involvement in two speech disorders: Spasmodic dysphonia and stuttering. The architecture has broad usefulness to many areas of otolaryngology and health science.
Titration Streptomycin Therapy for Bilateral Meniere's Disease
Authors: Langman Alan W. , Kemink John L. , Graham Malcolm D.
Published: October 2014

Initial reports of the use of parenteral streptomycin for bilateral Meniere's disease (MD) have demonstrated success in reducing the vestibular symptoms and, in some patients, stabilizing hearing. The long-term follow-up (mean, 5.1 years) of 19 patients treated with intramuscular streptomycin for bilateral MD is presented. The amount of streptomycin administered (5 to 50 g) was determined by clinical symptoms and by serial testing of the reduction in the slow-phase velocity on electronystagmography. Episodic vertigo was totally relieved in 12 patients and improved in severity and frequency in an additional 4 patients. Permanent posttreatment dysequilibrium occurred in 47% of the patients treated. The changes in hearing (speech reception threshold) were independent of the therapeutic effect of streptomycin on the vestibular system. The overall results suggest that the intramuscular titration of streptomycin should continue to be considered as one of the therapeutic options in patients with disabling vertigo due to bilateral MD.
Histopathologic Grading of Salivary Gland Neoplasms: II. Acinic Cell Carcinomas
Authors: Batsakis John G. , Luna Mario A. , El-Naggar Adel K.
Published: October 2014

Acinic cell carcinomas display varied cytoarchitectural patterns of growth that should allow for formulation of histopathologic grading. Grading of these carcinomas may serve to identify subsets whose biologic behavior is more aggressive than the usually accepted low-grade behavior of acinic cell carcinomas as a group. To that end, a three-level histopathologic grading scheme is presented.
Platysma Myocutaneous Flap for Repair of Hypopharyngeal Strictures
Authors: Friedman Michael , Schild Joyce A. , Venkatesan T. K.
Published: October 2014

Hypopharyngeal strictures, either isolated or in conjunction with laryngeal and esophageal strictures, can occur following lye ingestion. Extensive stricture formation requires reconstruction to create a functional funnel system that empties below the cricoid. Esophageal replacement is not a substitute for adequate hypopharyngeal reconstruction. The pectoralis major muscle is often inadequate, because it yields too much bulk and often leads to continued aspiration. The platysma myocutaneous flap for hyopharyngeal reconstruction has not been previously reported. The inferiorly based platysma myocutaneous flap was used in two of our patients with lye burns, and bilateral superiorly based flaps were used in one. All are able to eat normally and have no significant stenosis. The platysma myocutaneous flap is a relatively simple and reliable alternative that is within the capability of every head and neck surgeon.
Microbiology of “Normal” Tonsils
Authors: Brook Itzhak , Foote Perry A.
Published: October 2014

Core tonsillar cultures for aerobic and anaerobic bacteria were performed on four normal tonsils removed from four children because of velopharyngeal insufficiency and on four tonsils removed from four children because of recurrent tonsillitis. The data illustrate the presence of polymicrobial flora in the cores of normal noninflamed tonsils and the increase in their number and encapsulation during the inflammatory process.
Histologic Study of Eustachian Tube Cartilage with and without Congenital Anomalies: A Preliminary Study
Authors: Yamaguchi Nobumasa , Sando Isamu , Takahashi Haruo , Hashida Yoshie , Matsune Shoji
Published: October 2014

We investigated histopathologically the development of the eustachian tube (ET) cartilage at a cellular level in individuals with and without congenital anomalies. Fourteen specimens were obtained from 14 individuals ranging in age from 24 weeks' gestation to 3 years who had cleft palate or trisomy 21 (Down) syndrome; the 49 specimens in the nonanomaly (control) group were from 49 individuals ranging from 26 weeks' gestation to 85 years of age. All temporal bone specimens included the ET and its accessory structures, and all were processed and stained with hematoxylin and eosin for histologic study in a routine manner. The number of cartilage cells in the midcartilaginous portion of the ET was determined by light microscopy. In all groups, cartilage cell density of the ET decreased with increasing age. However, cell density tended to be higher at all ages for individuals with cleft palate and microtia versus controls, and tended to be lower at all ages for individuals with Down syndrome.
Age-Related Changes in Evoked Otoacoustic Emissions
Authors: Collet Lionel , Moulin Annie , Gartner Myriam , Morgon Alain
Published: October 2014

Outer hair cells of the organ of Corti play an important part in the genesis of evoked otoacoustic emissions (EOAEs), which are related to cochlear biomechanics. The aim of this study was to investigate the age factor in relation to EOAEs in 166 ears of subjects between 6 weeks and 83 years of age. The results show that when age increases, the presence of EOAEs by age group and the frequency peak in spectral analysis decrease, and EOAE threshold increases. Thus, there is an effect of age upon EOAEs, and it seems linked with alteration of cochlear biomechanics and/or hair cell loss. Such an effect has to be taken into consideration when EOAEs are used in clinical applications, and limits the use of EOAEs in older subjects.
Histopathologic Grading of Salivary Gland Neoplasms: III. Adenoid Cystic Carcinomas
Authors: Batsakis John G. , Luna Mario A. , El-Naggar Adel
Published: October 2014

Histopathologic grading of adenoid cystic carcinomas can provide valuable prognostic information, particularly when the presence or absence of a solid growth architecture is noted. Other growth patterns, exemplified by a tubuloductal or cribriform-cylindromatous differentiation, are associated with a more protracted biologic course and less rapid mortality. A three-tiered grading system based on the three growth patterns of the carcinoma is presented.
Recurrent Laryngeal Nerve Avulsion for Treatment of Spastic Dysphonia
Authors: Netterville James L. , Stone R. E. , Zealear David L. , Rainey Cheryl , Ossoff Robert H.
Published: October 2014

Treatment of spastic dysphonia by recurrent laryngeal nerve section has resulted in reproducibly good results in the early postoperative period in most patients. However, critical long-term follow-up has shown a high recurrence rate of adductor spasms by the third year after initial nerve section. A patient who developed recurring adductor spasms 1 year after nerve section was reexplored, with identification of neural regrowth into the distal segment of the recurrent laryngeal nerve. The technique of neural avulsion removing the distal nerve up to its insertion into the laryngeal muscles is described. Neural regrowth, which is just one of the possible mechanisms for recurrence of spastic dysphonia, should be prevented by this surgical modification. Twelve patients who have undergone neural avulsion primarily for spastic dysphonia are being followed up without recurrence of symptoms thus far. Although these results appear promising, this short follow-up that averages 1.5 years must be extended to firmly support these concepts.
Laryngeal Changes during Exercise and Exercise-Induced Asthma
Authors: Hurbis Charles G. , Schild Joyce A.
Published: October 2014

Exercise-induced asthma is defined as bronchospasm within the distal airways initiated by exercise. Whether the larynx responds to produce an exacerbation or alleviation of symptoms during an attack has never been evaluated. Thirty subjects were tested, including 15 normals and 15 with exercise-induced asthma. Laryngeal response to exercise was determined by measuring the area of the glottic aperture before, during, and after exercise. The glottis was visualized with a flexible laryngoscope and video images were recorded during monitoring of respirations. Asthma was induced in subjects by having them exercise on an ergometer for 10 minutes while breathing dry air at 10°C. Measurements were subsequently made from recorded images and relative glottic areas were compared between groups. Our data quantify the normal physiologic response of the larynx to exercise and demonstrate a substantial laryngeal contribution to asthma induced by exercise.
Contemporary Management of Neurofibromatosis
Authors: Miyamoto Richard T. , Campbell Robert L. , Roos Karen L. , Worth Robert M.
Published: October 2014

The neurofibromatoses are two distinct entities with different genetic origins. The phenotypic expressions and required treatments are different. The devastating nature of neurofibromatosis-2 may be more effectively controlled through the application of advanced imaging techniques and contemporary neurotologic procedures. The most common manifestation of neurofibromatosis-2 is that of bilateral acoustic neuromas. The eventual total bilateral sensorineural deafness associated with this condition can be obviated in selected cases if the diagnosis is established early. Follow-up data are reported for three patients in whom hearing was preserved in at least one ear. When removal with hearing preservation is not possible, subtotal tumor removal with decompression of the internal auditory canals may delay progression of hearing loss. A new approach to tumors of the pterygomaxillary fossa that have extended to the middle cranial fossa has been successfully applied and is described.
Measurement of Human Cochlear Blood Flow
Authors: Miller Josef M. , Suonpää J. , Bredberg Goran , Lindström Bo , Grenman Reidar , Didier Anne
Published: October 2014

Cochlear blood flow (CBF) was measured with a laser-Doppler (L-D) flowmeter (Periflux PR2-B) in four unanesthetized human subjects with chronic tympanic membrane perforations and nine anesthetized human subjects undergoing middle ear operations. The L-D recordings were made over the promontory and/or the round window membrane during carbogen breathing and direct electrical stimulation of the cochlea in both groups and with warm water irrigation of the external ear canal in the anesthetized subjects. Carbogen led to little or no change in CBF as monitored with either measurement approach in either subject group. Electrical stimulation yielded an increase (15 % to 25%) in CBF as recorded from the promontory in seven of the nine subjects tested. Warm (44°C to 49°C) water irrigation produced changes of 20 % to 60 % in CBF that were partially recoverable in the 10 minutes available for study. This study demonstrated the feasibility of direct CBF measurement in humans with the L-D method. Moreover, the data indicate that carbogen has little influence on CBF and that electrical stimulation at relatively safe levels and warm water irrigation of the ear canal produce increases in human CBF.
Vertical Partial Laryngectomy: A Critical Analysis of Local Recurrence
Authors: Laccourreye Ollivier , Weinstein Gregory , Trotoux Jacques , Brasnu Daniel , Laccourreye Henri
Published: October 2014

The purpose of this study was to evaluate local recurrence following vertical partial laryngectomies in 416 patients with either T1N0M0 or T2N0M0 glottic carcinoma. Local failure was reported according to the T stage, the precise tumor location within each stage, the true vocal cord mobility, and the surgical procedure performed. No local recurrences were observed among 42 patients who underwent thyrotomy and cordectomy when the tumor was confined to the middle third of the mobile true vocal cord. Local failure occurred in 8 of 111 (7.2%) patients in whom hemilaryngectomy was performed for tumors confined to one mobile true vocal cord. There was a diverse group of lesions within each T stage that responded differently to the surgical approaches. The differences in the initial recurrence rates are discussed in terms of careful preoperative assessment and choice of surgical technique for early glottic carcinoma.
Hemangioma of the Temporalis Muscle
Authors: Sharma Bhawani S. , Joshi Kusum , Chari Padmanabha S. , Rajvanshi Arvind
Published: October 2014

A rare case of an intramuscular hemangioma of the temporalis muscle is reported. The clinical examination, carotid arteriogram, computed tomographic scan, and aspiration cytology suggested the vascular nature of the tumor, but an exact diagnosis could only be made after histopathologic examination. Temporary occlusion of the ipsilateral external carotid artery and subperiosteal dissection permitted complete, wide excision without much bleeding.
Laryngeal Dystonia: A Series with Botulinum Toxin Therapy
Authors: Blitzer Andrew , Brin Mitchell F.
Published: October 2014

Laryngeal dystonia is a syndrome characterized by action-induced, involuntary spasms of the laryngeal muscles. Most patients have involvement of the adductor laryngeal muscles producing uncontrolled spasms during phonation, and a “strain-strangle” speech pattern commonly termed “spastic dysphonia.” Other patients have involvement of the abductor muscles producing “whispering dysphonia.” Rare patients have paradoxical vocal cord motion during respiration with adductor spasms on inspiration. Over the past 5 years we have used botulinum toxin (BOTOX) to treat more than 200 patients with laryngeal dystonia. This group includes patients with adductor involvement (phonatory dystonia, recurrent laryngeal nerve section failure, respiratory dystonia) and those with abductor involvement (whispering dystonia). Patients received benefit within 24 to 72 hours, with sustained improvement for 2 to 9 months with an average of 4 months. Patients improved to an average of 90% of normal function. Clinically significant adverse effects included extended breathy dysphonia and mild choking on fluids. BOTOX has become our treatment of choice for dystonic conditions of the larynx.
Transtracheal Delivery of Oxygen: Efficacy and Safety for Long-Term Continuous Therapy
Authors: Johnson Jonas T. , Ferson Peter F. , Hoffman Leslie A. , Wesmiller Susan W. , Mazzocco Marion C. , Sciurba Frank C. , Dauber James H.
Published: October 2014

Transtracheal (TT) oxygen delivery involves administration of oxygen percutaneously through a catheter inserted in the suprasternal trachea. Transtracheal oxygen delivery has been proposed as a means of overcoming the high visibility, inconvenience, and discomfort associated with nasal cannula use. This report describes our experience using TT delivery in 40 patients with chronic obstructive pulmonary disease (n = 32) and other types of lung disease (n = 8). Overall acceptance of TT catheter use was high and only 5 subjects elected to discontinue use. We believe the TT route is a relatively safe approach for oxygen administration and a promising method of improving patient compliance. It also offers the potential of more adequately oxygenating patients with refractory hypoxemia.
Surgical Voice Restoration with the Blom-Singer Prosthesis following Laryngopharyngoesophagectomy and Pharyngogastric Anastomosis
Authors: Bleach Nigel , Perry Alison , Cheesman Anthony
Published: October 2014

Surgical voice restoration using the Blom-Singer technique is a well-established procedure in patients who have undergone simple laryngectomy. Operations for hypopharyngeal carcinoma are more extensive and require reconstruction using regional skin or myocutaneous flaps, or reanastomosis with colon, jejunum, or stomach. We report the use of the Blom-Singer prosthesis in four patients who had undergone pharyngogastric repair following laryngopharyngoesophagectomy and who had failed to achieve a satisfactory voice. All patients initially developed good speech using the prosthesis. Two patients subsequently had their prostheses removed: One because of recurrent malignant disease and one because the procedure had not significantly altered the quality of the voice. The remaining two patients have continued to use the device at 2 and 5 years after insertion with good voice production.
Histologic Evaluation of the Larynx in Sudden Infant Death Syndrome
Authors: Harrison Donald F. N.
Published: October 2014

Seventy-four larynges removed at death from children who died of sudden infant death syndrome (SIDS) have been studied by serial sectioning in the transverse plane. An increase in subepithelial glandular tissue is seen in many specimens, and the reduction in the available subglottic area has been measured with the Measuremouse Image Intensifying system. This preliminary report confirms that in some of these children with SIDS, particularly around the age of 3 months, there is a potentially lethal reduction in subglottic airway secondary to an increase in mucus-secreting glands, possibly from an associated mild upper respiratory tract infection. Accepting that adequate control infants within this age group who have not had any trauma to the laryngotracheal area are not available, these findings offer a possible explanation for what are always tragic events.
Radiographically Confirmed Cochlear Otospongiosis among the Chinese
Authors: Huang Tsun-Sheng , Lee Fei-Peng , Chen Liang-Kuang
Published: October 2014

A high-resolution computed tomography (HRCT) study on 55 patients with surgically confirmed clinical otosclerosis confirms the existence of cochlear otospongiosis among the Chinese. Positive radiographic results of cochlear otospongiosis (13 ears, 12%) were found in patients with mixed-type deafness but in none with conductive hearing loss. Although there is a positive correlation between audiologic and radiographic findings, the HRCT results showed a lower positive rate and less severity than anticipated from the audiologic results. However, compared with the occurrence and extension of radiographic findings in similar studies of white people, it would seem to support our previous contention that the disease is indeed milder in Chinese people. Cochlear otospongiosis with extensive labyrinthine demineralization was found in three young patients with rapidly progressive hearing loss. This is important evidence of the overlooked fact that cochlear otospongiosis may also be one of the causes of sensorineural hearing loss in the Chinese. Thus, a high index of suspicion of the existence of this inner ear disorder is of paramount importance, and in such cases an HRCT study should be performed and sodium fluoride given to prevent further hearing deterioration.
Pathophysiology of Streptococcus Pneumoniae Otitis Media: Kinetics of the Middle Ear Biochemical and Cytologic Host Responses
Authors: Nonomura Naobumi , Giebink G. Scott , Harada Teruhiko , Juhn Steven K. , Aeppli Dorothee
Published: October 2014

Streptococcus pneumoniae is an important bacterial pathogen in the pathophysiology of otitis media. To elucidate the inflammatory responses that occur during pneumococcal otitis media, the kinetics of the biochemical and cytologic middle ear responses to heat-killed encapsulated and nonencapsulated pneumococci were studied in the chinchilla model. Inoculation of the middle ear cavity with at least 106 S pneumoniae cells induced an early, brief vascular response with leakage of small (albumin) followed by larger (α2-macroglobulin) proteins, followed by sustained influx of acute inflammatory cells and lysozyme. The threshold for a sustained lysozyme response was 1,000 times lower for nonencapsulated than for encapsulated pneumococci. These results indicate that nonviable S pneumoniae organisms with an intact envelope initiate the middle ear inflammatory response. Therefore, interventions that enhance the clearance of pneumococcal cells from the middle ear may reduce the inflammatory response and prevent chronic middle ear inflammation.
Terminal Duct Adenocarcinomas of Salivary Tissues
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Terminal duct adenocarcinoma is recommended as an encompassing diagnostic designation for a preponderantly intraoral salivary gland carcinoma that has also gone under the names of polymorphous low-grade adenocarcinoma, lobular carcinoma, and low-grade papillary adenocarcinoma. The carcinoma is biologically low grade, with its papillary phenotype manifesting a more aggressive behavior than nonpapillary forms.
Role of Partial Laryngectomy after Irradiation in the Treatment of Laryngeal Cancer: A View from the United Kingdom
Authors: Shaw Henry J.
Published: October 2014

This retrospective study evaluates the use of conservation surgical salvage techniques in cases of early (T1 and T2) laryngeal cancer after full-dose external irradiation. Fifty patients in one London hospital and 68 patients in another were studied for the period 1963 to 1988. Treatment policy directed that the majority of limited glottic and supraglottic tumors should be treated initially by external irradiation. The small number of glottic treatment failures had a good chance of salvage by vertical partial laryngectomy if recurrence or a new primary was detected early. Recurrence of supraglottic cancer was salvaged occasionally by horizontal partial laryngectomy if strict indications were observed. Total laryngectomy remained the final minority salvage option.
Recurrent Laryngeal Nerve Section for Spastic Dysphonia: 5- to 14-Year Preliminary Results in the First 300 Patients
Authors: Dedo Herbert H. , Behlau Mara S.
Published: October 2014

This presentation compares the preoperative voice recordings and the latest follow-up voice recordings, made 5 to 14 years postoperatively, of the first 300 patients with various degrees of spastic dysphonia whom we treated with recurrent laryngeal nerve (RLN) sections from 1975 to 1982. Voice therapy was usually given afterward and in some patients, when necessary, “fine tuning” surgery was performed later. The 243 patients who could be located were asked to answer a questionnaire regarding their voice production and communication abilities, and to make a voice recording. The preoperative and long-term postoperative voice recordings were analyzed by means of perceptual voice evaluation and acoustic analysis of the voice spectra. Fifteen percent developed recurrence of mild to moderate spasticity 6 to 24 months after the RLN section. This was curable with laser vocal cord thinning via direct laryngoscopy. Eighty-two percent of patients had little or no voice spasticity 5 to 14 years after their RLN section. The experimental alternative of injecting botulin directly into the vocal cord to temporarily paralyze it is discussed.
Vocal Fold Medialization by Surgical Augmentation versus Arytenoid Adduction in the in vivo Canine Model
Authors: Green David C. , Berke Gerald S. , Ward Paul H.
Published: October 2014

There are a variety of methods for treating unilateral vocal cord paralysis, but to date there have been few studies that compare these phonosurgical techniques by using objective measures of voice improvement. Vocal efficiency is an objective voice measure that is defined as the ratio of the acoustic power produced by the larynx to the subglottic air power. Vocal efficiency has been found to decrease with glottic disorders such as vocal cord paralysis and carcinoma. This study compared the effects of vocal fold medialization by surgical augmentation to those of arytenoid adduction on the vocal efficiency, videostroboscopy, and acoustics (jitter, shimmer, and signal-to-noise ratio) of a simulated unilateral vocal cord paralysis in an in vivo canine model. Arytenoid adduction was superior to surgical augmentation in vocal efficiency, traveling wave motion, and acoustics.