bluuebunny/crossref_metadata_2025 huggingface dataset:
Cellular Proliferation of Mucosa-Associated Lymphoid Tissue with Otitis Media: A Preliminary Study
Authors: Haginomori Shin-Ichi , Balaban Carey D. , Takasaki Kenji , Miura Makoto , Sando Isamu
Published: October 2014

Histopathologic and immunohistochemical analyses were used to investigate the cellular proliferation of mucosa-associated lymphoid tissue (MALT) in human temporal bones with and without evidence of otitis media (OM). Anti–proliferating cell nuclear antigen (PCNA) antibody (clone PC10) was applied after the antigen retrieval procedure. Positive PCNA expression was observed in temporal bones that had been stored for 10 to 31 years in 80% ethanol. In specimens with purulent OM, the MALT had faint germinal centers (GCs). Positive PCNA expression in the MALT was moderate and scattered. In specimens with mucous OM, the MALT had complete GCs. Positive PCNA expression in the MALT was moderate to strong, and the distribution of PCNA-positive cells was associated predominantly in the GCs, the mucosal epithelial layer, and/or the subepithelial layer. In specimens with serous OM, the MALT also had complete GCs. However, the PCNA expression was weak and scattered, and appeared to be similar to that of the MALT in the temporal bones without OM. These results indicate that the cellular proliferation of MALT in the temporal bone might reflect the activity that produces secretory IgA against invasion of foreign antigens. However, further studies are needed to elucidate whether the PCNA expression within MALT in the eustachian tube and middle ear is associated with a mucosal immune response to inflammation as in OM.
Effects of Prednisone and Ibuprofen on Radio Frequency Volume Tissue Reduction in a Rabbit Model
Authors: Han Joseph K. , Woodson B. Tucker
Published: October 2014

This study investigates whether acute anti-inflammatory medications (prednisone and ibuprofen) alter muscle volumetric reduction following radio frequency tissue ablation (RFTA). We used a rabbit model to measure changes in leg muscle volume using serial magnetic resonance imaging in 3 groups: RFTA without medication (group 1), RFTA with prednisone and ibuprofen (group 2), and no RFTA or medication (group 3). The mean volumetric changes for groups 1 and 2 differed on days 1 and 7 (+0.5 cm3 versus −0.4 cm3, p < .0001; and −0.03 cm3 versus −0.7 cm3, p < .05), but not on day 28 (−0.8 cm3 versus −1.0 cm3, not significant). Group 3 had no change in volume. The volumetric reduction varied. Impaired volumetric reduction (<50% mean change) occurred in 30% of extremities and correlated to lower tissue impedance (p < .04). Combined steroidal and nonsteroidal anti-inflammatory medications did decrease acute edema, but not the final volumetric reduction, following RFTA. Volumetric changes are variable and may be altered by tissue impedance.
Sensitivity and Specificity of Intraoperative Recurrent Laryngeal Nerve Stimulation in Predicting Postoperative Nerve Paralysis
Authors: Otto Randal A. , Cochran C. Spencer
Published: October 2014

Bilateral recurrent laryngeal nerve (RLN) paralysis after thyroidectomy is infrequent, but serious when it occurs. Intraoperative knowledge of the status of the nerve after dissection could potentially provide the surgeon with important decision-making information. The current study examines the sensitivity and specificity of intraoperative stimulation of the RLN during thyroid surgery for predicting postoperative RLN deficits. Eighty-one RLNs in 55 patients were identified to be at risk of injury during thyroidectomy or parathyroidectomy performed between January 1998 and February 2000. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator (Xomed, Jacksonville, Florida) set at 0.5 mA. Injury was assessed by palpating for a contraction of the posterior cricoarytenoid muscle while the stimulus was applied. Postoperative assessment of RLN integrity was determined by using indirect or direct laryngoscopy to visualize vocal fold mobility. Nine RLNs failed to elicit a posterior cricoarytenoid contraction after nerve stimulation, and 4 RLNs were determined to be deficient in the postoperative evaluation. The calculated sensitivity and specificity were 75% and 92.2% with a positive predictive value of 33.3% and negative predictive value of 98.6%. The RLN injury rate was 4.94%. We conclude that intraoperative RLN stimulation is a relatively safe and useful method of determining what RLN function will be after thyroid or parathyroid surgery.
Incidence of Cochlear Involvement in Hyperbilirubinemic Deafness
Authors: Oysu Cagatay , Ulubil Arif , Aslan Ismet , Baserer Nermin
Published: October 2014

Neonatal hyperbilirubinemia remains an important cause of childhood deafness, especially in developing countries. After neonatal hyperbilirubinemia, the auditory neural pathways, cochlea, or both may be affected. In this study, we aimed to determine the incidence of cochlear impairment and the appropriate means of hearing screening in hyperbilirubinemic neonates. A retrospective review of 1,032 pediatric patients with hearing loss revealed 67 cases (6.5%) of severe hyperbilirubinemia in the neonatal period. Thirty of these patients had neonatal hyperbilirubinemia as the single identifiable risk factor for hearing loss. In 26 of 30 cases (87%), otoacoustic emissions (OAEs) were absent, whereas in the remaining 4 cases (13%), robust emissions were detected despite an absent auditory brain stem response (ABR). Auditory screening of newborns with jaundice by OAEs possesses a significant risk of undiagnosed deafness. On the other hand, if the ABR is used as the single means of screening, auditory neuropathic conditions will probably be underlooked. Therefore, we recommend dual screening of hearing by ABR and OAEs in hyperbilirubinemic newborns.
Role of Medialization in the Improvement of Breath Control in Unilateral Vocal Fold Paralysis
Authors: Périé Sophie , Chaigneau-Debono Géraldine , Roubeau Bernard , Bruel Magali , Liesenfelt Isabelle , St Guily Jean Lacau
Published: October 2014

A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory function in unilateral vocal fold paralysis and the role of medialization in the improvement of breath control. In addition to physical examination, an acoustic and aerodynamic analysis, as well as patient self-assessment, were performed both before and after medialization (14 fat injections, 4 thyroplasties) to evaluate voice and both phonatory breath control and respiratory function outcome. Preoperative and postoperative results, at short, middle, and long term, were compared to data from 14 control subjects and evaluated by statistical analysis. Preoperative acoustic and aerodynamic parameters were significantly disturbed in comparison to controls. Independently of the pulmonary status, medialization induced an improvement in most of the parameters at short and long terms, whereas a diminished effect was observed at middle term. Phonatory breath control, as evaluated by maximum phonation time, mean flow rate, and expired volume, was statistically improved, with the best results being obtained in women. From the questionnaire, it was clear that voice, as well as phonatory breath control and respiratory function, showed considerable improvement, although some difficulties persisted during effort. This study demonstrates that there is a disturbance of phonatory breath control and respiratory function in adult unilateral vocal fold paralysis. Improvement following medialization supports the concept that the respiratory dysfunction seen beforehand is most probably the result of air escape rather than laryngeal obstruction. Although medialization may provoke an extrathoracic obstruction, its feature of variability appears to improve breath control.
Otolaryngological Surgery and Upper Respiratory Tract Infections in Children: An Epidemiological Study
Authors: Kværner Kari J. , Nafstad Per , Jaakkola Jouni J. K.
Published: October 2014

The objective of the study was to assess the occurrence of different procedures of upper airway surgery and estimate their relationship to specific upper respiratory tract infections and constitutional factors. In a population-based cross-sectional study in Oslo, Norway, of 3,763 preschool children 3 to 4 years of age, the otolaryngological surgeries adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion, and combinations of these were the outcome measures. The results showed that by 4 years of age, 13% (n = 501) had undergone operation, and approximately Two thirds of the operations involved middle ear surgery. Although surgery was related to the occurrence of upper respiratory tract infections, the type of surgery was not related to the specific infection. In the children with operations, the occurrence of recurrent otitis media (≥3 infections in the previous 12 months) was almost fivefold higher than in children without operations (adjusted adds ratio [ORadj] = 5.19 [3.15 to 8.54]). A low level of maternal education (ORadj = 1.61 [1.05 to 2.7] compared to the group with a high level of education) and atopy on the part of the child (ORadj = 1.58 [1.20 to 2.07]) increased the probability for upper airway surgery independently of the experience of infections. In conclusion, early pediatric otolaryngological surgery is common. The decisions for surgical treatment vary substantially and are not closely related to the specific infections. The influence of other factors such as maternal education indicates that decisions for surgery are not entirely based on medical evidence.
Analysis of Spiral Ganglion Cell Populations in Children with Normal and Pathological Ears
Authors: Miura Makoto , Hirsch Barry E. , Sando Isamu , Orita Yorihisa
Published: October 2014

This study analyzed features of total and segmental spiral ganglion cell populations in children with normal ears and those with various pathological conditions. Sixty-three human temporal bone specimens, obtained from 43 children 4 days to 9 years of age, were studied histopathologically. These specimens were divided into 5 diagnostic groups: group 1, normal ears (13 ears); group 2, congenital infectious diseases (13 ears); group 3, chromosomal aberrations (11 ears); group 4, multiple craniofacial anomalies with hereditary or genetic causes (21 ears); and group 5, perinatal and postnatal asphyxia (5 ears). Eighteen of the 63 ears had documented profound deafness. In either normal ears (group 1) or those with various pathological conditions (groups 2 through 5), the total number of ganglion cells did not change as a function of age during the first 10 years. The total number of ganglion cells was significantly larger in group 1 (33,702) than in each of groups 2, 3, 4, and 5 (p < .01), and the number was significantly larger in group 2 than in each of groups 4 and 5 (p < .01 and p < .05, respectively). The ratio of basal to apical ganglion cell populations remained constant in both normal and pathological ears. Each ratio of the number of basal and apical ganglion cells in groups 2, 3, 4, and 5 to the mean number in group 1 (basal and apical survival ratios) was at least approximately 40%. There was no statistical difference between these Two ratios in groups 2, 3, 4, and 5. The mean (±SD) total number of ganglion cells in ears with documented profound deafness was 15,417 ± 5,944, which is approximately 40% of those present in normal ears. Our results suggest that normally, cochlear neurons are completely present at birth and minimally regress during the first decade of life. In addition, although intergroup differences among various pathological groups were present, the majority of pathological ears had more than 10,000 spiral ganglion cells present. Cochlear implantation has gradually been recognized as an effective and reliable tool for rehabilitation of children who have profound deafness, even congenitally or prelingually deafened children. On the basis of the results obtained in this study, we discuss the implications for cochlear implantation in children.
Nasal Polyposis in Children with Cystic Fibrosis: A Long-Term Follow-up Study
Authors: Yung Matthew W. , Gould Jim , Upton Graham J. G.
Published: October 2014

The incidence of nasal polyposis among children 5 to 18 years of age with cystic fibrosis (CF) was investigated with a systematic examination of all children on the local CF register. Out of 23 children with CF, 13 had endoscopic evidence of nasal polyposis. Four children had grade 2 polyposis, and 9 children had grade 3 polyposis. Complete opacity of the maxillary sinus was identified on a computed tomographic sinus scan in all but 2 of the children. Only 1 child had a developed frontal sinus. Between 1989 and 2000, 12 children underwent radical endoscopic sinus surgery for their nasal polyposis. There was good postoperative improvement in all of the children; however, 7 eventually required revision surgery because of recurrence of the nasal polyps. The median interval between repeated sinus surgeries was 4 years (range, 18 months to more than 6 years). This information can help in the counseling of parents when sinus surgery is considered for children with CF.
Glucocorticoid-Induced Differential Expression of the Sialylated and Nonsialylated Lewisa Epitopes and Respective Binding Sites in Human Nasal Polyps Maintained under ex vivo Tissue Culture Conditions
Authors: Delbrouck Carine , Nifant'ev Nikolay E. , Gabius Hans-Joachim , Kaltner Herbert , Bovin Nicolai V. , Kiss Robert , Danguy André , Vandenhoven Guy , Hassid Sergio
Published: October 2014

We characterized the anti-inflammatory effects of budesonide on the expression of adhesion molecules involving Lewisa (Lea) epitope, its sialylated derivative (sLea), and their respective binding sites in human nasal polyposis. By computer-assisted microscopy, we quantitatively characterized the level of histochemical expression of L- and P-selectins, sialylated and nonsialylated Lea epitopes, and their respective binding sites in both surface epithelium and glandular epithelium of human nasal polyps obtained from surgical resection, maintained under ex vivo tissue culture conditions for 24 hours, and treated or not with budesonide. Intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) were chosen as methodological controls, because data already published in the literature clearly indicated budesonide-mediated effects on ICAM-1 and VCAM-1 levels of expression. The present data show that budesonide significantly modified the levels of expression of ICAM-1 and VCAM-1, and to a lesser extent that of P-selectin, in the surface and glandular epithelia. Budesonide markedly decreased the levels of expression of the binding sites for both Lea and sLea, while those of Lea and sLea remained globally unchanged. In conclusion, the present study documents that glucocorticoid-induced effects can encompass receptors for Lea epitopes different from E- and P-selectins on epithelial cells of human nasal polyps.
Effects of Clarion Electrode Design on Mapping Levels in Children
Authors: Franck Kevin H. , Marsh Roger R. , Shah Udayan K. , Potsic William P.
Published: October 2014

The design of the placement of the Clarion cochlear implant's intracochlear electrode array has undergone 2 revisions since its introduction, each to improve modiolar proximity. Stimulation with modiolar proximity may reduce current requirements for threshold levels and most comfortable levels of stimulation. This study analyzed the effects of electrode design on programming levels for deaf children implanted with the 3 cochlear implant designs and followed at The Children's Hospital of Philadelphia. Psychophysical data were reported if measurements were taken approximately 3 months after initial activation, and programming parameters included nonsequential monopolar stimulation of 75-μs-per-phase biphasic pulses presented at 813 Hz per electrode. The threshold level and most comfortable programming level were measured by standard clinical techniques appropriate for children. The results indicate that the 2 electrode placement revisions have each significantly reduced threshold levels and most comfortable stimulation levels. These results are discussed in the context of device aesthetics, safety, and function.
Localization of Glucocorticoid Receptors in the Murine Inner Ear
Authors: Shimazaki Toshiki , Suzuki Masashi , Ichimiya Issei , Mogi Goro
Published: October 2014

We performed an immunohistochemical investigation of the distribution of glucocorticoid receptors (GRs) in the murine inner ear and found that GRs were expressed extensively, but with various degrees of immunoreactivity in different regions. We observed the strongest GR expression in the type III fibrocytes of the spiral ligament. Although the immunoreactivity of the cochlear hair cells and of the vestibular sensory epithelia was weak, the neighboring cochlear supporting cells and the subepithelial regions of the vestibular sensory epithelia were immunostained. Staining for GRs was also positive in the spiral ganglia and vestibular ganglia, as well as in the endolymphatic sac. The role of GRs in the inner ear is discussed.
Topical Nasal Anesthesia and Laryngopharyngeal Sensory Testing: A Prospective, Double-Blind Crossover Study
Authors: Johnson Paul E. , Belafsky Peter C. , Postma Gregory N.
Published: October 2014

Laryngopharyngeal sensory discrimination testing (LPSDT) has become a popular means of detecting sensory deficits in patients with voice and/or swallowing complaints. During this procedure, transnasal fiberoptic laryngoscopy (TFL) using a specialized fiberoptic scope is performed in order to deliver discrete pulses of air to the laryngopharyngeal mucosa. Historically, topical anesthesia has been applied to the nasal mucosa to lessen discomfort during TFL. Because of the concern that topical nasal anesthesia could also anesthetize the laryngopharynx, it is usually not used during sensory testing. To prospectively compare LPSDT scores after the nasal administration of cocaine hydrochloride, oxymetazoline hydrochloride, and saline solution, we prospectively evaluated 15 subjects undergoing LPSDT. Each had the procedure performed on 3 separate occasions. Before examination, each patient was administered either 4% cocaine, 0.05% oxymetazoline, or saline solution by atomizer (2 sprays of 1-second duration to each naris). By the conclusion of the study, each patient had undergone sensory testing with each of the test agents. During each examination, the minimal air pulse eliciting the laryngeal adductor reflex was recorded for both sides of the laryngopharynx. Both patient and examiner were blinded to the test agent used. The mean sensory score for saline solution was 3.9 mm Hg. The sensory scores for oxymetazoline and cocaine were 3.4 and 3.5 mm Hg, respectively. When compared to saline solution and oxymetazoline independently, sensory testing of the laryngopharynx during which the nose was anesthetized with cocaine resulted in similar thresholds for eliciting the laryngeal adductor reflex (p = .40 and p = .85). We conclude that topical anesthesia can be applied to the nasal cavity during LPSDT without altering laryngeal sensation.
New Therapy for Orolaryngeal Manifestations of Crohn's Disease
Authors: Ottaviani Francesco , Schindler Antonio , Petrone Mara , Capaccio Pasquale , Porro Gabriele Bianchi
Published: October 2014

Crohn's disease is a chronic inflammation that may involve the entire gastrointestinal tract, from the mouth to the anus. The most widely accepted etiologic theory involves an immunologic aberration leading to local tissue destruction. Cell-mediated immunity with increased tumor necrosis factor (TNF) production may play a role in mucosal damage. Oral and laryngeal involvement are rare manifestations of Crohn's disease that are usually treated successfully by steroids. We here report a rare case of extra-intestinal Crohn's disease resistant to steroid therapy, which was successfully treated with infliximab, a chimeric antibody directed against TNF-α that is the only registered agent for the treatment of Crohn's disease. The relative safety, efficacy, and efficiency of infliximab make it an alternative treatment of which otolaryngologists should be aware.
Minimally Invasive Orbital Decompression for Graves' Ophthalmopathy
Authors: Vaseghi Marmar , Levin Peter S. , Tarin Thomas T. , Terris David J.
Published: October 2014

We reviewed a 7-year experience at a tertiary-care, academic medical center with balanced, minimally invasive decompression for Graves' ophthalmopathy, in an effort to define the goals, risks, and outcomes of surgical intervention. Endoscopic medial decompression was performed in 26 patients; 23 underwent lateral decompression as well, and 13 also had inferior decompression. Septoplasty, turbinate reduction, and orbital rim augmentation were performed as needed. The indications for surgery were threat to vision (n = 10) and proptosis with a desire to return to the predisease state (rehabilitative, n = 16). The exophthalmos improved by a mean of 4.4 mm (p < .001). All patients who had surgery for threatened vision had improved vision after the operation. There were 3 patients with new-onset postoperative diplopia, 2 of whom underwent strabismus surgery. There was 1 case of postoperative sinusitis, which resolved with oral antibiotics and nasal decongestion, and 1 case of transient ulnar neuropathy. There were no other intraoperative or postoperative complications. Modern methods of orbital decompression provide a minimally invasive, effective, and relatively safe approach to the treatment of Graves' ophthalmopathy.
Congenital Conductive Hearing Loss in Dyschondrosteosis
Authors: De Leenheer Els M. R. , Kuijpers-Jagtman Anne-Marie , Sengers Rob C. A. , Oudesluijs Grétel G. , Rappold Gudrun A. , Cremers Cor W. R. J.
Published: October 2014

Conductive hearing loss was detected in a boy with a previous diagnosis of dyschondrosteosis. Dyschondrosteosis is a rare inherited condition characterized by mesomelic dwarfism and Madelung's deformity. The syndrome can be caused by mutations in the SHOX gene, and in that case, the pattern of inheritance is pseudoautosomal dominant. Indeed, SHOX mutation analysis in our patient revealed a deletion. The combination of dyschondrosteosis and conductive hearing loss has been reported in 2 previous cases. In our patient, exploratory tympanotomy revealed ankylosis of the stapes and a malformed incus. A substantial gain in hearing threshold was obtained by a stapedectomy in combination with a malleovestibulopexy.
Facial Nerve Schwannoma
Authors: Kim Jenny C. , Bhattacharjee Meena , Amedee Ronald G.
Published: October 2014

Facial nerve schwannomas are clinically challenging tumors. This is a case study of a young woman with an extensive facial nerve schwannoma. The clinical presentation, radiographic diagnosis, pathological confirmation, and treatment options for this relatively rare tumor are discussed.
Natural History of Sigmoid Sinus Thrombosis
Authors: Agarwal Anurag , Lowry Patricia , Isaacson Glenn
Published: October 2014

To demonstrate the evolution of sigmoid sinus thrombosis, we performed a prospective observational study on a 6-year-old girl who presented with mastoiditis, epidural abscess, and occipital osteomyelitis from multiple drug–resistant Streptococcus pneumoniae. She underwent mastoidectomy and partial occipital craniectomy. This procedure produced a window in the occipital bone that allowed serial ultrasonography of the sigmoid sinus during medical treatment. Computed tomography was performed, followed by weekly Doppler ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The natural history of a treated episode of sigmoid sinus thrombosis was illustrated. Venous occlusion resolved over a 4- to 6-week period without surgical drainage or venous anticoagulants. Collateral flow, reversal of normal venous flow, and ultimate return to normal venous transport characterized the period of resolution. We conclude that an occluded sigmoid sinus from mastoiditis can naturally recanalize. Aberrant venous flow can be demonstrated during the period of resolution. This case supports a conservative approach to management of the occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal of perisinus infection is sufficient for cure.
Risk Factors and Prognosis of Anterior Commissure versus Posterior Commissure T1-T2 Glottic Cancer
Authors: Rucci Lucio , Romagnoli Paolo , Bocciolini Corso , Olofsson Jan
Published: October 2014

For better understanding of the causation and behavior of T1–T2 commissural glottic laryngeal tumors, we retrospectively analyzed risk factors and outcome related to T class and type of therapy for tumors involving the anterior (184 cases) or the posterior (60 cases) commissure. The patients' smoking habits and alcohol consumption were similar, regardless of involved subsite. The disease-free interval was longer after surgery than after radiotherapy. The survival rates after recovery upon relapse were similar among subsites, T classes, and types of therapy. In anterior commissure tumors, the larynx remained preserved more frequently after partial laryngeal resection than after radiotherapy, and was more frequently preserved the lower the T class. In posterior commissure tumors, larynx preservation was less frequent and apparently independent of type of therapy or T class. In conclusion, smoking and alcohol consumption play similar pathogenetic roles in either subsite; partial laryngeal resection gave a higher rate of laryngeal preservation than did radiotherapy; and anatomic peculiarities of the subsites influence tumor behavior.
Barotrauma Vis-a-Vis the “Chronic Otitis Media Syndrome”: Two Conditions with Middle Ear Gas Deficiency
Authors: Sadé Jacob , Ar Amos , Fuchs Camil
Published: October 2014

We compared 17 patients (29 ears) with barotrauma with 171 patients suffering from “chronic ears” (secretory otitis media, atelectasis, or previously operated cholesteatoma). The patients with “chronic ears” were followed up prospectively, and none were found to suffer from barotrauma after flying on a commercial airplane. The mastoid pneumatization (seen on lateral mastoid radiographs) was significantly larger in ears with barotrauma, averaging 16.85 cm2, versus 12.9 cm2 in normal controls, whereas in “chronic ears” it was only 3.6 cm2. During flight on a commercial airplane, the middle ear has to equalize about 20% of its gas volume with the ambient pressure. This equalization must happen within 15 to 20 minutes of ascent and descent in order to avoid barotrauma. This 20% is a fivefold greater task for ears with a large mastoid pneumatization than for ears with an undeveloped pneumatization; “chronic ears” usually have an undeveloped mastoid pneumatization. The smaller the middle ear (mastoid) volume, the smaller the volume of gas needed to pass through the eustachian tube in order to equalize pressure changes during flying. This factor may explain why “chronic ears” rarely suffer from barotrauma. It also implies that eustachian tubes of secretory otitis, atelectatic, and cholesteatomatous ears have little problem in equalizing large pressure differences (over 2,000 mm H2O) within 15 to 20 minutes of landing, in contrast to what has been traditionally believed. Individuals with “chronic ears” can be advised that they can fly safely.
Contact Endoscopy for Intraoperative Parathyroid Identification
Authors: Dedivitis Rogério A. , Guimarães André V.
Published: October 2014

Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.
Cross-Sectional Analysis of Hearing Threshold in Relation to Age in a Large Family with Cochleovestibular Impairment Thoroughly Genotyped for DFNA9/COCH
Authors: Bom Steven J. H. , Kemperman Martijn H. , Luijendijk Mirjam W. J. , Huygen Patrick L. M. , Cremers Cor W. R. J.
Published: October 2014

Hearing threshold was analyzed for each frequency in relation to age in 88 members of a large Dutch family with cochleovestibular impairment caused by a P51S mutation in the COCH gene within the DFNA9 locus (chromosome 14q12–13). The participants in this study were 34 mutation carriers and 54 relatives without the mutation (control subjects). A sigmoidal dose-response curve with a variable slope was used to fit the mutation carriers' threshold-on-age data. Progression started at about 40 years of age and only lasted for some 20 to 25 years; the associated average progression was 2.9 dB/y for all frequencies. However, some hearing impairment was already present before, predominantly at the high frequencies. The mean thresholds in the young mutation carriers (<33 years of age) were significantly higher (by 4 to 13 dB) than those in age-matched controls at 2 to 8 kHz. Presumably, mutation carriers have a congenital, stable offset threshold (10 to 29 dB) at these frequencies, and develop progression later in life.
Multiple Familial Facial Glomus: Case Report and Review of the Literature
Authors: Magliulo Giuseppe , Parnasi Erika , D'Amico Raffaello , Savastano Vincenzo , Romeo Salvatore
Published: October 2014

Facial paraganglioma is an extremely rare tumor that originates from abnormal paraganglionic tissue situated in the intrapetrous facial canal. A review of the English-language literature shows that only 8 cases of facial nerve paraganglioma have been published. In each case the facial glomus presented itself sporadically, completely independent of any other form of paraganglioma. This study reports an intrapetrous facial glomus that occurred in a case of multiple paragangliomas with a hereditary pattern. To our knowledge, this is the first report of such a combination.
Central Facilitation of the Glottic Closure Reflex in Humans
Authors: Sasaki Clarence T. , Hundal Jagdeep , Jassin Basem , Rosenblatt William , Kim Young-Ho , Ross Douglas A.
Published: October 2014

The sphincteric function of the larynx, essential to lower airway protection, is most efficiently achieved through strong reflex adduction by both vocal cords. We hypothesize that central facilitation is an essential component of a bilateral adductor reflex and that its disturbance could result in weakened sphincteric closure. Five patients during supraglottic laryngectomy underwent evoked response laryngeal electromyography under 0.5 and 1.0 minimal alveolar concentration (MAC) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. Consistent threshold responses were obtained ipsilaterally from 0.5 to 1.0 MAC anesthesia. However, the contralateral reflex responses approached 0% in successive trials as anesthetic levels approached 1.0 MAC. In human subjects, alteration of central facilitation by deepening anesthesia abolishes the crossed adductor reflex, predisposing to a weakened glottic closure response. A precise understanding of this effect may improve the prevention of aspiration in patients emerging from prolonged sedation or under heavy psychotropic control.
Posterior Cricoarytenoid Myoplasty with Medialization Thyroplasty in the Management of Refractory Abductor Spasmodic Dysphonia
Authors: Shaw Gary Y. , Sechtem Phillip R. , Rideout Benji
Published: October 2014

Of the approximately 100,000 Americans with primary (idiopathic) laryngeal dystonia, 10% to 15% are thought to have the abductor form. Botulinum A toxin injected into the posterior cricoarytenoid muscle and/or cricothyroid muscle has been employed as the “gold standard” for therapeutic management; however, successful results are significantly less frequent than with injections for the adductor form. This report describes a new phonosurgical procedure, posterior cricoarytenoid myoplasty with medialization thyroplasty, designed for these refractory patients. Posterior cricoarytenoid myoplasty with medialization thyroplasty has been performed on 3 patients with abductor laryngeal dystonia. All patients had failed at least 5 previous botulinum A injections to the posterior cricoarytenoid and cricothyroid muscles. All patients underwent preoperative and 3 postoperative (2 weeks, 3 months, and 1 year) phonatory analyses. Analysis consisted of recording an aloud reading of a standard passage while a blinded trained speech pathologist counted prolonged voiceless consonants. The patients also completed a satisfaction survey at 1 year. The results demonstrated significant, long-lasting, uniform reduction in breathy breaks in all subjects. The participants all judged their symptoms as greatly improved. Bilateral procedures may be necessary, but should be staged to prevent possible airway compromise. When applied appropriately, posterior cricoarytenoid myoplasty with medialization thyroplasty is a viable tool in the management of refractory abductor laryngeal dystonia.
Is Secretory Otitis Media a Single Disease Entity?
Authors: Sadé Jacob , Fuchs Camil , Russo Eyal , Cohen David
Published: October 2014

The outcome of 809 children who had middle ear effusion (MEE) was correlated with their age and medical history and the bacteriologic and cytologic findings of the MEE. Three groups emerged. Group A (n = 384) had a medical history of relatively recent acute otitis media (AOM) with a peak prevalence of 2.6 years of age, and its MEE was hypercellular (mostly polymorphonuclear leukocytes) with a 24% rate of positive bacteriologic culture. In contrast, the peak prevalence of group B (n = 280) was approximately 5 years of age. Its MEE followed no otologic medical history and was bacteriologically sterile with relatively few cells (mostly lymphocytes typical of viral infections). Group AB (n = 145) resembled group B except that they had a history of AOM some years before hearing loss onset. Altogether, the clinical features of group A are statistically distinguishable from those of groups B and AB in most respects. These findings explain the bimodal peak prevalence distribution that was found in many available epidemiological studies of secretory otitis media (SOM) and that was also seen in our data. It appears that SOM should neither be termed nor treated as an otitis media, but as a sequela of either bacterial AOM (group A) or of insidious, asymptomatic, probably viral otitis media (groups B and AB). Our data do not support antibiotic treatment for SOM (otitis media with effusion) — especially not in chronic cases.
Inhalational Anesthetic Technique in Microlaryngeal Surgery: A Comparison between Sevoflurane-Remifentanil and Sevoflurane-Alfentanil Anesthesia
Authors: Pandazi Ageliki K. , Louizos Antonios A. , Stivaktakis John M. , Davilis Dimitrios J. , Georgiou Loucas G.
Published: October 2014

We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.
Prevalence of Otomycosis in Outpatient Department of Otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Authors: Pradhan Bibhu , Tuladhar Nhuchhe Ratna , Amatya Ramchaya Man
Published: October 2014

Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.
Obstructive Congenital Gingival Granular Cell Tumor
Authors: Charrier Jean-Baptiste , Droullé Pierre , Chassagne Jean-François , Vignaud Jean-Michel , Stricker Michel
Published: October 2014

Congenital gingival granular cell tumors (also known as congenital epulis or Neumann's tumor) are rare and always benign intraoral tumors originating from the alveolar ridge. They are typically seen as a mass protruding out of a newborn child's mouth. We report a case of a large obstructive congenital gingival granular cell tumor of the mandibular ridge. The intraoral mass was first detected on a 38-week prenatal ultrasound scan and resulted in neonatal airway obstruction. Complete surgical removal was performed with an uneventful postoperative course. Histologic and immunohistochemical assessments with antibodies against S-100 protein confirmed the diagnosis. The clinical and morphological aspects, differential diagnosis, histogenesis, and treatment are discussed.
Acoustic Neuroma in Patients with Completely Resolved Sudden Hearing Loss
Authors: Nageris Ben I. , Popovtzer Aaron
Published: October 2014

Approximately 30% of patients with sudden hearing loss show complete recovery. Researchers have long questioned whether extensive evaluation is necessary in these cases. Recently, however, with the increasing widespread application of magnetic resonance imaging, a higher rate than expected of acoustic neuromas has been detected in patients with sudden hearing loss. Two studies have suggested that affected patients may even partially regain hearing. The aim of the present clinical study was to determine whether acoustic neuroma–induced hearing loss may be associated with full recovery. The files of 67 patients evaluated for sudden hearing loss at Rabin Medical Center from 1989 to 2000 were reviewed. All patients underwent pure tone audiometry, acoustic reflex tests, and auditory brain stem evoked response tests. Hearing evaluation was followed by magnetic resonance imaging scan and, 1 month later, a second hearing test. Findings were compared between patients with and without evidence of tumor on imaging, and between patients with tumor with and without full recovery. Twenty-four patients (36%) had a diagnosis of acoustic tumor, of whom 4 (16.7%) recovered hearing after 1 month. All 4 tumors were intracanalicular. Two of these patients had low-tone hearing loss, and 2 had flat curves; 3 had a pathological auditory brain stem evoked response. Of the 43 patients without tumors, 26 (60%) showed complete resolution of the hearing loss. We conclude that complete recovery of hearing loss does not exclude acoustic tumor, and these patients therefore require full evaluation. The reason for the recovery remains unclear.
Otosclerosis and Chronic Tinnitus
Authors: Gristwood Ronald E. , Venables William N.
Published: October 2014

Chronic subjective tinnitus is a common feature of clinical otosclerosis. Analysis of the records of 1,014 consecutive cases of clinical otosclerosis, all confirmed by stapes surgery in South Australia between 1960 and 1972, gives a preoperative prevalence of this symptom of 65%. The association of tinnitus with various predictors is considered, and a statistical analysis is presented. Tinnitus has an association with gender (p < .0001), mean preoperative bone conduction (BC) level (p = .0012), mean air conduction (AC) level (p = .0192), and mean air-bone gap (p = .0075). The associations between tinnitus and the age of the patient, the duration of deafness, the presence of Schwartze's sign, and the severity of footplate pathological involvement were all nonsignificant. The association of tinnitus with the AC and BC thresholds is unexpectedly paradoxical. An economic predictive model for tinnitus in otosclerosis has been constructed from the 2 strongly significant variables, gender and mean BC hearing level, by logistic regression. In this large series of cases, the log odds in favor of finding tinnitus are about 0.810 for male subjects and 1.394 for female subjects when the BC level is zero. The log odds fall by 0.014 for each decibel of mean BC rise.
Effect of Modern Fibrin Glue on Bleeding after Tonsillectomy and Adenoidectomy
Authors: Vaiman Michael , Shlamkovich Nathan , Eviatar Efraim , Segal Samuel
Published: October 2014

We performed a prospective randomized study in 179 patients to examine the second-generation surgical fibrin sealant Quixil as an effective substitute for different types of electrocautery in tonsillectomy and adenoidectomy. We compared the rates of hemorrhagic complications in a group with bipolar or needle point electrocautery and in a group in whom fibrin glue was used to stop intraoperative bleeding and to prevent postoperative bleeding. The operations were performed under general anesthesia in typical fashion with sharp dissection. For the control group, hemostasis was achieved by bipolar or needle point electrocautery. For the fibrin glue group, hemostasis was achieved by spraying Quixil fibrin glue approximately 0.5 mL to each tonsillar fossa and 0.5 mL to the nasopharynx (in adenoidectomy). The results were excellent in all the patients of the fibrin glue group, with complete hemostasis and resolution of the major symptoms. In this group, the intraoperative blood loss averaged 15 mL in tonsillectomy and 9 mL in adenoidectomy. There were no cases of postoperative hemorrhage or any other complications. The electrocautery group required a longer time for healing, and its intraoperative blood loss (tonsillectomy) averaged 29 to 33 mL. The incidence of posttonsillectomy bleeding in this group was 4.35% (4 patients). Three patients (3.26%) had primary hemorrhage (bleeding that occurs within the first 24 hours of surgery), and 1 patient (1.09%) had secondary hemorrhage (bleeding that occurs after the first 24 hours). We conclude that Quixil fibrin glue application to the operative sites in tonsillectomy and adenoidectomy provides effective hemostasis and sealing with good systemic and local compatibility. With the help of Quixil, we minimized surgical trauma and achieved absolute hemostasis at the same time. We found this fibrin glue to be a more convenient and effective hemostatic sealant than bipolar or needle point coagulation.
Surgical Anatomy of the Recurrent Laryngeal Nerve: Implications for Laryngeal Reinnervation
Authors: Damrose Edward J. , Huang Robert Y. , Berke Gerald S. , Ye Ming , Sercarz Joel A.
Published: October 2014

Functional laryngeal reinnervation depends upon the precise reinnervation of the laryngeal abductor and adductor muscle groups. While simple end-to-end anastomosis of the recurrent laryngeal nerve (RLN) main trunk results in synkinesis, functional reinnervation can be achieved by selective anastomosis of the abductor and adductor RLN divisions. Few previous studies have examined the intralaryngeal anatomy of the RLN to ascertain the characteristics that may lend themselves to laryngeal reinnervation. Ten human larynges without known laryngeal disorders were obtained from human cadavers for RLN microdissection. The bilateral intralaryngeal RLN branching patterns were determined, and the diameters and lengths of the abductor and adductor divisions were measured. The mean diameters of the abductor and adductor divisions were 0.8 and 0.7 mm, while their mean lengths were 5.7 and 6.1 mm, respectively. The abductor division usually consisted of one branch to the posterior cricoarytenoid muscle; however, in cases in which multiple branches were seen, at least one dominant branch could usually be identified. We conclude that the abductor and adductor divisions of the human RLN can be readily identified by an extralaryngeal approach. Several key landmarks aid in the identification of the branches to individual muscles. These data also indicate the feasibility of selective laryngeal reinnervation in patients who might be candidates for laryngeal transplantation after total laryngectomy.
Difference in Attachment of the Tensor Veli Palatini Muscle to the Eustachian Tube Cartilage with Age
Authors: Suzuki Chiaki , Sando Isamu , Kitagawa Miwa , Balaban Carey D. , Takasaki Kenji
Published: October 2014

To test a hypothesis that ventilation of the eustachian tube (ET) varies with age, we investigated the relationship between age and the attachment of the tensor veli palatini muscle (TVPM) to the lateral lamina of the ET cartilage in 12 normal human temporal bones obtained from individuals 3 months to 81 years old. We used computer-aided 3-dimensional reconstruction and measurement methods. We found that the length of the TVPM attachment and its ratio to the length of the ET, especially that of the cartilaginous portion of the ET, increases with age from infancy to adulthood, and decreases with age from young adulthood to later life. These findings are thought to be related to postnatal development and aging. The possibility of differences in ventilation function with age is discussed.