bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvements in Respiratory and Psychosocial Functioning following Total Laryngectomy by the Use of a Heat and Moisture Exchanger
Authors: Ackerstaff Annemieke H. , Hilgers Frans J. M. , Balm Alfons J. M. , Aaronson Neil K. , van Zandwuk Nico
Published: October 2014

A prospective clinical study in 61 patients was undertaken to investigate the subjective and objective influence of a heat and moisture exchanger (HME) on the respiratory and psychosocial problems following total laryngectomy. Although statistical comparisons failed to detect significant differences between the experimental and the control groups, there was a clear trend toward improvements in respiratory and psychosocial functioning in the experimental group. Analyses of differences over time within the HME user group showed significant reductions in the incidence of coughing, the mean daily frequency of sputum production, forced expectoration, and stoma cleaning. Significant improvements were also found in shortness of breath, fatigue and malaise, sleep problems, levels of anxiety and depression, and perceived voice quality. Pulmonary function tests showed significant improvements in inspiratory flow and volume values following use of the HME. This objective improvement in inspiratory pulmonary function reflects the decrease in sputum production reported by the patients.
Inverted Papilloma of the Middle Ear
Authors: Roberts William H. , Dinges David L. , Hanly Mark G.
Published: October 2014

Inverted papilloma is a benign neoplasm confined almost exclusively to the sinonasal tract. We present the first known case report of an inverted papilloma arising from the middle ear. In this paper we discuss the pathophysiology and review the literature of this interesting clinical entity.
Wegener's Granulomatosis and Antineutrophil Cytoplasmic Autoantibodies
Authors: Batsakis John G. , El-Naggar Adel K.
Published: October 2014

Serologic tests for antineutrophil cytoplasmic autoantibodies can serve as markers for a number of necrotizing vasculitides and other inflammatory disorders. In the case of Wegener's granulomatosis, an immunofluorescent cytoplasmic pattern and immunoassay for proteinase 3 are quite specific for the disease and are capable of serving as additional criteria for diagnosis. As with any laboratory test, however, results are to be interpreted in the whole clinical and pathologic framework of the disease.
Multivariate Predictors of Audiological Success with Multichannel Cochlear Implants
Authors: Gantz Bruce J. , Woodworth George G. , Knutson John F. , Abbas Paul J. , Tyler Richard S.
Published: October 2014

To predict the audiological outcomes of 2 multichannel cochlear implants, a preoperative battery of historical, audiological, electrophysiologic, and psychologic variables from 48 postlingually deafened adults was tested in a prospective randomized clinical trial. Multivariate analyses were used to select and combine these preoperative variables in a predictive index that was significantly related to audiological outcome at 9 months. The preoperative variables included in the predictive index were duration of profound deafness, speech reading ability, residual hearing, cognitive ability, measures of compliance and engagement with treatment, and use of nonverbal communication strategies. The preoperative predictive index had correlations of .81 with the Iowa Sentences Test, and .78 with the NU6 word understanding scores, both obtained in a sound-only test Probability and percentile curves generated from these data offer considerable optimism in forecasting the range of likely audiological outcomes that would be realized by postlingually deafened adult candidates for multichannel cochlear implants.
Rhinophyma: A New Approach to Hemostasis
Authors: Stucker Fred J. , Hoasjoe Denis K. , Aarstad Robert F.
Published: October 2014

Rhinophyma is a benign tumor of the nose. It possesses both functional and cosmetic implications. The pathophysiology of the disease is reviewed to illustrate the basis for the treatment options. Many different therapeutic modalities have been reported in the literature, each with reasonable success. A new treatment approach to this condition is developed using a combination of the Weck blade and the argon beam coagulator. This modality is found to be relatively simple and less traumatic than all the other techniques used by the senior author.
Airway Protection during Breath-Holding
Authors: Mendelsohn Martyn S. , Martin Ruth E.
Published: October 2014

Little is known about laryngeal function during breath-holding. The completeness of laryngeal closure during breath-holding is clinically relevant during the supraglottic swallow. To investigate this phenomenon, vocal cord position was studied prospectively in 10 adults during breath-holding using nasolaryngoscopy with video recording. The position of the vocal cords was not consistent during breath-holding. Some subjects closed the glottis, while others had variable amounts of glottic opening. Straining and vocalizing at the onset of breath-holding produced both glottic and supraglottic closure, increasing the number of levels of laryngeal closure during breath-holding. Nasolaryngoscopy can be used clinically to document the airway protection, the effects of various protective maneuvers, and any resulting aspiration during breath-holding and during the supraglottic swallow.
Arachidonic Acid Metabolites in Experimental Otitis Media and Effects of Anti-Inflammatory Drugs
Authors: Goldie Pamela , Jung Timothy T. K. , Hellström Sten
Published: October 2014

Previous studies have shown that arachidonic acid (AA) metabolites are important in the pathogenesis of otitis media with effusion. The AA metabolites in 4 different experimental models for otitis media were analyzed, and the effect of anti-inflammatory drugs was studied. Purulent otitis media was induced in rats by inoculation of Streptococcus pneumoniae in the tympanic bulla, serous otitis media by blocking the tympanal orifice of the eustachian tube, and mucoid otitis media by combining the two procedures. Middle ear effusion was also induced by stimulating the external auditory canal with cold air. Indomethacin and hydrocortisone were used to inhibit AA metabolism in the latter model. Lipoxygenase products dominated in the purulent and cold air otitis media models. Cyclooxygenase products dominated in the mucoid and serous models. Indomethacin inhibited accumulation of middle ear effusion in the cold air otitis media model, whereas hydrocortisone did not Apart from AA metabolites, other mechanisms and mediators appear to be responsible for the increased vessel permeability observed in the cold air otitis media model, such as interactions between mast cells and nerves in the middle ear mucosa.
Comparison of the Chondrogenic Potential of Free and Vascularized Perichondrium in the Airway
Authors: Hartig Gregory K. , Esclamado Ramon M. , Telian Steven A.
Published: October 2014

Revascularized perichondrium or periosteum may be the ideal graft to repair severe laryngotracheal stenosis because of its pliability, potential for bone or cartilage formation, resistance to infection, and rapid mucosalization. To begin our evaluation of these grafts in airway reconstruction, this study was designed to quantify the chondrogenic capacity of free and vascularized perichondrium placed in the airway. In a rabbit model, free auricular perichondrium (N = 16) produced a mean cartilage thickness of 0.15 mm, whereas vascularized auricular perichondrium (N = 18) produced a mean of 0.45 mm at 8 weeks (p < .0001). In a third group of rabbits (N = 4) vascularized auricular perichondrial grafts were subjected to a 2-hour intraoperative ischemic insult in order to simulate the ischemia of revascularization. The mean cartilage thickness at 8 weeks was 0.50 mm. We conclude that in the rabbit model, vascularized perichondrium provides significantly more cartilage than free perichondrial grafts.
Microlaryngoscopic Surgery for T1 Glottic Lesions: A Cost-Effective Option
Authors: Myers Eugene N. , Wagner Robin L. , Johnson Jonas T.
Published: October 2014

Excision of squamous cell carcinoma of the vocal cord using microlaryngoscopy (ML) with or without laser is a cost-effective treatment option in highly selected patients. A retrospective review of 50 cases of invasive and microinvasive squamous cell carcinoma demonstrated a failure rate of 8% (4 patients), all of whom were successfully salvaged by hemilaryngectomy (1 patient) or irradiation (3 patients). Other treatment options for T1 glottic lesions include hemilaryngectomy or radiotherapy, yielding similar cure rates of 95% and 67% to 93%, respectively. Investigation of the potential savings by extrapolating 1992 health care costs into the treatment options for T1 glottic carcinoma resulted in costs of $12,956 per patient for ML, while hemilaryngectomy averaged $35,616 per patient and radiotherapy netted costs of $32,588 per patient. Extrapolating these costs to a theoretic group of 100 patients, ML provided savings of 2.4 million dollars when compared to the other treatment modalities. In selected patients, ML for T1 glottic cancer provides an effective therapeutic modality suited to our cost-conscious environment.
Composite Reconstruction of the Esophagus and Hypopharynx after Severe Caustic Injury
Authors: Doolin Edward J.
Published: October 2014

The ingestion of caustic materials may cause burns and subsequent strictures of the esophagus. Depending on the extent of the injury, the stricture may require dilation, excision, or bypass with an esophageal replacement. There is also a risk of esophageal dysfunction, perforation, and malignancy. Here is presented a case of a burn so severe that the hypopharynx was deformed and the esophagus destroyed. Composite techniques restored complete gastrointestinal continuity while maintaining excellent swallowing function.
Comparison of Cytophotometric Characteristics to Histology and Proliferation Markers in Acoustic Neuromas
Authors: Welkoborsky Hans-J. , Mann Wolf J. , Haibt Gabriele , Amedee Ronald G.
Published: October 2014

Specimens of histologically confirmed acoustic neuromas obtained during operation in 25 patients were examined. Quantitative DNA measurements were performed with an image analysis system. From the single cell measurements, the mean DNA content of all tumor cells, 2c deviation index (2c DI), DNA entropy, DNA grade of neoplasia, and percentage of tumor cells with a DNA content of more than 5c (5c exceeding rate) were derived, as well as the mean nuclear area of the tumor cells. Proliferating cell nuclear antigen (PCNA) was identified immunohistochemically. A PCNA score was developed in determining PCNA-positive cells in a total amount of 1,000 cells. Results of quantitative DNA measurements and PCNA scores were compared to clinical symptoms, histology, and time between first onset of symptoms and diagnosis of the tumor. Quantitative DNA measurements revealed the existence of hyperdiploid tumor cells in all neuromas. According to the frequency with which they occurred, tumors could be divided into two categories: 1) tumors with a high percentage of hyperdiploid cells (“hyperdiploid tumors”) and 2) those with a low percentage (“diploid tumors”). Hyperdiploid tumors showed increased values for the 2c DI, mean DNA content, DNA grade of neoplasia, and DNA entropy as signs of increased proliferation. In addition, the PCNA scores were higher in these tumors, indicative of increased DNA synthesis. The mean nuclear area was higher in these tumors. No correlation was found between the results of the DNA analysis and the PCNA score, or the clinical data and the predominant histologic subtype. The results of this study could explain the known differences in growth rate of acoustic neuromas and might also have clinical relevance in identifying patients at high risk for developing tumor recurrences.
Nasal and Otologic Effects of Experimental Influenza a Virus Infection
Authors: Doyle William J. , Buchman Craig A. , Skoner David P. , Seroky James T. , Hayden Frederick , Fireman Philip
Published: October 2014

Past studies showed that experimental rhinovirus colds in adults resulted in eustachian tube dysfunction and abnormal middle ear pressures. In the present study, the symptoms and pathophysiologic findings accompanying experimental influenza viral infection were documented. A total of 33 healthy adult volunteers were intranasally challenged with an influenza A/Kawasaki/86 (H1N1) virus and cloistered over a 9-day postchallenge period to monitor for evidence of infection, signs and symptoms of illness, and the extent and frequency of pathophysiologic responses of the nose, eustachian tube, and middle ear. Results showed a protective effect of high (≥16) prechallenge specific hemagglutination-inhibition antibody titer on the rate of infection and the magnitude and extent of provoked symptoms and pathophysiologic findings. Infected subjects with low (<16) prechallenge serum antibody titers (n = 21) developed significant respiratory illness. These subjects also had objectively measurable increases in nasal secretion production, and decreased nasal patency and mucociliary clearance rates. More than 80% of the infected subjects developed eustachian tube dysfunction, and approximately 80% had middle ear underpressures of less than −100 mm H2O on study days 4 and 5. Five of 21 infected subjects with low prechallenge antibody titers had otoscopic evidence of otitis media with effusion. These results support a causal role for viral upper respiratory tract infection in the pathogenesis of otitis media, possibly mediated by the early development of eustachian tube dysfunction and abnormal middle ear pressure.
New Clinical Severity Staging System for Cancer of the Larynx
Authors: Piccirillo Jay F. , Sasaki Clarence T. , Wells Carolyn K. , Feinstein Alvan R.
Published: October 2014

Although statistics for cancer of the larynx are reported according to the tumor, node, metastasis (TNM) morphological staging system, functional clinical distinctions can identify major prognostic differences within the same morphological stage. This study was done to improve the staging system by incorporating pertinent clinical variables. In 193 patients with cancer of the larynx first treated between 1973 and 1985, the total 5-year survival was 66% (127/193). By TNM stage it was I, 78% (60/77); II, 67% (32/48); III, 60% (27/45); and IV, 35% (8/23). In three new functional severity stages that combined symptom severity and comorbidity, the corresponding rates were alpha, 83% (89/107); beta, 58% (34/59); and gamma, 15% (4/27). The functional severity stages could be combined with TNM stages to create a powerful new clinical severity staging system, in which the survival results were A, 88% (53/60); B, 80% (24/30); C, 63% (38/60); and D, 28% (12/43). These results demonstrate that inclusion of clinical variables in a formal staging system can strikingly improve prognostic estimations and classification of patients.
Retrograde Dilation of Postsaccal Lacrimal Stenosis
Authors: Steinkogler Franz Josef , Kuchar Andreas , Huber Ernst , Karnel Franz
Published: October 2014

The causes of nasolacrimal duct stenosis in adults can vary greatly. In general, the symptoms can also vary, but most cases share a tendency toward recurring inflammations in the prestenotic area. The treatment of these disorders is limited to either conservative therapy to control inflammation or surgically invasive measures. By using balloon catheters, usually applied in percutaneous transluminal coronary angioplasty (PTCA), dilation of the relative postsaccal stenosis can be performed under radiographic control. An exact diagnosis using various testing methods, including digital dacryocystography for detailed localization and documentation of any pathologic changes, is decisive to success. Only in cases of incomplete postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct indicated. A guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris, under visual control with an image converter. The balloon catheter is retrogradely threaded over the guide wire. The balloon is then placed at the site of the pathologic stenosis under radiographic control and dilated with high pressure. To ensure the permeability of the system, monocanalicular silicone intubation has to be performed immediately afterwards. This procedure has been performed successfully on 6 patients with a follow-up of 6 to 27 months. These initial results give rise to the hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis.
Changes in Glottal Area Associated with Increasing Airflow
Authors: Sercarz Joel A. , Kreiman Jody , Berke Gerald S. , Ye Ming , Bielamowicz Steven , Green David C.
Published: October 2014

Laryngeal resistance varies inversely with airflow during phonation. This study evaluated the morphological changes in the glottis that accompany decreases in laryngeal resistance at higher levels of airflow. An in vivo canine model of phonation and a video analysis system were used to assess changes in area. Four animals were examined stroboscopically as airflow increased, with constant recurrent laryngeal nerve stimulation. Glottal dynamics were evaluated by means of photoglottography, electroglottography, and measures of subglottic pressure. Analysis of digitized stroboscopic images indicated that increasing airflow had no obvious effect on the glottal chink (vocal process contact). Increasing airflow was associated with an increase in the area of peak opening and an increase in the glottal area integral.
Fundamental Frequency and Amplitude Perturbation in Reconstructed Canine Vocal Folds
Authors: Jiang Jack J. , Wexler David B. , Titze Ingo R. , Gray Steven D.
Published: October 2014

A submucosal fat autograft was implanted within the cover of injured vocal folds of 5 dogs. The implant occurred 6 weeks after unilateral mucosal excision had been performed. Three months postoperatively the larynges of these animals were excised and their phonation was compared to that of normal dog larynges and to other larynges with mucosal excision (but without fat grafting). Radiated acoustic pressure from the artificially driven larynges was recorded and digitized at 20 kHz with 16-bit resolution. Amplitude and fundamental frequency perturbations were extracted from a segment of phonation to assess the stability of the acoustic signals from the 3 groups. It was found that fat augmentation after mucosal excision reduced amplitude and frequency perturbation measures. There was no significant difference between fat-augmented and normal vocal folds. The acoustic measures were also positively correlated with phonation threshold and phonation efficiency measures reported earlier. The results suggest that submucosal fat autograft implantation within an injured vocal fold cover can restore not only the “ease” of phonation, but also the stability of phonation, which is a component of vocal quality.
Lemierre's Syndrome: Postanginal Sepsis Due to Anaerobic Oropharyngeal Infection
Authors: Ahkee Sunket , Srinath Latha , Raff Martin J. , Huang Anna , Ramirez Julio A.
Published: October 2014

Lemierre's syndrome is an uncommon clinical entity. It consists of oropharyngeal infection and anaerobic bacteremia, followed by jugular vein septic thrombophlebitis with embolization to lungs and other areas. Although it occurs less frequently than in the preantibiotic era, it is important that the typical presentation be recognized because of its lethal potential. A case of Lemierre's syndrome in Louisville, Kentucky, is described.
Anatomic Relationships between Ostmann's Fatty Tissue and Eustachian Tube
Authors: Aoki Hajime , Sando Isamu , Takahashi Haruo
Published: October 2014

To examine anatomic relationships between Ostmann's fatty tissue (OF) and the eustachian tube (ET), we evaluated serial histologic sections of 32 normal temporal bone—ET specimens and made a quantitative analysis of several measurements (height, width, and volume). We compared results in specimens from individuals in whom the ET was still developing (those 19 years and younger) to results in specimens from individuals with adult ETs (those older than 19). We found that 1) the main body of OF is located at the inferolateral aspect of the ET and 2) postnatally, OF grows in volume, mainly by an increase in height, so that OF maintains the same vertical relationship to the growing ET and does not increase in width. The former finding indicates that OF might exert static pressure on the ET not to open widely. The latter finding indicates that the relatively thicker mass of OF may narrow the ET in those with immature ETs. These results indicate a possible role for OF in ET function, which in turn has been implicated in otitis media with effusion.
Vascularized Fascia as a Transferable Bed for Experimental Laryngeal Reconstruction
Authors: Delaere Pierre R. , Van Damme Boudewijn , Feenstra Louw
Published: October 2014

Laryngeal defects were reconstructed with a combined vascular flap consisting of lateral thoracic fascia used as a transferable vascular bed. A buccal mucosal graft was fixed on this bed as an internal lining. An autogenous cartilage graft, circumferentially wrapped in vascular connective tissue, was used as external support. The first focus of interest of this experimental study was to investigate the necessity of epithelial lining in the repair of a full-thickness laryngeal wall defect. The second focus of interest was to study reconstruction of the posterior glottis by introducing additional supporting material.
Salivary Duct Carcinoma
Authors: Murrah Valerie A. , Batsakis John G.
Published: October 2014

Salivary duct carcinoma is a high-grade neoplasm associated primarily with the parotid gland. Its abysmal prognosis demands aggressive clinical management. Initially named after its resemblance to intraductal carcinoma of the breast, this entity derives its histogenesis from the excretory duct reserve cells, which are also the source of origin of other biologically high-grade neoplasms. As this is a lesion seldom encountered by the clinician, it is important for the pathologist to clearly make the distinction between this malignancy and more indolent neoplasms, such as terminal duct adenocarcinoma.
Three-Dimensional Motion of the Arytenoid Adduction Procedure in Cadaver Larynges
Authors: Neuman Thomas R. , Hengesteg Arne , Kaufman Kenton R. , Lepage Richard P. , Woodson Gayle E.
Published: October 2014

To determine whether variation in suture placement could improve the results of the arytenoid adduction procedure, a model was developed using fresh human cadaver larynges. Three-dimensional (3-D) motion of the arytenoid was determined by utilizing computed tomographic imaging with radiopaque markers on the apex and muscular and vocal processes. By utilizing principles previously applied to the study of rigid body mechanics for the carpal, knee, and tarsal joints, rotation and translation of the arytenoid about the axial, coronal, and sagittal axes were calculated. Subglottic airflow resistance was measured before and after the procedure. Posterior glottic closure was reproducibly achieved, as determined by computed tomographic imaging and airway resistance. Conflicting reports on cricoarytenoid joint mechanics can be attributed to reliance on trigonometric analysis of two-dimensional images, which results in errors in out-of-plane motion. This paper presents a useful model for obtaining detailed anatomic information describing arytenoid 3-D motion.
Primary Liposarcoma of the Larynx
Authors: Hurtado Jose Francisco , Aranda Francisco Ignacio , Lopez Juan Jose , Talavera Jose
Published: October 2014

Laryngeal liposarcoma is an unusual tumor. Only 16 cases have been previously reported. We describe a new case of well-differentiated laryngeal liposarcoma and review the literature. The tumor was treated by surgical removal. Immunohistochemical study showed an immunophenotype consistent with liposarcoma. The case described is of the oldest patient (83 years old), the second to be found in a woman, and the second to be localized to one true vocal cord (according to the literature reviewed). The patient is still free of tumor 2 years later. The treatment and prognosis of liposarcoma of the larynx are discussed.
Proposed Grading System for Subglottic Stenosis Based on Endotracheal Tube Sizes
Authors: Myer Charles M. , O'Connor David M. , Cotton Robin T.
Published: October 2014

The classification of airway stenoses has been a problem for many years. As a result, both intradepartmental and interdepartmental comparisons of airway sizes remain difficult. It follows that comparisons of therapeutic maneuvers are even more difficult. A system is proposed that is simple, reproducible, and based on a readily available reference standard. Endotracheal tubes, which are manufactured to high standards of precision and accuracy, can be used to determine the size of an obstructed airway at its smallest point. The endotracheal tube that will pass through the lumen, if one exists, and tolerate normal leak pressures (10 to 25 cm H2O), can be compared to the expected age-appropriate endotracheal tube size. By using the outside diameters of the endotracheal tubes, the maximum percentage of airway obstruction can be determined. We present a conversion of tube size to the proposed grading scale: grade I up to 50% obstruction, grade II from 51% to 70%, and grade III above 70% with any detectable lumen. An airway with no lumen is assigned to grade IV.
Transformation of Mucosal Secretory Elements in Chronic Maxillary Sinusitis after Endoscopic Sinus Surgery
Authors: Fang Sheen- Yie
Published: October 2014

To evaluate the secretory element transformation of maxillary sinus mucosa after endoscopic sinus surgery (ESS), I enrolled 20 patients. Five normal antral mucosae were used as controls, and 15 antral mucosae were investigated according to pathologic and secretory patterns. The post-ESS mucosa was evaluated at the 16th week, when gross recovery appeared. Specimens from the rear wall of the antrum were observed under a scanning electron microscope (x2,000). A significant decrease of goblet cells and increase of glands was illustrated in the sinusitis cases, especially the polypoid and purulent groups. In post-ESS cases, the number of goblet cells is about the same as in controls, but the number of gland openings is higher. My conclusions were that 1) the repair of the antral mucosa requires more time than gross recovery and 2) post-ESS follow-up should be longer than 16 weeks to prevent recurrence.
Indium 111-Labeled White Blood Cell Scintigraphy as an Unreliable Indicator of Malignant External Otitis Resolution
Authors: Redleaf Miriam I. , Angeli Simon I. , McCabe Brian F.
Published: October 2014

The field of otolaryngology-head and neck surgery has seen many advances in the treatment and prognosis of malignant external otitis (MEO). However, establishing the resolution of the infection remains problematic. A recent report suggests that indium 111-labeled white blood cell scintigraphy may be a reliable and timely indicator of resolution of infection. We present a case of a false-negative white blood cell scan in a patient with persistent MEO. A discussion of this case and a review of the literature illustrate that there continues to be no “gold standard” for establishing MEO resolution.
Restoration of Brain Stem Auditory-Evoked Potentials by Gene Transfer in Shiverer Mice
Authors: Fujiyoshi Tatsuya , Hood Leroy , Yoo T. J.
Published: October 2014

We studied the shiverer mouse as a model for correcting hearing disorders resulting from genetic abnormalities of the central nervous system (CNS). Shiverer mice are homozygous for an autosomal recessive mutation (deletion) in the gene for myelin basic protein (MBP), a major protein component of the myelin sheath in the CNS. Under electron microscopic observation of the cochlear nerve, the CNS portion in shiverer mice showed hypomyelination, but the peripheral portion, including spiral ganglion cells, was normal. We produced MBP-transgenic mice by microinjection of an MBP cosmid clone into the pronucleus of fertilized eggs from shiverer mice. The transgenic mice were found to recover MBP levels up to 25% of normal. A greater number of axons in the transgenic mice were myelinated than in the shiverer mice, but the myelin sheath was not as thick as in normal controls. Every interpeak latency of brain stem auditory-evoked potentials was prolonged in the shiverer mice and improved in the transgenic mice. This study provides an example of gene therapy for hearing disorders caused by a CNS abnormality. We discuss some strategies for researching genetic hearing impairment or deafness in both animals and humans.
Statistical Model Estimating the Occurrence of Otitis Media from Temporal Bone Pneumatization
Authors: Homøe Preben , Rasmussen Niels , Lynnerup Niels , Skovgaard Lene Theil
Published: October 2014

In order to investigate the relationship between the pneumatization of temporal bones and the occurrence of otitis media in Greenlandic Inuit, 36 Greenlandic Inuit were examined by radiography of the temporal bones. The pneumatized cell area was measured planimetrically. All subjects answered a questionnaire on infectious middle ear disease (IMED), and an objective otologic examination was performed. Nine persons of 34 (26%) reported IMED in childhood, and there was IMED reported in all pneumatized areas below 400 mm2. Based on bilateral area measures, a polychotomous logistic regression model was applied. The occurrence of IMED was shown to be associated with smaller areas, and unilateral IMED was associated with pronounced asymmetry. The model has enabled risk assessment, and 8 persons were designated by the model as having had IMED with a sensitivity of 67% (confidence interval 30% to 93%) and a specificity of 92% (confidence interval 74% to 99%). When the model was applied to a historical anthropological Inuit material from 1700 to 1800 AD, 6 of 56 crania were designated as having had IMED. This method has improved the accuracy of estimating the occurrence of IMED in ancient populations.
Electrocochleography with Postural Changes in Perilymphatic Fistula
Authors: Campbell Kathleen C. M. , Abbas Paul J.
Published: October 2014

The present study investigated the effect of altering body position on electrocochleographic findings in the presence and absence of perilymphatic fistula. Three groups of guinea pigs included 1)10 normal control animals, 2) 10 experimental animals with induced perilymphatic fistula, and 3) 10 control animals with induced perilymphatic fistula. In the first two groups, animals were successively tested in three positions: first with the ventral aspect down, again after 30 minutes with the test ear up, and again after 15 minutes with the test ear down. In the third group, body position was not altered. Stimuli consisted of clicks and 6,000-Hz tone bursts. Data analysis included summating potential (SP) amplitude, action potential (AP) amplitude, and AP threshold for the click stimuli. Only the normal control group showed a significant effect of body position for the SP/AP amplitude ratio. Average change was greater in the experimental group, but high variability precluded statistical significance. Both fistulized animal groups exhibited high variability in the SP/AP amplitude ratio, with and without postural change. The SP/AP amplitude ratio and SP amplitude were significantly larger for the two fistulized groups than for the normal control group. No significant change in threshold occurred across positions for any group.
Lichen Planus and Lichenoid Lesions of the Oral Cavity
Authors: Batsakis John G. , Cleary Karen R. , Cho Kyung-Ja
Published: October 2014

Lichen planus is a mucocutaneous disease of unknown cause that has its principal clinical manifestations in the skin and mucosa of the oral cavity. The natural history of the cutaneous form is one of spontaneous resolution over time, while oral lichen planus pursues a much more chronic course with a low order of resolution. Oral lichen planus must be distinguished from lichenoid lesions, including lichenoid dysplasia. Malignant change in oral lichen planus is rare and is prompted by carcinogenic cofactors. There is no increased risk of development of carcinoma in cutaneous lichen planus.
Surgical Reporting Instrument Designed to Improve Outcome Data in Head and Neck Cancer Trials
Authors: Weymuller Ernest A. , Casiano Roy R. , Laramore George , Schuller David , Al-Sarraf Muhyu , Ahmad Khurshid , Scott Charles B. , Jacobs John R.
Published: October 2014

Precise reporting of surgical staging and operative data in multi-institutional protocol studies could provide a number of benefits: 1) fewer cases would be discarded because of inadequate data, 2) staff review time would be reduced, 3) there would be assurance that participating surgeons were performing similar operations on similar tumors, 4) the resulting precision in stratification should improve the likelihood of achieving accurate comparison of the treatment options under study, and 5) by comparing the surgical parameters with local-regional control of disease, the specific factors that have a statistically significant correlation with outcome could be identified. This paper presents a computer-based, anatomically oriented reporting instrument that should improve the reliability of surgical data available to multi-institutional protocols.
Immune Response to Moraxella Catarrhalis in Children with Otitis Media: Opsonophagocytosis with Antigen-Coated Latex Beads
Authors: Faden Howard , Hong Jung J. , Pahade Nickesh
Published: October 2014

Opsonic antibody activity against Moraxella catarrhalis was determined in sera from children with otitis media. The antibody was determined with a new assay utilizing outer membrane antigen-coated latex beads. Antigen-coated beads opsonized in heat-inactivated pooled human serum phagocytosed 47.5 ± 36.1 beads per 100 neutrophils compared to 15.6 ± 10.2 beads per 100 neutrophils opsonized in hypogammaglobulinemic serum (p < .025). Antigen-coated beads opsonized in homologous sera from 11 children with M catarrhalis otitis media demonstrated increased opsonic activity in convalescent sera (34.6 ± 27.1) compared to acute sera (15.5 ± 6.7;p< .05). These data suggest that infection with M catarrhalis is associated with the development of opsonic antibody.
Leiomyosarcoma of the Middle Ear and Temporal Bone
Authors: Zbären Peter , Ruchti Charles
Published: October 2014

Leiomyosarcoma is a malignant tumor of smooth muscle origin. It is rarely encountered in the head and neck area. A patient with leiomyosarcoma of the middle ear and the temporal bone with unusual bone destruction is presented. To our knowledge it is the first report of a middle ear and temporal bone leiomyosarcoma.
Laryngeal Involvement in Epidermolysis Bullosa
Authors: Lyos Andrew T. , Malpica Anais , Levy Moise L. , Sulek Marcelle
Published: October 2014

Epidermolysis bullosa (EB) represents a group of rare hereditary mechanobullous disorders marked by blister formation following relatively minor trauma. There are three categories depending on the site of disruption within the skin: simplex (above the basement membrane), dystrophic (below the basement membrane), and junctional (at the lamina lucida). Laryngeal involvement is rare, but has been reported primarily in association with junctional EB. Presented is our experience with 5 children with EB who demonstrated laryngeal involvement. Three children required tracheostomies acutely and 1 died of airway obstruction. One patient, with the Dowling-Meara type of EB simplex, was treated conservatively with good results. Tracheostomy should be an early consideration in the management of these patients to protect the airway in the acute setting and to prevent any further laryngeal injury associated with endotracheal intubation. The rate of complications of tracheostomy appears to be low; however, the prognosis for decannulation is poor.
Spindle-Shaped Glottal Insufficiency with and without Sulcus Vocalis: A Retrospective Study
Authors: Lindestad Per-Åke , Hertegård Stellan
Published: October 2014

The clinical records of 186 patients with spindle-shaped glottal insufficiency were studied in order to evaluate the clinical background of the finding. The patients formed two main groups: those with and those without sulcus vocalis. Most of the sulcus patients were females, comparatively young at the onset of symptoms and at the time of diagnosis. In contrast, the majority of patients with spindle-shaped glottal insufficiency without sulcus were male and they often had a history of either laryngitis or chronic general disease causing decreased physical ability. Some patients in this group had long-standing symptoms, possibly caused by a disturbance in pubertal voice change. The data also indicate differences between the groups in vocal fold vibratory pattern. It is evident that the spindle-shaped glottal insufficiency observed in patients with and without sulcus has different causes and different pathophysiologic explanations.
Videoendoscopic Diagnosis and Correction of Velopharyngeal Stress Incompetence in a Bassoonist
Authors: Gordon Neil A. , Astrachan David , Yanagisawa Eiji
Published: October 2014

Musicians who play woodwind or brass instruments must generate extremely high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as difficulty in holding high notes or in playing sustained music compositions, or noise production from turbulent nasal cavity emissions. Throughout the literature, there are few reports of these entities. We will present the case of a 31 -year-old concert bassoonist who complained of “noise from her head” only when she played the bassoon. This resulted in numerous failed auditions and threatened her professional career. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthesia with the subject playing the bassoon. The use of videoendoscopic techniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.
Rib-Muscle Pedicle Flap for the Repair of Congenital Tracheal Stenosis
Authors: Willner Ayal , Velez Francis J.
Published: October 2014

Congenital tracheal stenosis (CTS) is an uncommon congenital anomaly that presents early in life with symptoms of biphasic stridor. Most cases require surgical correction. Techniques have included dilation, resection of the involved segment, and tracheoplasty. Today pericardium and costal cartilage are the most frequently used materials for tracheoplasty, but patients still often encounter problems with the graft, with the procedure, or with late complications. This preliminary study was undertaken to determine the feasibility of a rib-intercostal muscle pedicle flap for the treatment of CTS. Tracheoplasties were performed on seven 3.5- to 5.5-kg piglets with a pedicled segment of the right fourth rib via a lateral thoracotomy incision. The method was found to be technically feasible, and pedicles of greater than 2.5 cm were easily developed. The repair provided good structural support and an airtight seal at high ventilator pressures. Histologic examination after 2 weeks showed the flap to be incorporating into the native trachea and to be without degenerative changes. This “vital” composite flap has several real and theoretic advantages over current methods of repair and may prove to be valuable in the treatment of CTS. The clinical application of this myo-osseous pedicle graft in the treatment of patients with stenoses not amenable to surgical resection and primary anastomosis should be explored.
Does Intracochlear Implantation Jeopardize Vestibular Function?
Authors: Huygen Patrick L. M. , Van Den Broek Paul , Mens Lucas H. M. , Spies Teun H. , Admiraal Ronald J. C.
Published: October 2014

We present the results of the vestibular function tests of 35 patients who were selected for cochlear implantation. Vestibular function was evaluated with a caloric test and a velocity step test. The preimplant data were compared to those in previously reported series. Intracochlear implantation was performed in 25 patients. The vestibular complications encountered in this group are presented and discussed. Six patients had normal or residual (but substantial) vestibular function in the ear eligible for implantation. Vestibular function was preserved in 3 patients and was lost in 3 patients, in 1 case through an iatrogenic cause. We estimate the risk of losing vestibular function as a result of intracochlear implantation as between 50% and 60% on the basis of the present and previously reported data.
Possible Role of Adenoid Mast Cells in the Pathogenesis of Secretory Otitis Media
Authors: Berger Gilead , Ophir Dov
Published: October 2014

The distribution of mast cells in the adenoidectomy specimens of 76 children with enlarged adenoids was studied. Forty of the patients had secretory otitis media; the remaining 36 had normally aerated middle ears. The mast cells were identified on the basis of the metachromatic staining of their cytoplasmic granules with toluidine blue. Patients with secretory otitis media had a twofold increase of their mast cell population compared to those without middle ear disease. Statistical analysis confirmed that the difference between the two groups is significant (p = .0001). The results of the study are consistent with the previous finding of increased histamine concentration in adenoids of children with secretory otitis media and lend support to the adenoid mediator release hypothesis, whereby the adenoid mast cells degranulate and release histamine and other inflammatory mediators that induce eustachian tube insufficiency and otitis media with effusion.
Middle Ear Gas Exchange in Rhesus Monkeys
Authors: Doyle William J. , Seroky James T.
Published: October 2014

The mechanism of gas exchange between the middle ear and tissue is fundamental to understanding middle ear physiology and pathophysiology. In this study, the middle ears of six rhesus monkeys were inflated on separate occasions with nitrogen (N2), carbon dioxide (CO2), and oxygen (O2), and middle ear pressures were recorded at defined times postinflation for up to 4 hours. From these data, rate constants governing the exchange of these gases were estimated and compared to those predicted under both diffusion and perfusion limitations. The results show that the rate constants for middle ear to tissue exchange of O2 and CO2 are consistent with a diffusion-limited process. In contrast, middle ear pressure did not decrease over the study period following introduction of N2 into the middle ear. This is interpretable as a much slower rate of N2 exchange than that predicted by either perfusion or diffusion-limited models calibrated to the O2 and CO2 rate constants. These results have significant implications for middle ear gas exchange and suggest that for relatively short observation periods, the behavior of middle ear pressure is controlled by experimentally established O2 and CO2 gradients.
“External Counterpressure” and “Internal Distention” for Optimal Laryngoscopic Exposure of the Anterior Glottal Commissure
Authors: Zeitels Steven M. , Vaughan Charles W.
Published: October 2014

External laryngeal counterpressure and internal laryngeal distention produce forces that are helpful for enhancing laryngoscopic exposure of the anterior glottis. These principles were formally described in the early 20th century, but are seldom used today. Hand pressure has been the typical source for external counterpressure. Since this maneuver is unstable if provided by an assistant and wasteful if provided by the surgeon, it is often neglected. Current phonomicrosurgical techniques require wider glottal exposure; therefore, a reexamination of the value of external counterpressure and internal distention is worthwhile. During the last 2 years, 125 microlaryngoscopic procedures were performed for a variety of benign, premalignant, and malignant lesions. All patients were placed in the Boyce-Jackson position and sustained with a modified Killian gallows, with resulting elevated-vector suspension. Internal distention was achieved by placing the largest-lumen glottiscope possible between the endotracheal tube and the infrapetiole region. Exposure was also improved by using silk adhesive tape to apply external counterpressure to the lower laryngeal framework. The use of both external counterpressure and internal distention as an adjunct to microlaryngoscopy was most helpful for the surgical management of lesions located near the anterior commissure. Seemingly, the two resultant forces are in opposition to each other, but in fact they are complementary, both to each other and to the orthodox laryngoscopic principle of elevated-vector suspension.
Age-Related Changes in Pharyngeal and Supraglottic Sensation
Authors: Martin John H. , Diamond Beverly , Aviv Jonathan E. , Jones Michael E. , Keen Monte S. , Wee Tien Ahn , Blitzer Andrew
Published: October 2014

As one ages, sensory discrimination in the oral cavity progressively diminishes, and dysphagia and aspiration are more likely to occur. Whether similar age-related laryngeal and pharyngeal sensory abnormalities exist and contribute to dysphagia and aspiration is unknown. The purpose of this study was to determine if sensory discrimination in the area innervated by the superior laryngeal nerve diminishes with increasing age. By applying a previously described new device and technique that utilizes brief air pulse stimulation of the anterior wall of the pyriform sinus, sensory discrimination can be reliably determined. We carried out 672 trials in 56 healthy adults divided into three age groups: 20 to 40, 41 to 60, and 61 to 90 years of age. Overall, the average sensory discrimination was 2.30 ± 0.50 mm Hg. In subjects 20 to 40 years of age, sensory discrimination was 2.07 ± 0.20 mm Hg, while in subjects 61 to 90 years of age, sensory discrimination was 2.68 ± 0.63 mm Hg (p < .05). There also was a statistically significant difference between the 41- to 60-year and 61- to 90-year age groups (p < .05). Progressive diminution in pharyngeal and supraglottic sensitivity with increasing age might be a contributing factor in the development of dysphagia and aspiration in the elderly.
Interarytenoid Notch Height Relative to the Vocal Folds Pilot Study
Authors: Smith Richard J. H. , Neville Michael B. , Bauman Nancy M.
Published: October 2014

We measured interarytenoid notch height (IANH) in 20 young children who required direct laryngoscopy under general anesthesia. By means of a specifically designed instrument, we found that the average IANH approximated 3 mm. Laryngeal incompetence on swallowing or in the presence of gastroesophageal reflux is associated with a low ianh (p < .0001). Therefore, ianh may be a measure of relative laryngeal incompetence.
Neuropeptide Participation in Canine Laryngeal Sensory Innervation
Authors: Hisa Yasuo , Okamura Hitoshi , Tadaki Nobuhisa , Taguchi Jun-Ichi , Uno Toshiyuki , Ibata Yasuhiko
Published: October 2014

We investigated the quantitative participation of calcitonin gene-related peptide (CGRP), substance P (SP), and leu-enkephalin (ENK) in canine laryngeal sensory innervation by immunohistochemistry in combination with retrograde labeling using the recently introduced retrograde tracer cholera toxin subunit B—conjugated gold (CTBG). In the nodose ganglion, neurons labeled from the internal branch of the superior laryngeal nerve with CTBG were investigated immunohistochemically by means of antisera against CGRP, SP, and ENK. The percentages of neurons immunoreactive to each neuropeptide were as follows: CGRP 81.5%, SP 24.5%, and ENK 7.0%. These results suggest that CGRP is the main sensory neurotransmitter in canine laryngeal sensory innervation.