bluuebunny/crossref_metadata_2025 huggingface dataset:
Elastin at the Hinge Portion of the Eustachian Tube Cartilage in Specimens from Normal Subjects and Those with Cleft Palate
Authors: Matsune Shoji , Sando Isamu , Takahashi Haruo
Published: October 2014

The density of elastin in the intermediate portion between the lateral lamina and the medial lamina of human eustachian tube (ET) cartilage was examined in six normal adults, seven normal children, and six children with cleft palate (CP) in order to obtain information about how the physical properties of the ET cartilage differ as a function of age and presence of CP. Cross sections of the midcartilaginous portions of the ETs that had been stained with Weigert's elastin stain were photographed at uniform magnification, the area for study was projected, and the meshlike area of the ET cartilage that stained elastin-positive was represented on paper by lines. A digitizer was used to measure the total length of all the lines representing elastin in each photomicrograph, and the mean was determined for each of the three groups. The mean density of elastin was significantly greater in normal adults than in normal children (Student's t test, t = 2.781; p< .02). It was also significantly greater in normal children than in CP children (Wilcoxon t = 24.0; p< .05). These results appear to indicate that CP children have poorer elasticity in this area of the ET cartilage, which might cause functional obstruction (floppiness) of the ET in those children.
Chronic Perilymph Fistula in the Guinea Pig with Implications in the Human
Authors: Parnes Lorne S. , Campbell Kathleen C. M.
Published: October 2014

To improve understanding of the pathophysiology of perilymph fistulas, a predictable animal model of a chronic fistula was developed. Our findings suggest that guinea pig fistulas do not remain patent for prolonged periods. By extrapolating these findings to humans, we postulate that the symptoms and signs of perilymph fistula are possibly due not to one prolonged constant fistula, but rather a series of “blowouts” from an inherent congenital or posttraumatic weak spot in either the round or oval window. We feel that a diagnosis of perilymph fistula must be considered in any patient presenting with a Meniere's-like symptom set concomitant with a congenital inner ear deformity or a history of inner ear trauma.
Treatment of Tracheal and Endobronchial Lesions with the Potassium Titanyl Phosphate Laser
Authors: Ward Robert F.
Published: October 2014

Lower tracheal and endobronchial lesions represent a difficult management problem. While there has been some success in the treatment of these lesions with the carbon dioxide laser, the limitations of its delivery system have restricted its use in infants and neonates. The potassium titanyl phosphate (KTP) laser, transmitted via a flexible quartz fiber, can be precisely manipulated even through rigid pediatric bronchoscopes as small as 3.0 mm. In addition, the Hopkins telescopic lens may be used to improve visualization and control. We report our experience using the KTP laser to treat 15 pediatric patients with tracheal and endobronchial lesions. The nature of the lesions, the details of the technique, and the results are presented.
Experimental Otitis Media Evaluated by Magnetic Resonance Imaging: An in Vivo Model
Authors: Chan Kenny H. , Doyle William J. , Swarts J. Douglas , Kardatzke David , Hashida Yoshie , Wolf Gerald L.
Published: October 2014

The use of magnetic resonance imaging in otitis media research is being explored in our laboratory. In this study, we present a new method for studying changes in the middle ear cleft due to an episode of induced otitis media in the chinchilla model. It uses gadolinium-diethylenetriamine pentaacetic acid, a magnetic resonance imaging contrast agent, to examine the uptake and washout characteristics of middle ear mucosa during an inflammatory episode. Parameters such as the time to maximum intensity of the mucosa and the washout rate of the contrast agent from the mucosa were significantly correlated to the duration of the infection.
Lepromatous Leprosy: Nasal Manifestations and Treatment with Minocycline
Authors: Lalwani Anil K. , Tami Thomas A. , Gelber Robert H.
Published: October 2014

Nasal involvement in lepromatous leprosy is universal and occurs early in the course of the disease. Nasal symptoms include obstruction, crusting, bleeding, and hyposmia. Traditional therapy with dapsone, rifampin, and clofazimine is limited by its cost and toxicity. Minocycline hydrochloride, a tetracycline antibiotic with limited side effects, is promising as a new treatment for leprosy. A case is presented that highlights the clinical presentation, diagnosis, and treatment of lepromatous leprosy.
Airway and other Complications of Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients
Authors: Riley David A. , Strauss Melvin
Published: October 2014

The purpose of this study was to look at complications associated with percutaneous endoscopic gastrostomy (PEG) in a group of head and neck cancer patients. We retrospectively reviewed charts of 46 patients referred for PEG. Three of 29 patients without secured airways (10.3%) had acute airway obstruction after administration of sedation for the PEG procedure. Two required emergency tracheostomy. Three additional patients of these 29 (10.3%) presented within 2 months of their PEG attempts with tumor-related airway obstruction requiring emergency tracheostomy. There were no other serious complications noted in our review. We concluded that our group of head and neck cancer patients were at high risk for airway obstruction, especially when sedated, and that the acute risk was not directly associated with the PEG procedure. We also concluded that referral for PEG should be made in anticipation of future nutritional needs and that PEG should not be used only as a late-stage procedure.
Free Jejunal Graft: Effects of Longitudinal Myotomy
Authors: Haughey Bruce H. , Forsen James W.
Published: October 2014

Pharyngoesophageal reconstruction using the free vascularized jejunal graft results in dysphagia in approximately 20% to 40% of patients. This may be caused by graft contractility, and we therefore developed this canine model to assess the functional effects of myotomy on transplanted jejunum. Nine female dogs underwent microvascular transposition of jejunum to the neck, the bowel being placed subcutaneously with two end jejunostomies. Baseline functional manometry was performed. Five animals then underwent complete longitudinal myotomy and four animals underwent a sham procedure. Graft function was then reevaluated after complete wound healing. Contraction frequency, contraction amplitude, and total work done by the graft were recorded; all grafts demonstrated activity and were more active postrecovery than at the time of operation. Although myotomy animals showed a within-group trend to decreased contractility postintervention, this was not statistically significant. Furthermore, there was no significant postintervention difference between the sham and myotomy groups. We conclude that our model is effective for the study of activity in the free jejunal graft and that longitudinal myotomy does not significantly reduce, let alone ablate contraction.
Functional Neck Dissection: Three Decades of Controversy
Authors: Gavilán Javier , Gavilán César , Herranz Jesús
Published: October 2014

Functional neck dissection (FND) is a neck-functional, tumor-radical approach for the management of the neck in patients with head and neck cancer. Based on the anatomic knowledge of the lymphatic compartments of the neck, FND is a different surgical technique rather than a modification of the classic procedure described by Crile. From an oncologic viewpoint, FND is a relatively safe operation to treat the cervical spread from head and neck cancer as long as the indications and technical details are carefully followed. In this report, based on our experience with more than 1,000 FNDs, we analyze the history and the philosophy of the operation.
Factors Predicting Postoperative Sentence Scores in Postlinguistically Deaf Adult Cochlear Implant Patients
Authors: Blamey Peter J. , Pyman Brian C. , Clark Graeme M. , Dowell Richard C. , Gordon Michael , Brown Alison M. , Hollow Rodney D.
Published: October 2014

A sample of 64 postlinguistically profoundly to totally deaf adult cochlear implant patients were tested without lipreading by means of the Central Institute for the Deaf (CID) sentence test 3 months postoperatively. Preoperative promontory stimulation results (thresholds, gap detection, and frequency discrimination), age, duration of profound deafness, cause of deafness, lipreading ability, postoperative intracochlear thresholds and dynamic ranges for electrical stimulation, depth of insertion of the electrode array into the scala tympani, and number of electrodes in use were considered as possible factors that might be related to the postoperative sentence scores. A multiple regression analysis with stepwise inclusion of independent variables indicated that good gap detection and frequency discrimination during preoperative promontory testing, larger numbers of electrodes in use, and greater dynamic ranges for intracochlear electrical stimulation were associated with better CID scores. The CID scores tended to decrease with longer periods of profound deafness.
Synovial Sarcomas of the Head and Neck
Authors: Carrillo Rosario , Rodriguez-Peralto Jose Luis , Batsakis John G.
Published: October 2014

Springing from mesenchyme rather than mature synovial tissues, synovial sarcomas are high-grade neoplasms that express epithelial as well as supporting tissue features. Accordingly, their histologic phenotypes can be epithelial, stromal, or mixed. Between 3% and 10% of all synovial sarcomas originate in the head and neck, particularly from parapharyngeal sites. These is no appreciable difference in biologic activity between synovial sarcomas of the head and neck and those arising from other anatomic sites. Five-year survivals are misleadingly optimistic and do not adequately reflect the natural history of the sarcoma. Synovial sarcoma is known to metastasize late, and few patients survive that event.
Effect of the Radioprotector WR2721 on Irradiation-Induced Injury to Ciliated Cells of Eustachian Tube
Authors: Jung Timothy T. K. , Park Young Min , Panossian David , Weeks Douglas , Miller Stanley K. , Sandefur Jere , Krohn Kenneth A.
Published: October 2014

Our previous studies revealed that injury to the ciliated cells of the eustachian tube may be the primary cause of irradiation-induced serous otitis media. The purpose of this study was to investigate the effects of the radioprotector WR2721 on irradiation-induced injury to ciliated cells of the eustachian tube (ET) in chinchillas. Twelve chinchillas were divided into two groups: the control group and the experimental group, which was pretreated with a single intraperitoneal dose of the radioprotector S-2-[3-aminopropylamino]ethylphosphorothioic acid (WR2721) 400 mg/kg. The two groups were exposed to 30 Gy of 13-MeV electrons in a single fraction to the area of the bullae and nasopharynx. Ciliary dysfunction was tested and ciliated cells of the ET were examined by scanning and transmission electron microscopy. Pretreatment with WR2721 was found to protect ciliated cells of the ET from irradiation injury.
Electrocochleography in the Presence and Absence of Perilymphatic Fistula
Authors: Campbell Kathleen C. M. , Savage Michael M. , Harker Lee A.
Published: October 2014

The purpose of the present study was to evaluate the effect of an acute perilymphatic fistula on the amplitude ratio (SP/AP) of the summating potential (SP) and action potential (AP). The effect of the acute fistula on AP threshold was also addressed. Electrocochleo-graphic recordings were obtained before and immediately after surgical laceration of the round window membrane in 19 guinea pigs. Stimuli comprised clicks and 2,000-Hz and 8,000-Hz tone bursts, presented initially at 100 dB peak equivalent sound pressure level and in descending 10-dB steps. After fistula induction the SP/AP significantly increased for the click and 8,000-Hz tone burst stimuli but not for the 2,000-Hz tone burst stimuli. No significant change in AP threshold occurred. These findings suggest that the SP/AP may be sensitive to perilymphatic fistula, at least in guinea pigs. The changes in the SP/AP do not appear to be related to changes in threshold.
Detection of Human Papillomavirus Infection in Diseased and Nondiseased Sites of the Respiratory Tract in Recurrent Respiratory Papillomatosis Patients by DNA Hybridization
Authors: Pignatari Shirley , Smith Elaine M. , Shive Cynthia , Gray Steven D. , Turek Lubomir P.
Published: October 2014

We examined 12 recurrent respiratory papillomatosis patients, who were undergoing treatment for recurrence of their disease, for the presence of human papillomavirus (HPV). Biopsies were obtained from their respiratory papillomas and nondiseased sites (NDS) of the respiratory tract: the nasopharynx, posterior tonsillar pillar, aryepiglottic fold, cervical trachea, intrathoracic trachea, and bronchi. The presence of HPV DNA was determined by using the ViraPap/ViraType DNA hybridization procedure. Two thirds of the patients were infected with HPV 6/11 in either the diseased papilloma or NDS: 50% of patients with papilloma specimens typed positive (6 of 12), and 40% of the patients typed HPV-positive in one or more biopsies from the NDS (4 of 10). No single NDS was more likely to be infected with HPV than any other. No oncogenic HPV types 16/18 or 31/33/35 were detected in the papillomas or NDS of these patients. Only patients with multiple, and not isolated, papilloma involvement were found to harbor HPV DNA in NDS; and 80 % of those with infected NDS, compared to 20 % of those without infected NDS, required a shorter (no more than 3 months) surgical treatment interval. Our results show that HPV infection frequently persists in adjacent, clinically normal sites, and suggest that the extent of NDS involvement may predict both the extent of disease and the likelihood of recurrence.
Animal Model for Ischemic Facial Nerve Paralysis with Selective Vascular Embolization
Authors: Kumoi Takeo , Nishimura Yoshihiko , Iritani Hiroshi , Minatogawa Toru
Published: October 2014

An experimental model that reliably and easily produces acute ischemic facial nerve paralysis would be useful for the controlled study of treatment and to improve our understanding of the pathophysiology and treatment of facial nerve palsy. Most documented models that simulate clinical facial nerve palsy cause direct damage to the nerve. We describe an experimental model for ischemic facial nerve paralysis in the cat that employs arterial block of the internal and external maxillary and posterior auricular arteries using embolizing material (Avitene). All animals develop stable acute ischemic facial nerve palsy lasting for approximately 2 months. Electromyographic study of this model revealed that the site of the lesion resulting from selective embolization may be within the temporal bone. This model has the advantages of simplicity of technique, cost-effective use of cats, and reproducibility of facial nerve palsy.
Malformation and Degeneration in the Inner Ear of MOS Transgenic Mice
Authors: Rauch Steven D.
Published: October 2014

Transgenic mice carrying the mos proto-oncogene linked to a retroviral transcriptional control sequence display behavioral abnormalities including circling, hyperactivity, head tilt, and bobbing. Axonal degeneration, neuronal chromatolysis, spongiform encephalopathy, gliosis, and inflammatory infiltrates are reportedly found in the central nervous systems of all mutants with the behavioral traits. Hearing was tested by means of broadband free-field rarefaction clicks with auditory brain stem response recorded between vertex and mouth electrodes. No detectable auditory response was elicited in transgenic animals, in contrast to five distinct positive peaks observed in littermate control animals. Light microscopic survey of temporal bone histopathology in mutants revealed extensive degeneration of the organ of Corti with loss of hair cells in all cochlear turns and loss of supporting cells and atrophy of spiral ganglion cells. The spiral Iimbus was deformed, with replacement of the usual convexity of the superior surface by a flattened trough configuration. Hair cells of the vestibular end organs appeared normal. Pathologic alteration in levels of mos transgene RNA appears to have a direct effect on the structural integrity of the inner ear.
Otolaryngologic Manifestations of the Mucopolysaccharidoses
Authors: Bredenkamp James K. , Williams Julian C. , Smith Marshall E. , Crumley Roger L. , Dudley James P. , Crockett Dennis M.
Published: October 2014

A retrospective review of 45 children with mucopolysaccharidoses was performed to determine the frequency of complications related to the head and neck. In this series, every patient had at least one complication involving the head and neck region, and in over half, operative intervention by the otolaryngologist was required. Upper airway obstruction occurred in 17 (38%) and necessitated a tracheostomy in 7 (16%). Cervical spine instability occurred in 8 (18%), making airway management difficult. Recurrent respiratory infections occurred in 17 (38%), and chronic recurrent middle ear effusions were noted in 33 (73%). This review demonstrates that children afflicted with the mucopolysaccharidoses frequently have otolaryngologic-related complications that are common throughout their life span and often the primary management issue in their continuing care. The otolaryngologic management of these patients is outlined based on the results of this study and review of the relevant literature.
Expression of Intermediate Filament Proteins in the Adult Human Vestibular Labyrinth
Authors: Bauwens Louis J. J. M. , De Groot John C. M. J. , Veldman Jan E. , Ramaekers Frans C. S. , Huizing Egbert H.
Published: October 2014

The immunohistochemical detection of intermediate filament proteins, cytoskeletal constituents that allow the characterization of tissues, was investigated in frozen sections of the chemically fixed, nondecalcified, adult human vestibular labyrinth. Cytokeratins (CKs) were detected in all epithelia (including the sensory epithelia), although substantial differences in the degree of staining between individual cells occurred. The expression of CKs 7, 8, 18, and 19 as detected with our subunit-specific monoclonal antibodies in the vestibular epithelia is typical of “simple” epithelia and is identical to the CK subtypes found in the human cochlea. Although immunostaining for CK 7 was very weak and was limited to certain vestibular wall cells, the other CKs demonstrated a pronounced and rather uniform distribution throughout the different epithelia. All epithelia (including the sensory epithelia) displayed expression of vimentin, thus demonstrating co-expression with CKs. Vimentin was also present in the subepithelial connective tissue fibroblasts and mesothelial lining of the vestibular labyrinth. Neurofilament proteins were detected in all neuronal structures. The intense staining for CKs in the maculae and cristae implies that these sensory organs are rigid structures, a finding that may possibly be of importance in the mechanoelectrical transduction process for the sense of equilibrium.
Primary Salivary Gland Amyloidosis Causing Sicca Syndrome
Authors: Myssiorek David , Alvi Aijaz , Bhuiya Tawfiqul
Published: October 2014

Sicca syndrome (SS), consisting of xerostomia and xerophthalmia, may be caused by various disease processes. We present a unique case of SS secondary to primary amyloidosis. Amyloidosis is a rare but definite cause of SS and should be included in the differential diagnosis of any patient who presents with sicca symptoms. A literature review comparing amyloidotic patients with SS and patients with amyloidosis only demonstrates that both of these groups of patients present similarly with regard to symptoms. However, the majority of patients with SS present with sicca symptoms initially in addition to symptoms of amyloidosis. These SS patients also present with proteinuria and negative serology test results. Therefore, patients presenting with sicca symptoms, proteinuria, and negative serologic findings should be suspect for amyloidosis. The importance of distinguishing the diagnosis of Sjögren's syndrome from SS in these patients cannot be overemphasized. There is a significantly higher incidence of developing a lymphoma in Sjögren's syndrome patients. This has important implications for the head and neck surgeon treating these patients.
Interpretation of Electrocochleography in Meniere's Disease and Normal Subjects
Authors: Campbell Kathleen C. M. , Harker Lee A. , Abbas Paul J.
Published: October 2014

Electrocochleographic recordings were obtained from 20 subjects with normal hearing and 10 subjects with Meniere's disease by using an eardrum electrode. Stimuli included clicks and 6,000-Hz tone bursts. Results were not significantly different between the two groups for summating potential (SP) amplitude, action potential (AP) amplitude, or the SP/AP amplitude ratio. Interpreting the results in light of symptoms on the date of assessment or hearing threshold did not appear to improve separation between the two groups. Various SP/AP amplitude ratio criteria have been proposed in order to separate normal patients from those with Meniere's disease. Applying these proposed criteria to our data did not successfully separate the two groups.
Vestibulo-Ocular Compensation following Unilateral Vestibular Deafferentation
Authors: Li Cheng-Wei , Cousins Vincent , Hooper Robin
Published: October 2014

Vestibulo-ocular compensation following vestibular deafferentation was investigated in 26 acoustic neuroma patients following tumor removal and in 5 Meniere's disease patients following vestibular nerve section by using sinusoidal harmonic acceleration testing. All three test parameters (phase lead, gain, and asymmetry), when averaged, shifted significantly on the first postoperative test (average 0.4 months after operation). A marked progression in central compensation with gain returning to the range of normal control values was seen in the tests performed 1 to 6 months (average 2.6 months) postoperatively. However, phase lead and asymmetry (especially at 0.01, 0.02, 0.04, and 0.08 Hz) remained outside the range of normal control values, and all three parameters failed to return to their preoperative level even when tested at more than 12 months (average 20.2 months) after operation. This finding indicates that the deficits of the vestibulo-ocular reflex to head acceleration are of long duration if not permanent.
Reading Skills and Auditory Processing Ability in Children with Chronic Otitis Media in Early Childhood
Authors: Updike Claudia , Thornburg Judith D.
Published: October 2014

The effect of recurrent middle ear disease during the first 2 years of life on auditory perceptual skills and reading ability was examined in two groups of 6- and 7-year-old children who were pair-matched by age, gender, socioeconomic status, and receptive vocabulary. Group 1 consisted of children with documented chronic otitis media at an early age, and group 2 had no history of middle ear problems. Tests of auditory perceptual skills and reading ability were administered. Significant differences in performance on all tests of auditory processing ability and reading ability were noted.
Epithelial-Myoepithelial Carcinoma of Salivary Glands
Authors: Batsakis John G. , El-Naggar Adel K. , Luna Mario A.
Published: October 2014

Epithelial-myoepithelial carcinomas comprise approximately 1 % of all salivary gland neoplasms. They are preponderantly tumors of the parotid glands with a relatively low mortality but a decided locoregional aggressiveness. Histopathologically, the carcinomas are characterized by a dual cell population of epithelial (ductal) cells and myoepithelial cells. These cells vary in their dominance and phenotypic expression
Noninvasive Technique for Estimating Subglottic Pressure and Laryngeal Efficiency
Authors: Bard Michael C. , McCaffrey Thomas V. , Slavit David H. , Lipton Richard J.
Published: October 2014

The clinical assessment of aerodynamic parameters is important in the physiology and pathophysiology of laryngeal function. Vocal efficiency is among these objective measurements and can be calculated from simultaneous recordings of subglottic pressure, airflow, and sound intensity. Modern techniques allow us to accurately determine sound intensity and airflow. However, methods to determine subglottic pressure are either invasive or laborious. We have evaluated a noninvasive, indirect method to determine subglottic pressure by using a technique based on the interruption of transglottic airflow during phonation. The correlation between the indirectly acquired subglottic pressure measured in the oral cavity by using this technique and the subglottic pressure obtained directly by translaryngeal puncture in human volunteers was highly significant in 35 trials (r = .92, p < .01). This study describes a reliable technique for the noninvasive measurement of subglottic pressure, sound intensity, and airflow.
Lidocaine Effects on the Laryngeal Chemoreflex, Mechanoreflex, and Afferent Electrical Stimulation Reflex
Authors: McCulloch Timothy M. , Richardson Mark A. , Flint Paul W. , Bishop Michael J.
Published: October 2014

The use of lidocaine hydrochloride as either a topical or intravenous agent has become a common practice for minimizing laryngospasm and the reflex cardiovascular effects resulting from upper airway manipulation. The efficacy and mechanism of action of lidocaine for this purpose remain unclear. We evaluated the effect of lidocaine on the laryngeal chemoreflex (LCR), mechanoreflex (LMR), and superior laryngeal nerve electrical stimulation adductor reflex (SLN-ESAR) in piglets. Cardiopulmonary responses were used to assess LCR and LMR. Latency following SLN stimulation was used to assess SLN-ESAR. Intravenous lidocaine hydrochloride at 3 mg/kg produced no suppression of the LCR, LMR, or latency (SLN-ESAR onset latency before lidocaine 11.7 ± 0.7 milliseconds, after lidocaine 12.2 ± 0.5 milliseconds; peak latency before lidocaine 13.2 ± 0.2 milliseconds, after lidocaine 13.4 ± 0.4 milliseconds). Topically applied lidocaine at the same dose eliminated both LCR and LMR responses in all animals, with return of reflex responses 15 minutes after application. No effect on the SLN-ESAR was seen with application of topical lidocaine. This study supports topical lidocaine as a suppressant of laryngeal mucosal neuroreceptors without central neural reflex effects. Intravenous lidocaine did not affect peripheral neuroreceptors, nor did it significantly affect the latency of the SLN-ESAR neural reflex arc. Intravenous and topical lidocaine differ in mechanism of action and efficacy with regard to modulation of reflex effects induced by laryngeal stimulation.
Effect of Endotoxin on Cultured Chinchilla Middle Ear Epithelium
Authors: Nakamura Akihiko , van Bliterswijk Clemens , DeMaria Thomas F. , Lim David J.
Published: October 2014

The effect of endotoxin on the growth and morphology of cultured chinchilla middle ear epithelium was examined. Within 24 hours of culture, cells maintained in medium containing endotoxin exhibited dose-dependent morphological changes. The highest concentration of endotoxin (100 mg) resulted in cell death. The growth curve of the cells in culture demonstrated a dose-dependent, significant increase in cell number when endotoxin was added to the medium.
Electrophysiologic Investigation of Lower Cranial Nerve Diseases by Means of Magnetically Stimulated Neuromyography of the Larynx
Authors: Thumfart Walter F. , Zorowka Patrick , Pototschnig Claus , Eckel Hans E.
Published: October 2014

Zoom endoscopic electromyography of the larynx, as introduced in 1979, has contributed greatly to the diagnosis of lower cranial nerve palsies, but in the early stage of a vagus nerve disorder one cannot investigate the nerve conduction from the brain stem to the laryngeal muscles with electrical stimulation. As with the early diagnosis of facial nerve palsies, up to now the intracranial part of the motoric brain nerves could not be stimulated directly. With a new magnetic coil device (Novametrix, Magstim 200) this intracranial stimulation is easily possible in the awake patient with painless magnetic stimuli that induce a muscle action potential into the laryngeal muscles. Hence, an immediate diagnosis is possible. Two coils with mean diameters of 8.5 or 3 cm were used. The stimulator delivered current pulses of peak amplitude up to 5,000 A with rise times of 140 microseconds and 65 microseconds, respectively, that generated peak fields of up to 2 T. In a healthy population, cisternal stimulation of the vagus nerve leads to a muscular response in the vocal muscle after 4 to 6.6 milliseconds (mean 5 milliseconds). Cortical stimulation leads to such a response after 9.5 to 12 milliseconds. Potentials in healthy individuals have been shown to be very uniform. Stimulation in recurrent nerve palsies may show prolongation of these latencies up to 30 milliseconds. The method is limited by the fact that complete neural blocks cannot be overcome by proximal stimulation. We have applied magnetic stimulation to 190 patients with different disorders of the vagus nerve. It allows a differential diagnosis of palsies immediately after their onset, and is thus the first method to make such an early investigation possible.
Stenting for Pediatric Laryngotracheal Stenosis
Authors: Zalzal George H.
Published: October 2014

The treatment of pediatric laryngotracheal stenosis using open surgery to expand the airway has become a widely accepted and effective method. Stents and cartilage grafts represent the main features of expansion laryngotracheal surgery, which is indicated after failure of endoscopic treatment and/or in the presence of severe stenosis. Stenting is needed in all situations with the exception of using a single cartilage graft in the anterior subglottic lumen. There are several options available for stenting. The most valuable and commonly used stents are the Aboulker stent and the Silastic sheet roll. In looking for the features of an ideal stent, I analyzed 51 procedures using the Aboulker stent on 48 patients. The purpose of this report is to discuss these features and relate them to the Aboulker stent.
Macroporous Biphasic Calcium Phosphate Efficiency in Mastoid Cavity Obliteration: Experimental and Clinical Findings
Authors: Daculsi Guy , Corlieu Pascal , D'Arc Maurice Bagot , Gersdorff Michel
Published: October 2014

Following our previous experimental studies on the performance of macroporous biphasic calcium phosphate (MBCP) in canine mastoid cavities, we used this material in patients requiring surgical intervention. Twenty-two cases were selected, and in eight specific cases a biopsy specimen was taken. Histologic, ultrastructural, and microanalysis studies were performed. This study demonstrates the effectiveness of MBCP implants as bone graft substitutes for mastoid cavity obliteration. Clinical evaluation of the series and histologic and ultrastructural results demonstrated the bioactivity and osteoconduction of this material, with partial transformation of MBCP granules into lamellar bone after several months.
Anatomy of the Guinea Pig Temporal Bone
Authors: Goksu Nebil , Karademir Nalan , Haziroglu Rifki , Bayramoglu Ismet , Kemaloglu Yusuf , Akyeldiz Necmettin
Published: October 2014

The middle ear of guinea pigs has long been used for experimental studies, but no detailed information about its temporal bone anatomy is available. In 18 adult guinea pigs, the temporal bone, eustachian tube, and inner ear anatomy, in addition to the anatomy of the middle ear, were investigated under the dissection microscope. In addition to properties of the eardrum, ossicles, air cell system, and cochlea previously described, the appearance of Huschke's foramen and the crista stapedis in an adult guinea pig ear, the structure of the eustachian tube, the architecture of the internal auditory canal, and the communication of the mastoid cells with the tympanic bulla are described. Differences and similarities among guinea pigs, other experimental animals, and humans are discussed to show the advantages and disadvantages of the guinea pig ear for experimentation.
Fascia and Perichondrium Atrophy in Tympanoplasty and Recurrent Middle Ear Atelectasis
Authors: Buckingham Richard A.
Published: October 2014

Fascia and perichondrium grafts to replace and reinforce thin, atrophic tympanic membranes (TMs) are recommended by several authors to correct middle ear atelectasis by forming a fibrous, collapse-resistant TM. This study reviewed the status of connective tissue grafts performed over the 10-year period from 1979 to 1988 to determine if these grafts would maintain sufficient strength and fibrous character to resist recurrent atelectasis. The author used fascia or perichondrium to repair 89 TM defects, and 63 ears were available for follow-up: 54 had cholesteatomas and 9 had perforations. Graft atrophy was judged by microscopic otoscopy and Kodachrome otophotography. Fascia TM grafts atrophied in 35 of 43 ears (80%), and perichondrium atrophied in 8 of 20 ears (40%). Grafts maintained their relatively thick and fibrous character in only 20 of 63 ears (32%). If fascia and perichondrium used to correct atelectasis were to atrophy at the same rate as the grafts in this series, atelectasis would recur after attempts to reinforce atrophic TMs. Atelectasis-prone middle ears require intubation despite surgery.
Organ-Limited Laryngeal Amyloid Deposits: Clinical, Morphological, and Immunohistochemical Results of Five Cases
Authors: Godbersen Godber Sönke , Leh J. Friedemann , Rudert Heinrich , Hansmann Martin L. , Linke Reinhold P.
Published: October 2014

Five cases of organ-limited laryngeal amyloid deposits with no evidence of systemic disease are reported in detail and classified immunohistochemically. In four of the five cases the amyloid reacted with anti-AΛ antibodies and in one case with anti-Aκ antibodies. Four of our five female patients had already passed the fifth decade of life. One was 11 years old. Hoarseness was the predominant symptom in four cases, in which we found amyloid deposits in the glottic area. Only one patient, with amyloid deposits in the aryepiglottic fold, complained of pain. The therapy of choice of idiopathic, localized, or organ-limited amyloid deposits without underlying disease may be local excision. In one of the cases reported in this paper, a laryngofissure was performed, and in another a partial laser resection was performed. No therapy was performed in three of our five cases. In the larynx, as in many other locations and only if possible, removal at intervals is more feasible than radical resection, because these amyloid tumors grow slowly.
Computer Applications in Otolaryngology: Computer Recognition of Brain Stem Auditory Evoked Potential Wave V by a Neural Network
Authors: Freeman Donald T.
Published: October 2014

A neural network simulator was used for the recognition of the presence and location of the peak of wave V of the brain stem auditory evoked potential (BAEP) test. Waveforms selected from BAEPs performed in the last 4 years at the University of Pittsburgh Presbyterian University Hospital were digitized and sampled, and the resulting amplitudes were normalized. A training set was composed of the waveforms resulting from the stimulation of 50 ears. The normalized amplitudes were used as the initial activation values for the networks. The desired outputs (the target locations for wave V) were represented in the output layer by setting the output element, which corresponded to the target location and its immediate neighbors, to high activation levels, and all the remaining output units to zero activity. Two network architectures, differing only in the hidden unit layer, with 40 and 16 hidden units, respectively, were trained by using standard back-propagation. Several trials from different starting points were performed for each architecture. The best network, found after 60 epochs (3,000 presentations), was able to correctly identify 17 of 20 cases (85%) from a set of test cases that were independent from the training set.
Intraoperative Laryngeal Electromyographic Assessment of Patients with Immobile Vocal Fold
Authors: Woo Peak , Arandia Hernando
Published: October 2014

The differential diagnosis of laryngeal ankylosis versus paralysis is occasionally difficult in patients with immobile vocal folds. Eight patients with acute and chronic evidence of vocal fold immobility were investigated by intraoperative electromyography (IEMG) during planned microlaryngoscopy. Bipolar hook wire electrodes were inserted into the thyroarytenoid muscle, of which the electrical activity was monitored during neuromotor blockade and emergence from anesthesia. The normal side and the side with ankylosis or stenosis showed normal IEMG activity. There was progressive recruitment of larger motor units during recovery from muscle relaxation. Patients with laryngeal paralysis failed to show such recruitment patterns. Thus, IEMG can be used as a diagnostic tool during operative laryngoscopy to differentiate neuromotor injury from anatomic causes of vocal fold immobility. The advantages of IEMG are its ease of application and certainty of electrode position. It can also be used to monitor recurrent nerve integrity and detect early laryngospasm. Further IEMG clinical study is warranted.
Recovery from Repeated Sudden Hearing Loss with Corticosteroid Use in the Presence of an Acoustic Neuroma
Authors: Berenholz Leonard P. , Eriksen Christopher , Hirsh Fayne A.
Published: October 2014

Sensorineural hearing loss of sudden onset may be the presenting symptom in up to 14% of patients with acoustic neuroma. We present the first reported case of sudden hearing loss in an only hearing ear with recovery to normal levels after steroid therapy on four separate occasions. Evaluation revealed a 1.5-cm acoustic neuroma. After middle cranial fossa decompression, a fifth episode with recovery after steroid use was documented. A review of the recent literature is presented, emphasizing the possible causation of sudden sensorineural hearing loss with recovery to normal in patients with acoustic neuroma. Modalities of therapy for the dilemma of the acoustic neuroma in an only hearing ear are discussed, including surgery, radiotherapy, and chemotherapy. An aggressive approach to the evaluation of the cause of sudden hearing loss is suggested.
Histopathology of Tubotympanum of Children with Otitis Media Treated with Ventilation Tubes
Authors: Takahashi Haruo , Sando Isamu
Published: October 2014

We studied histopathologically the middle ear (ME) and eustachian tube (ET) in 12 temporal bones from eight children who had had otitis media with effusion that had been treated with ventilation tubes (VTs) for 3 weeks to 11 months. In the ME, 1) only a minimal amount of effusion was seen in most of the ears treated for 3 months or longer, 2) the severity of submucosal inflammation almost paralleled the amount of effusion, 3) the amount of granulation tissue on the tympanic membrane at the site of VT insertion also seemed to parallel the degree of ME inflammation, and 4) epidermal ingrowth was seen in both of the two ears treated with VTs for 10 and 11 months. Pathologic findings in the ET were generally more severe than those in the ME, but tended to decrease with longer VT therapy. In two ears with VTs obstructed by inflammatory granulomatous tissue, the entire ME cavity was filled with effusion, and dense effusion plugged the bony portion of the ET. The results of this study indicate that 3 to 11 months of treatment with a VT is effective for reversing the ME effusion and for reducing inflammation in the ME. Some inflammation may be left in the ET, however, even with 11 months of VT therapy, and epithelial ingrowth should be watched for when VT therapy lasts 10 months or longer. Despite the fact that most of our temporal bones were from infants and children who had a variety of systemic diseases or disorders and in whom their terminal event might have contributed to our findings, we consider these temporal bones to be informative.
Junctional Epidermolysis Bullosa of the Larynx
Authors: Berson Shelley , Ward Robert F. , Lin Andrew N. , Carter D. Martin
Published: October 2014

Epidermolysis bullosa (EB) is a group of rare inherited disorders in which minor trauma causes blister formation in the skin and mucosa, including the esophagus. Morbidity varies with the type of disease and ranges from occasional trivial skin blisters to death in infancy. Laryngeal involvement presenting as hoarseness and respiratory distress has been reported in nine patients, five of whom had junctional EB. We present the sixth case of junctional EB with laryngeal involvement, and offer guidelines for otolaryngologists and anesthesiologists caring for these fragile patients.
Rhinoscleroma and Rhinosporidiosis
Authors: Batsakis John G. , El-Naggar Akel K.
Published: October 2014

For North American otolaryngologists, rhinoscleroma and rhinosporidiosis are moving more into the differential diagnosis of chronic inflammatory diseases of the upper airway, particularly the nasal cavity. This change is occasioned by the influx of immigrants from parts of the world to which the diseases are endemic. Diagnosis is established by identification of the causal organisms, the readily seen Rhinosporidium seeberi for rhinosporidiosis and the more elusive Klebsiella rhinoscleromatis for rhinoscleroma.
Continuous Positive Airway Pressure as a Promoter of Laryngospasm during Halothane Anesthesia
Authors: Silva David A. , Sanders Ira
Published: October 2014

Twenty mongrel dogs were anesthetized with halothane 2.0%, 1.25%, 0.94%, and 0.63% in oxygen. Thyroarytenoid (TA) and posterior cricoarytenoid (PCA) electromyography (EMG) tracings were recorded with the animal at rest, following mechanical irritation of the glottis, and during 20 mm Hg continuous positive airway pressure (CPAP) following either airway occlusion or hyperventilation. Adductor laryngospasm was defined as continuous tonic TA EMG activity, silent PCA EMG, and vocal cord adduction. Abductor laryngospasm was defined as continuous tonic PCA EMG activity, silent TA EMG, and vocal cord abduction. Combined laryngospasm was defined as continuous tonic PCA and TA EMG activity, with variable vocal cord position. The incidence of adductor laryngospasm following mechanical irritation was 30% to 50%. The combined incidence of laryngospasm during application of CPAP following airway occlusion or hyperventilation was 25% to 50%, and differed from the incidence of irritation-induced adductor laryngospasm by 5% or less at the same anesthetic level. Continuous positive airway pressure appears to be a stimulant of laryngeal muscle spasm comparable to mechanical irritation of the glottis.
Laryngotracheal Reconstruction in Adults with the Sternocleidomastoid Myoperiosteal Flap
Authors: Friedman Michael , Mayer Amy D.
Published: October 2014

Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous and durable and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-stage reconstruction. Success has been achieved in reconstruction of long-standing subglottic and/or tracheal stenosis and in cases of extreme tracheal defects. On the basis of 8 years' experience with this flap, we present the results from a series of 26 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Twenty-five of the 26 patients were successfully decannulated. Complications have been expanded to include one case of osteomyelitis of the sternum with mediastinitis, and 1 patient required revision. Subsequently, modifications of technique and patient management have been adopted. The complications compare favorably in frequency and in seriousness with those of other techniques for laryngotracheal reconstruction. We describe additional experience with this procedure and longer follow-up to establish its position as a first-line reconstructive approach for widespread clinical use.
Bilateral Choanal Atresia Associated with Malformation of the Anterior Skull Base: Embryogenesis and Clinical Implications
Authors: Dunham Michael E. , Miller Robert P.
Published: October 2014

A number of craniofacial and systemic malformations have been described in association with choanal atresia. We report a case of bilateral choanal atresia associated with congenital absence of the cribriform plate, crista galli, and perpendicular plate of the ethmoid bone. The anterior skull base defect was detected by using high-resolution computed tomography with three-dimensional reconstructions. The findings support the mesodermal flow theory of choanal atresia, in which there is excess migration of neural crest cells into the developing nasal septum and posterior choanae. This occurs at the expense of cells that would otherwise form the rest of the ethmoid complex. Clinical implications include the need for adequate preoperative imaging of the anterior skull base and consideration of potential intracranial complications during surgical repair.
Embryoma (Sialoblastoma) of Salivary Glands
Authors: Batsakis John G. , Frankenthaler Robert
Published: October 2014

There are four clinicopathologic categories of the exclusively major salivary gland tumors that present in the perinatal period. The two with the smallest representation among the 20 cases reported to date are those with a hamartomalike appearance and those with benign adult equivalents — The pleomorphic and monomorphic adenomas. Five cases have been undifferentiated or basaloid salivary carcinomas. Embryomas (sialoblastomas) are the most numerous. These tumors manifest a histologic phenotype like that of the epithelial anlage of the salivary glands, albeit in an arrested state of differentiation.
Effects of Otitis Media on Extended High-Frequency Hearing in Children
Authors: Margolis Robert H. , Rykken Joni R. , Hunter Lisa L. , Giebink G. Scott
Published: October 2014

Extended high-frequency (EHF) hearing was studied in children with and without histories of chronic or recurrent otitis media (OM). The EHF thresholds were found to have good test-retest repeatability. Children with OM histories had poorer EHF hearing than children without OM histories. The EHF hearing in OM children appeared to be related to OM severity. Children with residual tympanometric abnormalities had poorer EHF hearing than OM children with normal middle ear function. The results suggest evidence for middle ear and inner ear components of EHF hearing losses in children with OM.