bluuebunny/crossref_metadata_2025 huggingface dataset:
Distance from the Labyrinthine Portion of the Facial Nerve to the Basal Turn of the Cochlea Temporal Bone Histopathologic Study
Authors: Redleaf Miriam I. , Blough Richard R.
Published: October 2014

The middle cranial fossa approach to lesions of the geniculate ganglion and internal auditory canal preserves cochlear function and affords access to the lateral internal auditory canal. The labyrinthine portion of the facial nerve tends to course near the basal turn of the cochlea, just beneath the middle cranial fossa floor, and is usually dissected in this approach. To determine the distance from the labyrinthine portion of the facial nerve to the basal turn of the cochlea, measurements were obtained in the temporal bones of 24 subjects (48 ears) 9 to 76 years of age. These subjects had no history of facial nerve or ear disease, and had normal audiograms. The distances ranged from 0.06 to 0.80 mm, with 21 of 24 right ears (87.5%) showing distances less than the standard size of the smallest diamond drills (0.6 mm), and 18 of 24 (75%) less than 0.5 mm. Incidental note is made of the distance from the geniculate ganglion to the ampulla of the superior semicircular canal, which ranged from 2.06 to 4.88 mm in the 48 specimens. These measurements can serve as guidelines for the surgeon working in the middle cranial fossa.
Plasma Platelet-Derived Growth Factor: Preliminary Study of a Potential Marker in Head and Neck Cancer
Authors: Gleich Lyon L. , Srivastava Laxmi , Gluckman Jack L.
Published: October 2014

The role of growth factors in the development and spread of head and neck cancers has received little attention. Platelet-derived growth factor (PDGF) is a potent mitogen that is released normally in wound healing, but is also secreted by human malignant epithelial cells. In breast and ovarian carcinomas, elevated plasma PDGF has correlated with a poorer prognosis. This preliminary study was designed 1) to determine if PDGF is elevated in the plasma of patients with squamous cell carcinoma of the head and neck and 2) to determine whether there is any change in levels following surgical ablation. The PDGF was measured by radioimmunoassay in 18 patients with head and neck squamous cell carcinoma and in 12 normal controls. In the control group the mean level was 7.4 fmol/100 μL (range 2.8 to 12.5, median 7.6), in spite of the fact that PDGF is reportedly not measurable in normal subjects. The mean PDGF level in the cancer patients was 20.4 fmol/100 μL (range 4.1 to 35.7, median 20.5) and as compared to the control group was significantly elevated (median two-sample test, p < .001). Of the 20 cancer patients, only 4 had levels less than 12.5 fmol/100 μL. Moreover, 2 of these had undergone prior radiotherapy. In all cases, PDGF levels decreased significantly after surgery. These results support the importance of the further investigation of plasma PDGF levels as a potential biomarker to evaluate efficacy of treatment, possibly to aid in the detection of tumor recurrence, and even to be a potential indicator of tumor aggressiveness.
Similar Distribution of Mast Cells and Substance P- and Calcitonin Gene-Related Peptide-Immunoreactive Nerve Fibers in the Adult Human Larynx
Authors: Domeu Siw , Eriksson Anders , Dahlqvist Åke , Forsgren Store
Published: October 2014

The mechanisms causing supraglottic and subglottic edema in the human larynx are not fully understood. Substance P (SP)- and calcitonin gene-related peptide (CGRP)-containing nerve fibers and mast cells have been suggested to induce inflammation and edema in other parts of the body. In this study of the adult human larynx the distribution of mast cells was studied in relation to SP- and CGRP-containing nerve fibers. Substance P- and CGRP-immunoreactive nerve fibers and numerous mast cells were found in the epiglottis and in the subglottic region of the larynx. Only occasional mast cells and no nerve fibers showing SP- or CGRP-like irnmunoreactivity were found in the vocal cords. In conclusion, the present study has shown that the distribution of nerve fibers showing SP- and CGRP-like irnmunoreactivity and mast cells has a similar regional variability. As the highest density of SP- and CGRP-containing nerve fibers and mast cells was present in the regions of the larynx where edema occurs, SP, CGRP, and/or mast cells might be involved in the pathogenesis of edema.
Interstitial Iodine 125 in Advanced Recurrent Squamous Cell Carcinoma of the Head and Neck with Follow-up Evaluation of Carotid Artery by Ultrasound
Authors: Mohr Rose M. , Chen Kurt Y. , Silverman Craig L.
Published: October 2014

We retrospectively reviewed our experience with 24 patients in the treatment of advanced recurrent squamous cell carcinoma of the head and neck, using salvage surgery and intraoperative iodine 125 (125I) implantation. Surgical complications and survival results were compiled and compared with those of other studies. The long-term effect of 125I on the carotid artery was evaluated by ultrasound We had a major complication rate of 21 % and an overall complication rate of 50%. Our 2-year overall and determinate survivals were=29% and 50%, respectively. Within the survival group, carotid ultrasounds were obtained to evaluate the long-term effect of I All ultrasounds obtained at least 1 year from the time of treatment showed minimal or no change from the contralateral side We conclude that intraoperative 125I and salvage surgery are an acceptable treatment for recurrent squamous cell carcinoma with minimal complication and effect on the carotid artery.
High-Speed Imaging of Vocal Fold Vibrations and Larynx Movements within Vocalizations of Different Vowels
Authors: Maurer Dieter , Hess Markus , Gross Manfred
Published: October 2014

Theoretic investigations of the “source-filter” model have indicated a pronounced acoustic interaction of glottal source and vocal tract. Empirical investigations of formant pattern variations apart from changes in vowel identity have demonstrated a direct relationship between the fundamental frequency and the patterns. As a consequence of both findings, independence of phonation and articulation may be limited in the speech process. Within the present study, possible interdependence of phonation and phoneme was investigated: vocal fold vibrations and larynx position for vocalizations of different vowels in a healthy man and woman were examined by high-speed light-intensified digital imaging. We found 1) different movements of the vocal folds for vocalizations of different vowel identities within one speaker and at similar fundamental frequency, and 2) constant larynx position within vocalization of one vowel identity, but different positions for vocalizations of different vowel identities. A possible relationship between the vocal fold vibrations and the phoneme is discussed.
Postnatal Change in Angle between the Tympanic Annulus and Surrounding Structures
Authors: Ikui Akihiro , Sudo Masaharu , Sando Isamu , Fujita Shuji
Published: October 2014

Postnatal developmental relationships in human ears were studied by a computer-aided three-dimensional reconstruction and measurement method. We measured the angle, in reference to the horizontal plane, between the tympanic annulus, the oval window, and the internal auditory canal (IAC) in 20 normal temporal bones obtained from individuals between 1 day old and 76 years old. The horizontal plane was defined as the plane sloped 30° infero-anteriorly from the plane of the horizontal canal in each specimen. The plane of the tympanic annulus changed from a nearly horizontal orientation (34.2° from the horizontal plane) in neonates to a more vertical orientation (63.3° from the horizontal plane) in adults. The tympanic annulus and oval window planes remained at the same angle to each other (11.9° ± 5.1°) throughout postnatal development, as did the plane of the tympanic annulus and the LAC (68.6° ± 5.3°). These findings have implications for ear surgeons, especially those operating on young children.
Increase in Expression of IL-4 and IL-5 Mrna in the Nasal Mucosa of Patients with Perennial Allergic Rhinitis during Natural Allergen Exposure
Authors: Lee Chul Hee , Rhee Chae-Seo , Min Yang-Gi , Oh Seung Ha , Lee Myung Sook
Published: October 2014

To understand the role of cytokines in allergic nasal disease in humans, we designed this study to investigate the expression of cytokine mRNA in the nasal mucosa of 10 control subjects and 10 patients with perennial allergic rhinitis using a reverse transcription—polymerase chain reaction (RT-PCR) for IL-4, IL-5 (Th2 cytokines), and IFN-γ (Th1 cytokine). Both IL-4 and IL-5 mRNAs were expressed in a significantly larger number of patients with allergic rhinitis than in control subjects. When the levels of expression of cytokines and β-actin mRNA were quantitated, the mean density ratios (cytokine/β-actin) for IL-4 and IL-5 were higher in patients with allergic rhinitis than in control subjects. In contrast, there were no differences in the number of subjects who showed expression of IFN-γ mRNA, or in mean density ratios for IFN-γ between the two groups. This study suggests that both IL-4 and IL-5 mRNAs are expressed almost universally in the nasal mucosa of patients with perennial allergic rhinitis during natural allergen exposure and also that Th2-type cytokines play a crucial role in the development of allergic nasal diseases in vivo.
Nasopharyngeal Carcinoma, with Emphasis on its Relationship to Epstein-Barr Virus
Authors: Vasef Mohammad A. , Ferlito Alfio , Weiss Lawrence M.
Published: October 2014

Nasopharyngeal carcinoma (NPC) is an epithelial tumor with a distinct geographic distribution and a characteristic histologic appearance. It is rare in Europe and North America, but it is among the most common cancers in southern China. Genetic predisposition, environmental factors, and Epstein-Barr virus (EBV) all have been associated with the pathogenesis of this tumor. There is an increasing body of evidence that among all these factors, EBV appears to be the strongest and most consistently related factor. According to the current sensitive in situ hybridization methods for the detection of EBV-encoded small RNAs (EBER), almost 100% of cases of NPC, irrespective of their histologic subtypes, have demonstrable EBERs in the nuclei of the tumor cells. In this review paper, we discuss the predisposing genetic and environmental factors and the role of EBV in the pathogenesis of this tumor with particular emphasis on the role of EBV.
Significant Correlation between Symptom Score and IGG4 Antibody Titer following Long-Term Immunotherapy for Perennial Allergic Rhinitis
Authors: Nakai Yoshiaki , Sakamoto Hirokazu , Ohashi Yoshihiro , Okamoto Hideki , Tanaka Ayaki , Ohno Yoshiharu , Kakinoki Yasushi
Published: October 2014

Although there is evidence of some measure of clinical benefit as well as immunologic change during the early phase of immunotherapy, a sustained clinical response is only possible with prolonged therapy. Immunotherapy has to be administered for about 3 to 5 years for such sustained clinical efficacy. This study aimed at investigating the dynamics of IgE and IgG4 antibodies after more than 5 years of immunotherapy, to examine the statistical correlation between these antibodies and symptom scores. Our study demonstrated that the allergen-specific IgE antibody level significantly decreases and the IgG4 antibody level significantly increases following immunotherapy. However, the percent decrease in IgE antibodies did not correlate with the percent decrease in symptom scores. On the other hand, the percent increase in IgG4 antibodies correlated with the percent decrease in symptom scores. We infer that an elevation of IgG4 antibodies is not simply an epiphenomenon unrelated to the underlying working mechanism of clinically successful immunotherapy, but probably makes an active contribution to symptom relief.
Selective Cochlear Neurectomy for Debilitating Tinnitus
Authors: Foyt David , Wazen Jack J. , Sisti Michael
Published: October 2014

Eighth nerve sections have been performed to control debilitating tinnitus, with various success rates (45% to 76%). Patients with a unilateral profound sensorineural hearing loss and disabling tinnitus perceived in that ear are candidates for such surgery. The concept of a selective cochlear neurectomy with preservation of the vestibular nerve is introduced with two case presentations. The indications for surgery, surgical technique, and results are described. Advantages of preserving the vestibular nerve fibers include the lack of postoperative vertigo and disequilibrium and thus a shorter length of hospital stay, and the conservation of a symmetric vestibular input, obviating the lengthy compensation process that might otherwise be needed, particularly in the elderly. A selective cochlear neurectomy for the control of debilitating tinnitus has proven to be successful in controlling tinnitus in the two patients presented, with the added advantage of preservation of their vestibular function. Further controlled studies are necessary to confirm the advantages and effectiveness of this technique.
Role of Tumor Necrosis Factor and Interleukin-1 in Endotoxin-Induced Middle Ear Effusions
Authors: Prazma Jiri , Triana Rudolph J. , Ball Steven S. , Dais C. G. Dean , Pillsbury Harold C.
Published: October 2014

In a rat model, we investigated the role of tumor necrosis factor (TNF) and interleukin-1 (IL-1) in endotoxin-induced middle ear effusions (MEEs). After the eustachian tube was obstructed, the middle ear was transtympanically injected with 35μL of either 1) 1 mg/ mL lipopolysaccharide (LPS); 2) LPS and 100 μg TNF binding protein (TNFbp); 3) LPS and 1 μg IL-1 receptor antagonist (IL-1ra); or 4) LPS, TNFbp, and IL-1ra. Every 2 hours, the fluid within the middle ear was collected, and the quantity of albumin in the fluid, an index of vascular leakage, was determined by enzyme-linked immunosorbent assay. After 6 hours, the middle ear was fixed for histologic analysis. The TNFbp significantly attenuated vascular extravasation into the middle ear. The IL-1ra did not significantly alter effusion development. These results indicate that TNF, but not IL-1, is a mediator of LPS-induced MEE. Therefore, TNFbp may represent a novel approach to the treatment of otitis media with effusion.
Role of Flexible Laryngoscopy in Evaluating Aspiration
Authors: Kaye Glenn M. , Zorowitz Richard D. , Baredes Soly
Published: October 2014

Flexible fiberoptic laryngoscopy is used to evaluate dysphagia, but its clinical utility has not been compared to that of the videofluorographic swallowing study (VFSS). This study correlates parameters of both procedures and identifies laryngoscopy predictors of aspiration in 105 patients. Presence of aspiration, pharyngeal residue, laryngeal sensation, vocal cord mobility, and glottic closure during flexible laryngoscopy (FL), and gag reflex were correlated with aspiration during the VFSS. An algorithm for laryngoscopically detecting aspiration was synthesized. Aspiration (p = .004) and pharyngeal residue (p < .00001) were highly correlated between the two studies. Aspiration during the VFSS was correlated with pharyngeal residue (p < .00001) and laryngeal sensation (p = .027) during FL, but not glottic closure (p = .169) nor vocal cord mobility (p = .056). Patients with a normal gag reflex and without aspiration or pharyngeal residue during FL had a 2.94% risk of aspiration during the VFSS. Flexible laryngoscopy can be used as a relatively safe, portable screening test for aspiration, but cannot always replace the VFSS to identify the presence or cause of aspiration.
Trigeminal Neo-Neurotization of the Paralyzed Face
Authors: Cheney Mack L. , McKenna Michael J. , West Carol , Megerian Cliff A. , Elahi Mohammed M.
Published: October 2014

Sporadic reports throughout the literature have documented the spontaneous return of facial function following deliberate intraoperative sacrifice of the facial nerve. Trigeminal reinnervation of the facial muscles has been suggested as one possible mechanism for this occurrence. Evidence for the phenomenon of trigeminal neo-neurotization has been documented experimentally. The case of a 62-year-old woman who underwent total left parotidectomy with transection of a large facial nerve segment is presented in order to provide further clinical evidence supporting trigeminal neo-neurotization of the facial nerve. Despite the lack of any efforts to reinnervate the patient or graft the facial nerve defect, the patient spontaneously developed return of facial function. Postoperative clinical and electrical testing in this case supports trigeminal-facial reinnervation as the cause for return of facial function. The case report is summarized with a brief discussion, and the relevant literature is thoroughly reviewed.
Clinical Observations on Acute Low-Tone Sensorineural Hearing Loss
Authors: Imamura Shun-ichi , Imamura Mayumi , Nozawa Izuru , Murakami Yoshihiko
Published: October 2014

We retrospectively analyzed the clinical records of 137 patients who were treated at our clinic for acute low-tone sensorineural hearing loss of unknown cause over a period of 8 years. The analyses of the clinical records indicated the following clinical characteristics: female preponderance; peak incidence during the fourth decade of life; frequent accompanying tinnitus, sensation of ear fullness, and/or autophony; suspicion of bilateral involvement; and association with autonomic imbalance. The hearing in most of the patients completely recovered, but some selected patients experienced fluctuating hearing loss or progression to Meniere's disease. Our results suggest that a subgroup of patients with severe initial hearing loss should be carefully followed up, although it is difficult to predict the outcome of this disorder.
Local and Regional Anesthesia for Functional Endoscopic Sinus Surgery
Authors: Lee Wai Chung , Kapur Tilak R. , Ramsden Walter N.
Published: October 2014

An effective topical and regional anesthetic technique using 25% cocaine paste combined with intravenous midazolam hydrochloride was used in 554 patients undergoing functional endoscopic sinus surgery. The operative fields were excellent and all procedures were completed with little patient disturbance. Patients recovered rapidly from sedation and were usually fit for discharge on the same day. There were no anesthetic complications. The major surgical complication rate was 0.5%.
Role of Suprahyoid Neck Dissection in the Treatment of Squamous Cell Carcinoma of the Lower Lip
Authors: Koç Can , Akyol M. Umut , Çekiç Ali , Çelikkanat Serdar , Özdem Cafer
Published: October 2014

Treatment of squamous cell carcinoma of the lip is primarily surgical. Unlike other oral lesions, lower lip cancers do not metastasize to lower cervical lymph nodes without invading submental and submandibular lymph nodes. This study presents 30 patients with NO lower lip carcinoma who were treated by en bloc resection of the tumor with suprahyoid neck dissection. Occult metastasis was found in 4 patients (13%). Four patients, 3 of whom had no occult metastases, died of local or regional uncontrollable disease. Suprahyoid or modified radical neck dissection appears to be beneficial, even in small tumors of the lower lip, in detecting occult metastases.
Three Familial Cases of Hearing Loss Associated with Enlargement of the Vestibular Aqueduct
Authors: Abe Satoko , Usami Shin-ichi , Shinkawa Hideichi
Published: October 2014

The present report describes three familial cases of recessive hearing loss associated with enlargement of the vestibular aqueduct (EVA). Six siblings from three families showed EVA. The common characteristic of these patients was the presence of congenital, high-frequency, fluctuating sensorineural hearing loss. These cases suggest that EVA may be a useful discriminator between different types of recessive hearing loss.
Endoscopic Ligation of the Internal Maxillary Artery for Treatment of Intractable Posterior Epistaxis
Authors: Pritikin Jordan B. , Caldarelli David D. , Panje William R.
Published: October 2014

Lack of universal success with both transantral ligation of the internal maxillary artery and percutaneous embolization of the distal branches of the internal maxillary distribution has led to consideration of alternative techniques to control intractable posterior epistaxis. One such technique takes advantage of advances in endoscopic technology and instrumentation, as well as a nearly constant anatomic configuration. The internal maxillary artery divides into terminal branches within the pterygomaxillary fossa, sending branches through the bony maxilla to exit the posterolateral nasal wall in the posterior aspect of the middle meatus. Endoscopic identification and ligation of these terminal branches of the internal maxillary artery (the sphenopalatine and nasopalatine arteries) as they exit the maxilla has been performed on 10 patients with a 100% success rate and no morbidity or mortality associated with the procedure. These results compare favorably to the average reported success rates of 89% for transantral ligation and 94% for percutaneous embolization, and average complication rates of 28% and 27%, respectively. This endonasal procedure has been performed for spontaneous epistaxis as well as postsurgical nasal bleeding with equal success. The ascending scale of treatment previously outlined in the literature may be amended, as a potentially definitive procedure is available, and we believe that this technique is easier to perform, has less associated morbidity, and has equal efficacy in comparison to transantral ligation or percutaneous embolization in the treatment of intractable posterior epistaxis.
Comparison between Diagnoses of Human Experts and a Neurotologic Expert System
Authors: Kentala Erna , Juhola Martti , Auramo Yrjö , Pyykkö Ilmari
Published: October 2014

The decision-making ability of a recently developed neurotologic expert system was compared with the diagnoses of six physicians. Five of the physicians were residents and one was a specialist in the field of otolaryngology. The test patients were randomly selected from vertiginous patients referred to an otolaryngology clinic. The expert system and the physicians first had identical information on patient history, symptoms, and tests. During the second phase of the study the physicians were allowed to use the full medical records. The correct diagnoses were certified by an experienced specialist in neurotology. The expert system did better in decision-making when both the expert system and the physicians had identical information on patients. However, when the physicians were allowed to use patient's complete medical records, they surpassed the expert system. The expert system diagnosed 65% of the cases, while the physicians first diagnosed 54% of the cases, and then with complete information, 69% of the cases. From the patients' medical records, the physicians obtained information on the time perspective of the symptoms and the progression of the disease. These aspects will be used to further improve the expert system.
Laser-Induced Fluorescence Imaging in Localization of Head and Neck Cancers
Authors: Kulapaditharom Boonchu , Boonkitticharoen Vipa
Published: October 2014

Laser-induced fluorescence tumor imaging exploits the difference in tissue autofluorescence properties between normal and cancerous tissues. The effectiveness and reliability of fluorescence imaging with a lung imaging fluorescence endoscopy (LIFE) system for cancers in the head and neck were compared to those of white light endoscopy (WLE). Examinations by WLE and LIFE were conducted on 25 patients suspected for malignancy. Histologic diagnosis was confirmed by biopsy. Posttreatment evaluations were performed on 6 cancer patients identified by this study. By LIFE, all 16 cancerous lesions, including 2 occult cancers, were identified (100%), while WLE achieved only an 87.5% detection rate. LIFE (specificity 87.5%) was greatly helpful to WLE (specificity 50%) in differentiating inflammation from malignancy, though it failed to exclude granuloma. The results of this study suggest potential roles of LIFE in early detection, correct staging, and treatment evaluation of cancers in the head and neck.
Corniculate-Cuneiform Flap for Reconstruction in the Extended Vertical Partial Laryngectomy
Authors: Persky Mark S. , Damiano Angela
Published: October 2014

The extended vertical partial laryngectomy involves removal of the vocal cord and adjacent arytenoid cartilage. Arytenoid sacrifice predisposes the patient to postoperative aspiration, since adequate laryngeal closure during swallowing cannot be accomplished. Various techniques have been previously described for reconstruction of this defect. We present five patients who had reconstruction of this area with a local, mucosally based corniculate-cuneiform flap. All patients were decannulated, had no long-term aspiration, maintained socially acceptable voice quality, and had no tumor recurrence with a minimum of 3 years of follow-up. Our preliminary data suggest that this flap can be used in previously irradiated patients. The corniculate-cuneiform flap is an effective method of reconstruction in patients undergoing an extended vertical partial laryngectomy.
Correlations between Pathologic Changes in the Stapes and Conductive Hearing Loss in Otosclerosis
Authors: Cherukupally Shilpa Reddy , Merchant Saumil N. , Rosowski John J.
Published: October 2014

The goal of this temporal bone study was to quantify the relationship between specific histologic changes at the stapes footplate and the magnitude of the air-bone gap in otosclerosis. The study material comprised 26 specimens with otosclerosis and 37 age-matched controls. Detailed anatomic measurements were made on each histologic section through the stapes footplate in each bone, resulting in 30 different measurement parameters for each bone. For frequencies 250 to 2,000 Hz, the conductive hearing loss correlated highly with (p <.01) and appeared to be caused primarily by narrowing and loss of the annular ligament, especially at the posterior stapediovestibular joint space. The size of the air-bone gap appeared to be determined by the extent and degree of this pathologic change. Schuknecht's hypothesis that bony ankylosis of the footplate would be associated with an air-bone gap of >30 dB was supported by our data. However, the degree and extent of bony footplate ankylosis could not be reliably predicted by the size of the air-bone gap.
Human Olfactory Mucosa in Schizophrenia
Authors: Smutzer Gregory , Lee Virginia M.-Y. , Trojanowski John Q. , Arnold Steven E.
Published: October 2014

Recent evidence indicates that developmental anomalies may underlie some symptoms of schizophrenia, while psychophysical studies have demonstrated olfactory deficits in this disease. The postmortem olfactory mucosa of elderly schizophrenic patients was examined to characterize the molecular phenotype of this tissue. The distribution of developmentally regulated cytoskeletal proteins, a synaptic vesicle protein, a neural marker protein, a receptor for trophic molecules, axonal guidance and cell migration proteins, and neuronal and glial cytoskeletal proteins of various degrees of phosphorylation was examined by immunohistochemistry. Both schizophrenic and control subjects exhibited dystrophic neurites that were immunoreactive for synaptophysin, microtubule-associated proteins (MAP1B), and neurofilament proteins. No major histochemical or morphologic differences in either the expression or distribution of these proteins were observed in the olfactory epithelium of schizophrenic compared to control subjects. These studies indicated that dystrophic neurites frequently occurred in the olfactory mucosa of both schizophrenics and neurologically normal adults. The absence of major immunocytochemical abnormalities suggested that olfactory deficits in schizophrenia may be due to more subtle cellular or molecular differences or to abnormalities in olfactory regions of the central nervous system rather than in the olfactory epithelium.
“Exploratory” Surgery for Advanced Carcinoma of the Larynx: A Relatively Safe Approach
Authors: Tucker Harvey M.
Published: October 2014

Between the years 1970 and 1986, the author managed 132 patients with T3 glottic carcinoma. Over half of these patients were explored in an effort to safely perform subtotal laryngectomy. Twenty-seven of them were found to have extension of tumor that required immediate conversion to total laryngectomy. Five-year survival rates were essentially the same for all three groups: immediate total laryngectomy, subtotal laryngectomy, and total laryngectomy following attempted subtotal laryngectomy. I conclude that carefully selected patients with T3 glottic cancer may be candidates for subtotal laryngectomy after surgical exploration, since conversion to total laryngectomy yields local control rates as satisfactory as those of initial total laryngectomy. When subtotal laryngectomy is possible, local control of tumor and recurrence rates are as satisfactory as those of total laryngectomy.
Assessment of Two Objective Voice Function Indices
Authors: Piccirillo Jay F. , Painter Colin , Haiduk Andrea , Fuller Dennis , Fredrickson John M.
Published: October 2014

In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage “The North Wind and the Sun,” and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.
Visual-Induced Postural Sway in Children with and without Otitis Media
Authors: Casselbrant Margaretha L. , Redfern Mark S. , Fall Patricia A. , Furman Joseph M. , Mandel Ellen M.
Published: October 2014

Children with otitis media with effusion (OME) have been shown to have a significantly higher velocity of sway than normal children. To further evaluate the effect of OME on balance, we studied visual dependency for balance by investigating the influence of optic flow on postural sway. The results of this preliminary study suggest that children with OME may be more visually dependent for balance than healthy age-matched controls. This was particularly evident for higher-frequency stimulus conditions (0.25 Hz) as opposed to lower-frequency stimulus conditions (0.10 Hz). These findings indicate that OME may affect vestibular function in children, thereby causing excessive reliance on other, nonvestibular sensory cues to maintain balance. Further studies are needed to define the role of vestibular function in the management of children with OME.
Sarcoidosis of the External Nose Mimicking
Authors: Goldenberg John D. , Shamsai Roohanguiz , Kotler Howard S. , Gruber Benjamin
Published: October 2014

A 52-year-old man with a large external nasal mass is presented. Initially, the mass was thought to be rhinophyma, but biopsy of the mass revealed noncaseating granulomata consistent with sarcoidosis. The mass resolved following several steroid injections. The case is discussed in detail, along with a review of the literature pertaining to sarcoidosis of the nose and nasal cavity.
Surgical Treatment of Laryngotracheal Stenosis: A Review of 60 Cases
Authors: Gavilán Javier , Cerdeira Marí A. , Toledano Adolfo
Published: October 2014

Management of laryngotracheal stenosis (LTS) remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Sixty patients with LTS were surgically treated in our institution over a 20-year period. Most patients were adults; the mean age was 29 years. There were 39 males and 21 females. The most frequent cause of stenosis was intubation, in 25 patients, and tracheostomy was the cause in 21. Forty-two patients (70%) were successfully decannulated following 117 procedures in this series. An average of 1.95 procedures per patient was performed. The median time between treatment and decannulation was 561 days. These results confirm the complexity of the management of LTS. Decannulation is not always possible, and to achieve this goal, more than one treatment is frequently required. It is better to prevent LTS rather than to treat it once it has occurred.
Finite Element Modeling of Vocal Fold Vibration in Normal Phonation and Hyperfunctional Dysphonia: Implications for the Pathogenesis of Vocal Nodules
Authors: Jiang Jack J. , Diaz Carlos E. , Hanson David G.
Published: October 2014

A computer model of the vocal fold was developed using finite element modeling technology for studying mechanical stress distribution over vibrating vocal fold tissue. In a simulated normal phonation mode, mechanical stress was found to be lowest at the midpoint of the vocal fold and highest at tendon attachments. However, when other modes predominated, high mechanical stress could occur at the midpoint of the vocal folds. When a vocal fold mass was modeled, high shearing stress occurred at the base of the modeled vocal fold mass, suggesting that the presence of a vocal nodule or polyp is associated with high mechanical stress at the margins of the mass. This finding supports a hypothesis that mechanical intraepithelial stress plays an important role in the development of vocal nodules, polyps, and other lesions that are usually ascribed to hyperfunctional dysphonia.
Effect of Substance P on the Short-Circuit Current of Rat Nasal Mucosal Epithelium
Authors: Yang Ping-Chang , Zhang Tao-Yuan , Liu Tao , Fan Dao-Sheng
Published: October 2014

Rats were sensitized by intranasal application of toluene diisocyanate as a nasal allergy model. By means of the Ussing chamber technique, rat nasal epithelial short-circuit current (Isc) was measured. Enhanced Isc of the rat nasal mucosa resulted from stimulation of substance P (SP) in a dose-dependent manner that could be inhibited by pretreatment with NK1 receptor antagonist CP-96345, the Hi receptor antagonist pyrilamine, the H2 receptor antagonist ranitidine, and the neurotoxin tetrodotoxin, respectively, to different extents. The results indicate that SP is able to cause ion secretion of the nasal mucosal epithelium, perhaps by activating mast cells to release histamine. These data suggest that mast cells and sensory nerves participate in the regulation of SP-induced ion secretion during nasal allergy.
Prognostic Factors in Supraglottic Carcinoma Patients Treated by Surgery or Radiotherapy
Authors: Kowalski Luiz P. , Santos João C. R. , Santos Carlos R. , Magrin José , Sabóia Murilo V. , Fogaroli Ricardo C. , Torloni Humberto
Published: October 2014

The decision regarding treatment of supraglottic carcinoma remains controversial, despite recent advances in radiotherapy and surgical procedures. The need to evaluate the prognostic importance of demographic, clinical, pathologic, and treatment-related variables prompted this study. The patient population was of 164 consecutive cases of supraglottic carcinoma. Clinical charts were reviewed and cases were restaged according to the 1987 version of the UICC-AJC classification based on the initial clinical description: 18 Tl, 30 T2, 58 T3, 58 T4, 61 NO, 24 Nl, and 79 N2a-N3. Management policy for these patients varied during the study, reflecting different opinions of the responsible physicians and technical advances. Seventy-seven patients (47%) underwent surgery. whereas the remaining 87 (53%) were submitted to radiotherapy as the first treatment. At the study closing date, 47 and 4 of the patients who underwent surgery and radiotherapy, respectively, remained alive with no evidence of disease. The 5-year actuarial survival rates were 58.5% for patients initially treated by surgery, and 16.3% for patients in the radiotherapy group. Although several demographic, clinical, and pathologic variables were studied, only initial treatment (p < .0001), N stage (p = .0003), and T stage (p = .0017) were deemed to have independent prognostic value by multivariate regression techniques based on Cox's proportional hazards model. This study has shown that survival of supraglottic carcinoma patients depends on the treatment modality, T stage, and N stage. Our results are disappointing with regard to radiotherapy as a treatment for supraglottic carcinoma in patients with tumors at clinical stages III and IV.
Giant Cell Tumor of the Larynx
Authors: Devaney Kenneth O. , Ferlito Alfio , Rinaldo Alessandra
Published: October 2014

Among the more uncommon tumors that may sometimes be encountered in the laryngeal region is the recently described giant cell tumor of the larynx. This lesion is a true neoplasm, presumably of the fibrohistiocytic series. Histologically, it closely resembles the more familiar true giant cell tumor of long bone. The laryngeal giant cell tumors appear, to date, to be nonmetastasizing lesions; it is possible that they may recur locally if incompletely excised (although this remains to be demonstrated). In view of the rarity of these tumors, a tentative diagnosis of such a neoplasm should always prompt consideration of other (more frequently encountered) differential diagnostic possibilities, including cytologically malignant giant cell-rich tumors such as malignant fibrous histiocytoma and sarcomatoid carcinoma.
Effects of Angiogenic Growth Factors and a Penetrance Enhancer on Composite Grafts
Authors: Hom David B. , Winters Margaret
Published: October 2014

Skin-cartilage composite grafts are invaluable tissues used in facial reconstruction, yet their survival is unpredictable beyond a 1-cm diameter. In this study, the angiogenic growth factors basic fibroblast growth factor (bFGF) and endothelial cell growth factor (ECGF) and a penetrance enhancer (dimethyl sulfoxide [DMSO]) were applied to composite grafts to determine their effects on survival and vascularization. We applied ECGF, bFGF, and DMSO either topically or by intradermal injection to 120 auricular composite grafts (3.0 cm diameter) in New Zealand White rabbits. Dermabrasion was performed in 2 groups to attempt to increase transdermal delivery. Graft viability and vascularity were evaluated 3 weeks later by template analysis and angiography. In the results, ECGF and bFGF, when grouped together, had a 40% increase in vascular ingrowth as compared to controls (p < .001). However, neither ECGF nor bFGF increased graft survival. A coincidental finding was that DMSO with dermabrasion significantly improved graft viability (>100%) with or without an angiogenic agent (p < .02). The potential of DMSO with dermabrasion to increase composite graft viability warrants further investigation.
Bilateral Simultaneous Hearing Preservation Mastoidectomy in Otogenic Meningitis
Authors: Job Anand , Jacob Annie , Kurien Mary , Mathew John
Published: October 2014

Bilateral simultaneous hearing conservation mastoidectomy has not been previously documented. We present our experience with this procedure. Three patients with pyogenic meningitis secondary to bilateral unsafe ears had hearing preservation surgeries of both ears in a single sitting. Although ear surgery carries risk of inner ear damage, in our series there was no deterioration of inner ear function in the 6 ears operated on. The air conduction threshold improved in 3 (50%) of the ears. When meningitis results from bilateral otogenic foci as in our series, simultaneous mastoidectomy in both ears may be the preferred method of treatment to eradicate the source of infection.
Ablation of Teflon Granulomas in the Canine Larynx with the Free-Electron Laser
Authors: Reinisch Lou , Kuo Timothy , Lano Charles F. , Ossoff Robert H. , Bryant G. Lee , Garrett C. Gaelyn , Werkhaven Jay A.
Published: October 2014

This study develops a canine model for the treatment of laryngeal Teflon granulomas and demonstrates endoscopic ablation using the free-electron laser (FEL) set at a wavelength of 8.5 μm. Laryngeal Teflon granulomas may cause dysphonia and airway obstruction, and they are difficult to remove. The infrared absorption spectrum of Teflon reveals a strong absorption peak centered at 8.5 μm. In this study, 12 dogs had the right vocal cord injected with Teflon paste. Two months later, Teflon granuloma formation was confirmed histologically. Laser incisions into the granulomas were performed at 3 different wavelengths: 7.4 μm (FEL), 8.5 μm (FEL), and 10.6 μm (carbon dioxide laser). Histopathologic analysis was performed at 1 week and 6 weeks after the laser incisions. The FEL at the 8.5-μm wavelength was found to optimally ablate the Teflon granulomas, but the granulomas persisted in the specimens treated with 7.4 μm (FEL) and 10.6 μm (carbon dioxide laser).
Transverse Infrahyoid Approach to Bilateral Glottic Tumors
Authors: Reino Anthony J. , Lawson William , Biller Hugh F.
Published: October 2014

Glottic exposure and entry for vertical partial laryngectomy procedures has traditionally been through the subglottis. Although this approach is generally satisfactory for the resection of unilateral vocal cord lesions, it may be unsafe in cases in which tumors extend across the midline and/or subglottically. In these instances, we prefer the superior transverse infrahyoid approach to the glottis, which transects the petiole of the epiglottis and reflects the contents of the preepiglottic space posterior and superior. This improved visualization of the larynx has permitted precise tumor excision without sacrifice of uninvolved segments of the vocal cords. This procedure has been performed 35 times over a 15-year period at our institution for the resection of bilateral glottic tumors, with and without subglottic extension. In none of the cases in which it has been employed was there a positive surgical margin.
Immunologic and Histologic Observations in Reo Virus-Induced Otitis Media in the Mouse
Authors: Meek Robert B. , Berrebi Albert S. , McGrew Benjamin M. , Spirou George A. , Cuff Christopher F. , Wetmore Stephen J.
Published: October 2014

The goals of this study were to develop a mouse model for virally induced otitis media, and to study the immune response to infection. Intranasal inoculation of mice by reovirus was used to induce otitis media. Immunohistochemical evidence for the presence of reovirus in the nasopharynx, eustachian tubes, and middle ears and the amount of infiltrating B-cells and T-cells in those sites were serially evaluated by painlessly sacrificing animals over a 21-day period. Reovirus antigen was detected in the middle ear mucosa by day 4 in 75% of infected animals, and histologic evidence for otitis media was found in 54% of all infected animals. A significant increase in B-cells in the nasopharynx and eustachian tubes was noted 7 to 10 days following infection. The number of infiltrating T-cells did not vary significantly from that in the control animals at any of the sites. These results provide a basis for further investigations of the immune response in otitis media.
Histopathology of Congenital Subglottic Stenosis
Authors: Holinger Lauren D.
Published: October 2014

A precise delineation of each laryngeal abnormality is critical to planning rational therapy. Since congenital cricoid cartilage anomalies are easily overlooked, a systematic approach to their identification is as important as a clear concept of their classification. The purpose of this communication is to present the pathologic findings and classification of congenital cricoid cartilage deformities and to summarize updated information derived by the whole organ macrosection technique. The classification of congenital subglottic stenosis is based on study of the English-language literature and the collection in the Laryngeal Development Laboratory at The Children's Memorial Hospital in Chicago. Twenty-nine specimens with congenital cricoid abnormalities have been identified. Fourteen have an elliptical cricoid cartilage; 12, a laryngeal cleft; 5, a flattened shape; 1, a large anterior lamina; and 3, generalized thickening. Some specimens have more than 1 anomaly. Eight cases of fragmented or distorted cricoid cartilages are thought to be acquired lesions. An anterior submucous cricoid cleft has been identified and is presented for the first time.
Rare Middle Ear Anomaly in a Patient with Turner's Syndrome
Authors: Hamzah Abdul Razak Rahman , Jalaluddin Mohamed Amin , Raman Rajagopalan
Published: October 2014

A patient with Turner's syndrome presented with a rare anomaly of absent oval window, inferiorly placed facial nerve, and abnormal stapes. To our knowledge, this is the first report of this combination of malformations.
Carbon Dioxide Laser Debulking for Obstructing Endolaryngeal Carcinoma: A 10-Year Experience
Authors: Laccourreye Ollivier , Biacabe Bernard , Lawson Georges , Laccourreye Laurent , Muscatello Luca , Brasnu Daniel
Published: October 2014

The results of the carbon dioxide (CO2) laser debulking procedure for obstructing endolaryngeal carcinoma were analyzed in terms of efficiency, complications, secondary tracheotomy rate, and peristomal recurrence rate in a series of 50 patients consecutively managed at our department. The CO2 laser was used to reestablish a safe airway without resorting to tracheotomy and without performing a transoral resection. Our series included 42 patients in a pre—definitive treatment group (group 1) and 8 patients in a palliation group (group 2). Complications included death, pneumonia from inhalation, and cutaneous burns in 2 patients, 1 patient, and 1 patient, respectively. Thirty-two percent of patients required a repeat laser treatment to maintain the airway. Overall success rates of 92.8% and 87.5% were achieved in group 1 and group 2 patients, respectively. None of the variables under analysis could predict the success of the CO2 laser debulking procedure. The overall incidences for secondary tracheotomy were 4.7% and 0% in group 1 and group 2 patients, respectively. Peristomal recurrence was not encountered in patients managed with definitive therapy with curative intent.
Treatment of Hypertrophy of the Inferior Turbinate: Long-Term Results in 382 Patients Randomly Assigned to Therapy
Authors: Passàli Desiderio , Anselmi Marco , Lauriello Maria , Bellussi Luisa
Published: October 2014

A number of surgical techniques are commonly performed to control the symptoms of inferior turbinate hypertrophy unresponsive to medical treatment. We report long-term results in 382 patients randomly assigned to receive electrocautery (62), cryotherapy (58), laser cautery (54), submucosal resection without lateral displacement (69), submucosal resection with lateral displacement (94), and turbinectomy (45). Outcomes of objective test results from rhinomanometry, acoustic rhinometry, mucociliary transport time, and secretory immunoglobulin A levels were compared to the symptom scores before and yearly after surgical treatment. These data indicate that submucosal resection with lateral displacement of the inferior turbinate results in the greatest increases in airflow and nasal respiratory function with the lowest risk of long-term complications.